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Post by Natalie & Maddy Mae on Mar 11, 2014 20:33:03 GMT -7
I have a 5 year old mini dachshund, 9 lbs who started showing signs of pain in her back leg three days ago. I have another dachshund who has had a leg injury that turned out to not be IVDD, but he was treated similarly so I am familiar with crate rest etc. so I immediately put her in a crate and gave her some muscle relaxers. Her main symptoms were yelping when being lifted. She was walking and eating fine, though she was resting in her crate on her own and not running over for any treats or additional food so I knew something was not right. When I returned home last night and let her out to potty, she was in more pain. I immediately took her to urgent care. They pushed on her back and said she was showing signs of pain her lower vertebrae. The recommendation was strict crate rest, prednisone, pepcid, and tramadohl. They said she is not showing any signs of neurological loss as of yet.
I have been taking her out every few hours and she's using the bathroom fine. Today, after her first full day on the medication, she is feeling quite "well" (in her mind). She is super alert and tries to get extra steps in while out to potty. She's resting quietly now, though I think it's because she recently got her next dosage of medication.
Question: Is acupuncture or laser light therapy helpful when there are not any signs of neurological issues?
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Post by Pauliana on Mar 11, 2014 21:06:31 GMT -7
Hi Natalie, welcome to Dodgerslist! Good for you getting Maddie Mae to the Vet right away and on medications and crate rest. Glad she seems to be feeling better now that she is on her medications. -- What are the doses in mgs and frequencies of the Prednisone and Tramadol? Here is a video that shows how to pick up and carry a dog with IVDD: 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. Please let your Maddie Mae 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.htm |
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Post by Natalie & Maddy Mae on Mar 11, 2014 21:20:49 GMT -7
Thank you. Maddy Mae's medication list is as follows:
Tramadol 50mg: 1/4 pill every 12 hours
Pepcid AC 10mg: 1/4 pill every 12 hours
Prednisone 2.5mg: 1 pill every 12 hours
Should laser light therapy, acupuncture, or electroacupuncture be considered before there are any nerve issues?
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Post by Pauliana on Mar 11, 2014 21:33:35 GMT -7
Hi Natalie,
Laser and acupuncture are great for pain relief and reducing inflammation whether there are nerve related issues are going on or not.. Both are great therapies for IVDD.
Is Maddie pain free from dose to dose with her current dosages of the medications?
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Post by Natalie & Maddy Mae on Mar 11, 2014 21:47:54 GMT -7
She seems to be pain free. At about the 10 hour mark she was the most alert and wanting out of the crate. When I took her to potty, she tried to walk around more than she should, though I didn't let her. She has not yelped when I lift her since yesterday prior to the medication.
When she goes out to potty, she still does her downward dog stretch, but not her forward stretch.
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Post by Pauliana on Mar 11, 2014 21:55:26 GMT -7
Hi Natalie, Sounds like she is doing well so far.. Do keep watch for signs of pain and please read this: www.dodgerslist.com/literature/healingpain.htm and www.dodgerslist.com/literature/healingsweling.htmGenerally when they are healing, and not quite up to all their stretches they avoid doing the ones that hurt them.. You will know when she is feeling back to normal, because she will do the all over shake, roll over on her back for tummy rubs and do all her normal stretches.. : ) |
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Post by Natalie & Maddy Mae on Mar 15, 2014 12:28:51 GMT -7
Update on Maddy Mae:
she seems to be the same. Not in pain, wags tail, stretches when let out etc. however something is definitely off still. Sometimes when we get home, she is up in her crate alert and wanting to greet us and other times, she doesn't move in the crate at all. Even when we open it up to take her to potty.
There are some potty issues too. She has not been drinking a lot of water, even with the prednisone. She will only pee 1-2 times a day. She poops normal but I think she might be dehydrated. I've tried adding chicken broth to her kibble but she won't eat it. She eats a dehydrated beef disc for meals and still only wants that and bananas.
I have a be a call into the vet to see what they think.
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Post by Pauliana on Mar 15, 2014 19:19:53 GMT -7
Hi Natalie,
Let us know about what the Vet has to say when you get a chance..
Sending healing thoughts to Maddy Mae.
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Post by Natalie & Maddy Mae on Mar 16, 2014 20:37:53 GMT -7
We heard from the vet (after Maddy Mae used the potty 3 times!) and they seem to think it's a reaction to the tramadol. They said as long as she is going, and is not lethargic, in pain, or not eating, to proceed as normal.
We start to ween her off the ▼prednisone tomorrow. We've already started to reduce the tramadol today and she is not showing any signs of pain.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Mar 17, 2014 4:59:28 GMT -7
Prayers for a pain-free taper for Maddy Mae, Natalie. Please keep us updated.
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Post by Natalie & Maddy Mae on Mar 21, 2014 13:42:58 GMT -7
Maddy Mae seems to be the same. She has energy most of the time and is excited to go outside to potty and I don't think she's in pain, though she's not wanting to be very active either. We are about half through the first week of reduction from the prednisone. I have completely stopped giving her pain medication.
