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Post by Daniel&Peke on Jan 21, 2014 22:01:10 GMT -7
Hello, and thank you for such a wonderful and informative website. Dodgerslist has helped us get on the right track and we owe it all to this great community.
It started on Christmas morning. Peke was whimpering and my wife Isela knew something was wrong. I'll never forget that morning, she was in a lot of pain. We immediately took her to the emergency vet and the doctor gave her a check up. He let us know that it looks like a case of IVDD with severe back pain. He said we could get the x-ray and let us know that it doesn't show us much as an MRI. We went with the x-ray and he said there was a very narrow part of the vertebrae right in the middle of her back. We had no idea at the time what was coming our way.
We were sent home and Peke was given a pain killing shot. She was out for pretty much the rest of the day. We were given Tramadol, Methacarbamol and Prednisone. The Pred lasted for 4 days 1 pill, and every other day after that. That day though, we had to make our way to Mexico as we had extremely urgent business to take care of. It was hard to leave her, and it just about killed my wife leaving her. We left Peke with her mother and daughter. We didn't know about the 24/7 crate rest as the Vet only told us that it would take 6 weeks.
So week 1 went by without the crate rest. Then by the end of that week I learned about Dodgerslist. I said it would be best to leave Peke at the Vet and they would give her meds and make sure she doesn't move. I wanted to make sure she was watched all day in case something bad happened. She was watched all day before, but I was really worried that something would happen and that she was moving around too much with us not there. I came back during that week and visited her a couple of times and Isela's daughter did as well. Peke is one of those dogs that doesn't like a crate, and fights till the bitter end.
So by the end of week 2, my wife came back as well as Peke and we started restricting her movement. I went out and purchased a cage and we have been slowly trying to get her used to it. Week 4 has been a solid week of rest/resctricted movement. Week 3 was about 80% restricted as it was hard for her to deal with it. She has an awkward way of lying down with her neck stretched way up, maybe it's nothing I don't know.
Peke weighs 16 pounds but was at 18 when this happened. We have changed her to a better food as well. She has never lost control of bladder function or become paralyzed at any moment. A little sluggish and lazy but that's normal with meds and such, but also normal Her tail can wag, but this all happens when she is on her meds. When she is off her meds, she can quickly return to being in a lot of pain.
Her poops look fine, pooping more we have noticed though. No discoloration. She has also been eating/drinking well the whole time. Drinking more due to the steroid of course.
A little over a week ago, I believe the beginning of week 4 the pain was bad on a Sunday and we spoke to the Vet again. They prescribed Peke the Gabapentin and it has helped a lot. We noticed quite a change in activity level after that, but like I said, when she is off the meds she can quickly return to being in pain. We have tried to make the pain meds continuous so there isn't a lot of downtime. They also told us to start the▲Prednisone again for 7 days. So we are beginning the tapering off the steroid again as of tomorrow, as it's been a week. I was concerned from the beginning when the doctor didn't say to give her Pepcid. So we made sure to ask again and sure enough they said it was ok. We were giving her yogurt with the pills, so it's not like we weren't only giving her the pills. We give the prednisone always with food too. We are giving her the 10mg tablet of Pepcid. Should we cut that in half?
We took an extra step and decided to get laser therapy for her. it seemed to help the day after. Although, yesterday was her second treatment and she had a bad day. My wife picked her up and she yelped in pain just about each time. The doctor actually pressed on her spine and Peke did not yelp at all, but when the doctor touched her stomach, she yelped. At the end of the appointment she ended up getting a pain shot. Doesn't make sense she relapsed like that. Week 3 went very well. No more sleeping with her, no more couch or steps. Doesn't make sense.
This is my wife's first dog and it will kill her if Peke doesn't make it through. Sometimes we feel like she makes progress and the regresses. Is there anything else we can do? How do her chances look? Is there anything we are doing wrong? Sorry if my thoughts are all over the place. We really appreciate any help and will answer any questions anyone may have. Thank you all so much
Daniel & Isela & Peke & Bella
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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 7:58:07 GMT -7
Welcome to Dodgerslist, Daniel and Isela. 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.htmCan you give us a bit more in essential information about your dog: 1. Crate rest. When was the date you started doing the all important 100% STRICT crate rest 24/7? 100% 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.htm2. Prednisone taper. Since you are seeing signs of pain, it is not time to taper the Prednisone. Call your vet today and advise that there is still pain and request a continuation of the Prednisone. A taper is done to test for pain. Pain = swelling = more time of meds. Usually a taper of the pain meds are done at the same time so a true test for pain can be made. Sometimes it takes a week or two for the swelling to resolve but for some dogs it can take a month or more of being on an anti-inflammatory dose of a steroid. Please let us know what the dosage of the Prednisone has been all along. Dosages in mgs, frequency given, how many tapers have been done and how each taper went. 3. Pain. Since there is still pain, please ask your vet to adjust the pain medication. Since we don't have the dosages of the meds, we can't advise you if enough is being given. There should be no signs of pain from one dose of the meds to the next and all pain should be completely under control within one hour after administering. 4. Medication. What are the exact names, dose in mgs and frequency of all meds? 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.html5. Pepcid AC dosage is 5 mg 30 minutes before each dose of the anti-inflammatory and thereafter every 12 hours. Good job on getting that on board. 6. Change of food. You should keep her on the food that she is used to. Sometimes a change of food can cause diarrhea or stomach upset and you won't be able to tell if the problem is from the change of food or the medication. 7. Position of neck. Did the vet say anything about this being a neck problem? You mentioned that she lays with her neck stretched out and that might indicate pain in her neck. Neck problems can be more painful than back problems and can take longer to resolve. I would mention that to your vet, also. 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. We're here for you and Peke and will help you through this. Please let us know what your vet says after speaking to him and let us have the additional information asked for above so we can support you better. Blessings to you all.
