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Post by Laura & Houston on Nov 12, 2019 19:52:03 GMT -7
Houston’s back injury Houston 4 yr old Cardigan Corgi 9.5 kgs injured Nov 06,2019 he is currently on Metacam 1.5 mg/ml, 0.65 mls once a day. Gabapentin 100 mg, 2 tablets every 8 hours Robaxin 500 mg, 1/2 tablet every 8 hours [Moderator's Note. Please do not edit
20.94 lbs
Metacam as of 11/6: 1x/day for ? days, then a test stop to reveal any: _pain / _neuro
gabapentin 200mgs 3x/day
Robaxin 250mgs 3x/day
no GI tract protector, Pepcid AC, on board w/ Metacam! ]Our diagnosis was a narrowing of space between vertebra right beneath the ribs. His pain seems controlled well. He’s in good spirits and on complete kennel rest. Hes is eating and drinking ok not well but I think ok. Poop seems ok though he currently has no control over pooping or peeing. We find his bed wet. He’s not moving his back legs at all. We saw a regular Veterinarian who took xrays. We were sent home with some meds but not much in the way of support or prognosis. I’m hoping for some advice on what more we can do to provide Houston with the best possible chance of recovery.  |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 12, 2019 21:27:15 GMT -7
Laura, welcome to the IVDD Forum. Sorry to hear Houston is suffering with a disc episode. Glad to hear the current meds are totally controlling pain dose to dose and when he has to move. If not, then the vet needs to know to make further adjustments.
—Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. There should be no sign of pain from one dose of meds to the next. 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 ? EXPRESSING THE BLADDER How often are you expressing (every 2-3 hrs when first learning?) If no lesson, then reading and viewing the video at this page will help you get more out of th lesson first thing in the am: www.dodgerslist.com/literature/Expressing.htm NOTE the video also for expressing poop at link.
If you've not been expressing the bladder, he likely already has developed a uninary tract infection (UTI). The vet will do a urinalisys to proove if bacteria and if antibiotic is needed.
PEPCID AC to suppress acids causes by Metacam
Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach.
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).
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
Since both the stress of changes in routine and Metacam will cause extra stomach acids, we follow the proactive vets who use Pepcid AC (famotidine) when any anti-inflammatory is in use.
The usual dose during a disc episode is Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours.
Give the anti-inflammatory with a meal as added protection. www.1800petmeds.com/Famotidine-prod11171.html
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 crate rest during the 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 including the nerve healling phase. 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.htmQUESTIONS For how many days will he be on Metacam? What country are you in? |
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Post by Laura & Houston on Nov 13, 2019 13:17:48 GMT -7
I have a call into my vet today to speak about expressing bladder, I also have a suspicion that Houston has a UTI as there was small amount of red tinge on his bedding last night. Houston is showing me he is in a small amount of pain this morning as his tummy seems tense. Wondering if this could be from a UTI? I will ask my Vet about Pepcid AC and long term treatment and medication plan. I was not given an idea on length of time for medications or treatment plan during the diagnosis appointment.
We are living in Canada.
A friend pointed me in this direction yesterday when she found out what we are dealing with. thank you for providing me with enough knowledge to ask my Vet better questions and to better help our wonderful Corgi to recover.
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Post by Romy & Frankie on Nov 13, 2019 14:32:46 GMT -7
Blood in the urine definitely indicates a UTI so tell the vet about that and have his urine tested. You should be able to drop off a urine sample at the vet's office so to avoid transporting Houston.
The pain could come from the UTI especially since the pain was controlled earlier. If Houston is in pain, no matter what the cause, the pain meds need to be adjusted. Pain caused by a UTI should stop shortly after the treatment is started.
Expressing the bladder is a skill that must be taught, practiced and learned. We have to do this to keep our dog's bladders healthy. I needed to have more than one lesson on expressing before I became able to successfully express my dog's bladder during his IVDD episode. Eventually I became proficient. You will too.
Usually the anti-inflammatory (Metacam) is given for around 7 days, After that it is stopped and the pain meds are also stopped or cut back. If no pain is seen when the anti-inflammatory and pain meds are stopped, the swelling is gone and no meds are needed. If pain is seen when the meds are stopped, more time on all the meds is needed. It is not uncommon for dogs to go through this test for pain more than once before the swelling is gone.
The nerve damage that has been caused by the disc material pressing on the nerves of the spine will take longer to heal. Some dogs have regained function after months or in rare cases even years. There is no medicine to repair the nerve damage. Time is what can heal it. It is very early on for Houston. There is much healing that can still take place.
