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Post by Coco & Munchkin on Oct 13, 2013 18:17:37 GMT -7
4 weeks ago, my little 7 pound Pekingese, Munchkin, started limping on her front left foot. After a few days we took her to the vet and she was put on Deramaxx. She did really well on it until she vomited, so I took her off of it. We then took her to another vet who said that she thought she has inflammation in her leg so we put her on Metacam. She improved slowly on that and after a week she was walking near normally. Yesterday we got up and she refused to go to the bathroom after eating like she normally does. We took her out and it looked like she was struggling to get up. We then took her again to the vet who took xrays which were negative, and she also examined her again and this time thought she has a disk problem. We took her off of the Metacam and put her on Tramadol and we are to start a steroid on Tuesday. She can walk but is staggering when she does and does not want to go to the bathroom. Yesterday she finally went after 22 hours and today it was also 22 hours. No bowel movement since Friday. Needless to say I am a basket case. I have read so many things on the internet and I am now convinced she has a brain or spinal tumor. I love her so much it is breaking my heart to see her like this. I have been crating her since yesterday, but until she can take her steroid on Tuesday, she won't have any improvement I guess. Any and all advice or encouragement are appreciated. I don't know how to get her or myself through this. Thanks so much.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 13, 2013 18:42:01 GMT -7
Coco, welcome to Dodgerslist. I'm sorry to hear Munchkin is possibly suffering with a disc problem. Education will be very important to understanding the enemy you face so you can care for her and wn the battle with this enemy. This is really great stuff you will want to have under your belt… the 4 phases of healing, meds, how long, etc : www.dodgerslist.com/literature/healingpage.htmTo expedite getting thing right for Munchin: 1. Are you doing 100% STRICT crate rest 24/7. ONly a very, very few footsteps when carried to and fro the potty place…no sniff fests? 2. Usually there is a need for a washout when switching between steroids <-->NSAIDS (Deramaxx) <--->NSAID (Metcam) of 4-7 days to protect the GI tract from damage. It does not appear this happened with the NSAIDs. Now the vet is wanting to switch to steroids in 2 days in due to nerve damage…. Strongly advocate for stomach protection. Anytime a NsAID or steroid is in use Pepcid AC should be on board. With a short washout a 2nd protector in addition to Pepcid AC is needed. So you can be in a position to discuss and advocate on behalf of Munchkin, do as we all do….read up on each med. I bookmark this vet site for myself: www.marvistavet.com/html/pharmacy_center.html3. Is her pain fully under control dose to dose of Tramadol? What is the exact dose in mg's and how often are you giving it? Not wanting to go to the bathroom can be due to pain. Other signs of pain are: shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy, holding leg flamingo style not wanting to bear weight? Tramadol often will not control pain unless given every 8 hours because it has such a short half life of 1.7 hours. Let us know what you are observing for pain. Know your pain meds used with IVDD: www.dodgerslist.com/literature/healingpain.htmTramadol can cause constipation. Pumpkin's high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. To firm up the stool add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato. 4. Knowledge will take quit a bit of fear away, give you the information to know you are taking care of her correctly and carry on needed discussion with your vet. You will get over this bump in the road and Munchkin will have many happy years to share with you. |
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Post by Coco & Munchkin on Oct 13, 2013 19:50:22 GMT -7
Thanks so much for your very helpful and informative response. I think we only gave Munchkin 2 or 3 doses of the Derramax before she got sick from it. Her last dose of that was on Sunday, then she started the Metacam on Wednesday. I didn't know that this was too soon. I feel bad that I didn't research better. I will now wait until Thursday at the earliest to start the steroid. I will definitely call the vet in the morning to find out the correct dose to give of the Pepcid AC.
The bathroom problem is really a tricky one. Munchkin likes to spin repeatedly before she goes, and I don't know how to stop her from doing that. She wont' just walk up and go. She is blind so she has always gone indoors on a potty pad. It seems like when she spins on it, it appears the her feet slip out from under her like she is on ice. To solve that we have put a rug on top of her pad for her to go on, which has helped. I don't know whether she is refusing to go from being in pain or from the weakness in her legs. It does look like she is having problems in all four legs from what we can tell. We haven't seen her move much since she is confined.
