Jacqueline's Rigby 11/22 rlpse conserv. NECK; GRAD 1/19

Jacquelilne, welcome to the Care and Support Forum. We are really glad you are here.

FIRST, pain needs to fully control pain with a more typical  aggressive pain med approach. Call you vet or get to ER if need be to get proper adjustments.
  Make sure the medications are fully controlling pain from dose to dose with no break through in pain as will often happen with and every 12 hrs dose Rigby is getting!. Continued phone feedback to your vet is vitally important until the pain medications have been properly adjusted for your dog. There is no "one-size-fits-all" pain control.

These are the typical pain medications used to treat IVDD to address each source of pain:
--Tramadol as the general pain reliever. It has a short half life of 1.7 hours and may need to be prescribed at a minimum of every 8 hours.
--Methocarbamol treats painful muscle spasms. Also prescribed every 8 hours.
--Gabapentin for nerve pain. Veterinarians are finding this medication works synergistically in combination with Tramadol.  Again gabapentin needs to stay high enough in the body to help with pain...that means dosing every 8 hrs promptly
--Amantadine. When the above three meds have been Rx'd at the aggressive dose in mgs and at every 8 hours, but pain is still not fully controlled, then advocate for the addition of amantadine - allows other analgesics to function more effectively. The Mar Vista vets explain the mysteries of amantadine marvistavet.com/amantadine.pml

PREDNISONE
     Both classes of anti-inflammatories require stomach protection. The steroid class is the most powerful of the two classes (Prednisone, Dexamethasone, etc.) The lessor class are the NSAIDs (Rimadyl, Metacam, Deramaxx, etc.) Anti-inflammatories should be accompanied by a stomach protector such as Pepcid AC (famotidine) to avoid serious gastrointestinal damage of GI problems of damage.
    Proactive vets don’t wait til there is lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. marvistavet.com/famotidine.pml  

ANTIi-INFLAMMATORY drugs are used with a disc episode:
   An anti-inflammatory, steroid prednisone can take 7-30 days (exluding any steroid taper days) to resolve all pain. During a test-for-pain steroid taper is the time to watch for any returning signs or increased neuro diminishment.Pain/neuro diminishment indicates another course of the steroid  After repeated attempts to go off any anti-inflammatory, if pain cannot be totally resolved, surgery becomes a consideration. Please do read the full aritcle so you are well informed to speak up when needed, ask good questions and best understand the approach vet is using. LINK TO READ: www.dodgerslist.com/literature/healingsweling.htm

I'm sorry you did not get an Rx for 100% STRICT crate rest 24/7 only out of recovery suite for a very, very few footsteps at potty time.  The taper, the walking all revealed there is still inflammed tissue around the spinal cord. So far while Rigby has been on pred for only 15 days..  Five of those days were wasted when he went on a walk and this disc very likely retore putting him back at square one for 8 weeks of crate rest and likley several courses of pred to get all the swellign finally resolved.

Let us know, now, you are following STRICT rest:
- no laps - no couches - no walks
- no baths - no sleeping with you
- no chiro therapy - no dragging or meandering at potty times.

Carry your dog to and from the recovery suite to the potty place and then allow a very, very few limited footsteps.
    Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!

Have you tried a pack and play? It's a baby play pen.

My dogs hated being crated but tolerated the playpen much better.

You're doing a great job advocating for Rigby.

Jacqueline, 
   If the pain meds were correct, then you would not notice "when the meds kick in" that Rigby felt pain free eough to want to move around. The pain meds are clearly NOT right yet. All pain should be fully in control dose to dose, when he has to  move such as at potty time.  

Gabapentin quesitons
   Would you look at the bottle for the information re: how many mgs of gabapentin are contained in one mL?   Also while you may have been given a range of how often to give, we need to know what you are actually giving--- every 8 hrs or every 12 hrs.  With Rigby in pain before gabapentin kicks in it definately should be prompty on time every 8 hrs.  If you are doing that, then clearly one pain med is not sufficient. Strongly advocate for the more typical approach of covering each of the three different sources of pain with it's own pain med AND all to be dosed every 8 hrs.
-- tramadol as the general analgesic
-- gabapentin   unknown mgs dose should be every 8 hrs for nerve pain
-- methocarbamol for the type of pain from muscle contractions dosed every 8 yrs

PREDNISONE
Depending on the dosage, steroids can be a replacement steroid hormone in dog not able to make sufficient hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive effects for other diseases.

For a 14lbs dogs with a disc episode, the usual is to Rx the upper end of the "anti-inflammatory" range.  So that may be something to bring up for discussion with your vet as to moving up to 4.2mgs twice a day. Normally a vet would round up to 5mgs 2x/day. The goal is to expedite getting the swelling resolved quicker that the upper range of the anti-inflammatory dose does.

A med chart is very useful for noting cause and effects for discussion with a vet and making sure all meds have been given on time.  D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf

Jacqueline, for clarity.... it is noted on the gabapentin bottle that there are 75mgs of gabapentin in one mL of liquid?

