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Post by Becky&Lady on Jan 21, 2014 19:22:24 GMT -7
Hello all,
I have visited this site many times during the last week and I have found much needed help as a result of all the contributions. Now, I seek personal advice.
Allow me to provide an update on my Lady's situation.
Lady is a soon-to-be 4-year-old American Cocker Spaniel. She has been relatively healthy all her life (we've had her since approximately 5 weeks of age). The Sunday before last, we went for a run to chase off the smell of an intruding canine from our yard (as usual), when we came inside, she jumped off the bed to chase my mother, who was holding a toy of hers. Upon entering the kitchen, Lady abruptly stopped, yelped, and sat down. When my mother picked her up around her abdomen, she yelped again. She was obviously in pain, which we attributed to her pulling on her harness whilst running. We restricted her movement and attempted to keep her from jumping at all. Later that night, when my mother touched her around the same area, she yelped again. I suspected a pulled muscle might be to blame. Upon researching treatment options, I decided to wait 24 hours to see if the symptoms improved.
Lady continued to be lethargic and seemed to be in periodic pain. We took her to the vet (whom I have never seen before) on the following Tuesday. This particular "veterinarian" told us Lady had a pulled muscle and jumping would not hurt her; she further told us that if this continued past 24 hours of pain medication, we should "give {her} a call". That Thursday, Lady seemed to be much better. She even wanted to run about outside (which I prohibited her from doing). Around 5 pm, upon returning from a short walk, she shook, as a furry Cocker is want to do, when suddenly she began to yelp in pain. I called the doctor and set up an appointment first thing Friday morning. During the night, neither she nor I slept because she was restless and in pain. Whenever I touched her spine, I noticed swelling.
Friday, we saw the head vet. Immediately upon seeing her, he knew she had an injury to her back. An x-ray showed she had, in his words, a "bad disc", to which I responded, "Her disc is deteriorated" (seriously, vet, I am quite intelligent-give me the facts, please). Another disc also appeared to be slightly deteriorated. Obviously, this disc was causing her spinal cord to be pinched, thus the pain. He recommended 6 to 8 weeks crate rest and let us know that, if needed, she was a good candidate for surgery since paralysis is a possibility. Because he never used the term "Inter-vertebral Disc Disease", I asked him what would cause such an injury. He replied, "Life". He also told me that it was okay for her to continue sleeping with me in my bed. Furthermore, he said she could even have a bath in two days. Obviously, I did not think this was a good idea. However, he did mention that if her pain had not improved by the morning we should bring her in again. He prescribed her more Tramadol, a corticosteroid, and Sucralfate.
What bothers me is how nonchalant he seemed about her condition. After conducting a great deal of research on this issue I discovered my Lady has IVDD, and requires a great deal more care and concern than he would have led me to believe. Although he did not show signs of incompetence a la his co-worker (seriously, he license should be suspended for such egregious diagnostic errors), I wonder about his capabilities.
So far, my conservative treatment is consisting of:
1. Strict crate rest (being carried to and from outdoors to relieve herself, eating and drinking from elevated bowls, a memory foam mattress, etc.)
2. Proper administration of medication, which seems to have almost, if not entirely alleviated her pain.
3. A recent purchase of Vetri disc (I have read positive feedback about this product, although I have not yet received it in the post).
Although I am certainly hoping since her condition has not advanced (I believe she is in Stage 1 or 2), she will make a full "recovery" after 8 weeks crate rest, I remain incredulous and worry about her long-term prognosis.
Here are my questions:
1. What are realistic expectations for her type of injury?
2. Should surgery be performed merely as a preventative or cautious measure? I have read conservative treatment usually does not preclude recurrence as well as surgical (somewhere in the range of up to 50% likely to recur in comparison to surgery). Would the risks outweigh the benefits at this point?
3. In searching for a board-certified neurologist in my area (West Georgia), I discovered two at the Atlanta Georgia Veterinary Specialist's Sandy Springs location; however, this is almost two hours from my home and I do not believe such a trip would be appropriate for Lady during cage rest. After cage rest, should I meet with one of these surgeons simply for a consultation?
4. How worried should I be that IVDD becoming fatal? I would not put my Lady to sleep unless she was unhappy and there was absolutely nothing that could be done to help her; I would treat her as I would my own child. Even if paralysis is in her future, couldn't she live a happy life?
