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Post by Aleksandra & Doglog on Oct 13, 2018 14:12:01 GMT -7
Hello, My name is Aleks and I'm a recurring poster :/ dodgerslist.boards.net/thread/5344/aleks-doglog-conservative-canada-grad My 6 year old mini-doxie, Doglog, had her first IVDD episode in June 2017, the second one in January 2018, and seems like we're entering the third. I don't know what's happening - it's very early, but I'm spotting troubling symptoms: - She lost her balance and fell over a couple of times in the last 2 days - She slipped or lost footing a couple of times, which was unusual - I'm noticing odd foot placement - nothing overly obvious, but noticeable to my careful eye. There's no obvious wobble or "drunk walk", yet, but she seemed reluctant to move too much this morning. When walking, it's not her usual "trot", it's slower and more hesitant. And I have to say it is almost wobbly.. (maybe I don't want to admit it to myself) No obvious signs of pain, tail is wagging, responsive to food, she went potty on her own. I'm very concerned because she had her dental 8 days ago, with 9 extractions. She was on an anti-inflammatory for 7 days after this (metacam, the dosage based on her 5.4kg [11.9lbs] weight, every 24hrs. I don't know how many ml - the syringe is per weight). Everything's been normal so far, and she's off the anti-inflammatory for a day and... the balance issues started. The vet knew she had IVDD, so they assured me they were very careful when handling her, but I know that there was still as risk something would happen. It makes sense that any problems would become obvious once the 7 day anti-inflammatory course was done. My instructions are to put her back on Metacam, and add Tramadol (up to 0.2ml every 6 hours), if she starts showing signs of pain. She just had her first dose. Starting today, I also added 5mg of Famotidine every 12 hours. [Moderator's note: please do not modify
5.4 kg/11.9 lbsmetacam as of 10/: for 7 days for dental. STOPPED 10/12 as of 10/13: 1x/day for ? days then stop to test for pain/neuro√pain, √neuro issues as of 10/12Tramadol ?mg in one mL?: ?mgs every 6 hours NOT GIVENfamotidine 5mgs 2x/day] I also have the rest of the meds (Gabapentin, Diazepam) on standby. Fortunately/unfortunately I'm well versed in the protocol. If she keeps getting worse and actually goes down, we have a neurosurgeon vet in the city. He's off tomorrow, so hopefully we make it to Monday.. So that's where we are. I put her in her recovery crate - we had 2 episodes already so I never dismantled it and made the crate a permanent feature in the living room, it was her "lounge". So she's crated. My plan is to watch her like a hawk for any signs of futher deterioration, but I would appreciate any other pointers. I hate this disease and I'm grateful to have a place to post here. |
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Post by Romy & Frankie on Oct 13, 2018 14:45:31 GMT -7
Welcome (back) to Dodgerslist, Aleks. I am so sorry that Doglog is having another IVDD episode. There is no way to tell for sure if it is related to her dental but you are doing the best thing for her by keeping her on Strict crate rest and starting her back on Metacam. Just a reminder that Strict crate rest 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. Carry her to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! www.dodgerslist.com/literature/slingwalk.jpgThese are the signs of pain we look for ☐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 you are seeing any of these signs do not hesitate to give Doglog the tramadol. Three times a day typically is needed to give best relief. Pain is a lot harder to control once it has started then to keep at bay. How long was the Metacam prescribed for? The mgs of in one mL might be written on the bottle t won't take much to bone up and get back up to speed on your dog's disease. Follow the button that pertains to the situation now at hand. click the YELLOW button "Conservative Treatment: Overview essentials" at this link: www.dodgerslist.com/healingindex.htm As time permits in the next days, do check out all the colored buttons on this page for many happy years ahead of living with an IVDD dog. |
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Post by Aleksandra & Doglog on Oct 13, 2018 14:55:25 GMT -7
Hi, thank you for your quick reply.
The metacam syringe says there's 1.5mg/ml. The vet didn't give me a length of time to use it for :/ I will need to call them next week. I assume it's at least 1-2 weeks (and she's already been on it for 1 week except yesterday)..
