PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Aug 12, 2019 7:53:01 GMT -7
Hope the regular vet can fit him in today and confirm what is going on with Demo.
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Post by Ann Brittain on Aug 12, 2019 8:06:20 GMT -7
Hope you get this figured out for Demo. Good luck at the vet's!
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Post by Susan & Demo on Aug 12, 2019 13:26:05 GMT -7
THE LATEST Regular vet (after studying lab results done 2 months ago and last weekend, thinks this might be cushings symptoms caused by prednisone so he said to taper as follows: He had 5mg this morning, do not give again tonight. Repeat morning only for 5 days. Then move to 5 mg every other day for 5 days.
[Moderator's Note. Please do not edit 16.8 lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 6 days, as of 7/14: 5mgs 2x/day for 17 days; 7/31 test taper √8/1 pain as of 8/1: 5mgs every 15 hrs in error of Rx for 7 days, as of 8/9: 5mgs 2x/day for 3 days, 8/12 taper due to cushings signs tramadol 50mgs 3x/day gabapentin 100 mgs 3x/day Roboxin 125mgs 3x/day Pepcid AC 5mgs 2x/day ]
IS THIS A TYPICAL PRED TAPER SCHEDULE? More about pred taper:
Since dr wants him off pred to see if cushings symptoms reduce, he instructed me to continue his pain mgmt meds. I realize that is opposite of pred taper to judge pain. ------------
[Post by Susan & Demo on 9 hours previous] Vet office said dr will call me. They did not offer appointment, probably because they know hour in car is hard on Demo?
I also have my own dr apts this afternoon.
Demo being sick is having serious effects on me. Lots of loss in my life this past year so maintaining Demos health is vital to me.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Aug 12, 2019 18:20:59 GMT -7
Your vet has designed a pred taper in light of the lab report comparison.
Susan, we really only know one disease...that is IVDD. So you will have to ask questions of your vet so that you are in the loop with him to understand things. Did you ask what signs are you to watch for on the taper that might indicate cushings symptoms reducing?
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Post by Susan & Demo on Aug 12, 2019 20:41:23 GMT -7
Yes. It appears things i saw as ivdd or meds related can be cushings symptoms as well.
I will be watching for less panting, less irregular breathing, more stable heart rate, less leg weakness, drinking less water and peeing less, ideally no signs of pain with pred taper. It is challenging distinguishing these symptoms from signs of pain. Maybe i need to look for cushings forum online? My vet was hesitant to say Demo had [cushings] this unless he has the form caused by prednisone and says this is our first step to make dx.
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Post by Susan & Demo on Aug 16, 2019 20:46:39 GMT -7
PRED TAPER QUESTION 8/12. 5 mg am, 2.5 mg pm 8/13. 5 mg am, 2.5 mg pm 8/14 5 mg am, 2.5 mg pm 8/15. 5 mg am, 2.5 mg pm I think he panted less, more tail wagging. Legs stronger. 8/16. 5 mg am, none pm
Within 2 hours he was trembling, not wanting to move around and started whining (different from "let me of the dang cage" whine)
So i just gave him 5 mg pred.
Is there a schedule on here that shows how to taper/give med ?
Thank you
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Post by Romy & Frankie on Aug 17, 2019 15:15:46 GMT -7
The most common type of taper we see is x days (where x is number of days) on the full 2x a day dose. When the vet wants to start the taper the same dose but only one time a day. Then the dose goes to every other day.
But there are different ways to taper. Your vet seems to want to taper more slowly, by decreasing the dosage before decreasing the frequency. No problem with that.
But, as you know, if during the taper a dog shows pain, they should be back on the full dose of all meds. This may be an issue if the vet suspects steroid related Cushings.
It might be possible for Demo to switch from the pred to an NSAID type of medication if the vet, believing this to be an emergency, knows to protect the stomach with both Pepcid AC and Sucralfate. Without the two stomach protectors on board this would not be safe. You could speak to your vet about this. Otherwise, a 5 to 7 day washout period where the dog would not be on any anti-inflammatory would be necessary before the NSAID can start. This would mean that Demo has nothing working on the spinal cord inflammation and would be at risk for increased pain.
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Post by Susan & Demo on Aug 18, 2019 5:49:22 GMT -7
Demo back half fell over while stepping away from peeing. His left foot was turned in 90 degrees just before the fall. I did not think to go turn it.
Isnt it late in the game for that? Thats how the first disc issue STarted.