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Post by Daniel&Peke on Jan 22, 2014 18:46:34 GMT -7
Thank you so much for your response! You are awesome!
I would say it's been about 1 1/2 weeks of 100% crate rest. It took a week for her to get used to the crate. The week before that was at about 80%. She has been fighting us and even now she whines...
We spoke to the doctor today as this was her 3rd laser therapy session. They said that we should try to taper off the ▼steroid again and if she is still in more pain, then they will give her another week of a pill everyday. Not sure if I agree with that, but that's what they told us. We let them know she had pain on Sun and Mon, obviously when she was there she had to get a shot, so I'm not exactly sure about there reasoning.
We have had the pain under control other than Sun & Mon, it's just that for some reason she just had a bad couple of days. She has been completely fine Tuesday and Today with no yelping at all. No sensitive tummy, shaking or arching of the back. She get's extremely excited while in her cage though when my wife's daughter comes home. Worries me she might twist in a weird way, but we are trying to come in and not make a lot of noise and tell her to hush.
As for the meds, She is on 16 pounds 50 mg of Tramadol, 1/2 pill every 6 to 8 hours. We had to start giving her a full pill and still are about 2 weeks ago as it wasn't enough. Methocarbamol 500 mg, we are giving a 1/2 tablet every 8 hours. Gabapentin 100 mg, we are giving that every 12 hours. Prednisone 5 mg, we are doing the tapering again with 1 every other day now. She had one today, so none tomorrow.
As far as food, I definitely wouldn't have changed it if I had know it was better to keep it the same. It was probably one more thing for her to have to deal with unfortunately... I know better! We were giving her Pro Plan which in my research isn't a very good food. So I decided on either Wellness or Organix and I went with Organix. She has been on it for two weeks and she hasn't had any diahrea. My wife fed her an orange yesterday which I think made her have soft stool for the first time. Today they have been harder though. Other than just last night maybe because of the orange, she seems to have taken to the food luckily.
The doctor didn't say anything about the neck having a problem. They spoke to us and let us know it was right in the center of her back. Although, that first night when my wife lifted her head to see what was wrong, she yelped in pain. I'm thinking that moved her body/back a little which made her feel it. She just sleeps weird. Sometimes she is halfway on the bed, which may make her back feel better I don't know. We have seen her sleeping with her neck pointed way up and if she yelped in pain when my wife lifted it up, maybe it's getting better or the pain killer is taking the pain away. I see what your saying, but it's hard to make sense when she sleeps in positions that look like it would be painful.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Jan 22, 2014 21:56:20 GMT -7
Daniel, keep on with observing for any hint of pain that may surface as the taper continues. Prompt feedback to the vet will be necessary to get Peke back on the higher anti-inflammatory dose for a bit longer. We've got our fingers cross you will not see any signs of pain. What was the original Pred dose: ?mg; ?x/day
Are you still giving Pepcid AC, 5mg 2x a day?
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Post by Jean & Mimi on Jan 23, 2014 7:18:12 GMT -7
Daniel, just wanted to say I have my fingers crossed for a successful taper.
I also wanted to reassure you that if you see signs of pain and the pred needs to be increased again not to worry. That can happen and some dogs just need a longer time period (some even close to a month - that was me) before the swelling is completely down. Let us know how it goes.
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Post by Daniel&Peke on Jan 23, 2014 13:22:35 GMT -7
Thank you so much for your help Paula. As far as the Prednisone, the first bottle was 5mg once daily for 4 days, then 1 every other day for the remaining pills. The second bottle was also [prednisone] 5mg, but once daily for 7 days, then once every other day. We have 3 pills left now.
Jean I really appreciate your support. I have a strong feeling that Peke will need at least 2 or 3 more weeks of the steroid. I think the vet should have put her on it for 2 weeks straight after the first bottle didn't work.
We had a setback today after two days of good resting and suprising playful energy. We of course didn't play with her, but we could see that she wanted to play. Then today, my wifes mother and grandmother came over to watch the dog as they have been when my wife goes out to work for a few hours. My wifes 2 uncles came over as well this time, and we are thinking that Peke became too excited or nervous being in the cage and overexerted herself. As they left, my wife tried to pick her up and she yelped in pain. Her back was a little arched and she could see Peke was in pain. She is fine now, asleep actually, but now we have to figure out who can watch her and have no one come to the house or put her in the room when someone comes. We keep on having relapses and it's extremely defeating and frustrating.
We have our fourth laser treatment tommorow. They said they would discuss with us how much more steroid she would need. They said they are concerned about the side effects of the steroid. We have been giving her 5mg of Pepcid before the steroid in the morning along with food.
I'll post what the doctor says tommorow as soon as I know. I really appreciate the help, Thank you.