Right now there's no pain - none of the symptoms you listed ... I'll carefully monitor.
do you have a recommendation for an at-home laser device?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 13, 2018 15:24:28 GMT -7
Alex, good job on identifying signs, crating at once and getting symptoms checked out by the vet!
How many mgs are in one mL of the tramadol? What dose in mL are you actually giving right now?
Are all signs of pain fully covered by the one pain med (tramadol) dose to dose, round the clock? If not, it is the pain meds that should be adjusted and not rely on a laser light device.
Tell us more what results you are looking to achieve with laser light.
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Post by Aleksandra & Doglog on Oct 13, 2018 15:41:18 GMT -7
She's just on Metacam right now. There are no signs of pain. If I do see any at all, I will give the Tramadol as well. It's a liquid, I don't know how many mgs are in the ml.
With the laser, I'm looking to ease inflammation and speed up healing and nerve repair.
Edit. and sorry, but I clearly already said there is no pain.. I feel like you didn't even read my messages above. I asked about which laser you'd recommend because one of you recommended one in the messages above. It seem strange now you're asking what I'm wanting to get out of a laser? I don't mean to come across wrong, but I feel like noone is even taking the time to read what I wrote, and is just copying and pasting generic info.
Since this is the 3rd time she's having an episode since only 2017, and this one clearly has neuro involvement, is surgery recommended at this point? seems like since the summer of 2017 we get about 6 months in between episodes. What do you see done in cases like this? I'm watching her, and she is declining in her ability to walk. Yesterday before I crated her it was just a few limps and wobbles here and there. Now she's very obviously wobbly. I'm resigned and expecting her to continue declining, but at least the neurosurgeon is available mon-fri.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 15, 2018 7:14:25 GMT -7
Aleks there is the not inexpensive Assi Loop your vet can prescribe for at home use. www.assisianimalhealth.com/product/loop/ The more critical thing to me is not the laser device but attending to getting meds adjusted.....the anti-inflammatory if there is new/increased neuro loss. If you are seeing increased neuro diminishment, then the vet needs to know right away! Time matters when nerve cells are dying to up getting the swelling down. It is not at all something to be resigned that there will be continued neuro decline, but instead to take action, alert the vet to get help. Normally, you would phone the vet and report the signs to avoid a risky to the disc car transport to get meds adjusted. IF it is not clear whether you are dealing with muscle atrophy or nerve diminishment, it may take a vet visit and exam. Pad out the crate with rolled up blankets to protect from shifting his body as you brake or take a corner. WHERE is Doglog on the neuro list below?As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. √ Pain caused by the tearing disc & inflammation in the spinal cord 2. √ Wobbly walking, ? legs cross3. ? Nails scuffing floor 4. ? Paws knuckle 5. ? Can no longer move up into a stand ? Legs do not work (paralysis, dog is down) 6. Bladder control is lost 7. Tail wagging with joy is lost 8. Deep pain sensation (DPS), the last neuro function, a critical indicator for nerve healing in conservative treatment or after a surgery. Only trust the word of a specialist about the tricky to identify DPS. After a dog is paralyzed, the existence of deep pain sensation is an indicator that surgery could STILL be successful. That window of time is 12-24 hours from losing deep pain sensation (DPS). Even after that window of time, surgery is often successful. The spinal cord is very fragile, the more hours after the window, the less chance of a complete recovery. new or increased neuro DECLINE happens: --- when the anti-inflammatory is not strong enough. There are two classes of anti-inflammatory drugs. Steroids, the most powerful class. Non-steroids (NSAIDs), the lessor class. When there is neuro diminishment a vet has to make a decision. IF the vet decides that neuro diminishment is an emergency to treat, then he would switch from the NSAID (Metacam) to the steroid class without the safety of a 5-7 days washout before the the steroid. The vet would then up the GI tract protection so that two protectors are on board: famotidine PLUS sucralfate--- double protection! Learn more about the two classes of anti-inflammatory drugs and how they work during a disc episode PLUS a reference card to keep in your purse: www.dodgerslist.com/literature/healingsweling.htm--- when there has been too much movement for the back/neck. That is during the crate rest time to allow the disc to heal there was a lapse in the 100% STRICT rest 24/7, only out for a very, very few footsteps at potty time. Too much movement would disrupt the early forming scar tissue causing a relapse to the healing disc. From the article on "Surgery Considerations": www.dodgerslist.com/literature/healingsurgery.htmWhen surgery is a consideration • If your dog can't walk OR with STRICT crate rest, neurological functions worsen and are lost (legs and bladder control) • STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns • If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and mix of pain relievers) yet the pain can’t be brought under control • if a dog is experiencing similar signs of neck or back pain, or mild neurological deficits for the 3rd or 4th time, meaning it may be the same disc is involved. LEt us know what your vet thinks if there is new/increased neuro diminishment. Change in meds? Addition of 2nd stomach protector if change to a steroid anti-inflammatory such as prednisone. |
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Post by Aleksandra & Doglog on Oct 16, 2018 15:30:22 GMT -7
Hi, thank you for your reply. Our vet is getting us a neuro referral. He thinks it's best that we consult the specialist and get a MRI done, since it's her 3rd episode in little more than a year. If she continues to get worse and I see she's losing the ability to walk we will take her to see the neuro for emergency surgery without waiting for the referral.
