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Post by Romy & Frankie on Feb 12, 2019 15:34:54 GMT -7
Dodgerslist supports a full 8 weeks of crate rest for dogs being treated conservatively. We use the analogy of a cast on a broken arm. The cast is used to immobilize the arm while the bone heals. We cannot use a cast on the spine, so we use the crate as the best way to immobilize the spine and allow the disc to heal. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.
During crate rest there may be some muscle loss, but muscle will quickly be regained when the crate rest is over and the dog returns to regular activity. If there is too much movement during the crate rest period while the disc is stabilizing more disc material may push against the spinal cord and lead to additional nerve damage. Nerves heal very slowly when damaged. This short video shows how this damage can occur.
There will be plenty of time for short walks when the crate rest period is over. For now, the safest thing for Kallie is to remain in her recovery suite.
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Post by Karleigh & Kallie on Feb 12, 2019 16:07:56 GMT -7
Ok I will keep her resting. I think the vets feedback is based on having little experience with IVDD. Kallie is slim for her frame as it is so the vet said any amount of weight loss is worrisome. She’s still eating well so I’ll try not to worry much about weight loss from muscle.
She’s made so much progress in such a short time as it is so I rather play it safe and keep her resting.
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Post by Julie & Perry on Feb 12, 2019 17:15:09 GMT -7
If you like your vet and they are willing to learn about IVDD, there's free literature available at the main website.
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Post by Karleigh & Kallie on Feb 14, 2019 14:36:46 GMT -7
Just an update: today, things took a bit of a turn. She was doing welll, but when I came home today, she was clearly in pain and the walk was worse. I don’t know what happened.
[Moderator's note: please do not modify 12 lbs Prednisone as of 2/5: 2.5mgs 2x/day for 5 days, then SUN 2/10 taper test √ 2/14 pain/ √ 2/14 neuro issues methocarbamol 125mgs 2x/day; stopped 2/10 gabapentin 50mgs 3x/day; stopped 2/10 Pepcid AC 5mgs 2x/day]
My vet is closed now but tomorrow I’m asking to get back on the full dose of prednisone and more pain meds. I’m also going to ask for a sedative for when I’m not home because her anxiety is keeping her moving when I’m not home so I need something to keep her down when I’m gone.
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Post by Romy & Frankie on Feb 14, 2019 14:58:38 GMT -7
I am sorry to hear that Kallie is doing worse today. It is possible that when you were gone she moved too much in her crate and had a setback. Having a sedative for when you are away is a good idea.
It may also be that the pred taper, which started on Sunday revealed that the swelling in the spinal cord still exists and more time on the full dose of pred and pain meds and Pepcid AC is needed.
When you can, let us know what the vet says.
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Post by Karleigh & Kallie on Feb 15, 2019 10:17:02 GMT -7
I called my vet for prescription refills and we are doing another 5 days on the full dosage of prednisone and then 5 days tapered. Refilling methocarbamol and gabapentin [NOT GIVEN Waiting on compounding ] at the same doses as well.
[Moderator's note: please do not modify 12 lbs Prednisone as of 2/5: 2.5mgs 2x/day for 5 days, then SUN 2/10 taper test √ 2/14 pain/ √ 2/14 neuro issues as of 2/15 2.5mgs 2x/day for 5 days then 2/20 taper test for pain/neuro issues Pepcid AC 5mgs 2x/day]
I’d say yesterday her progress went back to where she was on day one with the wobbly walk and pain. She didn’t seem to be worse than when we started this so I’ll just assume the taper is what caused the decline rather than further injury. Maybe she just needs more time.
My vet was against the idea of throwing in another medication for sedation. She said reintroducing the methocarbamol combined with the gabapentin she’s already on should help sedate her.
In addition, I have ordered a small pen for her to help limit the space. Hopefully she is less anxious in this style of rest area than her current crate since it is open at the top.
My vet is getting less and less supportive of conservative treatment. I understand her concern, but I’m being pressured to go to a neurologist and I just can’t afford it. Given that she can still walk, I don’t see them wanting to operate right now anyway so I can’t justify a $250 evaluation and MRI cost.
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Post by Julie & Perry on Feb 15, 2019 10:49:14 GMT -7
Karleigh, I've been where you are. What your vets telling you is he/she isn't comfortable treating IVDD.
Kallie sounds like she just wasn't ready yet to taper.
Many dogs take 2 or 3 times to taper off. It's just a matter of the swelling being down. That can take time. Kallie shouldn't be in pain. Is she still taking gabapentin and tramadol? They work together for pain control. The Prednisone is for the swelling and methocarbomal is for the muscle spasms.
Don't get pressured into seeing a neurologist unless you want to. MRI's are only needed before surgery.