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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 Jan 23, 2014 19:06:55 GMT -7
Hi Daniel, I'm Sabrina. I'm so sorry to hear Peke was showing pain today. Your plan of keeping things as quiet as possible for her is a good one. If you haven't seen this already, here is a page of strategies for helping Peke stay calm in her crate: www.dodgerslist.com/literature/EmergencyCrate%20Training.htm#EmergencyconfinementFor dogs of Peke's size, the typical anti-inflammatory dose is 5mg 2x/day - I would discuss this with the vet. It is true that there are no safe medications. There are two safety factors with drugs. One is a vet who practices safe medicine with a blood test to verify the liver and kidneys are healthy prior to starting the medications. The other is an owner who is educated on what the side effects are and monitors their dog. We ask that all members read about each med their dog is on or may take as a safety measure. www.marvistavet.com/html/pharmacy_center.htmwww.dodgerslist.com/literature/healingsweling.htmwww.dodgerslist.com/literature/drugs.htmBut it is also definitely not "safe" for Peke to have swelling/inflammation going on (that is the cause of her pain). Pain actually hinders healing, so it is vital to get the swelling/inflammation under control asap with the "anti-inflammatory" dose of the steroid (and to control the pain fully with pain medications while the anti-inflammatory is doing it's job). www.dodgerslist.com/literature/healingpain.htm))Hugs!((
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Post by Daniel&Peke on Jan 25, 2014 11:17:48 GMT -7
Thanks Sabrina! We had our 4th laser surgery yesterday and so far things are going well. She was a little anxious going there, but then she calmed down. The ride home was surprisingly quiet. I think she may be getting used to her carrier, crate, these trips and all the changes. So we discussed the prednisone with the laser technician and she didn't see in the notes how long we should keep giving her the steroid. We let her know that we only have until this coming Monday and she told us that the doctor said to just give it to her everyday. The tech gave us some more Prednisone in case we ran out, so we are good there. On Monday she said the doctor would reassess the situation regarding the steroid. I let her know that she has had pain when tapering so I think that this time we will get her on it for a longer period. I'll also ask the doctor if twice a day is necessary. She seems to be doing well today, we are making her rest even though she looks like her old self. This has happened before, so we are being very careful, she could easily re-injure it. Sometimes she seems sore after that laser therapy but today she looks good. At first I was concerned about her laying with her neck stretched out, but now I'm concerned with something else. I think I know what it is though. So when she gets startled in her bed or tries to get up quickly, she has a way of getting up. She kind of twists herself to get her lower body straight and upright to stand. It's something she has always done and I think it could be because of her weight. It's almost like she needs to swing or get momentum to get her lower body upright to be able to stand or sit up. When she does that, the middle of her back looks like it takes most of that pressure. A couple weeks ago that's exactly how she hurt herself. Her daughter came home and she got really excited and the barking soon turned to really bad yelping. No way to stop that other than getting her weight down, but it's hard with her taking the steroid. We want her to have food in her but not gain at the same time. She's lost 2 pounds in a month, but she needs much more, probably another 4. Any ideas on how to get her weight down a little faster? She got this way because she was having two servings. our other dog Bella doesn't eat a lot so Peke was eating it. We have that under control now, but man what a piglet.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jan 25, 2014 12:17:41 GMT -7
Daniel, so you have more knowledge about the job of a steroid when you speak to the vet: The body makes it own steroid hormone called Cortisol (hydrocortisone) which is vital for regulating the body's functions. That is the real reason for the taper, to let the body know it has to start making it's own steroid which is at a low level. Vets use a higher level of oral steroids to work more effectively in getting painful swelling down. Rxing a tentative lower end dose of Pred (5 mg 1x a day) rather than being aggressive with the upper end of the dosing for inflammation (5 mg 2x a day) means Peke is being strung out on a long use of prednisone that may be similar to what the body makes on its own… so the job is not getting done. It is imperative to get the swelling down. Swelling presses into the spine and causes pain and can cause nerve damage. Peke has still not been on an anti-inflammatory dose. That may very well be why there was still pain upon the taper. You don't want to get into a position where every time a taper is tried, there is still pain. You want that pain (swelling) gone as quickly as possible so all meds can be stopped. Please speak to your vet ASAP (I wouldn't wait until Monday) about increasing the Prednisone to an anti-inflammatory dose of 5 mgs 2x/day. If your vet is hesitant about being aggressive about the swelling, then you should try to find a vet who will work with you correctly to get the swelling down. In addition, 5 mg of Pepcid AC needs to be given every 12 hours (twice a day) as long as Peke is on the Prednisone. As for Peke's weight, right now is not the time to diet. She has a lot of repair jobs to do so continue her normal food rations. It is good to watch her intake of calories such as avoiding treats outside of her normal meals. Treats if any should be low cal carrots, piece of apple or some frozen broth ice cubes to lick. If you feel after crate rest she still needs to diet, then it will be safe for more activity plus she can go on a bit of a diet to slowly get her down to a good weight over a period of several months. This page explains feeding for weight loss (for after crate rest): weight loss diet with illustrations www.nonprofitnw.org/drnw/id47.htmlPlease let us know what the vet says after speaking to them.
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Post by Daniel&Peke on Jan 29, 2014 13:33:59 GMT -7
Sorry for not replying sooner. We have been busy with schedule changes and making sure Peke always has someone to watch her.
Thanks Marjorie. I completely agree with what your saying. If 2 tapers didn't go so well, then something else needs to be done. On Sunday, I called the Vet to try and explain that we need to know how long to give her the steroid and that we need to try something different, including upping the dose. We unfortunetely didn't get a call back from them. We had a Monday laser session and they still didn't have a response for us other then to keep giving her the steroid once a day. It's been since Jan 21st that we have been giving her one a day. So yesterday, Jan 28th we finally heard from the Vet and they told us to give her half a pill for a week and then begin another taper after that.
