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Post by Becca Vandeneynde on Sept 10, 2019 13:45:59 GMT -7
Second time with IVDD
Hi, I am looking for opinions and thoughts. I have a 5 year old puggle named Lilly that was diagnosed with IVDD two and a half years ago. She had surgery in L4-L5 area in February it was two years. She has been doing good since, up until about two weeks ago. We noticed she was moving slower and her energy level was way down. She started to lose some function in her back legs again. (Wobbly, and falling over often) Since then, we have put her on medicines ranging from Prendisone, Gabepentin, and carprofen.
[Moderator's Note. Please do not edit
23 lbs
Prednisone start date? ? mgs ?x/day taper date? Stopped 9/10
carprofen start date? ? mgs ?x/day stop date? Stopped 9/10
gabapentin ? mgs ?x/day
no GI tract protector, Pepcid AC, on board w with pred nor carprofen!!]
We were not seeing much improvement but also was not seeing a huge decline either. We met with the surgeon today and he thinks she herniated a disc in her cervical spine this time. They said this is common for a dog that had one disc problem to have more in their life span. They are wanting surgery to be done again. After paying the first time $6,000 we are un sure what to do. The conservative approach may have to be our option. They are telling us even if they do the surgery this time she may need it again even after this one. There is no way real way to tell. I am just looking for opinions on what to do or if any one has a dog that has had more than one surgery and how they are after.
Thank you so much!
Becca & Lilly.
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Post by Romy & Frankie on Sept 10, 2019 14:14:28 GMT -7
Welcome to Dodgerslist, Becca. We are 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!
Some dogs have multiple IVDD episodes over their lives and some have only one. Unfortunately, there is no way to know how many episodes a dog will have.
We have dogs on Dodgerslist who have been treated medically for one episode and then conservatively for another. We have some info on when to consider surgery here:
www.dodgerslist.com/literature/healingsurgery.htm
Since Lily can still walk, although wobbly, she is a very good candidate for conservative treatment. Are you currently crating Lily? 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.
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.
Carry Lily 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
If she is too big to carry it is still important that the amount of movement to the potty place be minimized. Try a pee pad right outside the crate.
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:
Is Lily showing any signs of pain? ☐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 between doses. If not in control your vet needs to know asap to adjust meds.
How much does Lily weigh?
Please list the exact names of meds currently given, their doses in mgs and times per day given.
If currently on a steroid….what was the start date & dose? Date of steroid taper? If on a NSAID, for how many days has it been prescribed for?
All IVDD dogs are at risk for excess stomach acid which can cause damage to the GI tract. Dogs on an anti-inflammatory are at particular risk. We can help prevent damage to the GI tract by using a stomach protector like Pepcid AC. Ask the vet if Lily 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
The usual dose of 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
Is Lily showing any signs of GI Tract problems? —Eating and drinking OK? No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?
We encourage you to register and become a member of the Forum. That way it will be easier for you to reply and make it easier for us to track your dog and give the best of comments and support. Tips on registering:
www.dodgerslist.com/forumads/RegisterFORUM/register.htm
Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD as soon as 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
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Post by Becca & Lilly on Sept 10, 2019 14:38:10 GMT -7
Lilly is showing signs of not being able to find a comfortable position, is not her perky self, she shows signs of pain when touching her upper neck she will jerk away, her breathing becomes husky at times. She looks arched over where she cant lift her head all the way. She really just lays there and doesn't move unless we get her up to go outside. She does walk when we stand her up to do so, just very wobbly and not to the extent she was doing before.
Lilly weighs 23lbs.
The vet took her off of prednisone, carprofen, gabapentin, and today and started her on
Tramadol 50mg twice a day and Amantadime 100 mg 1/2 once a day.
She was on prednisone and carprofen but they said since it was only a few days to not worry about tapering her off that she would be okay to switch. They [credentiasl of "they"?] did recommend the over the counter to help with stomach lining which we are going to pick up today.
[Moderator's Note. Please do not edit
23 lbs
no GI tract protector, Pepcid AC, on board w/ with pred nor carprofen!!!!!!!!!!
Prednisone as of 9/2: ? mgs ?x/day for 8 days Stopped 9/10
carprofen as of 9/6 : 25 mgs 2x/day for 4 days Stopped 9/10
tramadol 50 mgs 2x/day
amantadine 50 mgs 1x/day ]
You said STRICT crate rest, she really just lays around on the couch. Does it have to be in the crate or is the couch okay if we are WITH her where she cant fall off?
Also, since she can walk still you were saying to try to limit it as much as possible? So should we try to NOT let her walk and keep her resting as much as we can even if shes wanting to get up? I was not sure if not letting her use the legs that are still working will make them more stiff or if its better to let them rest.
Thank you for your help.
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Post by Romy & Frankie on Sept 10, 2019 15:26:58 GMT -7
Thank you for registering, Becca. Prednisone and Carprofen are anti-inflammatories. What were the dates Lily was taking these meds? Prednisone is a steroid type and carprofen is an NSAID. It is dangerous to have both these meds in the body at the same time because of a risk to the GI tract caused by excess stomach acid. There should be a washout of 5-7 days when neither of these two types of medication are in the dog's system. Was there a washout period or did these two drugs overlap? Since the Prednisone and Carprofen were stopped there is no anti-inflammatory working on the swelling pressing on the nerves of the spine. It is this swelling that causes the pain and the neuro deficits, like wobbly walking. Do you know why the vet stopped the anti-inflammatory? An anti-inflammatory is almost always used for IVDD dogs. Please speak to the vet about an anti-inflammatory for Lily. If the vet wants to start an anti-inflammatory again soon, either a steroid or an NSAID, never both, it can be safely done with double stomach protection. Sucralfate is a prescription medication. It is inexpensive and it is a bandaid of sort for the stomach. This in addition to the over the counter Pepcid AC will help keep Lily protected. Tramadol and Amantadine are medicines for pain control. Is Lily showing signs of pain since starting these medications? Tramadol does not last long in the body and may need to be prescribed three times a day for full relief. If she is still showing signs of pain let the vet know right away so adjustments can be made. Strict crate rest is very important. Any time the dog is out of the crate it is risky. The reason for this is that it is immobility that can heal the disk. Movement may cause additional pressure on the spinal cord which could result in more pain and an increase in neuro deficits. I know that Lily is not moving much but dogs can do the unexpected in a heartbeat. It would be just terrible if too much movement caused additional difficulties for Lily. You mentioned that you are concerned about muscle weakness that could result from crate rest. Minimal movement can cause muscle weakness but as soon as crate rest is over and the dog return to activity the muscles will begin to strengthen and the muscle loss will be made up quickly. Any damage to the spinal cord caused by too much activity can take a very long time to heal.
Healing thoughts for Lily.
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Post by Becca & Lilly on Sept 10, 2019 15:35:33 GMT -7
There was a small overlap.
We did gabapentin and prednisone for about 8 days. We then tried JUST carprofen for about 3. Now today she [surgeon? ACVS or ACVIM?] switched us to these two new medications. Doesn't the tramadol help with ani-inflammatory too? Do you recommend her being on the prednisone with the tramadol and the amantadime? The only one I was against her having was the gabapentin I feel like it made her way too drowsy and uncoordinated.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 10, 2019 16:23:24 GMT -7
Becca, an hour ago you reported many red flag signs of pain. Lilly is off all anti-flammatories (carprofen and prednsisone) so nothing is there to work on the painful swelling any longer. Have absolutely no patience with pain. It hinders healing not to mention what torture! If the pain meds have been properly adjusted, expect pain to be masked in one hour and stay that way right up to the next dose of pain meds Anti-inflammatory drugs can take 7-30 days before they can resolve painful swelling. So they are not pain relieves in my book. Report back to the vet about the pain. Advocate for: -- tramadol promptly every 8 hrs. AND to be given at a higher dose in mgs. My 13 pound dog was Rx'd 50 mgs!!! -- a muscle relaxer: methocarbamol also every 8 hrs. -- re Rx gabapentin at every 8 hrs. -- for getting back on either pred or carprofen BUT NOT BOTH together. -- when ther is an emergency of pain not being controlled and a 5-7 day washout is not doable, THEN, two (2) stomach protectors are brought on board: 1. Pepcid AC (famotidine) to supress stomach acids all anti-inflammatory cause 2. Sucralfate to coat whereever they might be damge to the stomach lining. 100% STRICT crate rest 24/7 only out for potty time with a very, very few footsteps at potty time is how the disc heals. NO couches, no laps, no walking.....instead very limited footsteps to keep the neck and back from moving too much. You can help us by always using dates. And identify the kind of vet who does things make it clearer to follow along (your DVM vet, a specialist ortho-ACVIM or neuro-ACVIM vet, ER DVM vet). The vet who prescribed prednisone at the same time as giving carprofen put Lilly in great jeopardy. There should be a 5-7 days of washout from one before the start of the other. I would be very helpful if you would make a new post with proper dates and other detail for the two meds below: Prednisone start date? ? mgs ?x/day taper date? Stopped 9/10 carprofen 9/7 started? ? mgs ?x/day Stopped 9/10 name of stomach protector ? mgs ?x/day Vets choose an anti-inflammatory during a disc episode to get painful swelling down in about 7-30 days. These powerhouse meds do wonders OR they can be dangerous. Vets who practice safe medicine and owners up to speed on medications make all the difference. Did you get all four questions right? Answers here:
We most anxiously await news that meds have been adjusted so that Lilly is no longer suffering with needless pain. Let us know the adjustment in mgs, times per day and exact name of all meds. Here are the extra things you can do at home to help with a neck disc: www.dodgerslist.com/literature/cervical.htm Also there you will find more detail on the three pain relievers that are SO, so very typical to a neck disc episode. Please let us know the credentials of the surgeon today (neuro (ACVIM) or ortho (ACVS). |
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Post by Becca & Lilly on Sept 10, 2019 17:16:22 GMT -7
I just spoke with the surgeon they said to go ahead and continue ✙carprofen with the tramadol and the amantadine.
Tramadol 50 mg 1 tablet twice a day Start date: 9/10/2019
Amantadine 100 mg 1/2 tablet once a day Start date: 9/10/2019
Carprofen 25 mg 1 tablet twice a day Start date: 9/6/2019
✙Prilosec 10 mg 1 tablet once a day 9/10/2019
The surgeons credentials are DVM,MS,CCRP Diplomate ACVS
[Moderator's Note. Please do not edit
23 lbs
no GI tract protector, Pepcid AC, on board w/ with pred nor carprofen since 9/2!!
Prednisone as of 9/2: ? mgs ?x/day for 8 days Stopped 9/10
No DOUBLE GI tract protection with start of carprofen!!!!
