Kristen's Bella 12/26 conservative Cav Kng Chrs- GRAD 2/20

Around 12/5 we noticed bella limping and having some hind leg weakness.

We went to our vet on 12/7 for the weakness.
The 12/26 was just her follow-up appointment. I brought another dog to the

vet 12/12 and when I told her there was no improvement, maybe even more weakness, the vet took her off the carprofen and had her start the prednisone Friday 12/15. From there Bella basically lost use of her back legs.

We do try to take her out every 2-3 hours. I guess I have two questions- what would your recommendations be now for medication that she had a flare up. And should we re-start the 8 weeks of crate rest? Thanks for your help!!

Her area for crate rest are four 3x3 panels that interlock. She has an egg crate covered with a mattress pad and blanket, and rolled up blankets in the remaining spaces (which are minimal). We leave her water when we are gone but notice she spills it a lot (any suggestions for that?). She’s fed twice a day. I copied the layout for her space from this site.

Kristen, I've compiled a timeline of events to be able to understand things better.  Can't know for sure, BUT the boarding at the vet likely was not the cause of the increased pain you saw when discharged from vet stay on 1/18. One would expect a vet facility would have personnel attuned to the special needs of STRICT rest during a disc episode. There is really not enough information provided to pin point things. 

Prednisone is a hormone drug. It must be tapered to allow the dog's body to again make its own steroid hormone. That taper allows humans a window of preview to know if all the disc-damage-caused swelling is fully gone.  It can take in the range of 7-30 pred days up at the "anti-inflammatory level dose" to resolve all swelling. Taper days are excluded as the dose is too low and serve a different purpose
    --  If boarding  personnel continued with STRICT rest (no walking at potty time, being carried to and from the potty place, etc) then you could pin point the increase of pain to the pred taper. New/increased pain or neuro issues gives the answer to not to stay in the taper.  Pred has more work to do!
    -- Instead vet would have added a 2nd pred course (5mgs 2x/day) for maybe a 4-day course. Then observe for surfacing pain or neuro when the "test" taper starts.
    -- If the boarding personnel did not do the STRICT rest, then the disc could have had a relapse (re-tear of the early healing disc) and the need for all meds back on board. The need to start from square one of the 8 weeks STRICT rest count to ensure the disc heals.
    -- By the time you picked up Bella on 1/18 looks like the final taper dose had been given on 1/6(?).  
    --Did the boarding personnel report any pain during the 12/30 to 1/6 taper days?
    --Did Bella over do movement on the day you picked her up causing a relapse to the disc (evidenced by new pain)?  
    --Unfortunately not enough details with date info to pin point anything.  Did she relapse on the disc healing?  Did the taper reveal pred had not finished the job of resolving pain? 

MOVING ON Actions
How  old is Bella?

Let me just summarize the great points Ann has made for you to follow:
 ==  Ensure you are doing the 100% STRICT rest til graduation day on Feb 20.
    This gives the disc opportunity to make good strong disc scar tissue.  
    Do checkout the link and see which tips will work for you and Bella in maintaining STRICT rest. You will find the tip of DIY bowl attachment to recovery suite here!! :
 🚩 dodgerslist.com/2020/05/14/strict-rest-recovery-process/

==  Make sure she is not WALKING around at potty time. Only the barest few minimal footsteps to take care of business.

== Avoid transports into vet when at all possible. Vets who know IVDD understand and adjust meds over the phone and take your phone updates.  At home inside the recovery suite is THE single most important of care for the healing disc.

== If you feel you must have acupuncture, then hire a mobile vet to come to your house.

== Is the pain only associated with acupuncture treatments, alleviated by traMADol?  Does every acupuncture treatment cause pain and a need for traMADol?
   Pain at other days/times of the day, may mean the disc caused spinal cord was never fully resolved by pred. Discuss with vet if another 4-day pred course is needed for spinal cord swelling.

== Your need to potty her every 2-3 hours and she not on thirst-causing prednisone, suggests she may have lost bladder control.      Let's find out for sure. Cause if lost, you should (important for health reasons) be expressing the bladder. That health reason then would override the risk of a transport to get a necesary hands on expressing lesson. 
    🚩==> dodgerslist.com/2020/05/05/bladder-bowel-care/


    1) Carry her to the potty place.  Set her down on an old pee spot. Does she do the any of the usual of sniff, circle, then stop? Then you see her releasing urine?  That is the test to know if she has bladder control.
   2) Tell us if she still has tail control. Because she is deaf, let her "see" a yummy treat. Also brighten your face with a huge smile. Does she give you a happy wag?
      Good for you to be aware of the order neuro functions repair in OR are lost.
        Nerves heal typically in the reverse order of the damage to the spinal cord:
    1. _Deep Pain Sensation: the first neuro function to return.
DPS is the 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 this very tricky to correctly identify neuro function.
    2. _Tail wagging with joy at specifically seeing you or seeing food.
    3. _Bladder and bowel control verified with the "sniff and pee" test.
    4. _Weak rear leg movement, and then
        _ability to move up into a standing position, and then
        _wobbly walking.
    5. _Being able to walk with more steadiness and
       _ properly place the paw without it knuckling under.
    6. _Ability to walk unassisted and perhaps even run.
LEARN MORE:
🚩  dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/

== Pepcid AC is used only when a NSAID (carprofen) or a steroid (pred) is on board.

Kristen, sorry about my tracking of the many chain of events.  Thanks for the date corrections!

   It leans to, then, if final pred taper dose was given on 1/6 AND she had no pain or new neuro issues, that pred had done its job of resolving all painful swelling around the cord.
 
Right now, due to current acupuncture therapy, if there is still pain that would need pred, observation of pain is being blocked by acupuncture.  Just as when there is a pred taper,  all meds are stopped, only then do you have a clear picture about swelling around the cord.
    -- Acupuncture is normally used as an adjunct to an already aggressive use of pain meds, if needed, to obtain full pain control.
    -- Acupuncture is used to stimulate nerves.  The body does the job of repairing nerves.  
Seems as though a test to find out what is going on with swelling should take place.  What about ceasing acupuncture and traMADol and then note all specifically observed signs?

⚙︎ shivering-trembling      ⚙︎ yelping when picked up or moved
⚙︎ tight tense tummy         ⚙︎ arched back, ears pinned back
⚙︎ restless, can't find a comfortable position
⚙︎ slow or reluctant to move in the suite or at pottytimes 

Let us know about the tail wag. That is an important piece of information.
2) Tell us if she still has tail control. Because she is deaf, let her "see" a yummy treat. Also brighten your face with a huge smile. Does she give you a happy wag?

Also tell us about bladder control confirmation:
1) Carry her to the potty place. Set her down on an old pee spot. Does she do the any of the usual of sniff, circle, then stop? Then you see her releasing urine? That is the test to know if she has bladder control.
    
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