She doesn't seem to be in pain, although she is pretty much just laying there. She does change positions once in a while but that is it. She wags her tail when we talk to her and seems pretty happy. I haven't noticed any shaking or anything like that. She is taking
10 mg. of chewable Tramadol twice-per-day.
So I should get ask the Vet then to give change it to every 8 hours? Maybe that would help her to go to the bathroom more. I guess that is my biggest worry, that she only wants to go once-per-day. I don't know how she can hold it that long.
At this point we have her blocked off in a corner with her bed and a tiny bit of floor space. I just noticed that she is sleeping on the floor. Is that acceptable or should she have absolutely no space but the bed. I can't stop her from moving in the bed either. I am just so afraid I am not doing this correctly and have to make sure. I will definitely spend the rest of the night reading up on everything. Again thanks so much for your help, I appreciate it.
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Post by Pauliana on Oct 13, 2013 21:50:41 GMT -7
Hi Coco, So sorry to hear Munchkin is having a rough time. Have your vet adjust the timing of her Tramadol to every 8 hours.. My Shih Tzu Tyler was on 25 mg every 8 hours but he weighs 13 pounds and is bigger than your little one.. There are other medications that can help, Methocarbamol for muscle spasms or Gabapentin for nerve pain.. Both of those work well with Tramadol and are commonly prescribed for IVDD.. www.dodgerslist.com/literature/healingpain.htmHere is some info on creating a recovery suite for Munchkin: www.dodgerslist.com/literature/CrateRRP.htmShe may need help going to the bathroom since she doesn't seem to want to go more often than once a day. This would also help her avoid doing the spinning. Have the Vet or Vet tech teach you how to express her. To get more out of the lesson please read this and watch the video. www.dodgerslist.com/literature/Expressing.htmAny urine that remains in the bladder can lead to urinary tract infections or if she's overflowing, the bladder can stretch out of shape, so learning to express her is a good idea for now until she she is able to pee on her own. Also as Paula said, getting Pepcid AC and possibly Sucralfate on board to protect her stomach. She was already showing signs of GI distress with the vomiting earlier.. and that can turn serious quickly with Ulcers or stomach bleeding.. Sending healing thoughts and prayers her way. |
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Post by Coco & Munchkin on Oct 14, 2013 7:49:43 GMT -7
Thanks so much for your reply. I have been reading everything I can and think we are getting it down some.
I still have a question about the Tramadol. Munchkin pretty much just lays there all of the time without moving, except around 6 hours after she takes her Tramadol, she then seems more like her old self. Does it take that long for the Tramadol to take effect? Or is she too drugged the other times?
Also, I am scared to wait until Thursday to give her the Prednisone and I am also scared to give it to her tomorrow with only a couple of day wash-out. If I get her the Pepcid AC and the Sucralfate, would it then be safe to start her tomorrow? I am so scared of screwing this up, I love her so much and want to do right by her.
Thanks again.
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StevieLuv
Helpful Member 
Conservative Treatment 3x. It really does work!
Posts: 1,335 
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Post by StevieLuv on Oct 14, 2013 9:28:30 GMT -7
Steriods can be started so soon with really good stomach protection - both Pepcid and Sulcralfate are usually used, and there are risks. These have to be weighed out against the benefits that the steriod will give as far as resolving swelling. You have to be very vigilant in watching for signs of gastrointestinal distress, and you should double check by calling your Vet to confirm all of these points.
Have you switched the Tramadol to every 8 hours?? she may not be moving or acting like herself because of pain.
Keep us posted - we are here for you.
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Post by Coco & Munchkin on Oct 14, 2013 9:33:34 GMT -7
Again, thanks so much for everything, I appreciate it more than you can know. We have another vet appointment in a couple of hours so we can learn how to drain her bladder. I am going to write a list of things to ask about then. This is so scary, and the worst part is that we are just beginning this journey. It helps so much knowing I can pop in here with any questions and to get answers from very knowledgeable people. Thanks much!
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 14, 2013 9:43:04 GMT -7
Making a list of questions is a good plan - I hope that the Vet gives you all of the help you need. Keep us posted! (I've got a soft spot for pekes!)  |
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Post by Coco & Munchkin on Oct 14, 2013 14:21:29 GMT -7
I thought your profile picture was a peke! (what a cutie) Munchkin used to be a sleeve peke, but has put on a bit of weight lately, trying to work on that. Again thanks!
Just got home from the vet clinic. Munchkin has not had a bowel movement since Friday, so they gave her an enema and cleaned that out. The vet emptied her bladder and even though it had been about 22 hours since she last went, it wasn't really that full. She wasn't very concerned that she is going so little because when she starts the prednisone, she will start going plenty.
She told me to go ahead and start her on the Prednisone today because she feels the benefits outweigh the risks. I am not brave enough to do that, so I think I am going to try to hold off another day or two if we can, depending on how Munch is doing. She said to give her Pepcid once-per-day at only 3.7 mgs. She doesn't feel like she needs the Sucralfate because she is on a very low dose (2.5 mgs. 2X per day) of cortisone and that it shouldn't be very irritating on her stomach.
The vet also did not want us to empty her bladder. She said that Munchkin's muscle tone was very good in her bladder and that sometimes if you keep emptying it by hand it causes problems. Munchkin has always held on to her urine for long periods of time, just not 22 hours though.
Anyway, thanks again.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Oct 14, 2013 15:04:12 GMT -7
The point with sucralfate is so you CAN start pred now. Sucralfate is being proactive. It does not matter the dose of pred, it can potentially cause GI tract issues. Munch does not need any more problems of vomit, diareah, bleeding ulcers or a perforated stomach lining on top of this disc episode. I would advocate for an Rx to sucralfate today to lessen the risks and if your vet thinks pred should be started then start it. Swelling in the spinal cord will cause damage to the nerves resulting in wobbly legs, knuckling, etc. So do discuss with your vet the pro and cons of waiting or starting now with Pred. I definately would strongly advocate that you want sucralfate to be on board along with Pepcid AC.
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Post by Coco & Munchkin on Oct 14, 2013 15:42:14 GMT -7
I will give the vet a call and demand the Sucralfate so we can start her on the Prednisone hopefully tomorrow. It all gets so confusing, so it is hard to know what to do. Also, does she need to take the Pepcid once or twice per day? The vet said to do it once, but I thought I read to give it twice. Thank-you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Oct 14, 2013 16:11:54 GMT -7
The range of effectiveness for Pepcid AC is 12-24 hours. We follow vets who are conservative with max stomach protection by given the dose 2x a day. Here at Dodgerslist where we watch and observe 1000's of dogs we see when vets are not proactive, stomach issue can happen, some have been tragic. Each dog is different some can tolerate IVDD meds but so many do not. How do you know which your dog is? So why take a chance, be proactive.
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Post by Coco & Munchkin on Oct 14, 2013 16:48:26 GMT -7
Thanks yet again. I found that I have a bottle of Sucralfate that is still good. I am going to stop at the vet with that and find out how much to give and also find out the correct dosing for 2 times per day of Pepcid. Is there a particular order to the pills that is used? Also, how many times daily do people usually give the Sucralfate? I am so sorry to keep bombarding you with questions, but I have to do this the right way for Munchkin's sake. I want to make absolute sure that she gets the right pills in the right order. I can't possibly thank you enough for your help.
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Post by Pauliana on Oct 14, 2013 18:14:04 GMT -7
Hi Coco, Sucralfate is given on an empty stomach 1 hour prior to Pred and food. Pepcid is given 30 minutes after the Sucralfate.. You are so right to ask the Vet for guidance on dosing the Sucralfate you have in your possession and it's a great idea to take it with you.. Pepcid is generally 5 mg given every 12 hours.. About Tramadol and Munchkin feeling better 6 hours later.. It may be because she has had good rest during the time the Tramadol was working on keeping her pain under control and she wakes up refreshed.. Keep in mind an enema is not a good idea during a disc episode..It makes the back move too much and cause further injury. Not good for any dog with IVDD and too many Vets don't know this.. It is far better to use Pumpkin pr Sweet Potato as Paula told you in an earlier post. Also expressing is a good idea and emptying the bladder. If urine is left in it too long it can become a breeding ground for bacteria and cause Urinary Tract infections.. We have had many, many dogs on Dodgerslist develop UTI's during the 11 years we've been in existence and it's very common with IVDD dogs. Leaving it in there can cause her to overflow eventually and that can damage her bladder muscle tone.. All the best to you and Munchkin...  |
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Sabrina
Helpful Member
My Charley-dog, a Dodger'sList grad enjoying life!
Posts: 471
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Post by Sabrina on Oct 14, 2013 18:15:37 GMT -7
Hi Coco, I'm Sabrina. I'm so sorry to hear of Munchkin's struggles. This page: www.dodgerslist.com/literature/drugs.htm was a huge help to me as I worked to educate myself about all the meds my dog was on during his episode - it seemed like he was on so many! Sucralfate needs specific timing so that it can work to form a sort of "bandage" for the stomach. It needs to be given on an empty stomach at least one hour before meals. Also, "Sucralfate requires stomach acid in order to form its protective gel. If possible, it should be given 30 minutes prior to the administration of an antacid." www.marvistavet.com/html/body_sucralfate.htmlSo, when the vet oks Sucralfate for Munchkin and tells you the correct dose to give, a "typical" schedule would be: - 1 hr before the meal with the pred: Sucralfate - 30 mins before the meal with the pred: Pepcid AC - Meal with the prednisone. My dog was on Sucralfate totally as a preventative measure (he was showing no GI symptoms) and his vet had me give it one hour before each dose of pred. With GI problems present be sure to ask your vet how many doses Munchkin should get per day. Munchkin is lucky to have you - well done on asking questions and educating yourself so that you can provide/advocate the best care for her! ))Hugs!(( - Sabrina |
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Post by Coco & Munchkin on Oct 14, 2013 19:10:43 GMT -7
Thanks Sabrina! You have given me the exact info I was looking for. I can now present this to the vet and tell her this is what I want to give to Munchkin and hopefully she will agree. I really don't see why not, it sounds like the sucralfate is a very safe drug with hardly any side-effects to speak of. I feel so much better having a plan now and a clear idea of what to do. Thanks so much!
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Post by Coco & Munchkin on Oct 15, 2013 6:28:23 GMT -7
I had no idea that an enema is bad! I do not understand why this is not common knowledge with vets, geez. I started her on pumpkin yesterday, so hopefully that will get things moving.
I have been reading about urine expressing and can try to do it. The doctor will not show us how to do it and is against it. Hopefully when she starts the Prednisone today, she will start going more. Plus we are going to use a sling now to help her stand up, so hopefully that will make things easier.
Going to start the pills as soon as I can find out how much of the Sucralfate to give, hopefully in a few minutes.
Boy, this is so scary. Thanks so much, yet again!
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Post by Jean & Mimi on Oct 15, 2013 6:33:18 GMT -7
Wow, sorry your vet is against expressing urine. Not a moderator or an expert like some of these great folks are, but to me that seems strange. When my Mimi was not peeing, it was for less than 24 hours and I asked my vet to show me how to do it. He didn't think I would need to but he showed me anyway. Maybe ask why they are against it? From everything I have read here it seems like a pretty standard thing. Good luck!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Oct 15, 2013 11:28:57 GMT -7
If your dog has bladder control then you SHOULD NOT express her.