I think he is in some pain with just reducing pm dose to 2.5.
The dr did tell me to do a faster taper. "1 in am, none at night for 4 days, then every other day for 4 days." When i saw pain w no pred at nite, i went to 1/2 tablet. Tonight i will skip pred. I just dont know what to do if he is in pain with that.
I hate to say it, but I think his disc is blown. The same spot hurts him if i touch it very lightly.
What are outcomes with surgery on an 11 year old dog?
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Post by Ann Brittain on Aug 18, 2019 7:36:16 GMT -7
So sorry to read that Demo is having pain. Without an MRI, it's hard to tell whether he has had another disc episode or if this is a continuation of the original issue.
Since Doxie's tend to live longer than other breeds, surgery at 11 years may be something you can consider. You would want to discuss the pros and cons with your vet and/or schedule an appointment with a veterinary neurologist to determine if Demo is a good candidate for surgery.
I'm sure others with more knowledge of meds will comment about reducing Demo's prednisone especially when he's has swelling and pain.
Hope things improve for Demo soon.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Aug 18, 2019 8:51:16 GMT -7
Susan, age is not a deterrent to a surgery. The only outcome a surgery produces is to decompress the spinal cord. The surgery removes disc material from where it is not supposed to be. Not supposed to be invading the spinal cord canal and squishing the cord. Only a consult with a board certified surgeon can give you that answer if at this point in time a surgery would be a consideration.
If conservative treatment is the avenue you and your vet decide to go forward on, then it might be that Demo would remain on some pain reliever(s) so he can finish out healling his disc by graduation day of SEP 2. The hope is with time the offending disc material might be absorbed by the body or at least shrink back enough so that the nerves are not aggrevated. So it might be that until t hat happens, he would stay on pain relief in order to get back to enjoying his life with the aid of medicine, just like people take meds to be able get on with life
Is Demo still taking these pain meds on the pred taper? tramadol 50mgs 3x/day gabapentin 100 mgs 3x/day Roboxin 125mgs 3x/day
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Post by Susan & Demo on Aug 18, 2019 11:11:48 GMT -7
Yes, dr said to keep him on all pain meds and get him off the prednisone so we can see if cushings symptoms decrease.
The drive to the surgeon is well over an hour and he wont be still in his crate in the car - that is my main reason for not already doing that. I worry he hurts himself on the ride.
GOOD TO KNOW MY DEMO IS IN MIDDLE AGE!!!!!!
QUESTIONS: 1. Is it common for his legs to be getting weaker to the point of falling over 5 weeks into crate rest? 2. What to do if his pain meds arent enough? I have trazadone also given by the cushings doctor but have not used it.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Aug 19, 2019 5:33:31 GMT -7
Yes, weakness of legs can be due to lack of movement during crate rest. If he's suddenly falling over now after tapering the Pred, it may be a sign of worsening of neuro function. Did that just happen the one time or are you seeing a general worsening? Either way, if you're concerned, that is enough reason to let the vet know.
Weakness of legs is not a sign of pain. Do you see signs of pain that you're concerned about? Trazadone is a sedative, not a pain med.
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Post by Susan & Demo on Aug 19, 2019 18:34:32 GMT -7
His left leg is getting weaker. When he stands to pee, his left leg/foot is turned in - up to 90 degrees. When he hunches to poop, his left side of rear is closer to the ground. This weakening just appeared maybe 10 days ago. The ER vet said it was a sign of Cushings. Demos vet said could be caused by prednisone so we are tapering. The ER vet gave us trazedone because she said he was at max amounts of pain meds. I have given him trazedone twice so i could sleep. Im having trouble judging pain. There is a spot mid spine that if i even lightly touch, he reacts unless tramadol has just kicked in. The last time around we did 8 weeks crate rest and then surgery, he spent 4 months total crated that year. He whines and whimpers and im not sure why. May be sick of the crate and the buggy ?
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Aug 20, 2019 5:28:24 GMT -7
If Demo has pain in his spine, then there is still swelling pressing on the nerves of the spine and still a need for the anti-inflammatory dosage of the Prednisone. I understand that the taper is being done to test for Cushings. Do you see any other sign of pain?
