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Post by Jonathan & Switch on Jan 15, 2014 18:45:30 GMT -7
Hi everyone, I only found this site yesterday and have been reading as much as possible, but I apologize if I am not quite up to speed yet.
My dog's name is Switch; he's a Shiba Inu that will be thirteen years old in a few weeks. He is a little overweight right now at about 35lbs...he should probably be more like 32 and I'm working on that. His current meds are
tramadol 50mg twice per day
gabapentin 100mg twice per day,
prednisone 5mg once per day,
pepcid
as well as penacillamine, vitamin e, and denamarin for his liver (he has copper associated hepatitis.) Oh, and since reading about it here, today I started giving him pepcid before the prednisone. He's eating and drinking well, and no problems walking - he wags his tail and ususally seems fine when it's time to go out. He does have a little trembling here and there.
In the last two years he's had three incidents of back pain, separated by 9-10 months of being totally fine and pretty active. The first two times he got a pain shot, instructions to rest (he's never been crated, though) and tramadol and he recovered fully, though the second time he trembled on and off for about a month. His last incident was on October 19th. Xrays were taken this time and showed a reduced intervertebral space in his lumbar spine. We followed the same routine as usual and he got better, but some days he would still tremble, particularly in the mornings and when I tried to reduce his tramadol. So, we went to see a neurologist on Christmas Eve, and started on gabapentin and prednisone. The prednisone is currently a low dose of 5mg because he was on 7.5mg for liver inflammation in the summer and was very out of sorts and peeing in the house. The neurologist said his diagnosis is uncertain without an MRI but that it might be a herniated disc. He recommended strict rest for two weeks, but when I told him Switch has never been crated and won't poop in the yard, he said to just 'do what you can.' So we stayed with the same routine - out on leash 3-4 times per day and one trip across the street to poop. Switch got better and stopped trembling after a few days, but then I screwed up - I was concerned about his nails being too long and throwing him off, so I tried to cut them....he fought me a bit and started trembling again. (I feel awful about that by the way). That was about a week ago. He now seems totally fine most of the time - no weakness or wobbliness and he walks great - I have to slow him down sometimes. But sometimes he still trembles a little - this mostly happens in the mornings when he's been sleeping all night and is due for his pain meds. There have also been a couple of times when I was away during the day and he seemed to be sleeping the whole time (about five hours) and he was trembling when he woke up. This was also when he [trembling] was due for his meds. In the mornings I have started trying to give him his meds 20 minutes before taking him out, and that seems to be helping a little. This morning his trembling was just barely noticeable.
So my questions are whether this does sound like a herniated disc, and if so where to go from here. He has been on the low dose of prednisone for three weeks now, and the neurologist was talking about weaning him off, but since he's still having discomfort, would it make sense to try a little longer with the full dose of 7.5 mgs? And second, what do you think of his restrictions? I am worried that he wouldn't tolerate being crated; a couple of months ago I tried crating him outside so he could get some fresh air, and he wouldn't settle down - just stood there the whole time. I'm also afraid that he might try to get out and hurt himself. And of course the pooping is a problem as he refuses to go in my yard. Reading this site was the first time I heard anything about 8 weeks of crate rest for disc injuries...and in fact, I was told by a (human) friend that her doctor advised her to keep moving with a disc injury so the muscles stay strong. Any information on this aspect would be great.
Sorry this is so long...I figured I'd just get everything out there. just trying to do the best thing for my boy. Thank you so much for your help.
