Carmen's Josie 10/30 conservative CERVICAL - RIP

Welcome to Dodgerlist. My name is Paula what is yours?

First things first….. Josie is being totally UNDER medicated for pain. Please get on the phone ASAP with your vet or get to an ER asap and strongly advocate for what vets who know this disease prescribe right from the get go regarding pain meds:
Tramadol
Methocarbamol
and then Gabapentin if the above two need extra help.

 Must read on meds and things you can do to help with a neck disc in  addition to the 100% STRICT crate rest 24/7 only out to potty: www.dodgerslist.com/literature/cervical.htm

Must knows about the danger practices of anti-inflammatory use:  www.dodgerslist.com/literature/healingsweling.htm

When you get back from ER, let us know. how much she weighs.

Also be aware this vet made a dangerous decision IF there was no washout of 4-7 days between Metacam and Previcox. I would ask for a 2nd stomach protector called sucralfate as double protection in addition to Pepcid AC.  Please let us know the dates so we understand better.

These are the pages you need to get under your belt regarding how conservative treatment works and background for discussing things with the surgeon:
www.dodgerslist.com/literature/healingpage.htm
www.dodgerslist.com/literature/healingsurgery.htm

You can get through this, but the first priority today is to get pain fully under control for Josie so she can get on with the business of taking care of all the healing phases with this neck disc.

Carmen, these are the things you have in your arsenal to help Josie listed below. Pain simply can't be allowed as it not only deters the whole healing process but believe me it is torture for these dogs with a Cervical disc problem.  So if there is ANY minimal yelping, that is no good and you would need to get vet help right away.  It makes ALL the difference in the world when the pain meds are right. 

ARSENAL items:
1. Gabapentin is available in most pharmacies as a 100mg capsule of powder.  it is hard to find the lower dose tablet form and takes too long to get it compounded into a liquid. Call around and find the pharmacy who has the capsules, then have your vet call in an Rx to that pharmacy.   My 13 pound doxie was prescribed 25mg of gabapentin powder 3x a day. All I needed to do was divide the 100mg capsule powder into four equal parts by dumping into a creased pieced of paper and with a razor blade move the powder into four equal piles. Also just as easy to get 33mg by dividing one 100mg capsule powder into three parts.  The remainder of the powder piles I stored in one of those 7 day pill boxes with a lid for each day.
How much does Jose weigh? And what is the dose of tramadol in mgs and how often do you give it?
Tramadol- 12-20 lbs dachshund could be prescribed as much as 50 mgs every 8 hours IF the vet prescribes it so. So if the pain is not being controlled, it is up to you to advocate on behalf of Josie just the same as you would be very squeaky if you were in such pain to your own doctor. Get to an ER vet if necesary tonight. It is not fair nor right to have her in pain tonight nor on Sunday, when her meds could be easily adjusted.

2. Sucralfate is one med  that may have to be timed to avoid absorption issues. It is easy enough to do as you will read here:  www.marvistavet.com/html/sucralfate.html  1000's of vets we observe across the USA typically prescribe use together Sucralfate, Pepcid AC, Tramadol, gabapentin and Robaxin  without issues and with good pain control with this kind of schedule:
  Sucralfate 1 hour before a meal
  Sucralfate 30  mins before Pepcid AC
  NSAID and pain meds with a meal 30 mins after Pepcid AC

3. Steroids/ NSAIDs You would not expect any anti-inflammatory (Prednsione, the steroid OR Previcox nor Metacam the NSAIDs) to have immediate effect in controlling pain.  Anti-inflammatories can take 1-2 weeks or longer to resolve all the swelling.  Neck discs can be more of a challenge and normally more painful, too.   So since no anti-inflamamtory is expected to immediately stop the pain, it is necessary for aggressive pain medications, dose and frequency to be use.  The switching between all these anti-inflammatories is a clear signal your vet may not be comfortable in treating a disc episode.  
     What specifically where the signs that Robaxin, a muscle relaxer, made things worse? A muscle relaxer helps so much with a neck disc caused spasms. There are other muscle relaxers that could be prescribed, why was one not prescribed?
     What specifically were the signs that made you and vet think Prednisone did not help her at all?   At the time Prednisone was used was she on Pepcid AC?  Did she not want to eat, vomit, loose stools, diarrhea?

