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Post by Penny & Sherman on Oct 22, 2019 15:15:17 GMT -7
Penny's Sherman 10/21 Conservative-second episode. Earlier this summer Sherman recovered nicely from IVDD surgery and over the last few months really gained strength and was feeling good. Unfortunately yesterday morning (October 21st) I sensed he wasn't feeling well. Others living in the house said he seemed subdued and last night he didn't want to move much. This morning I saw signs of ataxia and took him [10/22] immediately to the vet.Without imaging, there's a suspected "lesion" and his therapist agrees he has definitely backpeddaled. Current status: Vet indicated good neuro signs with proprioception working . Bloodwork showed no other problems. weight is 10.3kg [22.71 pounds]conservative crate rest recommended for ~six weeks with sling support at potty time under close observation for deterioration therapy recommended at four weeks
Meds: Prednisone 5mg every 12 hours (will give first dose shortly), tapering after 7 days Pepcid indicated to be OK taken before prednisone (given) Gabapentin 250/5ml given 1ml every 8-12 hours for pain (first dose given) Trazodone 100 mg, 1/2 tablet every 8 hours as needed to keep calm (none yet dosed) [Moderator's Note. Please do not edit 22.71 lbs Prednisone as 10/22: 5mgs 2x/day for 7 days, then 10/29 test taper to reveal any: _pain / _neuro gabapentin 250/5mL: 50mgs 3x/day trazadone 50mgs 3x/day Pepcid AC 10mgs 2x/day]To my knowledge he has not yet urinated since this morning. We took him outside for a try -- no luck -- and it seemed his ▼ proprioception was not that good and he seemed to be i n some pain. (He is currently on gabapentin, resting in his crate with no apparent signs of pain.)I'm crushed. With his original episode it was similar with ataxia and overnight turned to complete paralysis. I will not put him through a second surgery.
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Post by Pauliana on Oct 22, 2019 17:15:16 GMT -7
Welcome back Penny, I am sorry to hear that Sherman is having another disc episode.. Some dogs have one episode in their life and others have multiple.. That doesn’t mean they can’t heal or need surgery.. Sherman is a great candidate to heal using conservative therapy.. Medications and crate rest for 8 weeks to make sure his disc has the time to form secure scar tissue and for him to heal.. 6 weeks is normally used to surgery cases.. The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/literature/CrateRRP.htmSTRICT 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. Sherman is going to need help to relieve his bladder since he is unable to go..If he isn’t expressed he will start to overflow urine and that can lead to urinary tract infections.... Review video then get a hands-on-top-of-your-hands expressing lesson from your Vet or Vet tech ASAP.. www.dodgerslist.com/literature/Expressing.htmFor pain control make sure that Sherman stays pain free from dose to dose.. Usually we see dogs on more than one pain med.. Pain slows down healing, so have no patience with it…. What we normally see along with Gabapentin is Tramadol and also a muscle relaxant such as Methocarbamol, so contact your Vet if he continues to have pain to have his medications adjusted,.. More info here: www.dodgerslist.com/literature/healingpain.htmI know it's hard but things will get better..
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Post by Penny & Sherman on Oct 22, 2019 22:38:03 GMT -7
Well here we are at just after midnight, and Sherman managed to pee all by himself. What a relief, pun intended. I also forgot to mention, we're using an Assisi Loop every two hours. I don't know how much help it gives, but it makes us feel like we're doing everything we can. I also suggested to my husband that we keep a dated journal of all events including pee/poop, feeding, meds and Assisi Loop application. That will make it a lot easier to manage with multiple people possibly caring for him. My husband is absolutely adamant we give Sherman every chance we can to heal, even though I'm emotionally drained have a negative outlook after the earlier surgery recovery. Hubbie is taking the lead and I'm thankful and I think he's right. We're looking at prognosis based off the grading scale: www.dachshund-ivdd.uk/symptoms-treatment/clinical-diagnosis/clinical-ivdd-grading-scale/ (Is there one like this on Dodgers List?) Presently it doesn't seem like Sherman is in any pain but I'm keeping a close eye in case I think we need to ask for additional prescriptions.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 23, 2019 8:38:24 GMT -7
Penny, glad you have your husband's positive outlook to guide you. The problem with those grading scales is dogs do not read them! So they heal with the help of mother nature and a dog's own self healing ability on their time schedule without aid of those dire/depressing scale % prognostications. Here is what you need to be monitoring for so you can alert your vet for possible adjustment to prednisone and of course alert if pain is not fully in control dose to dose of the unusual one pain med on board (usually it takes 3 pain meds each addressing a different source of pain). NEURO FUNCTIONS As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 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. A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservativePAIN MONITORING If you are seeing any pain, then advocate via phone call to your vet for pain meds to be Rx'd 3x/day (every 8 hours) and addition of other pain meds to cover all sources of pain. — Methocarbamol works on the pain of muscle spasms 3x/day — Tramadol is the general pain reliever 3x/day — Gabapentin works on nerve pain 3x/day There should be no sign of pain from one dose of meds to the next. No pain when having to move such as at potty time. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock.