Swelling usually takes 7-30 days to resolve. From what I can tell, Demo has been on Prednisone for more than 30 days. With conservative care, it is hoped that the body will reabsorb the damaged disc and that the disc will heal with limitation of movement of the spine. Sometimes that doesn't happen and a dog may have to remain on a low-dose anti-inflammatory or pain meds. Or if there is too much movement of the spine at some point during crate rest, the damaged disc can re-tear, causing pain and loss of neuro function and you're basically back to square one with the 8 weeks of crate rest.
Be sure to let the vet know how Demo is reacting when you touch his spine.
If you do decide to take Demo in to the surgeon for a consult, you do have the Trazadone to help calm him in the car. Pad his crate well with rolled up towels/blankets to he has little room to move and to protect him when you turn corners or brake the car.
I'm so sorry that you and Demo are going through all of this. Healing prayers for Demo and prayers for strength and wellness for you.
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Post by Susan & Demo on Aug 21, 2019 10:02:51 GMT -7
advice needed...
how do i know we have an emergency if he is not in visible pain?
his left leg has been weak and turning in and giving out. we have been trying to taper off pred to see if it is causing weakness.
last nite vet says time for him to see neurologist.
this morning demos right leg was weak and turned in.
he has reached the point that pottying is diffocult. trying to use sling...
so i called neurologist and they cant see him any time soon without referral. my vet has the day off today. neurologist is at emergency clinic so they said if i thought he was "going down" bring him to their er and a regular vet will see him.
so how do i know when to take him to er
i am assuming his meds are handling most pains. id say he was uncomfortable. [conflicting statement with opening sentence!]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Aug 21, 2019 12:12:30 GMT -7
If not in visible pain, then one would believe he is in a state of comformt, not in pain. Monitor for the usual signs of nerve diminishment to determine what is an emergency til you'd want Demo to get checked out by a neuro. As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. 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. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservative
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Post by Susan & Demo on Aug 21, 2019 13:19:03 GMT -7
Demo has not tried to poop because he wont get in that position. I dont know if it hurts or if he knows his back legs wont hold him. He has not adjusted to the sling yet. The last 2 times he pooped, it was less than usual. Maybe it hurts to push. His stools have been great til yesterday.
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Post by Romy & Frankie on Aug 21, 2019 13:29:38 GMT -7
Are you adding pumpkin to his diet? This works very well for dogs who are constipated. Add equal parts water to each kibble meal along with 1 teaspoon of plain canned pureed pumpkin for every 10 pounds of body weight, 1x a day. If he doesn't like pumpkin (my dog loved it to my surprise) you can tried peeled, mashed, very rip pear or a peeled and mashed sweet potato.
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Post by Susan & Demo on Aug 21, 2019 13:40:20 GMT -7
I will do that but i dont think hes constipated? Im assuming he cant hold his weight or that position hurts.
I am trying to get him into a neurologist. They are busy.
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Post by Susan & Demo on Aug 21, 2019 20:57:24 GMT -7
Demo may have surgery tomorrow. I took him to the ER MEDVET in Dallas that has a neurologist. Options were: (1) IF I had not really done real crate rest, had been letting him walk around the house etc, then she would take over the case, make some adjustments in the meds and it would be 4 more weeks of strict crate rest. I told them I had been good but not perfect, there was a time the housekeeper let him walk around and a couple of times at night let him lie on the bed for a few minutes between buggy and cage. Downside of waiting is that he has something on his spine, mid spine, which I knew, maybe disc issue, maybe tumor?, and if I took him home and he kept declining, surgery later might not be as effective. (2) They keep him overnight, put him on valium and morphine tonight. Tomorrow do a CT and then consult with me and if they think they can do successful surgery, they will recommend and do it immediately. He will be there several days afterwards. The neurologist surgeon is Jennifer Rich. I believe she helped with the very successful surgery Demo had in 2017 that they thought was impossible. She worked with the best in town. The best in town has retired. They said he was a healthy 11 year old with no other medical issues and still had good neurological function and it was good that he still knew how to walk. They asked about CPR vs DNR and I started crying and said I had been through a lot of trauma and lost several people in the past year and he was all I had now and I could not lose him. I did not think long and hard about this but because of the past year, I do not know if I could make a better decision after days of more thought. IF ANYONE HAS ANY ADVICE OR WARNINGS AT THIS POINT, PLEASE SHARE THEM.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Aug 21, 2019 21:11:59 GMT -7
The CT will give you and the Neuro information to best know whether to proceed with the surgery.. it might be a consideration as that you have been doing proper crate rest and have tried to go off meds several times and it seems each time there is pain not fully resolved. So getting this consult with the Neuro should help you decide. Please keep us posted as you find out more
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Post by Susan & Demo on Aug 22, 2019 1:44:03 GMT -7
I went back and read 2017 saga. He was in terrible pain for months from poor health care before we got to lewisville surgery center. Demo saw the same surgeon who saw him today. She got his pain under control and then moved to this clinic. Dr. Ducote did an amazing and successful surgery. But the next three weeks, demo was in constant pain. Neither of us slept. The neuro did not take calls on the weekend and then she went on vacation and no one would see him or change meds. It settled down at 3 weeks. Are animals supposed to be in pain post surgery? If her med plan and me perfecting crate rest can fix him, I will choose that over 3 weeks of intense pain for demo. They took him from me and did the exam in the back and then talked to me without him. I went to say goodbye and opened cage door and he jumped up on me with arms around my neck. $6000-8000.(they asked me to bring his meds from home, im thinking 6K Should include meds.) My concerns now are 1. Since he is in far less pain than before, is surgery too soon? 2. Does the weakening legs advancing mean he is definitely going downhill or can that happen mid recovery? 3. Im not going to let him be in pain post op.