When she goes outside to potty, I try to rub her belly/back to see if she will wag her tail or yelp. She does neither. Sometimes I put my arm in her crate and give her rubs and she does her usual thing of barking when I stop- wanting more. She's on such a small does of the prednisone as it is, I'm not sure what the signs are that she should stay on the twice a day routine longer.
We check in with the neurologist on Monday.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Mar 21, 2014 19:24:37 GMT -7
Natalie, pain is the sign to indicate swelling is still going on in the spinal cord: shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy.
Let us know how the neuro appointment goes on Monday.
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Post by Natalie & Maddy Mae on Mar 25, 2014 10:14:28 GMT -7
Maddy Mae is now down to 2.5 mg of prednisone every other day. Today is the first day on no medications. This morning I came home and let her out of her crate to potty. She was super excited to see me (I had been gone for two days) and came right out of her crate. I sat down on the ground so she wouldn't jump up but she still did a little and did yelp a tad bit when she did. I immediately put her back into her crate.
My question is: Should she still be in pain after two weeks of the prednisone? She doesn't seem to be in pain when she in her crate, walking to potty or going potty. Only when she comes out of her crate and attempts to jump up.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Mar 25, 2014 13:05:19 GMT -7
The sign of pain that you saw, yelping upon movement, is a sign that there is still swelling pressing on the spine. You'll need to immediately let your vet know that Maddy Mae still has swelling and needs to be returned to the original dosage of the Prednisone, as well as the Tramadol and Pepcid AC. It can sometimes take a month for the swelling to resolve. Hopefully, the next taper will be a pain-free one, indicating that all swelling has resolved.
I see that the original dosage of the Prednisone prescribed was 2.5 mg 2x/day. We usually see 5 mg 2x/day as the anti-inflammatory dose prescribed for standard size Dachshunds. You should speak to the vet and ask what the anti-inflammatory dose would be for a 9 lb. dog. The anti-inflammatory dose is needed to get the swelling down; anything less would not be effective.
Please let us know what the vet says after speaking to them.
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Marjorie
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Post by Marjorie on Mar 25, 2014 13:10:33 GMT -7
I also just noticed that you mentioned that she has no pain when walking to potty. She needs to be carried in and out to potty with only a few steps being taken when doing potty. Is that what you meant - no pain when she takes a few steps to do potty?
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Post by Natalie & Maddy Mae on Mar 25, 2014 15:05:22 GMT -7
Thanks Marjorie
Yes, she is carried outside in her crate to potty and only take a few steps She likes to do the circle thing before going.
I'm dropping her off with the neurologist tomorrow for the day so they can check on her swelling.
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Post by Jean & Mimi on Mar 25, 2014 16:42:36 GMT -7
Let us know how things go tomorrow. Prayers for Maddy Mae.
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Post by Natalie & Maddy Mae on Mar 26, 2014 13:40:54 GMT -7
The dr. reported that she still does have pain in her lower back. Mainly when he picked her up a certain way and when he extended her hips, but not when he pushed on her back. He recommended we do an MRI to see what we're dealing with in terms of compressed spots.
He does not recommend staying on the prednisone b/c even though when she was on it, it was helping, she shouldn't have been in pain when we started to reduce it. He said we could try other medications etc and wait it out but he thinks the end result will still be surgery.
We're currently waiting on the results of the MRI.
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Marjorie
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Post by Marjorie on Mar 26, 2014 14:57:33 GMT -7
Dear Natalie, It is not uncommon at all for a dog to still have swelling/pain after two weeks on a steroid. It can sometimes take a month for the swelling to go down. The taper is just a test for pain - pain = swelling = more time on meds. As I mentioned yesterday, the usual anti-inflammatory dose of Prednisone is 5 mg 2x/day. Anything lower than the anti-inflammatory dose would not be effective. Maddy Mae was only on half of that for 5 days and that may be why there is still swelling. MRIs are usually only done prior to surgery. With conservative care, it doesn't matter which disc has herniated. I'm sure the MRI will show a herniation or disc material pressing on the spine. However, there has been no sign of neurological deficits, which makes her a very good candidate for conservative care. Surgeons will usually not operate on a dog showing no neurological deficits unless the pain cannot be brought under control after numerous tapers of an aggressive anti-inflammatory. This is only the first taper. Your vet needs to be more aggressive with the anti-inflammatory and give it more time. Here are the situations where surgery should be a consideration: www.dodgerslist.com/literature/healingsurgery.htmI urge you to get a second opinion with a Board-certified neurologist before deciding on surgery. Prayers for Maddy Mae. |
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Post by Natalie & Maddy Mae on Mar 26, 2014 17:10:37 GMT -7
Just heard from the neurologist. Good news is the MRI showed no signs of any back issues or compressed disks. Her pain is coming from her lower back area and he said that area of the spine looks good. (she yelped in pain this morning not when he pushed on her back, but when he lifted her and pulled back her hips) There was evidence of a past "minor disk protrusion" at T12 and T13 but he did not think that was the cause of any current pain as it was healed. He does not recommend surgery.