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 1) How often are you actually dosing 1mL of gabapentin? every 8 or every 12 hrs? 2) Pepcid AC - are you giving 10mgs 2x/day? A med chart is an excellent idea to ensure all meds/treatments are given especially when there are multiple care givers!. Here is a sample download and print in order to adjust to Sherman's meds: www.dodgerslist.com/literature/crateRRP/medchart.pdf
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Post by Penny & Sherman on Oct 23, 2019 17:16:42 GMT -7
Hello again Paula. Today, Sherman's condition has deteriorated. He can still stand with assistance but he can't walk and has lost proprioception. He still has not pooped. I did have my husband call the vet to see if given the deterioration, they wanted to change any medications. The vet to whom he spoke: - was unwilling to alter the prescriptions, including addition of another type of pain medication
- suggested we bring him in to discuss surgical options (we declined)
- stated the most important thing in lieu of surgery is lots of rest
- assured us that if he needs to poop, it will happen (involuntarily?)
I don't see any obvious signs of pain but he does occasionally shiver (could also be anxiousness or actual cold since in our Midwestern climate it's getting nasty out). I would prefer to know he's slightly overmedicated than undermedicated. I may try a second conversation with an on-duty vet tomorrow.
1) How often are you actually dosing 1mL of gabapentin? every 8 or every 12 hrs? We're currently dosing every 8 hours.
2) Pepcid AC - are you giving 10mgs 2x/day? Yes. We're targeting 1/2 hour before the prednisone doses.
Thank you for the chart link. That layout is ideal. Can one edit the actual PDF chart? I work as a Software Engineer and it may be a fun little project to make a chart generator online or as a plugin for various hosted sites if such functionality doesn't yet exist.
Although I didn't think he was ready to discuss the possible eventuality, my husband stated if Sherman doesn't recover mobility we'll get him a set of wheels. We'll be sacrificing some of our quality of life (travel if we can't find assistive care) for our little guy. I'm sad and happy at the same time. For me it means I don't have to be afraid to still love on Sherman and I won't miss our routines.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 23, 2019 19:27:20 GMT -7
Penny, as far as you can tell, is the diminishment related to possible too much movement of the back— say at potty time or being rambunctious in his suite or more than limited footsteps (instead walking) at potty time? Put on the detective hat to see what shivering might be due to --- anxiety? try some soothing talk, coming close to him, petting to see if he is calmed and less anxious, stops shivering. These calmers can help with anxiety: Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives (ACE, alprazolam or trazodone). Of course always keep your vet in the loop on all things you give your dog. Place a DAP pheromone diffusor at floor level where the recovery suite is: --DOG Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/Use diffusor with one oral calmer from below: Oral calmers: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.php 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com --- cold shivering? Try placing a warmed towel blanket from the dryer over him to see if shivering lessens. --- Pain shivering? Often will also have other signs of pain. Pain shiver can be nearing the next dose of gabapentin or when he has to move such as at potty time. With proprioception loss, are then both back paws knuckling under? Is he slow to right the paws or no longer has ability to place them correctly? Let us know what the morning vet says about possibility of upping the prednisone a little bit to help get the swelling down, possble to round up to 10mgs 2x/day? The pressure on the cord is what causes nerves to die. Nerves can self generate, but best if nerve damage is prevented.. That would be totally impressive and so very useful to pet parents to have a med chart generator. Our PDF med chart is not something that can be edited but just used as a guide in making one's own chart. . When things settle would love to learn more! Just PM me and let's talk! As your husband is thinking all is not lost if perchance at the end of 8 weeks for the disc to heal, there is still a very good life to live for Sherman. Funny story my husband and I were traveling with my post-op wheelchair guy who was not one of the lucky ones to regenerate his nerves. At the checkin desk one night we explained we have a pet who is in a wheelchair. He does not pee on his own, we help him do that. So we go up to our room. It looked a bit different. Looked at the bathroom and looked at each other. Broke out laughing. The clerk had given us the handicapped room. So traveling with Clark was really never a problem but always a joy, he was just the same fun loving dog he had always been. Fingers crossed that Sherman's neuro dimishement will steady and start the process of regenerating. Please keep us posted on communications with the vet in the morning.
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Post by Penny & Sherman on Oct 26, 2019 7:12:40 GMT -7
Well here we are four days in. I don't think Sherman's deterioration was due to movement because he hasn't been moving much and was crated immediately when I saw the ataxia. There has been no further deterioration so I hope we've seen the worst of the injury.
Over the last day and a half, I think there's been some improvement. He has wiggled his toes on both back feet a couple times when I tickled his paw pads. He's also assisting in getting to a standing position when it's time to come out of the crate. Yesterday I helped him into a careful variation on his poo posture and he had a successful BM (this made us rejoice).
The prednisone is definitely working because he needs to urinate (without expression) at least once every two hours. I've also noticed that use of the Assisi Loop seems to bring a good bathroom event about 5 minutes after the treatment is finished.
I've noticed after potty breaks when we settle him back in his crate that his back legs will be quite stiff/locked. I always very gently move them and within a few seconds he releases the joints. I don't know if this is good, bad or a combo?
