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Post by Susan & Demo on Jul 8, 2019 17:15:21 GMT -7
hurt back, but not down, advice?(5/3/17 lda)
Demo, now 11, is 2 years past his surgery and has just been moving slower lately. About 2 weeks ago, after 2 years of perfect behavior, jumped off the couch while someone sitting with him! He showed no changes then. For the past 2 days, he woke me every 2 hours to go outside and poop and would stand and wait for me to carry him from one place to another. Not typical. Sometimes nothing happened. He really felt bad because he did not even ask to eat yesterday! That's what scares you! Went to vet this morning, saying he was lethargic, and he all but tap-danced in the exam room. He found nothing wrong and then I asked him to check his back and he found a sore spot. Prescribed prednisone and said give tramadol as needed. Another med for his stomach. He has slept all day. [Moderator's Note. Please do not edit 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 5 days, Sat 7/13 a test taper to reveal _pain / _neuro tramadol 12.5mgs 2x/day Metronidazole 100 mg every as hours no GI tract protector Pepcid AC on board! ]
Do I need to keep him crated or just carry him around for a matter of weeks? He is not running or jumping when not in crate, just follows me from room to room or wanders in the yard a bit. It is just the two of us here so I like him to sit on the couch with me, so I better build or buy a furniture blocker? any new advice since 2 years ago??
thank you for still being here!
susan newton
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Post by Julie & Perry on Jul 8, 2019 18:27:19 GMT -7
I'm so sorry Demo is having another IVDD episode. He needs to be crated immediately for 8 weeks. This sounds like a mild episode that was caught early and you want to keep it that way. Conservative crate rest is much stricter than after surgery. Read up at the main website on it at www.dodgerslist.com under the IVDD 101 section. Please list Demo's names of meds, strength, times given, ECT. IVDD is very painful so give tramadol every 8 hours. Not as needed. Sending healing thoughts and prayers.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 8, 2019 19:05:49 GMT -7
Susan, sorry to hear Demo is having a disc episode. As Julie reminds you, there is a BIG difference in the STRICTER need to protect the disc with 100% STRICT crate rest 24/7 only out of the recovery suite for a very, very few footsteps at potty time. No offending disc material has been removed via a surgery. How much does Demo weigh now?Prednisone is working to reduce painful inflammed tissue around the spinal cord. It might take anywhere from 7-30 days excluding any taper days. Can you provide the full details about pred: --- How many mgs for each dose, how often do you given it. For how many days untill the taper starts?Tramadol is one pain med that is used as the general analgesic. --- How may mgs and how often are you actually giving? Pain meds with a disc episode are never given as needed. The t ime to back off or stop pain meds is during the prednisone test taper to verify if all pain is really gone. If you are seeing any signs of pain, then call your vet and strongly advocate the other two typical sources of pain be covered with gabapentin (nerve pain) and methocarbamol (muscle contraction pain). Let us know if tramadol alone provides full dose to dose, round the clock pain relief. That you are not seeing any signs of 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 ◻︎ 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 ◻︎ not their normal perky selves Let us know you on the same page with us about protecting the healing disc with limited movement: --Super tried and true tips for setting up the recovery suite: www.dodgerslist.com/literature/CrateRRP.htm -- PLUS further guidance on conservative treatment on our "All Things IVDD page: www.dodgerslist.com/literature/healingpage.htm www.dodgerslist.com/healingindex.htmSTRICT means: - no laps - no couches - no laps - no baths - no sleeping with you - no chiro therapy - no meandering at potty times. Carry your dog to and from the recovery suite to the potty place and then allow a very, 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! Refresh youself on IVDD. Read and learn about the things that pertain to the now and in the next days come back to this link to be fully up to speed on IVDD: IVDD 101 Treasure Trove link
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Post by Susan & Demo on Jul 8, 2019 21:21:10 GMT -7
Demo is a medium - weighs 15.4 now but was heavier thru the winter. I think 14 is ideal. He eats 1 1/4 cups of RD and gets frozen green beans and peas before bed. Dr. was happy with weight. Has been sleeping with me with pillows bordering around the bed. After reading list of signs of pain, he has been exhibiting some for a while, which I was crediting to getting a little older and slower. There is a brick trim around the garden bed that he likes to hop over and he has slowed that down. I took him in a month ago for "not being his normal self" but didn't ask about his back because I had been checking his back and getting no response. They ran $300 of blood work and said he needed his teeth cleaned. Do I need to take him for an xray to be sure? He had the procedure that was supposed to prevent upper back problems and then disc surgery for a disc at tail bone. He was in a crate for 4 months that year. Prescribed: Metronidazole 100 mg every as hours for upset stomach. Prednisolone 5 mg: 1 tablet once a day for 3-5 days [??], then 1/2 to 1 every other day as needed. Tramadol - he said give as needed. 