Please let us know the answers to what I asked. Also we've guessed you went to the vet for this cervical problem on 10/31 and when you started STRICT crate rest… is that right? Is that the date Prednisone> Metacam> Previcox was prescribed? We sure hope you are observing no signs of pain (no shivering, no yelping, no tight tense tummy, no holding her head high nor nose to the ground)  My dog had a cervical disc problem so I am acutely aware of the pain and need to get it fully managed.  If the pain can be managed then she may be able to heal with conservative treatment.  If aggressive pain meds are on board and the pain still will not be managed then surgery surely is a consideration.

Hoping to hear good news on the pain for your dear Josie.


  

Carmen, let me know if this is the correct list of meds:
12 pounds
Prednisone  (owner gave one dose 10/29ish??? and stopped)
Meds Rx'd on 10/30:
    Tramadol 12mg 6x/day
    Robaxin  stopped due to observing more  pain
    Metacam liquid stopped, too hard to administer
     Pepcid AC ? mg's, ?x/day
Previcox chewable  started 11/2


The gabapentin powder can be placed with a tiny spoon into the well of a small mashed banana ball, a cream cheese ball, liverwurst ball or inside of a sticky marshmallow and sealed so no gaba powder is on the exterior.  Use the three treat method.  2 treats with no meds inside PLUS the med ball.  Give plain treat while holding med ball in front of eyes. The idea is your dog will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so she will hurry to swallow the med ball to get to treat #3.

Can you afford surgery if you can barely afford a $1000+ MRI?  If you can't afford surgery there is no reason at this point to be spending that kind of money on an MRI. The fact is Josie has NEVER been given aggressive pain meds. So you  don't even know if the pain can be fully controlled.  IF the pain can be controlled Josie may well be able to heal under conservative treatment.

So I would advocate strongly if Josie were my dog for the following from your local vet, if not him find a vet who is comfortable in using pain meds aggressively as demanded by this disease.
1. Gabapentin
2.  Since she did not tolerate Robaxin, ask for a different muscle relaxer.  Neck discs so often cause a good deal of pain due to muscle contractions.  
3. Rather than such a small dose of Tramadol at 12 mgs, discuss with your vet about giving 50mg every 8 hours. Here is why. A med has the same half-life until it reaches very small amounts at that point may not really be effective.    For easier math… imagine a med with a half-life of five minutes, for example. If we start out with 4 oz of it, five minutes later we will have 2 oz remaining, and in another five minutes only 1 oz remaining.   Tramadol has a half life of 1.7 hours. 
4. Because of no washouts between Prednisone, Metacam liquid and then Previcox, get sucralfate on board along with Pepcid AC.  Are you giving Pepcid AC 5mg every 12  hours?   Josie does not need bleeding ulcers or worse on top of what she is dealing with the disc problem.

With adding pumpkin, do  make sure she is getting extra liquids or you will have further constipation issues.  Soak each of her kibble meals in equal parts of water to add the needed extra moisture that pumpkin needs to soften stools.

Xrays can be used to suspicion where the disc problem is but not prove it. An MRI proves exactly where the disc problem is and all the details that are needed to plain out a surgical procedure.  If conservative treatment and aggressive pain management is going to be employed then there is no need to know which disc…all discs receive limited movement that a healing disc requires.  Know and understand both treatment options. These are two very good  pages to help you.  As Dr. Isaac's board certified neurology says do not be pushed or rushed into surgery…make that decision be yours and an educated choice.
www.dodgerslist.com/literature/healingsurgery.htm
www.dodgerslist.com/literature/surgery.htm

We are here to support you with a decision whether it be surgery or conservative treatment. The first order of business today is to not observe any hint of pain and to get her stomach protected.