I did not contact the vets a couple days ago as I wound up in the ER myself. (I'm fine, probable stress-induced migraine that occurred at work.) Fortunately Sherman has been relaxed and I have seen no signs of pain so I plan on calling the vets right around the time we start the prednisone taper.
Since there are three of us taking care of Sherman, there have been some miscommunications about his care. Dose times are sliding around when someone gets home late, the Assisi Loop doesn't have to be applied exactly every two hours, etc. My husband sure would like a website or app to track this but being in IT I absolutely do not trust something this important to a service that might somehow become unavailable and prefer to have everything on paper, including a running log with potty times and comments. Ideas fomenting.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Oct 26, 2019 7:26:28 GMT -7
Penny, sorry to hear of such a bad migraine it needed ER.
You are reporting some good things about Sherman: --- no further neuro diminishment. Means the pred is working to reduce swelling around the spinal cord nerves!!l --- A good normal BM is a good sign of the body processing nutrients. --- I would hold off on tickling paws. It causes a reflex reaction that could be too much movement of the back in leg jerking. Instead look (observe) some sort of head level involvement with the tail, with a limb or with release of urine so we know the movement was done with purposeful thinking (the brain could send a message to a body part). ✶ Sniff (head level nose) then release of urine would be brain directed. ✶ Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail/leg movement during potty time can often be a reflex ✶ Itchy sensation at at neck and then tries to scratch would be purposeful movement.
--- It is not a bad idea to reposition his legs properly so that the brain, muscle memory, etc can relearn what should be. As you are doing, gently move the joints into proper position. This also keeps the joints moving and helps with lubrication. --- The prednisone taper test may reveal IF pain still exists that same day or it may take several days for enough pred to leave the body and reveal pain IF there is any pain to reveal. So before the pred taper test for pain/neuro increase would start on 10/29 you will definitely want to know WHICH your vet prefers regarding pain masking gabapentin. 1. to back off gabapentin on 10/29 or..... 2. full stop gabapentin on 10/29 Do let us know what your vets wants
I'm keen to know what you will devise on the med chart thing. I agree there is nothing better than paper to track and have a physical thing to look at when updating ones vet. Nothing wrong with using one of those pill apps to remind you to give a dose, plenty of free ones available. But when there are several care givers, that paper med chart is invaluable in not missing doses, notating cause/effects, etc.
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Post by Penny & Sherman on Oct 27, 2019 6:29:21 GMT -7
Having a scary episode right now. My husband took Sherman to his potty break (big pee) and I found poop in the crate so like a whirlwind I restaged his crate with fresh bedding while my hubby sat with Sherman. A minute or so after my husband put him back in the crate, I noticed Sherman panting. Respiration rate was about 88/minute. We also noted some shivering. Unfortunately with Sherman's medical history, this could be one of three things. - Pain related to spinal injury.
- Lung irritation. He's been hospitalized with multiple bouts of pneumonia and has compromised lungs, various questions over the years if he maybe has megaesophagus. I keep Benadryl on hand to stop escalation.
- Trazodone side effect. He got a half dose last night at 10:30 pm which was in the 7-hours-ago range. I had noted some issues with trazodone with his last recovery. Maybe seratonin syndrome?
Husband is feeling a bit badly because he said Sherman was trying to refuse being put in the crate and struggled a bit, but I'm thinking hubby just didn't notice he was already breathing heavily.
I called the vet hospital, they had no advice other than to bring him in if we continue to be concerned.
Because I'm having issues with anxiety, I'm relying on my husband to make the decisions. He decided we'll stay put for now and monitor. His prednisone dose is due in five minutes. We'll wait at least an hour to see if that helps and if not, decide what to do next.
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Post by Ann Brittain on Oct 27, 2019 7:09:54 GMT -7
So sorry to hear Sherman is having an issue with pain.
It is good that you checked with the vet and that you plan to monitor Sherman's condition to see if the pain subsides.
I would get him checked out if his condition gets worse after you give him the prednisone. You know your dog's behavior better than anyone, so trust yourself to do what's right for him.
It's good you have a support system. Anxiety can be very difficult to deal with, but staying positive for Sherman is important.
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Post by Romy & Frankie on Oct 27, 2019 12:11:18 GMT -7
Here is some information that may help you understand Sherman's behavior.
If you are not sure if the shivering is a sign of pain or not, look for another sign of pain to confirm. I am putting the signs of pain here again for your easy reference; ☐ 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? If you are seeing any of these signs in addition to the shivering it is almost certainly pain. Let your vet know you are seeing signs of pain so his pain meds can be adjusted. I see that
Sherman will be starting to taper fairly soon. If a dog is in pain it is not the right time for the pred taper to start.
Panting is a known side effect of steroids like prednisone. A fan near the recovery suite but not pointed at the dog can help with this. You can also try frozen broth ice cube to lick on.
We also have some information from Dr. Andrew Isaacs, DVM Diplomate ACVIM (Neurology) about panting here: www.dodgerslist.com/neurocorner2/panting.htm
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Post by Penny & Sherman on Oct 28, 2019 1:53:06 GMT -7
Thanks so much Romie for the side-effect information. I believe it explains what's going on with Sherman's newly observed pattern. During his last recovery he was on carprofen so I didn't see this. My husband made the call to stay put and not rush off to the vet hospital where we'd probably be charged for an IV that wouldn't help much so he made the right call.
