Lesa's Dolly 8/30 conservative

Lesa, 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!

Do not listen to that BAD advice from the vet. 
Struggling with quality of life questions? See for yourself here: www.dodgerslist.com/index/more.htm

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 Is there still currently pain?
❑ shivering, trembling ❑ Arched back
❑ yelping when picked up or moved ❑ can’t find a comfortable position
❑ tight tense tummy ❑ nose to the ground or head held high
❑ reluctant to move much in crate such as shift positions or slow to move
❑ Holding front or back leg flamingo style not wanting to bear weight
❑ Not their normal perky interested in life selves?

Neuropathic 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 this type of pain. Dodgers Digest article on neuropathic pain: www.dodgerslist.com/literature/neuropathy.pdf

❖2 How much does your dog weigh?
…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?

legs paralyzed 8/30
meloxicam (SP?) as of 8/3 vet #1: STOPPED on what date?
steroid treatment as of 9/6 vet #2: injection or IV? for 6 days
name of stomach protection????--- Pepcid AC (famoidine)?
name of each pain meds? ? mgs ?x/day

…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).


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

❖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 What was the date you saw the vet for CONSERVATIVE treatment?
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
◼︎laser or acupuncture for severe neuro damage is best at home via a mobile vet. 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 Can your dog specifically sniff and squat and then release urine which is bladder control – OR- do you find wet bedding or leaks on you when lifted which are indication of an overflowing bladder and loss of bladder control?
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
    How often are you expressing.... every 2-3 hours??



❖6 Currently can your dog  wag the tail when you specifically do some happy talk?



Getting an IVDD diagnosis is often very overwhelming leaving you feeling vulnerable and placing hope you have the right vet. Often an owner has not been able to research a professional's skills for this one disease. Dodgerslist's aim is to get you up to speed so you can be an active participant in helping your dog heal. No more blindly following instructions.

Knowledge is the power to commit to the right treatment and win this IVDD battle! You will be very amazed how quickly you can learn a lot about just one disease which a vet is not able to know in great detail for every disease known to cats and dog.

With knowledge you'll be able to dialog with your vet in a way that allows understanding a prescribed treatment (meds, rest, etc), and when you do not understand, the ability to ask good, pertinent questions on behalf of your furry loved one.   OR if need be hire a new  more IVDD knowledgeable vet.



The very best thing you can do for YOU, the caregiver, and for your dog is to read. Good place to get a speedy overview of conservative treatment, about surgery, too, if it would be consideration for your family should indications arise: www.dodgerslist.com/literature/healingpage.htm
Follow the rest of the colored buttons in the next days to become the IVDD savvy pet parent your dog will need at Dodgerslist IVDD 101 page. Don't forget to bookmark it:  www.dodgerslist.com/healingindex.htm

I called him and he doesn't know anything about gabapentin, he said he would be happy to write me a prescription.  Dolly weighs 17 pounds.  I will answer the other questions below for further advice.  I'm going to pick her up today at 330pm.  He has wrapped her leg for now and she isn't trying to chew it.

Thank you for trying to help me.

meloxicam started on 8/30 and stopped on 9/4.
Steroid injection on 9/4 and again Friday 9/7. Stopped steroids due to diarrhea and blood in stool, he did not give her any pepcid, I did read that and mentioned it to him but he ignored me I guess.

She has developed feeling in her left leg, pain doesn't seem to be an issue, she cannot stand she drags her back legs, she has never yelped or cried when picking her up. Tail started wagging a couple of days after starting the meloxicam. She could feel it when the doctor would try and clip toenail or pinch her tail but he would have to bear down really hard.

Lesa, if you can fill us in more on her med list with what you currently know

17 lbs
legs paralyzed 8/30
meloxicam as of 8/3: for 5 days   STOPPED on 9/4
name of steroid injections as of 9/4 and 9/7: for 2 days
no stomach protection (no famotidine no sucralfate!!), no 4-7 days washout with switch- bloody diarreah!

For neuropathic pain, you would expect for a 17 pound dog a range that might be 50mgs or more given promptly every 8 hours to provide an adequate level round the clock. Gabapentin has a short half life and why every 8 hours. Let us know what the vet prescribes.

What kind of vet was vet #2. A general DVM vet? An ER Vet.

Why did you go to vet #2 on 9/4.
---Had you been doing 100% strict rest since the 8/30 disc episode?
--- did the leg function get worse on 9/6?

What kind of vet is #1? your regular general DVM vet?

Meloxicam's ONLY purpose is to get the painful swelling down over the course of 7-30 days. No anti-inflammatory (steroid or NSAID) repairs nerve damage. The body does that on it's own. A dog who can still move their leg, can do a happy tail wag has a very good chance for more nerve healing. A big mystery why a vet would call for PTS, unless they do not know about IVDD!? Confirmed this vet #2 doesn't know IVDD as he switched from NsAID to steroid without a 4-7 days washout AND he gave no stomach protection for the deadly risk he subjected Dolly to. AND he is not aware of neuropathic pain and gabapentin.

Nerve repair usually takes more like months to self repair. You report seeing specifically a happy tail wag because of seeing you or hearing some happy talk from you (tail and leg movements during potty time are likely reflex) 

While the entire focus of 100% STRICT rest 24/7 for the full 8 weeks, only out of the recovery suite for a very, very few footsteps at potty time is to get the disc to heal you may or may not see self repair of neuro function.

IT may be at this point now with 5 days of Meloxicam and 2 days of steroid that all swelling in the spinal cord is gone. It can take in the neighborhood of 7-30 days for an anti-inflammatory to reduce swelling. Anti-inflammatory drugs do not heal nerves, just get the swelling down which very often is a painful thing and requires pain meds. BE prepared to monitor for pain when she comes home. Pain would indicated the need of a course of prednisone (steroid) on board pronto to finish the job of resolving all swelling. Let us know what you observe when she's back home.

Is he sending you home on oral steroid in a tapering dose to signal the body to again produce it's own life regulatiing CORTISOL steroid?

When you can, what is the name of steroid injection?

Lesa, yes you will need an e-collar. Just wrapping the leg will not prevent her chewing through the wrapping. Below is a temporary idea til you can get an e-collar to prevent reaching back legs.

Directions + picture:
forum.greytalk.com/index.php/topic/220138-create-your-own-surgical-collar/



Since last steroid injection was given on 9/7 and stopped due to diarrhea that was an abrupt stop. Not typical...as the body usually needs to be reminded by tapering down to start making its own corisol steroid. You will have to discuss with this vet the if at this point an every other day taper with prednisone is the way to go.
--- if prednisone, then a MUST to have PEPCID AC as well as SUCRALFATE on board. They each work in a different way to protect the GI tract. The vet should have given at the get go with his steroid injections!  Go back to click the blue links to read about each protector.  Might be a good idea to leave this vet with the printouts to increase his IVDD knowledge when using anti-inflammatory drugs.
--- if no steroid taper, then Dolly just needs gabapentin every 8 hrs prescription.   Ask if there is a range in mgs you could give if you see neuropathic pain is re-surfacing and it is at night or weekend when the vet is not open.  An ER vet visit is expensive, best to  have a Plan B worked ahead of time where you could increase the gabapentin dose in mgs for the every 8 hrs dose.

Whether you hire a new vet to be on Dolly's health care team depends.
--- Can you get yourself up to speed on this disease to steer treatment in proper direction if needed.
--- Is your current vet open to learning what you have learned.
--- If not being IVDD aware yourself means you can best hire the right vet.  It is like the difference between night an day to have an IVDD knowledgeable vet on board. Still that would not relieve you of being in the know to monitor and always "say no thank" you to well meaning but harmful advice any professional might offer.  Self educatiobn is how we protect our dogs.

      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. 

