Jessica's Maggie 2/11ish? Conservative Bristol CT

Mostly I am looking for another vet because they said her chances of getting better without surgery is very slim, they want her to go see a neurologist but that in itself is 2000$. We love our dog dearly and feel terrible that we can not provide any of these services for her. My dogs name is Maggie and my name is Jessica. Maggie is a miniature dapple dachshund shorthair and weighs around 12 pounds. She is about 8 years old. The vet did not specifically come out and say she has IVDD but they did say that she has a disk putting pressure on her spinal cord. They said her back legs are not moving because the nerve to the brain is not working because of this. She has some pain in her back legs but is a little delayed with the pain. She wags her tail and has feeling there.

The first vet visit was on Feb 10th where they prescribed some medicine the tramadol metacam and metacarbamol, at this point she was holding her legs up instead of dragging them.

Her second visit was Feb 17 and they took her off the metacam and prescribed her all the other medications I had listed before. Other than her legs not working she seems fine, I thought she might still be in some pain because she cries and yelps in the kennel but when you sit by the kennel with her she is all right. At this point we are not moving her, the vet suggest to let her do her duty in the Kennel so the only time she is moved is to clean the blankets out. Her stools are normal and her urine as well. She has been eating chicken and rice and pure pumpkin filling. She is all there, still a happy dog you wouldn't even be able to tell anything was wrong with her if you saw her in the kennel. Currently the dog does wobbley walk and sort of crawls I guess you would say, the tail wags, and she even barks when she hears someone at the door. When she gets excited (ever since she was a puppy) she would pee on you. We have no been lifting her up or moving her a lot since this all started. Her eating and drinking are normal. I am just nervous because my mom is starting to think without doing the surgery there is no hope for her and we need to put her to sleep even know she is completely herself. And also we heard the price of acupuncture is around the same amount as the surgery? Her medications are
tramadol 50mg, 1/4 tablet orally 3x a day.
Methocarbomal 500 mg 1/4 tablet orally 3x daily.
Sucralfate 1g 1/4 tablet 3x daily - 1 hour before or 2 hours after other medicine.
Famotidine 10mg 1/2 tablet 2x daily - 1 hour before or 2 hours after other meds. And
Prednisone 5 mg 1/2 orally 2x daily for 7 days. Then 1/2 tab orally 1x daily for 7 days. Then 1/2 tab orally every other day until gone. 

Thank You! And if you need any other information please let me know!

Maggie is in a wire crate. We have a couple of questions, after the 8 weeks of crate rest will she still need the medications she is on? And also how will you know she is better and needs the two wheels? How much are the 2 wheels? Where would be the cheepest place to buy it? Does she need to be measured by length or by small medium and large? What would you reccomend? And how often should she be going to see the vet? Right now she is going 2x a week but it is getting very costly. And they do not even have hopes for her getting better on crate rest!

Hi Jessica, You are in the scariest part of this whole thing! The part where you don't know what to do for the dog and everyone has an opinion! Your dog is no where near ready for euthanasia - you said yourself she seems just fine other than the leg thing. Please don't give up on her. Maggie just needs the time to heal. This web site and this forum are so helpful - I couldn't have done it without them. I'm only two weeks in on the crate rest but feel so much better about my decision to not put Emmie through surgery. I feel hopeful and if the worst thing at the end of this is a happy dog on wheels - then so be it! I don't have to make that decision or purchase yet - and neither do you. Get Maggie the meds she needs and then let her rest. Please take the time to explore the dodgerslist site fully - there are so many good videos and so much excellent information to help you with this. Best wishes from Emmie (smooth shaded red mini) and me.

Jessica, you indicated this was the dosage for Maggie:

Prednisone 5 mg 1/2 orally 2x daily for 7 days. Then 1/2 tab orally 1x daily for 7 days. Then 1/2 tab orally every other day until gone.

This seems to indicate that she is on a 5mg tab, given in 1/2 tab increments twice daily. That would only be 2.5 mg 2x daily. She needs to be on a full 5mg tab 2x daily for the anti-inflamatory dosage. Can you let us know which one it is? I know this is soooo confusing with all the medication.

Don't think about a cart yet. She has so much time to heal and recover. I also agree with Marjorie. The only time we took Mimi to the vet was when she failed a taper and her neuro function went down or when the vet wanted to see her progress after being on the steroids for a bit to determine the taper. Otherwise, everything was done with a phone call because none of us wanted to move Mimi around more than was absolutely necessary. Please talk to the vet about that.

Hang in there, the early stages are the toughest. But you will get through this...keep fighting for Maggie

Jessica, thanks for clarifying all the meds and the doses in mgs.

12 pounds.
tramadol 12.5mg 3x a day.
Methocarbomal 125mg 3x daily.
Sucralfate 250mg 3x daily - 1 hour before or 2 hours after other medicine.
Famotidine 5mg 2x daily - 1 hour before or 2 hours after other meds. And
Prednisone as of 2/17: 2.5 mg 2x daily for 7 days. Then taper

During the time on the anti-inflammatory the pain meds may need to be adjusted so that there is no pain surfacing dose to dose of pain relief medications. Pain deters healing. You are reporting there are no signs of pain, so it is clear the pain meds are correct for Maggie.  I'm confused on the neuro functions.  Can you clarify that Maggie can wobbly walk with her rear legs? Or is she dragging them behind? Where is Maggie #3 or #4 or ???