Needs expressing IF she shows:
1. leaks on you when lifted
2. finding urine leaks in bedding when you have taken her outside in a timely manner (every 2-3 hours)
Does NOT needs expressing when there is bladder control evidenced by:
1. Take her outdoors to sniff an old pee spot.
2. Watch for attempts to squat and watch for urine to come out
Let us know what you are observing regarding bladder control.
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Post by Coco & Munchkin on Oct 15, 2013 11:45:56 GMT -7
Hi Paula, My vet said the very same exact same thing- she does not need to be expressed since she has bladder control. Munchkin is able to stand and is able to urinate, she just does not want to. The vet could feel that Munchkin has good bladder control. In fact, when I went in yesterday after Munchkin had not gone for 22 hours, she did not even have a full bladder. I am however worried about her getting a bladder infection because she is not going. She stands up to go and then lays down again because I think she is in pain. I don't know what to do. We are getting pretty stressed out around here with worry. It has now been 24 hours, going to call the vet soon. The vet didn't seem really concerned, she thought that once she gets on the Prednisone she would drink alot and have to go. I think the whole thing is is that Munchkin always spins before she goes and she can't do that now, so she doesn't want to go.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 15, 2013 12:09:56 GMT -7
Stevie likes to spin around before peeing too. She had to be held up with a sling for so many weeks that she did learn to pee without the spin. Now that she is walking again she does her tight little circles again. Hang in there - you will both figure out a new way to cope |
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Post by Coco & Munchkin on Oct 15, 2013 12:33:26 GMT -7
Thankfully, she has finally gone! She got up on her own and did it- so her bladder control is good. I am crying tears of happiness right now. I don't get how she can hold it for 25 hours though. She will hopefully start drinking alot now that she started her Prednisone. Thanks again for everyone's help. I have never seen a nicer or more helpful group of people, ever!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Oct 15, 2013 12:35:02 GMT -7
Coco, please give us an update on the meds:
7 pounds
Tramadol 10 mg. of chewable twice-per-day
Sucralfate?mg, ?x a day
Prednisone ?mg, ?x a day, did you start it…today or yesterday??
Pepcid AC 3.7 mgs. mg 2x a day
Here is what I notice that may be the reason why she does not want to move to urinate:
1. Quite possibly the reluctance to move is due to pain. Her pain meds are VERY light. She is very likely being under medicated for pain. So often disc episodes require at 2-3 pain meds, especially during a washout when no ant-inflammatory is on board. I would get on the phone and strongly advocate for methocarbamol to be added for the type of pain with muscle spasm. Gabapentin is added when Tramadol/methocarbamol is just not enough. Also Tramadol 2x a day is not likely to help with pain at all, it can go to every 8 hours…ask your vet. Munchkin is not getting the pain meds she needs.
2. Holding urine over 4 -6 hours invites bacteria to breed in the bladder. It is possible she has a bladder infection (UTI) making it a painful thing to pee. Can you bring in a urine sample for a screening test, a urinalysis, the vet runs in his clinic while you wait or phones you later. If there is infection, she would need an anti-biotic.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 15, 2013 12:40:21 GMT -7
YAY!!! for pee. We get very happy about pee and poop on this site Hopefully that will act as a breakthrough moment for her and she will be more willing to go now that she has once already. Like Paula says, if you can clarify all of her meds for us then we can help you if she needs some adjustments. She is a real little dolly!! |
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Post by Coco & Munchkin on Oct 15, 2013 15:50:41 GMT -7
Here is the list of Munchkins medications:
Sucralfate- 1/4 of a 1 gram pill (morning-afternoon-evening)
Pepcid- 2xs per day (morning-evening) 4 mgs each time
Prednisone- 2.5 mgs. twice per day (seeing how it goes in a couple of days)
Tramadol- twice per day 10 mgs.
Pumpkin with her food.
I do have some dip stix that test for bladder infections- I wonder if I could use one of them? I would think so. I have to wait until she goes again whenever that will be.
Munchkin always has waited for long periods of time to pee. She regularly goes 12 to 14 hours without going. Her kidneys were tested 2 weeks ago and were fine.