Sucralfate is a prescripton item your vet would give you. Either he has some in his clinic or he will write an Rx so you can take it to your local pharmacy to fill. Pepcid AC is over the counter on the grocery store shelves. AGAIN stomach protection if still having loose stool OR if decided tapering off the steroid injection at this point in time is still needed.  Discuss with vet if a prednisone taper to signal the body to produce cortisol is needed now 4 days after last steroid injection.  We do not know the name of the specific steroid used so can't comment. Some steroids last in the body for quite some days, others have a shorter life.

Pepcid AC (famotidine) for 17 lbs dog: "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

IF your 17 lbs dog is to have prednisone tapering down off of a steroid at this point in time, then sucralfate would be 500mgs (1/2 of a 1 gram sucralfate tab).

Gabapentin is typically available in 100mgs capsules.  You will need to carefully open the capsule and tap half the powder into the smaller side.   So......
-- do the tapping over a creased sheet of paper. Any overshooting powder you can easily tap from the creased paper back into the capsule.  Do you best to eyeball half powder is in each part of the capsule halves.
-- have ready some cream cheese or other pasty stuff.... to seal off one half of the capsule to be saved for a later dose.
---  have ready quite a small spoon where you can rest the larger half of the capsule with half the powder (50mgs) until you can free your hands of the small half of the capsule containing 50mgs filled not quite to the top.
-- cap off the small part with cheese to be used as the current dose you will give
-- go back and cap off the larger part of the capsule with cheese and save til 8 hrs later dose.

Gabapentin is VERY, VERY bitter. Do not let Dolly get a taste!
Make sure you do not transfer any dust from your fingers to the outside of the pill treat. Wash your hands!  I mash a piece of banana, cream cheese to form around the 50mgs part of the capsule. If necessary drape a piece of thin deli meat around ball for further tastiness!

Some vets have a 50mgs tablet at their clinic which would make dosing easier, but most vets do not.
There is compounding of gabapentin into a liquid. Takes too long, several days to get it back from compounding pharmacy...not good.  So most vets just prescribe the 100mgs capsule which you will have to subdivide.

What date did you take Dolly to Chiro?

Lesa.

Do you have an ER Vet in your area??  If so take her immediately..This can not wait!  She needs Gabapentin that works on Neuropathic pain that is causing her to chew her feet..You have already seen she has chewed her toes off..  This is an emergency!!  Most Vets know what Gabapentin is.. My Dog weighs around 15 lbs and gets 100mgs of Gabapentin 3 times a day when he has a disc episode.. 

Neuropathic 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 this type of pain. Dodgers Digest article on neuropathic pain: www.dodgerslist.com/literature/neuropathy.pdf

Hopefully your ER has a Neurologist available, they would be the most knowledgeable for IVVD and Neuropathy..  

Pepto Bismol has an ingredient that related  to Aspirin which is a NSAID.. NSAIDS should not be given when using any steroid..  Run as fast as you can from this Vet.. He has done great harm to Dolly.  Pepcid AC and Sucralfate for stomach protection as Paula posted in her posts to you..

Dolly needs pain meds, a disc episode is very painful.  Tramadol, gabapentin and Methocarbamol are commonly used for IVDD..  Please read this for more info.. dodgerslist.com/literature/healingpain.htm

Please help Dolly and take her to ER!!!  

Healing thoughts and prayers!

You can continue with the Pepcid AC for a few more days but what you really need is a prescription for Sucralfate. Pepcid AC suppresses excess acid. Sucralfate works in a different way to bandaid the damaged mucus lining and also promotes a healing environment. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/html/sucralfate.html

You can also give her some pumpkin to help with the diarrhea. To firm up the stool, add 1 teaspoon pumpkin to kibble 1x a day.

