Dave's Mr. Pickles 2018 Conservative

Welcome to Dodgerslist. So glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you.
**Disc disease is not a death sentence! ** Struggling with quality of life questions? Re-think things: www.dodgerslist.com/index/SDUNCANquality.htm

It's very dangerous to give a steroid (Dexamethasone) so close to giving a NSAID (Meloxicam) without stomach protection. A switch from a NSAID to a steroid requires a 4-7 day washout period. When medically necessary, such a switch can be made with the addition of TWO stomach protectors - Pepcid AC and Sucralfate. Please speak to the vet ASAP this morning and advocate for the addition of these two stomach protectors to prevent GI distress from occurring.

It will help us work together with you and avoid offering ideas that could cause harm or lead the discussion in the wrong direction delaying help for your dog — please share a bit more detail with us:

❖1 IVDD is usually very painful and pain meds are required to mask the pain until the anti-inflammatory can resolve the swelling pressing on the nerves of the spine.  Is there still currently pain?  Pain may be the reason why Mr. Pickles has not pooped, not wanting to move due to pain.  Signs of pain:  ☐shivering, trembling ☐yelping when picked up or moved ☐reluctant to move much in crate such as shift positions or slow to move ☐tight tense tummy ☐can’t find a comfortable position ☐Arched back ☐ Holding front or back leg flamingo style not wanting to bear weight ☐head held high or nose to the ground ☐Not their normal perky selves? Full pain relief is expected in 1 hour and stays that way dose to dose. If not in control your vet needs to know asap to adjust meds.

Neuropathic pain not common. This kind of pain is abnormal, phantom pain sensations with severe spinal cord damage. Signs are obsessive licking of paw, leg, genitals, tail. Escalates to biting, life-threatening chewing off parts. Immediately put on an e-collar (or lengthwise folded towel around neck and duct taped closed) to prevent access to lower body. Contact vet immediately for Gabapentin or stronger Lyrica (pregabalin) for neuropathic pain. More info: www.dodgerslist.com/literature/neuropathy.pdf

❖2 A Please list the exact names of meds currently given, their doses in mgs and times per day given.
…B If on a steroid….what was the start date & dose? Date of steroid taper? 
…C PEPCID AC: Ask if your dog has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). canigivemydog.com/wp-content/uploads/2011/10/can-i-give-my-dog-pepcid-ac-300x300.jpg 
Doxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours. NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.html
Also Sucralfate is needed due to no washout period.

❖3 GI Tract problems? —Eating and drinking OK? No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?

❖4 The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.
Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/literature/CrateRRP.htm
STRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: www.dodgerslist.com/literature/chiropractic.htm ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.

❖5 Overflowing bladders need to be expressed to avoid UTIs. Review video then get a hands-on-top-of-your-hands expressing lesson. www.dodgerslist.com/literature/Expressing.htm
Expressing can take some practice.  Expressing is a matter of physics. That means the pressure applied to the bladder has to be greater than the strength of the urinary sphincter. Sometimes you have to hold that pressure many seconds longer than you think before the sphincter is overcome.  While on Dexamethasone, you should try to express every 2-3 hours.  Keep trying - you can do it!

❖6 Currently can Mr. Pickles move the legs at all? or wag the tail when you specifically do some happy talk?

❖7 What is your name? 

Usually when bladder control is lost, bowel control is also lost.  There is no medical necessity to express for poop - reflex will take care of it.  If you believe he's constipated, pumpkin can help firm up stools. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. Note alternatives for constipation: really ripe mashed fresh pear, just take off the peel; microwaved and mashed peeled sweet potato.



Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD soonest possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. Your dog will be depending on your ability to learn - excellent video series here: www.dodgerslist.com/literature/theater.htm
 PRINT OUT this link and tape to your fridge: www.dodgerslist.com/literature/healingpage.htm
 use the printout as your roadmap to avoid dangerous detours in your dog’s care
 make notes/highlight to keep yourself on track
 follow all the links in the next days to become the IVDD savvy pet parent your dog needs. Use the “search box” to easily locate topics over at our Main www.Dodgerslist.com website: www.dodgerslist.com/index/searchBOX.jpg

If there is great pain or severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering.
CAUTIONS: ~~ Laser light therapy is contra-indicated with tumors which are detected via x-ray.
~~ During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back can increase a disc tear and escape of disc material into the spinal cord . For an animal with very mild neuro deficits, the risk of transporting to therapy has to be carefully weighed against what benefit is to be gained. www.ahvma.org/find-a-holistic-veterinarian/
~~ Why Chiropractic is not recommended for IVDD dogs: www.dodgerslist.com/literature/chiropractic.htm

Healing prayers for Mr. Pickles.

