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Post by Chad & Bently on Feb 26, 2014 20:06:34 GMT -7
This is our story of Bentley. He is a 9 year old, full size, long haired dachshund that we rescued in 2009 from a bad home. He weighs 17.6 pounds, and has no real medical problems except for bad teeth, most of which were removed in 2009 when we rescued him.
My wife noticed that he was limping a little bit two days ago, and would not climb the back two steps like he usually does. We had no experience with IVDD so we really didn't know what was going on. The next morning his walking was worse but we still weren't sure what was going on. My wife called me frantically at 9 in the morning because Bentley couldn't stand up for more than a couple seconds without falling and was vomiting when she picked him up. I rushed home from work and we took him straight to the vet, who suspected a disc rupture and sent us immediately to the neurosurgeon in our area. By the time we got to the neurosurgeon an hour later, he was unable to use his back legs at all, but he still had sensation to deep pain. They offered us an MRI and surgery, but they said it would cost about $10,000 and we just cant afford that. They told us they didn't want to start steroids because of his vomiting and because he had a history of one bout of pancreatitis, so we brought him home.
Thank god my wife and I found this website, because I called the vet this morning and demanded they start him on steroids. It breaks my heart to say, but I checked Bentley's response to deep pain today and he has lost sensation to deep pain. As of last night, he cried when I tested his deep pain, but now he just pulls his foot back but doesn't cry out. With that said, Bentley is now on day 1 of strict crate rest and
5mg prednisone twice daily. He doesn't seem to be in pain, but we do have
tramadol to give him as needed for pain (but he hates the taste and won't take it!).
I realize that the loss of deep pain is a bad prognostic factor and when I saw that today I cried for an hour, but I'm hoping that in starting the steroids today and the strict bed rest, our little man will make a full recovery. I had my first attempt at expressing his urine and it was a success! He hasn't pooped in about 24 hours, so I will have to try to express his stool tonight, and we will see how it goes! Wish us luck and keep Bentley in your prayers.
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Post by Pauliana on Feb 26, 2014 22:59:09 GMT -7
Welcome to Dodgerslist! We are a friendly group and go by first names, my name is Pauliana, what's yours? Please let your Bentley 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.htmWhat is the dosage of the Tramadol and how often is it to be given? Tramadol is very bitter, as Bentley has let you know. It's a good idea to hide it in a food or treat that has a taste he loves and can hide the taste of the Tramadol. We used lunch meat.. and other members have used cheese or peanut butter. Make sure there is no powder or anything from the Tramadol on your fingers transferred to the tasty treat or he will be suspicious..My Tyler used to watch every move I made in the kitchen because he knew it had something to do with the hated Tramadol.. Our lunch meat trick: Take a piece of lunchmeat big enough to hide the Tramadol in.. and take out another two small pieces.. Give him a piece of lunchmeat without the Tram.. He'll love it and then give him the one with the Tram in it and he should gulp it down and the follow with the 3rd small piece.. This worked every time for us even with suspicious Tyler. : ) Cortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. Pepcid AC is a generally safe over-the-counter suppressor of stomach acid production for healthy dogs. Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach. We ask that all members read about each med their dog is on or may take as a safety measure. This directory is in alpha order: www.marvistavet.com/html/pharmacy_center.htmwww.dodgerslist.com/neurocorner2/stomachProtection.htmwww.petplace.com/drug-library/famotidine-pepcid/page1.aspxIt's not unusual for the dogs to get constipated because of the medications they are on. 