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Post by Laura & Houston on Nov 14, 2019 10:07:58 GMT -7
Update:
Spoke with the Vet last evening, we are going to continue the meds for another few days.
[Moderator's Note. Please do not edit
20.94 lbs
Metacam as of 11/6: 1x/day for 12? days, then 11/18ish a test stop to reveal any: _pain / _neuro
gabapentin 200mgs 3x/day
Robaxin 250mgs 3x/day
no GI tract protector, Pepcid AC, on board w/ Metacam! ]
He hasn't mentioned any change in dosage at this point. I pick the refill up today and I will know more then. I did ask about an acid reducer and benefits of a pro biotic. He is going to get something together for me. I dropped off a urine sample this morning which was a miracle, as I am having trouble expressing Houston's bladder. He is resisting me and I suspect its pain related from the UTI infection.
On the plus side, Houston has had no DPR [Deep pain sensation (DPS) ?] since Nov 7 and on Nov 13 I seen decent responses in both hind legs. He is still not mobile at this point with no movement in hind legs, but if he's propped up he will stand for a short period of time. We have had him on strict kennel rest with potty breaks outside 4-5 times a day. We have been using a Light-force Laser therapy lamp 4-5 times a day. Alternating between circulation setting and pain settings. I asked the Vet about other alternative therapies, specifically acupuncture. He recommended a good therapist in my area, but expressed feelings that we should get through this critical stage first before alternative therapy should be used. I guess my question is: when should I start looking into alternative therapy for healing and recovery? I will be adding it in as a maintenance and life long therapy post recovery. But I wouldn't want to miss any opportunity to have the best healing possible in the early injury stages.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 14, 2019 13:04:34 GMT -7
Laura, hope if it is a UTI, getting antiobiotic on board will make Houston feel more comfortable. When you get an actual target date for the Metacam STOP test let us know. No one knows how long a Metacam course to Rx. So a vet just must make a guess such as may be a 7-day or 14-day course. The test stop along with stopping/backing off of pain meds, lets you and the vet know if another course is needed or not. Many general DVM vets are not practiced enough to discern the pressence of lack of DPS. Can Houston give you a happy tail wag if you specifically do some happy talk to him or he sees a treat coming? That would identify the existence of DPS. 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. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservativeTransporting is always a risk that must be very carefully weighed. Too much movement of the back could cause permanent nerve damage. Do you have any mobile vets who would come to your home? Keep us updated on the urinalysis and what the refill details are. |
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Post by Laura & Houston on Nov 15, 2019 12:13:06 GMT -7
Picked up refill of prescriptions last night and everything is staying exactly the same for now. I am suppose to be in contact with the vet early next week with an update. Urinalysis came back clean no infection, which i find surprising. The urinalysis did indicate there was presence of some protein in his urine and have recommended a food change. I was only able to speak with the tech at the counter when i picked up the prescriptions as Vet had already gone home for the day so I am going to try and touch base with vet today to make sure that we are all on the same page. There is no indication of a test taper or stop test for any of the medications, including Metcam. Because I asked about acid reducer for GI tract and stomach support Vet has also prescribed Omeprazole and Fortiflora.
[Moderator's Note. Please do not edit
20.94 lbs
Metacam as of 11/6: 1x/day for 12? days, then 11/18ish a test stop to reveal any: _pain / _neuro
gabapentin 200mgs 3x/day
Robaxin 250mgs 3x/day
Omeprazole ? mgs ?x/day ]
He didn't get one dose of the Gabapentin yesterday and when I got home last night from work with the refills i could tell he was not feeling well. He was panting a bit and his eyes showed some pain and or anxiety. Houston did seem much more comfortable this morning and tummy seems less tight. Houston has no tail as it has been docked. He has the cutest butt wiggle instead but we haven't seen it since the injury. Not sure what will be the next positive sign we will see but fingers crossed that we start to see some bladder control. I am still having a hard time expressing him but i keep trying and keep watching the videos.
I do think i will put a call into another vet for a second opinion. I am maybe being a worry wart but i have been hoping for a little more support and involvement in the treatment plan of Houston and I am wondering if this Vet is maybe not qualified enough, hes done great but is quite young and very busy. We don't have any specialists in the area but I have been recommended a very qualified vet that is also and acupuncturist and has a lot of holistic experience. I will however keep in mind that transporting Houston at this point isn't in his best interest. So an exam by a new vet is really out of the question.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 15, 2019 12:49:56 GMT -7
Laura, good that there is no UTI causing painful discomfort. Then it would be clear that signs of pain are due to the disc episode. Less pain, not as much pain is not good enough. The goal is no hint of pain at all dose to dose of pain meds nor when having to move PERIOD!