Forgive me if I forget to fill in the details. A combo of being distraught because my little buddy is hurt, lack of sleep and I don't want to wake him if he's sleeping by walking past him to go look at his meds or something.

Although Mr Pickles is not a "registered, certified or whatever documented ESA", he's pretty much a very effective ESA for me, and a friend (kid with fur too) for my anxiety, PTSD and depression, so seeing him like this really hurts me.

My name is Dave, I'm in Kewaskum, WI. About 50 miles North-Northwest of Milwaukee.

The Meloxicam was just one dose, we went back to the vet with the deteriorating symptoms before giving the next dose.

The Dexamethasone is sub-q injections, it was 4.25ml every 8hr, I'm starting at 8pm sept 7, 0.4ml every 12hrs for 5 days.

The Prozosin was stopped on the vet's orders when the Meloxicam was started

I forgot to mention that Mr Pickles is also on Tramadol as needed., 25-50mg depending on pain level, twice daily

Mr Pickles is scheduled to see the vet again on 9/13 to see how he's doing.

I had a rather in depth conversation with the owner/head vet at the clinic today in regards to expressing Mr Pickles' bladder and his stool retention/constipation. He showed me how and where to properly express, however upon doing this on Mr Pickles, he's just hard as a rock and he leaks more on the pee pads than I can get out of him by expressing. I have held pressure but still not all that much comes out. Its a pretty significant pressure to over come his stout muscular body, I really don't want to press much more... if someone was pressing like that on me, I would be saying it hurts. I alternate carrying him outside to express and expressing in his pen on a pad that needs to be changed anyways.... just to limit how many times I'm moving him in a day.

The vet also said I could try ducosate as a laxative starting with 25mg. I have some older 100mg duc-Q-lace liquid gels from a surgery & opiate prescription a few years back, so I popped a hole in one and dripped a drop or two on a piece of bread and Pick ate it without problems. He washed it down with a carrot and some water. This was at 3:15pm today. Around 7:15pm, I was trying to express Pick when he popped out a couple well formed, normal colored "logs" when I was exerting pressure on his bladder area. So FINALLY! Bowel movement, although not necessarily on his own command.

Mr Pickles has no control over his rear legs. They are floppy when I need to move him. However, when I'm expressing him, I get some tail wiggle upon pressure and when washing the urine off him with a warm washcloth, I can feel his muscles in his legs tense up a bit.

I gave him a new squeaker today. He just absolutely loves them, but no happy movement of his tail, it was limp upon movement. Also to note, Pick was pretty dominant with his little pickle pick tail sticking straight up when he walked around proudly - Now its usually hanging down, sometimes between his legs.

Pickles eats without issue, he loves to eat and get vocal about dinner time. He is drinking quite a bit more now that he's on the steroids. He has not vomited.

So with that all said. Anything else you or the group would like to know?

Thanks

Dave, it is good your vet gave you a range for the Tramadol. We, however, need to know exactly how much tramadol you currently give. As Pauli noted in the above post unless it has been Rx'd for the max analgesic dose of 50 mgs Tramdadol every 8 hours, it is not likley to control pain for an 18.5 lbs dog.
--- Advocate for the other two type of pain to be covered: Gabapentin for nerve pain, and methocarbamol for muscle contraction pain.

Let us know how many mgs of dexamethasone are on one mL of liquid. That info should be on the bottle

Let us know you definately have Pepcid AC on board and the 2nd which is an Rx of sucralfate. EVEN ONE dose of Meloxicam will stay in the body for 4-7 days!!! Take no chances as Pauli prompted and protect Pickles.

Please provide the missing info for Pickle's med list:
18.5 lbs.
Meloxicam as of 9/5??? for one day- stopped on 9/5
Dexamethasone sub-q injections ?mgs in one mL as of 9/6: ?mgs (4.25mL) 3x/day for 1 day
                              as of 9/7: ?mgs (0.4mL) 2x/day for 5 days then taper to test for pain/neuro loss
Tramadol Which? 25-50 mgs 2x/day as needed
No stomach protection for NSAID to steroid switch!