He does seem hot so we added a fan, and his gums are a good color so it's not pneumonia. Also by now, the trazodone should be entirely out of his system. I've also noticed he pants a bit more when there's a potty break or household event e.g. someone comes home. His appetite is excellent, he's still to relieve himself and signals us when he needs either type of potty.
Tomorrow 10/29 is his seventh day of crate rest, so I believe his taper starts on or just after tomorrow. Based on what I recall reading in other threads, I should be looking for signs of pain. I call the vet for advice and refill under such circumstances? I don't think I have any instructions from the vet for gabapentin taper but I'll double-check tomorrow.
I'm wondering if Sherman is starting to gain more sensation in his hind quarters. Seems to me there's more tail movement, albeit more flicking and definitely not happy tail wagging. He's also sometimes not all that happy with me touching his hind end, but I think it's more anticipatory of being made to move than anything else.
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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 Oct 28, 2019 5:27:31 GMT -7
The taper of the Prednisone is to start on 10/29. However, you've recently seen signs of pain so it would not be time to start a taper of the Prednisone. While panting can be a side effect of Prednisone or anxiety, it can also be a sign of pain. You've today reported that Sherman pants more when there's a potty break (when he has to move) or when someone comes home (possibly more movement due to excitement). You also recently reported shivering when taken for a potty break. You have reported today that he's sometimes not at all happy when you touch his hind end but you think that's more anticipatory of being made to move. Moving can cause pain and it sounds as though Sherman is reluctant to move, which is another sign of pain. Dogs can be very good at hiding pain but it sounds as though Sherman is saying that it hurts to move.
Pain means there's still swelling pressing on the nerves of the spine and still a need for all current dosages of all meds for a bit longer. It can take 7-30 days for swelling to resolve so it's not at all unusual that there may still be swelling.
Please speak to the vet today about extending the anti-inflammatory dosage of Prednisone for awhile, possibly another 7 days. Anything less than the anti-inflammatory dosage will not be effective on reducing the swelling pressing on the nerves of the spine. It's very important that the anti-inflammatory dosage be given to reduce swelling as it's that pressure on the nerves of the spine that can cause nerve damage as well as pain.
I know you previously spoke to the vet about adjusting Sherman's pain meds and he was unwilling to do. Strongly advocate today for an adjustment in pain meds. Pain does hinder healing and you don't want Sherman to have any pain. Tramadol can be added as a general pain med and Methocarbamol can be added for the pain of muscle spasms which often accompany an IVDD episode.
To answer your question about the giving of Gabapentin during the taper of Prednisone, having a pain med on board during the taper would hinder your ability to recognize any sign of pain. The sooner you recognize that there is still pain/swelling, the sooner the anti-inflammatory dosage of Prednisone can be resumed. So yes, Gabapentin should also be tapered or even stopped completely during the taper of Prednisone.
Please let us know what the vet says after speaking to them today.
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Post by Penny & Sherman on Oct 31, 2019 21:30:58 GMT -7
Hi Marjorie.
I did keep Sherman on his original, non-tapered dose of ✙prednisone. The last day and a half he must have been feeling pretty well because he's rambunctious, wanting attention and to get out of his crate.
[Moderator's Note. Please do not edit 22.71 lbs Prednisone as 10/22: 5mgs 2x/day for 7 days, via owner as of 10/31: 5mg 2x/day for ✙7 days, 11/7 taper test gabapentin 250/5mL: 50mgs 3x/day trazadone 50mgs 3x/day Pepcid AC 10mgs 2x/day]
I also called the vet hospital about his medications. Unfortunately his original vet isn't in until tomorrow so an on-duty vet reviewed his records. She agreed he needs to be pain free and keeping him on his original dose is fine, but she would not refill his prednisone without him coming in for a re-evaluation. I'll see if I can speak to his original admitting vet and/or get a refill from my normal vet (OK by tonight's on-duty vet) because I'm not thrilled about the idea of transporting him back to the hospital. Frustrating to say the least.
Some positive news, Sherman has been more active and wags his tail a bit when we take him out of his crate. Also another scare though, I didn't fasten the door on his crate correctly and he crawled out a pretty good distance within the space of literally one minute. I'm still horrified that happened and sure hope he didn't do too much damage.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Nov 1, 2019 6:12:35 GMT -7
Penny, good news that Sherman is feeling more himself and is wagging his tail. It can become quite a challenge to continue crate rest once they start to feel better. But be vigilant and stay strong!
On what date did Sherman escape from his crate? Did you see any sign of pain or neuro loss after that escape? Hopefully he's dodged a bullet and the escape has not resulted in any further damage to the spine.
I'm sorry to hear that the vet didn't fully appreciate the importance of strict crate rest and wanted a re-evaluation before refilling the Prednisone. I don't know what she expected to accomplish by a re-examination. You can observe whether Sherman is in any pain or is getting worse in any way and report your observations to the vet. I hope you can work that out with the original admitting vet or the regular vet so a needless, risky transport is not necessary. You'll need enough Pred to do the taper, too, as Pred cannot be stopped without tapering.