If your are still seeing signs of pain, then your job is to advocate for adding in a third...Tramadol 3x/day.
NOTE about omeprazole
This acid suppressor take 3-5 days to reach peak efficiency in acid suppression. Then it is supposed to be very good. Not the best choice with a disc episode when immediate suppression is wanted. Pepcid AC (famotidine) works in 30 mins and lasts for 12 hrs.
What is the dose of omeprazole in mgs and how often are you to give.
Do try some happy talk both as a spiriti lifter and as a neuro test to for being able to do a wigglly butt thing.
Vet vists should be for only the most important of benefits. If you are finding Houston leaks in his bedding then that is a health issue warranting going into the clinc where you express him and have the vet tech check your work and provide some tips for you. Can you tell us more about what "having a hard time expressing" means for you?
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Post by Laura & Houston on Nov 18, 2019 11:35:53 GMT -7
I have tried some happy talk with no butt wiggling yet. I have decided to go with the ✙Pepcid AC for stomach protection instead of the omeprazole. Houston is getting 10 mg, 2 times a day. And we are giving it to him half hour before his Metacam.
[Moderator's Note. Please do not edit
20.94 lbs
Metacam as of 11/6: 1x/day for 12? days, then 11/18ish a test stop to reveal any: _pain / _neuro
gabapentin 200mgs 3x/day
Robaxin 250mgs 3x/day
✙Pepcid AC (famotidine) 10 mgs 2x/day]
Expressing his bladder is getting better with each time. I still feel like i'm not 100% effective, but the Vet tech has been great in her guidance. I don't think that I am getting a complete empty of the bladder each time, and Houston seems to tense his tummy against my pressure. I will have a visit with with the Tech again today to discuss my technique.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 18, 2019 12:24:10 GMT -7
Laura, thought that a test stop of Metacam might be today? Do you have an update when the Metacam test stop will be? I probably would not hurt to occasionally every couple of day carry Houston outside and place on an old pee spot in the grass to first give him a change to sniff/ test to see if maybe bladder control is coming back. See if he then attempts to release some urine on the spot/ mark it. Let us know what you observe. When bladder control starts to come back, they can feel you expressing and may not like it. If Houston is not leaking on you when lifted and he is not leaking urine in his bed, then you would be doing a good job of expressing pretty much all the urine out. Technically, we probably can't express every last drop out. But we can express often enough and fully enough so that there are no urine leaks. How are you doing with expressing for poop. Not a health issue like urine. But more to avoid Houston becoming anxoius when finding poop where he sleeps. poop video and tips: www.dodgerslist.com/literature/Expressing.htm |
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Post by Laura & Houston on Nov 18, 2019 15:31:46 GMT -7
There is no set date for the test stop of the Metacam. But We have an appointment tomorrow with the vet so I will question that tomorrow. I take Houston outside once a day and let him sniff around. He hasn't attempted to pee yet but I do think we are getting closer to that day. I think maybe you are right and he can feel me trying to express him. He doesn't leak when I lift him but his bedding still will have wet spots. He is pooping when we take him out of his crate. I have only found poop in the kennel once or twice. I feel that even one time on the weekend he poop outside on purpose.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 18, 2019 18:41:07 GMT -7
Laura, transporting a dog on conservative treatment has to be for a really good reason. The benefit of the vet visit needs to surpass the risk to the disc. Vets who know IVDD understand this principal and will take a phone call with any observations of pain, or neuro diminishment to adjust meds. What overwhelming benefit do you expect from the visit scheduled for tomorrow?
-- All vets must simply take a guess of how many days to be on Metacam before calling for a stop. Often that will be a 7 or 14 day course. Naturall if you are seeing any hint of pain then there would be no need to do the Metacam test stop. This is some thing that can be discussed on the phone what date to test stop Metacam that avoids risk to the disc with a transport. BTW, no one wants a dog on Metacam one bit past the benefit of all swelling resolved. Metacam carries with it many adverse side effects.
-- You are very capable of observing and reporting any signs of pain, any reduction or diminshment of neuro function that would avoid risk to the disc with a transport.