When meds are right, then Pickles can rest comfortably in his recovery suite and you can rest your mind that he is getting the right treatment for a disc episode.

While on Dex you may need to express him every 3-4 hours.  Are you doing that?

Stay strong, keep positive!  Your Pickles can get back to enjoying family life and many happy years ahead with you after this distressing bump in the road of life.

Seven days does seem long for the results of a urine cultures but I think some bacteria just takes longer to grow.

Now that Mr Pickles is taking the right antibiotic the constant leaking should stop. You may need to express Mr Pickles every 3 or 4 hours while on the steroid. Steroid type drugs cause more frequent urination although this is less common with Dex than other steroids. The other thing to keep in mind when thinking of how often to express is that when someone is still becoming proficient they may not get all the urine out each time they express. This would mean the dog would have to be expressed more often. Once the steroid is discontinued and you have had sufficient time to practice expressing, you would only have to do it about as often as he was taken out to potty prior to the disk episode.

Not wanting to lie down and not wanting to move are signs of pain. I know you are concerned about overmedicating Mr Pickles and nobody wants a dog on more meds than needed. The vet has given you some leeway in giving the meds but these types of meds are better given on a regular schedule than on an "as needed" basis. The reason for this is that it is much harder to get pain under control once it has started. I hope the gabapentin in addition to 25mg of tramadol every 8 hours will relieve his pain. Pain will only slow his healing.

This quote is from an article on pain control for dogs and I think sums it up nicely. "The best way to deal with acute pain is to give pain relievers before it occurs. When this is done it can be demonstrated easily that lower doses of pain relief can control the pain and that the duration of need for pain relief is often shorter."
www.vetinfo.com/dpain.html

5mg of Pepcid AC should be given 30 minutes before the anti-inflammatory and then every 12 hours afterwards. Giving the anti-inflammatory with a meal provides extra protection. Give the Pepcid as long as he is on the steroid.

Give 10 mgs of Pepcid AC now for immediate protection! And then thereafter every 12 hours for as long as Dex is in use.  IF you note any RED FLAG signs of GI tract (nausea of lip licking, drooling moving to vomit, diareah) act fast to get sucralfate on board.  This is an Rx item you will have to advocate for from your vet. What sucralfate is:  marvistavet.com/sucralfate.pml

The usual is to give Pepcid AC 30 mins before the steroid.  But in Pickles case he needs Pepcid AC asap, now!

 In Pickles case he still has the NSAID in his body even with one dose it can take 4-7 days to leave the body. That is why when there is an emergency need to switch and the 4-7 day washout out simply can't be done, it is IMPERATIVE to give double stomach protection for the double jeopardy the GI tract is under.


Let us know if the rather low use of tramadol and gabapentin actually work to keep pain fully at bay.  If it does then that would be really great!    These two meds have a short half life meaning they do not stay at a high enough level to mask pain dose to dose usually for the painful disc episodes if not Rx'd for every 8 hours.

Learning to express is a skill thing. Express often enough maybe when first learning give it a try at every 1-2 hours and work your way up to longer intervals as your proficiency level increases. It is a matter of being able to find the bladder. Then pressing with your hands so that the pressure overides the sphincter muscle's ability to stay closed. Don't hesitate to return for another lesson where you express in the clinic and a vet tech checks your work.

I love this vet's drug directory. I look up each med that goes in the mouth. I think you'll want to bookmark it for yourself, too, to read up on Pepcid AC (famotidine) and others. Here is the directory: www.marvistavet.com/pharmacy-center.pml

Since you and your wife will be giving meds, you may find it helpful to use a med chart where you also can note cause and effect, etc, to discuss with the vet.
D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf

Dave, when there is a multi-modal pain medication approach so that each of the three sources of pain are covered, then a vet has the best possibility to fully control pain.  Promptly every 8 hours is the key PLUS using an appropriate by weight mgs of each of the pain meds.  All three pain meds work together to provide comfort.  Assume a painful disc episode IS painful and treat as if there is pain.  At the taper of Dex on Sep 12 will be time enough to do the test for pain/neuro by also stopping/reducing pain meds at the begin of the Dex taper. Don't reduce pain meds now.

Having a return of deep pain sensation is not the same as suffering with pain.  Is Pickles experiencing increased suffering of pain? What specifically are the signs that you observe?      There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock. 

How is his eating, loose stool?  Is the PepcidAC helping to protect enough?