50 mg, I gave him 1/4 this am and 1/4 this pm. Since the doctors prescriptions are much shorter than what this typically requires - I think I need to find out exactly what the doctor felt. Crate ALL the time, PAIN signs: NO slow walking around house? ONCE shivering-trembling NO yelping when picked up or moved SLIGHTLY SLOWER WALKING NO tight tense tummy NO arched back, ears pinned back ◻︎ head held high or nose to the ground. NO restless, can't find a comfortable position NO slow or reluctant to move much in crate such as shift positions TODAY before dr visit, looks up with just eyes and does not move head and neck easily. NO not eating due to painful chewing or in too much overall pain NO holds front or back leg flamingo style not wanting to bear weight YES not their normal perky selves Guess throwing bean greens for him to chase is off the list?? BIG THANK YOU TO YOU ALL!!! Posted July 9 on the graduate board 38 minutes ago by Susan's DemoI posted and got some replies and now cannot find them and this is showing me as a new member. Can someone help me find myself? TONIGHT'S QUESTION: Is there such a thing as a little pain that does not require 8 weeks strict? How would I know the difference? I think he looks more depressed than in pain. His world just changed. Instead of being in the crate for 6 hours while I'm at work, he was in it for 24 hours. He wasn't allowed to wander the yard or crawl up in my lap. After him barking for hours, I brought him out for supper and he stood still as I told him to. Then we sat on the wood floor for about half an hour, him not moving between my legs. Then he got up and got into his crate and just put his head down on his pillow. Really will appreciate your knowledge and thoughts..... don't want to be an enabler here.... or make his life miserable if not necessary.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 9, 2019 20:36:25 GMT -7
Susan, tell us about the prednisone. It is given for a definate time--- not 3 to 5 days. The vet must take a guess when he thinks the painful swelling will have been resolved by pred. So the course might be a 5 day course, a 14 day course AND THEN the test prednisone taper will begin. Your job at home would be to monitor and asses for pain. It can take in the range of 7 to 30 days excluding any taper day for prednisone to complete riding the body of inflammation. Discuss getting Demo's Prednisone adjusted: The anti-inflammatory dose for a 15 lbs dog is 5mgs 2x/day. He has been prescribed a taper dose at 5mgs once a day that is not likely to be effective in getting spinal cord inflammation resolved.Rule of thumb pain = swelling = back up at anti-inflammatory dose, pain meds and Pepcid ACYour indication of pain signs with tonight posting indicates Demo is woefully undermedicated for pain! --for a 15 pound dog 12.5 mgs tramadol 2x/day is like not givning any pain med! Please advocate even if it needs to be with and ER vet tonight to get the pain meds right for Demo. There is no reason for suffering with pain. -- Tramadol at the max aggressive dose.... you would expect the vet to dose nearing a full 50 mgs tablet and every 8 hrs promptly --- gabapentin for nerve pain also every 8 hrs. --- methocarbamol for muscle contraction pain every 8 hrs. STOMACH protection. Metronidazole is an antibiotic. It does nto suppress stomach acids pred causes. Pepcid AC is the stomach protector of choice by most vets. Please do no delay in getting PepcidAC (famtodine) on boardl Proactive vets don't wait til there is lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. Pepcid AC (famotidine) blocks the production of acid. The usual dose of Pepcid AC (famotidine) with a disc episode for doxies is 5mgs 2x/day (0.44mg mg per pound every 12 hours.) Pepcid AC has a very limited potential for side effects. 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).
HEALTH ISSUES: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.” marvistavet.com/famotidine.pml XRAys Are not used to proove a disc episode but when a vet is suspicious of another disease to rule that out. Most IVDD is diagnosed by history of dog being born with IVDD like Demo is, they way they act at the neuro exam. Education is the key to IVDD! Our goal is to help you maneuver things that can be overwhelming with an IVDD diagnosis in caring for your dog. Getting quickly up to speed on intervertebral DISC disease helps you in understanding the why of what your vet advises and the ability to bring things to the table in working together to help heal the disc. You will be very amazed how quickly you can learn a lot about just one disease which a vet is not able to know in great detail for every single disease known to cats, dogs, birds, and many other species they treat.
Keep in mind the key word in the name of the disease is DISC. #1 Take a look so you can visualize just why the need to be strict about 8 weeks of crate rest for the DISC is so important in preventing a surgery
#2 How/why meds are used while the DISC is healing. A good review of the many things your vet mentioned about his diagnosis, the Rx’d meds, crate rest, other stuff that you may not have fully processed during that short vet visit.