-Jonathan and Switch
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Post by Pauliana on Jan 15, 2014 21:05:45 GMT -7
Welcome to Dodgerslist Jonathan. With a damaged disc from either an injury or due to having been born with a degenerative disease (IVDD) the disc needs time to heal and form good secure scar tissue. Little movement the recovery suite provides lets the disc work on scar formation…. it is movement of the back that can disrupt that process and the disc could rupture into the spinal cord causing loss of function.. This happened to my dog Tyler. We woke up one January morning and he couldn't move his back legs.. He has recovered very well and can walk perfectly now. He was crate rested for 6 weeks after surgery.. We had a recovery suite for him in the living room, a crate in our office and one in our bedroom.. We kept him included in family life..and we got through it.. It sounds like a long time but really we were so busy taking care of him that time went pretty quickly for us.. www.dodgerslist.com/healingindex.htmGood for you getting Pepcid AC for Switch.. Excellent! Switch should be carried out to potty.. Just a few footsteps at potty time and then back to the recovery suite. Humans with a disc injury are different than dogs with IVDD. A dog with a herniated disc and a human with a "bad disc", “slipped disc”, or “bulging disc”. Two important differences are dogs’ anatomies and that dogs do not understand “take it easy and rest for a couple of weeks”. A poor understanding of these differences often results in dogs being treated with human recommendations, which can lead to catastrophic results. I understand your worry about crate rest but it is possible to make it bearable for him. You could use what we call a recovery suite... or ex pen.. More on this in this article. www.dodgerslist.com/literature/CrateRRP.htm and here is some info on emergency crate training to help you and Switch: www.dodgerslist.com/literature/EmergencyCrate%20Training.htmTrembling and shivering are signs of pain.. and sometimes of anxiety or nervousness. He is being under medicated for pain. Tramadol has a short half life and every 12 hours is way too long between doses. It is far more effective dosed at every 8 hours. So please discuss this with your Vet so Switch can begin to heal. Pain deters healing. Also discuss with his Vet about going on the anti inflammatory dose of Prednisone twice a day.. He was likely peeing all over the house because a dog on Prednisone is very thirsty and drinks a lot. They need to go outside every 2 to 3 hours while on Prednisone.. If this is a disc episode, then with the mild symptoms of pain only, Switch would be a good candidate to recover under conservative treatment and avoid losing the ability to walk, IF, if you can commit to what you have been reading AND the pain is fully under control dose to dose of the Tramadol and Gabapentin. 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks …. No stairs ever, No laps, no couch, no sleeping in bed with you, no meandering 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. The meds serve another purpose other than healing the disc. More on the medications is here: www.dodgerslist.com/literature/healingpage.htmSending healing thoughts and prayers for Switch.. |
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Post by Jonathan & Switch on Jan 15, 2014 22:23:54 GMT -7
Hi Pauliana, thanks so much for your help and for the positive thoughts. I'm fully willing to do whatever it takes to make my boy better, and I went through two knee surgeries with my German shepherd, but I don't really know how to make the 24/7 crating work with Switch. First is the fact that I don't know if he will even tolerate being crated; I'm going to try to slowly get him used to it (I already have an expen partially around his bed) but I don't know if he will be comfortable enough to rest in there, and if he decides to try to get out, it could be really bad. But i guess I can try and see how it goes. Second is having to carry him....again, I'm perfectly willing....but I don't know how he will tolerate it...Wouldn't all the picking up and putting down put stress on his spine? And if so, might slow, controlled walking out to pee be ok instead? We're in New England and will likely be dealing with snow and ice again soon....and carrying a dog that doesn't want to be carried sounds kind of dangerous (for him, not me) in those conditions. Finally, there's the pooping problem. He almost never goes in the yard....so I've had to walk him across the street once a day. Carrying him over there in snow and ice sounds like asking for a fall...
Not trying to be negative, but it seems like there are a lot of potential problems...do any solutions come to mind? Any thoughts on a back brace that maybe he could wear at potty times? Thank you so much.
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Post by Pauliana on Jan 15, 2014 22:51:04 GMT -7
Hi Jonathan,
Here is a video that shows how to lift and carry a dog with disc problems/IVDD.
We are in Indiana and we have to deal with the snow and ice here too. Last year Tyler's surgery and recovery was during the winter and it sure did complicate things.. He is only 15 pounds though and used to being carried. Neil would go out and shovel a short path for him when needed so he and Tyler wouldn't fall. And on nice days we would carry him out to his favorite spot on the road.
With Switch being set in his ways and not used to being carried, I would try lifting him and carrying him while in the house at first. At first just lift him, as you see in the video and then set him down. As he seems to relax more, carry him a bit further. Since he doesn't like to go in his yard, can you drive him to his favorite spot and then let him walk a few steps with a harness and leash on?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Jan 16, 2014 9:25:33 GMT -7
Jonathan consider setting up a fenced in potty area that only allows a very few footsteps. For our little doxies it is a 6 foot diameter area. This way Switch both has visual and a physical notice that no sniff fests, no walking around is going to happen at pottytimes. If carrying 35 lbs is really not feasible, then you must do everything possible to limit foot steps, avoid steps/stairs. It is movement that will damage the disc's weak forming scar tissue. Do you have a deck off of your sliding glass door? Can you set up some snow or dirt there? Then you can have him take just the minimal footsteps to the potty place or maybe he will even let you carry him that far. This set up uses an expen to fence off the snow-layer potty area. The sling is used in this photo to protect the rear from tipping over because the dog was unstable, wobbly.  A Snuggle Safe may provide him comfort, something warm to snuggle or lean against. My dog does the happy dance when he sees his placed in his bed. www.valleyvet.com/ct_detail.html?pgguid=E53AAF66-347A-4789-AFCC-5D6FA77ED8B6&item=30459&ccd=IFP003&utm_source=froogle&utm_medium=free&utm_content=30459 He may need some help in relaxing there. Because of his liver problems to first pass any of these calmers by your vet first. Using any oral calmer in combination with a Pheromone diffuser seems to work best to calm. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives.