Right now she's on #2 in the scale: Wobbly walking, legs cross, but it's very hard to tell what's going on. I added Gabapentin and Diazepam to her meds this morning and it made her extremely drowsy and dizzy. She was walking pretty much fine for potty first thing this morning (just went for #2) then I gave her the Gabapentin and Diazepam, spaced 1 hour apart, and within 20 minutes of Gabapentin she was absolutely doped up and hardly able to move or stand... I've taken her for #1 and it was very difficult... we finally managed at 2pm with a sling.
These were the same dosages of Gabapentin and Diazepam she was on in previous 2 episodes, but it hit her a lot harder today. So I'm watching her very carefully as the day goes on and these start to wear off... whether she still has trouble moving, or was it the meds that knocked her out. I know both of those can create wobbliness and dizziness as a side effect. It's 4:25pm and she's a lot more alert and got up and moved around a bit in the crate anticipating her dinner. I'm crossing fingers any my entire body that it was just side effects of the meds. I'm terrified of this progressing to further neuro loss.
Thank you for being there for us.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 16, 2018 18:42:47 GMT -7
Aleks, hmmm... .could you update the med list so we can better understand things
5.4 kg/11.9 lbs
metacam as of 10/: for 7 days for dental. STOPPED 10/12
as of 10/13: 1x/day for ? days then stop to test for pain/neuro √pain, √neuro issues as of 10/12
Gabapentin ? mgs ?x/day as of 10/16
Diazepam ? mgs ?x/day as of 10/16
famotidine 5mgs 2x/day
I see your quandry if the addition of pain meds today was the cause of being weak legged or if you are observing neuro loss. Metabolism can change with aging. Filling in the new info about gabapentin and diazepam can aid our understanding of things better.
Did you also end up giving tramadol...does the bottle have the mg in on mL listed, should be?
What signs of pain did you observe that made you decide to give gabapentin and diazepam after your last post on Oct 13 where there were no signs of pain but a concern of increased wobbliness?
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Post by Aleksandra & Doglog on Oct 18, 2018 11:48:04 GMT -7
Hi Paula, here are the meds
5.4 kg/11.9 lbs
metacam as of 10/08: for 7 days for dental. STOPPED 10/12
as of 10/15: 1x/day for 14 days then stop to test for pain/neuro √pain, √neuro issues as of 10/12
Gabapentin 25 mgs 2x/day as of 10/16
Diazepam 2.5 mgs 2x/day as of 10/16
famotidine 5mgs 2x/day
Tramadol 20mg 3x/day
[Moderator's note: please do not modify
5.4 kg/11.9 lbs
√pain, √neuro issues as of 10/12 due to dental???
metacam as of 10/8: for 7 days for dental. STOPPED 10/12
as of 10/15: 1x/day for 14 days then 10/29 stop to test for pain/neuro issues
Gabapentin 25mgs 2x/day
Diazepam 2.5mgs 2x/day
Tramadol 20mg 3x/day
famotidine 5mgs 2x/day]
There was no pain until 10/16. Now we have shivers a couple of times a day. I know that's a sign of pain. She also appears generally miserable and reluctant to move.
I added Gabapentin and Diazepam as I noticed her scratching her ear to the point of bleeding. Our vet thinks it might be nerve related. Diazepam as I noticed muscle spasms.
The Gabapentin is a half dose for now, I don't think I will increase it. We were told to take 50mg twice a day, but it made her incredibly dopey on the first dose and hardly able to move. I didn't see this reaction the last two episodes, only some slight wobbliness. Like you said, something changed in her metabolism. We had her bloodwork done prior to her dental and her liver and kidneys are functioning properly, no issues.
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Post by Romy & Frankie on Oct 18, 2018 13:43:29 GMT -7
With the half dose of gabapentin is she now steadier on her feet? Gabapentin can definitely make a dog a bit woozy and as Paula mentioned metabolism and reactions to meds can change over time.
With the decreased dose was there more signs of pain like reluctant to move and shivering?
Ear scratching is not a sign of nerve pain that we have often seen associated with IVDD. Has the decrease in gabapentin increased the scratching?
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Post by Aleksandra & Doglog on Oct 19, 2018 10:41:19 GMT -7
Hi, yes, the decreased gabapentin definitely made her steadier on her feet. I think it might've been a combination of both gabapentin and diazepam that caused the wobbliness. She was barely able to move.
We're seeing improvement today. She's a lot more alert and able to move around in her crate more. Barked at the postman. No signs of shivering or pain today. Whining for food. All good signs. I hope we don't have a setback.
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Post by Romy & Frankie on Oct 19, 2018 13:08:01 GMT -7
Very good news that Doglog has improved and showing no signs of pain..
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Post by Aleksandra & Doglog on Oct 20, 2018 16:58:51 GMT -7
Hi, we continue to be doing good in controlling the pain, but I need your input on something... Doglog has gone from being alert and mobile yesterday and overnight (enough to lift herself easily) to pretty much catatonic all of today. She's just been laying prone all day [pain] and sleeping. It's evening after all day of this and she won't get up for even the tastiest morsels. We went outside to the potty spot, and it's like she forgets why we went there... She did walk around a bit in our potty spot today. She wasn't assisted, I just held the harness taut in case she stumbled, but she didn't. She's just very reluctant or not at all willing to get up. [pain]
Like I said, this is our regimen: 5.4 kg/11.9 lbs metacam as of 10/8: for 7 days for dental. STOPPED 10/12 as of 10/15: 1x/day for 14 days then 10/29 stop to test for pain/neuro issues Gabapentin 25mgs 2x/day I dropped this to 20mgs 2x/day as of 19/10 [Oct 19]Diazepam 2.5mgs 2x/day I dropped the Diazepam completely as of 10/18 - she was barely moving after it Tramadol 20mg 3x/day I cut this down to 20mg at 2am, 15mg at 10am, and 15mg at 6pm as of 19/10. [Oct 19]famotidine 5mgs 2x/day] [Moderator's note: please do not modify
5.4 kg/11.9 lbs
√pain, √neuro issues as of 10/12 due to dental???
metacam as of 10/8: for 7 days for dental. STOPPED 10/12
as of 10/15: 1x/day for 14 days then 10/29 stop to test for pain/neuro issues
Gabapentin ▼20mgs 2x/day
Diazepam 2.5mgs 2x/day STOPPED Oct 18
Tramadol 20mg/▼15mgs/▼15mgs 3x/day
famotidine 5mgs 2x/day] I don't know what is happening. I dropped the dosages slightly yesterday to see if the pain is still controlled, and it is. I have no idea why she's so extremely drugged up... I checked the meds about 10 times now to make sure I'm administering them correctly. I've gone to websites to make sure I'm understanding the syringe measurements and all checks out. I'm worried something else might be going on. Her pee color is normal, poops were normal, although we didn't have one since yesterday evening. She ate all her food for today. I just checked her temperature and its 37.7c (99.86f), which is normal (?) [normal rectal temperature is 100.5°F to 102.5°F]We've done 2 episodes already, and I can't recall her being this dopey in any of them. Have you seen something similar in cases here on the forum? My vet is closed today. 8pm. Never mind. I think I've been mistaking the lethargy for something it's not. It's pain. The trembling's back, arched back, suffering  I hate this disease. |
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Mary & Mila
Helpful Member 
FEMALE— DACHSHUND
Posts: 218 
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Post by Mary & Mila on Oct 21, 2018 4:28:27 GMT -7
Hi Aleks,
So sorry to read that Doglog is having another IVDD episode.