#3 The very best thing you can do for YOU, the caregiver, and for your dog is to read and learn as quickly as you are able. Calm your mind by being “in the know” how long each the 4 phases of healing is expected to take. What treatments for which phase? At what point would a surgery be considered? This is the page to bookmark and return to in the next days to have a full understanding of the now and the future of living many happy years ahead with your IVDD dog. Here is the link to bookmark: www.dodgerslist.com/healingindex.htm
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Post by Susan & Demo on Jul 9, 2019 22:22:05 GMT -7
Well I am very confused about signs of pain. I am not seeing him suffering with pain. He barked when he was in his crate when he is usually not. He stood still to eat like I told him. And sat still with me on the firm floor like I told him, then took 2 steps and got in his crate and laid down with his toys. Is him appearing better behaved my sign of pain? The amount of tramadol knocks him right out. If I give it 3 times a day he will be asleep all the time. But if that is good for him, I will. Demo has had 2 surgeries so I thought I understood this better. The vet did not say we were in that territory. That's why I got on here to see what we do when there is "some soreness". The doc said we would add the additional meds at the end of this short trial if necessary. This may be where this vet disconnects with more experienced ivdd vets? Does anyone recommend a vet in Dallas TX that is especially knowledgeable with this - besides the surgeons? I don't believe we gave him any Pepcid AD for the other 2 episodes but I have some. I have no reservations about giving him any meds he needs. He is eating the same but has not had or attempted a bowel movement in 2 days. I assumed the other med was "dog Imodium" since he had had some diarrhea when I took him in. He is not jumping around and barking at me for more food, but he is fairly sedated. My biggest challenge is identifying signs of pain . Before and after his last operation, I would take him in (with videos) showing them what I thought were signs of pain and the surgeon would roll her eyes and say he was walking well, moving his neck well, shaking his body well. final question: can these dogs "strain" their backs like we do and with a week or so of crating and meds be okay (like people can)?
or is any and all soreness leading us to bigger trouble?
Demo is 11 and I would like him with me at least another 5 years so want to take good care of him. Thank you.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jul 10, 2019 4:58:06 GMT -7
Hi, Susan. The signs of pain that you mentioned before were slow or reluctant to move, looks up with just eyes and doesn't move head. If Demo is still showing those signs of pain, then you need to give the Tramadol 3x/day to see if that gets the pain completely under control. If that doesn't get the pain completely under control, then you need to contact the vet to let him know about the pain you're seeing and have him increase the dosage of the Tramadol. If you no longer see those signs of pain, then the Tramadol 2x/day is doing its job and no need to adjust meds. Looking up with just eyes and not moving head are signs of a neck injury. When the vet examined Demo and found a sore spot, was that in his neck? You know Demo best. When my Jeremy is upset, he puts his head down and looks up with just his eyes but he has no difficulty moving his head. If this is a neck injury, there are several things that you should do to help Demo's neck heal, such as softening hard kibble, raising food/water dishes so he doesn't have to bend his head. If you're not sure if this is a neck injury, then it's OK to still do these things. More info here: www.dodgerslist.com/literature/cervical.htmAs for the Prednisone, the vet has prescribed a course of 3-5 days. Three days is very short so 5 days would be best before trying to taper. Do speak to the vet about stopping the Tramadol at that 5-day mark. Having pain meds on board during a taper makes it difficult to determine if there is still pain/swelling. If there is still pain when the Prednisone is tapered, then there is still swelling and not time to taper. If pain returns during the taper, then the vet would need to prescribe the original dosage for a bit longer. If there is no pain at any time during the taper, then there is no longer any need for meds as the swelling has resolved. It can take 7-30 days for the swelling to resolve and as long as there is swelling, there is still a need for the original anti-inflammatory dosage of the Prednisone. This is something new for you as the swelling would have resolve much quicker after the surgeries. Any time a dog with IVDD is showing back pain and a disc injury is suspicioned, a full 8 weeks of strict crate rest must be done, no matter whether it's a mild injury or a severe one. That's how long it takes for a damaged disc to completely heal and form secure scar tissue. Conservative care is much different than post-op care. The limitation of the movement of the spine must be very strict, the less movement of the spine, the better. Too much movement of the spine and the slightly torn disc can tear more, even rupture, and that can result in paralysis. The crate protects the spine from further damage by limiting Demo's movement. Think of the crate as a cast for the spine. Carry Demo in and out to potty with only a very few steps allowed at potty time. Do speak to the vet about getting Pepcid AC on board. Demo doesn't need any problems with his GI tract due to taking the anti-inflammatory. It's best to be proactive and prevent a problem rather than trying to fix a bleeding ulcer if it were to happen. The meds can cause constipation. Pumpkin can help to loosen stools. Give one teaspoon of pumpkin for every 10 pounds of body weight per day. 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. I'm not sure why the vet gave you a 3-5 day course of Prednisone rather than a specific time but a 5-day course is not unusual. He sounds willing to give another course of Prednisone if needed. It's best to try to continue to work with the present vet. Going to a new vet would mean another trip and exam for Demo and that is risky in that it might involve too much movement. Do know that if you are dissatisfied with this vet, the surgeons can be consulted with to get the correct meds on board and are not seen solely for surgery. But again it would mean another trip to a vet for Demo. You're doing a great job caring for Demo and always have. Just know that conservative care is much different from surgery so you have a whole different way of caring for him this time around. Healing prayers for Demo.
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Post by Susan & Demo on Jul 10, 2019 5:46:54 GMT -7
Thank you for your answers.