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. So glad you started Bentley on the all important 100% STRICT crate rest 24/7 only 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)? More info and tips on crate rest: www.dodgerslist.com/literature/CrateRRP.htm www.dodgerslist.com/literature/cratesupplies.htm-- Eating and drinking OK? Laser light therapy, acupuncture and electroacupuncture which sends a microcurrent of electricity to and from acupuncture points (which are really big nerve bundles), can be very beneficial at helping to re-establish the nerve connections in the body. Any one of these therapies can be started right away if in your budget... they not only help relieve pain and inflammation but will kick start nerves to begin regeneration. Find a holistic vet here: ahvma.org/Widgets/FindVet.html www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] NOTE: Chiropractic is not recommended for IVDD dogs There is every hope for Bentley to recover.. REGAINING NEUROLOGICAL FUNCTION has no time limit for nerves to heal. Nerve repair is individual as each injury is different and each dog’s ability to heal is different. If deep pain perception (DPP) is present, even in paralyzed legs, there is a chance your dog may be able to walk again. For those dogs who have lost DPP, do know nerve regeneration can take place and that function may return. Once deep pain perception is regained, your dog has a chance at a walking recovery. Thousands of dogs on Dodgerslist have regained functions in as little as 2 weeks, others 11 months, and still others 3 years later. IVDD is a disease of patience to allow the body to heal on its own terms. Acupuncture and Laser Therapy stimulate the cell’s metabolism that leads to the body’s natural repair abilities and can be started at any time! |
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Post by Chad & Bently on Feb 28, 2014 8:30:29 GMT -7
Hi Pauliana! My name is Chad and my wife's name is Stacey, sorry I forgot that part earlier. Thank you so much for getting back to me so quickly. You answered so many of the extra questions my wife and I had. Bentley is taking 25mg of Tramadol every 8 hours (when we can get him to take it)! He absolutely hates the taste of tramadol. We used your trick and it works sometimes, but if he tastes it in the second piece he spits it out and refuses to eat any other food, even if there is no medication in it. We are going to call the vet and see what other analgesia options we have. With that said, he doesn't seem to be in much pain.
To start with some good news: Bentley seems to have gotten the ability to hold his bladder back! The first 24 hours he would pee all over himself constantly throughout the day, but since yesterday morning, he has been holding his urine and we haven't had any accidents!
He is not drinking as much as I thought he would, being that he is on prednisone, but he is still drinking okay. As for food, he is doing as good as we could hope for. Considering he can't move anywhere, he doesn't eat as much as he used but he still eats a small breakfast and dinner. We are also giving him small bites of food in between meals for his medications.
Thank you for the Pepcid idea! I picked some up on my way home from work, and he is taking that without a problem. We give it 30 minutes before the steroid and we haven't had an issue yet.
My biggest concern right now is his constipation. I use the tip on the website about stimulating around his anus to stimulate a bowel movement, but we haven't had a ton of luck. I take him out three times a day to express his bladder, and I try to get him to poop every time as well. I have gotten very small amounts of stool out a couple of times, but I keep praying for a good sized bowel movement. We just started pumpkin yesterday, and he was willing to eat a little bit of it, so we will be patient.
We are starting laser therapy at our vet on Monday. They want to try one session and see how he does. If he shows any improvement, they offer package deals for 6 treatments session at a discounted rate. We are hopeful that it will help. Once we get through that, we might try acupuncture down the road, depending on how things progress.
