Laura's Kerby 1/12 Conservative - Corgi; GRAD 3/9

Welcome to Dodgerslist, Laura. 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.

Whenever a dog with IVDD shows signs of a disc problem, the first thing to do is immediately crate to protect the spine from further damage. Kudos to you for not listening to a vet who has told you to do moderate rest with short walks. The crate rest during conservative care must be more strict than post-op and be done for a full 8 weeks (more on that below).

A bit of pain is too much pain. Pain must be completely under control from one dose of pain meds to the next. There should be no sign of pain. Please speak to the vet ASAP this morning about adjusting the pain meds. Gabapentin and Methocarbamol both work most efficiently when given three times a day. We don’t have the dosages in mgs so we cannot advise as to whether the dosage can be increased. Tramadol as a general pain med can also be added.

If your current vet will work with you to get the proper pain meds on board, there would be no reason to make a risky transport to a neurologist unless there was a worsening of neuro function.  Consults with  neuros can be done even if surgery isn't being considered (and very few vets will operate on a dog that can still walk) but at this point, only the pain meds need to be adjusted and strict crate rest continued.  Kerby is a very good candidate for conservative care

The wobbly walking is a sign of nerve damage and is not a sign of pain.

Please, NO physical therapy during the 8 weeks of crate rest. The less movement of the spine, the better. Too much movement of the spine and the damaged disc could tear more, causing more pain and possibly more nerve damage, even paralysis. Acupuncture can help severely damaged nerves to get a jump start on healing but this is a mild episode so it’s not needed and transport to have it done is too risky. You’re doing the most important thing – the strict crate rest.

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 Signs of pain to be aware of and to advise vet if observed ☐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.

❖2 More  med info is needed

     …A Please list the exact names of meds currently given, their doses in mgs and times per day given.
     …B If on a NSAID, for how many days has it been prescribed for?
     …C PEPCID AC necessary whenever an anti-inflammatory is given: 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

❖3 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.

❖4 DOGs with BLADDER CONTROL: Carry 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

❖5 Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho?

Please know that dogs will IVDD should never go up or down stairs again or jump up and down from furniture.

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

Please let us know what the vet says after speaking to them this morning.  Healing prayers for Kerby.

Wowzers! Laura, you wasted no time in getting an IVDD knowledgeable vet on board. Double Kudos to you. She sounds like a real gem as well as your neuro also being in the know about conservative treatment!

Yes, it is like the difference between night and day when you have an IVDD knowledgeable vet on board working to to help Kerby disc heal.

I'm not so sure the  not wanting to walk (reluctance to move) at potty time does not mean Kerby is experience some pain.  The pain meds use with a disc episode have a short half life and normally to not provide the needed full round the clock pain relieve required with a disc episode unless Rx'd for every 8 hrs. Gabapentin and methocarbmaol are at 2x/day!

When one knows a disease is pretty painful, then we ought to act like is IS painful.  We side with the World Small Animal Veterinary Association (WSAVA) guidelines as well: "We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt" www.wsava.org/WSAVA/media/PDF_old/jsap_0.pdf 

Are you keeping a med chart to not only make sure all meds are given, but to also note cause and reaction.
D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf




Does the potty time reluctance correlate to nearing the  next dose of the two pain meds?  You stagger methocarb and gabapentin.  It may be useful to give them at the same time.  Pain control is adjusting til it is perfect.  
Read Dr. Galle (Neuro) over on the Dodgerslist Neuro Corner about timing meds:  www.dodgerslist.com/neurocorner2/timingmeds.htm  
And do discuss with your new DVM vet if an every 8 hr dose Rx should be considered.  

Try some calmers to see if that will help Kerby
Using any oral calmer in combination with a Pheromone diffuser seems to work best.  It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives (ACE or trazodone). Of course always keep your vet in the loop on all things you give your dog.