As damage to the spinal cord increases, there is a predictable stepwise deterioration of functionsWhen nerve healing begins, often it follows the reverse order.
1. Pain caused by the tearing disc & inflammation in the spinal cord
2. Wobbly walking, legs cross
3. Nails scuffing floor
4. Paws knuckle
5. Legs do not work (paralysis, dog is down)
6. Bladder control is lost
7. Tail wagging with joy is lost
8. Deep pain sensation, the last neuro function,

Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 7-30 days before all the swelling is gone. When the vet guesses swelling might be gone there will be a taper. Often a vet will take a guess at the 7 day mark as your vet did. 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.

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.

So what I would do tomorrow is call to update the vet on pain and neuro functions and let him know that little movement of the spine is your concern to avoid transporting unless absolutely necessary and to update via phone.  Things are going well and there is no taper to start it appears until Sunday Feb 23.

Thurs 2/20, discuss and work out a plan together: 
-- If Maggie legs do not move at all, she drags her back legs, then advocate strongly for getting swelling down asap (Thurs AM) by bumping up to the anti-inflammatory level (5mg 2x a day). The longer nerves are pressured the more nerve cells die.  Death of nerves are evidenced by loss of leg function, loss of bladder control.  He needs to be reminded surgery is not an option here. Meds are needed to serve the purpose of relieving pressure on the spinal cord...the Prednisone.  
-- getting a clear and immediate picture of painful swelling by backing off or stopping the pain meds with the upcoming taper.
--what is plan B "IF" the taper shows there is still painful swelling? Having meds on hand or an Rx to have needed supply for another course of Pred + pain meds.

We encourage all members to move up into a role as the Captain of their dog's health care team. You hire the essential member, the vet.  You both work together as a team.  To fulfill your role, means beefing up your knowledge of IVDD through reading so you become a good communicator and a good advocate for Maggie. Knowledge is how you discuss confidently various issues from medications to recognizing if suggestions of activity would be harmful to the healing disc. Have you been on our main website… this is a very good start place "Overview: the essentials" yellow button it will give you the degree of understanding you need right away…. as time permits continue to read all the orange buttons and the blue button "Disc Disease 101 core readings" to complete your education. Here is the link www.dodgerslist.com/healingindex.htm

If your current vet is open minded to learn what you have learned here, then he can be a good vet to stay with. Any vet who indicates there is no hope, is showing there is a absence of personal experience in that department. You'd have to make it clear you a quite confident there IS hope and you have hired them to HELP Maggie. Negativity is not helpful to Maggie's caregiver!

IF at some point he becomes uncomfortable in prescribing meds... that is his way of telling you about his lack of expertise, then you'll need to find a vet who is more IVDD knowledgeable such as another general DVM or a specialist in neurological disease such as IVDD to get meds right. Any vet needs to know up front what is an option and what is not...so make it clear you would be coming for conservative treatment because surgery is not an option for your family. You are hiring them for their expertise in IVDD meds which your local DVM vet was not comfortable in using.  It's a no brainer how crate rest works, you require the services of a vet for support and meds.

Do change over to carrying Maggie outdoors to relieve herself.  Minimal footsteps are achieved by a 6 foot leash, sling and harness OR setting up a 6 foot diameter fence and a sling to keep the rear from tipping over.



Let us known how the morning phone conversation goes. 

It is all guess work as to how long it will take to get swelling down. If Pred went to anti-inflammtory level tomorrow, on the 2/23 taper you will observe for any hint of pain or worsening of neuro functions to know if Pred needs to be extended.

To give a clear snapshot if painful swelling exists, vets will back off or stop the pain meds which of course mask pain.

Prednisone is known for the adverse effect on the GI tract.  Therefore Pepcid AC should be on board. Your vet put Maggie at risk because he made a switch from Metacam to steroid class without the safety of a 4-7 days washout. He thought there was an emergency with loss of leg function on 2/17 and he was right. He weighed the risk vs. the benefit of a washout. He covered the risk part by adding a 2nd stomach protector, sucralfate. Unfortunately he was not confident in pred use. There is a range of Pred doses, he is choosing the lower end at 2.5mg 2x/day.

With legs paralyzed it is really imperative not to dawdle with ineffective doses of Pred, but instead be aggressive in trying to save the spinal cord. With every treatment the risk vs. the benefit has to be weighed. Should you use Pred, well yes. But there is risk! Right, and that risk is being addressed by being proactive with double  stomach protection.

It is important for you and the vet to know if Maggie still has bladder control. The only way for us humans to know if there is bladder control is with the sniff and pee test. 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. Finding leaks in bedding or leaking on you when lifted indicates loss of bladder function. Please let us know exactly what you observe. Loss of bladder control means the need for a lesson expressing and something the vet needs feedback on asap in the morning.

It is really a good thing that Maggie was able to move herself up into a standing position!  Yeah!

The chicken and rice should only be temporary for a few days as it is not a balanced diet. The body has lots of repair jobs to work on and the right balance of minerals, vitamins are always necessary but even more so when sick. Can you transisition her over the course of a couple of days back to her kibble.

Boil up a hambuger patty in a cup or so of water. Cool and discard the fat layer. Use 1-2 teaspoons of the meat on top of the kibble to make it more inviting to eat. Soak the kibble equal parts of the broth or liquid too.

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.

Slings can be a long winter scarf, a belt, an ace bandage.

Harnesses just need to fit, not all brands will fit every dog. Here are the features to look for and a start point:
Surefit harness www.pawmark.com/products.php?cat=367
Puppia www.puppiaus.com/PuppiaUs/ProductList.asp
Noodles and Friends  www.noodleandfriends.com/Dachshund-Harnesses/c11/index.html