Getting a sense of these meds is very important in understanding what is going on.

Prednisone is not a pain reliever.  Its job is to resolve painful inflammed issue over the course of 7-30 days. So in  my book prednisone just can't be called a pain reliever for a disc episode.  I mentioned discussing going up to the anti-inflammatory level of prednisone during a disc episode is because that is what most vets do.  The idea is to work on getting the swelling resolved in a timely manner...lower doses such as Rigby is on drags out the process.  Nerves do not like swollen tissue. Often it will compress the spinal cord. The nerves in the cord react by dying (nerve function of legs, bladder, etc are dimished or lost.)  So far Riggy has not suffered neuro diminishment. Perhaps a discussion of moving to the upper end of the anti-inflammatory level will expedite swelling resolution for Rigby.

Pain relievers take action in one hr or less.  Pain from a disc episode comes from nerves, from muscles, skeletal. Different pain receptors are blocked by different drugs….thus the usual need for several classes of pain meds. Getting dose to dose pain relief will happen in an hour when the meds are right for your dog. Working with your vet, giving prompt specific observational feedback about pain is how the meds are tweaked (change mix of pain meds, adjust the dose in mg and/or the frequency to give) to get it just right for your dog. There is no reason that Rigby should not be provided fully round the clock pain relief benefit from a cocktail of pain relievers.

When my dogs have an episode they take 3 different medications for pain: Tramadol for general pain 3x daily, gabapentin for nerve pain 3x daily, and methocarbomal for muscle pain 3x daily.

This has worked well to keep them comfortable.

Sending healing thoughts and prayers for you both.

Pain meds should never be given "as needed" but need to be consistently given every 8 hours. I understand that this is difficult given your work schedule. Possibly a neighbor or family member could stop by to give Rigby his meds when you're at work? Or the vet's office may have a vet tech who could be hired to stop by? It's important that the meds be given consistently to keep pain consistently under control. All of the pain meds that Paula previously discussed have a short half life and should be given consistently every 8 hours. If given 3x/day some days and only 2x/day other days, pain may arise and that can hinder healing.

The dosage of the Gabapentin is within the usual dosage given for dogs of Rigby's weight. Gabapentin works on nerve pain. Methocarbamol works on the pain of muscle spasms. Tramadol is a general pain med. It often takes all three of these pain meds to get the difficult pain of IVDD completely under control. Pain should be completely under control within one hour of giving new course of meds and remain completely under control from one dose to the next.

As for the Prednisone dosage, 5mg 2x/day is the standard anti-inflammatory dosage that we see given for a 14 lb. dog. It's important to get the swelling that's pressing on the nerves of the spine down as quickly as possible.

I hope the vet will be able to get Rigby's pain completely under control this morning. Healing prayers for Rigby.

OK, I'm not a vet but I have two dogs with IVDD and have been dealing with it for years.

Unfortunately, neither of the doctors you're dealing with are comfortable treating IVDD.

If they were they would know IVDD is very painful in multiple areas.

I appreciate you are doing the very best you can.

Keep pushing and I wholeheartedly agree with you that it's time for an IVDD savvy vet to take over Rigby's care!

Sorry you're having to go through this resistance and lack of support.

Hang in there and keep pushing and looking.

Best wishes to you both.

Hi Julie. 

My stomach has been in knots all day over this. I feel like there’s no one in my area that has experience in treating IVDD. I even called the Emergency Vet today thinking perhaps they might know of someone. She was not any help either. How can this be? It is very common...especially in dachshunds. Additionally, neither Vet mentioned Pepcid today....I told them that I added this to his med routine and how I am dosing....the comment, “Oh, ok...that’s ok.”? Seriously??? 

Thank God, Rigby is not getting worse. It has only been 3 days on strict crate rest and 3 days with the 2.5 mg addition of prednisone at bedtime. He did not seem painful when he woke this morning (no hunching, head down, etc). Still a great appetite, pooping and peeing normal, tail wags, etc...I remain hopeful about the addition of tramadol.

thanks for your support! I so appreciate it!

jacqueline

So very glad to hear that Rigby appeared to be comfortable this morning, Jacqueline! That's great news. Of course, should you see any sign of pain in the coming days, you'll need to advocate further with the vet for an adjustment in meds. However, if in fact the vet has now been able to get Rigby's pain under control, it may be best to stay with this vet until after the 8 weeks of strict crate rest is over and then find a vet more familiar with IVDD so as to avoid transport and exam by a new vet while the damaged disc is still healing.

According to the schedule that you gave, Gabapentin is being given 4 times a day. Please confirm how many times a day Gabapentin is being given.

Just to confirm, please also give the Pepcid AC 30 min. before the Prednisone and then every 12 hours thereafter for as long as Rigby is on any dose of Prednisone, even once the Prednisone starts to taper. For how many days is the new dose of Prednisone to be given before starting to taper?

Good news, too, that your friend is willing to stop by to give Rigby his meds while you and Christian are at work! You're doing a great job getting Rigby all that he needs to heal. Kudos!

