Theo's Ella 11/16 Conservative

Welcome to Dodgerslist. There is a window of time when surgery will be successful after loss of deep pain sensation. That window of time is 12-24 hours from losing deep pain sensation (DPS).  The spinal cord is very fragile, the more hours after the window, the less chance of a complete recovery.  Was it a board certified neuro (ACVIM) or ortho (ACVS) who diagnosed loss of DPS?  Generally, vets do not see enough cases of IVDD to make an accurate assessment of loss of DPS.  Here is more information about surgery:
www.dodgerslist.com/literature/healingsurgery.htm
www.dodgerslist.com/literature/surgery.htm 

The alternative to surgery is conservative care.  It's the hope with conservative care that the spine will reabsorb the injured disc with meds and limited movement. The nerve damage can reverse once the disc material is reabsorbed.

Good job on getting Ella into a crate right away. 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks is the hallmark component of conservative treatment. Carried in and out to potty. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM). In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc.

How are you doing expressing her bladder?  How often are you expressing? Do you find wet bedding or leaks on you when lifted up? While on Prednisone, she will be more thirsty and probably drinking more, so she should be expressed every 2-3 hours until you become proficient expressing.  Here's more info on expressing:
here: www.dodgerslist.com/literature/Expressing.htm

Can you give us a bit more in essential information about your dog:

-- Is there still currently pain? Signs of pain are holding the head in an unusual position, head held high or nose to the ground, shivering/trembling, not wanting to move much or moving gingerly, yelping, tight/tense stomach muscles, arched back, holding leg up flamingo style, not wanting to bear weight on the leg, just not their usual perky-interested-in-life self.

-- What are the exact names, dose in mg's and frequency of all meds? Please get your vet's permission to give 5 mg of Pepcid AC (generic is famotidine) 30 minutes before each dose of the anti-inflammatory and thereafter every 12 hours). Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If your vet says your dog has no health issues such as liver, heart, etc to keep her from taking Pepcid AC, then do get it on board.

-- Eating and drinking OK?

-- Poops OK - normal color, firmness, no dark or bright red blood?

The best way for you to help your dog is by learning about this disease. Here are some links to get you started. Please click on all of them to get a good background of understanding. www.dodgerslist.com/healingindex.htm

The very, very lightest least aggressive range of motion and leg massage is necessary for paralyzed legs during conservative treatment once off all meds and there is no pain. The information highlighted in PINK pertains to a dog who can't walk but only after all meds are stopped and there is no pain. www.dodgerslist.com/literature/massagepassiveexercises.htm

Laser light therapy, acupuncture and electroacupuncture which sends a microcurrent of electricity to and from acupuncture points (which are really big nerve bundles), can be very beneficial at helping to re-establish the nerve connections in the body. Any one of these therapies can be started right away if in your budget... they not only help relieve pain and inflammation but will kick start nerves to begin regeneration. Find a holistic vet here: ahvma.org/Widgets/FindVet.html www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] NOTE: Chiropractic is not recommended for IVDD dogs.

Please don't despair. IVDD is not a death sentence. Many dogs regain use of their legs and even if they don't, their lives can be happy ones.
www.dodgerslist.com/index/SDUNCANquality.htm

Once we receive more information from you, we'll be better able to support you through this.  We're here for you and will help you in any way that we can.  

Prayers for a complete recovery for Ella.

Ella seems to be feeling better everyday and there is no indication of pain. She is on:

Prednisone 5 mg, 1 tab 2x day for 10 days then, 1 tab for 1x day for 20 days
Methocarbamol 500 mg, 1/2 tab 3x day for 3 days then 2x a day
Tramadol, 50 mg 1/2 tab 2x day

I do not know whether or not the vet had the certifications you mentioned. I am going to contact another vet that does laser treatments - mine had not idea about it.

DPS was not present on Monday but we are noticing that she can move a leg slightly - is that normal? She wags her tail happily after we express her bladder. We have been doing expressing about 3 to 4 times a day. Two things about that - we noticed that she now squeals a bit when we do it and this morning I did notice wetness/leaking - what does that mean? Thank you for the expressing link - that is the best one that we have seen yet.

Ella is eating and drinking - it's not her normal ravenous appetite - but I guess that's ok given the situation. There is nothing unusual in her poop as yet.

We are sad for her - but not despairing - whatever happens she is loved and we will deal

Thank you  I love my doxies so much! They are such characters! 

