Danielle’s Ellie 1/6/20 conservative

Sigh, why didn’t the vet just give me that this evening when we picked up the pred? I need to start her on it tomorrow before I leave for work, she can’t wait another 24 hours! So frustrating.

Do you think it would be okay to start her on the prednisone now or wait until morning? Her last dose of Rimadyl was yesterday morning at 9am. I just hate that she hasn’t been on any kind of steroid being down for 3 days now.

Danielle, I'm sorry to hear that Ellie is having another disc problem.

Meds should never be self-prescribed and must be given with the direction of a vet. The reason for you to not self-prescribe is your vet has responsibility for the health of your dog in meds he prescribes based on his exam, the health history of your dog, how meds interact, not things we or you might know as we are not veterinarians.

While there usually needs to be a 4-7 day washout period, as Julie mentioned, when a vet deems it medically necessary to switch from a NSAID to a steroid, that switch can be done without a washout period with the addition of both Pepcid AC and Sucralfate. Don't make the switch before getting Sucralfate on board and without speaking to the vet first.

Please let us know the doses and frequency given of the Prednisone, Pepcid AC and Sucralfate when they start being given. For how many days is the Prednisone to be given before tapering?

Meds are never to be given "as needed" which I see was the direction given with the Tramadol. You do mention in your med list that Tramadol is being given 3x/day which is what should be given. How much does Ellie weigh now? Is her pain completely under control with this course of meds?

Acupuncture and laser therapy can help given a jump start in healing but those treatments cannot prevent a degenerated disc from tearing or rupturing. We can try to help prevent a disc from tearing by preventing an IVDD dog from going up and down stairs and from jumping up and down on furniture but even with those precautions in place, a disc can still be damaged from disease. So please don't beat yourself up about that.

Healing prayers for Ellie.

The Rimadyl washout is for 5-7 days because any dose of it stays in the body for 5-7 days depending on each dog's ability to metabolize and excret it. So that means both pred and Rimadyl are in the body at the same time causes extra acids.  Since it is deeemed an emergency to not do a washout, then double stomach protection is in order.

Quotes from veterinary pharmacists who know all about drug interactions: 
1.   "Steroids should never be given concurrently with a non-steroidal anti-inflammatory. Over the years, I have been involved in several cases of both bleeding and also perforated gastric ulcers, some of which required transfusions and/or surgery. Many non-steroidal medications have a very narrow therapeutic dose and the addition of even one dose of steroids can lead to severe intestinal consequences. It is VERY important to look carefully at medication history before starting either a steroid or a NSAID." Beth Davidow, DVM, DACVECC "Steroid Rules to Live By" www.criticalcarevets.com/sites/default/files/RDVM_spring_woot.pdf

2.  When switching a patient from one NSAID to another (when no side effects have been seen), a washout period of 5 to 7 days minimizes chances for adverse drug interactions. Informing clients of the potential adverse effects of NSAID therapy and signs of NSAID toxicity greatly increases the likelihood of safe use of this class of drugs. Guidelines for safe and effective use of NSAIDs in dogs. Lascelles BD, McFarland JM, Swann H. Vet Ther 6:237-251, 2005.
www.researchgate.net/profile/B_Duncan_X_Lascelles/publication/7468324_Guidelines_for_safe_and_effective_use_of_NSAIDs_in_dogs/links/02e7e5166e788375a7000000.pdf

3. "NSAIDs have significant drug interactions with glucocorticoids (gastrointestinal ulceration is potentiated by glucocorticoids via inhibition of prostaglandin synthesis), benzodiazepines, salicylate containing herbs (meadowsweet or willow), gingko, garlic, ginger, ginseng, and aminoglycosides. ... Consider a minimum of a 7-day washout period between NSAIDs and either glucocorticoids or other NSAIDs." SMALL ANIMAL PAIN MANAGEMENT CLINICAL PHARMACOLOGY Katrina R. Viviano, PhD, DVM
secure.aahanet.org/eweb/images/AAHAnet/phoenix2009proceedings/pdfs/01_scientific/025_SMALL%20ANIMAL%20PAIN%20MANAG.pdf