Demo has been through conservative care, then surgery, the post surgery crating - TWICE. So we have been down this road.
Is there a way for me to access my old posts so I can compare those with now - as I have forgotten a lot of this.
I saw pain on Monday morning but not since. This morning I carried him to kitchen and sat on floor with him while he ate. Afterwards he started licking the floor and did not stop. I put him back in crate and he kept sticking his tongue in and out. I know I've seen that before but don't remember what it means.
I have enough prednisone to do a week and then taper and I can stop Tramadol whenever is appropriate.
The whole "is he in pain?" or "is he a nervous wreck from being caged constantly?" is hard to discern.
The vet is a sweetheart but very, very conservative. He says he has seen crating go both ways so is not very strict or instructional (might be why Demo has had 2 surgeries now though).
That 8 week business is daunting.
So - Lengthen time on prednisone; stop tramadol BEFORE reducing prednisone; add Pepcid; keep him in the dang cage. Find out about licking. Add pumpkin. Am I on the right track?
And no, the tenderness was not at his neck - pretty much half way down his back.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 10, 2019 6:36:56 GMT -7
Susan, you can see all of your past posts by clicking on the blue "Susan & Demo" link in the left side of the page above the photo of demo. Thank you for clarifying you no longer observe any of the signs of pain you reported on Monday(shivering/trembling, slow to walk, not his normal perky intersted in life self) are being controlled by his pain med. So if Tramadol 12.5mgs every 12 hrs is working to provide full round the clock pain relief, then there is not a need to increase to 3x/day. PRED TAPERSo going with the vet's 5-day course of pred, seems reasonable. That means the taper doses will start on Saturday 7/13. --- Let us know your vet is on board with the stop of tramadol 7/13 so you can quickly and accurately monitor for any hint of pain surfacing. Pain would signal the vet needs to Rx another course of pred. --- With any taper, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free! Let us know what you and your vet's Plan B is.
Pain= another course of prednisone + all pain meds, protectors back on board. No Pain= complete the pred taper..just finish out the 8 weeks of crate rest for the disc to heal. NOTE: Helpful if two or more signs of pain are observed to confirm it is actual pain. Some things can signal pain or something else. So observing for pain may require putting on your detective hat to figure things out. -- panting: pain, cooling off, anxiety -- shivering/tremblling pain, cold, anxiety TONGUE observation--- early sign of GI tract damageLicking can be one of the early red flag signs of GI tract damage! Licking or drooling can be a sign of nausea. GI Tract damage progresses: lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids predisone cause. Let us know you have PEPCID AC (famotidine) 5mgs every 12 hrs on board soonest today! Pepcid AC has a very limited potential for side effects. 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). HEALTH ISSUES: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.” marvistavet.com/famotidine.pml Tips on finding an IVDD knowledgeable vet www.dodgerslist.com/literature/VetchkList.htm As Marjorie explained, seeing a new vet requires a risky to the healing disc transport into the new vet for an exam. If you can work with your vet, by having a good understanding of IVDD so you can offer ideas, question when things seem a danger to Demo's disc, then you can handle things on the phone since your vet has already examed Demo. The goal with conservative treatment is all about limited movement of the back to protect the body's efforts in healng the disc. Consider adding food and water bowls inside the recovery suite. The only time Demo should be out of his suite is for necessary potty times. He should be eating inside his suite. Dachshunds are not just short people with back ache. A disc episode for a canine is a much more serious situation demanding crate rest! When the disc material invades the spinal cord’s canal that puts pressure on the nerves it causes painful swelling. Dogs are different than people anatomically! LOL. The vertebrae go all the way into the hip area while for people the vertebrae stop mid back. This means for people with a disc problem there is not likely to be paralysis, loss of bladder control just pain. But with a dog neuro diminishment is quite likely when the disc is in the back where the nerves get trapped and pressured by the boney vertebrae. Although even with a neck disc there is the potential for bladder and back legs to be affected. In summary -- prednisone taper is to begin on Sat 7/13. What is your plan B? Stop tramadol at the same time the pred taper starts. Review of how the taper works and what your job is during the taper: www.dodgerslist.com/literature/healingsweling.htm-- Pepcid AC should be on board every 12 hrs as long as pred is being used. -- If constipated high fiber can help. Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe. >To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day. >To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble.--What was the reason your vet Rx'd Metronidazole? What signs did Demo show that caused the vet to Rx this antibiotic Metronidazole helps alter the profile of gut bacteria to assist in clearing up the runny stool IF bacterial caused diarrhea. Antibiotics, as you know are indiscriminate... they kill both the needed good bacteria as well as the bad baceria. Metronidazole is best given with food. As always it is important that owners read up on each med their dog gets. You can't monitor, protect or question without knowledge: Mar Vista Vet Pharmacy on metronadazole: marvistavet.com/metronidazole.pml
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Post by Susan & Demo on Jul 10, 2019 14:37:42 GMT -7
OMG! I went back and read what we went through in the summer of 2017. I had blocked it from my mind like a bad car accident. We are in a challenging spot here. I am scheduled to have 2 surgeries within the next 6 weeks where I will not be able to lift Demo at all. I had been wondering who would come in occasionally to help me. So..... have details to work out. I cannot allow him to go through the pain he did that summer and spending over 4 months in a cage. I will work on his med schedule and post later. Thank you all so much.