I would start looking around for a vet who's comfortable treating an IVDD dog.
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Post by Karleigh & Kallie on Feb 15, 2019 12:02:41 GMT -7
She had her usual prednisone last night and this morning I reintroduced the second dose to bring her to the full dosage and it's been a few hours and it's already a clear improvement. I am fully convinced it was too early of a taper. I can't pick up her pain meds until the gabapentin is compounded to a liquid, so she won't have [pain meds] them until tomorrow [SAT 2/16] , but even just with the increased prednisone she doesn't seem to be in any pain right now and is trying to walk. The reduced swelling must be enough to relieve most of the pain.
I am forwarding her medical records to a different vet for a consultation. This vet offers traditional vet services as well as holistic therapies like cold laser and acupuncture, which I have heard great things about for IVDD dogs. I can't get in for a week, but I hope this is a better option for us.
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Post by Romy & Frankie on Feb 15, 2019 14:50:41 GMT -7
I am very glad to hear that Kallie is feeling better now that she is back on the full dose of pred. It is not uncommon for dogs to have to taper several times before all the swelling is gone. For how long will she be on the full dose before another taper is tried?
If you are do not have confidence that your current vet is IVDD knowledgeable, you are right in looking for another vet. Cold laser and acupuncture can be helpful to an IVDD dog. Many acupuncture vets will make home visits. This way you can avoid the risk of transporting Kallie for treatment.
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Post by Karleigh & Kallie on Feb 15, 2019 16:02:26 GMT -7
They gave me another 5 days pred at the full dose and 5 days taper. I'm glad to hear multiple tapers is common, good to know there is a possibility of her still recovering even though this taper failed.
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Post by Karleigh & Kallie on Feb 18, 2019 14:10:01 GMT -7
Just an update now that it’s been a few days with Kallie back on the full dose. She is doing very well. No signs of pain. Walk is still wobbly, but seems to be improving. She’s getting a bit more ballsy and trying to run when she goes out to potty (I don’t let her). Her walk looks pretty good, some minor crossing but no dragging. The only time it’s really noticible is when she’s squatting to pee or poop because she seems to really struggle balancing herself and she sometimes falls.
She is scratching her ears with her back legs more the past day or so. When she first went down she wasn’t able to really do that at all so hopefully it’s a good sign.
I ditched my previous crate that she wasn’t doing well in in favor of a small pen which she seems to prefer, though not by much.
We try tapering again on 2/20 so hopefully she doesn’t decline like she did the first time we tried to taper.
They gave me another 5 days pred at the full dose and 5 days taper. I'm glad to hear multiple tapers is common, good to know there is a possibility of her still recovering even though this taper failed.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 18, 2019 16:20:41 GMT -7
Karleigh, good news all around about pain in control an improvements with neuro function. The first prednisone was a short 5-day course. Some dogs can get the swelling down in such a short time but most dogs will need somewhere in the neighborhood of 7 days to even up to 30 days. All taper doses, of course, can not be counted as the dose is too low to work on swelling. It is all guesswork as to how many days it will take. So that is the reason for a vet to call for a course and then a taper to find out how things are going. At potty time are you using a sling to make sure there is no chance that Kalie will fall down anymore. As she is going potty the sling is just there, slacked off bit, so you are at the ready if you see her start to get off balance you can stop a fall, a twisting of the back. An ACE bandage, long winter scarf, a belt can make a good sling. With her feeling better and want to run, make sure you either have a harness on her to control speed or are using an ex-pen outdoors so she understands with the physical and the visibility of the fence there will be no running or darting off.Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep your dog's back aligned and butt from tipping over. A harness and 6 foot leash will 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!
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Post by Karleigh & Kallie on Feb 19, 2019 12:03:23 GMT -7
Not sure if this is a good or bad sign but she is chewing on her back feet. They are clearly bothering her. She can still walk and nothing has gotten worse neurologically. She never lost pain perception. In fact, she was doing better righting her paws when flipped over too. I was pretty sure she was doing better neurologically, but yesterday she was really going at her feet. Is this a good sign? Bad sign?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 19, 2019 12:12:11 GMT -7
Karleigh, please contact your vet right away in case this might be neuropathic pain. Gabapentin is a med not only used for nerve pain but also for phantom nerve pain (neuropathic pain). Everyone has experienced numbness or pins and needles tingling in your legs when sitting in a bad position for too long a time. Your dog can be feeling abnormal nerve sensations that are mild pins and needles to quite painful burning, on-fire feeling that makes them bite to stop the pain. These are abnormal signals explaining why a dog with back leg nerve damage might feel this neuropathic pain. You would need to stay on top of observing for any more signs of chewing on body parts as this can lead to death. Immediately put a e-collar on or a lengthwise folded towel and secured closed with duct tape. Phone your vet and describe what you are observing. Directions + picture: forum.greytalk.com/index.php/topic/220138-create-your-own-surgical-collar/Let us know what your vet tells you on the phone.
