Lori's Rocky 7/4 Conservative

Welcome to Dodgerslist, Lori. 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.

**Disc disease is not a death sentence! ** Struggling with quality of life questions? Re-think things: www.dodgerslist.com/index/SDUNCANquality.htm

Three emergent things that must be dealt with ASAP:

Please immediately crate Rocky to protect his spine from further damage. Movement of the spine must be limited as much as possible. More on strict crate rest below.  It's imperative that he be crated.  Think of the crate as a cast for the spine.

Not wanting to move is a sign of pain.  You need to speak to the vet or emergency room vet ASAP this morning about any sign of pain that you're seeing. Have no patience with pain as it does hinder healing. ☐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.

Not knowing the dosages of the meds currently prescribed, I can't say if the dosages can be increased or not.  Gabapentin works on nerve pain and can be added to the mix.

Not wanting to eat is a red-flag sign of GI distress. No stomach protection has been prescribed. Please speak to the vet or the ER vet ASAP this morning about getting stomach protection on board. Anytime a dog is taking an anti-inflammatory, stomach protection must be added. 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

Some reading after you take care of the emergent matters above about when surgery should be a consideration:  www.dodgerslist.com/literature/healingsurgery.htm

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
…A Please list the exact names of meds currently given, their doses in mgs and times per day given.  What was the name of the pain injection given and was it a long-lasting injection?
…B For how many days is the Meloxicam prescribed for?

❖2 No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?

❖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 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 bladder control?
Overflowing bladders need to be expressed to avoid UTIs. Review video then get a hands-on-top-of-your-hands expressing lesson. www.dodgerslist.com/literature/Expressing.htm

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 Currently can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk?

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

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

Lorie, Rocky is very likely showing you red flag signs of early GI tract damage due to Meloxicam and not having any GI protector on board.  SIGNS:  lip licking, nausea, √not wanting to eat, √vomit, loose stool,  bleeding ulcers, black or red blood in diarehea, deadly perforated stomach lining.

Please read and see if you believe Rocky has no health issues. If no issues I would highly consider getting Pepcid AC on board now (purchase at the grocery store). Keep your vet in the loop as soon as he reopens.

The usual dose during a disc episode is Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the Meloxicam and thereafter every 12 hours.   So for a 16 pound dog that would be 5mgs every 12 hours.
Give the anti-inflammatory with a meal as added protection. 


QUESTIONS
  It is good to have the Rx include a range of frequencies for dosing.  What we need to know is what do you actually dose at.
  -- Methocarbamol 125mghs every 8 or every 12 hrs?
  -- Tramadol 25mgs every 8 or every 12 hrs.?
   -- Meloxicam injectable.  for how many days are you to give the injection?

PILLING
Put the pill into the well of a small mashed banana ball, a cream cheese ball, liverwurst ball, Gerber Lil' meat sticks, or inside of a sticky small marshmallow and sealed completely so no taste is on the exterior.
    Use the three treat method. Prepare 2 treats with no meds inside PLUS the med ball. Give plain treat while holding med ball in front of eyes. The idea is your dog will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so she will hurry to swallow the med ball to get to treat #3.
    NOTE: Tramadol is very bitter. Make sure you have washed your hands after splitting pills so as not to transfer Tramadol dust onto the pill treat.  

Excellent technique for cases where you need to pill him

Not eating normally is a sign of G.I. tract damage. Do you have Pepcid AC on board yet?

Reluctant to turn on his side May indicate he is in some discomfort. Meaning his pain meds would need adjustment.

QUESTIONS
It is good to have the Rx include a range of frequencies for dosing. What we need to know is what do you actually dose at.
-- Methocarbamol 125mghs every 8 or every 12 hrs?
-- Tramadol 25mgs every 8 or every 12 hrs.?
-- Meloxicam injectable. for how many days are you to give the injection?

Lorrie, the pain meds when for a disc episode are never as needed. This diease is known to be a painful one. So IVDD knowledgeable owners and vets act like it is by using an aggressive pain med approach and that is promplty on time every 8 hrs to prevent any hint of pain surfacing.
--- Tramadol at 25mgs 2x/day for a 16 pound dog is like not giving it at all!
--- methocarbamol to prevent the pain of muscle contractions works for round the clock pain, dose to right up the next dose when given promptly on time every 8 hrs.
--- Pepcid AC. The is idea is NOT to have in on hand in case you needed, but rather to be proactive so that Rockey never suffers GI tract damage.  He has enough to deal with this disc episode and doesn need bleeding ulcer on top.  Rocky is showing you very, very likely alread RED FLAG signs his GI tract is incurring damage.  Please let us know you have started 5mgs Pepcic AC promptly every 12 hrs.

You ARE describing pain for Rocky.
--- not eating well can be do to pain as it can be due to the damage melocam and stress can do to the GI tract.


The veterinarians at Best Friends Veterinary Center give a good explanation about complicated topic on pain:

The time to stop pain meds is when Meloxicam Rx ends.  Until then act like this is a painful disease by giving meds on time.

We are kinda left in the dark about Rocky's meds.  Could you kindly fill us in on this very important information abou his meds:

QUESTIONS
It is good to have the Rx include a range of frequencies for dosing. What we need to know is what do you actually dose at.promptly and on time every 8 or every 12 hrs?
-- Tramadol 25mgs every 8 or every 12 hrs.?
-- Meloxicam injectable. for how many days are you to give the injection?

Very glad to hear that Pepcid AC has now been added. Hopefully that will get him back to eating his regular kibble soon.

A few pain yelps is far too many pain yelps. Please let us know what the vets says after speaking to her this morning. And please let us know whether you're giving the pain meds every 8 hours.

