Christine's Abby 1/1/20 conservative- NECK

Christine, welcome to the Forum. Glad to hear you understand the crate rest is to get the disc to heal and that takes 8 weeks!  Wonderful to have the assist of your MIL in giving the meds on an every 8 hr schedule. It is clear that Abby is way under medicated for pain! When the pain meds are correct pain is in control in 1 hr or less and it stays in control dose right up to next dose.

Blue Pearl should have someone there tonight to read her file and get those meds right.
--- neck discs just ARE more painful and an aggressive pain med approach should be impletented.
--- Gabapentin for nerve pain every 8 hrs.
--- methocarbamol for muscle contraction pain every 8 hrs
--- tramadol as the general analgesic also every 8 hrs.
     The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours. So for Abby that may mean close to a full Tramadol tablet, not the minimal 12.5 mgs of tramadol Rx'd.  See Plumb's reference below so you can advocate for adjustment. Plumb's is considered the "drug bible" of the veterinary world. -- Extra things you can do at home to help with a neck disc.  BTW, did the vet confirm it was a neck disc?  These tips won't hurt even if it is a back disc: www.dodgerslist.com/literature/cervical.htm

ACID SUPPRESSOR a must with Prednisone!

CALMERs
YOu may need to help Abby to be able to relax in her recovery suite.
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

RECOVERY SUITE
A wire crate is often preferred over the plastic airline type of crate because wire gives better visitity and feels less isolating.  An expen is also anothe type of suite.  Some dogs do well in a pack N Play, too.

Christine, if the pain is indeed fully under control round the clock, right up to the next dose of pain meds (gabapentin and tramadol) then Abby has a very good chance to heal her disc in comfort while the prednisone works on getting all the painful inflammation resolved.

To prevent delay in advising, so we are prepared and at the ready to provide good comments when needed,
   1. Would you bring us up to speed on what is her actual med list is now. The concern is that  since there is a taper to begin tomorrow (SUN 1/5) but pain has only just now been brought under control.  Likely all swelling would not have been resolved by Sun (with that rather short 4-day pred course)  Recall that it often takes in the range of 7 to 30 days (excluding any taper days) to resolve all the inflamed tissue). 
   2. What is the Plan B with your vet if pain were to  surface on Sunday's start of the taper when your vet is closed? Do you have extra pills to back up to the orig anti-inflammatory pred dose  OR do you have a script you can fill at a local 24hr pharmacy?

8 lbs /3.63 kgs
Prednisone as of 1/1: ?mgs 2x/day for 4 days, then SUN 1/5 test taper to reveal if any: _pain / _neuro
tramadol 12.5 mgs 3x/day
gabapentin as of 1/3: ? mgs ?x/day
Pepcid AC on board??     5mgs??   twice a day?

Christine, the calmer can take a couple of days to reach peak. Still there are some dogs that just do need an Rx item to help them be able to relax.  Still with Abby being on two drugs (prozac and tramadol) already that allows more serotonin to accumulate, the vet will be quite aware to take that into consideration before adding another drug that could cause Seratonin Syndrome.
    It is always a good idea to read up on each med your dog takes to be in the know and best able to ask your vet pertinent questions.  I keep the Mar Vista Vet page bookmarked for this purpose myself:  Mar Vista Vet Drug Directory

Consider some of these other calming 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

-- Put a garment you have been wearing and have not washed in the crate.

-- Nan Arthur, CDBC, CPDT, KPACTP: 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. [NOTE: for crate resting dogs, shift your body a bit] .... 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.]

-- At night, try placing the crate on a sturdy bedside table to sleep next to you.

-- During the day try the coffee table or the dinning room table so there will be a view out a window and a better perspective on what is going on in the house from a high.

-- Make the crate or ex-pen more cozy by draping a blanket over part of the top. 

-- Relaxation Music for Dogs! Here's the playlist for 70+ "tunes"

How is Abby doing on the taper today, Christine? Any sign of pain returning or any worsening of neuro function?

With pain meds on board, it will be difficult for you to quickly determine pain/swelling and the need for the return to the anti-inflammatory dosage of Prednisone. Usually a vet will also taper or stop the pain meds when the taper of Prednisone starts. It's important to know whether there is still swelling pressing on the nerves of the spine as it's that pressure that can cause nerve damage.

Prayers that Abby does well on the taper of the Prednisone.

For example with tramadol your vet Rx'd it at either 2x or 3x/day. So you could go down to tramadol 25mgs 2x/day as a backing off of it. Same idea with gabapentin.   Let us know what you do re-backing off of pain meds so we have a record.  Would not hurt to call and specifically ask your vet. A vet will tell you their preference: 1) either full stop of all pain meds  OR  2) backing off and what that means in terms of down to dose in mgs and/or how often to give.

When backing off of pain meds you would be monitoring for re-surfacing pain.
When taper pred you would be monitoring for any worsening neuro function from the point she is at the start of the pred taper.

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.

Hi
I noticed yesterday Abby was panting a bit in her crate.  She was panting again this morning, as well. She was trembling, but she's been a trembling dog her entire life. 

We ended the prednisone taper yesterday.  She is showing no other signs of pain/neuro damage. She's pottying well, shaking her ears, wagging her tail. No crying/yelping, no arched back. 

Any advice?
   tramadol 25 mgs 2x/day
   gabapentin: 25mgs 2x/day
   Prozac 5mgs 1x/day