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Post by Romy & Frankie on Jul 10, 2019 14:56:44 GMT -7
Good news that Demo is not showing any signs of pain now. Is he still showing signs of constipation? If so, give the pumpkin a try. It worked very well for Frankie when the meds made him constipated. I thought he might not like it but he really enjoyed it.
I am sorry that you will be having multiple surgeries so close together. If you have no friends or neighbors that could help, perhaps you could find a high school or college student on summer vacation wanting to make a little extra money. If you will be there to supervise no experience would be needed, just a love for dogs.
Let us know about the meds when you can.
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Post by Susan & Demo on Jul 10, 2019 19:38:27 GMT -7
Now I think he is hurting. When I take him out, he doesn't attempt to run or play. When I sat him on hard floor for a minute between my legs, he sat down and did not mind going right back into the crate.
If I can afford it, what are the reasons to not just take him to the surgery center, get the MRI and let them operate? He is 11 now, is that too old for surgery. And I don't walk him regularly so not in great cardio shape. I guess I better go back and read how hard or easy that surgery was on him.
Meds: ▲Tramadol - 3x day - 12.5 mg - for pain - not sure its enough but seems to keep him knocked out around the clock. Prednisolone - 5 mg -1 tab for 5 days, then 1 every other day, then "as needed" ✙Pepcid AC - will start tonight Metronidazole - 100 mg - 1 tab every 12 hours - for stomach bug. Today he had 2 perfect poops.
[Moderator's Note. Please do not edit 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 5 days, Sat 7/13 a test taper to reveal _pain / _neuro tramadol 12.5mgs 2x/day Metronidazole 100 mg 2x/day ✙Pepcid AC 5mgs 2x/day ]
Demo is typically a type A attention getter - always wants to be on top of whoever is here, loves belly rubs, quick to turn himself over, will bark and drag a blanket out to get someone to adore him. He seems surrendered now. Did not try to get on my lap when we sat on floor for a moment. I don't think he would be deciding to mind me after 11 years so I'm thinking pain. Again - the surgeon last time said he was not in pain unless he was frozen in one position, squealing and panting.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 10, 2019 20:57:43 GMT -7
Susan, have you checked for a tense tight tummy type of pain? What about any of the other typical signs of pain that can be associated with a disc episode? What time did you take him out of the crate…what was the last time he had been dosed with the one pain med Tramadol? SIGNS OF 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 ◻︎ 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 ◻︎ not their normal perky selves Thinking surgery may be jumping the gun at this point in time. Just because you can afford a surgery does not mean it is needed at this point in time. Most surgeons would not want to operate on a dog who can walk..preference is to try the least invasive metho (conservative) first. Good to read: www.dodgerslist.com/literature/surgery.htm www.dodgerslist.com/literature/healingsurgery.htm Treating a dog conservatively means using an aggressive pain med approach which has not yet been in effect. So if, indeed, Demo if, IF, now suffering with pain, then it would be time to advocate with the vet to use a max analgesic dose of tramadol. So you would expect for the vet to Rx a dose nearing a full 50 mgs tablet and give that dose promptly every 8 hrs. You can scroll back up to read about the other two pain meds that make up a traditional pain relief cocktail used with a disc episode. All given every 8 hrs: tramadol, gabapentin, and methocarbamol. Prednisone is actually being given at a lower than anti-inflammatory dose at 5mgs once a day and likely not very effective in getting painful swelling down. Advocate for an Rx at the upper range of the anti-inflammatory dose level….. 5mgs every 12 hrs.
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Post by Susan & Demo on Jul 11, 2019 8:21:59 GMT -7
I went back and read through all my notes and that was an awful year.
I now believe his back has been bothering him for over a month - wasn't as perky and was sitting away from me on couch and bed. I would run my fingers down his back with slight pressure but got no response.
Last weekend I saw the holding still, ears back, breathing. Now have him on meds I last listed and will call my vet today. It's hard to judge pain from annoyed off when he is in crate. I have taken him out a couple of times and sat him on floor between my legs in safe position and he is not comfortable and if I lightly place my hand on his back, he turns around and gives me the stink-eye.
I read in the old notes that they thought he had more anxiety than pain and switched tramadol to trazodone at one point. I think he has both.
Poor guy is used to sitting on my lap most of the day and sleeping with me. I work from home half the time so he is unhappy. He does move around quite a bit in crate, flipping over and wriggling to show his belly and the second he is out of crate, does a whole body shake. Can he hurt himself doing those things? I hate to tell him NO every time he moves.