Theo, while you are learning become proficient in expressing and while she is on pred you would likely need to express every 2-3hours to keep her dry. As your skill to feel the bladder increases, the last stage of emptying when the fingers of one hand can almost feel the fingers of the other hand, then you can extend the time between expressing sessions. Can you feel the bladder's shape at all stages of emptying. Don't hesitate to express in the clinic and have the vet tech check your work.

How much does Ella weigh? Often good pain control with Tramadol require giving it at minimum 3x a day because it has such a short half life of 1.7 hours. Do phone your vet and tell him of your observations of pain.
--Good page to review on pain meds: www.dodgerslist.com/literature/healingpain.htm
--Good flyer to print for your fridge so the whole family recognizes problem and what to do Print and put on your fridge so your whole family knows what signs/symptoms to look out for:
www.dodgerslist.com/literature/FridgeInfo81907.pdf

I agree with StevieLuv, if Ella's been overflowing (leaking on you when lifted or you are finding urine leaks in her bedding) bring in a urine sample for the vet to run a urinalysis to rule out infection… bladder infections can happen quickly.

Not eating is a red flag sign that Pred is causing GI upset. Do get Pepcid AC on board today. Cortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. 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. We ask that all members read about each med their dog is on or may take as a safety measure. This directory is in alpha order:
www.marvistavet.com/html/pharmacy_center.html

Your obvious love and devotion is going to be wonderful support to Ella. Self education is a critical way to help Ella…so as soon as time permits read all you can from this page… knowlege is power in understanding the enemy and winning!!! www.dodgerslist.com/healingindex.htm

Please update us on Pepcid AC, pain med adjustments, ruling out a bladder infection and how much she weighs

Theo, gosh please tell me your vet did not just prescribe Cipro to avoid UTI's if he had no proof a bacteria infection existed! Did he run a urinalysis on Thurs to prove bacterial infection in the bladder? Prescribing antibiotics when there is no need of them means the good bacteria living in the intestines and help regulate everything are being killed.  Disc disease may itself causes neuropathic pain. It seems another antibiotic would be more prudent with an animal in the middle of a spinal cord problem. 

Dr. Jay S. Cohen writes: "Hopefully, the new warnings will also make doctors pause before prescribing quinolones for common infections of the bladder, prostate, or sinuses.  The seriousness of potential reactions -- tendon ruptures, nerves injuries, joint pains, cardiac effects -- warrant a very cautious attitude about prescribing quinolones.  quinolone package inserts now include warnings about peripheral neuropathies (injuries to the nerves outside the brain or spinal cord).  The question is, will doctors notice these warnings? Quinolones are overused for minor conditions when other, safer antibiotics would suffice.  My stance is that quinolones should be reserved for serious infections for which other antibiotics have been ineffective or for organisms that are only sensitive to quinolones." medicationsense.com/articles/may_aug_05/warning_antibiotics_052205.html

Nerves can heal on their own…we just have to wait to see how much they can heal. So if acupuncture or laser light therapy is in your budget you might investigate. Laser light therapy, acupuncture and electroacupuncture which sends a microcurrent of electricity to and from acupuncture points (which are really big nerve bundles), can be very beneficial at helping to re-establish the nerve connections in the body. Any one of these therapies can be started right away if in your budget... they not only help relieve pain and inflammation but will kick start nerves to begin regeneration. Find a holistic vet here:
ahvma.org/Widgets/FindVet.html
www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] Chiropractic is never recommended for IVDD dogs.

Prednisone could be the reason for weight gain, but not likely a whole pound in 4 days. Scale could be a different one calibrated differently. The person weighing Ella, could have created an error, lots of reasons why.  

We see vets on this list prescribing Pepcid 5mg 2x a day for a 16 pound dog which goes along with the information on-line.

Sometimes a bladder infection will have signs you can observe such as odor, color change, leaking urine drops and other times there are no obvious signs. That is why a urinalysis is done…this prooves whether bacteria are breeding out of control or not and whether an anti-biotic needs to be on board or not.

Loss of bladder control is identified when a dog leaks on you when lifted or you are finding urine leaks in their bedding. Bladder control exists when a dog can sniff an old pee spot in the grass and then make a conscious decision to release urine. In other words the brain can send a message down to the bladder's sphincter muslce to open and release urine. Lack of bladder control causes urine to be released not by the brain but by reflex. When the bladder become so overstretched and full of urine, the body's natural protection kicks in. The overstretching activates a reflex to open the sphincter muscle…no brain invovement.

If Ella can't pass the sniff and pee test it is likely overflowing and not peeing on her own by choice. Are you still expressing? Has then been a change in how often you express (likely you would need to express every 2-3 hours to keep her dry while on Pred.