-- Nerve healing may or may not take place in the short time it takes for the disc to heal. So if there is still no new neuro function improvement to report, that would not be unusual as best to think in terms of month rather than days/weeks for nerves to heal in. For the vet to see or not see nerve improvement is not worth the possible risk to the disc during a transport.
-- Feel you need more expressing instruction, then the benefit of a transport is a real health risk to ward off bladder infections. Expressing in the clinic and getting your work check is then a very good reason to transport Houston into the vet. Pad out the crate with rolled up blankets so he is snug. This way tht when you stop or take a corner his body will not shift.
-- Where do you believe Houston is on the neuro monitoring list below?
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. NOT YET??- Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors.
8. NOT YET- 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. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.
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Post by Laura & Houston on Nov 19, 2019 16:33:11 GMT -7
We had an appointment this morning to address expressing Houston's bladder. Vet and tech both felt that Houston is harder then normal to Express his bladder, which made me feel better knowing that I was doing it correctly. He is in fact resisting and that hes uncomfortable with us doing it. Fingers crossed that it means he has some bladder control coming back. He can clearly feel us pressing. we had a discussion to finish the 14 day Metacam course and then go to every other day. So he will receive his final everyday dose Nov 20, and then we will not give him a dose on Nov 21. If we see any discomfort or pain we are to go back to the everyday dose. We are going to continue that for one week with a reevaluation Nov 28.
I believe Houston is between 7-8 on the scale. With no tail to wag its hard to see him wiggling his butt. I do think that his bowel and bladder function is not a complete loss at this point, hes not sniffing and peeing on purpose yet, but hes thinking about it.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 19, 2019 17:06:14 GMT -7
Laura, steroids are the type of anti-inflammatory drugs that DO require a taper for health reasons. Non-steroid anti-inflammatory drugs such as Metacam do NOT need to be tapered. No one wants a dog on any anti-inflammatory one bit past the benefit of all swelling having been resolved due to adverse side effects. In addition drawing out the time on Metacam by this slow walking every other day doses for a week means delay in getting started on Houston’s important very, very least aggressive range of motion/massage for his legs. That needs to wait till he is off all meds and not revealing any pain. Vets who understand the meaning of stopping Metacam as a test, do these things: — At the close of the the 14 days course of metacam, either all the pain meds are backed off or they are full stopped. This gives you a true ability to accurately assess for pain without blinders of pain meds being on board. What is the harm in quickly finding out this information? — Hope you will be able to present a successful advocacy to not delay finding out if all swelling is really gone or not on starting with a complete Metacam stop on Nov 20. — Excellent overview of how anti-inflammatory drugs are used with a disc episode: www.dodgerslist.com/literature/healingsweling.htm— Let us know which your vet wants on the 11/20 full stop of Metacam backing off of pain meds or the full stop of them. Every couple of days carry Houston outdoors and place him on an old pee stop for the SnIff and Pee test. The only way for humans to know if there is bladder control returning is with the “sniff and pee test.” Carry outdoors, set them on an old pee spot to sniff. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. See if they will release urine on the old urine area. If urine comes out after sniffing, bladder control is returning. You should continue to do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe. |
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Post by Laura & Houston on Nov 20, 2019 16:15:10 GMT -7
I haven't had a chance to discuss the full stop of the Metacam verse the decrease to every other day option that I was given yesterday. I do know that both Vets that have consulted on Houston's case feel that the anti-inflammatory properties of the Metacam are still a benefit to Houston at this point, and want him to remain on it [Metacam] for another week. The decrease to every other day was to appease me when I questioned if he still needed the full medication load. I will have another discussion with the vet hopefully this evening after all his cases are finished for the day regarding a stop to test for pain.
[Moderator's Note. Please do not edit
20.94 lbs
Metacam as of 11/6: 1x/day for 15+ 7 days, then 11/27 a test stop to reveal any: _pain / _neuro
gabapentin 200mgs 3x/day
Robaxin 250mgs 3x/day
Pepcid AC (famotidine) 10 mgs 2x/day]
On a different note I took Houston outside this morning and though he didn't lift his leg, which would be normal for him, he did sniff and pee a small amount. My daughter called me at work this afternoon to let me know he has done it again today. I would say that bladder control is defiantly starting to return. The small victories feel glorious.
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Post by Julie & Perry on Nov 20, 2019 16:59:05 GMT -7
Woohoo! That's awesome. It's wonderful he's getting bladder control back.
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Post by Romy & Frankie on Nov 21, 2019 14:06:32 GMT -7
Good news that bladder control is starting to return.
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