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Post by Wendy & Kado on Mar 2, 2014 16:52:03 GMT -7
I am not sure what I should advocate for regarding Lola's pain meds, with her new round of prednisone (50mg tablets, 1 tablet every 12 hrs for 5 days, then 1 tablet every 24 hours for 10 days, then 1/2 tablet every 24 hours for 10 days) lola will be starting her taper on Wednesday, however the first taper dose is the same as her start dose the first round. Should her pain meds be reduced or stopped at the first taper dose so we can see if there is any pain...or...at the last taper when she is closer to coming off the pred?
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Marjorie
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Post by Marjorie on Mar 2, 2014 17:09:52 GMT -7
I see from a previous post that your vet only gave Lola enough Tramadol to carry her through the beginning of the taper and said that you could try to discontinue them when the taper started. Usually pain meds are tapered or stopped when the taper of the Prednisone starts. So it's fine to stop the Tramadol and Robaxin on Wed. when the Prednisone begins to taper again. I realize that the vet increased the Prednisone higher than the original dose but it's still a taper so that pain meds should also be tapered or stopped at the beginning of the taper so a true test for pain can be made.
I do think you should contact the vet on Monday and make a plan for what you should do if pain again returns during this taper. You should have some of each medication on hand in case Lola has pain and needs it and find out exactly what the vet wants you to give Lola, should you see signs of pain or see neuro function worsening and not be able to reach her (after hours or on the weekend). It's best to be prepared.
Prayers that this taper will be a pain free successful taper.
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Post by Wendy & Kado on Mar 3, 2014 6:07:30 GMT -7
Thankyou Marjorie. I am also wondering about pursuing laser therapy or acupuncture for Lola. I have found a canine holistic specialist but am concerned transporting Lola, she is not small like a daschund and I am concerned that carrying her in and out of the car will cause movement that is not good for her healing. Is it better waiting until her 8 weeks are completed, or, is it worth it to bring her in now to begin the therapy?
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PaulaM
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Post by PaulaM on Mar 3, 2014 9:05:15 GMT -7
Wendy, I think your concerns about transporting her to acupuncture are good ones. Since Lola can wobbly walk and her size makes it more difficult to carry & protect the back, then perhaps waiting til her disc has healed at the the end of 8 weeks would be the better idea. At the end of 8 weeks you can assess if she even needs acupuncture. She has a relatively mild neuro loss that will likely self heal maybe during crate rest or not too distant after the 8 weeks.
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. 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. <--- Lola 6. Ability to walk unassisted and perhaps even run.
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Deborah & Angel
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Post by Deborah & Angel on Mar 3, 2014 10:13:58 GMT -7
Oh Wendy...the move to a ground floor unit would be AWESOME in this situation. I'm hoping you are getting along better with Lola. As time goes by, we seem to fall into a "new" routine, as the healing process takes place and we figure out what we need to do to keep our FurBabies safe, and recouperating. Hugs and much love coming your way...keep up the good work, your doing a GREAT job..
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Post by Wendy & Kado on Mar 3, 2014 10:57:55 GMT -7
Thanks Paula , wow! when I look at where she is on your list I feel so much better! she really doesn't have that far to go and she is only 1.5 weeks into her healing. I keep looking at her thinking she may not change or recover any more but I really needed your list to see where she is and how well off she is.
Thankyou Deborah, a ground floor would take away any of my concerns for Lola returning to my son! I am hoping it all works out well timing wise. It certainly is a big job caring for Lola, she is a lovely dog and tolerating this very well, but, her physical care is quite time consuming and a lot of heavy lifting as well as managing all her medications and their timing. I thought I was busy before! : )
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Post by Wendy & Kado on Mar 4, 2014 6:45:03 GMT -7
Well I stopped Lola's pain meds yesterday and am pleased to say she is doing great! She is still weight bearing on her hind legs, no knuckling and moving both legs nicely when walking....a bit wobbly if I loosen the sling, but doing well. The only issue is that she now wants out of the crate, sitting up more and asking for attention, whining to get out and looking with her puppy dog eyes to be set free . This will be a long 6 more weeks in trying to keep her contained and happy...the frozen food in the kong works for a while, as does snow in a dog dish as she loves eating snow. next step will be the pred taper on Wednesday morning, I hope it goes as well!
