JoAnn's Izzy 4/15 conservative

Hi Izzy and welcome to Dodgerslist!  First thing to know is that it IS in the cards for your sweet girl to get back to enjoying life after recovering.

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. Are you ready? Here's the link: www.dodgerslist.com/healingindex.htm

Add this comprehensive "must-have" $3 DVD on IVDD to your arsenal of educational resources. Friends, family and those who will be caring for your dog should also watch this DVD: www.dodgerslist.com/store/DVDorder.htm
Tape this flyer to your fridge so the whole family knows what things are emergencies:  www.dodgerslist.com/literature/FridgeInfo81907.pdf

In order to help you more, could you please answer these questions?

► What is your dog's name?

► What breed is your dog and did you specifically get a diagnosis of IVDD, aka: a disc problem, a disc herniation, a bulging disc, slipped disc?

► What was the date you saw the vet and started the all important 100% STRICT crate rest 24/7 only out to potty for this current disc episode? …. STRICT means 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)?

► Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy?

► How much does your dog weigh? List the exact names of meds currently given, their doses in mg's and times per day given? What was the start dose if a steroid, date of taper? Please include the all important stomach protector such as Pepcid AC. Phrase the question to your vet this particular way:" Is there a medical/health reason for my dog not take Pepcid?" If there is no reason, we follow vets who are proactive in stomach protection by giving doxies 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory.

► Currently can your dog wobbly walk? move the legs at all? or wag the tail when you do some happy talk? The very, very lightest least aggressive range of motion and leg massage is necessary for paralyzed legs during conservative treatment once off of all meds and there is no more pain. The information highlighted in PINK pertains to a dog who can't walk.
www.dodgerslist.com/literature/massagepassiveexercises.htm

► Can your dog specifically sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up?

► Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?

► If there is pain or neuro diminishment, dogs can benefit greatly with acupuncture or laser light therapy. These therapies can be be started right away to help relieve pain and to also to kick start energy production in nerve cells to sprout. So if this therapy is in your budget, seek out a holistic vet.

We all have been through this horrible disease and look forward to helping you and your sweetie get through this.  Please let us know the answers to the above so we can help you better.  ((HUGS))

We are a friendly group and just go by first names. My name is Paula what is yours?

We can only be of best help with details. Can you fill us in on these:
-- What is the exact dose of Prednisone in mgs and how often do you give it?  Has the vet noted when there will be a taper, a decrease?
-- Izzy is not on any pain relievers. That is unusual. Do you see any of these signs of pain: shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy, head held high or nose to the ground, not normal perky self?
-- Can Izzy wag her tail if you specifically do some happy talk to her?
-- Do you find urine leaks in her bedding or when you lift and carry her to and from the potty place?

While on prednisone Izzy's GI tract needs to be protected. Did you specifically ask the vet: Does Izzy have any health issue to keep her from taking Pepcid AC (famotidine)? If the answer is she does not have health issues, please let us know she is on 5mg Pepcid AC 30 mins before Pred and thereafter every 12 hours. This is important as Izzy does not need a bleeding ulcer on top of all else she is dealing with.

Loss of neuro functions do have the potential to reverse as the nerves begin to heal. The single most important part of her care is the 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks. The 2nd most important thing you can be doing is reading and becoming a savvy IVDD advocate.  Have you been able to start here at this link?:  www.dodgerslist.com/healingindex.htm

Never give up, stay focused, stay postitive and stay strong!  You and Izzy will get through this bump in the road of life.

We look forward to learning the specific details with your answers.

JoAnn, the yelp that you heard is a sign of pain. She needs to be on pain meds. Dogs are very good at hiding pain, but that a yelp was definitely a sign. Also, a taper of the Prednisone should not be done at this time since she is still in pain. It usually takes 7-30 days for the swelling to go down so the vet had her on a very short round of Prednisone before the taper, only 2 days. You'll need to speak to the vet to let them know about the yelp when being picked up, advocate strongly for pain meds and for the Prednisone to be continued for a longer period of time, at least 7 days. Pain = swelling = more time on all meds. Please also be aware that the dosage of the steroid was very light. We usually see 5 mg 2x/day of Prednisone given. