Lisa's Khaleesi 3/1 relap conserve— Terrier mix

Lisa, with a disc episode, there needs to be 8 weeks of STRICT rest for the disc to heal. The legs may not be permanently paralzyed if you begin strict rest now, pronto, immediately.  Your local DVM did not prescribe the single most imporant part of the care--- 100% STRICT crate rest 24/7 only out for a very, very few footsteps at potty time.

AFTER conservative treatment of crate rest and meds, then a wheelchair, then a drag bag. Right now protection of the spinal cord is imperative if you intent ot give your dog every chance possible to self heal her damaged nerves.

Lisa, 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!

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 the details with us:

✦1 Is there still currently pain?
◼︎ shivering-trembling ◼︎ yelping when picked up or moved ◼︎ slow to move ◼︎ tight tense tummy
◼︎ arched back, ears pinned back ◼︎ head held high or nose to the ground.
◼︎ restless, can't find a comfortable position ◼︎ slow or reluctant to move much in crate such as shift positions
◼︎ not their normal perky interested in life selves
+ pain from neck disc:
◼︎ looks up with just eyes and does not move head and neck easily.
◼︎ not eating due to painful chewing or in too much overall pain
◼︎ holds front or back leg flamingo style not wanting to bear weight
Full pain relief is expected in 1 hour and stays that way dose to dose, round the clock. If not in control your vet needs to know asap to adjust meds.

✦2 MED LIST
How much does your dog weigh?
A.. Please list the exact names of meds currently given, their doses in mg’s and times per day given.

B.. anti-inflammatory?
Steroid....what was the start dose of Monday Feb 18?

C. The reason for the GI tract damage is your vet did not prescribe Pepcid AC on Feb 18!  Please get Pepcid on board until the last dose of pred is given.
     Please include the all important stomach protector such as Pepcid AC (famotidine) when taking any anti-inflammatory med (steroid or NSAID). We follow vets who are proactive against not eating, vomit, diarrhea, bleeding ulcers by giving doxie weight dogs 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory.



✦3 GI track damage as of now, today?
—Eating and drinking OK? No nausea/not eating, no vomit?
—Poops OK? Normal firmness & color -no dark black blood of bleeding ulcers nor bright red blood ? No diarrhea?

✦4 What did the specialist surgeon (ACVIM neurology or ACVS ortho) say about an operation?
    -- Did the surgeon say it was intervertebral disc disease: two treatments conservative or surgery.
    -- Degenerative mmyelopathyylopathy mentioned on Dodgerlist FB page is not addressed by surgery. AND usually found in German Shepherds not terriers.


Super tried and true tips for setting up the recovery suite:
www.dodgerslist.com/literature/CrateRRP.htm

STRICT rest means ( www.dodgerslist.com/literature/healingdisc.htm ):
◼︎ no laps ◼︎ no couches ◼︎ no baths ◼︎ no sleeping with you
◼︎ no chiro therapy "whys" --> www.dodgerslist.com/literature/chiropractic.htm
◼︎ no dragging at potty times.

CONSERVATIVE: The hallmark component of conservative treatment is the crate rest part. 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 back movement to allow good strong disc scar tissue to form. PT waits til graduation day. LASER or ACUPUNCTURE for severe neuro damage is best at home via a mobile vet. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment during conservative treatment.

✦7 Tell us about current neuro functions as of today
A. can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk?
B. Can your dog specifically sniff and squat and then release urine which is bladder control - OR- do you find wet bedding or leaks on you when lifted which are indication of an overflowing bladder and loss of control?

LOSS of BLADDER CONTROL
How are you doing with expressing. Staying dry session to session?
If there is no bladder control, you would be expressing every 2-3 hours depending if still on pred. Do not hesitate to express in the vet’s clinic and have the vet tech check your work, give you additional pointers. It may take a weeks worth of expressing to reach “pro level.” Doesn’t hurt to re-review the tips and video on expressing to keep your dog dry session to expressing session: www.dodgerslist.com/literature/Expressing.htm Express for poop, not the health issue urine is but to prevent anxiety of your dog finding poop where he sleeps.

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.  Your education/knowledge is to protect your dog from those who are not IVDD knowlegable and be able to say no thanks to maybe well intentioned but harmful advise.

You will be amazed with yourself on how well IVDD educated you can become in a such a short time!  Follow the buttons that pertain to the now and the rest of the colored buttons in the next days to become the IVDD savvy pet parent your dog will need.  www.dodgerslist.com/healingindex.htm

I'm so sorry your Khaleesi endured more than she should have with this disc episode. Now that you are aware not all vets can know every disease, but YOU CAN— you will be better able to protect her now during the 8 weeks of crate rest and for many,  many happy years together living with IVDD.

She was on pred for 9 days, so maybe there is a chance that pred could have done its job of resolving all painful swelling.  ONLY when the pain meds  have been stopped would you know for sure or whether another course of pred is needed.