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Post by Romy & Frankie on Jul 11, 2019 13:12:02 GMT -7
If Demo is wanting to flip onto his back that's okay. You can't really stop him from doing those things and if they caused him pain he would not do them.
There are a lot of meds that can be used to control pain in IVDD dogs. Some work synergistically. If you think there is still pain please speak to your vet about adding gabapentin, and methocarbamol to his tramadol. If you are concerned about him taking too many meds I don't think you need to be. He will be taking these meds only for as long as he needs them. Pain only slows the healing process.
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Post by Susan & Demo on Jul 12, 2019 6:01:05 GMT -7
Demo is still having pain. Yesterday I gave him ▲ Tramadol 25 mg, 3 x day. I was doing 12.5 mg. [Moderator's Note. Please do not edit 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 5 days, Sat 7/13 a test taper to reveal _pain / _neuro tramadol ▲25mgs ▲3x/day Metronidazole 100 mg 2x/day Pepcid AC 5mgs 2x/day ]Since he has no chance to do regular dog stuff, and appears okay, I am testing pain by LIGHTLY just touching his back and when I get to the middle area, he moves away from my hand, once pushing my hand with his paw. Tomorrow SHOULD start his prednisone taper but since I know he still hurts, I am going to call vet and ask if we can extend to a 7 (or 14?) day prednisone course before taper and give 5 mgs twice a day; ask about Tramadol 50 mg every 8 hrs; ask for Gabapentin every 8 hrs …. amount for 15 lb dog ask for Methocarbanol every 8 hours . . . amount for 15 lb dog? and tell him I have added Pepcid AD, 5 mg 2x day. Can someone way in on 7 vs 14 day pred? And the amounts of Gabapentin & Methocarbanol? Thank you! Susan & Demo
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 12, 2019 7:45:13 GMT -7
Susan, the vet gave the OK to up tramadol? what effect did you notice re: tramadol increase? --- within an hour or less, was he his normal perkey self, showing no pain when rolling over for belly rubs? --- were all pain signs masked right up to the next dose?
The length of a prednisone course is a guess a vet must make. Since Demo will have completed a 5-day course and you believe you are still observing signs of pain, then perhaps a 7-day course would be prudent to discuss with your vet.
There is a really wide range of mgs gabapentin doses used, so your vet will choose what is appropriate for Demo. Gabapentin does have a short half life, so every 8 hr dose helps to keep the level more for round the clock pain control
Methocarbamol also has a range of mg doses. Typical reports on med lists show for a 15 lbs dog at 125mgs every 8 hrs.
Opposed to telling him "no" when you see behavior you don't like, try redirecting his attention. --- rolling over on back for a belly rub, then redirect his attention and for example give the command to "sit." When he sits then lavishly praise him "good sit!!" A tiny small reward of a piece of apple or carrot randomly given can help punctuate his good behavior. For dogs the exact moment they are doing something right is when to praise, reward. Waiting even a couple of seconds later when they might be doing something different, means you are rewarding that particular behavior. These observations show Demo is in no pain: --- can roll over for a belly rub --- doing a full body shake. WHEN do you see that behavior— after he has had his meds? nearing the next dose of meds. When do you see behavior that is a typical pain sign? after he had had meds? nearing the next dose of meds? when he needs to move such as at potty time or repositioning in his suite?
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Post by Susan & Demo on Jul 12, 2019 15:54:00 GMT -7
The vet is in agreement with extending pred and adding other meds and crating. I will see him in the morning to get dosages.
When Demo is out of crate he acts like he is just fine. He does a whole body shake once out of crate.
The tramadol puts him right to sleep so cant judge how well it works when. He sleeps on his stomach w chin propped up on pillow or all curled up. As of TODAY 7/12 - only reaction is if i touch his back and he moves away. I went into kitchen to fix afternoon meds and heard him rattling cage and then he just walked into the kitchen 🐕😏. May need a combination lock.
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Post by Susan & Demo on Jul 14, 2019 19:40:28 GMT -7
I WILL NEED SOME INPUT HERE:
Got meds from vet yesterday. Only change I made yesterday was adding another 5 mg Prednisone at night.
[? ? ?] DR. DIRECTIONS based on last event two years ago: PREDNISOLONE - 5 MG TABLET - Take every 12 hours for 7 days; if improved decrease to 5 mg tablet once a day for 7 days. If still doing well, decrease to 5 mg tablet every other day ROBAXIN-V - 500 MG -Give 1/4 tablet every 8-12 hours as needed. (I have 15 tabs) GABAPENTIN - 100 mg - Give 1 capsule every 8-12 hours as needed (I have 30 capsules) TRAMADOL - 50 mg - Give 1/2 - 1 tablet every 8-12 hours as needed. (Have 30 tablets) PEPCID AC - 5 mg - every 12 hours
QUESTIONS: 1. Today, 7/14 - would have been his 7th day taking 5mg Prednisolone. But now I have the prescription for two 5 mg tablets a day for 7 days.
