Tina's Paco 3/3 Conservative NECK?

Welcome to Dodgerslist, Tina. 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.

Paco’s pain needs to be brought completely under control today. Have no patience with pain as it does hinder healing. Pain should be completely under control with no sign of pain from one dose of meds to the next. Please speak to the vet this morning about adjusting Paco’s pain meds.

Both Methocarbamol and Gabapentin have short half lives and work most efficiently when given 3x/day (every 8 hours). Please advocate strongly for the vet to increase both meds to 3x/day.

We usually see dogs of Paco’s weight taking 5mg of Pepcid AC 30 mins. before the Prednisone and then every 12 hours thereafter for as long as they’re on the Prednisone. What dosage is Paco taking at bedtime?

We are not vets and do not know the specifics of each dog's health. We are making these suggestions based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet.

For how many days will Paco be on the Prednisone before a taper starts?  What instructions has the vet given you regarding the stopping or tapering of pain meds when the taper of Prednisone starts?

Please let us have a bit more clarification on your potty setup. Are you letting Paco pee and poop in one crate and then moving him to a clean crate? You mentioned that he pulls himself up to poo but do you also see him squat to pee? Or are you just finding wet bedding? Unless you see him deliberately squat and pee, it would be difficult to determine whether he still has bladder control or whether his bladder is overflowing. Allowing the bladder to overflow is not healthy for the bladder. If Paco does not have bladder control, he needs to have his bladder manually expressed. Unless you see him deliberately squat and release urine, you should do a sniff and pee test. Carry Paco to a spot where he or another dog has peed before, support his hind end but not under his belly, let him sniff and see if he can release urine. If he can, then he has bladder control. If not, you’ll need to learn how to express his bladder.

Neuropathic pain not common but you should be aware of it. This kind of pain is abnormal, phantom pain sensations with severe spinal cord damage. Signs are obsessive licking of paw, leg, genitals, tail. Escalates to biting, life-threatening chewing off parts. Immediately put on an e-collar (or lengthwise folded towel around neck and duct taped closed) to prevent access to lower body. Contact vet immediately for Gabapentin or stronger Lyrica (pregabalin) for neuropathic pain. More info: www.dodgerslist.com/literature/neuropathy.pdf

Can Paco move his legs at all? Or wag his tail when spoken to in a happy voice or when given a treat?

With severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering.
CAUTIONS: ~~ Laser light therapy is contra-indicated with tumors which are detected via x-ray.
~~ During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back can increase a disc tear and escape of disc material into the spinal cord . For an animal with very mild neuro deficits, the risk of transporting to therapy has to be carefully weighed against what benefit is to be gained. www.ahvma.org/find-a-holistic-veterinarian/
~~ Why Chiropractic is not recommended for IVDD dogs: www.dodgerslist.com/literature/chiropractic.htm

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

Tina, you need to be speaking with your vet asap this am to report you current observations with accurate dates and observations.

No if's and but's  VERY strongly advocate to get the max anagesic doses on board PRONTO. Not fare to have a dog in pain when there are meds to provide comfort.   WARNING: It is the vet's job to prescribe a change in dose, not yours.  Your job is to be the eyes and ears for the vet at your house and to advocate for what Paco needs.
--- methocarbamol 125 mgs every 8 hrs
--- gabapentin dose that would be administered every 8 hrs.
--- amantidine  is something we are seeing neuros Rx as part of the pain med cocktail as it allows other analgesics to function more effectively.  The Mar Vista vets explain the mysteries of amantadine www.marvistavet.com/amantadine.pml Basically when stressed as our dogs are with a disc episode they may be more susceptible to physical pain. Muscle spasms hurt worse, everything hurts more. Amantadine alone is not an effective analgesic but when combined with the other IVDD pain relievers (methocarbamol for muscle spasms, gabapentin for nerve pain and tramadol as the general