It is a horrible disease.
You are correct about the signs of pain, have you increased the pain meds again to the original doses?
Please let us know if this improved things for her and stopped the shivering etc.
I really hope it does.
Hugs to you and your little girl.
Mary.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 21, 2018 5:14:41 GMT -7
As Mary has asked, please do let us know whether all pain meds are back on board at the dosages when Doglog's pain was under control. Is her pain now under control again? Pain meds should continue to be given at the maximum dosages prescribed until October 29 when the Metacam is stopped. That's the time when a test for pain should be made. The Metacam is working on the swelling which causes the pain. Until the Metacam has done its job and has gotten the swelling that's pressing on the nerves of the spine completely resolved, pain meds at aggressive dosages are needed to keep Doglog comfortable. An IVDD episode is very painful until the swelling is gone.
It can take 7-30 days on the anti-inflammatory to get the swelling down. On October 29th when you test for pain by stopping all meds (or at least tapering the pain meds, whichever your vet advises), you'll need to again be on the alert for the return of pain.
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Post by Aleksandra & Doglog on Oct 21, 2018 15:26:32 GMT -7
Hi,
I returned Tramadol to 20mg/3x day.
Something is not adding up for me, though. I kept careful notes of Doglog's symptoms and meds since the beginning of the flareup, and there's a definite correlation between her collapsing and being extremely dopey / unable to move and the administration of Gabapentin and Diazepam. This is extremely confusing, since her symtomps overlap with down symptoms and we don't know what we're seeing.
Have a look at this:
Oct 13 - Only Metacam. Strange foot placement, uncoordinated but have to look very carefully to spot it, start crate rest. Happy/alert/moves about in crate otherwise.
Oct 14 - Only Metacam + Famotidine. Noticeably wobbly. Front foot buckled [knuckled]. No pain. Shakeoffs/tail wags/alert. Happy/alert/moves about in crate otherwise.
Oct 15 - Metacam + Famotidine + Tramadol in PM. Subdued/sleeps all day. Mild shaking in PM, start Tramadol. No wobble during potty break, can support herself up with no issues. Shakeoff more hesitant.
Oct 16 - Metacam + Famotitine + Tramadol. First day with Gabapentin and Diazepam. Full doses (50mg Gaba, 5mg Diazepam) Doglog goes potty for #1 in AM before Gaba and Diaz - sure steps, can support herself, no problems with wobbliness. Given both Gaba and Diaz shortly after, and we go out to try for #2. She collapses. We have to use a sling for the front and back.
Oct 17 - Metacam + Famotitine + Tramadol. No Gaba or Diazepam because of the experience yesterday. Not weak, dopey, or wobbly. Tail wags/alert. Can support herself on her own feet no problem during potty.
Oct 18 - Metacam + Famotitine + Tramadol. We try half dose Gabapentin and full dose Diazepam. She collapses. We have to use a sling for the front and back.
Oct 19 - Metacam + Famotitine + Tramadol. We try less than half dose Gabapentin and NO Diazepam at all. She can move on her own. Barking, moving around in the crate, moving around on her own for potty, not wobbly. Happy/alert.
Oct 20 - Metacam + Famotitine + Tramadol. We try half dose Gabapentin. She's noticeably dopey all day. Doesn't move as easily. No poo. Won't get up. We do full dose Diazepam for muscle spasms in PM. She collapses. We have to use a sling for the front and back.
Oct 21 - Metacam + Famotitine + Tramadol. We continue half dose Gabapentin. full dose Diazepam in AM, because of the muscle spasms last night. She's alert before breakfast, moves around in the crate. Then collapses after Gaba and Diazepam. Not able to move without slings.
