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Post by Chris & Bella on Mar 17, 2014 12:07:55 GMT -7
Hello everyone,
I found this site while trying to do as much research as possible about IVDD.
Our beagle Bella (4.5 years old, 21lbs) was diagnosed this past Friday with Hansen Type 1 IVDD. We had originally taken her to the vet thinking she was having some gastrointestinal pain, but it turns out the doctor said he saw three tiny calcified places in her disc(s).
They did a 4mg injection of Dexamethasone in the office and sent us home with the following meds:
21 lbs
Rimadyl 25mg (1 pill a day for 14 days) - this was just started last night (3/16)
Methocarbamol 500mg (1/2 a pill 2x a day for 14 days)
Pepcid AC (1/2 of a 10mg tab 2x/day).
Additionally when we started Bella on the Rimadyl last night we started her on Pepcid AC (1/2 of a 10mg tab 2x/day).
And based on a recommendation from our vet and other info I have red, we also started capsules of Vetri-Disc (2x/day).
When we picked Bella up at the vet on Friday she was back to her old self - wagging tail, etc, but she did seem tired. She has been confined, and watched 24-7 since Friday. Luckily I work from home. One of us slept in the living room with her last night.
Unfortunately when the Dexamethasone injection wore off yesterday (after 2 days), her pain returned quickly. To the point that as the day went on and since then, she has not wanted to get up to potty or eat or drink.
She has a good appetite (willingly eats/drinks when you bring it TO her) but otherwise really just lays around. I know this is what we WANT (no activity) but I feel so bad for her as I think she is in pain. I finally got her off of her bed this morning to go potty by bribing with food, though it did take a few minutes. She seems like she is afraid to move as she thinks it will hurt. She was fine walking the few steps while pottying, without signs of pain (whimpering, etc) but once back inside retired back to her bed and just lays there looking very sad.
Her urine has looked normal and when she has had a bowel movement (last one was yesterday afternoon), it was well formed and of normal color.
I called our vet this morning to let them know she was showing signs of pain (slight shivering, some whimpering when we first got up) - they said that while she did well on the steroids, since she had one tab of the Rimadyl last night they could not switch her and that she needed to stay on it. (The signs of pain this morning were about 12 hours after her first ever Rimadyl and before her first 1/2 tab of Methocarbamol for the day).
I feel bad that she can't have another tab until about 7:30 this evening. The once a day dosing seems like maybe it is not enough?
The vet is saying that the Rimadyl can take some time to build up and show signs of progress, but it is heartbreaking watching our normally happy and active girl just lay there in what I feel is pain.
Any thoughts?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Mar 17, 2014 12:46:28 GMT -7
Chis is that your name? I'm Paula. You have an emergency, you have a vet who is not comfortable in treating a disc episode. 1. Gave dex then three days later switches to the other class of anti-inflamamtory, NSAIDs (Rimdayl) Both classes are known for the serious damage to the GI tract. Hence vets who know IVDD prescribe stomach protection. Vets who know IVDD and the meds used look for a 4-7 days washout when switching steroid (Dex) <--> NSAID. All NSAID package inserts carry this similar FDA required warning:
Rimadyl package insert sheet: "Concomitant use of Rimadyl with other anti-inflammatory drugs, such as other NSAIDs or corticosteroids, should be avoided because of the potential increase of adverse reactions, including gastrointestinal ulcerations and/or perforations." www.rimadyl.com/content/RIM016007.pdf
------------ Most dogs tolerate and benefit from NSAIDS, except the ones that have adverse side effects including death. What is the difference? It is a vet who practices safe medicine and an informed owner. The vet checks organ functions with blood work, alerts owner of what serious side effects to observe for. The owner is informed and monitors to stop the med if any one side effect is observed. Here is one place to begin your own research: www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm196295.htm
The FDA and manufacturer pkg insert indicate gastrointestinal problems are side effects of using NSAIDs. The natural defenses of the stomach to shield against stomach acid is hindered when taking NSAIDs. Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms. I would also request a prescription for a 2nd stomach protector on top of Pepcid AC. It is called sucralfate. Background info here: www.marvistavet.com/html/sucralfate.html 2. Disc episodes are quite painful. No patience can be had with pain as it is not just torture but actually slows the whole healing process. Know your pain meds so you can discuss getting proper pain meds on board asap. www.dodgerslist.com/literature/healingpain.htm3. You have an option to get so up to speed on IVDD to put you in a position of monitoring, asking questions or knowing when to ignore harmful advice with this vet. Or you can get on the phone today and find a vet more comfortable in using meds and treating IVDD. This link will explain how, give vet recommendations, etc. www.dodgerslist.com/literature/VetchkList.htmWith this particular disease self education is critical as you have come to know not just to you make sure the right things are being done for the best recovery but so you have the ability to recognize when harmful treatments are prescribed. Because not all vets can know in depth each and every disease for each and every species (birds, dogs, cats, farm animals) it is up to you know know just one disease to protect our dogs. Have the ability to question and discuss things that concern you. You will have no opportunity for concerns if just blindly following a treatment. The goal of our Forum is to support you, to teach you how to learn to look up things, question everything and read so you become the most important part of your dog's health care team. Dr. Nancy Kay, DVM, ACVIM highly recommends this kind of relationship with your vet: "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdfThere are four phases of healing from a disc episode. Each happens with different treatments, different amounts of time. So you can quickly get "in-the-know" about each this is must-do reading: www.dodgerslist.com/healingindex.htmLet us know that proper pain meds are on board. Expect pain to be in control in one hour with proper mix, dose and frequency and stay that way thereafter. Let us know the GI tract is being protected with Pepcid AC and sucralfate. Once meds are right and you are doing 100% STRICT crate rest 24/7 only out to potty, the disc can continue to heal as Rimadyl takes anywhere fromm 7-30 days to complete resolution of the painful swelling. |
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Post by Chris & Bella on Mar 17, 2014 13:00:28 GMT -7
Thanks for your quick reply. Yes, my name is Chris.