QUESTIONS
- After the strongest of med doses/frequency are on board this am— is pain still not in control within 60 mins and stays that way dose to dose?
- Does he have a fever (normal rectal temperature is 100.5 to 102.5 degrees Fahrenheit)?
- Is there any loss of voice or a horse bark?
- Is there increased respiration/ labored breathing (short, open-mouthed, abdominal breaths)?
       The above signs are indicators of another disease on top of a disc episode. This disease is called Myelomalacia.  I don't want to scare you but I do want to make you aware www.dodgerslist.com/literature/Myelomalacia.pdf It is important that owners are familiar with symptoms in order to promptly get their vet's help at any hour of the night or day.
     With Myelomalacia, what happens basically is that the spinal cord starts to die from the point of the spinal cord trauma moving forward toward the head. It can happen fast. It is a very painful ending.. making a dog unable to breathe.
      Deep pain sensation or leg function not returning right away alone are not a symptoms of myelomalacia. The cause of M or how it progresses is still unknown. I'm hoping and praying that Paco is not developing Myelomalacia and is just having a hard time getting pain under control due to inadequate pain meds. Do discuss Myelomalacia with the vet.


On Sat 3/2, back legs paralyzed; vet thought to be in back only and NO indication of this being a neck disc
                indicators of 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
◻︎ holds head high or nose to the ground

On Tues 3/5, increased pain of moving upwars to the NECK (head held high).

Today 3/8, increased neuro diminishment affecting front legs to push up to sit up. 

Pain has NOT been in full control since 3/2, not all pain meds have been Rx'd for every 8 hrs.

Please let us know how Paco is doing when you can. I sincerely hope that changes in the pain meds will relieve Paco's pain.

Tina, you need to be prepared an ANY hour of the night to get to ER if necessary. The full information about Myelomalacia is below.

Not all vets have seen Myelomalacia because it is not so common. So print out this list of symptoms below to discuss with the ER vet if necessary in the wee hours of the morning.  

With Myelomalacia, what happens basically is that the spinal cord starts to die from the point of the spinal cord trauma moving forward toward the head. It can happen fast, within hours. It is a very painful ending.. making a dog unable to breathe.

There is no cure for Myelomalacia and it is fatal. Should a dog be developing myelomalacia, before there is difficulty breathing, you would want to help to cross to the rainbow bridge to spare a very painful death.

I'm hoping and praying that your dog is not developing Myelomalacia and once the adjustments to provide strongest of meds  are all on board will get the pain in control.

Symptoms of Myelomalacia:
* about 3-4 days into recovery, they become painful.   Within the first week, they are in a LOT of pain.  
* acute disc extrusion with no deep pain sensation
* development of excruciating pain (more than just pain from the original disc herniation)
• hyper-esthesia (over-reaction to any touch sensation on body)
• even the strongest pain meds do not help
* loss of anal tone, the anus hangs open, (anal flaccidity) and areflexia (below normal or no reflexes)
* neurologic deficits that localize to more than one neuroanatomical section of spinal cord (e.g. T3-L3 myelopathy and an L4-S3 myelopathy)
* loss of cutaneous trunci reflex at a level more cranial to a previous evaluation over a period of hours to days with or w/o surgery
* development of fever (normal rectal temperature is 100.5 to 102.5 degrees Fahrenheit)
* sudden twitching or jerking of the neck and/or head
* loss of voice, horse bark
* Front legs can't hold body up, can't hold head up
* increased respiration/ labored breathing as the nerves to the lungs begin to shutdown

I'm hoping and praying that M is not developing.  Will be thinking of you tonight and hope in the morning you have good news.

I'm so very sorry to hear this, Tina. My sincerest condolences to you on your tragic loss. Please know that there was nothing you could have done to prevent Myelomalacia from happening. It's a terrible disease and I'm so sorry that it developed with Paco. My prayers are with you.

Tina, I am so, so sorry. You cared for Paco in such a loving way... surely he did sense how much you loved him. The gift you gave was one of the most difficult, but kindest to spare him a painful ending.  Myemalacia is not anyones fault.

As you continue life’s journey you will come to see all the gifts Paco left for you. All the wonderful days of happiness, all the doors of opportunity he opened for you to meet people, all the quiet peaceful times you spent together. Now he lives in your heart forever. May he soon bring you smiles again, as you think back on all his funny antics and all the years of joy. 

The pain of losing a loved one is great and deserves your attention and time to process.  Maybe what Carmen, one of our members, has written about the grieving process will help you, too.    www.dodgerslist.com/literature/grief.pdf 

Warmest of ((hugs)) and my sincere condolences.