We are trying to stay positive. The last few days have been hard on all of us. Our poor guy looks so depressed in his crate. He cries at times, refuses to eat, and whines a little at night, but overall I think he is doing as good as we could hope for. You advice and support is greatly appreciated, and we are so thankful we found such a great community!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,597
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Post by PaulaM on Feb 28, 2014 13:40:08 GMT -7
17.6 pounds : prednisone 5mg twice daily as of 2/26 tramadol 25mg 3x/day Pepcid AC 5mg 2x/day Chad, has there been any decrease to Pred, has there been a date the vet want to try a decrease? Bently should not be in any pain at all if his meds are correct for him. So when you write "not in much pain" what specifically are you observing? Any trembling, shaking nearing next dose of Tramadol or after being moved? Any yelps, tight tense tummy, reluctance to move/shift sides in his crate, moves gingerly/slowly, not his normal perky self? Good job on getting expressing skills down so that there is no overflowing urine in bedding! Be sure with the addition of extra fiber you are also soaking each of his kibble meals in equal parts liquid. Otherwise extra fiber and no extra water means firming up stools. Not what you want. What date did you start Pepcid AC, 2/26? Are you giving 5mg 2x a day. Giving Prednisone with a meal? Being depressed, refusing to eat, not eating normal amount, not drinking more while on pred are signs to address with the vet. Not their normal perky self can be an indication of being in pain. Not eating/drinking can be associated with stomach upset a precursor to bleeding ulcers. I would discuss perhaps getting a 2nd protector on board: sucralfate. Each work in a different way to protect the GI tract against the damage prednisone can do. Good place to get needed background info in prep for discussing meds with your vet: www.marvistavet.com/html/pharmacy_center.htmlAlso be aware of the signs of pancreatitis: the most common clinical signs include nausea, vomiting, fever, lethargy, abdominal pain, diarrhea and decreased appetite. During an attack, dogs may take a "praying position", with their rear end up in the air while their front legs and head are lowered onto the floor. Let us know what your vet prescribes and thinks. |
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Post by Chad & Bently on Mar 1, 2014 16:20:51 GMT -7
Hi Paula,
Our vet ordered 5mg of prednisone twice daily for 7 days (until 3/5), followed by 5 mg once daily after that, without a set end time. We have an appointment tomorrow (Monday) for our first laser therapy, and I will ask her then how long we should continue. Does this sound like the dose that you guys usually hear? It seems to be on par with what I have read here on the site.
As for his pain, he rests comfortably the majority of the time. At times he will start to cry, but it is usually because he is uncomfortable and I find that if I rotate him to the other side of the crate, he stops crying and acts normal. He does still yelp on occasion when I take him out of the crate for his bathroom breaks. Like everything else, this is a learning experience and I am getting better at taking him out without any discomfort, but it's easier said than done sometimes. He does shake every once in a while after I take him out and express his bladder, but usually he does very well.
Our biggest concern is still his constipation. We are taking all the steps we can in terms of pumpkin, extra water, and wetting his food, but we are still not seeing much in terms of stool output. I was going to ask my vet about pediatric glycerin suppositories. I know they are safe and very effective on young kids with constipation, and I have read online that they are safe for use in dogs, but I wondered if you guys have had any experience with this?
Thank you, as always, for all of your care and support. I can't express how much this forum has helped change Stacey and my outlook on Bentley and this process.
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Post by Pauliana on Mar 1, 2014 21:50:57 GMT -7
Hi Chad! It would be a good idea to talk with your Vet and get his Tramadol dose adjusted or perhaps change his pain medication to get his pain under control from dose to dose. Pain deters healing. Here is an article that explains the pain medications commonly used for IVDD: www.dodgerslist.com/literature/healingpain.htmTyler didn't poop for about 5 days and then suddenly he started pooping normally again. He hates Pumpkin so we used fresh cooked and mashed sweet potato with water added to his kibble. He loved that..We didn't use any laxatives at all.. He had no further constipation problems after that.. Here is a video that shows how to lift and carry Bently: |
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Post by Chad & Bently on Mar 7, 2014 13:20:17 GMT -7
Update on Bentley: It's been 10 days since he became paralyzed and we are still having good days and bad days. My wife and I both think that he is doing better overall, but we still have a long way to go. We are doing Laser therapy every other day, and we are two treatments in, with the third scheduled for 4pm today.
He still has no motor function or bladder control, but he does pull away with deep pain. He doesn't seem to feel the pain (in that he doesn't yelp or try to bite), but he does pull his foot back. I don't know if this is actually a good sign, or simply a reflex? Maybe you know more about that?
Our biggest issue is that he seems to be in a lot of pain. We brought this to our vets attention, and she added Gabapentin 100mg twice daily, to go with the tramadol 25mg every 8 hours. She ordered 5mg Prednisone to be taken twice daily for the first week, followed by 5 mg one daily. We did as she instructed and backed down his prednisone to once daily on Wednesday (the same day we started the gabapentin), but it seems like his pain has really increased since we did that. We were thinking of starting the prednisone twice daily again, but I was wondering what your experience was with that? I am well aware of the side effects of high dose steroid use, but he seems so miserable since we cut him down. He has spells where he just lays there and cries, shakes, and pants, and it seems like its been more frequent over the past couple of days. I used to take him outside to pee without issue, but now anytime I try to pick him up he cries and tries to bite me. I have watched the video on picked him up, and I have been doing things that way without much of a problem until recently.