I'm thinking that there is a communication problem since we are speaking to two different locations of the same Vet company. The laser sessions are not near us so we have to go to one of their other locations.
She seems to be getting a lot better though.y. She is able to shake herself harder and harder everyday. She hasn't yelped in pain for a little over a week and she is moving a lot more now. We are still caging her and making sure she is lying down as much as possible. It's getting harder and harder though. When we take her out to potty, she is starting to run and we have to try and get her to stop!
I thought that we should have increased the steroid a week ago as well, but they just told us to keep the same dose of one a day for another week. I'm getting the immpression that the Vet is weary of using the steroid for a long time. If this taper does not work, then I will make sure we try either a stronger dose or find another Vet. Two failed tapers is not a good track record, I definitely won't settle for three.
I will keep this updated.
Thanks
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Post by Pauliana on Jan 29, 2014 20:46:07 GMT -7
Hi Daniel! Such a shame that the Vet doesn't want to give Peke an anti inflammatory dose to get rid of that swelling.. I really would consider finding a vet more experienced in the treatment of IVDD. Here is a link that tells what to look for when considering a vet treating your dog for this condition. It also has a search engine to check for vets in your area: www.dodgerslist.com/literature/VetchkList.htmHave you been using a harness and a leash when you take Peke out to potty. Remember only a few footsteps during conservative treatment. A harness is easier on the back and neck than a collar.. With an IVDD dog, a collar is only for license and Id tags.. I see what you mean about the communications problems within the Vet company.. That is hard to deal with, especially when you are worried and need answers.. Thanks for keeping us updated.. Sending healing thoughts.
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Post by Daniel&Peke on Feb 4, 2014 14:46:06 GMT -7
Ok, so after 3 days of tapering Peke off of the steroid and she was in pain and yelped today. We were able to get the medication from the Vet and have 22 prednisone pills now. We have no other choice but to either find a new Vet or give Peke the steroid twice a day on our own. I was hoping to get the Vets approval but now they want to refer us to a nuerologist. Will a neurologist actually do anything different?
If we do decide to give Peke the 5mg steroid twice a day, how long is the reccommended length of time? 4 days? A week? It will be hard on her body, but at this point we have no other choice. Peke has been on the steroid for a month, but not consistently. We have tried 3 tapers and in between tapers there has been a couple days without a pill.
She was doing so well while on the steroid. A full week of energy, no pain. We tried to keep her crated as much as possible, although it's hard when she would run inside the house after going outside to potty. We are done with the laser therapy as of last Friday.
This is getting really frustrating. Not sure exactly what to do right now. We really appreciate any help. Thank you.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 4, 2014 16:13:32 GMT -7
Daniel, I think it would be a very good idea for you to take Peke in for a consult with a neurologist. Hopefully, the neurologist that you see will have enough knowledge about IVDD to prescribe an anti-inflammatory dose of the Prednisone (5mg 2x/day) and that will get the swelling down. Prednisone is not something that you should try to administer yourself.
I am concerned about your statement that she's run into the house after doing potty. A harness and leash should be used for potty times to prevent that from happening. Carried out, set down with harness and 6-foot leash, allowed to do a few steps to do potty, then picked up and carried back to crate. Did she happen to run in the last couple of days? If so, that may well be why she has pain and it might not even be related to the taper. Too much movement and the not-yet-healed disc can re-tear, swelling gets worse and pain is back. I'd like you to think carefully about when she last had more movement than a very few steps at potty time. When was the last time that happened? If in fact a re-tear of the disc is suspected, she would have to start off with the 8 weeks of crate rest and meds from the start. If you feel that she was fine for several days after having too much movement, then the taper would be the cause of the pain.
If you're unsure of when she last ran, an examination by a neurologist is definitely in order to assess whether there has been an aggravation or re-tear of the damaged disc.
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Post by Daniel&Peke on Feb 5, 2014 10:23:22 GMT -7
Thanks Marjorie, I honestly believe it is the taper that is causing this. We haven't been leashing her for potty time and she has ran before when she was on the 5mg per day does. Now that she is on the 2.5mg dose, with the same activity, she is in pain.
We have since yesterday, started using a harness(that doesnt pull her neck) and been picking her up to go out and back in to potty. We are going to be 100% no questions asked rigid with this now. I think we were too relaxed on her because she didn't seem to be quite as bad as other dogs with IVDD. Now we know she will be if we don't follow the strict healing regimen.
I know you recommend to see a nuerologist, but I have to be honest and say that we cannot afford an MRI or Surgery. If we could, I would absolutely do it. That's why I wonder if going to a nuerologist is even necessary. If you think that he will prescribe a better dose of the steroid or something else, then we will. I just don't want to go to them and have them give us the 2 options of euthanization or surgery.
Would an NSAID be an alternative for Peke? Or is the steroid the better option? We can't go to the Vet we've been going to anymore, they just don't want to prescribe a higher dose. Seems like they are pushing us to go to the nuero without even trying the higher dose of steroid.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Feb 5, 2014 13:12:24 GMT -7
Daniel, it is quite possible that the extra movement of running after potty time disrupted the weak scar tissue in the process of forming. I'm glad to hear that as of Feb 4 you will institute true conservative treatment. Meaning 100% STRICT crate rest 24/7 only out for a very, very few footsteps at potty time. Carried to and from the potty place. Using a harness and leash while you stand in one spot, Peke may only take a few footsteps the 6 foot leash allows.