THANK YOU SO VERY MUCH!
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Aug 22, 2019 7:35:29 GMT -7
Susan, there is no reason for a dog to be in pain after this type of surgery. The surgeon has so many ways to control pain. With surgery, the severe pain of IVDD would be gone since any compression on the spine would hopefully be alleviated by the surgery. The only pain would be from the surgical site. Swelling following surgery usually only lasts for about two weeks so after that there should be no pain or reason for meds. It's unusual for there to be severe pain three weeks post-op.
Legs can get weak from lack of use during crate rest; however, you also mentioned that his foot was now turning in and that's a sign of worsening of neuro function.
If in fact he has had a worsening of neuro function due to too much movement being allowed at any time during the crate rest, the 8 weeks of strict crate rest would have to start over from that point. Do you remember when the housekeeper let him walk around too much? Was it shortly before he started to get worse? If so, then he had a relapse and the 8 weeks of strict crate rest would have to start from that date. I doubt if he worsened due to you letting him lie on the bed for a few minutes since it doesn't sound as though he had too much movement from that.
If the worsening of condition was not near the time the housekeeper let him walk around, then he most likely has not had a relapse. If that's the case, then surgery would be a consideration since his condition worsened during strict crate rest.
Plus, Tempo has had a difficult time getting off of meds. Usually swelling/pain is resolved within 7-30 days of taking an anti-inflammatory. Sometimes it can take longer. With a few dogs, the damaged disc does not heal correctly or the body does not absorb the extruded disc material and a dog may have to remain on a low-dose anti-inflammatory and/or pain meds following crate rest.
Prayers for you and the vet as decisions are made. Please keep us updated and let us know of any questions or concerns.
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Post by Susan & Demo on Aug 22, 2019 12:06:05 GMT -7
Surgery 8/22/2019
They are getting ready to do a CT. surgeon said this morning, Demo has 85 % chance of good recovery with crate rest or surgery. The advantage of surgery being the offending material is removed. I like the surgeon. She guaranteed me that she would have contingency pain controls written out for when she is not there and if exhausted she can be called - waiting results of ct now
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Post by Romy & Frankie on Aug 22, 2019 13:03:18 GMT -7
Please keep us up to date on Demo. We will be wanting to hear.
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Post by Susan & Demo on Aug 22, 2019 13:30:50 GMT -7
CT showed ruptured disc between 3 and 4 with lots of material, his last 6-7 surgery looks good, little age showing but no other problems. She said easier surgery and said she would do it on hers. She knows and loves Demo so I know he is in good hands. Will keep you posted!
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Post by Romy & Frankie on Aug 22, 2019 13:40:57 GMT -7
Thanks for keeping us updated. Has the surgery been scheduled yet?
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Post by Susan & Demo on Aug 22, 2019 13:44:11 GMT -7
Shes doing it now since already sedated for catscan. Should take 2 or so hours.
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Post by Romy & Frankie on Aug 22, 2019 13:47:31 GMT -7
We will be anxious to hear news when you are updated by the surgeon. Sending the most positive of thoughts for a good surgical outcome to get all the offending disc pieces removed and relieve Demo's pain.
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Post by Julie & Perry on Aug 22, 2019 14:12:23 GMT -7
Susan, I'll be praying for you and Demo. Please care for yourself too. Eat and rest. God bless.
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