I will ask about the addition of Sucralfate to her Pepcid AC regimen to make sure her GI tract is protected.
I'm wondering if her Rimadyl and Methocarbamol is not sufficient and I should ask for an additional pain reliever such as the Tramadol or Gabapentin? The vet today was not the vet who treated her originally (he is off today).
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Mar 17, 2014 13:06:00 GMT -7
Rimadyl can take 7-30 days to get the painful swelling down in the spinal cord. So yes, of course, the proper pain meds MUST be on board right now.
Methocarbamol has room to move up to even 3x a day. It is the pain med that works on pain from muscle spasms
Tramadol is the the usual go to general pain reliever. It likely will not control pain unless rx'd 3x a day
Gabapentin is added to the mix when there is hard to control pain. It works synergistically with Tramadol.
So your vet has so many options he is not using to control pain.
Feedback about how the pain med is working will be essential to tweaking dose in mg, X/day given and whether the combo mix is right to fully control pain. The "off today" vet is the one who prescribed Dex followed by Rimadyl? Hope this vet on duty today will be one who understands using meds safely as well as the need for aggressive pain control with a disc episode.
Do give us a new list of meds, mgs, frequency when you can.
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Post by Chris & Bella on Mar 18, 2014 7:48:40 GMT -7
We added Tramadol to the mix today, so her meds are:
21 lbs
Methocarbamol: 250mg 2x/day
Rimadyl: 25mg daily
Tramadol: 25mg 2x/day
Pepcid AC 5mg 2x/day
Vetri-Disc (neutriceutical) 1 capsule 2x/day
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Deborah & Angel
Helpful Member 
No current back issues... Living Life.. <3
Posts: 294 
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Post by Deborah & Angel on Mar 18, 2014 8:10:54 GMT -7
Hi Chris, my name is Debbie, good to have Tramadol onboard but you may still need to have the Methocarbamol increased.. every FurBaby is different. What did the Vet say about adding Sucralfate for Bella tummy? I know how hard this is and right now you are Bella's voice, she needs You to speak for her...NO FurBaby should be in pain during the healing process. You are doing a GREAT job.. Hugs and Prayers for you and Bella from me and my FurBaby, Angel..  |
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Post by Chris & Bella on Mar 18, 2014 8:34:21 GMT -7
Debbie, thank you for your reply. Honestly in my quest to make sure she got some pain relief I had forgotten to ask about the Sucralfate. So far she seems to be tolerating everything well, no stomach issues, firm normal-colored and frequency bowel movements and normal intake of water and food both.
I gave her first dose of the Tramadol about 45 minutes ago - she is sleeping now.
This has been very difficult on us to see our girl mopey and just not herself.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Mar 18, 2014 11:04:02 GMT -7
Chris as long as the current med list is controlling pain fully dose to dose that would be wonderful.
Do be aware that for a 21 lbs dog your vet is being light on pain meds and thus has much room to move up IF more pain control is required. So make sure there is no hint of pain surfacing nearing the next dose of pain meds. A vet needs feedback to know if further tweaking of pain meds is necessary....as each dog's needs are different as Deborah pointed out.
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Post by Chris & Bella on Mar 21, 2014 18:44:52 GMT -7
Just checking in here - it's been a long few days. Bella had a major setback and was not responding to additional higher levels of pain meds. Our vet gave us a referral to one of the best vet hospitals here in Richmond for a CT as he was thinking more and more that this was not going to resolve itself medically.
We got in the same day - and 90 minutes later our girl was in surgery. She had a significant extruded disc between L4-L5 that was pressing on the spinal cord. The surgeon told us post-surgery that there was even more disc material to be removed than the CT showed.
One day post-surgery she was up and walking out to potty, eating and drinking normally. I'll say the amount of hair they shaved for the incision was a lot - and that's one nasty looking scar right now!
She will be home on a drug regimen of:
Prilosec 10mg 1x/day
Gabapentin: 100mg every 8 hours
Tramadol: 50mg every 8 hours
The surgery and hospitalization (including the CT) was approximately $3,600.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,548
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Post by PaulaM on Mar 21, 2014 19:00:09 GMT -7
Chris, glad to hear the surgery went well and already Bella is moving easily! Guessed the date of surgery was on the 19th, is that right? Let us know what the surgeon directs for PT at home and for crate rest. New members can benefit with your surgery information. We'd love to have you put it in our directory: dodgerslist.boards.net/board/10/guidelines-postingState: Hospital: Address: Cost: Date of surgery: What was included in cost (MRI?, days stay, ER? PT? meds for home, sling, etc.) Comments: |
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