Gina's Bella 10/7 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!

You are 100% right to be concerned about possible stomach damage. Asprin is an NSAID type of anti-inflammatory and Pred is a steroid. It is dangerous to mix those two together without a 4-7 day washout. We have found Pepcid AC to be very effective against damage to the GI tract caused by excesss stomach acid. The incidence of side effects is low and in the US can be purchased at any drugstore or supermarket. If you cannot reach your vet quickly, please read about Pepcid AC and if you believe Bella does not have heart, liver or kidney issues, give Pepcid AC and keep your vet in the loop tomorrow. Read here about the relatively safe of over the counter acid suppressing Pepcid AC: www.marvistavet.com/famotidine\

The dose for Bella is 5mg Pepcid AC (famotidine) every 12 hours. Give it 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory.

Are her poops okay Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea? If the answer to any of these questions is no, ask you vet as soon as possible about an additional drug Sucralfate. Even without any symptoms you can speak with him about it. Sucralfate sort of “bandages” the ulcer and accumulates healing tissue factors in its bandage; it not only protects the ulcer but actively assists in the healing process. This is a prescription medicine. You can get some general info about it here:
www.marvistavet.com/sucralfate.pml

It sounds to me like Bella is in pain. These 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, restless, can't find a comfortable position. Ears pinned back, 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 between doses of correctly Rx/d pain meds.

Disk episodes are usually very painful. It will often take three medicines working togerher to fully relieve pain.

Methocarbamol for painful muscle contractions.
Tramadol Rx'd 3x/day as the general pain reliever
Gabapentin for nerve pain also Rx'd 3x/day.

Speak to your vet about adding tramadol and Methocarbamol to her gabapentin as soon as you can. There is no reason for Bella to be in pain. Pain will slow the healing process.

Some of our members have had some success with CBD oil but it is no substitute for the meds above.

If I am looking at my calendar right she was on 5mg 2/x a day for 5 days. Is she now on the tapering dose of 1/x a day. Bella should not start to taper the pred while she is showing signs of pain. This is important and and should be discussed this with your vet as soon as possible.

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.

Do you know anything else about the steroid injections she was given in the hospital? Sometimes you can find this info on your bill. What is the dosage of the gabapentin tablet?

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.jpg

Currently can Bella move the legs at all? or wag the tail when you specifically do some happy talk?

The things to address right away are her meds, which are not controlling her pain and her stomach protector. When she is no longer in pain she can heal comfortably. Do not be concerned that you have not seen improvement in her legs. Nerve healing is a slow process.
Do not beat yourself up about the mistake with the  asprin.  You are now becoming knowledgable about this terrible disease. 
What is your name? I am Romy and my boy is FRankie.

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

Gina, thanks for given additional information on the meds. Prednisone is a bit more complicated than the average drug and the reason we need to have exact details in order to understand things. Can you fill us in?

What date did two 5mg Pred tabs 2x/day start?  The reduction to the anti-inflammatory level  used for disc episodes is to begin on Thurs Oct 18.  The taper which will be less than/below the anti-inflammatory level does not start until the dose goes to 5mgs once a day.

Actually two mg tabs (10 mgs) for an almost 12 pound dog is the immune suppressive dose. The anti-inflammatory dose would be 5mgs twice a day.

It is not expected that nerve repair would come back with the start of steroid blasting nor even with the use of prednisone pills.

Once nerves have been damaged it can take weeks even months for the body to self repair. So in short prednisone is not used to repair nerves...the body does that on its own.

Prednisone's job is to get the swelling down in the spinal cord over the course of 7-30 days. It is merely a guess by the vet as to how long the course of pred at the anti-inflammatory dose should be. Some guess at 5 days some maybe 14 days. The taper of prednisone is a test to find out if that guess is correct.

Often when prednisone is stopped the pain meds are stopped also. This is done to determine if the painful swelling in the spinal cord is gone.
----It is this swelling that causes both pain and can cause neuro deficits.
--- If the dog is still taking pain meds it will mask the pain that indicates the swelling is still there.
--- If the  pain meds are stopped on the begin of the taper and no pain surfaces the swelling is gone. Pred taper goes to conclusion and only the remaining period of crate rest is needed.
--- If pain returns when these meds are stopped, more time on all meds is needed plus back up to the anti-inflammatory dose for a bit longer.


I am in aggreement to not only get Pepcid AC 5mgs twice a day on board pronto, but to also very strongly advocate for an Rx of sucralfate.  High doses of steroid blasting and immune suppressive 10mgs 2x/day are a very great danger to the GI tract!   GI tract damage progression:
      Nausea of not eating, lip licking, vomit, loose stool, bleeding ulcers, black or red blood in diarrhea, moving to deadly perforated stomach lining.

Bella is just plain being under medicated for pain with only one pain med on board, meaning only one source of pain is being address!   IF this vet will not help, do you have another vet in your town?
 
__ Tramadol - synthetic opiate as the general analgesic. Expect Rx to be every 8 hours.
√ Gabapentin - is for nerve pain
__ Methocarbamol for muscle contraction pain. Also expect an Rx to be every 8 hours.
__ Sucralfate - to gel coat any areas of the GI tract that have been damaged from the steroids

Knowledge helps you help Bella best.  Be polite, stay strong, never give up. Advocate for what Bella needs to remain free of pain while prednisone is at work til this steroid has completed the job of getting rid of all spinal pain.  Healing is hindered when there is pain to content with.

A good jumping off place is this summary on disc episodes with links to delve in further as time permits:  www.dodgerslist.com/literature/healingpage.htm

Hi Gina,

He is using the higher dose of Prednisone to try to get the swelling down faster.. What we see more often is 5 mg every 12 hours..  I hope the Vet is more receptive to you.. Tell him Bella is still in pain and see what he suggests.  That's one way of starting the conversation on medications.  Read this about Tramadol and Methocarbamol and the other medications used, so you can feel more confident about how they are used in a disc episode:   dodgerslist.com/literature/healingpain.htm

As Paula and Romy said, Sucralfate will help heal any damage in the GI tract from the high doses of the Prednisone, so ask for it as well.  Glad you got the Pepcid AC started!  

Here is some information about emergency crate training. Lots of tips on how to teach her to be calm in the crate:  dodgerslist.com/literature/EmergencyCrate%20Training.htm#Emergencyconfinement

Some dogs do better in pack and plays or ex pens.. This article has a video with an ex pen set up. Lots of good ideas to make Bella feel more comfortable in her recovery suite.  dodgerslist.com/literature/CrateRRP.htm

Don't be too hard on yourself about the Aspirin.   You didn't know.. Now you do, and you are learning a lot more besides.  

Healing thoughts and prayers.  

We started giving Bella the 2  5mg prednisone tablets 2x a day on Friday October 12th. We started giving 1 5 mg prednisone tablet twice a day today Wednesday, October 17th. We are supposed to keep her on the 1 5 mg tablets twce a day for the next 5 days. Then we are supposed to give her 1 5 mg tablet every other day for 6 days.

For the Pepcid AC we found the 20 MG tablets and cut them in 1/4ths. We started giving them yesterday evening October 16th. We gave her the 1st dose of the pepcid AC 1/2 hour before she had her prednisone. We gave it again this morning 1/2 hour before this mornings dose of prednisone. We are planning on giving it twice a day.

I plan on slipping into the vets office here in the next couple of hours to try see if I can talk them into a 2nd pain med and the stomach protector. 
----

So, I went to the vet and they wouldn't do anything until they see her again. They want to see her at 8:15 in the morning so they can assess her level of pain. I got home and she went poop and there is an area in her poop that is significantly darker so now I am concerned. I took pictures of it if anyone would like to take a look and tell me if what I am seeing is normal or if I should take her to an emergancy vet in another town.

Ok, so I know this is pretty nasty. Admin please remove if these photos are inappropriate. I just don't know what to look for and the veterinarian is just so unconcerned. After I posted I called the vets office to see if they could have him call me this evening so I could discuss her bowel movement and they said he said she'll be fine until morning that we could address it then. I think we are going to have to find a different vet in a different town. I will just have to request her medical records and take them with me to the new veterinarian. Even if the bowel movement turns out to be nothing I don't feel right that he is so dismissive and not willing to call me to discuss it or worry about her being in pain.

   

Paula, thank-you so much for all of your help and information. This site has been a God Send. It has shown me that even though this has been a scary situation there is hope and it doesn't have to mean Bella can't have a good life. It's really educating me on what we need to do to help her recover. And maybe it has helped me to dial back my expectatations a little to know that just because Bella isn't showing signs of moving her back legs right now it doesn't necessarily mean that she won't get at least some movement back in her back legs. And if she doesn't it will be ok As far as what makes me think Bella is in pain is she shakes/shivers, whines and groans, and pants really hard.  When she is like that her eyes even look glazy like she is having pain. It's hard to explain.Today she did let out a yelp for no reason that I could see. She also gets so she won't relax or stretch out in her crate. I can tell when she is feeling better because she'll be more alert/perky, wants to bark at noises and even do some tail wagging. But when she's hurting there is just the heavy heavy panting and when I try to calm her or talk to her it doesn't calm her.

Fire your vet immediately. They obviously aren't comfortable with IVDD and aren't willing to learn.

I'm with you, the vet hospital sounds like the best place for Bella.

Just put rolled blankets all around the inside edges of the crate.

Make sure it's securely fastened in place.

I'd go ASAP.

Gina, you report such wonderful progress with Bella!  

When the time comes we will post the "crate rest is over, now what?" article that will give you tips on how to ease her gradually back into her new normal.   

When they start to feel better it becomes more of a challenge to keep them from taking off ,that is where the harness, leash and sling comes in and you are already doing that.. 

What we did with Tyler was carry him out to go potty, just a very few footsteps on harness and leash and carry him back to his recovery suite ex pen.. 

You can also use an ex pen to make a small potty area..use it like a fence in other words..That way he sees a boundary...

Keep up the good work!