Since there is no way to specifically tell why the pain returned (scar tissue disrupted or lowering pred or a combo of both), personally I would assume the worst and start crate rest from Feb 4. The hallmark component of conservative treatment is the limited movement part so the disc can heal. There are no meds to heal a disc, it is only limited movement that provides the right environment for the body to form strong secure scar tissue….that takes 8 weeks.
The reason to seek a consult with a specialist is that you can't find any local vet who is comfortable in using an anti-inflamamtory up at the anti-inflammatory dose for the length of time needed to get all of the inflammation resolved. So when you make the appointment you must tell him that surgery is not a financial option. It is his expertise in using medications that your local DVM vet is not comfortable in using that you are asking for a consultation. Make it clear that you want to continue with conservative treatment, be honest that you have been lax and that is likely the reason it may appear pred is not doing the job, but now are committed to the 100% STRICT rest.
A specialist may also have a better idea where the problematic disc is. If it is in the neck, which from your reported observations sounds as though it could be, that also would explain why it can take longer to heal… necks discs just take more time and can be more painful.
Steroids are the most powerful of the anti-inflammatories. The other class is the lesser and known as non-steroid anti-inflamamatory drugs (NSAID). Switching between the classes requires 4-7 days washout where Peke takes nothing but the pain relievers and Pepcid AC, in other words there is nothing in her body to work on swelling. This page will prepare you with more indepth info on anti-inflammatories.
Let us know you have either found another local vet who is comfortable in using an anti-inflammatory or that you obtained a consultation appointment with a specialist.
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Post by Daniel&Peke on Feb 6, 2014 10:21:21 GMT -7
Hey Paula, so we scheduled the neuro appointment for this Saturday. I'll make sure to let them know our limits and that we will want to continue conservative treatment.
It could be possible that she re-tore something, after going through this 2 other times now, I tend to lean towards it being not enough steroid and not keeping her in the crate 100%.
The doctors said that the slipped disc was right in the middle of her back. She kind of twitched a little when we were doing the laser therapy, as if it was sensitive on that area when the technician was rubbing the laser on her. Since x-rays aren't definitive, it very well could be in the neck or a different area than we think. It looks like it's in the middle of the back though. Like you said, it is taking a longer time to get the swelling down, so it could be that it is higher up the spine and a combination of the steroid and crate rest problem.
I just don't understand why the Vet doesn't want to prescribe us a stronger dose of the steroid. I thought maybe they think it could really hurt her or they just want to push us to their neurologist. They could be not as knowledgable as you guys are about this problem as well too, I dont' know.
She has been good so far today. A little slow, but we haven't let her out. My wife is on board with 100% crate rest now. I think it was really hard for her to accept that this injury was this serious, that's not her fault, but she isn't going to give in to Peke anymore. I think it was because she was doing better, but not completely healed. I knew that she wasn't right, I could just tell. I feel bad for my wife though, she is taking care of her like a baby, it's been hard on her.
I'll post as soon as we get back from the neurologist on Saturday.
Thanks
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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 Feb 6, 2014 13:31:11 GMT -7
Hi Daniel. I'm hopeful that the neurologist will be knowledgeable and confident with medicating Peke during her conservative treatment. Is the dr. you have an appointment with "Board Certified"? "Vets who have qualified for specialization are called board certified; they have completed an approved residency and passed the board’s exam. Board certified vets are referred to as Diplomates of the Board. Veterinary Internal Medicine (ACVIM) is the official organization of the veterinary specialist of neurology among several other specialties. American College of Veterinary Surgeons (ACVS) veterinarian who has been board certified in veterinary surgery and is called a specialist in veterinary surgery While many vets who are not board certified do call themselves specialists, board certification is the good standard by which to measure competence and training." www.dodgerslist.com/literature/VetchkList.htmI am so sorry that you and your wife and Peke have to go through this! Has your wife been reading the articles on Dodger'sList about IVDD? When my Charley was first diagnosed it was several days before I learned about Dodger'sList and the need for 100% strict crate rest. I didn't understand until I'd read (and re-read!) just about everything on the Dodger'sList main site how vital a full 8wks of 100% strict crate rest is so that secure scar tissue can develop to protect the disc(s). If your wife is just getting started with her reading, this page is an excellent place to start: www.dodgerslist.com/literature/healingpage.htm))Hugs(( to you all!
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Post by Daniel&Peke on Feb 8, 2014 11:40:29 GMT -7
Ok, so we just got back from the Neurologist. The Veterinary Neurological Center was the place and it came through as board certified on the vet check list.
The doctor evaluated her and his conclusion was that this was a neck problem and not a back problem. He said that the symptoms of raising the neck with pain, hunched back with the ability to still walk and the fact that she is also still in pain since Dec 25th.
I made it clear that I couldn't afford the $5000 dollar surgery and asked him if there was a chance that it could heal on its own. He said it could... He also said that the reason why the pain comes back is because there is disc material still there and that the meds are treating the symptoms but not the disease. I can see that. I can see that when the steroid is tapered, the pain returns because the material is still there.
So he prescribed the prednisone for 5mg twice a day until this coming Tuesday [4 day course]. He said that he will most likely want her on it for longer, but to just check up with him to make sure she is ok with no extreme side effects.
We are on our last hopes with this attempt. We want her out of pain, but if crate rest can help this then we will try. If not, we want to get her out of this pain and let her go. The doctor said there was a chance and I made sure to ask him that... so I think we can only try.