carprofen as of 9/6 : 25 mgs 2x/day for 4 days Stopped 9/10
as of 9/10 pm: 25mgs 2x/day for ? days, then a test stop to reveal if any issues: _pain / _neuro
tramadol 50 mgs 2x/day
amantadine 50 mgs 1x/day
✙Priolosec 10 mgs 1x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 10, 2019 18:33:27 GMT -7
Becca, the situation of using carprofen when prednisone was just stopped today is a concern. There has been no 5-7 days of washout from pred before continuing carprofen. Prilosec is a proton Pump Inhibitor. It takes 3-5 days to reach peak efficiency. I recommend you do your own homework to read and be able to successfully advocate for DOUBLE stomach protection from the double jeopardy of two classes of anti-inflammatory drugs still in Lilly's body. It takes time for the body to metabolize and rid the body once a med has stopped. carprofen is a non-steroid anti-inflammatory Reading references:
" Steroids should never be given concurrently with a non-steroidal anti-inflammatory. Over the years, I have been involved in several cases of both bleeding and also perforated gastric ulcers, some of which required transfusions and/or surgery. Many non-steroidal medications have a very narrow therapeutic dose and the addition of even one dose of steroids can lead to severe intestinal consequences. It is VERY important to look carefully at medication history before starting either a steroid or a NSAID." Beth Davidow, DVM, DACVECC "Steroid Rules to Live By" www.criticalcarevets.com/sites/default/files/RDVM_spring_woot.pdf========= " NSAIDs have significant drug interactions with glucocorticoids (gastrointestinal ulceration is potentiated by glucocorticoids via inhibition of prostaglandin synthesis), benzodiazepines, salicylate containing herbs (meadowsweet or willow), gingko, garlic, ginger, ginseng, and aminoglycosides. ... Consider a minimum of a 7-day washout period between NSAIDs and either glucocorticoids or other NSAIDs." SMALL ANIMAL PAIN MANAGEMENT CLINICAL PHARMACOLOGY Katrina R. Viviano, PhD, DVM secure.aahanet.org/eweb/images/AAHAnet/phoenix2009proceedings/pdfs/01_scientific/025_SMALL%20ANIMAL%20PAIN%20MANAG.pdf Colin F. Burrows, B.Vet.Med., PhD, MRCVS, DACVIM College of Veterinary Medicine, University of Florida Gainesville, FL, USA 2003 There are nevertheless, certain fundamental principles that must be applied to all patients. ...protection of the gastric mucosal barrier... This can be minimized with aggressive prophylactic therapy early in the disease process. Intravenous ranitidine is a good initial choice with an oral proton pump inhibitor in severe disease. Oral sucralfate is also beneficial since it forms a protective shield over the eroded mucosa.www.vin.com/proceedings/===== 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats* Use gastroprotectants to either treat suspected gastropathy or prevent its occurrence, especially if no washout period occurs. Proton pump inhibitors, H2 antagonists, misoprostol (the drug of choice in humans), and sucralfate can be helpful.www.animalsurgical.com/wp-content/uploads/pain-management.pdf===== For symptomatic animals, GI protectants are very important. Mild gastrointestinal irritation may be treated symptomatically with antacids, such as magnesium or aluminum hydroxide. Misoprostol is helpful for treating or preventing gastric ulceration caused by NSAIDS as it stimulates mucus and bicarbonate secretion and increases gastric mucosal blood flow (contraindicated during pregnancy due to its abortifacient activity). H2 blockers, sucralfate and omeprazole can also be used to manage and/or prevent gastric ulcers. Sharon Gwaltney-Brant, DVM, PhD, DABVT, DABT. Toxicity of pain medications (Proceedings). 2010. veterinarycalendar.dvm360.com/toxicity-pain-medications-proceedings-0 You may find this little card handy to have with vet discussions to keep all the meds straight D/l and pring from here: www.dodgerslist.com/literature/MedCard.pdf
what the ref card looks like:  So in summary -- since there is a continuation of carprofen when Pred was only stopped today (no washout was done) double stomach protection is a real concern. Both Prilosec and sucralfate should be on board. Sucralfate is an Rx item from your vet. Remember Prilosec (Omeprazole) can take 3-5 days to be effective. Sucralfate should be on board now. -- if pain in not fully in control in one hr of having dose tramadol and amantine, the meds are then not right. Advocate for gabapentin and methocarbamol to be added. Most of the time these pain meds have a short life in the body. Thus with the more pain ful neck discs they are Rx'd for every 8 hours. Talk about that. Montior for GI tract damageGI tract damage progression: Nausea of not eating, lip licking, vomit, loose stool, bleeding ulcers, black or red blood in diarrhea, moving to deadly perforated stomach lining. Let us know you've been successful in advocating for sucralfate. Homework to learn the timing with food, with Prilosec (Omeprazole): marvistavet.com/sucralfate.pml |
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Post by Michelle & Keira on Sept 10, 2019 22:15:58 GMT -7
Hi Becca,
In response to your first post, yes we have done the surgery twice.