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Post by Penny & Sherman on Nov 2, 2019 20:01:30 GMT -7
Hello again Marjorie.
I have some great news. Today I left Sherman in hubby's care and both Sherman and hubby got a decent amount of rest over the afternoon. When I returned home, Sherman stood up on all fours and greeted me with a happy tail wag!
Sherman's crate escape occurred on October 31, so I think he did manage to dodge a bullet. I called my regular vet and I have an appointment for Tuesday, November 5th for the purposes of renewing the prednisone prescription through taper. My regular vet hasn't seen him in his current condition so wants to do an evaluation and I'm still dismayed that the emergency vet hospital wouldn't refill his prednisone prescription without re-evaluation.
As of Monday, Sherman will be 14 days out from being re-diagnosed as having an IVDD issue.
I'm planning on attempting the taper and carefully watching for any deterioration. My understanding is the painkillers (gabapentin) should also be tapered to reveal any issue with the prednisone taper. I'll call my regular vet for advice prior to our appointment, but generally speaking how should the parallel tapers work?
So happy for Sherman.
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Post by Julie & Perry on Nov 2, 2019 22:42:35 GMT -7
Standing up and a happy tail wag! That's awesome. I'm doing my Snoopy happy dance for you both. Woohoo!!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Nov 3, 2019 5:11:45 GMT -7
What wonderful news, Penny! Very happy for all of you.
Try to speak to someone else at the hospital, if you haven't already. Possibly it was just that one vet who was being stubborn about renewing the Prednisone. Or possibly the regular vet would agree to renew the Prednisone without an evaluation if he could review the hospital records. If you requested it, the hospital should fax the records to your regular vet - they can't refuse to do that. My vet once gave my Jeremy an additional pain med that the hospital refused to give just based on a review of the hospital records. It would be terrible if the trip to the vet and exam proved to be too much movement of the spine and Sherman should have a relapse. If you have to take Sherman in, be sure to pad his crate well with rolled up blanket/towels to prevent too much movement when you brake and turn corners.
Yes, the Gabapentin should be tapered or stopped completely when the Prednisone starts to taper. Some vets believe Gabapentin should be tapered, others will just stop it. All vets do tapers differently. Usually the dosage is reduced for a few days, then reduced again for a few days and then possibly skipped a day. The vet will work out a schedule for you. Be sure a plan B is arranged ahead of time so that if the pain/neuro loss happens at night or on weekends when the vet is not open, you know what meds to give.
Prayers for a pain-free taper off of all meds for Sherman.
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Post by Penny & Sherman on Nov 5, 2019 22:35:04 GMT -7
I haven't had any luck getting any vets to refill Sherman's prednisone prescription, so through this morning I kept him on his original prescription doses and came home early from work to take Sherman to his regular (and miles closer) vet.
Once I got home and helped Sherman out of his crate, I saw the first signs of leg movement. He was paddling a bit in the back in a walking-like motion along with some vigorous happy tail wagging.
The vet noted Sherman still has deep pain sensation although proprioception is now absent. Both his ✙prednisone and ✙gabapentin prescriptions where refilled, and the vet suggested I keep him on the current doses for another two weeks. Prednisone over four weeks seems long to me?
[Moderator's Note. Please do not edit 22.71 lbs Prednisone as 10/22: 5mgs 2x/day for 7 days, via owner as of 10/31: 5mg 2x/day for 7 days, 11/7 taper test as of 11/5: 5mg 2x/day for ✙14 days, TUES 11/19 taper test gabapentin 250/5mL: 50mgs 3x/day trazadone 50mgs 3x/day Pepcid AC 10mgs 2x/day]
In any case, the vet openly admitted he doesn't see many IVDD cases and strongly suggested that I follow through with the vet hospital therapist's evaluation at four weeks and follow their guidance. I mentioned that I'd rather not move him until eight weeks is up, but he again suggested I follow through with the experts. Basically, Sherman's regular vet is deferring care and doesn't represent a second opinion.
I've noticed lately that Sherman seems to have a really good day followed by a day of backtrack. I'm wondering if this isn't due to his feeling good and moving around too much followed by a day of "ow". I've been told that while hubby and I are home he fusses for attention and once we depart he settles right down.
