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Post by Janet & Luna on Sept 15, 2023 19:35:50 GMT -7
Hi . Thank you for allowing me to join. My dog began showing symptoms of cervical IVDD in July. She is a 7 year old French Bulldog who had a flareup in her back about 2 years ago. She recovered quickly that time with rest and meds.
★1 There is currently occasional stiffness in her neck and some spasms
★2 My dog weighs 22 pounds and just turned 7.
She began taking Azium (dexamethasone) .5 mg on July 24 after seeing her regular vet.
The dose had been adjusted up to 3x/day but was
tapered to 2x/day on August 26, when she saw her neurologist. Then tapered to 1 per day on Sept. 3, and has been
on 1 pill every other day since Sept. 10.
She is also currently taking :
100 mg Gabapentin 3x/ day (every 8 hrs)
250 mg Methocarbamol 3x/day (every 8 hrs)
50 mg Amantadine 2x/day (every 12 hrs)
She is also on Clavamox for a UTI since 9/7 for two weeks
Her neurologist advised tapering Amantadine to 50 mg per day but when we did that as of 9/10, her spasms returned almost immediately. So she is now back on 100mg per day
[MED LIST/HISTORY- Moderator's Note. Please do not edit
27lbs 7 y.o.
Dex as of 7/24: 0.5mg 2- to 3x/day for a month, 9/3 taper (as of 9/10 EOD): for √9/10 Pain! _neuro?
Amantadine 100mgs 1x/day
gabapentin 100mgs 3x/day
methocarbamol 3x/day
clavamox 9/7 for 14 days]
☆ 4 Luna is a French Bulldog . My name is Janet.
☆ 5 Yes, suspected disc problem but she has not yet had any diagnostic imaging.
Started treatment with general
and as of August 26, under neurologist's (DACVIM) care.
☆ 6 Treatment by her general vet was sketchy from 7/22 and the following few weeks until she could get in to see her neurologist. As a result, there was a lot of medication adjustments and she did not have complete pain control until 8/26. She was doing well on that protocol until we tapered the steroid and Amantadine.
☆ 7 bladder control? Yes but I am watching closely as she did have a UTI last week
☆ 8 Yes, Luna is walking but does display some weakness in front legs which occasionally have given out upon getting up from her bed or when squatting to potty. She also slips on tile and wood floors but is limited to her pen where the floor is covered with rugs.
I am not sure what to do as her neurologist has recommended tapering all of the medications as of this week and I have a call into her and she has yet to respond. She indicated in our last communication that if Luna showed breakthrough pain, an MRI is recommended (and possibly surgery). I am reluctant to go that route just yet because I feel like we only got her pain completley managed two weeks ago and now by tapering too soon, we are relapsing. I feel very unsure that I'm doing the right thing at this point but I want to avoid surgery if possible. Any advice you may have will be greatly appreciated.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on Sept 15, 2023 21:24:40 GMT -7
Welcome Janet, we are glad you've joined us. There is no clear proof all painful inflammation is truly gone yet. That is because 3 pain meds are on board where their job is to block pain to give the dog comfort. However, it seems there is some pain still existing on 9/10 when amantadine was lowered and pain spasms returned. You DO have a working diagnosis from the neuro. Mostly a disc episode is diagnosed by the breeds being prone to IVDD, how they act and by the hands on neuro exam. Typically, the steroid is given for a 7-day or a 14-day course not for 41 days straight as it appears for Luna. Then a taper along with stopping the pain meds to see if Dex had done its job or if another course is needed. It generally can take Dex 7-30 days to fully resolve the painful swelling/inflamation (excluding any taper days). DEX data, it's a bit hard to follow but Luna might have been given the anti-inflammatory level doses for 41 days (7/24 thru 9/2)? Please fill in the missing info in pink to help us accurately understand Luna's treatment:1) DVM as of 7/24: 0.5mgs 2x/day for ? days2) DVM as of date?: 0.5mgs ▲3x/day for ? days due to pain?3) Neuro as of 8/26: 0.5mgs ▼2x/day for 8 days 4) Neuro as of 9/3: begin tapering to less than anti-inflammatory level DexIn order for Dex to not be interupted in doing its job, the dog's care must be VERY STRICT limited movement of the neck and back. This limited movement allows the disc to heal and not increase impact on the spinal cord.
Sounds like your neuro wants accurate info if the inflammation is really gone by calling for tapering all meds week of 9/11 with the EOD dex ending taper.
You have two choices if pain is reveled with backing off all pain meds during the final EOD dex doses. What end date is the last every other day dose given?
1) Dex is a very strong steroid and has the known reputation to damage the stomach lining (ulcers). There has been no mention of Pepcid AC to protect. Luna is one lucky dog.
Bone up on stomach protection if an other course of steroid is your choice + all pain meds back on board (often a course will be a 7- or a 14-day course. Discuss using the more typical prednisone steroid + Pepcid AC to give better insurance against bleeding ulcers.
STOMACH protection info: dodgerslist.com/2020/05/06/stomach-protection/
ALSO learn just how an anti-inflammatory is typically used for a disc episode. The more you increase your knowledge the better you can speak up, bring things up for discussion, advocate on behalf of Luna. dodgerslist.com/2020/04/18/steroids-vs-nsaids/
2) An MRI will rule out other diseases mimicking a disc episode and also see why if you've have been doing VERY STRICT rest since 7/24, what is the situation of the disc (if disc material has escaped into the spinal cord canal in the neck or what/where.....)
Read up on surgery vs. conservative treatment. Good stuff to have under your belt with discussions with your neuro and to ask pertinent questions. dodgerslist.com/2020/02/10/surgery-vs-conservative/
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Post by Janet & Luna on Sept 19, 2023 18:29:56 GMT -7
Thank you for all of this information. I will discuss with neurologist [9/20] tomorrow when we do a check-in call.
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