5. What are the chances of her becoming paralyzed, based on the limited scope of knowledge I have provided you with concerning her condition?
Basically, I am extremely worried and stressed because of this situation. She is so young. I want her to live a full and happy life. I've even begun construction plans on indoor ramps for when she recovers. I will do whatever is necessary, I simply would like to know what realistic expectations I should have at the moment.
Any advice is much appreciated. Also, I apologize for the lengthy text, I simply wished to be thorough.
Thank you,
Becky
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Jan 22, 2014 6:03:04 GMT -7
Welcome to Dodgerslist, Becky. Please let your dog know with your utmost confidence that things are going to be ok…because they will. With this disease self education is critical not just so you make sure the right things are being done for the best recovery but for your own emotions. The unknown is simply a scary place. Get ready to fight this disease now and in the future by knowing all things IVDD. There is no better place to start than on our main web page with "Overview: the essentials" and then read all you can as soon as possible. Here's the link www.dodgerslist.com/healingindex.htm100% STRICT crate rest 24/7 only out to potty for a full 8 weeks is the SINGLE most important thing you can do to help your dog-- it 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. www.dodgerslist.com/literature/CrateRRP.htm1. Pain. You said "...medication, which seems to have almost, if not entirely alleviated her pain". Pain must be entirely alleviated and if not, then a call must be made to the vet so meds can be adjusted. Pain hinders healing and there should be no signs of pain from one dose of meds to the next and pain should be entirely under control within one hour after giving. 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. 2. Medication. What are the exact names, dose in mgs and frequency of all meds? How much does Lady weigh? It's important that you be knowledgeable about each medication being given and all cautions concerning them. www.dodgerslist.com/literature/drugs.htm#intestinaldrugsmarvistavet.com/html/pharmacy_center.html3. Currently can your dog wobbly walk? move the legs at all? or wag the tail when you do some happy talk? 4. Can your dog sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up? 5. Eating and drinking OK? 6. Poops OK - normal color, firmness, no dark or bright red blood? 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. We have a very helpful DVD that will educate you, your family members and friends, pet sitters, etc. about caring for an IVDD dog. Please see the link in my signature line. To answer each of your questions: 1. From what you've mentioned above, it sounds as though the only symptom Lady has at this time is pain. If that is the case, she is a very good candidate for conservative care. Most surgeons would not operate when there are no neurological deficits. If you commit to 8 full weeks of crate rest and the steroid takes care of the swelling and she can go off of all meds with no pain, Lady has a very good chance of recovering fully from this disc episode. 2. As mentioned above, Lady is a good candidate for conservative care. It is the hope with conservative care that the damaged disc will be reabsorbed by the body. The crate acts as a cast to limit movement of the spine to allow the disc to heal and scar tissue to form. Continue with what you've been doing and try to take it one day at a time. 3. Lady can travel while on conservative care. Secure her crate firmly in the car and pad the sides well with blankets so she doesn't jolt around. Drive slowly and carefully with smooth stops. However, your vet has prescribed the correct medication (although we don't know yet whether the dosage is correct) and was correct in prescribing crate rest, although it's a full 8 weeks, not 6-8 weeks. You are correct, however, that he should not have said she could have a bath or sleep on the bed. Have you checked these sites for an IVDD vet? Board-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals. You can locate others in your area here: www.acvim.org [neuros] online.acvs.org/acvsssa/rflssareferral.query_page?P_VENDOR_TY=VETS [orthos] Dodgerlist Members' vet recommendations - dodgerslist.boards.net/board/10/guidelines-posting4. Yes, she can live a perfectly happy life should she become paralyzed. My Jeremy, also a Cocker, became paralyzed two years ago, had surgery but it took 6 months before he was able to stand and move his legs again. He had a cart and he flew in the wind in it! They can pick up on your unhappiness and stress so always show a happy face and voice to Lady and tell her every day that she'll be OK, because she will. Dogs don't know what being handicapped means. 5. At this point, if you limit her movement to only a very few steps at potty time and if the meds do their job, the chances are good that she will not become paralyzed from this disc episode. However, IVDD is a lifelong disease and while some dogs only have one episode during their lifetimes, some can have several. Kudos to you on beginning to plan for her future by looking into ramps. As you read up on IVDD and become more knowledge, the stress will ease. We're here for you and Lady and will help you through this. |
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Post by Becky&Lady on Jan 22, 2014 11:21:42 GMT -7
Thank you for your response!
To respond to your questions:
1. She has shown absolutely no signs of pain since Friday the 17th (the date of her appointment).. I should have clarified that I am not sure she is 100% pain-free since she cannot verbally reassure me of her comfort.
2. Lady was given Dexamethasone injection on 1/17, size small. She is currently taking:
--Prednisone 5mg (2x daily for 5 days, then 1x for 5 days, then every other day until gone-there were 40 tablets)
--Tramadol 50mg (half, twice a day as needed-30 tablets)
--Sucralfate 1gm ( half, twice a day-10 tablets)
--Benadryl 25mg (once at night to sleep, if needed)
I researched all side-effects and dosage recommendations.
3-6. Yes. Lady is wagging her tail. She eats and drinks quite a bit more than usual, no doubt a side-effect if the Prednisone.. She has successful and easy bowel movements and urination (except the occasional loose bowel, a side effect of her sensitive stomach). She can easily move around and sniff; no trouble walking, which means it is very difficult to prevent her from running, although it is feasible.
I want to wait to take her to a neurologist because she is naturally very nervous and a car ride would simply exacerbate this. However, I am definitely going to research and switch to a more knowledgable and competent veterinarian.
Thank you,
Becky Nunnally
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,595
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Post by PaulaM on Jan 22, 2014 11:52:17 GMT -7
Becky, thank you for answering those questions, very helpful. Right dog's have different ways of letting us know they are in pain…so the pain signs Marjorie gave you will let you know. With the taper then to begin tomorrow 1/23? that is the time for you be very observant for any hint of pain surfacing. Often it takes being at the anti-inflamamtory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like 30 days in all before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going by observing for pain. To have an accurate picture about painful swelling on the taper, the pain meds are normally backed off or stopped. Did the vet discuss that with you? I there is an occasional loose bowel, while on any dose of pred, I would get Pepcid AC on board with the sucralfate they work in different ways to protect the stomach. Pepcid AC reduces stomach acids, sucralfate bandaids the damaged parts. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid and thereafter every 12 hours. Med lookup: www.marvistavet.com/html/pharmacy_center.htmlA reason to seek out a specialist other than for surgery is when you want help with meds that a local DVM is not comfortable in using. So far it appears that the right meds ARE on board and that Lady is going in the right direction of healing. The taper will be the test to see if pain surfaces and show the need to stay on pred a bit longer. Keep us updated the taper. |
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Post by Becky&Lady on Jan 22, 2014 13:06:45 GMT -7
Paula,
Thank you for your input!
Actually, the vet did not give me much information at all. I discovered nearly everything through personal research, in addition to applying previous knowledge. Common sense and my general knowledge of pain medications (both my parents experience pain on a regular basis; last year, my mom had an anterior cervical discectomy performed for her disc disease). Unfortunately, because I currently live in a very rural area, knowledge and information-sharing is extremely limited. This, in addition to many other reasons, has prompted my search for a vet outside of the immediate West/Central Georgia region; a vet who will provide greater care and competency.
Lady was experiencing occasionally loose bowel movements before Prednisone was administered. She has a sensitive stomach, so any change in diet will cause loose bowel movements for a few days until her system is acclimated. Either her new treats or possibly the Tramadol may have caused this to occur. Should I still give her Pepcid AC as a preventative measure?
Also, should I be concerned that Lady is experiencing panting as a side-effect of Prednisone (mainly, she does this in her sleep or when she's quite thirsty)?
Thank you,
Becky Nunnally
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Post by Jean & Mimi on Jan 22, 2014 13:46:46 GMT -7
Becky, you are doing an amazing job being an advocate for your sweet Lady and for providing great care. I would get the Pepcid on board (or the generic is fine too) as it is just an extra protectant for her stomach, especially if she has a sensitive one to begin with. Regarding the panting, make sure she has plenty of cool water available to her and try placing a fan near her crate but not directly on her to see if that helps with the panting.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jan 22, 2014 17:29:52 GMT -7
Jean is right, Becky - get the Pepcid AC on board along with the Sucralfate. Since Lady has a history of occasional loose bowels, it will be difficult to tell whether it's the medication or not so it's best to be safe and protect her before she has side effects. Also, stay away from trying any new foods until after the meds have stopped. Panting can be a side effect of meds or it can be a sign of anxiety or pain. As Jean said, a fan near but not pointed at the crate will help. Also a rice sock from the refrigerator can help them cool by laying their tummy along side of it. Fill a sock with 1-2 cups of rice and tie the end of the sock closed. Try a frozen broth ice cube to lick on. If a fan helps, then it is most likely a side effect of the meds. Keep an eye out for other signs of pain. This is what Dr. Isaacs says about panting: www.dodgerslist.com/neurocorner2/panting.htm |
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Post by Becky&Lady on Jan 22, 2014 21:33:35 GMT -7
Ah yes, the fan does seem to help her. Also, I will get some Pepcid for her.
