Chris' Duke 2/15 Conservative

Chris, welcome to Dodgerslist.  Reading is a critical element of making sure Duke gets the right care.  Stories are good for the spirits!  The essential core information to understand this disease, the meds, etc. is located on our main Dodgerslist webpage… did you find it:  www.dodgerslist.com/healingindex.htm

Here is how prednisone works so you can be prepared:

During the time on the anti-inflammatory the pain meds do need to be adjusted so that there is no pain surfacing dose to dose of pain relief medications. Pain deters healing.   Have you seen any shaking/trembling, tight tense tummy, yelping, not his normal perky self?

Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 7-30 days before all the swelling is gone.  Duke is not on an anti-inflammatory dose of pred. When the vet guesses swelling might be gone there will be a taper maybe in 5-7 days.  The dose is lowered to less than the anti-flammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too and should be discussed with your vet.  

Rule of thumb is: pain = swelling = more time on Pred, pain meds and Pepcid AC is needed.

If there is no pain on the taper then it goes to completion. Then no meds at all are needed. Disc healing will continue for the remainder of the 8 weeks. Nerves can continue to self heal…think in terms of months.

It is ok for Duke to sleep curled up.  You will need to start out expressing every 2-3 hours. As your proficiency builds you will be able to move up to every 3-4 hours while on pred. Once off of pred then you can move to every 6-8 hours and he would stay dry.  Do not hesitate to express in the vet's office and have the vet tech check your work while you are learning.  The goal is to feel the bladder at the last stage of empyting where it is so flat you can almost feel the fingers of your other hand.  Have you seen the video and tips at the main web site for expressing the bladder and for poop?  www.dodgerslist.com/literature/Expressing.htm

Now is really not a good idea to change his normal food while he is on meds.  Do try the pumpkin instead of changing kibble.  Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. To firm up the stool add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato.

Is there a friend/family who can come and check on Duke midday. Some vet techs can be hired to do that too. Is your work situation such that you could bring Duke there?

I hope you'll be over the flu soon, you do have a full plate.  Good news on your other dog!

Prednisone is one medication that needs the guidance of a vet to administer. Has the vet prescribed the second Prednisone for 7 days? Yes, the anti-inflammatory dose is 5 mg 2x/day so please discuss with the vet and ask him to increase the dosage. Don't try to do this on your own. If your vet will not prescribe the anti-inflammatory dosage of the Prednisone, you'll need to find a vet who understands IVDD and will treat Duke properly. If the vet does prescribe the Prednisone 5mg 2x/day, that should be given every 12 hours. Pepcid AC should be given 5 mg 30 min before the Prednisone and then every 12 hours thereafter.

You should also speak to the vet about the sedation affect of the Tramadol. If the Tramadol is reduced, be sure to let the vet know if any pain arises. The pain needs to be kept under control.

My Jeremy is incontinent and I take his water away about 2 hours before bedtime. I express him right before bed and he usually is dry all night. How are you doing expressing? Getting a couple of good streams of urine each time? Does the bladder feel flat after expressing?

Was the tail wag that you saw in response to speaking to Duke in a happy voice or when you gave him a treat? If so, then the connection from his brain to the nerves of his tail are working correctly and that's great news!

Please let us know what the vet says after speaking to them.

Blessings to you both.

Nerves heal typically in the reverse order of the damage to the spinal cord:

1. Deep Pain Sensation (Only correctly identified by a specialist.)
2. Tail wagging with joy at seeing you or getting a treat or meal.<---- Duke
3. Bladder and bowel control verified with the "sniff and pee" test.
4. Leg Movement, and then ability to move up into a standing position, and then wobbly walking.
5. Being able to walk with more steadiness and properly place the feet.
6. Ability to walk unassisted and perhaps even run.

The only way for us humans to know if there is bladder control is with the sniff and pee test. We need to see a head level action (sniff) in association with release of urine.  Carry outdoors, set on an old pee spot to sniff it. See if urine is then released. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. If urine comes out after sniffing, bladder control is returning. You should do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe.

As nerve functions return to the legs, there will be control of muscles where the muscles can tense/relax, etc to  make moving up into a standing position or making walking movements possible.

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

Chris, can you tell us if you are seeing one or more of these signs of pain: shivering, trembling, yelping, not his normal perky self, tight tense tummy muscles?

While on this taper there is no clear picture of the degree of painful swelling left in the spinal cord. The reason is Duke is on pain masking pain meds (Tramadol and gabapentin). Usually the pain meds are backed off or stopped along with the taper so there is no doubt if any hint of pain appears. Have you discussed stopping the pain meds so there is a more immediate sense if Pred needs to be continued.

The arched back can take time to lesson, it usually does.  Good job on being conscientious about the strict crate rest so that Duke's disc will have the best opportunity to heal.  At the end of 8 weeks when he should have been off all meds for a least a week, he'll be ready to gradually work back into physical activity.  Have you made a plan yet...there is a good sample plan in our "All Things IVDD" page in the column AFTER CRate REST Then WHAt?   www.dodgerslist.com/literature.htm#afterrest

I would check on that tense belly when he should be relaxed. It might be a sign of pain when taken out to urinate since he's being moved. But when dogs start to have a return of bladder control like he is, they sometimes don't want to be expressed and tense up. Also, you might be feeling some tenseness due to excitement from being outside. See if he's tensing up his belly when being picked up or after he comes back inside after being moved.

The problem with still being on pain meds during a taper is that, as Paula mentioned, a true test for pain can't be made.  If there is still swelling pressing on the spine, then Duke needs to be returned to the anti-inflammatory dose of the steroid. But that can only be determined if the pain meds are stopped. If the pain meds are stopped and there are no signs of pain, then great, the taper of the steroid can continue. Upon the finish of the taper and there is still no pain, then all meds can be stopped.

It's not a matter of how long pain "should still be there". Each dog is different. You don't want him to take steroids with their risks if there is no longer a need for them. But a true test for pain needs to be done to determine whether the steroid is still needed.

How much pain medication is he currently on (exact dose in mgs & frequency given)?