[Moderator's Note. Please do not edit 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 6 days, as of 7/14:5mgs ▲2x/day for 7 days Sun 7/21 test taper tramadol 25mgs 3x/day Roboxin 125mgs which is actually given 2x or 3x/day? Metronidazole 100 mg 2x/day Pepcid AC 5mgs 2x/day ]
The vet tech said that meant start taper tomorrow. I don't know if that is what the doctor meant. Is it better to start over or not? 2. Demo is now almost 12 years old. This morning I gave him the 5 pred, 25 tram and added the Robaxin. He has been asleep all day. Is that the goal??? I'm concerned he might be too old to have all these drugs in his system??? 3. Since I was not seeing additional pain, should I not add the Robaxin and Gabapentin?
No active sign of pain when he does wake up. He still reacts if I barely touch the middle of his back.
IT'S ONLY BEEN THE FIRST WEEK.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 14, 2019 20:14:17 GMT -7
Susan, please do not report meds given 2 yrs ago. It has nothing to do with what the vet prescribed today/yesterday and add to confusion.
What are the current medications your vet said for Demo to take? Take a look at the med list below and make it simple by only correcting the dates the mgs, frequency, adding any missing meds he is getting but not on the list, Once we have an accurage and correct med list we can comment.
MED LIST 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 6 days, as of 7/14: 5mgs ▲2x/day for 7 days Sun 7/21 test pred taper tramadol 25mgs 3x/day Roboxin ?mgs ?x/day Metronidazole 100 mg 2x/day Pepcid AC 5mgs 2x/day
The time to take pain meds away is on the scheduled date of the prednisone taper....7 day on Sun July 21. YOu and your vet came to the conclusion that Demo still had pain. So your it appears prescribed an "anti-inflammatory level" 7 day course of pred (5mgs 2x/day). The bottle should read exactly what the vet prescribed. What does your prednisone bottle say word by word?
It is confusing that now you talk about not giving pain meds, pain meds are too many? Did you have that conversation with the vet...what did he think?
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Post by Susan & Demo on Jul 14, 2019 22:53:21 GMT -7
Sorry that was confusing. The dr looked back at what he gave Demo at the last disc problem 2 years ago to determine these prescriptions and dosages:
Prednisolone 5mg - give 1 tablet every 12 hours for 7 days. If improved decrease [begin the taper] to one tablet per day for 7 days. If still doing well, decrease to one tablet every other day.
Robaxin-v 500mg - give 1/4 tablet every [which?]: 8-12 hours as needed.
Note: I asked the vet if we should put him back on same medicine regimen as we did 2 years ago, based on what i have read on here. I have not asked the vet yet about too much medicine because today was first day i added one and he slept all day. I will be calling him tomorrow and will get the answers from him.
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Post by Julie & Perry on Jul 15, 2019 2:31:07 GMT -7
Susan, at first the meds can make them sleepy. As Demo gets used to them the sleepiness will likely pass. However, right now rest is exactly what Demo needs most to help him heal.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jul 15, 2019 5:29:59 GMT -7
Susan, pain meds should never be given "as needed". That would mean letting pain arise so you can see it and then giving meds to get the pain under control. What is needed is consistent pain control, keeping pain completely under control from one dose of pain meds to the next. Robaxin has a short half life and works best when given 3x/day. What are you giving Demo?
As Julie said, rest is what Demo needs. If he's sleeping comfortably, that's fine. If he's so lethargic, for example, that he can't get up for his meals, then the meds would need to be adjusted.
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Post by Susan & Demo on Jul 15, 2019 15:17:32 GMT -7
Thank you, I think every 8 hours makes sense to me.
I don't SEE him in pain. But he sure is unhappy in the crate. I think I may need a larger one. Should he be able to walk around a bit in his crate?
Right now his day consists of sleeping, lying down looking zoned out, or sitting in crate barking when I leave the room.
He can always get up for a meal, in fact he is ravenous on the prednisone.
My next goal is find someone to sit with him this weekend, unexpected trip necessary. I don't think y'all can help with that though.
Thank you so much for the information and encouragement!!
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Post by Julie & Perry on Jul 15, 2019 16:32:33 GMT -7
It's best to keep to every 8 hours for pain meds even if your dog doesn't seem to be in pain for several reasons.
First, dogs are great at hiding pain. It's a natural instinct.
Second, most pain meds wear off quickly and unless given every 8 hours you can see breakthrough pain.
Last, IVDD is known to be very painful. It's much easier to keep the pain under control than to get it back down.
As for the crate, it should be just big enough to sit, stand, and stretch out. Demo needs to rest in order to heal. Too much room equals too much movement.
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Post by Susan & Demo on Jul 17, 2019 18:17:35 GMT -7
Demo is getting medication as close to every 8 hours as I can but I am single parent to Demo and today it was after 9 hours when i got home and he got meds.