Jacqueline, such good news that all pain is fully in control by your finding an IVDD knowledgeable vet in how pain meds are used!   Over time, if you continue to find this vet is a good fit for treating conservatively, please do consider adding her name to our Member's Vets Directory. It sure would be helpful to another trying to locate a vet comfortable wth Conservative Treatment medications for a disc episode.

Where to add to the directory:   dodgerslist.boards.net/board/10/guidelines-posting

vet recommendations: 
Name of Vet
Name of Clinic
Street Address
City:
State or country:
Type of vet (general/board certified surgeon, acupuncture, etc.)
Comments:  

It appears that you will be able to mark your calendar for Dec 30 graduation day upon a full 8 weeks to get that neck disc to heal!  With no current ambulatory issues, there will likely not be any reason to need physical therapy.

The beauty of pills being on board to provide full pain relief, means that you most likely would not need to used other therapies of laser or acupuncture as an adjunct to help control severe pain. In fact with his current meds, IF, if there would be an arise in signs of pain, there is still room to move up the meds to provide more pain relief.   I think if you are committed to the principal of 100% STRICT crate rest 24/7 only out of the suite for a very, very few footsteps at potty time, Rigby should be able to avoid any more relapses to the early healing disc.  If there  a true need for laser or acupuncture, the safer idea would be to avoid those risky-to-the-healing disc transports in to the clinic by hiring a mobile vet who will come to your house. 

Acupuncture and laser therapies.  Those two therapies can also help help to reduce pain when an already aggressive pain med approach is on board making the risk of transport worth the benefit of pain relief.

Laser light can help to kick start nerves to self heal by jump starting the process. The laser light energy promotes a photochemical reaction which increases cellular metabolism. This, in turn, expedites cell repair.  Warning Laser light is not for use if there is existing tumor or cancer.  Your report so far is that Rigby does not have any neuro diminishment...has that changed? 

Good morning friends.

Whew....we made it through Thanksgiving and all the company in our home without issue. Rigby is doing fantastic. The round the clock med routine is managing his pain. Last week (Dec. 3), Dr. Fletcher reduced the ▼tramadol to 2X daily (every 12 hrs). It has been 6 days now and he has responded very well to this slight reduction. We began the prednisone taper today (Dec. 9). 2.5 mg 2X daily (every 12 hrs) vs 5mg am and 2.5 pm that he has been on.

[Moderator's Note. Please do not edit
14 lbs
prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro
                      as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro
                     as of 11/18: 5mgs 1x/day for 5 days
                    as of 11/23 neuro: 5mgs am/2.5mgs pm for 16 days, 12/9  test taper
11/4 short walk prior to 8 weeks of disc healing time
tramadol 12.5 mgs ▼2x/day
gabapentin 75mg/mL: 75 mgs 3x/day
Methocarbamol 125 mgs 2x/day
Pepcid AC 5mgs 2x/day]

He has received 3 total laser treatments so far and we go for his 4th today. We have established a safe transport routine with Rigby. The Vet comes to the car to get us when they are ready for our appointment. I am very pleased thus far with her and will definitely add her to our list of IVDD savvy veterinarians if she continues to impress me.

to be continued......jacqueline

Good morning and Happy New Year friends!

I am writing to give a brief update on Rigby. Just to clarify, Rigby began strict crate rest on November 22. The day of his neurological/surgical consult. And so, he is still on strict crate rest until Jan 18. He is doing quite well. Dr Fletcher has him on 2.5 mg of prednisone am and pm.
▼Tramadol 12.5 am only. ▼Methocarbamol 125 mg pm only. 50mg/ml ▼ am and pm. He has remained on the 5mg of Pepcid am and pm since November 22.
We have an appointment today (01.06.20) for laser therapy and med tapering. He will go again next Monday (01.13.20) for his final laser treatment and begin water therapy Jan 20 as long as he is still progressing well.

[Moderator's Note. Please do not edit
14 lbs
prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro
                         as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro
                         as of 11/18: 5mgs 1x/day for 5 days
                        as of 11/23 neuro: 5mgs am/2.5mgs pm for 16 days, 12/9 test taper 
                        as of 1/6: still on 2.5mg 2x/day
11/4 short walk prior to 8 weeks of disc healing time
tramadol 12.5 mgs ▼1x/day
gabapentin 75mg/mL: ▼50 mgs 2x/day
Methocarbamol 125 mgs ▼1x/day
Pepcid AC 5mgs 2x/day]

Thank you again for your input and prayers. Who knows where he would be in this process had I not discovered this community!

Best,
Jacqueline

Thank you Majorie. I too have wondered why so long on the meds? At this point could you offer a recommendation based on your experience with tapering that I could suggest to when I am there today? We have continued with the laser therapy per the veterinarian’s recommendation and because he seems to be benefiting from the treatments. I will heed your warning about water therapy and let them know that we will not move forward with that until Rigby had had sufficient time to acclimate to movement again. 
thank you so much!