[Moderator's note: please do not modify]
5.4 kg/11.9 lbs
√pain, √neuro issues as of 10/12 due to dental???
metacam as of 10/8: for 7 days for dental. STOPPED 10/12
as of 10/15: 1x/day for 14 days then 10/29 stop to test for pain/neuro issues
Gabapentin (a liquid? ?mgs in each mL?: 20mgs 2x/day
✚Diazepam 5mg tab: 2.5mgs 2x/day as of Oct 21
Tramadol 20mg 3x/day
famotidine 5mgs 2x/day ]
What is going on here? If she was progressing to down stages and becoming paralysed, surely it wouldn't flip flop back and forth like this? I have a really bad feeling that something is wrong with these meds and even thought this is NOT Gabapentin in the bottle. It's a liquid, so there's no cellophane with the name on it. She's been on Gabapentin in much higher doses in the past (150mg/day) with only very slight wobble side effects.
Of course we now have to weigh whether to rush her into surgery - today she's not able to support herself on her front 2 paws, and barely able to use the rear legs. She just splays out when going to potty. When I tickle her front paws she withdraws them and is not impressed. She's extremely dopey.
Just putting this out here as I'm questioning whether I'm going crazy, or are you seeing the same correlation? Are you seeing a dog that's basically well on the way to being down, or something else with these meds?
EDIT: I really don't mean to make this more detailed or confusing, but I just discovered something. The Diazepam pills we've been prescribed for this episode are based on a 10mg pill (a blue pill) that's split into 4 pieces, 2.5mg each. The pills from the previous episode were yellow, and based on 5mg per pill split in two, so same thing 2.5 mg dose. This is what I gave her initially the first time, since we still had some left and they were not expired. I stupidly thought that if I then give the blue 1/4 pill then I'm giving a half dose, while in fact it was the exact same thing. So no wonder we're getting the same results! :/ Writing this out really helped me to understand... I think it's something to do with this Diazepam all along...I hope.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 21, 2018 17:16:21 GMT -7
I hope you at least now have an understanding. Still fuzzy to us.
I think having a vet check Doglog's neuro status to be certain why going down in the front legs and the back AND check all of her meds would be an extremely prudent thing to do amidst all this confusion of information. Normally a dog who has a neck disc could go down in the front or back legs. A back disc dog normally would not go down in the front legs unless there is another disease in addition to the disc problem. You need a vet to sort this out with surety.
The devil is in the detail. We can't easily follow along because we do not know what terms like "half a dose" "full dose" means in mgs with all the several mention of a medication names. Name a med and with it either:
-- give the size of the pill in mgs and then indicate 1/2 a pill or full pill OR
-- you would need to tell us exactly how many mgs are in a dose with each med mentioned.
With liquid meds it is important to know how many mgs are in one mL. It should by all rights be accurately indicated on the bottle. Mistakes can be made and YOU having the correct information on bottles is just one more safety element that you are able to be a double checker...just like we note if there is something not right to us. We depend on what you report. If clear contents are not on the lable the clinic or the pharmacy who compounded it can can look it up for you.
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Post by Aleksandra & Doglog on Oct 22, 2018 12:29:45 GMT -7
Sorry, this is very difficult and I feel very overwhelmed.
here are the adjusted meds:
5.4 kg/11.9 lbs
√pain, √neuro issues as of 10/12 due to dental???
metacam as of 10/8: for 7 days for dental. STOPPED 10/12
as of 10/15: 1x/day for 14 days then 10/29 stop to test for pain/neuro issues
▲Gabapentin (a liquid, 100mgs in each 1mL: 50mgs 2x/day
✚Diazepam 5mg tab: 2.5mgs 2x/day as of 10/21
▼Tramadol 10mg 4x/day
famotidine 5mgs 2x/day
[Moderator's note: please do not modify]
5.4 kg/11.9 lbs
√pain, √neuro issues as of 10/12 due to dental???
metacam as of 10/8: for 7 days for dental. STOPPED 10/12
as of 10/15: 1x/day for 14 days then 10/29 stop to test for pain/neuro issues
Gabapentin (100mgs/mL: ▲50mgs 2x/day
Tramadol ▼10mg ▲4x/day
famotidine 5mgs 2x/day ]
I carried her for potty this morning and she walked and supported herself on her front feet just fine. Bit wobbly in the back. I see her knuckling her front feet right now [neuro diminishement] in the crate, but not sure if this is from being dizzy on be meds, or neuro issue. When I carried her out she was eager to go and pushing away from me with her front paw. Can inability to move legs/knuckling be intermittent? Have you seen something like that?
