Sherrie's Cheyenne 3/11 Conservative Multi-poo NECK

Welcome to Dodgerslist, Sherrie. Cheyenne has a lifelong disease which causes degeneration of the discs. At any time during her life, one or more of these discs can tear or rupture. Neck problems can be more painful and can take longer to resolve than back issues. However, many dogs recover with conservative care. The pain is caused by swelling in the spine pressing on nerves. The anti-inflammatory will bring that swelling down. Meanwhile, pain meds help deal with the pain until the swelling is gone. It can take 1-2 weeks or even a month for the swelling to go down. At some point, the vet will ask that the Rimadyl be stopped. At that point, if there is no pain, all meds can be stopped. Then she would just continue to rest in her crate for the full 8 weeks so the disc can heal and form scar tissue.  For now, she'll need to be on an anti-inflammatory, Pepcid AC, pain meds and strict crate rest.

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.htm

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.htm

There are some extra steps you should take with a neck issue, such as softening hard kibble and raising her food/water dishes so she doesn't have to bend her neck down. Those tips can be found here: www.dodgerslist.com/literature/cervical.htm

Can you give us a bit more in essential information about your dog:

1. When was the date you saw the vet and what date did you start doing the all important 100% STRICT crate rest 24/7?

2. Is there still currently pain? Signs of pain are holding the head in an unusual position, head held high or nose to the ground, shivering/trembling, not wanting to move much or moving gingerly, yelping, tight/tense stomach muscles, arched back, holding leg up flamingo style, not wanting to bear weight on the leg, just not their usual perky-interested-in-life self. There should be no signs of pain from one dose of the meds to the next.

3. 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
marvistavet.com/html/pharmacy_center.html

4. Pepcid AC should be given to protect your dog from the excess acid produced by the anti-inflammatory. Please get your vet's permission to give 5 mg of Pepcid AC (generic is famotidine) 30 minutes before each dose of the anti-inflammatory and thereafter every 12 hours). Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If your vet says your dog has no health issues such as liver, heart, etc to keep her from taking Pepcid AC, then do get it on board.

5. Eating and drinking OK?

6. Poops OK - normal color, firmness, no dark or bright red blood?

We're here for you, Sherrie, and will help you and Cheyenne through this. I know how hard a second episode can be, after rehabilitating them following surgery. My Cocker Spaniel, Jeremy, also had a second disc episode about 1-1/2 years after surgery and he recovered from the second episode with conservative care.

Healing prayers for Cheyenne.  Please let us know what the vet says after your visit.

Sherrie, can you be specific on exactly what you see in re: to pain. Does she hold her head high or nose to the ground, reluctanct to move head or in general reluctant to move. When she moves is it slow and gingerly? Any yelping, shivering, tight tense tummy muscles, arches back?

As Marjorie pointed out your ability to read and absorb information is necessary with this disease. So you can discuss treatments that may harm Cheyenne, know how to go about recognizing a vet comfortable in treating a disc episode and in generally living with IVDD. To understand really what anti-inflammatories such as Rimadyl do....good reading from one of the articles on the Overview page Marjorie pointed you to : www.dodgerslist.com/literature/healingsweling.htm Another to

With the pumpkin had you been adding extra liquid to the diet? 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.

Eating and running can cause reflexes to activate release of body wastes.  Having bladder and bowel control would mean a dog can override the reflexes and wait until in an appropriate place.  Sounds like she does not have bowel control since she is unaware of its release. In addition to expressing for urine, you can also express for poop: www.dodgerslist.com/literature/Expressing.htm#poop

Tell us about her rear leg movements. Does she wobbly walk with rear legs or ....???

During conservative treatment do avoid putting things on her whether that be thundershirts, back braces.  Cheyenne needs to move her self into the most comfortable position.  It is the recovery suite that keeps her from moving too much.

Consider a rice sock to rest the head on or lean against. Fill a sock with 1-2 cups of dry rice. Knot the end. Microwave for 1-2 minutes. Test in crook of your arm for warm not hot temperature. Wrap in a towel so it's not too hot for the skin and place in crate. Let your dog snuggle against when you are present to supervise in case your dog has a desire to munch on the warm rice. Note: human heating pads can get too hot burning skin on an IVDD dog.
Snuggle Safe is a commercial product that will keep warm the whole night. www.valleyvet.com/ct_detail.html?pgguid=E53AAF66-347A-4789-AFCC-5D6FA77ED8B6&item=30459&ccd=IFP003&utm_source=froogle&utm_medium=free&utm_content=30459

When a disc episode is relatively mild with solely  signs of pain, but not progressed to the point of nerve loss, it can be a challenge to diagnosis if this is a disc problem, arthritis, pulled muscle.  A 2nd opinion is never wrong to do if you have doubt.  Until you are sure you are not dealing with other than a disc episode it is very prudent to assume the worst and do the 100% STRICT crate rest 24/7 only out for potty times.

Laser treatment can help not just with spurring nerves to self heal, but also good to help with pain. We see a lot of success with this therapy on the Forum.

Hi Sherrie,

Is Cheyenne, pain free from dose to dose or does she show pain before it's time for the next dose?
If she does, her pain medications need adjusted and you should speak to her vet right away about this. Any pain at all, slows down her healing. 

I would avoid metamucel and continue with the pumpkin or mash some cooked fresh sweet potato and add it and water to her food.  Usually dogs get constipated when they are first on Tramadol but after a few days it eases up and they go fine, at least that was my experience with my Tyler..

Glad she is resting comfortably and we will look forward to your next update! 