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Post by Karleigh & Kallie on Feb 19, 2019 12:15:53 GMT -7
I already put her cone on that I saved from when she was spayed and she is still on ✙gabapentin.
[Moderator's note: please do not modify 12 lbs Prednisone as of 2/5: 2.5mgs 2x/day for 5 days, then SUN 2/10 taper test √ 2/14 pain/ √ 2/14 neuro issues as of 2/15 2.5mgs 2x/day for 5 days then 2/20 taper test for pain/neuro issues ✙gabapentin 50mgs 3x/day (correction, was STOPPED on 2/20) Pepcid AC 5mgs 2x/day]
I just don’t understand what this means. She’s improving standing and walking, why the tingling feet now? Is she getting more feeling back?
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Post by Romy & Frankie on Feb 19, 2019 14:12:30 GMT -7
The neuropathic pain is just an indication that there has been damage to the nerves. It is not that uncommon with IVDD dogs and usually goes away in time. It is important to let the vet know about this. He may want to increase the gabapentin or prescribe the stronger Lyrica (pregabalin) for this type of pain. There is a Dodgers Digest article on neuropathic pain: www.dodgerslist.com/literature/neuropathy.pdf The fact that she is correcting her knuckling more quickly is a sign of improvement and the neuropathy is not a sign that she is getting worse.
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Post by Karleigh & Kallie on Feb 19, 2019 16:50:43 GMT -7
Called my vet. Like you mentioned, she compared it to how we feel after our hand is numb for too long and we start to get sensation back so she seems to think this paired with Kallie’s better walking means she’s just uncomfortable due to a better nerve connection.
Again, she recommended a neurologist for an MRI and better insight, but I had to decline due to cost.
As Kallie wasn’t biting/licking enough to break skin, my vet didn’t recommend changing medication. She said to keep the cone on Kallie when I’m not home and when I’m home to monitor her closely to see if it continues.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 19, 2019 17:47:20 GMT -7
Karleigh, hope the licking does not escalate and maybe is an allergy. One never knows if this phantom pain until something is bitten off. So keep an eye on her. more on what phantom neuropathic pain is. Better to be knowledegable just in case. www.dodgerslist.com/literature/neuropathy.pdfKeep us posted, please
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Post by Karleigh & Kallie on Feb 24, 2019 18:59:48 GMT -7
Just an update: Kallie is doing well so far on this taper. No signs of pain yet. She’s way more energized than she’s been the past few weeks. She is more and more restless and really wants to get moving. She hasn’t chewed on her feet again so she’s no longer in the cone.
The wobbly walk is still there. I understand the nerves can take a bit longner to recover. She has her first acupuncture treatment scheduled for Tuesday morning (2/26) so I’m hoping we will see some improvement on the neurological issues with a few treatments.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 24, 2019 19:17:46 GMT -7
Karleigh, is Kallie still on gabapentin, a med that can mask pain IF it still exists. Is it being backed off by the vet or stopped so that you can have a clear assessment about pain during the test-for-pain prednisone taper?
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Post by Karleigh & Kallie on Feb 24, 2019 19:31:08 GMT -7
She stopped all pain meds with the 2/20 taper
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Post by Karleigh & Kallie on Feb 26, 2019 9:39:06 GMT -7
Today Kallie has her first appointment with her new vet and I feel so relieved to have a vet with more experience with IVDD conservative treatment. She put my mind at ease immediately.
This vet wants a longer taper than just 5 days, so we extended the prednisone taper to 3/1. She’s off her pain meds and not showing any signs of pain so far. I had initially gone into the appointment with acupuncture in mind, however she doesn’t want to start acupuncture until after Kallie is off steroids so we started with cold laser today.
Yesterday, Kallie was able to squat to poop without support!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 26, 2019 9:48:07 GMT -7
Karleigh, can you clarify about the prednisone.
What does "wants a longer taper than just 5 days" mean exactly?
Can you provide a date, mgs and frequency for each Pred dosing stage that finalizes on March 1 the new vet Rx'd?
Feb 26: ?mgs ?x/day for ? days Next date: ? mgs ?x/day for ? days Last date would be the every other day ?mgs dose that finalizes on March 1.
So happy to hear off all pain meds and still no pain surfacing! And very good to about being strong enough to squat on her own!
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Post by Karleigh & Kallie on Feb 26, 2019 10:38:31 GMT -7
Sorry for the confusion.