With both sucralfate and Pepcid AC on board that allows many dogs to continue with pred IF it is needed to get all of the painful swelling around the spinal cord resolved.  Did the neuro say when he wants to test to see if all the painful swelling is gone by backing off of gabapentin and stoping  methocarbamol?  Let us know.

DISC REPAIR
The disc demands there be limited movement of the bony vertebrae in order to heal. So as of today you have her inside of a recovery suite to ensure there will be no more tearing of the weak and still early healing disc scar tissue?  Let us know you have implemented the SINGLE MOST important care to protect the disc and prevent permanent nerve damage with crate rest.

NERVE REPAIR
During the short 8 weeks it takes for the disc to heal, you may or may not see nerve healing happen that fast. Often we  need to think in terms of months rather than days/weeks for this slowest part of the body to heal. So our motto is Stay stay strong and positive and never give up hope! 

HOPE is in the cards for each dog to get back to enjoying life after crate rest.
EMERGENCY CRATE TRAINING
  check out our page to see what you can implement to help her be able to relax in her recovery suite for the next 8 weeks.  Usually it will take TWO calmers and if not then speak with your vet about a stronger sedative.  Better a slightly drugged dog, than being too rambunctious and moving  her back/spine too much for the health of the healing disc.  Here is the link  www.dodgerslist.com/literature/EmergencyCrate%20Training.htm

QuESTIONS
-- Does she stay dry expressing session to session? No leaking on you when lifted and no urine leaks in bedding?
-- The reason to know if all painful swelling is really gone by the stop of pain masking pain meds is so you can start some least aggressive massage and ROM.  BUT ONLY if off of all meds and there is no pain showing. Let us know when you have proof and we can share the proper way for very, very light things to keep the legs in shape while waiting on nerve repair during the rest of the 8 weeks of rest.

Lisa, sounds like you have a good handle on expressing in that she is not leaking at all in between expressing sessions. Good Job! Know that you can express for poop so that Khaleesi would not suffer anxiety about finding poop where she sleeps. Simple to do, just watch the video to become a pro. Here is the webpage with tips on timing and the video: www.dodgerslist.com/literature/Expressing.htm#poop

DEEP PAIN SENSATION
Having no deep pain sensation (DPS) neuro function may not be a permanent thing.  The body CAN self heal nerves enough to bring back DPS at some point.  Then having DPS bodes quite well for even more nerve function to take place over time!!  While you would only take the word of a neuro about the tricky to identify DPS, the happy tail wag is something that no one can mistake.  Check byletter her hear some happy talk from you or letting her see/smell a yummy treat (all head level activities) and then observe if a message could travel down the spinal cord to the tail for a happy wag, even a weak happy wag would be very good!!  Let us know what you observe from time to time.  Again nerves can be very slow to heal and not really expected during the short time of 8 weeks for the disc to heal in.

VET Visits
Any time out of the crate is a dangerous time for a dog going through an IVDD disc episode. Transport to a vet is risky as there is a chance of too much movement of the spine pushing on the early healing disc. Most vets who understand how strict the crate rest must be will understand that it's too much of a risk to bring the dog in to the office for a follow-up exam. You can call to givestatus updates on pain and neuro function.  Ask that phone consults be done instead.  Vet visits should be kept to the only urgently needed ones that simply can not be handled over the phone.
      Vets usually estimate when they want the Prednisone to start to taper (lessen the dosage  below the anti-inflammatory level) and at that time, they also stop the pain meds so a test for pain can be made by your observing for any hint of pain resurfacing.
     If there would still be pain when the taper is scheduled to start, then it wouldn't be time to taper as there is still swelling, still pain. Do contact your vet with phone updates about pain so he knows if meds need to be adjusted. As you know, there may or may not be nerve function improvements in the short time of 8 weeks dedicated to healing the disc. Nerves can take months to heal and they self heal, meds do not help nerves to heal.
     With urgent vet visits, secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels on either side of the dog to prevent movement or jarring the spine when braking or turning corners.

MONITORING for REPAIRED NERVES
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 lost ID'd on 2/26 by neuro, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.  
       A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservative

PROOF that all painful swelling near the spinal cord is gone
-- There will be no proof until the vet tells you to either back off gabapentin, stop methocarbamol. Then you will observe with no meds on board whether pain re-surfaces. Pain the resurfaces indicated a need for Pred to be back on board as well as all pain meds for a bit longer, then another test for pain taper.
-- The benefit of finding out soonest if all swelling is really gone, is to be able to begin some very, very light range of motion and massage to the legs to keep them in shape during conservative treatment of limited movement of the back/neck.  We'll be able to share how to do when there is proof all pain is really gone.
-- It appears, then your surgeon will seek that proof in two weeks on Mar 12.  See if you can get a phone consult to report you are not seeing any signs of pain with pain-masking pain meds on board nearing Mar 12. Inquire when can you back off of stop the pain-masking meds to get real proof? Those are things that can be handled via a phone call eliminating a risky to the healing disc transport.