Quotes about Pepcid AC (famotidine) and sucralfate (aluminum):
1. The antiulcer effect of famotidine plus magnesium and aluminum hydroxides was greater than the sum of the effects of these drugs used separately.
www.merckfrosst.ca/assets/en/pdf/products/PEPCID-PM_E.pdf
MERCK CANADA INC.
Date of Revision: April 27, 2011

2. Colin F. Burrows, B.Vet.Med., PhD, MRCVS, DACVIM College of Veterinary Medicine, University of Florida Gainesville, FL, USA 2003
There are nevertheless, certain fundamental principles that must be applied to all patients. ...protection of the gastric mucosal barrier... This can be minimized with aggressive prophylactic therapy early in the disease process. Intravenous ranitidine is a good initial choice with an oral proton pump inhibitor in severe disease. Oral sucralfate is also beneficial since it forms a protective shield over the eroded mucosa.
www.vin.com/proceedings/

3. 2015 AAHA/AAFP Pain Management Guidelines
for Dogs and Cats*
Use gastroprotectants to either treat suspected gastropathy or prevent its occurrence, especially if no washout period occurs. Proton pump inhibitors, H2 antagonists, misoprostol (the drug of choice in humans), and sucralfate can be helpful.
www.animalsurgical.com/wp-content/uploads/pain-management.pdf

CONSTIPATION
Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe.
--To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day.
-- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble.

Good morning,

Ellie is supporting herself a bit when we go outside with her back legs, but I’m still using the scarf as she can’t stand for long.

She doesn’t seem to be in pain but kept waking me up to go outside to pee. She would only go a bit at a time and then wake me up again. She is pooping every few hours, it’s just still small. She’s also been leaking on the blankets she’s on. She will pop up from a sleep to let me know she has to go but then already have gone a bit. Any ideas what this is being caused from?

I’ll be calling the vet again this morning about the second tummy protector. It’s just super frustrating that the vet doesn’t follow protocol and sadly that’s the only vet we’ve really taken her to since we got her.

Thank you for all you’ve helped with so far!

Hi Marjorie,

Thanks for the quick response. Ellie is going to the vet Monday for her next acupuncture and laser, not just for an exam.

I’ll be calling about a possible UTI now to see what they say.

Prednisone causes increased urination, not leaking, unless you're not taking her out often enough, which it certainly sounds like you are since you're even getting up several times at night to take her out. There's no guessing with a UTI - only urine testing will determine whether there's a UTI or not. It's a simple matter of taking in a urine sample to have it tested and if she has a UTI, getting an antibiotic on board. Unbelievable that the vet tech would suggest waiting until Ellie is off of Pred to find out whether she has a UTI or not! So sorry you're dealing with that. Do call again and insist that a urine test be done today.

Finding a acupuncturist who will come to your home to do acupuncture and laser would be the best thing but if that is not available to you, do be very, very cautious of too much movement of the spine during transport and treatments. The less movement of the spine, the better. Be sure to pad out the crate well with rolled up towels and blankets to prevent Ellie from moving around too much when you brake or turn corners.

What did the vet's office say about adding Sucralfate?

Good afternoon!

My biggest issue is--I have a hard time still being polite when I'm persistent but it did pay off   she did have some blood in her urine so I'm picking up Amoxicillin today.  I think that she was unable to pee and I, for the past 3 years, have never been able to figure out how to express her when she can't go so I'm sure her bladder was full for far too long.  I finally figured it out last night, it was so easy!  I cannot wait to get her on antibiotics because she has been getting me up every hour to go out to pee, which most of the time she can do on her own but I make sure she is emptied so she can rest comfortably.

We did add the second protector as well-the ✙sulfectate (I know I spelled that wrong) and she seems to be improving except for being uncomfortable with the infection.  She is still putting pressure when we go outside and is wanting to stand on her own but not for long so I'll keep supporting her with the scarf.

Hoping we keep heading in the right direction here.