Kallie was on 2.5mg 2x/day up until 2/20. As of 2/20 she was on 2.5mg 1x/day originally scheduled to end on 2/25. However, my new vet wants a longer taper period - keeping her on 2.5mg 1x/day through 3/1.
Another note that had both me and our new vet deeply concerned is that Kallie lost .6 lbs since beginning crate rest. Given she's so small to begin with, that's a lot of weight loss. She's been eating normally. Her spine is really protruding, but she isn't really bony anywhere else so the vet thinks her back muscles are weakening faster than expected.
She recommended one more week of strict crate rest, but then to start introducing 5 minute walks twice a day, letting her walk around more when we're out to potty (and then back to the crate once inside). She said it will be difficult to measure neurological improvement if her back muscles are inhibiting her from a proper walk. She said usually she would push for 6 weeks strict rest, but .6lbs is 5% of Kallie's body weight and that's a significant amount of weight/muscle to lose.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 26, 2019 18:19:13 GMT -7
Karleigh, it is a dangerous line to take in weighing the risk of not doing crate rest for the still early healing disc vs the benefit to muscles with walking about. IF the early healing disc should re-tear, relapse prior to healing on graduation day of Mar 2, there is danger the spinal cord can be damaged. That damage can range from mild wobbly walking to full loss of legs and loss of bladder control and perhaps permanent paralysis. If muscles atrophy, they will again bulk up when it is safe after graduation day to resume active PT. The assessment of neurological improvement will happen in time, actually mother nature's time. It won't depend on any meds...just time to let the nerves self heal. So what if you are not able to measure how much neuro function has improved? You have no control over that anyway. What you have control over is making sure the disc heals by continue STRICT rest and eliminating the potential to do some real damage to the spinal cord. In my book protection of the spinal cord trumps muscles and knowing if there is neuro improvement. Neuro improvement is not expected during the 8 weeks of crate rest it takes the disc to heal in. Sometimes a dog can improve nerve function, but most often we need to think in terms of months.... not days or weeks for self repairing nerves. Once crate rest has been completed then it will be safe for the conservative treated dog to begin a slow introduction back to activity. Muscles will bulk up again. click to enlarge picture of recently graduated Oswald: Neuro function is monitored for diminishing or going in the improvement direction. 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 cross 3. Nails/toes scuffing floor 4. Paws knuckle under 5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. Tail wagging with joy is lost. 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS for this tricky to identify function. Where do you believe Kallie is on the above list with her back leg function?How about adding some calories of extra kibble to help her regain some weight?
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Post by Julie & Perry on Feb 26, 2019 19:41:44 GMT -7
I've heard about Myos canine supplement that is supposed to help build muscles in dogs with leg weakness.
It's expensive, $80-100 for a two month supply.
I haven't tried it but it might be worth researching it.
That way you could continue crate rest but address muscle wasting.
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Post by Karleigh & Kallie on Feb 27, 2019 15:50:55 GMT -7
I will keep her resting and give her some extra food to see if that helps. I don’t want to risk further injury.
As far as Kallie’s neurological status goes, she’s a 2 on that list. She’s walking, there’s just some crossing, no dragging. She’s improved already from when she first went down.
Now, she’s only crossing her legs when she turns around, but when she’s walking straight ahead, you wouldn’t be able to notice any neurological deficits.
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Post by Romy & Frankie on Feb 27, 2019 16:08:13 GMT -7
I am happy to hear that Kallie's walking has improved. You are right that keeping her crated until graduation is the best way to avoid further injury.
Giving her more kibble may help with her weight. Healthy snacks may also benefit her, but once she returns to activity her muscles will strengthen again.
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Post by Karleigh & Kallie on Mar 4, 2019 13:56:09 GMT -7
Update:
Kallie is totally off all medication and is doing very well.
I have her now on the Vetridisc supplement, 1 capsule a day. I know there isn't firm science behind it, but I have heard good things so I figured it couldn't hurt.
We go back for another laser session tomorrow. Kallie has been slowly improving, but I'm not sure if I can link it to the laser therapy.
Her proprioception test is still slow, her right foot especially, but her walking is pretty good. Her stability when squatting to potty has also improved.
It's been 4 weeks so I'm already pretty happy with progress considering the rest period is only halfway complete.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 4, 2019 14:51:13 GMT -7
Excellent that since March 2 off of all meds and no pain surfacing. Normally there would be 5-7 days fully off all meds before a graduation. So the graduation is now March 6 March 31just a several more days over and above the 8 weeks of crate rest she has already completed. Just want to make sure it is safe to begin a very slow and gradual introduction back to walking, family activity, etc.
Let us know on March 31 that you have seen absolutely no signs of pain resurfacing. We have LOTs to share with you in safely introducing her back to activity and things you can do to make your home back friendly, too!
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