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Post by Jackie & Auggie on Mar 18, 2024 16:43:54 GMT -7
Jackie's Auggie 3/15/24 conservative Frenchie- GRAD 5/13
Hi there, I am writing because Auggie is experiencing acute symptoms, and I need advice. In general, he had made a nearly full recovery since his IVDD surgery last February. He has been walking and even running. On Thursday, we put him on a leash for the first time without wheels and he walked up a big hill to the park. We were thrilled. He didn't exhibit any signs of pain. In fact, when he got home, he continued to walk around and wanted to play with his toys. The next day he was also fine in the morning. Around noon the UPS person came and he snuck out the front door and [3/15] went down a 1-2 ft step. Shortly after he was shaking and clearly in pain. I could feel his heartbeat in his back near his spine (this happened back in August and we went to conservative treatment and he made a full recovery).
[MED LIST/HISTORY- Moderator's Note. Please do not edit ]
36 lbs 4 y.o.
gabapentin 100mgs 3x/day]
I immediately gave him a 100 mg gapabentin and called the emergency vet to request anti-inflammatory meds. They would not prescribe any without him being seen. He absolutely hates the vet, and so I wanted to avoid bringing him in as I knew he would flail around and it could possibly do more harm. I then called his regular vet who comes to the house. By this point, it was after 5 pm on a Friday and the on-call vet also refused to give him anti-inflammatory meds without being seen. We were able to get him an appointment at 11 AM on Tuesday 3/19 with a neurologist and so I figured it was better to go that route and keep him comfortable at home over the weekend then possibly hurt himself more by going into the ER. We were able to manage his pain during the weekend and limited mobility by keeping him in the crate and carrying him outside to pee.
When I woke up this morning (Monday, 3/18), he was in good spirits and ate. I gave him the 100 mg gabapentin at 6:30 am. At noon my husband fed him lunch but forgot to give him his pain meds. Around 1:45 pm he started shaking and was clearly in pain. My husband realized that he had not given Auggie his pain meds. Auggie then appeared to be in acute pain, and cried out in severe pain (I have near heard him make this sound before) and he was really shaking. I could feel his heart beat quite strongly near his spine. I gave him a 300 mg gabapentin and called the on-call neurologist. She said I could bring him into the ER, but again, there isn't anything they can really do from a diagnostic standpoint, and I would prefer for him to see an expert who understands how to treat IVDD. In fact, before he had his emergency surgery last year, he walked into the emergency vet, they admitted him, and by the time he was able to see a neurologist the next day, he was paralyzed. Given this, I am reluctant to have him seen by a non-specialist or wait for long periods at the ER when he could absolutely hurt himself more. I am just so frustrated that none of these docs will prescribe an anti-inflammatory without him being seen! The doc today told me that there are legal and medical restrictions that prevent them from doing so.
In any case, he is now (3/18, 7:30 EST) comfortable, and I will keep him comfortable until his appointment tomorrow with the neurologist at 11 am. I am just worried that he may have ruptured another disc. He is still able to stand and walk, although I am preventing him from doing so.
Did I make the right call by waiting 4 days to get him to the neurologist and on anti-inflammatories?
Other than doing an MRI, is there any way for them to tell if he has a disc rupture or if it is just a serious flare-up?
The neurologist who did his surgery is out on medical leave for another month. At this point, I feel I am more of an expert on his condition and care than most of the doctors who have seen him over the 12 months. Based on past guidance from Dodger's list, I know we need to do conservative treatment for up to 4 weeks. In the past, we have done 10-day crate rest protocols with carprofen and gabapentin, but this one seems worse - maybe because we haven't had the right drugs for him. But how would you determine whether he should follow a 10, 20, or 30-day conservative treatment? Are there specific symptoms we should look out for?
Also, are there questions I should ask the neurologist tomorrow?
Thanks so much for your guidance. I am sincerely hoping we can get this managed because I don't think surgery will be an option for my sweet boy again.
With much appreciation.
Jackie
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Mar 18, 2024 20:44:39 GMT -7
Jackie, it does sound very much like a disc episode from a previous bad disc or yet another new disc. Only expensive advanced MRI imaging would be able to tell which disc. With conservative treatment all discs are treated the same so no need of an MRI. Strict rest to allow the disc to form good secure scar tissue. That takes 8 weeks for a disc to heal. With surgery, an MRI is necessary to plan on which specific disc to treat. Also if the neuro has quite a high suspicion this is not a disc episode, but rather another disease that mimics IVDD, he'd want to rule it out with and MRI. Good job on immediately crating him and carrying to and from the potty place. That is the NUMBER 1 most important thing. Too bad the vet situation did not allow an anti-inflammatory to get started. But at least you are able to fully contain pain by giving gabapentin every 8 hrs. Maintain strict resting. MED CHART How about a med chart to help when two people dose meds to make sure nothing gets skipped? The info you keep on the chart makes it a useful tool for quality communications with your vet. Helps you to have accurate dates to go with the patterns you observe. D/l here: dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdfCONSERVATIVE ROADMAP You will find the "Conservative Roadmap" helpful in keeping your mind clear on what is healing, when it heals and what it takes to heal each of the 4 phases of healing. Also it may bring questions to your mind you'd want to discuss at the neuro appointment. VIEW, DOWNLOAD and print: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf Here is what the RoadMap will look like taped to your fridge for handy reference during the next 8 weeks. Conservative vs. Surgical crate rest Do let us know if the neuro is able to confirm this is a disc episode. If not, then what other disease did he diagnose? |
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Post by Jackie & Auggie on Mar 19, 2024 9:31:15 GMT -7
Hi Paula, Thanks so much for the guidance. Auggie saw the neurosurgeon today. The did an exam and believe he is having a disc episode in his neck. He is able to use his front and back legs and he has full reflexes. They prescribed him
200 mg ▲gabapentin 3 times a day, 25 mg +Carprofen, and +AMANtadine 100 mg twice a day for 14 days. They did his bloodwork. Assuming there are no liver or kidney issues, they will refill all prescriptions. They want me to call back in 10 days with an update.