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Post by Jean & Mimi on Mar 4, 2014 8:16:59 GMT -7
Great news! Make sure to keep a careful eye out for pain when you do the taper. Fingers crossed all goes well
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Post by Wendy & Kado on Mar 4, 2014 10:15:11 GMT -7
When Lola's pred is tapered to once a day, do I still give Pepcid every 12 hours, or just give her the one dose 1/2 hour before the prednisone?
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Marjorie
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Post by Marjorie on Mar 4, 2014 14:21:32 GMT -7
You should continue giving the Pepcid AC every 12 hours for as long as Lola is on the Prednisone, Wendy. That will give her continued protection against any side effects.
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Post by Wendy & Kado on Mar 7, 2014 9:20:34 GMT -7
So we are on our third day of our prednisone taper and 5th day of no pain meds. She is so far doing amazing! No pain, continuing to get stronger in her sling waking each day when she goes out to relieve herself. Since her first taper is now the original dose she was on her first round, will we need to see after the 10 days when he nest taper occurs if the swelling has actually been resolved, or, can I assume it is resolved now? our next challenge seems to be how to keep her ok in the continual crate time. She is whining and barking when she needs out, and, when she is lonely and needing something to do. I think the pain meds perhaps sedated her a little, or, she is just feeling better and not liking being constrained.
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Deborah & Angel
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Post by Deborah & Angel on Mar 7, 2014 9:34:03 GMT -7
Hi Wendy, I haven't gone back over all your post to see how long Lola has left on Crate rest, but I know how anxious they can get...Do you have any of the "Kongs", that you hid treats in, that might entertain her for awhile..
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Post by Wendy & Kado on Mar 7, 2014 9:54:20 GMT -7
The sad thing is, she is just finished her 2 nd week if crate rest. I am using the kongs filled with canned food and frozen, they do work for a while, but, I don't want to have her continually eating. I have tried buying some bones etc but so far she is not interested unless there is some food in the chew toy.
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PaulaM
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Post by PaulaM on Mar 7, 2014 16:29:49 GMT -7
One can not assume all swelling is gone until the taper of Pred has gone to conclusion. Really sounds like things are going in a good directions with no pain so far.
Consider some of these ideas:
Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc.
Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” to mark the second he looks at you, and then give your dog a very.very small treat. Shift your body a bit.... wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.]
-- Make the crate or ex-pen more cozy by draping a blanket over part of the top. Play classical music or one of the wildlife TV shows.
- Most dogs need some 16-18 hours of sleep per day, people sleep 8-9 hours day. What are they doing in the crate? Laying around and sleeping! Don't give into the temptation to start a treat routine to combat non-existent boredom. Adding a bunch of treats as entertainment contributes to weight gain which isn't a good thing. What you CAN do is soak his kibble in broth and freeze each of his normal kibble meals into a Kong so he has a job... working for his food.
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Post by Wendy & Kado on Mar 15, 2014 11:20:05 GMT -7
Lola is doing well with her taper, Thankyou for the advice on supporting her through crate rest, it makes so much sense. We put our human feelings and thoughts on these dogs and it's not useful or accurate. We are at 25mg of prednisone every 24 hours with nothing for pain , only the Pepcid and she is doing great. I am a little concerned with her walking(in the sling to eliminate) as I had thought she was doing better, but, we had our huge amount of snow melt and she is now dragging her feet more than I had noticed in the snow. I am not hoping that she is not deteriorating( with the taper) and it is just because I could not hear her drag in the snow. There is absolutely no sign of pain or discomfort so far and she is eating and eliminating very well.
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PaulaM
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Post by PaulaM on Mar 15, 2014 12:15:39 GMT -7
Be sure to advise your vet of your observation of possible increased dragging feet on the taper. He needs to know this information in case he wants to make a med adjustment.
