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Post by tamsin on Mar 29, 2013 9:53:32 GMT -7
Hello,
I posted once about Bindi who went through eight weeks of crate rest to clear up a relatively mild (compared to some others on this list) flare-up (her first) last October. The help from dodgers list was terrific--I knew to ask for pepcid which Bindi clearly needed (everything else the vet did and prescribed was in synch with this site) and was much more strict with her crate rest than I would have been without the information I got from this site.
Bindi (a six-year-old female 15 lb. Boston Terrier) had pain the first time round and some neurological deficit in the hind legs both of which was pretty quickly cleared up with medication. I was careful about crate rest and have banned stairs and jumping (she used to be an agility dog, but of course no longer) as much as you can with a Boston! We did, after building back up slowly, return to the 2.5 mile walks 4 or 5 times a week we both like to take.
Bindi finished her last eight weeks of crate rest December 21 and seems to have been fine since. Two days ago, she was lifting her left rear paw in a funny way and then was limping. I brought her in immediately, she had neurological deficits in both rear legs and we've started her once again on eight weeks of crate rest with the same meds we had her on last time (10mg famtotidine 30 minutes before other meds, 2.5mg Prednisone 2x for five days before beginning to taper, 25mg tramadol and 250mg methacarbamol both 3x day). (She also did/is doing three rounds of laser treatments each time.)
She is already no longer limping and will get a recheck at the vet in two weeks.
My questions are this: Does anyone have any experience with this kind of re-occurrence over time? At what point should I consider surgery (something I don't want to put her through unless absolutely necessary) even if we can take care of the pain and it's not getting worse? My vet is talking about putting her on Gabapentin indefinitely to deal with nerve pain, but that wasn't even the issue this time (she didn't seem to be in any pain--certainly not the kind of pain she experienced last time round, but was experiencing neurological deficits--isn't it better to know when there's a flare-up so crate rest can be started?) How many times of letting her return to some semblance of normalcy and then returning once again to crate rest is possible and/or desirable? Is it possible we'll be doing two months on two months off for the foreseeable future?
Thanks for any insight--this site has been a real life-saver for us!
Cheers,
Tamsin
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,936
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Post by PaulaM on Mar 29, 2013 11:02:56 GMT -7
Tamsin, I'm sorry to hear about Bindi having another disc episode. The great news is you were IVDD educated and you acted quickly....quick to suspicion the need for vet help and crating at once. Kudos to you! See your award for prompt crate rest. Bindi was born with a degenerative disease of discs. There are 26 discs that have the potential to prematurely age. Some dogs have only one disc episode their entire life while other may have multiple... this is a nasty disease as it is just not predictable. Meds should only be used at the time of a disc episode and only until the swelling has been taken care of. Pain meds of course would do nothing to prevent a disc episode. Swelling = pain = need for anti-inflammatory + pain med for comfort. All meds have side effects so there are only risks to be had when using them when not needed...when there is no pain. If it appears that the same disc does repeatedly cause a problem, they surgery may be a consideration. I say "appear" because without an expensive MRI, CT or myelogram, it is hard to prove which disc. This article will give you insight in to xrays and what they show and don't show. www.dodgerslist.com/literature/CalcifiedDiscs.htmIs her pain fully under control? no shivering, trembling, yelping when picked up or moved, reluctant/slow to move, tight hard tummy, ? Often it takes being at the anti-inflamamtory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going by observing for pain. Is the Famotidine dose 10mg 2x a day or is it 5mg 2x a day? How much does Bindi weigh? Since you were last here we have a new page, a kind of quick refresher. www.dodgerslist.com/literature/healingpage.htm |
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Post by tamsin on Mar 29, 2013 12:08:22 GMT -7
Thanks so much for your quick reply. The vet prescribed 10mg famotidine once a day, but last time I split it in half to give a half-pill 30 minutes before each time Bindi had a prednisone pill. She is 15 lbs. Does that make sense?
I forgot to mention that both for her last incident and this time, the vet gave her a 2mg shot of Dexamethasone when we saw her and then I started Bindi on the prednisone the following day (we saw the vet on Wednesday, 3-27).
She has not seemed to have any pain at all this time round--except that I assume lifting her paw the first day indicated some discomfort when she put her foot down. She has not otherwise had any of the pain indicators. She was wobbly walking when I took her to the vet, but by the following day she looked like she was walking normally again (although I assume there was/is still some neurological deficit).
I guess I will just have to play it by ear, hope she recovers as well this time as she did last time and that we'll be able to go longer this time before another incident!
Thanks again!
Tamsin
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,936
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Post by PaulaM on Mar 29, 2013 12:56:12 GMT -7
Tamsin, we do follow the vets who are prescribing Famotidine every 12 hours and 30 mins before the steroids.. so if you are doing that do split the 10mg tab down to 5MG dose. And do give prednisone with a meal. Keep your vet in the loop about the famotidine.
Thanks for the full details on the Dex shot this time. The lifting of the back leg sounds very much like root signature pain. Where the disc is pushing on a nerve leaving the spinal cord bundle going out to the leg. Glad to hear the steroid did already bring the swelling down enough to allow better nerve function, normal walking.
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Post by tamsin on Jun 18, 2013 7:12:53 GMT -7
Hi Again!
Bindi (15 lb Boston Terrier) had her first IVDD incident and did eight weeks of crate rest with meds October 26, 2012.
Bindi had her second IVDD incident (first relapse) and did eight weeks of crate rest with meds March 27, 2013. I was even more careful this time when she ended her crating May 23, trying to build up walking slowly and banning all stairs, etc. She is now on Gabapentin 100mg/day indefinitely and she's had numerous laser treatments. What seemed to set off her relapse was standing up on her rear legs in excitement when a friend came by.