We declined to take her for the MRI today pending more observation. I'm really on the fence about this because of the risk of transporting her, and the risk of handling under anasthesia for the MRI. Unless she's going for surgery the treatment is the same as we have now. They told us they operate if 1. the dog is down, or 2. dog is not down but the meds can't control the pain. Right now neither [pain nor down] is true for us. The neuro office is standing by, though, I spoke to them this morning. Please let me know what you think.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 22, 2018 13:25:22 GMT -7
Aleks, knuckling has to do with neuro dimishment. I just went back to quickly scan all of your posts if you had ever reported knuckling. Knucling was first reported as happening on Oct 14 in your post yesterday (Oct 21) but not on any posts made on Oct 15. So there has been some nerve damage that has not repaired v.s. this is a new neuro diminishment as of today. Same front paw(s) knuckling or had only one front paw (L or R?) knuckled on 10/14? My Oct 15 post at 8:14am outlines IF there is new or increased neuro damage, then changing to the strongest class of the anti-inflammatory drugs (a steroid like prednisone) might be a consideration rather than to remain on the lessor class the non-steroids (NSAIDs). The same Oct 15 post, the predictible order of neuro decline also helps to guide you when a surgery might be considered as well as the information here: www.dodgerslist.com/literature/healingsweling.htm Did the neuro you spoke with today, think the disc is in the neck or the back? What was his take on why knucklilng of front left? or front right? or both front paws? could be? Did the neuro make adjustments to her meds or have you just now provided the corrected information? Tramadol was 20mg 3x/day = 60mgs Tramadol now is 10 mgs 4x/day = ▼40 mgs Gabapentin was 20mgs 2x/day= 40 mgs Gabapentin now is 50mgs 2x/day = ▲100mgs What is the qty dose in mL or cc that is Rx'd for gabapentin? |
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Post by Aleksandra & Doglog on Oct 22, 2018 14:37:50 GMT -7
Hi Paula, based on what you said, and reminding me that she was wobbly/had knuckling on Oct 14th, we decided to take her in for an MRI and possible surgery. She could have gone in tonight, but there's another wiener dog in the triage, and he/she is paralysed so they will operate on that one first. They told me it makes most sense to go tomorrow at noon, their next opening... I will keep you posted. I'm so scared.
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Post by Pauliana on Oct 22, 2018 21:39:31 GMT -7
Understand the fear, having been through taking Tyler in for his surgery 5 years ago. I was terrified but it turned out to be for the best as it got the offending disc herniation taken care of and he felt so much better afterwards compared to waking up paralyzed and screaming. I was surprised he was so bright eyed and excited to see us when we visited. Every disc injury is different and every surgery is different so results can vary.. Doglog's surgeon will let you know how long he wants for post op crate rest , many suggest 4-6 weeks and he will suggest what at home PT he wants for her. Surgical swelling lasts for about 2 weeks and after that you will see the direction her healing will take.. Thanks for keeping us posted.. Keeping you and Doglog in our thoughts and prayers. On discharge day these are some questions to ask your surgeon: dodgerslist.com/literature/dischargequestions.htm |
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Post by Aleksandra & Doglog on Oct 24, 2018 7:39:45 GMT -7
We had surgery scheduled for yesterday. she went in for a CT scan to show the site of the herniation. The results were normal. No herniation, no disk problem. They did an MRI to show the soft tissue. Our girl has encephalitis, which is an inflammation of the brain and spine and is now fighting for her life. The symptoms are nearly identical to IVDD, except for the lethargy and intermittent ataxia, which I was seeing in the last few days and struggled to understand. Even our neuro surgeon assumed IVDD upon examination yesterday, and the truth showed itself on the CT and MRI.