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Post by Jean & Mimi on Mar 15, 2014 14:09:07 GMT -7
Paula is right Wendy. Keep an eye on the possible decreased neuro function. You are doing a truly amazing job with her, and you have been a huge help to your son. He is so lucky to have you as his mom
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Post by Wendy & Kado on Mar 15, 2014 15:52:30 GMT -7
Thanks Paula and Jean, the more I am watching her, I see the scraping is from swinging her right leg under then over , her right leg had no movement a few weeks ago and was more affected than the left initially. I will keep watching this, I am pretty sure it isn't any worse, and, I just couldn't hear the scrape in the snow. I am hoping that after her 8weeks we can do some water therapy to try to get the right leg working a little better. I am also wondering if the weakness and swinging could be from not moving much the past 3.5 weeks and her muscles are a little atrophied? She is going out 5 times daily for maybe 15 to 20 steps each time, she is also holding her own weight when squatting to relieve herself.
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PaulaM
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Post by PaulaM on Mar 15, 2014 16:42:36 GMT -7
Wendy, not moving much can indeed cause muscle loss and legs not as strong. After crate rest when it is safe for the healed disc, Lola can work on strengthening those leg muscles.
I'm glad you are keeping a lookout for anything that would indicate nerve damage that needs to be reported to the vet during a taper. As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. 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,
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Post by Wendy & Kado on Mar 15, 2014 16:57:57 GMT -7
Thanks Paula , since Lola lost all her function suddenly other than her bowel and bladder at the onset , she has made gains regaining some of these functions, so, should I be expecting all of her functions to be working once the pred is finished or she will need to have more meds? or, is the fact that she has made some gains from the initial onset good and I should just be watching for the decline of the functions she currently has to report to the vet during the taper?
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PaulaM
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Post by PaulaM on Mar 15, 2014 17:19:28 GMT -7
Just a quickie overview here on what the body heals, what time heals and what medications heal: www.dodgerslist.com/literature/healingpage.htmDuring the taper of pred, more pressure to the spinal cord can build up as the anti-inflammatory dose has been lowered. So this is why you would report any neuro diminishment to the vet asap on a taper. A recent nerve loss could be quickly reversed getting back up on the anti-inflammatory level. Once nerves have been more severely damaged it can take weeks, months or even more like a year for the nerve endings to regrow enough to allow passage of messages from the brain to the lower body part. So you might expect that Lola's nerve damage will continue past the 8 weeks. The focus of 8 weeks crate rest is to let the disc heal.
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Post by Wendy & Kado on Mar 16, 2014 9:44:24 GMT -7
Thanks Paula,
i am noticing Lola dragging her left paw more now as she is walking to relieve herself. Our vet is closed for the week, but, I have emailed her as she said she would be checking her email. I am assuming the safest thing to do would be to put her back on the treatment dose of the prednisone and I asked her for that. I am just not sure exactly how long I can wait for her reply, or, if I should try to contact another vet for the pred? Would you ask for the dose to go way up to the 50mg twice a day we started on, or 50mg once a day which maintained her function, it seems the 25 mg once daily is the problem dose? Also, she is not showing any signs of pain, should I ask for her to be on the tramadol and Robaxin again, or just the pred?
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PaulaM
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Post by PaulaM on Mar 16, 2014 10:51:04 GMT -7
If a vet agrees this dragging is due to nerve damage rather than weakened muscles making the legs weaker, then the dose would likley go back to the original dose first prescribed... the anti-inflammatory level dose. If there is pain then certainly pain meds would be back on board. Because we are not veterinarians, of course we do not prescribe medications only suggest what you might discuss with your vet.. Only the vet has training in medications, body systems, etc, has most importantly done.... actually examined and knows all about Lola's health history. Is knuckling involved or just paw dragging some. If knuckling I would seek an ER vet if necessary.