Thank you,
Becky Nunnally
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Post by Becky&Lady on Jan 24, 2014 21:22:33 GMT -7
Update:
Lady just threw up twice within a few hours (she had food in between). The only changes are the addition of Famotidine approximately 24 hours ago, and a few small pieces of chicken my mother gave her this evening. She is acting normal otherwise. She still has a rather substantial appetite and thirst. Lady has been known to vomit like this due to her sensitive stomach.
I am going to call the vet first thing in the morning. Until then, does anyone wish to share anything helpful?
Thank you.
As mentioned above, she still wants to eat. In fact, she seems quite hungry. Also, I need to give her Tramadol and Benadryl tonight.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,595
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Post by PaulaM on Jan 25, 2014 9:28:27 GMT -7
In some very few cases a dog has had a minor side effect of nausea. If this pattern continues then you know Lady is one of them. I'd ask for a different stomach protector such as sucralfate.
Let us know what the vet says.
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Post by Becky&Lady on Jan 27, 2014 21:01:29 GMT -7
Yes. Lady has been taking Sucralfate the entire time. The "vet" suggested discontinuing the Tramadol and taking the maximum dosage of of Pepcid AC.
Thankfully, her stomach calmed down soon after my post.
However, since then, she has begun to taper off her Prednisone (today she should've begun alternatively taking one pill every other day). Of course, as expected, her swelling hasn't gone down entirely. I am going to call the "vet" tomorrow in order to inform him of this and, more pointedly, to suggest he change her prescription.
Thanks again. I will continue to keep everyone informed.
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Post by Jean & Mimi on Jan 28, 2014 6:29:32 GMT -7
Becky, good for you for watching what is going with Lady and advocating with your vet. You may want to increase her pain meds as well once her steroid is increased back to the anti-inflammatory level. Let us know what the vet says.
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Post by Becky&Lady on Feb 17, 2014 19:06:33 GMT -7
Okay, so I spoke with the vet. He put her back on the initial dose of ▲Prednisone for the same length of time. She just started to taper off today and her swelling, while lessened, has not completely gone down. At this point, any inflammation should have been taken care of, so what do I do?
P.S. It's very difficult to keep her from running, pulling, and sniffing during bathroom trips.
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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 Feb 17, 2014 19:29:07 GMT -7
It is not uncommon to have to extend the time on prednisone to ensure that all of the swelling is gone. My Stevie just went through a 6 weeks prednisone regimen to get swelling under control. Jean's sweet little Mimi girl also had an extended taper. You did a great job watching for trouble and Lady will feel better soon and then you can try the taper again. Keep your Vet in the loop- and keep us posted too. Hugs to you both.
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Post by Becky&Lady on Feb 17, 2014 20:08:36 GMT -7
Thanks, StevieLuv.
The problem I am facing is the vet's reluctance to prescribe more Prednisone. He may put her on a NSAID. My issue with that is the washout period, in addition to the fact she needs to taper off Prednisone. It cannot be good for her to have swelling this long, and the last thing I want to do is prolong effective treatment.
Basically, I need to obtain a referral to a neurologist. This vet is unhelpful at best and grossly incompetent at worst.
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Post by Pauliana on Feb 17, 2014 22:17:36 GMT -7
Hi Becky, It is so difficult to deal with a Vet that is not helpful or supportive during IVDD treatment. Here is an article that tells you how to find a vet experienced in IVDD and it also has a search engine to find one in your area. www.dodgerslist.com/literature/VetchkList.htmHope this helps you and Lady! |
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Post by Becky&Lady on Feb 17, 2014 23:04:37 GMT -7
Thanks Pauliana! Oh, I've already found a neurologist I want her to see. The issue is, since we live in such a rural area, so the nearest is almost two hours away ( near Atlanta). So, the first hurdle we must jump is the referral process, then the second is calming Lady for the drive. Either way, I am currently sorting this situation out and I will not put up with any more lackadaisical veterinary "advice".