Do you see any sign of pain at this time, Lesa? Signs of pain to be aware of:
◻︎ restless, pacing, can’t find a comfortable position
◻︎reluctant to move much in crate such as shift positions
◻︎shivering-trembling ◻︎yelping when picked up or moved
◻︎slow to move ◻︎tight tense tummy
◻︎arched back, ears pinned back ◻︎ head held high or nose to the ground.
◻︎looks up with just eyes and does not move head and neck easily.
◻︎ not eating due to pain of moving jaw with a neck disc or pain of back disc
◻︎ holds front or back leg flamingo style not wanting to bear weight
◻︎not their normal perky selves

If you do see any of the above signs of pain, that means there is still swelling pressing on the nerves of the spine and still a need for an anti-inflammatory, which can be done with the addition of BOTH Pepcid AC and Sucralfate, and additional pain meds. If that's the case and there's still pain, it would be best for you to get an emergent consult with a neurologist. Even if you can't afford surgery, a neurologist can be consulted to get the correct meds on board. Having the right vet in charge of Dolly's care can make all the difference.

Hopefully, no further pain is seen which would mean that the swelling has resolved and Dolly can just continue with the Gabapentin for the neuropathic pain and Sucralfate to heal the damaged GI tract.

Healing prayers for Dolly.

Lesa, I'm so happy to hear pain free and loose stools beginning to lessen and not wanting to pay attention to back leg....that is so wonderful for Dolly, finally, at last!

When a dog begins to feel good, that then is a challenge for you to make sure there continues to be limited movement of the back so that the disc can heal and not suffer a relapse (a tear) with too much movement.

Do you remember the date she visited the chiro?
What is the name of ointment for her toes
What is the name of tranquilizer 9/11---- still giving it?


If all continues to go well, then all that remains is to complete the 8 weeks of crate rest to allow her disc to heal. Please do stay in touch..we love updates to stay in the loop how Dolly continues to do.

My corgi many years ago developed Canine degenerative myelopathy which is not unusual in Corgis. She ate off her toes on one foot, and although we had an excellent vet..this was many years ago and the knowledge wasn't there. I was the nurse in the family and would change her bandage everyday. She was on an antiobiotic, but this was a long time ago.

just be brave and you can change her dressing. Sounds like you are making progress . Just remember you can do it because she needs you. Following your story and be strong for Dolly

I just started she has only had the gabpentin 2 times and once today, can she have 100mgs or should I stick to the 50mgs 3 times a day.

We changed the bandage she only has two toes missing.  It's sad to see her toes gone.

I am checking around doing my research for new vets in the area that are familiar with IVDD and then I will take her somewhere else.  I may still take her to the ER vet so they can do a consultation.

Thanks again.

Lesa

Dolly is doing well since she has been home, we started laser therapy on her foot and acupunture for her paralyzed legs and she is showing some improvement.  We go back for our second treatment Friday.  I do have a question what can I do to help my dog relax when we have to leave the house.  She hates the ecollar tries to scratch it off and last time we left she chewed her bandage off within 30 minutes.  We have to be gone today for a funeral and I'm afraid she will hurt herself and ideas what we can do to make her comfortable.

The vet suggested benadryl 25 mgs and continue gabapetin 50 mgs.  We got her some spray that is supposed to taste bad to spray on her other foot and the bandaged one.

I'm so afraid she will hurt herself while we are gone, very stressed.

Lesa

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Post by Lesa & Dolly on Sep 15, 2018 at 9:50am
Thank you so much for the encouragement! It breaks my heart she chewed her toes off, I feel so bad for her. Things seem to be getting a little easier but we have a long road ahead of us.


Posted by Lesa & DollySep 15, 2018 at 9:51am
Thank you just it is very sad. I am pretty sure she isn't in any pain but I am still following the meds 3 times a day etc.

Lesa, it is clear that likely you can't trust Dolly TODAY. She needs to be supervised and not left alone as you've not tested benadryl to see how it works for her.

Can you take her to the vet for watching, a neighbor, etc.?

Hi Lesa,

What types of e=collars have you tried, so I don't suggest ones you haven't had success with?

When Tyler had his neutering surgery he was sent home with an e-collar from the Vet and he couldn't deal with that.. I went shopping at the pet store and bought him an inflatable collar and he was fine with that..He liked it because he used it as a pillow of sorts and he never fought it..