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Marjorie
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Post by Marjorie on Nov 6, 2019 6:13:02 GMT -7
Wonderful news on the signs of leg movement, Penny! Sherman is well on the path of recovery. It can take up to 30 days for the swelling to resolve and sometimes even a bit longer and until the swelling is gone, the anti-inflammatory dosage of Prednisone and pain meds are needed. Vets who fully understand the usage of an anti-inflammatory during an IVDD episode will prescribe Prednisone for one-week periods and then try a test-for-pain/swelling taper. No one wants their dog on Prednisone for any longer than absolutely necessary and there's no way of knowing whether it's necessary without a taper to test for pain. The reason you didn't do this past taper was that you were seeing signs of pain. In another week, that pain/swelling may be gone. I would speak today to the vet you just saw and speak to him further about the taper of the Prednisone. Since you started another course of Prednisone on 10/31, a taper could be tried on 11/7 (unless you're still seeing signs of pain occasionally). If he's still having "ow" days as you mentioned, then discuss tapering one week from the new prescription, which would be 11/12. Here is more information about the inflammation phase of IVDD for your use in discussing this with the vet: www.dodgerslist.com/literature/healingsweling.htmSpecifically, what do you mean by "backtrack" followed by a day of "ow"? Are you still seeing days when Sherman shows signs of pain? If you're still seeing occasional signs of pain, then his pain meds need to be adjusted again. Pain hinders healing so have no patience with it. And if you feel Sherman is moving too much in his crate, then steps need to be taken to help him stay calm and resting in the crate - see more below.You are absolutely correct not to heed the hospital's advice about consulting with a therapist and hold off on that until the 8 weeks of strict crate are finished and Sherman has had an opportunity to gradually increase movement again. You've learned what it takes to heal a damaged disc and that gives you the information you need to say "no" to incorrect advice. Too much movement before the disc has healed can result in a relapse and you'd be back to square one. Just to confirm, Sherman's recovery suite needs to be only large enough for him to stand up, turn around and lie down with his legs comfortably extended. Any additional area must be filled in with rolled up towels/blankets. In the following post, I'll give some tips to help calm Sherman during crate rest. If you try some of these and they don't work and you feel that Sherman may be moving around too much, you may need to give a mild sedative from a vet. It's better to have a slightly sedated dog rather than a dog moving too much and not healing.
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Marjorie
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Post by Marjorie on Nov 6, 2019 6:15:05 GMT -7
Here are some tips to help calm Sherman in the crate. If these do not help, it may be necessary to have the vet prescribe a mild sedative. To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him/her. It also creates a den like feeling that dogs love. Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price. Place a DAP pheromone diffuser at floor level where the recovery suite is. Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones Use a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. 3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba) Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc. Consider some of these ideas: -- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising. More details on strollers: www.dodgerslist.com/literature/strollers.htm--Caster wheels can be added to a wire crate so the crate can be wheeled from one room to the next so your dog can stay with you. -- Put a garment you have been wearing and have not washed in the crate. -- Nan Arthur, CDBC, CPDT, KPACTP writes: "According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day. Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.] wholedogtraining.com/images/stories/Are_all_dogs_trainable.pdf -- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from on high. -- Play classical music or one of the wildlife TV shows. -- Fill a Kong with soft dog food and freeze. Put part of the dog's total daily dinner kibble in the Kong to lengthen time to consume dinner. Good low cal snacks are carrots, apples, or frozen green beans, licking a frozen low sodium broth ice cube. Good thick low salt/no fat chicken broth is full of cartilage-building proteins and amino acids. Freeze it up into cubes for easy access as you need it. Fun and keeps the body hydrated: place cubes in a bowl for licking.
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Post by Penny & Sherman on Nov 11, 2019 4:51:02 GMT -7
Sherman has been doing very well for the most part until this morning, another bit of a scare. I woke up to the sounds of vomiting. This is extra scary for us because of his propensity for coming down with aspiration pneumonia.
Fortunately what he expelled looked to be the water he'd just drunk and a trace of peanut butter he'd enjoyed earlier in the night. His breathing is slightly elevated but he has good gum color. There was also a miscommunication/mixup and I think we missed giving him his dinner last night :/ and I have noticed he seemed to gurgle a tiny bit the last couple of days when I picked him up, so I'm pretty sure this is stomach irritation. He still has an appetite so we fed him some breakfast and so far he's kept it down and looks comfortable.
Sherman is still on prednisone. Prior to the 11/7 taper attempt he was showing additional signs of improvement. He can now push off with his hind legs coming out of his kennel and moves both back legs easily although still doesn't have the ability to hold himself up and doesn't have full proprioception (and we don't intentionally test for this). With the 11/7 taper we saw subdued behavior and signs of pain again so continued with the usual dose and were planning on test tapering again 11/12. Our regular vet had suggested another two weeks regular dose from the 5th.
Now I'm thinking it would be wise to taper him _immediately_ and not wait another day. I called the vet hospital and was put in touch with a vet tech who wasn't really helpful other than to say if this is the first time he vomited, we could stay the course and observe for more vomiting or bring Sherman in and have him re-evaluated for taper instructions. Not helpful.
I have taper instructions right on the prednisone bottles from both the vet hospital and from his regular vet. The vet hospital version has a taper of seven days with a dose once every 24 hours, then another I believe four days with a dose every 48 hours. The regular vet has taper instructions to dose once every 24 hours for two days and then once every 48 hours until we're out of pills (we'd have extra pills left over due to early taper). Right now I'm preferring my regular vet's advice and will call him when the clinic opens in the morning.
In other news we have been managing to keep him pretty calm, but I now wonder if part of that isn't an upset stomach. He's currently wearing a calming collar, I occasionally use spray-form Adaptil and I've been giving him Anxitane per package instructions. He's also lost quite a bit of muscle mass due to the crate rest and prednisone.
Any additional advice regarding the vomit/prednisone greatly appreciated.