Thank you
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Feb 8, 2014 13:10:46 GMT -7
Daniel, sounds like you had a very good consultation with a knowledgeable neuro specialist who understands conservative treatment. OK here's the deal. Now that we know it is indeed a neck problem you will want to make sure you are doing all these extra things to help Peke: www.dodgerslist.com/literature/cervical.htmRemember Peke has not really been given a good opportunity to heal that neck disc because true conservative treatment was not implemented until Feb 4th regarding both the limited movement part and never really an anti-inflammatory level of prednisone Rx'd. So we can more easily follow Peke's treatment is this med list correct? 16 pounds Tramadol 50mg every 8 hours. Methocarbamol 500 mg tab: 250mgs every 8 hours. Gabapentin 100 mg, every 12 hours. Prednisone 5 mg twice a day for four days, check up to assess Pepcid AC 5mg 2x a day. Give 30 mins before Pred and give Pred with a meal. Here is the outcome to look for with conservative treatment and this neck disc: 1. Pain will be fully controlled dose to dose. If is it not, then discuss via phone call about Rxing gabapentin 3x a day to keep a more even level of gabapentin in the body. 2. Maintain 100% STRICT rest 24/7 and a very, very few footsteps at potty time. The disc WILL heal and form scar tissue with limited movement. We have changed your subject line to reflect that 2/4 is the restart of crate rest to give Peke every opportunity possible to create strong secure disc scar tissue. 3. Any disc pieces or bulge to the disc have the potential to shrink back/ be reabsorbed by the body so that the nerves learn to function around it and not be aggravated , not be in pain. So that is the hope that the body will do that kind of work. If the irritant does not shrink back enough, then rather than ending a life, we seek solutions to see how Peke CAN live and enjoy life through the miracle of drugs. She might have to have a very low dose of meds to allow her to enjoy a pain free life after 8 weeks of crate rest has been completed. But that is down the line…let's think positive that now that you have a vet comfortable in treating this disc episode, good progress will be made!
Do keep us posted on Peke! And if this neuro continues to be good support in conservative treatment consider adding him to our Vet Recommendation Directory to help another future member: dodgerslist.boards.net/board/10/guidelines-posting Name of Vet Name of Clinic Street Address City: State or country: Type of vet (general/board certified surgeon, acupuncture, etc.) Comments:
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Post by Daniel&Peke on Feb 8, 2014 21:31:15 GMT -7
Thanks for the encouragement Paula. Seems like you guys noticed it was a neck issue a long time ago Funny how you guys noticed it and the Vet we went to at first didn't... Unfortunate we were nickel and dimed for so much money. Pretty sad actually, but now we know what to do and what is ahead of us a little better. I have a couple of questions. So when Peke gets up out of bed, I think mentioned how she shakes herself like a lot of dogs do. She has had allergies in the past, including really dry ears and Benedryl seemed to help. Should we hold off on giving her Benedryl on top of all of these meds? I want to make sure because it is a lot that she's on. I'm just trying to find a way for her not to shake and keep her neck as still as possible. She just has to be such a dog!!! Would warm towels on her neck help with the healing or pain? Also, are the probabilities to recovery better for a neck injury or back injury? It just seems weird that so many people on here that have dogs with neck injuries need surgery, or can't walk and become paralyzed. Peke still walks, eats, pees and does pretty much everything while she is on the medications. I'm just trying to figure out if she is a luckier scenario than most dogs or if she is just like the others that will eventually need surgery.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 9, 2014 7:34:06 GMT -7
Having the right vet can make all the difference, Daniel. Neck injuries can be more painful and can take longer to resolve. It's more difficult to limit movement of the neck, so be sure to follow the tips on our cervical page. Paula gave you the link to that above. Raise Peke's food and water dish so she doesn't have to bend down (attach to side of crate as shown on cervical page), soak her kibble, etc. With limited movement and the correct meds, the disc can heal. Each dog is different. Peke's tear or herniation may be a different disc than other dogs you've seen here or theirs may have been a more severe injury. Each back injury presents differently, too - some with little to no nerve damage and some with paralysis. Peke is doing great - just need to get that swelling down with meds and allow the disc to heal with limited movement. As for the Benadryl, you'll need to check with your vet on the exact dosage as the wrong dosage can have dangerous side effects. As always, check with your vet before adding any medication for interactions with other meds. We recommend Benadryl to calm dogs in crates so I don't believe there would be any contraindications with the usual IVDD meds but check with your vet to be sure. Here's a good page to read up on Benadryl: www.marvistavet.com/html/benadryl.htmlWhile a warm towel may feel comforting to Peke, the pain needs to be controlled with meds. Only time and limited movement will help with the healing. If you see any signs of pain, then the meds need to be adjusted. I know it was helpful to me to think of Jeremy's crate as a cast for his back. That thought might be helpful to you and your wife, too, as I know how hard it is to see our beloved pets confined. And it's especially difficult to have to start all over again. Try not to look back since unfortunately what happened can't be changed. I didn't get proper medical advice when my Jeremy first went down and he ended up paralyzed. Peke still hasn't had nerve damage and you're on the right track now. Continued healing prayers for Peke.