Avoid q-tips and petroleum derivative products (vaseline) on delicate absorptive tissue.  Give this technique to help with poop expressing a try. It works also to encourage reflexes to move poop out.  Here is the technique and the instructive video demo:  
www.dodgerslist.com/literature/Expressing.htm#poop

Dave, good to hear he's eating. Since he is on one of the strongest in the category of steroids (Dex), and well known for the damage it can do do the Gi tract using the more aggressive end of PepcidAC might be a good idea---- 10 mgs of Pepcid AC every 12 hours

"Famotidine (Pepcid AC) The typical dose administered is 0.25 to 0.5 mg per pound (0.5 to 1.0 mg/kg) every 12 hours to 24 hours." www.petcarerx.com/medication-guides/famotidine-for-pet-stomach-ulcers/1116?page=all

KY Jelly, a personal lubricant is water soluble. Best however, is to use the technique shown in the video. It will work to express for poop when it is 30-60 mins before the body would naturally push out poop via reflex. Your expressing helps to expedite and get the reflexes moving more. Nothing gets inserted into the rectum where there is delicate tissue.



Specifically ask if Pickles has a neck disc. holding head high is typical of a neck disc. His meds need to be adjusted by a vet. It is very unfair that he is needlessly suffering with pain because meds are wearing off too soon. There are so many adjustments that a vet can make to give that round the clock relief from pain.

Let us know how your vet handles and what changes he makes to the meds in the morning.

Dave, plain and simple your Vet just doesn't know how to treat IVDD.  Your dog is in pain and he should have adjusted the pain medications.. Tramadol is too low..  Methocarbamol for muscle spasms could be added.. Lots more he could do.. Dex should NOT be tapered and stopped..  It can take from 7-30 days on Dex to get the swellling down.. Meloxicam is not as strong.. Makes no sense to switch now.  

You need a better vet pronto in order to save Pick..  How to find the right Vet for Pick. this also has a search engine to hopefully find one in your area:  dodgerslist.com/literature/VetchkList.htm

The couch is not a safe place for Pick either.. they can move in the blink of an eye, remember he doesn't feel handicapped.. the first noise could send him flying and he could be hurt even more.. 

Plus a dog with a disc episode on conservative care should NOT be running around in the wheel cart that is for after the 8 weeks of crate rest..  Your dear Pick CAN recover and we see many here on Dodgerslist recover walking,  but his rest has to be strict in order for that to happen. It's lack of movement that heals the disc..

Hang on, the right vet can help Pick!

Status update.

The pain is coming under control. 9/11 through out the day he was very good. So good he was trying to be his normal self in the pen and de-stuffed a squeaker toy. He was not shaking, was alert and looking bright. but I think that playing jarred things around because he was in discomfort last night and a little bit into this morning 9/12.

The medicine schedule is this.

50mg ▲Tramadol three times daily (6am, 2pm, 10pm)
100mg ▼Gabapentin 3 times daily (6am, 2pm, 10pm)

10mg Pepcid AC twice daily (10am, 10pm)
125mg ✚Amox/clav twice daily (10am, 10pm)
2.5mg ✚Lorazepam twice daily (10am, 10pm)

0.4mg Dexamethasone inj twice daily ( 10:30am, 10:30pm )

[Moderator's note: please do not edit
18.5 lbs.
Meloxicam as of 9/5??? for one day- stopped on 9/5
No stomach protection for NSAID to steroid switch!
Dexamethasone sub-q injections ?mgs in one mL as of 9/6: ?mgs (4.25mL) 3x/day for 1 day
                                               as of 9/7: ?mgs (0.4mL) 2x/day for 5 days then taper to test for pain/neuro loss
Tramadol ▲50 mgs 3x/day
Gabapentin 100mgs every ▼3x/day
Pepcid AC 10 mgs 2x/day
✚Amox/clav  125mg 2x/day
✚Lorazepam (tranquilizer) 0.25mg 2x/day]


I have a call into the vet asking to continue the steroid injections and to possibly switch to a more GI friendly drug like Prednisone [tablets]. The vet is in surgery all morning so I'm expecting a reply this afternoon.

I also figured out a way to put Pick in his crate safely and smoothly. Its darker and more secluded, its his safe spot of which he's been wanting to go into lately. Its far smaller than the playpen so hopefully this will slow him down a bit so he does not "over do it" like yesterday, playing with a toy. He is just so high strung and high energy, its so hard for him to adjust to this. I also really don't want to keep him in his crate all the time, its not permanent "Time out" punishment, so I'll have to figure out when he's had enough and wants to come out to be in the open with his pack family.