When his pain really flares up and he starts crying, my wife and I feel helpless and it feels like we are headed in the wrong direction. Any advice, or similar stories would be much appreciated. As always, thank you for all your past help, we would be lost without the advice and education of this site!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,597
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Post by PaulaM on Mar 7, 2014 15:46:59 GMT -7
Chad, one thing we do not have one minute of patience with is pain. Pain is detrimental to the entire healing process as well as just being quite torturous. The taper is a test to see if there is any hint of painful swelling still If there was still pain happening then there should not have been a taper on Wed. So it is a bit confusing to me hear about the start of a pain med (gabapentin) and yet still call for a taper. Clear communication with the vet is important so they understand what is going on at home. And from your end you know the why behind what the vet is saying. It is not enough to just blindly follow instructions. We may have to step up and questions things that don't make sense in our minds. Rule of thumb is: pain = swelling = more time on Pred, pain meds and Pepcid AC needed.
The "why" behind the above rule: Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 7-30 days. When the vet guesses swelling might be gone there will be a test taper. Usually the first course will be 5 or 7 days and then a taper. To have a clear picture on a taper, pain meds are also stopped or backed off too. The prednisone 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. Immediate feedback to the vet about any pain is necessary. Often a plan B is arranged ahead of time so that if the pain happens at night or on weekends when the vet is not open, you know what meds to give. When pred goes back to 5mg 2x a day after the phone call ... within the hour the IF pain is not being fully controlled. You'll need to report that PLUS strongly advocate for more aggressive pain medication. Tramadol for a 17 pound dog has much more room to move up from a 25mg dose 3/day. Background reading: vasg.org/t_drugs.htm#TRAMGabapentin may be more effective given divided up into 3x a day to keep the level at a more consistent level in the body. vasg.org/g_drugs.htm#GABAPMethocarbamol deals with the specific pain coming from muscle spasm so often associated with a disc episode and can also be Rx' at 3x/day. www.petplace.com/drug-library/methocarbamol-robaxin-v/page1.aspxWe ansiously wait hearing back on your vet call that pred is back at 5mg 2/day plus enough pain Rx to get that pain back under control for Bently. |
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Post by Chad & Bently on Mar 7, 2014 18:41:44 GMT -7
Thank you for getting back to us so quickly! From the get go, we have had the feeling that our vet doesn't have a lot of experience with IVDD, and tends to downplay the importance of pain medication. We were referred to a neurosurgeon at the start of this, so we might refer to them for all of our questions about pain medication. We started Bentley back on the prednisone 5mg twice daily, and he already seems better. Also, we moved his tramadol up to 25mg 4x/day and that has made a big difference in a short time. We are going to keep this regimen going for now, and we might give him a whole tramadol (50mg) for breakthrough pain if we have to. I will let you know what the neurosurgeon recommends after we talk with him. Thank you for your help and resources, I hope we can keep our little guy happy and on the road to being healthy.
His updated med list:
▲Prednisone 5mg twice daily
Pepcid AC twice daily (30 min before pred)
Gabapentin 100mg twice daily
Tramadol 25mg 4x/day
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Post by Pauliana on Mar 7, 2014 21:11:55 GMT -7
Hi Chad, Yes I would have the Neuro vet handle the pain management for Bently. They deal with more cases of IVDD than a general DVM would plus they are more comfortable with pain management. Here is an article that explains what to look for in a vet that is treating your dog for IVDD and questions you should ask the vet that you are considering. It also has a search engine to find one in your area: www.dodgerslist.com/literature/VetchkList.htmLet us know how Bently is getting along and please do let us know what the Neuro Vet has to say after he examines Bently.. |
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