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 18, 2014 6:05:30 GMT -7
I'm glad you have someone available to you, Becky. Hopefully, you'll be able to sort out an appointment quickly.
I do notice that you mention that it's been difficult to keep Lady from running, pulling, and sniffing during bathroom trips. A harness and a 6'leash helps keep their movements restricted. Another tip that members find helpful is to make a 6'potty area with plastic push-in-the-ground fencing or an ex-pen outside to limit too much sniffing. I know how difficult it was to carry my Jeremy outside during conservative care (he's also a Cocker weighing about 32 lbs). Have you had success in getting her to the potty spot without walking? If you have a wire crate, you can wheel the crate to the door or down a ramp. Or make a potty place with some snow on the deck, if you have one.
If Lady has had too much movement, that may be why the swelling hasn't gone down. Movement aggravates the not-yet-healed disc. Or movement may have re-injured the disc at some point. If that's the case and she hasn't been taking only a few steps to do her business, then you'll need to be upfront with a new vet and let them know that. I just wanted to bring this to your attention, particularly in light of the fact that Lady has been on the correct anti-inflammatory dose of the Prednisone.
Please let us know how the visit to the neurologist goes. My thoughts and prayers will be with you and sweet Lady.
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Post by Becky&Lady on Feb 18, 2014 19:15:09 GMT -7
Thanks!
Yes, we've always had a short leash and harness. I do carry her from her crate to outside, that's no problem. I even shorten the leash and attempt to walk hunched down closer to her height. She is just so hyperactive and neurotic. Also, she always smellls dogs, cats, and rabbits, which causes her to try to run. Yes, I know this initially caused her re-inflammation. Also, I know this is not good for future reduction in inflammation. I am quite aware of the issues with the disc, I am just not sure how to keep such an active dog from moving. We haven't had much success with acepromazine and the like in the past. Maybe we could try the small enclosure idea...thank you for the suggestion.
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Post by Becky&Lady on Mar 16, 2014 15:10:57 GMT -7
Update: Lady has passed her 8 weeks of crate rest. She has skin issues so after two months she had to have a bath. However, her swelling increased afterwards (she erratically dries her head when she's wet-there's no way to stop her, even rain causes her to do this). The good news is we finally got an appointment with Auburn University Veterinary Neurology on the 24th. Hopefully they will let us know what to do. However, she can't stay overnight for an MRI (why they would make her is debatable in my opinion). Should I ask about laser therapy? At this point I don't know if conservative treatment is best. I believe perhaps surgery may be the way to go. Opinions?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,595
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Post by PaulaM on Mar 16, 2014 16:47:43 GMT -7
So you are saying that Lady is in pain now? Is she on meds (mgs?, ?x/day). Do you have her back on 100% STRICT crate rest to prevent the disc from worsening and allow it to heal once again until the March 24 appointment? Can she walk, wobbly walk, move her legs at all? Wag her tail with joy? Where is she neurologically. If Auburn believes there could be something else going on that mimics a disc problem, an MRI could make that visible. If it is determined another disc episode by knowing her history, doing a hands on neuro exam, they may conclude if there is no severe neuro diminishment and pain can be control with meds that conservative treatment is a good approach. This page can help you sort things out in your mind in preparation to discussing with the neuro about surgery vs. conservative which would be the better avenue for Lady. www.dodgerslist.com/literature/healingsurgery.htm |
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Post by Becky&Lady on Mar 16, 2014 19:16:33 GMT -7
Paula,
She is walking around fine. She even wants to run. She wags her tail, barks, wants to cuddle, etc. Any pain would only be moderate, still, she is taking her regular dose of Tramadol (25mg twice a day) again because I would never let her be in pain.
I have her on crate rest. However, I don't believe conservative treatment alone is the best for her. I just don't believe she improved more than 50% at best during the 8 weeks. Honestly, I believe her disc can't heal again no matter how strict I am with her rest. This injury is in her cervical spine-so every time she moves her neck (which is all the time) she risks increasing inflammation. She jerks her neck constantly. She is rather excitable. Neurological symptoms are not apparent; nevertheless, I think surgery is her best option.
Thoughts on surgery?
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Post by Pauliana on Mar 16, 2014 20:52:54 GMT -7
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