He has been annoyed, barking, grunting, tongue going in and out (yes he gets pepcid, need more?) And has not settled in his crate for 2+ hours. He's usually mellow by now but i guess those late meds caused this. What times do working people give meds every 8 hours? Example: 6:30 am, 2:30 pm, 10:39 pm.?? Im not home til 5 pm. I worked at home his other episodes. I leave at 8:30 so if I did 8 am, 4pm, id have to be up at midnight. OPEN TO SUGGESTIONS....
I increased his ▲Tramadol to 50 mg every 8 hours and i think he was out of pain so think thats right.
[Moderator's Note. Please do not edit 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 6 days, as of 7/14:5mgs 2x/day for 7 days Sun 7/21 test taper tramadol ▲50mgs 3x/day Roboxin 125mgs which is actually given 2x or 3x/day? Metronidazole 100 mg 2x/day Pepcid AC 5mgs 2x/day ]
Is there anything im supposed to do if he sticks his tongue in and out for 15-20 mins and then stops?
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Post by Julie & Perry on Jul 17, 2019 19:47:09 GMT -7
Totally understand. I'm a single pet parent too. Just do your best.
Sometimes if I really can't get home for meds I enlist a family member or neighbor.
Was the tongue sticking out panting? Prednisone can cause that. If it happens again try using a fan aimed off to the side of Demo's crate. Not aimed at it, or Demo.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 18, 2019 6:48:50 GMT -7
Susan, did the vet give you a range, an option to move tramadol to 50 mgs....? Which are you actually giving Roboxin every 12 hrs or every 8 hrs. Panting can be a sign of anxiety and it can be a sign of pain and it can be a side effect of medications (prednisone and tramadol) So one has to put on their detective hat to figure out why the panting. -- if med related, you can try a fan near but not pointed at Demo. Getting air slightly circulating may help with med related panting -- if pain caused panting, then you may well see one or more other signs of pain to help you confirm. Once pain surfaces it can take longer to get it back under control. That is why during the course of pred, the pain meds should be Rx'd by the vet for every 8 hrs so that the meds can stay more even in the body —relieving pain dose right up to next dose, round the clock -- if anxiety you might be able to redirect his mind to something else reducing his anxious behavior sooner. Try giving a command to sit, to lie down that you know he is good at following so that he can be rewarded when he follows the command. A random small bit of food or lavish praise within in seconds of obeying will let him know you are pleased he followed you command. You can gradually move his pain med schedule til you get it more in line with something that works for your work schedule for those meds with an every 8hr schedule. Is there a neighbor/friend/family/church member, etc you might be able to enlist for the afternoon dose for a workable 6:30 - 2:30 - 10:30 schedule? The test pred taper will be starting on Sun 7/21 where the pain meds would be full stopped as well or backed off in x/day. Do you have a med chart set up to help you keep track? D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf
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Post by Susan & Demo on Jul 23, 2019 10:38:19 GMT -7
ongoing medication schedule:
prednisone as of 7/8: taper dose: 5mgs 1x/day for 6 days, as of 7/14:5mgs 2x/day for 7 days sun 7/21 test taper tramadol 50mgs 3x/day roboxin 125mgs which is actually given 2x or 3x/day? it is 3 x a day metronidazole 100 mg 2x/day this med was completed pepcid ac 5mgs 2x/day he has also been on gabapentin since 7/14, 100 mg, 3 x day.
7/21 should have started his pred taper but i was out of town and did not want sitter doing it. 7/22 i missed giving him his morning meds. first time for that. by noon he was uncomfortable, moving around crate and started shivering. then i realized he had not had his meds!!!
[Moderator's Note. Please do not edit 15.4lbs prednisone as of 7/8: taper dose: 5mgs 1x/day for 6 days, as of 7/14:5mgs 2x/day for 8 days 7/22 test taper 7/22√ Pain tramadol 50mgs 3x/day Roboxin 125mgs 3x/day Pepcid AC 5mgs 2x/day ]
i believe he is still in some element of pain. when completely drugged up and out of it, i can very lightly run my finger down his back. at any other time, when i get to the exact middle and it feels like the bone is higher there, he reacts - looks at me, moves away from me, pushes my hand away with his paw.
i do not know that he is ready to taper prednisone. i am going to call the vet today but wanted to check in and see if this could be a sign that surgery is needed? or do some need longer time on prednisone?
he has no neurological defects. not one foot slip as in last time. can bear all of his weight. when accidentally let go, he scampers away and i have to run and catch him.
thank you, susan
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Post by Romy & Frankie on Jul 23, 2019 14:20:49 GMT -7
If Demo is showing signs of pain, now is not a good time for the taper. Let the vet know the signs of pain that you observed so that Demo can have more time on the full dose.of pred. It can take a total of 30 days on the full (non-tapering) dose of pred to resolve all the swelling in the spinal cord. It is common for dogs to need more than one taper. At this point, this is not an indication that surgery is needed.
Since Demo has no neuro deficits and wants to get going be super careful that he does not move too much. It would be just horrible if he were to have a relapse of the healing disc.
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