Back in February 2017 we had the first surgery. Then a few months later Keira went down again, we did not rush into surgery. We tried conservative treatment twice, but for her unfortunately it wasn’t to be. So October 2017 we reluctantly did the second surgery...I say reluctantly because of the cost!
Fast forward to now, she is doing great. However, we were warned that it could happen again. After the second surgery, they did put her into the low risk category...but really they have no way of really knowing.
There are so many success stories on here with conservative treatment, surgery isn’t your only option.
I wish you and Lilly all the best with her recovery with whichever path you go with.
Take care,
Michelle
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Post by Becca & Lilly on Sept 21, 2019 18:59:10 GMT -7
Hi. Wanted to update on Lilly. The last 11 days we have been doing strict crate rest and all the meds listed above daily. Lilly is now acting like her normal self. We are trying very hard to continue the crate rest to be sure, and we are also continuing the medicines. We are having more trouble giving her medicine because now that she is acting normally she is jerking her head away and purposely throwing the medicine back up. We have tried everything including pill pockets, wrapped in food, shoving to back of throat. She is continuously finding ways to get rid of the medicine. Interested in thoughts on how long to continue the medicines. She had another follow up appointment with laser therapy on Tuesday so I will talk to them too but just wanted your thoughts too!
Thanks!
[Moderator's Note. Please do not edit
23 lbs
no GI tract protector, Pepcid AC, on board w/ with pred nor carprofen since 9/2!!
Prednisone as of 9/2: ? mgs ?x/day for 8 days Stopped 9/10
carprofen as of 9/6 : 25 mgs 2x/day for 4 days Stopped 9/10
as of 9/10 pm: 25mgs 2x/day for 13 days+ ? more days, then a test stop to reveal if any issues: _pain / _neuro
9/22 vomiting ; No DOUBLE GI tract protection: Pepcid AC + sucralfate
tramadol 50 mgs 2x/day
amantadine 50 mgs 1x/day
Priolosec 10 mgs 1x/day]
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Sept 22, 2019 6:46:06 GMT -7
Good to hear that Lilly is now acting like her normal self and that you are continuing with the crate rest.
Jerking her head away when giving pills is definitely not good, especially with a neck injury. Are you sure she's purposely throwing up the meds or is she feeling nauseous with vomiting due to no washout period between the Carprofen and Prednisone and no double protection of BOTH Prilosec and Sucralfate on board. Vomiting is a red flag sign of GI distress. Please immediately let the vet know (or an ER vet) of the vomiting and get Sucralfate on board ASAP today to help Lilly's GI tract heal. We've seen dogs quickly progress from vomiting to bleeding, ulceration and perforation so please address this ASAP.
The swelling may be gone at this point and meds may no longer be needed. The only way to tell is to stop the Carprofen and pain meds (not the Prilosec and the Sucralfate which hopefully will be added today) and see if the pain returns. If pain returns, then the meds are still needed for a bit longer. If meds are still needed, possibly the vet could prescribe some of the meds in liquid form to make it easier for Lilly to take (just make sure any liquid meds don't contain Xylitol). If pain does not return, then the Carprofen and pain meds are no longer needed. Please speak to the vet about doing a test for pain by stopping the Carprofen and pain meds.
Transport can be risky for a dog going through conservative care as it can cause too much movement of the spine, which is dangerous. The benefit of any treatment such as laser therapy needs to be weighed against the risk. You're already doing the most important part of Lilly's care - the strict crate rest. Possibly finding a vet who can come to your home to do laser therapy would be an option.
Please confirm that you will now get Sucralfate on board ASAP.
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