-Penny
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Marjorie
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Post by Marjorie on Nov 11, 2019 5:41:26 GMT -7
Sometimes Pepcid AC is not enough to counter the side effect of Prednisone. You need to contact any vet who will cooperate with you without an examination immediately to advocate for the addition of Sucralfate. Sucralfate works in a different way to bandaid the damaged mucus lining and also promotes a healing environment. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/html/sucralfate.html
www.marvistavet.com/sucralfate.pml corrected URL Be sure to get the Sucralfate on board today whether you proceed with the taper or not. What has the vet prescribed for the Gabapentin during the taper of the Prednisone - stopping completely or tapering off? Having pain meds on board during the taper would make it very difficult for you to quickly see if any signs of pain return. Pain means there is still swelling pressing on the nerves of the spine and still a need for all original dosage of meds for a bit longer. So do speak to the vet about stopping or at least tapering the Gabapentin during the taper of the Prednisone. Don't be concerned about the loss of muscle mass as that will return once the 8 weeks of strict crate rest are over and movement is once again gradually reintroduced. Good news on the signs of nerve healing that you've observed, Penny! That's wonderful. Prayers for a pain-free taper off of all meds. Please let us know what the vet says after speaking to them this morning.
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Post by Penny & Sherman on Nov 11, 2019 15:03:16 GMT -7
Hello Marjorie. I think the link you provided is outdated, it appears that the link is now: www.marvistavet.com/sucralfate.pmlI managed to get a prescription ✙[Sucralfate] from my local vet clinic, but the actual doctor who examines Sherman wasn't in today and will be back in on Wednesday. The vet on duty advised that I could reduce gabapentin to twice per day instead of every eight hours, but wanted me to see how Sherman tolerates the prednisone with the sucralfate before tapering. At any rate, I skipped his prednisone dose this morning until I could get his sulcrafate on board later in the day so we are in fact in the equivalent of a taper at the moment.[Moderator's Note. Please do not edit22.71 lbsPrednisone as 10/22: 5mgs 2x/day for 7 days, via owner as of 10/31: 5mg 2x/day for 7 days, 11/7 taper test as of 11/5: 5mg 2x/day for 14 days, TUES 11/19 taper testgabapentin 250/5mL: 50mgs 3x/daytrazadone 50mgs 3x/day✙sucralfate 1gram tab: ? mgs 2x/day Pepcid AC 10mgs 2x/day]The bottle came with big pills inside that I'm to split and administer. I remember at some point in the past Sherman had this medication and I was instructed to pulverize it and create a slurry for administration, as noted on the marvistavet site. Also, "Sucralfate requires stomach acid in order to form its protective gel. If possible, it should be given 30 minutes prior to the administration of an antacid." The vet didn't mention this but I'll be sure to administer it before famotidine as a slurry. Two hours after the sulcrafate dose, Sherman must be feeling pretty well because he kept his early dinner down (broken down into several servings spaced apart) and he's back to generally fussing in his crate. I'll be keeping a close eye on him for several more hours, and later tonight he'll get famotidine and prednisone with more close observation. I noted more improvement today. He has an anti-anxiety collar on that probably causes some irritation to his neck. More than once he scratched his shoulder/neck area with a hind paw.
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Marjorie
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Post by Marjorie on Nov 12, 2019 6:12:22 GMT -7
Thank you for pointing out the change in the Sucralfate link on the Marvistavet site, Penny. And good job on doing your own research about Sucralfate and how to give it! So glad that Sherman is feeling better with Sucralfate on board. Scratching with his hind paw must have been a most wonderful sight to see!
Prednisone is one drug that you, yourself, do NOT want to be self administering. The drug MUST be used under the strict direction of a vet...the body's own production of life critical corticol steroid hormone can be dangerously messed up with the use of synthetic Prednisone. Please do let the vet know that a dosage was skipped and do follow their current instructions and then speak to the regular vet on Wed. When I recently saw you mention that you were planning on tapering on 11/12, I thought that was with the vet's OK. Speak to the vet on Wed. about trying a taper at this time to test for pain/swelling. Decreasing the Gabapentin to 2x/day will help give you a clue as to pain. If no pain with that decrease, hopefully the vet will agree to test taper the Prednisone now.
What is the dosage of the Sucralfate?
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Post by Penny & Sherman on Nov 15, 2019 18:40:00 GMT -7
Well, another day started with great anxiety at 3 am. I woke up to the sounds of Sherman giving a plaintive bark, so I got up to take him to his potty area. I noticed he was exhibiting labored abdominal breathing. Shortly after placing him back in his crate, he regurgitated/vomited mostly clear material with a couple pieces of kibble. Happened twice more, so off to the vet hospital we went. For context, a similar episode happened early Monday morning (11/11/19) after which sulcralfate was added to his meds (no transport/vet exam: rx via phone).
The ER hospital vet we saw has two dachsies herself ("love the weens") and said that about 50% of the cases she sees in the hospital are back-injury related so immediately I felt a little more at ease with her expertise.
Due to the abdominal nature of the breathing, she was immediately concerned about possible hallmarks of myelomalacia. I let her know that Sherman had similar episodes in past with regurgitation, so after examining his blood panels and after his breathing rate came down she was a bit less concerned but still guarded.