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Post by Wendy & Kado on Mar 16, 2014 14:20:05 GMT -7
I am losing my confidence in my ability to assess this. When I sling walk her, if I take all the weight and lift her a bit, she is not knuckling, she is scraping her toes on the ground, if I give her more weight to bear, he toes scrape the ground and she is 1/2 knuckling on her toes only with her left foot only, when she squats to urinate etc. her toes and feet are flat. It seems she 1/2 knuckles when carrying more weight and walking. I also stood her on a mat and knuckled her foot ( with support ) and she does not correct, however, I do not thi she has since her episode. I am thinking of giving her the full tablet dose this evening, another in the morning and hope I can find a vet tomorrow that will give us another round of prednisone.....the emergency vet wanted me to being her in, and, I hate to lug her to the car and in to see a vet that wants to examine her and deal with their opinion of the situation. The very best situation would be that Lola's vet emails me and sends the script to a vet here in town. I am questioning if she is deteriorating, or, if it is the walking on the pavement, although, I did not see the .1/2 knuckling occur yesterday...sigh
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Marjorie
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Post by Marjorie on Mar 17, 2014 4:52:41 GMT -7
I hope you've heard back from Lola's vet by now, Wendy and that she can be evaluated today. The vet who examined her before should be able to make a determination as to whether her neuro function has deteriorated or not. Sometimes it's difficult for us to make that determination if the deterioration is slight. The fact that she doesn't have pain is a very good sign. Hopefully, it's just weakness from being in the crate.
Please keep us updated as we'll be awaiting word.
Healing prayers for Lola.
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Post by Wendy & Kado on Mar 17, 2014 8:08:53 GMT -7
I am seeing Lola is having the neurological issues, her legs are crossing again, her toes are knuckling,not continually, but they sporadically do knuckle. I have not heard from the vet via email, she is away and their clinic is closed until next monday. I panicked last night and started her on the original dosing of the antiinflammatory dose of prednisone. I only have 2 half tablets left and I have a call in to my own vet to see if they can help by either seeing Lola! or just giving another round of the prednisone. I will update when I hear from them as to what they will do. She is not showing signs of pain, but, I would imagine it would hurt? I'm not sure if I should advocate for the pain meds again as well even though I am not seeing the symptoms, but, I did not see symptoms in her at the beginning either?, she seems a very stoic dog.
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PaulaM
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Post by PaulaM on Mar 17, 2014 8:17:05 GMT -7
Increased neuro diminishment would be an emergency that a vet would want to take action on. Let us know what you and your vet discuss, meds, etc. You are with Lola so you are the one to observe for signs of pain: not her normal perky self, shivering, trembling, doesn't want to move much or moves slowly, yelps, tight tense tummy muscles indicating referred pain in the back/neck.
Let us know....
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Post by Wendy & Kado on Mar 17, 2014 10:50:37 GMT -7
So, I found a vet who I have worked with in the past who I did a phone consult with regarding Lola and her neuro deterioration. She is giving me the prednisone for a few days at the twice dose, then enough for the once daily dose until her vet returns next week, she feels that since Lola did well on the once daily dose, she will hopefully be maintained at that dose after a few days. She did not want me to being Lola in to her clinic as she said the prednisone lowers their immunity and she did not want to risk her picking something up. She fully agrees with the 8 week crate rest and is wondering if, even though we have Lola on the crate rest if some disk fluid leaked into her spine causing this deterioration! she said this can happen even on the strict rest we have her on. She is also pleased we have Lola on the Pepcid. I am so relieved she will take Lola's care on until the original vet returns. so....another round and more rest and hopefully the next taper will go better
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PaulaM
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Post by PaulaM on Mar 17, 2014 13:10:00 GMT -7
Would you consider helping another trying to make decisions. She sounds like she understands IVDD being on board with the 8 weeks of rest and knowing about steroids. dodgerslist.boards.net/board/10/guidelines-postingvet recommendations: 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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StevieLuv
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Post by StevieLuv on Mar 17, 2014 21:01:10 GMT -7
It's not unusual to have an extended taper. You did an amazing job of watching for neurological deficets and were persisent in finding a Vet to help you. Here's hoping for a successful taper in the near future.
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