As Pauliana explained, Sherrie, there should be no signs of pain at all from one dose of meds to the next as any pain at all hinders healing. Cheyenne is on a very low dose of Tramadol. Neck issues can be so much more painful than back issues. We often see the maximum doses of three pain medications being used for neck issues: Tramadol, Gabapentin and Methocarbamol. Since you did see pain arise an hour before the meds were due, you should speak to the vet today about increasing the Tramadol dose and/or adding Gabapentin. It's best to get the pain completely under control right at the start rather than waiting to see if it breaks through again.

The 5 mg of Pepcid AC should be given 30 minutes before the Rimadyl and then every 12 hours thereafter.

Please let us know what the vet says after speaking with him.

Hi Sherrie,

What did Cheyenne's vet have to say about adjusting or adding to her pain medications? 

Thinking of you and Cheyenne.

Hi Sherrie,

Vets who practice safe medicine will look for a 4-7 day washout from a NSAID (i.e.Metacam,Rimadyl etc) to a Glucocorticoids (i.e. Prednisone, etc) unless an emergency calls for a faster switch. Then it is a high consideration to double protect the stomach with not just Pepcid AC, but adding sucralfate.  Since it wouldn't be a good idea for Cheyenne to be without an anti inflammatory for a week.. Make sure they are double protecting her stomach to prevent Ulcers or a perforated stomach, if they decide they need to make the switch to a steroid.  Pepcid AC and Sucralfate work well for this.
========

”Drugs of the NSAID class should not be used concurrently as the potential for the aforementioned side effects increases. For similar reasons, NSAIDS should not be used in conjunction with corticosteroid hormones such as Prednisone, Dexamethasone etc. Pfizer recommends a 5-7 day rest period when changing over to Rimadyl or to another NSAID from Rimadyl. Allow at least one week between Prednisone and Rimadyl.”  
www.marvistavet.com/html/rimadyl.html

Sherrie, I would advocate for your vet to be aggressive with pain med use first before considering switching from Rimadyl to the other class of anti-inflammatories.... steroids. Neck discs are more painful and do require an aggressive pain relief approach.   If aggressive pain meds do not work, then serious consideration about a switch is necessary.

11lbs
Tramadol 3/11:12.5 mg; 3/13:▲25mg every 8 hours
Methocarbamol 125mg every 8 hours
Rimadyl 12.5 mg every 12 hours.
PEPCID AC?  Are you giving 5mg 2x/day?

CAVEAT: It is important to do your own reading about meds so you can participate in discussions. The reason for you to not self prescribe is your vet has responsibility for the health of your dog in med he prescribes based on his exam, the health history of your dog, how meds interact, not things we or you might know as we are not veterinarians. If you are not satisfied with how your vet handles this disc episode, then there is a need to hire a different vet who is comfortable in treating a disc episode.

-- There is still room for your vet to increase the dose of Tramadol every 8 hours. Background reading: vasg.org/t_drugs.htm#TRAM

-- Background reading on methocarbamol   www.petplace.com/drug-library/methocarbamol-robaxin-v/page1.aspx

-- Package insert for Rimadyl:  www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/UCM050406.pdf

-- Vets are finding good success in adding Gabapentin to the mix of Tramadol/methocarbamol for hard to control pain. Background reading: vasg.org/g_drugs.htm#GABAP
 Most all pharmacies carry a 100mg capsule (the smallest size it comes in)... just call around your local pharmacies for the best price and have your vet call in the Rx.  
 
As an example if Rx'd approx 33mg of gabpentin then,
 Divide the 100mg capsule powder into 3 equal parts by dumping into a creased pieced of paper and with a razor blade move the powder into 3 equal piles.  Store the remainder of the powder piles in one of those 7 day pill boxes with a lid for each day.  NOTE: both tramadol and gabapentin are very bitter tasting. Make sure you do not transfer any dust from your finger to the outside of the pill treat.  I mash a piece of banana, form a ball, make an indentation.  Spoon powder dose into well and close up. If necessary drape a piece of thin deli meat around ball for further tastiness!

Good news Cheyenne is doing much, much better! No breakthrough pain, No muscle spasms! She is eating well and pee and poo is same as before this incident. She has been comfortable for 36 hours with no pain signs. Still keeping her crated and off her feet but you can tell she is feeling much better! Thanks to everyone for helping me through this. I will keep you posted.
PS Cheyenne had her second laser therapy today and I really think this has helped.

At some point, the vet will decide to test for pain and will ask you to stop the Rimadyl. At that point, you'll be on the sharp lookout for any signs of pain. If you see signs of pain after the Rimadyl is stopped, you would need to let the vet know so Cheyenne could be returned to the Rimadyl. Pain = swelling = more time on all meds. Swelling can take a week or two or even a month to resolve. You would need to check with your vet as to how long he wants the Rimadyl to continue before a test for pain/swelling is done.

I believe this is the current medication schedule - if not correct, please let us know.

11lbs
Tramadol 3/11:12.5 mg; 3/13:▲25mg every 8 hours
Methocarbamol 125mg every 8 hours
Rimadyl 12.5 mg every 12 hours.
Pepcid AC 5mg 2x/day

As for the laser therapy, that's really up to your finances, how she progresses and what her therapist recommends.  If you can afford it, it's a beneficial supplemental treatment.  If not, you're already doing the most important treatment - the strict crate rest.

Glad Cheyenne is doing well.  Please keep us updated.

Sherrie, I'm a bit confused. In looking back through the posts, Tramadol was increased on 3/12. There was still breakthrough pain on 3/13. The first day that no pain at all was reported was on 3/14, just a few days ago. Why were the pain medications stopped? Have there been any signs of pain at all since the pain meds were stopped (shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, nose held to the ground, head held up high, tight hard tummy, arched back)?