Place a DAP pheromone diffusor at floor level where the recovery suite is:
--DOG Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/

Use diffusor with one oral calmer from below:

Oral calmers:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
www.vetriscience.com/composure-soft-dogs-MD-LD.php
3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com

Now with 100% STRICT rest 24/7 employed AND  already seeing the wobbly legs notlonger wobbiling you can really consider Kerby to be an excellent candidate to recover with conservative treatment. You did a wonderful thing for Kerby in hiring a new vet and being on board with STRICT Rest.

PAIN MEDS
What is the new date that carprofen will stop.
What is the dose for Pepcid aC in mgs and are you giving every 12 hrs?

Let us know if you need some ideas to make sure there are no more escapes.

Keep us posted on what your vet says about adjustment of pain meds.

Do you have an ER vet available to you today so you can get Kerby's pain completely under control? You're right in not wanting him in any pain at all. Pain does hinder healing. And dogs can sometimes be very stoic about pain and try to hide it. So the signs you're seeing do need to be addressed ASAP. If you do go to the ER, be sure to secure Kerby's crate in the car and pad it well to prevent him from moving around too much as you brake and turn corners.

Since that dosage of Methocarbamol can be prescribed by vets for every 8 hours (though your vet hasn't prescribed it 3x/day), I don't see any problem with you moving it up three hours so all meds can be given at the same time, other than the Pepcid AC which is correctly being given 30 mins. before the Carprofen.

Pain may be preventing Kerby from trying to poop. They hold it until they absolutely have to go. The meds can also cause some constipation which pumpkin can help. 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.

Is Kerby drinking enough water?

Laura, Pepcid AC with a disc episode is normally used 10 mgs every 12 hrs to be on the aggressive side of stomach protection.  When used aggressively, there are some dog that just need more. So in addition to Pepcid AC, a med that works in a different way to gel coat where the stomach lining is disrupted is called SUCRALFATE.

So if you are giving Pepcid AC 10 mgs every 12 hours and still seeing Kerby has stomach issues advocate for sucralfate.  Learn the timing with food, with Pepcid AC and to know why you are advocating for it:  marvistavet.com/sucralfate.pml

Have you checkout the emergency crate training info for more ideas to help Kerby be able to relax in his recovery suite?  here's the link:  www.dodgerslist.com/literature/EmergencyCrate%20Training.htm

Keep us posted on whether Kerby's stomach is continuing to hold and no more vomiting.

Kerby's doing all right physically on the Fentanyl. He is absolutely going bonkers in the crate (only when we're home...when I return home from being out he's calm as can be) and I'm continuing the Trazodone in the morning. His vet also put him back on the Gabapentin and Carprofen in case it's a pain thing, but I am certain that it's not a pain thing. As soon as I take him out of the crate to bring him outside, he stops shaking and is happy as can be.

He's absolutely acting like he's not on medication at all, personality and tiredness-wise. Not sleeping much, anxious as all get-out, and when I take him outside he takes full advantage of the situation to CHASE HIS TAIL and try to get me to chase him by running around in circles...and yes, I have a very small (sub seven foot) enclosure outside that is the only place he is allowed to go! I end up picking him up until he relaxes and when I put him down again it just starts over, so I'll bring him back inside and try again later. I know he's bored and going bonkers but shouldn't the medicine be knocking him out, even a little??? I'm so frustrated and feeling bad for him (but I'd be feeling worse for him if I was just letting him do whatever he wants, of course, since it would ruin everything)!

Great news! I decided to try a pack and play (the playpen I used for both of my children) and rolled up some towels, blankets, and yoga mats (covered with soft blankets) to cover the bit of extra space. He is in heaven compared to yesterday! What a difference. Calm, wagging his tail and I'm able to give him scratches when I walk by. I'll still be crating him when we leave, but he's happy in the crate as long as we're gone. What a relief!

He vomited last night so I'll call the vet and see if we can stop the carprofen. It's about time to check and see how he's doing off of it, anyway.

Because he's calmer, he didn't try to run around outside this morning. It is an ex-pen type enclosure so I was able to move it to a space that's maybe a little more than five feet.