"The most common clinical signs associated with encephalitis are paresis and ataxia and can often look identical to other causes of myelopathy such as intervertebral disc disease."
I'm absolutely shattered and facing the prospect of losing her. IVDD would be a blessing instead. Our world is completely upside down and I can't bring myself to do anything but sit and cry since I heard this yesterday. She's only 6.
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Post by Julie & Perry on Oct 24, 2018 8:26:44 GMT -7
Wow, that's so hard. I'm praying for you and Doglog. She's a fighter!! Do you have a friend or family member to support you? Do you have a place of faith to call for a prayer chain? Whatever our beliefs we will send positive energy out to you.
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Post by Aleksandra & Doglog on Oct 24, 2018 9:02:13 GMT -7
Thank you. My husband is here going through it with me. We also have a local community of doxie owners as a FB group. I posted this morning and the messages are pouring in. All we can do now is wait.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 24, 2018 9:50:18 GMT -7
Aleks, we wait here, too, and anxiously to hear how the treatment for the now diagnosed encephalitis is working for Doglog. My heart goes out to you as you wait. Sending prayers the particular cause of it will mean the treatment will have good long-term success potential.
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Post by Julie & Perry on Oct 24, 2018 19:17:39 GMT -7
Continuing to hold your family and Doglog in prayer.🌹
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Post by Pauliana on Oct 24, 2018 21:48:57 GMT -7
Aleks, I am so sorry to hear about Doglog's encephalitis diagnosis. What a shock to you and your family! I hope treatment works to get her through this..Prayers on the way!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 25, 2018 4:21:41 GMT -7
My prayers are with you all. So sorry to hear this.
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Mary & Mila
Helpful Member
FEMALE— DACHSHUND
Posts: 218
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Post by Mary & Mila on Oct 25, 2018 4:24:09 GMT -7
Oh Alexs, such very sad news, my heart goes out to you too, so unexpected.
Sending you all healing thoughts especially doglog <3 <3
Mary x
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Post by Aleksandra & Doglog on Oct 25, 2018 10:18:37 GMT -7
Hi everyone. Update on Doglog: she was put on IV chemo therapy and it worked. Her symptoms have been reversing, and she's able to walk today without assistance. She's still in the animal hospital and will likely stay for another couple of days, but the progress has been incredibly encouraging. We credit saving her life to the neuro specialist we have here, Dr. Jose Diaz. He's the only animal neurologist in western Canada, and just happens to be based here in Calgary. Even though he only had 3 cases of encephalitis in his career, he was quick to diagnose it and knew exactly how to act. This could've easily been a wild goose chase.
She will now need a course of predisone - I don't know for how long, I hope it's not a long term solution as I know how hard it is on the body. I have a lot of learning to do. Dr. Diaz mentioned that she will need injections of the chemo drug every 4-5 weeks going forward (cytaramine). I don't know what her future looks like yet. This can go into remission, or be back. But heart is lifting with hope she can be with us for a while longer.
Our regular vet couldn't believe the diagnosis, and how closely it mimicked IVDD. He told us she's a candidate for a medical journal case, one in a million. I suspect this disease is more prevalent, but extremely hard to diagnose. She was literally going in for disk surgery and the CT scan was used to pinpoint the herniation - and there was NONE. Even Dr. Diaz initially thought this was a classic disk case. They did an MRI after the CT to show the soft tissue, and he knew the direction to take immediately from there. He was literally in a frantic rush when he called me with the diagnosis, that they have to start the cytraramine IV RIGHT NOW. We are incredibly incredibly lucky.
I will have more updates for you as they come. Thank you so much for being there as a part of our journey.
Edit: thinking about this some more, IVDD has been a blessing in disguise for us. If it wasn't suspected so prevalent in her breed, and she suddenly came down with these symptoms... would she still get the CT and MRI? Not likely. It could've been treated as an infection, or gone in 50 different directions, nowhere where we need to be. Very interesting how all the events fell together. I'm not religious but I have to admit I prayed for the first time in my adult life. And something has been looking out for us.
And I have to thank you again, Paula, because it was your comment that finally mobilized me to take her in to the neuro. THANK YOU from the bottom of my heart.
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I hate this disease.