Meds can cause constipation. Pumpkin can help with that. To loosen the stool, add equal parts water to each kibble meal along with 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.

Lorie, would you be able to look at the Meloxicam injectable bottle to get us some very important information?

---

                    IMPORTANT information we need to best help you and Rocky
1) How many days total are the Meloxicam injections Rx'd for?  

2) Can you confirm about the Pepcid AC.   Are you now dosing Pepcid AC 5mgs every 12 hours (twice a day)?

---

Rocky has a lot of healing to do.  Hot dogs are quite high in fat and not a good diet, can mess with his system, maybe related to the gas.  He really needs to get transistioned back on to his normal kibble diet. The kibble is well balanced in vitamins, minerals and protein in the right formula to help with all the healing jobs his body is trying to do.

To encourage kibble eating, you might sprinkle a teaspoon of boiled (to defat hamburger) on top.  Defat the broth so it can be used on his kibble to make things more tasty.

Very glad to hear you now have Rocky's disc in a safe healing environment (his crate)!  Good job.

Please do let the vet know that you're giving the Pepcid AC as a vet should always be kept in the loop about what a dog is taking. You'll have to check with her about giving the Trifexis.

I'd be very hesitant about trying to move the pain meds from 8 hours to 9 or 10 hours. Pain meds should be given consistently every 8 hours to keep pain consistently under control. Pain should not be allowed to rise up as it will be more difficult than to get it back under control. There will be pain until the swelling pressing on the nerves resolves, which can take 7-30 days. Usually a vet will stop or taper the pain meds when the Meloxicam is stopped to test for pain/swelling. If there is still pain, that means there is still swelling and still a need for all meds. If there is no pain, there is no swelling and all meds are stopped.

Dogs are very good at hiding pain and IVDD is very painful. Therefore, it should be treated with aggressive, consistent pain meds to keep the pain completely under control from one dose of pain meds to the next.

Dr. Petty, DVM, CVPP, CVMA, CAAPM, CCRT is the current president of the International Veterinary Academy of Pain Management and is a frequent lecturer at local, state and national conventions.
"If pain is not controlled, it poses a huge threat to the well-being of a dog, as excessive pain often interferes with normal life functions. Even the most basic life requirement of eating, drinking and elimination can becomes difficult or impossible to perform... There is a pain medication or modality (procedure) for every dog, no matter what the health issues. Even severely debilitated dogs with major organ failure have pain relief options. Drugs are metabolized and excreted by different organs, and the knowledgeable veterinarian can tailor a pain-control program based on each dog's needs and condition.
After a lifetime of observing them, I have come to believe that most dogs look ahead only as far as the next event in their lives—when their owner comes home, when the next meal might be...." Dr. Petty goes on say that people understand there is hope in getting pain control and will seek 2nd and 3rd opinions to get help. Without dogs being able to understand there is hope the pain will stop..."Does it make them feel, sad desperate...Does it make every day another round of hell they have to bear?....This is why I agree dogs don't feel pain like us—for them, it is much, much worse."
Petty, DVM, Michael. Dr. Petty's pain relief for dogs: the complete medical and integrative guide to treatment pain. The Countryman Press, 2016.
pp 11-14 www.amazon.com/Dr-Pettys-Pain-Relief-Dogs/dp/158157309X

Do you know what the vet meant when she said "this" would take 4-6 weeks at a minimum? Strict crate rest needs to be done for a full 8 weeks to allow the damaged disc to completely heal and form secure scar tissue. If she meant giving the meds, as mentioned it usually takes 7-30 days for the swelling to resolve and once the swelling resolves, there is no longer any need for meds.

Lorie, thank you so much for giving specfic detail on his meds. This way you allow us to follow along and be at the ready to make good informed comments. Thanks so much.


Part of giving good protection to the healing disc is to make sure you are feeding Rocky inside of his recovery suite. So he would not leave his suite until it is for potty time.
    And then the protection when outside of the suite, would be a leash and harness to keep him from darting or taking too many footsteps. I found for my dog that a 6 foot diameter enclosed circle of an ex-pen in the grass or on my deck with snow was much easier for me than using a harness and leash.



Here is a DIY  way to attach water and feeding bowls to the inside of his recovery suite. Attached at head height so Rocky need not bend  his head down too much and also to prevent him tipping the bowls over as he repositions himself in the suite from time to time.



You live in the South or where there are now mosquitoes.  Trifexis is a 3 in one tab.  One of the ingredients is to prevent heartworms which can happen when an infected mosquito would bite Rocky. So if you live in the South, it would not be wise to stop Trifexis— do talk it over with your vet just to make sure.

I do hope that the vet won't have to examine Rocky in order to prescribe something for this rash, Lori. Possibly you could take a photo of the rash that you could email to her. You'd have to check with her as to contraindications of the meds and an antibiotic. We don't see rashes as a side effect of the IVDD meds. Check with the vet to see if he could take some Benadryl to help with the itching - that can calm them, too. Bayer's A+D® Original Ointment and Aquaphor Baby or Aquaphor regular Healing Ointment does not contain zinc, which is poisonous to dogs, and works well on rashes.

Is there any chance that he could be getting urine on his belly? Do you find that he leaks when picked up or are you finding any wet bedding at all? Urine can cause a rash.

Please let us know what the vet thinks after speaking to her.

Lorie since the Benedryl cream helped, it would be expected that the Benadryl pill (w/o zinc) would also help with the itching. Please let us know.

Can you make a different potty place, say on your deck or in the garage with a layer of pee pads. That will keep him out of the grass which seems to be related to his rash/itch problem. You might keep a piece of soiled paper towel in a ziplock bag. Place the used towel on the pee pad on your deck or the garage so that Rocky knows it is ok to pee in this new type of potty area.