Hello!

Kerby continues to do pretty well in the pack n play. Unfortunately he scratched off his Fentanyl patch last night (1/16) at around 6 and I supervised him through the evening to look for signs of pain. No signs of pain at all, thankfully, but he did wake up panting at 2:30 and I was about to leave for the ER vet when I noticed an "interesting" smell...turns out that he had diarrhea and instead of barking at me like he usually does when he needs to go out, he decided to keep quiet about it. He had diarrhea and when I brought him back in, he stopped panting and fell right asleep. He hasn't had any issues since last night and is resting comfortably.

He's still on the Pepcid, Carprofen and Gabapentin as well as Trazodone just in the mornings and I have been splitting his chicken and rice meals into four a day so as not to bombard his stomach. (I've also been giving him the "afternoon meals" in the Kong so it gives him a little something to do)! 

Quick question - is it better to wait outside in the pen with a dog who hasn't pooped all day, or take him out multiple times after waiting for a while for him to eliminate? Kerby hasn't pooped today at all but I feel like keeping him outside on all fours for longer than 5-10 minutes is a worse idea than letting him relax in his playpen and taking him out a few extra times a day. Thoughts please?

Also, this is probably a silly question...but now that he isn't stressed out and going wild trying to bark, cry, and paw his way out of his enclosure anymore, he's pretty drowsy and droopy all day. This is more what he's supposed to be like on the Gabapentin, Carprofen, and Trazodone - correct? He's fine when we go outside and still gets excited when a new person walks into the house. He's just more out of it . A huge change from the past week, which is a relief but every little thing worries me now.

I'm sorry if I'm asking too many questions or being paranoid. I just can't relax - nothing feels right or normal about this, even though he really seems to be doing well. Once burned and twice shy after last year's emergency surgery, I suppose. 

Laura, the pain meds can cause a bit of sedation and sleepiness. Not a bad side effect to help Kerby be able to relax in his suite.  As long as he CAN take footsteps and is not overly sedated to not know what's gong on in his world, he is fine.

So at potty time, if he doesn't go potty (poop or pee) in 1-2 mins, pick him up and back to his suite.  Try again in another hour or so.

I like Julie's idea of giving some high fiber water absorbing food like plain canned pumpkin puree to relieve constipation.  Kerby is a bigger boy than our smaller doxies.  Give one teaspoon of pumpkin for every 10 pounds of body weight.  So you can give 2 to 2.5  teaspoons once a day.  Make sure each of his kibble meals have been soaked in broth or water. Also that, as you have been doing, providing water attached inside his suite to lap up as he desires.
     NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.

I am very glad that Kerby is doing so well.

Try not to think of his crate rest as a sentence or jail time.  Try to think of it more like a retreat.  A kind of place where one goes to rest and recover.  I know from experience that this is easier said than done but when I began to think of Frankie's crate rest this way I felt more positive about it and I think Frankie felt my change in attitude.

One thing I did with Frankie to help keep his mind stimulated was a sort of shell game where I hid a treat under a cup and he had to pick the right cup to get the treat.  This game does not require much movement on his part and I played it with him in an ex-pen.  I still play this game with him even though crate rest was over years ago. 

Laura, graduation day is just around the corner on March 9th. Then you will begin a gradual increase in physical activity over the course of several months. The idea is to gradually give more freedom under controlled conditions. Not free reign of the house and yard immediately! Take a look at the suggested schedule and discuss with your vet. www.dodgerslist.com/literature/AfterCrateRest.htm

Is your home prepared to be back friendly as possible? Make home modifications so that you can reduce the stress on the spine in the future. No more stairs, ramps up to furniture, or blocking furniture all together. All those ideas and more are in this link: www.dodgerslist.com/literature/protectback.htm


Do keep us posted on how things are going post conservative crate rest.  It will be wonderful inspiration to let those just starting the IVDD journey that there is life after crate rest.

I've been using folding fireplace screens to block off my couch.

Easy to move and keeps my couch off limits.