Please update the med list re: gabapentin, Pepcid AC and sucralfate..the dose in mg's and how often you give them.  

p.s. Reading the documents now...and I am super assertive about my own health (and my clients too as I advocate for them) and won't be pushed into surgery for sure.

Got the gababentin. 100 mg capsule. my vet prescribed 50mg every 8-12 hours. I just gave her the robaxin, tramadol and now giving gababentin.

Yes I asked and he agreed to go back to original dosing. I am unsure about dosage though. She takes such a small dose at 4 hour intervals. what dose would I give that wouldn't oversedate her with the gaba and the robaxen? My vet told me he would be off text for a bit (we have been texting all day) so I want to give him a little break from me. He's been OVERLY generous with answering me by text all day...once reason I switched to this vet...they are amazing with communication and care.
So here's the latest:
4:30 p.m.
50 mg of gabentin
1/4 tablet of tramadol (50mg tablet)
1/4 tablet 500mg Robaxen
She's still in pain as she yelped a minute ago while digging herself a little nest in her kennel. she stops within a few seconds but I can tell she is still having twinges of pain. She goes 5-6 hours with nothing wrong and eats etc. then wham. pain. We leave for surgeon at 9:00 am tomorrow morning. I have all her stuff ready just in case. The vets biggest concern is that this could have been going on for a looong time.
What do you recommend to get through the night? I understand these are recommendations...My client waiver is two pages long when I advise for health related items for humans,

They will be doing an MRI or CT scan in morning when I get there after reviewing xrays, if surgery is to happen she goes in 7:00 am tuesday morning. she will be spending the night there if they decide she needs surgery as I am driving over an hour to get her there nad that will be very stressful.

Thank you. She had a terrible night last night on Tramadol, robaxen, gaba., stomach meds etc. Terrible. We went to the surgeon today. He is doing cat scan and calling me and more than likely she is a surgical candidate bc of her lack of response to any pain meds at all. I hope its not a tumor or something inoperable. Thank you for all your help. I am going to try and find a way to raise the money to pay her bill.

Carmen, thinking of you and Josie now. Anxiously awaiting for an update.

Surgery is to get rid of the uncontrollable pain, and having 2 neck discs herniated is pretty darn painful! She will have 6 weeks of strict cage rest after surgery to allow her to heal. Keeping you in thought and prayer. (((hugs)))

My Stevie had 2 discs herniated when she was paralysed in January, T13-L1 and L7-S1. We used conservative treatment. She walks now, a bit wobbly at times, but she walks

Carmen, I may be reading what you wrote incorrectly, but are you saying that the surgeon said that even with decompression surgery, she may have residual pain for life? She should have no pain after surgery once the surgical site has healed. Whether there is one disc or two, the surgery would take care of any pain she's having. Her health should be fine after surgery, whether there is one disc or two, except that she will always have IVDD disease with the potential for another disc rupture or tear.

The only reason you should be considering surgery is if Josie's pain cannot be controlled by aggressive pain medication. If the surgeon is saying that she will still have pain even with surgery, then that raises questions. Please confirm exactly what the surgeon said.

I think he was being more protective of himself just by saying that. In other words just like saying there's a possibility of you having surgery and not make it through it. He just said I can't guarantee 100% resolution because there are two areas instead of one. She is going in for surgery because even with aggressive pain management the vets weren't able to get it under control and she was in serious pain. I call my vet friend whose done multiple multiple ventral slots in the past when she had a clinic that she was able to work from with all the equipment and she said one or two areas doesn't matter and age is not a disease and that she's going to do great. I have no choice except to get her out of pain. Dr. Au does all the back surgeries at this clinic and he's had wonderful results. I have faith in him.

My prayers are with you and Josie, Carmen.

Surgery will be late today. I have been told she will do well...shes a healthy 13 year old. So you all have good hope for a double disc exclusion to heal normally after she is home?