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Post by Daniel&Peke on Feb 10, 2014 20:52:34 GMT -7
Thanks Marjorie, it was very tough thinking that most of our money hasn't been spent in the most efficient way but we did gain the knowledge which is so much more important. I even tried to call the vet back and ask if we could get some free laser sessions considering they were wrong on the diagnosis. They answered no of course... I made sure to let them know that they said she would be fine in 6 weeks and now the neurologist wants to do surgery? Not to mention I made sure to ask the neurologist if she could heal on her own and he reluctantly said yes? Wow, no free sessions and not even a discount. Safe to say we are done with them.
Anyway, we will move on just like you mentioned. We feel much better now that we have a higher steroid dose going along with her being in her crate 100% of the time. She had a ton of energy today, whining a lot more wanting to get out but we are maintaining. This brings me to my question.
I know the heavy panting is normal with the steroid, but should we put a fan near her? Or maybe give her some ice? I'm wondering if she is running hot at night and maybe we could try to cool her off.
My wife ends up putting a space heater near her in the early morning though, seems like that will help with her getting too sore when she wakes up after sleeping. I'm thinking the cold will make her get stiff.
So the doctor said to reduce the ▼ steroid from 5mg twice a day to 5mg in the morning and 2.5mg at night. This will happen tomorrow. They didn't say for how long we should stick with the new dosage, but I'm wondering if this is enough. I really don't want to go through another bad taper. Should we give her 5mg 2x a day for the last day instead of the 2.5 at night? I'm thinking it's necessary. She seems to be handling it well besides the heavy panting at night.
Also, we have a joint supplement from Petsmart that I purchased. Its called GNC Ultra Mega Hip and Joint Health. It's for senior dogs and Peke is 6 now. I'm wondering if it's better to wait or if we should start giving it to her. I know it will take a month or two to kick in(I take gluc and cissus for a shoulder issue) but I want to make sure it won't interfere with the other meds. I thought I read something about fish oil and gabapentin. Can't remember where though.
Sorry if I'm posting a lot here! I really appreciate the help. I also want to document everything on my case because I hate reading incomplete forum posts!
Thank you!
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Post by Pauliana on Feb 10, 2014 22:27:11 GMT -7
Hi Daniel, Here is the info about supplements for a dog with IVDD: www.dodgerslist.com/literature/Supplements.htmI would say to give the 5mg of Prednisone as normal tonight and then begin with the 5mg in the morning and 2.5 mg in the evening tomorrow as the Vet suggested and as you know watch for signs of pain and if you see any contact the vet and let him know so you can return to the twice a day 5mg dose of the Prednisone.. When Peke is panting put a fan near him but not pointed directly at him to give him some air circulation. Keep an eye that he doesn't get too chilly.. Healing thoughts and prayers for Peke..
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Post by Daniel&Peke on Feb 11, 2014 18:54:28 GMT -7
Ok so for the past 3 days Peke has been fine. She has been getting her energy back quickly due to the higher steroid dose. She even growled at me this morning as I got close to the cage which is normal for her. She always growled before this happened when I would get close to her bed. Then she will stop when I would pet her.
Then comes today... My wife left her in the crate to go see her grandmother in the hospital. Peke has been doing really well in her crate, but when I came home she was shivering and seemed out of breathe. I could tell she was in pain and I told my wife to get home as soon as she could. Peke started to calm down a little after I took her out to pee and gave her a little pieces of apple.
We have been giving her tiny treats like that when my wife, daughter or myself get home. The problem is that she gets so excited when she see's someone come home and the treats distract her but not this time.
So when my wife gets home, Peke starts barking and whining like crazy which then turned into painful yelping. She moves her head very slowly if she wants to look at something to the side of her. She looks like she is having trouble turning her head right now. Just yesterday she would look to the side normally. This has happened before where her neck looks stiff, but then it starts to loosen up after more steroid and her staying calm.
She went crazy because the steroid gave her enough energy to make her think she was ok. This all happened in the crate so how the hell can we prevent this. I'm so frustrated. She hurt herself and now we don't know if she made it worse yet again. We have tried a lot from the crate training page. The lavender oil, treats, we leave calming music while we are gone and we stay quiet and calm when we get home.
I'm starting to think she is going to need to get on some sort of relaxer like valium or something. Is there a certain calming med that is recommeneded, and if so what dosage?
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Post by Pauliana on Feb 11, 2014 20:38:13 GMT -7
Hi Daniel, Using any oral calmer in combination with a Pheromone diffuser seems to work best. 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. Of course always keep your vet in the loop on all things you give your dog. For medications to calm Peke, you would need to discuss with your vet,what he would want to use and the dosage.. If you want to try the natural approach these can take a few days to work.. Place a DAP pheromone diffusor at floor level where the recovery suite is: --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 diffusor 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 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com Plain Benadryl (Diphenhydramine) with no additional medications added. Buy at your grocery store or pharmacy. Get the dosage from your vet. The wrong dose can have dangerous side effects, so your vet needs to prescribe the proper amount for your dog. Other product brands may be available in your area… just shop by the active ingredient(s) on the label and the quantity for best price
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 13, 2014 8:39:51 GMT -7
How is Peke doing today, Daniel? Has she calmed down in the crate now and no longer showing signs of pain? It's more difficult to keep their necks from moving and that's why neck problems can take longer to resolve and why it can take quite a bit of tweaking to get the meds right. Did you speak to the vet about continuing with the anti-inflammatory dose of the Prednisone for a longer period of time? Since there were signs of pain, a taper should not have been done at that point.
We're thinking of you both and hope things have improved since your last post.