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Post by Coco & Munchkin on Oct 16, 2013 10:58:41 GMT -7
I was just wondering on average, when could I start seeing some improvement on the Prednisone? I am still worried sick that Munch has something else going on and won't be able to relax until she starts improving. She has had 3 pills so far. Thanks so much.
Update: She seems to have some improvement. Unfortunately, she was spinning again when she went to the bathroom today. It took us by surprise and we couldn't stop it. But what do we do about her spinning? She is so far refusing to go in a sling. I just hope she didn't re-injure herself spinning like that. On the plus side, it shows that maybe she is slightly improving. Also, her legs didn't look weak today either and she had just a slight limp in her original problem foot.
I also used an AZO bladder infection test strip to check her urine and it was thankfully negative. I am not sure of the accuracy of them for dogs, but it can't hurt to try it I guess. I have one left and will test again in a few days.
Thanks so much.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 16, 2013 15:56:15 GMT -7
Have you tried using a harness when Munchkin goes out to do potty, Coco? You might be able to control the spinning that way. She's allowed to take a few steps when doing potty but spinning around sounds like too much movement. Does she just go in a circle once or does she keep going around? Please don't expect to see improvements right away. The crate rest is to heal the disc and that takes 8 weeks. The nerve damage can take weeks, months, even a year or more to heal. It's very early in her healing process since she just recently started crate rest so it's great that you've already seen improvement. Hang in there. |
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Post by Coco & Munchkin on Oct 16, 2013 19:36:05 GMT -7
Munchkin spins probably 10 or so times, she reminds me of a little tornado she goes so fast. I would not be surprised at all if that is how she hurt her back to begin with.
She has always used a potty pad indoors, she never goes outside. I guess I could put a harness and leash on her though, although I know she won't like it. Pekes can be very stubborn.
I do feel better though that we have seen some slight improvement, it gives me something to hang onto. Thanks so much for replying.
2 hours later:
Munchkin already seems like a different dog tonight. She still has her slight original limp problem, but everything else is much better. She actually wants to go to the bathroom again, but gets mad and refuses to go when we won't let her spin. But at least now she is wanting to go again, thankfully. I know she still has a long road ahead, but I am encouraged by her progress so far. It is going to be really tough keeping the little terror on bed-rest, but I know it will be for her own good.
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Post by Coco & Munchkin on Oct 19, 2013 16:49:26 GMT -7
Munchkin has been doing pretty well, all things considered. She is eating, drinking and doing all of her bathroom business. The brief times we have seen her up, she appears to have just a slight limp. We do know for sure that her legs are not slipping out from under her anymore. Tomorrow she goes from 2 half pills of Prednisone daily down to 1 half pill daily. My question is, was 5 days on the twice daily dose enough? I have read other stories about dogs having problems again after lessening their dose of the Pred. I am worried sick of having to start from the beginning again as far as the weakness and pain go. She is now down to 1/2 the dose of Tramadol that she was on and seems to be doing fine with that. I sometimes wonder, as I am sure everyone does that goes through this, if this is going to end well. I know that Munch's case was not as bad as many others, but it is still worry-some for me. Thanks again for everything that you all do.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 19, 2013 18:53:47 GMT -7
Hi, Coco
The steroid is to get the swelling in the back down. The only way to tell if the swelling is down is to taper the steroid. If there is no pain during the taper, then all medications can be stopped. You don't want her on steroids longer than she has to be on them because of the side effects. Your job tomorrow is an important one. You'll need to watch her carefully for any signs of pain - shivering, trembling, yelping when picked up or moved, reluctant/slow to move, tight hard tummy, not her usual perky self. If you do see any signs of pain, contact your vet so he can adjust her meds.
Try not to worry - just be observant. If she does still have signs of pain when the steroid is tapered, the vet can just put her back up to the anti-inflammatory dose of the steroid for a little bit longer. It's just basically a test to see if the swelling is down.
Please let us know how she does tomorrow. I'm hoping for a pain-free taper for Munchkin.
All the best to you both.
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