[MED LIST/HISTORY- Moderator's Note. Please do not edit ]
36 lbs 4 y.o.
+ Carprofen as of 3/19: 25mg 1x/day for 14 days, test STOP 4/2: _ pain? ?neuro
Gabapentin ▲200mgs 3x/day +Amantadine 100 mg 2x/day
No stomach protector on board ]
He is comfortable and we will stick to the plan as far as the 8 week crate rest. Just glad we finally have the right meds to help with the inflammation. I will keep you all posted on how he does with the treatment plan. Thanks! Jackie |
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Post by Romy & Frankie on Mar 19, 2024 13:19:27 GMT -7
I am glad that you were able to get a diagnosis from the neuro. A neck disc episode can be more painful and take longer to resolve because almost all movement will involve moving the neck and head. We have some info on things you can do at home to help your dog's neck disc here: www.dodgerslist.com/2020/05/05/cervical-care-tips
Although Auggie is being kept comfortable with the meds he is on now, painful muscle spasms often accompany neck disc problems. If he shows any signs of pain going forward, you can speak with the vet about adding methocarbamol to his pain meds. You can read more about methocarbamol here:
All anti-inflammatories, like Carprofen, cause excess stomach acid, which can sometimes cause serious stomach issues. To guard against this, a stomach protector like Pepcid AC is used. Ask the vet if your dog has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory.
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Post by Jackie & Auggie on Mar 19, 2024 18:28:11 GMT -7
Thank you! The neck injury is new to us so we are reading up to ensure he is able to heal as best as possible. He loves his recovery suite and as long as he is next to me while I work, he is perfectly content.
I brought up the muscle relaxer today but the neurologist redirected me to the Amantadine. I can see if she would still prescribe the muscle relaxer. Is there something I should look out for to see if he needs it?
We are bummed we are here again but it’s just a reminder that he has a chronic condition and we need to ensure he doesn’t overdo it once he recovers.
Thanks so much!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Mar 19, 2024 21:15:23 GMT -7
Jackie, glad you got an exact diagnosis specifying it is a neck disc. Any hint of pain surfacing before the next dose of pain meds or when he has to move would indicate the need to move to an aggressive use of pain meds. SIGNS OF PAIN: ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned bac ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions ⚙︎ not their normal perky interested in life selves ➕if a neck disc: ◻︎ head held high/ nose to the ground ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg up flamingo style not wanting to bear weight
Fingers crossed the Rx for meds will keep Auggie out of pain round the clock. If not, do not have any patience with pain. Neck discs more often than not need all three sources of pain to be addressed. It is the resolution of spinal cord inflammation/swelling that provides the relief from pain. It can take carprofen a range of 7 to 30 days before all swelling is gone. While carprofen is at work, the pain meds do the job of giving Auggie full comfort from pain if Rx'd correctly for his needs.
-- traMADol- general analgesic -- methocarbamol- muscle spasm pain -- gabapentin- nerve pain -- amantadine- Amantadine is something we are seeing neuros Rx as part of the pain med cocktail as it allows other analgesics to function more effectively. The Mar Vista vets explain the mysteries of amantadine www.marvistavet.com/amantadine.pml Basically when stressed as our dogs are with a disc episode they may be more susceptible to physical pain. Muscle spasms hurt worse, everything hurts more. Amantadine alone is not an effective analgesic but when combined with the other IVDD pain relievers (methocarbamol for muscle spasms, gabapentin for nerve pain and tramadol as the general analgesic), it adds an extra dimension of pain relief.
April 2 stop of 14-day course of carprofen
A clear picture if carprofen has finished the job on Apr 2 is needed. On the stop, pain meds are also stopped or backed off too.
--- The full details on how non-steroidal anti-inflammatories work with a disc episode. Good reading to be able to ask the right questions and discuss treatment: dodgerslist.com/2020/04/18/steroids-vs-nsaids/ 1. Do you have a Plan B with your vet worked out should pain surface when vet is not open in the middle of the night.
2. How will pain meds be handled on the Apr 2 carprofen stop date? dodgerslist.com/2020/04/18/steroids-vs-nsaids/ IVDD, a diseaseIVDD is a disease a dog is born with. Often the first signs of prematurely aging discs for dogs born with IVDD, appear typically at 3-7 years old. Some dogs might have only one disc episode their entire life. While others might have several disc episodes. It is a great idea to understand this disease.... I can recommend: -- Shortcut thru IVDD dodgerslist.com/2020/06/26/time-and-ivdd/ -- and the Conservative Roadmap which you likely already have taped to your fridge. Please keep us posted how Auggie is doing. |
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Post by Jackie & Auggie on Mar 21, 2024 19:32:42 GMT -7
Thank you so much, Paula. I thought my post went through yesterday, but I guess not. The surgeon said she would call me later this week. When she does I will request the muscle relaxer as well as Extra carprofen so I have it on hand at the end of the 14 days or should we need to manage his pain and are unable to get in touch with his vet.
So grateful for your guidance. Auggie is resting comfortably!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Mar 21, 2024 20:27:45 GMT -7
Glad to hear Auggie continues be free of pain while carprofen is at work. I sure hope the 14-day course of carprofen will do the job. For the end of the 14-day course on 4/2, do find out when you next speak, what the vet's preference is on stopping pain meds or backing them down. Can you verify with a vet if there is any health reason Auggie can't take Pepcid AC (famotidine). Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach. If you get a “no health issues” answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). ** thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg |
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