He was going to preform a spinal tap and get another scan of her hip area since that was the main area of discomfort when he examined her this morning. He is also doing a urinary culture b/c she has had prior infections and previous to this episode, she was urinating small amounts frequently.
The bad news is, we do not know what is causing the pain. He said it could be swelling, cysts, arthritis ...
She is going back on 2.5 mg of prednisone 2x/day. She also might go on another medication. I will know more when I pick her up tonight.
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Post by Natalie & Maddy Mae on Mar 27, 2014 20:42:53 GMT -7
The spinal tap and MRI were normal. We're still waiting on the urine culture and word from the radiologist on his take of the scans. There was a slight bulge in the T12 and T13. I saw the scans. The neurologist said they were so minor he would be surprised if that was what was causing her lower back pain.
So at this point, we don't know what it is. After spending $2700 on testing, we are now back to crate rest, prednisone, tramadohl and now Clavamox.
We're on the same amounts as before: 2.5 mg of prednisone 2x/day for 5 days, then we start the weening.
The dr. wants me to give her tramadohl the entire week even if she is feeling okay. We go in and see him in 7 days.
They had pumped her full of fluids for the MRI and she has pottied twice in her crate- which she has never done before. She is also asking to go out more to potty.
Her appetite is great and her attitude is good. She doesn't like it when I try to pet her stomach or back inside legs- I think because she thinks I will pull on them like the dr. did. Once she realizes I am gentle with her, she allows it.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Mar 28, 2014 4:55:33 GMT -7
I would think that any type of bulge that can be seen on an image would cause pain. Something certainly is pressing on the nerves to cause pain. And that would explain why she doesn't have any neuro deficits since it's not a bad herniation. At least, those are my thoughts on it. Have you spoken to the vet about what the anti-inflammatory dose of the Prednisone would be for a dog of Maddy Mae's weight, Natalie? As I mentioned before, we usually see 5 mg of Prednisone 2x/day prescribed for a standard size dachshund. Although Natalie is a mini, she's not much smaller. I'm concerned that if the dosage isn't aggressive enough, it won't address the swelling and she'll just keep going through tapers that still show pain/swelling. The body makes it own steroid hormone called Cortisol (hydrocortisone) which is vital for regulating the body's functions. That is the real reason for the taper, to let the body know it has to start making it's own steroid which is at a low level. Vets use a higher level of oral steroids to work more effectively in getting painful swelling down. Rxing a tentative lower end dose of Pred (2.5mg 2x a day) rather than being aggressive with the upper end of the dosing for inflammation (5mg 2x a day) means Maddie Mae is being strung out on a long use of prednisone that may be similar to what the body makes on its own, so the job is not getting done. Did the vet give his reason for prescribing Clavamox? Does he suspect an infection somewhere? www.marvistavet.com/html/clavamox.htmlAlso, what is the current dosage of the Tramadol and how often given? Pain back to being completely under control now? |
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Post by Natalie & Maddy Mae on Mar 31, 2014 7:48:01 GMT -7
The urine culture came back negative. So we are left with not knowing what exactly is causing her discomfort.
She is on:
2.5 mg prednisone 2x/day
50mg Tramadol 1/4 pill every 12 hours
Clavamox 1x/day
10 mg famotidine 1x/day
The clavamox is incase she has any type of infection in her bladder causing the pain.
I did ask the neurologist about the lower dosage of prednisone. He said there are different amounts given with different timelines based on what results you are looking for. He does not believe her swelling warranted putting her on a higher dose and that a higher dose could cause more issues. Ultimately, she should not be on prednisone long.
All that said .... she is doing really well. Of course she is on a cocktail of drugs. We see the neurologist again in two days. Tomorrow we start the taper again. He does not want me to taper the tramadol. He said to only taper one medication at a time.
We did not test for bladder crystals yet, that could be the cause too.
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StevieLuv
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Conservative Treatment 3x. It really does work!
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Post by StevieLuv on Mar 31, 2014 10:13:21 GMT -7
Ideally she would be getting her pepcid/famotidine 5mg twice a day to be given 30 minutes prior to her prednisone. Did your Vet say why to only give it in a 10mg dose once a day? Remember to watch diligently for any neuro deficits when you start her prednisone taper, as she will still be on pain meds that will hide any pain that would be caused by residual swelling. Most commonly pain meds are tapered at the same time so that they can tell if swelling is present. Pain=swelling=more time on prednisone. If she is still on the full dose of tramadol the pain may be masked so signs to watch for would be a decrease in neuro function. I am not trying to be alarmist, just want to make sure that you have all of the info you need.
Fingers crossed for a pain free taper!
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