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Post by Daniel&Peke on Feb 13, 2014 14:31:38 GMT -7
Hey Pauliana, thanks for the extra tips on getting her more relaxed in the crate. I've since bought the rescue remedy and a Sentry diffuser. She was a lot better yesterday than the day before, so maybe that's the extra kick she needed to take the edge off. We have resorted to putting the TV really loud so they can't hear any of us come in. We have cut very small pieces of apples to give her so we can distract her while one of us comes in and that seems to be working really well so far. Seems like one obstacle after another. Feels like we are starting to get used to that.
Thanks Marjorie, Peke has been doing well today and yesterday. The neurologist I spoke to yesterday said to reduce the ▼steroid to 7.5mg a day instead of the 10mg. It seems like these vets really don't like giving the steroid. I told her that she had a bad day on Tuesday but had a complete turn around on Wednesday. She said to keep the 7.5 dose and call them back today. I feel like she needs it for a little longer but I can only wait for the dcotor to tell me what to do next. I should hear from the today or tommorow. I don't see why she would have only one day of 7.5 and then down to 5 again? Seems like not enough time on 7.5.
She wanted to bite my head off this morning again so that's good. She's just territorial, but that lets us know she has good fight in her right now.
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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 Feb 13, 2014 19:23:32 GMT -7
Hi Daniel - glad to hear that you're noticing Peke is more relaxed!
When you said she "wanted to bite your head off" this morning, do you think that was a sign of pain? Was it accompanied by any other signs (shivering, tight hard tummy, reluctance to move, etc)?
How many days had Peke been back at 5mg 2x/day? Did the neurologist have you back off of/stop the pain meds to get an accurate picture if Peke is still in pain? (Pain is the sign that the pred still needs to be at the anti-inflammatory dose.)
Could you give us Peke's current meds list?
))Hugs!((
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 14, 2014 5:41:52 GMT -7
Thanks for the update, Daniel. Very glad Peke's feeling better.
To review the taper, it looks like Peke started the anti-inflammatory level of the Pred (5 mg 2x/day) on Feb. 8 for a four-day course. Then she was tapered to 5mg twice a day to 5mg in the morning and 2.5mg at night on Feb. 11. So that was another 4 days on 7.5 mgs. And now the doctor wants to go down to 2.5 mg 2x/day today. It's not an unusual taper in and of itself. My concern is the day Peke showed signs of pain. On that day, (Feb. 11), she should have been moved back up to the full anti-inflammatory level of 5 mgs 2x/day. I can only assume that the vet felt that the complete turn around on Wed. was enough to continue with the taper.
I know you'll be keeping a close watch for pain as this taper continues. If you do see signs of pain, advocate strongly for a return to the anti-inflammatory level of the Pred, even for just a few days.
As Sabrina asked, are the pain meds also being tapered? Otherwise, the pain meds will mask pain and it will be difficult to determine if there's still swelling. That is something you should discuss with the neurologist when you check in with her today. You need to see that pain if it's still there as that's the only way to know if there is still swelling.
Please keep us updated.
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Post by Daniel&Peke on Feb 14, 2014 22:28:08 GMT -7
Hey Sabrina, sorry for being misleading Peke is a Dachshund with an attitude, she has always been territorial with her food and her sleeping area. When she first started feeling pain, she wasn't growling at me, and hasn't been for the past month and a half. Now, with the all the meds and healing time, maybe she is healing, she has begun growling at me again. So I guess that's a good sign lol Anyway, she is still on all four medications. The tramadol, gabapentin, methacarbamol and prednisone. All the same dosages, but of course with the higher steroid dose now.Hey Marjorie, we have been having success with getting Peke more calm with pieces of apple and loud music. The rescue remedy seems to be really helpful too. Although, yesterday we couldn't tell if she was in pain or not. She was staring straight ahead and not looking at us. We tried to give her some pumpkin and she turned her head.. but slowly. So we waited a bit thinking she was being a brat and just wanted food. Well, a half hour later, she was moving really, really slowly, and made a very, very slight yelp when she tried to get up. So now we know that when she looks to the side with only her eyes, and won't turn her head, that she is indeed in pain. We gave her a half pill of the pain med and she was fine, moving her head quicker just about an hour later. We have since shortened the time for the pain med as we don't want her to be in pain at all, to about 6 hours. A couple weeks ago we were giving her a half tablet. We have been giving her a full tab every 8 but since a few days ago we have decided to give her a full tab every 6. We will give her a half tab every 6 when we see less signs of pain. As far as the steroid, I was right when the doctor said they wanted to reduce the steroid to only 5mg a day. We didn't hear from them today as they were supposed to let us know what to do with Peke and her minor pain episode yesterday. I really feel like we should do this on our own. The neurologist is doing the same thing as the original vet. I already got really mad at the previous vet lol I would hate to have to go back to them, so we may have to find another vet yet again, but going through the whole thing and explaining peke's story only to be misunderstood by another vet will literally drive me crazy. We gave her the Pred 7.5mg today and did not move down to the 5mg.One question that I do have is, should we be giving Peke the gabapentin every 8 hours or 12? The bottle says 12, but we've seen a lot of posts and info saying that it should be every 8? I honestly feel like she needs to be on the full anti-inflammatory dose of the steroid for 2 weeks. That will really let us know how she is doing. I know that will be really hard on her, but this four days stuff isn't working. Maybe she just need more time. It's all too hard to say. Thanks again for all the help everyone. You guys are like canine back saving angels We need a little humor through all of this.
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