Place a DAP pheromone diffuser at floor level where the recovery suite is. Some brands to consider:
--Comfort Zone (DAP) wall plug-in diffuser 48ml www.petcomfortzone.com/dogs.html
--Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/
Use a diffuser with one oral calmer from below:
Oral calmers:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
www.vetriscience.com/composure-soft-dogs-MD-LD.php
Other product brands may be available in your local shops or on-line… just shop by the active ingredient(s) on the label and the quantity for best price
This thread discusses our thoughts about back braces: dodgerslist.boards.net/thread/826/back-bracesIs your vet in the loop about Pepcid AC with Switch's liver problems? (The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. www.marvistavet.com/html/famotidine.html )
Is his pain (shivering) still under control today?
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Post by Jonathan & Switch on Jan 16, 2014 13:04:19 GMT -7
Hi guys, just got home from work and have a few thoughts. The good news is that he slept in his expen last night with one panel open....so maybe there is hope that he'll adapt to it being closed. But I'm really unsure about the carrying. I do pick him up to get him in/out of the car and that has been ok, but its only for a few seconds and he doesn't like it. He's not the size of a dachshund either and I'm worried it might do more harm than good if he starts to struggle....BUT his expen is setup a few feet from the door and I am on the ground floor- there is just one step (maybe about six inches high) to get to the side yard. So maybe I could pick him up for that one step, or put a ramp down so he can get to the grass. Also, from there it is a distance of a few yards to the front yard, where he might poop if he is desperate. If not then yes I could try driving him, but he usually wants to walk around before pooping...though again, if he is desperate he might go quicker.
The other thing I'm trying to figure out is what to do about his prednisone as he's been on the 5mg for three weeks now. I would like to try the full dose but I am concerned about him being on pred for so long. Also, I called the best animal hospital I the area trying to get an appointment with their neurologist for a second opinion (as I'm not happy with the one we've seen) but they can't see switch for a week. I would like to wait the week and in the meantime get switch used to the crate, but if I do that I don't know about the prednisone. Would it be safe to continue at 5mg for an extra week knowing we may need an additional week at a higher dose? That would be five weeks all together. Or would it be possible/better to back off of the current dose in the coming week and then restart at a higher level?
This morning he looked good....I gave his meds twenty mins before going out and I didn't see any trembling today.
Thank you so much, you guys are awesome!
Oh, and I meant to ask: does the crate rest have to coincide with the prednisone? I mean, can I start him on the higher dose now and then start the crate rest in about a week, or does it not work that way?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Jan 16, 2014 20:45:25 GMT -7
Jonathan, the way to look at conservative treatment is in the phases of healing that needs to take place. All of the phases are best explained here: www.dodgerslist.com/literature/healingpage.htm Good job, then on the pain phase if giving med 20 mins earlier is keeping pain away! The disc healing phase only happens with 100% STRICT rest and that needs to be in place now, it can't wait it is a critical part of healing.. Crate rest IS the hallmark component because there are no meds to heal a disc. If that disc worsens with too much movement the spinal cord is at jeopardy for loosing neuro functions like legs being paralyzed and loss of bladder control So protecting the spinal cord is critical to your being committed to crate rest asap, now, today. Good work on getting Switch into the expen, now you need to secure that panel. Dogs do the unexpected in a blink of an eye. That just can't be allowed to happen with a disc in the middle of trying to heal…all efforts need to go to protection of the spinal cord from the healing disc. A torn disc is bad news for the spinal cord nerves. Prednisone is one drug you do not want to mess around with, use it only as directed by the vet. Steroids are associated with vital, life giving functions of the body. When using an artifical hormone such as Prednisone, the body stops making its own steroid hormone. So use it the exact the way the vet prescribed prednisone so as not to confuse the body's cortisol production… the adrenal glands. At potty time things need to change. Set up a fenced very small area to potty in. Put some old peed on dirt or grass in their as "inspiration." The space has to be small so that Switch may only take a very, very few footsteps.There can be no choices of where to poop or pee, no driving around to find a potty place, no going across the street. Again the focus is to always protect the spinal cord from too much movement of the back. If you can't carry him to and from the potty place, then thinking outside the box is needed. What can you do to keep his footsteps to and from the potty place to almost no footsteps? A few yards to the potty place is too far to walk, too many footsteps. Can you place an ex-pen fence right at the bottom of the step, a ramp over the step? If you live in an apartment type arrangement, you might have to place the ex-pen and take the ex-pen fence in each pottytime? |
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