He loves to be right by me, typically with in a nose reach. So on the couch, I cut a piece of plywood for a firm surface, put some padding on it and have two sides on it to prevent him from rolling off or easily climbing off. The couch arm and back form the other two sides. This way he can sit/lay on the couch next to me when I'm sitting or sleeping on the couch. Further there is small tall table that's in front of cushion where he is placed, so there is just no easy way for him to sneak off the couch. I have Anxiety, PTSD etc, so even if I'm sleeping, I'm very alert to sound and movement. Even if he grunts a little, it wakes me up... so I think the couch setup is quite safe for him... he moves far less on the couch than in the pen and is far far more comfortable and at ease.

Now for a question:

We have been lining his pen, his couch platform and his crate with pee pads. He has no control over his bladder so he is basically sitting in his pee wetness. Putting a towel over the pee pad just wicks UP the moisture.

I'm looking for something to WICK AWAY the moisture. let the pee go down to the pee pad and away from his skin.

I remember a blanket we had years ago, that probably would be a good choice for this application. Its was 100% synthetic fiber and it was like short, soft but standing up bristles on both sides of the blanket. I have no idea what that material is called. It's not fleece, fleece is like a mini wool, like a brushed fabric with balls of fuzz. I don't think fleece is very wicking with those balls.

So I'm looking for material names of what I can look for in Hobby Lobby or some other fabric store that would be good for wicking away the urine. Something I can cut to size for his crate, the pen and the couch platform.

I have a sewing machine, buttttt ... even though I have an electrical/electronic/mechanical engineering background, the sewing machine seems to be my evil nemesis. So I'm just looking for the materials where I can cut to fit and maybe layer without sewing.

correction on the Lorazepam dosage. Its 0.25mg not 2.5mg.

Thanks Alix for the encouragement, I'm trying my best, pushing through my physical pain but frequently this whole ordeal gets so overwhelming, I start to wonder if I'm making Pickles suffer through this just for my own need because I cannot let go.

Hope? Last night (9/13), while sitting with him watching TV, I was playing with his little stubby and pointy pickle pick tail like I've always done... he pulled it away. Not once, but twice. He's has some tail twitching and flickering since this injury happened but last night, these were purposeful and willful movements to curl it along his side.

When I was flexing his legs to keep his joints moving. I also felt some resistance. Very slight, but also seeing his leg muscles tense up at the same time.

I think this is progress... or am I being overly hopeful/optimistic, wishing for a recovery and taking any little twitch as a sign?

I spoke with the vet yesterday (Thursday 9/13) about Methocarbamol and Prednisone. First off, he told me that giving Pickles the ▼Gabapentin 3x a day was "off label" and had me go back to 2x daily, but to not give it with the Tramadol, off set the time to see if the duration of pain relief can be extended without giving more. I did receive some ✚Methocarbamol, 7 days worth with an update needed in 5 days... not entirely certain why just 7 days... but he did mention changing to cyclobenzaprine (Flexiril)[muscle relaxant]. The ✚Prednisone, again, a 7 day, 1 tablet 2x a day,then going to a maintenance of 1 tablet once daily.

[Moderator's note: please do not edit
18.5 lbs.
Meloxicam as of 9/5??? for one day- stopped on 9/5 
No stomach protection for NSAID to steroid switch!
Dexamethasone sub-q injections ?mgs in one mL as of 9/6: ?mgs (4.25mL) 3x/day for 1 day
                              as of 9/7: ?mgs (0.4mL) 2x/day for 5 days then 9/12  taper to test for pain/neuro loss 
Prednisone as of 9/13:                                              10mgs 2x/day for 7 days, 
                          as of 9/20 anti-inflammatory dose: 10 mgs 1x/day for ? days,
                                                                                       then a taper to test for pain/neuro
Tramadol  50 mgs 3x/day 
Gabapentin 100mgs every ▼2x/day
✚Methocarbamol 500mg tab:  ? mgs 2x/day   7 days worth!?
Pepcid AC 10 mgs 2x/day
Amox/clav 125mg 2x/day
Lorazepam (tranquilizer) 0.25mg 2x/day]


SO the updated medication schedule:

6am        50mg Tramadol, 0.25mg Lorazepam
8am        100mg Gabapentin
10am      125mg Amox/clav antibiotic, 10mg Pepcid AC, 500mg Methocarbamol
10:30am 10mg Prednisone
2pm        50mg Tramadol, 0.25mg Lorazepam
8pm        100mg Gabapentin
10pm      50mg Tramadol, 0.25mg Lorazepam, 125mg Amox/clav antibiotic, 
              10mg Pepcid AC, 500mg Methocarbamol
10:30pm 10mg Prednisone

*** Amox/Clav Antiboitic ... I list it that way to shorten the typing.
Its full name is Amoxicillin Trihydrate and Clavulanate Potassium


I don't think that it's the vet giving up on Pickle with the restriction or limitation of medications. Its like this at all of my doctors as well. In Wisconsin there is a big problem with drug addiction. The docs have been cutting back drastically on opiod drug prescriptions and anything that can be used to make Meth. So I think Pickles Vet Dr is doing the same thing. Probably some state or federal pressure on them to prescribe less.

Dave, I must commend you on your success in getting prednisone on board and a pain med to deal with muscle spasm pain.  Good job!  I'm sorry to hear your own physical pain is a challenge and surely makes life and caring for Pickles more difficult.  You are doing an excellent job in spite of it all.  Hang in there, you and Pickles will get back to happy days together again after all 8 weeks to heal his disc have been completed.  Mother nature and Pickles will then tell the story if nerve repair will bring back the leg function at graduation day or if THEN getting a wheelchair is a good idea while waiting on more nerve repair to take place.

Any vet who prescribes a wheelchair during a disc episode and the 8 weeks it takes to heal has basically decided to cut off chances of the disc to heal and may just cause permanent damage of the nerves never ever to heal. That in my opinion is a vet who has written off the dog.  

Here in Montana, it was hard for the pharmacy to track down Methocarbamol just recently.  If your vet can't get more, then his idea about cyclobenzaprine may be the deal---although we've never seen it Rx'd on this Forum so are not familiar with it.

Check that dose on methocarbamol.  The whole tablet is 500mgs.  What is the dose your vet has prescribed 2x/day?
Let us know with the addition of methocarbamol if the pain is now fully in control now.  If  not:
--- advocate for the correct dose in mgs to be given every 8 hours
--- advocate  gabapetin for every 8 hours on the basis it has a short half life in dogs. That means every 3-4 hours there is half of it left in Pickles body. In 4 hrs 50mgs left, in twelve hours less then 25mgs left!

It is really not a good idea to do any range of motion (ROM)  or other moving of his paws, back legs at this time. Waiting til off of all meds and no pain it the better way. Right now the entire focus is limited movement of the back. We do have info to remind you when off all meds how to do the appropriate very, very light least aggressive ROM with the YELLOW "Rom" avatar underneath Pickle's picture. So no toe tickling or touching of back paws as that can cause unexpected movement for the back/the disc/the spinal cord. Couches slope, not good either. The recovery suite on a sturdy coffee table pulled right up to the couch so you two can be together in that way is the safest place for Pickles healing disc.

Dave, that is wonderful that Pickles CAN move his paw when tickled.  Do let us know that you will avoid tickling the paws from now on...you want to make sure his back does not get jarred by too much unnecessary leg movement tickling could cause.  Protection of the spine is priority #1.

When you can double check and  let us know about the 500mg methocarbamol dose?
A whole methocarbamol tablet is 500mgs. What is the dose your vet has prescribed 2x/day?

Let us know with the addition of methocarbamol if the pain is fully in control now.

Monitor his licking of his back paw(s).  Licking can be as simple as you say cleaning himself.  On the other hand with a dog who does not walk it may, maybe, might be a sign of phantom pain.  IF it would be phantom pain, then licking would then escalate to biting in an attempt to do away with the painful phantom pain.

Everyone has experienced numbness or pins and needles tingling in your legs when sitting in a bad position for too long a time.   Abnormal phantom nerve sensations can be mild pins and needles to quite painful burning, on-fire feeling that makes a dog bite to stop the pain. 

A temporary DIY  e-collar with a lengthwise folded towel and secured closed with duct tape.
 Get to a vet for a medicine that can help to control these very painful sensations.   The name of the drug is called GABAPENTIN.

DIY temporary e-collar directions + picture:
forum.greytalk.com/index.php/topic/220138-create-your-own-surgical-collar/



Have a peaceful weekend and know we are here throughout the weekend if you need us.