His blood panel shows that systemically, he has tolerated the prednisone very well. Gastrically maybe not, so she wants him off the prednisone ASAP with possible washout to NSAIDs if necessary and was pleased to hear he's already on sucralfate and famotidine. [Thank you so much to this board for the educational material!]
She noted that he has neurological deficits and although his anal tone is good she noted some "softening" on the left side. She also mentioned "spinal walking" and said she didn't think he had made much neurological improvement. I'm not entirely buying this. He places his feet correctly and I've seen him scratching his neck multiple times with a hind paw, but I'm not an expert so I keep it in mind. She did also say he has both superficial and deep pain.
Sherman now has additional medications on board and we are tapering his ▼prednisone. If he vomits late at night his plan B is ✙Ondansetron 4 mg tablets, 1 tablet by mouth every 12 hours for nausea. If he backtracks in progress he will need to be washed out to an NSAID so he'll probably be back to the hospital for evaluation, unfortunately.
[Moderator's Note. Please do not edit 22.71 lbs Prednisone as 10/22: 5mgs 2x/day for 7 days, via owner as of 10/31: 5mg 2x/day for 7 days, 11/7 taper test as of 11/5: 5mg 2x/day for ▼11 days, 11/15 taper test + GI issues gabapentin 250/5mL: 50mgs 3x/day ✙methocarbamol 125mgs 2x/day ✙tramadol 25mgs 2x/day trazadone 50mgs 3x/day ✙Ondansetron 4 mg 2x/day sucralfate 500mgs 2x/day Pepcid AC 10mgs 2x/day]
* Continued Pepcid, sucralfate and gabapentin doses. * ✙Methocarbomol 500 mg tablets, 1/4 tablet by mouth every 8 to 12 hours as needed. * ✙Tramodol 50 mg tablets, 1/2 tablet by mouth every 8 to 12 hours as needed. * Continue prednisone every 24 hours for 7 days, then every other day for 7 doses, then discontinue.
It is now 7:31 PM and I'm glad to report that his breathing is no longer labored and he seems alert and anticipating dinner. I'm careful to space out the sucralfate and famotidine from the other meds and to give food with the prednisone to make sure absorption and protection are in place. I sure hope he sails through tonight and we all get some good sleep.
Exhausted but semi-relieved. -Penny
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PaulaM
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Post by PaulaM on Nov 15, 2019 21:05:02 GMT -7
Penny glad to most recent update of breathing well, alert and anticipating dinner! If he can place his paw correctly on ground, can scratch his ear with hind paw, then you are correct! By definition he would have to have deep pain sensation (DPS) to be able to do those things. Please keep us updated as the prednisone taper continues. Fingers crossed that no pain will surface nor will there be any diminishment in neuro function. Pain= another course of anti-inflammatory + all pain meds back on board. No Pain= finish pred taper...and finish out the 8 weeks of crate rest for the disc to heal. The full details on how any anti-inflammatory works with a disc episode. Good reading to be able to ask the right questions and discuss treatment: www.dodgerslist.com/literature/healingsweling.htmPlease advise: ✙methocarbamol 125mgs which? 8 or 12 hrs? ✙tramadol 25mgs which? 8 or 12 hrs? sucralfate ?mgs ?x/day
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Post by Penny & Sherman on Nov 16, 2019 7:47:38 GMT -7
Hello Paula.
The prescribed dose of sucralfate is 1g tab, 1/2 to 1 tab by mouth 1-2 hours before meals twice daily. We're giving 1/2 tab.
So far with the methocarbamol and the tramodol, we've been administering it once every 12 hours.
We also had to add a carabiner clip to the crate door. Little Mr. Escape Expert got out last night, got himself over to a storage bin, popped the top off, took out a bag of teeth cleaning treats and took the bag over to a mattress topper on the floor that we use near his crate. We found him joyfully helping himself to one of the treats. :/ We thought that was a fluke because someone left the door unlatched, but he popped the door open again an hour later.
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Marjorie
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Post by Marjorie on Nov 16, 2019 8:51:43 GMT -7
So sorry to hear that Sherman escaped from his crate, Penny, especially in light of the fact that he is currently in a taper of the Prednisone. Should any pain or loss of neuro function occur now, it would be difficult to determine whether it was due to too much movement of the spine during the escape or the tapering of the Prednisone. If it were due to too much movement, that would mean the disc re-tore and the 8 weeks of strict crate rest would have to start over. If it were due to the tapering of the Prednisone, that would mean there's still swelling and still a need for original dosages of all meds for a bit longer. Hopefully, he'll be OK and will be able to continue with the taper of the meds.
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Post by Penny & Sherman on Nov 21, 2019 22:24:30 GMT -7
Well, Sherman has made it to day 7 of the first taper; we just gave him his last dose of prednisone before we start the last seven doses 48 hours apart.
He's doing very well and thankfully his stomach seems to be settling with the reduced dose. I'm assuming I should continue with the Pepcid 12 hours apart until he's off prednisone?
We've both noticed Sherman seems to be exhibiting proprioception in his back legs, hoping this isn't just wishful thinking...
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