A couple of days ago we had some furniture delivered and again, although I grabbed her so it couldn't have been for more than a few seconds, she got excited and stood up on her hind legs. Since then she has seemed to me more tentative about walking although she does seem able to walk (after being absolutely thrilled that we were beginning to do some walking again, she is no longer excitedly pulling at the leash looking to get going). I've immediately restricted her activity and watched her closely when she potties. I've made an appointment with the vet but couldn't get it until next week.
In the meantime, I'm feeling at a loss. This is the third incident (if this is a full-fledged incident). I'm not sure she should be put back onto steroids (she seems pain-free--although if she's not eager to walk, that may mean she's feeling some pain when she walks?) We'll be going on vacation in a few weeks (we bring Bindi with us) and I'm just not sure what to do. At what point should surgery be considered even when the neurological deficits are relatively minor? What I read on the net suggests when the situation is "recurrent." If I can deal with this conservatively, I would still like to do so--aside from the tremendous expense (which would be a hardship to afford), I'm loathe to put her at such risk if it's not warranted. I could make an appointment with an orthopedic surgeon (Dr. Franczuszki practices within reach of me--or I could go to U. Penn.), but I'm afraid a surgeon's suggestion would be surgery so I want to think about my options before I go that route. Surgery has serious risks involved--Bindi still has good quality of life.
So I guess I'm just wondering about any thoughts or information anyone out there might have about what appears to be a relatively mild, but recurring situation--if I keep at it could she recover or am I playing Russian roulette with her health (but then isn't surgery a gamble as well)?
Sorry about the long post--I'm really just looking for experiences with a recurring situation. Thanks so much for any feedback!
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StevieLuv
Helpful Member 
Conservative Treatment 3x. It really does work!
Posts: 1,335 
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Post by StevieLuv on Jun 18, 2013 8:39:35 GMT -7
Hi, my name is Maureen. I am sorry that you and Bindi are going through this again. If it is any help what so ever, my Vet describes Stevie's IVDD as a condition to be "managed" rather than "cured", and we know that she may have re-occurances or relapses (she already has) and we take each day as it comes, trying to prevent trouble but knowing that things happen in spite of our best efforts. Hope this helps somewhat - Bindi is going through another "bump in the road" of IVDD, keeping you in thought and prayer.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,936
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Post by PaulaM on Jun 18, 2013 9:31:17 GMT -7
I agree with Maureen, disc disease does not go away…a dog is born with the disease and has it for life. Some dogs are lucky in that they only have one disc episode in their life time while other may have multiples. There just is no predicting with this disease. If you can identify the symptoms of pain such as reluctant to move, walk, crate at once to keep the disc from further tearing with movement you may be able to avoid surgery… She is on a pain med and that should not be for life. But used during the time there is swelling going on in the spinal cord. Swelling takes 1-2 weeks+ to resolve and you do not want Bindi in pain. Gabapentin does nothing to address swelling. It is NSAIDs or steroid type of anti-inflammatories that work on getting swelling down. She is STILL reluctant to take the very, very few footsteps permitted at potty time showing there is still swelling going on in the spinal cord. That is the indicator more time on pred is needed and then try another taper to see if swelling is gone. Crate rest is to limit movement so the disc cartilage can form scar tissue…that is a slow process so allow 8 weeks for that. So if you can keep disc episodes mild and treatable with crate rest and meds, do so. If they become too frequent, then surgery may be a consideration to avoid a life of pain. Post op crate rest is for 6 weeks and there are no guarantees that a different disc down the line could cause a problem…. just the same as it can happen with conservative treatment. Weight the two treatments here: www.dodgerslist.com/literature/healingsurgery.htm |
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Jun 18, 2013 10:19:18 GMT -7
Our Stevie has 8 "bad" discs - one, T13-L1, which caused her current episode - she had a CT scan, so we know where the problems are, and part of why we opted for conservative treatment.
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Post by tamsin on Jun 18, 2013 11:55:15 GMT -7
Thanks very much for your quick response! I see on the "when to consider surgery" page you directed me to (thanks! had completely forgotten to recheck that) that 3 or 4 recurrences is when you should begin to consider surgery. Bindi is still quite happy to walk to go potty and she's walking fine. She's just not scampering around the way she was before the furniture guys came (she was SO HAPPY to have more freedom after being crated). She is beginning to "get" that she's not supposed to go up on her hind legs anymore, so maybe with more time and training we'll be able to manage this better.
Thanks so much for the info on managing (as opposed to curing)--if I can get a handle on what affects her, maybe we can continue to manage (as opposed to surgery) for awhile longer. The swelling is, I believe, minimal at this point since she's not in pain and walking fine (I realize Gabapentin is just for the nerve pain--I did ask my vet how long she's supposed to stay on it and wondered why since Bindi appeared to be fully recovered and out of pain--I'm still not sure about that one; my vet seems to think Gabapentin is very safe, so there's no harm in her staying on it for an indefinite period, but what she's waiting for in order to discontinue it is actually not clear to me, I'll have to press her on that point again when I see her), but since I think there is a little something going on (she has no problem walking to go potty and she still wants to keep exploring rather than go in--she just is not trying to trot around the way she was a few days ago and it just seems to me she's walking a little less confidently), I'm going to crate her again just to be on the safe side. We'll see the vet next week and go from there. But of course in the meantime I will monitor her and if there's any worsening take her in for an emergency visit.
Thanks again!
Tamsin
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Post by Pauliana on Jun 18, 2013 21:16:26 GMT -7
Hi Tamsin,
Good idea to crate just in case until her Vet appointment. Let us know how you get along in training her not to stand up on her hind legs and if you discover any tips please let us know..
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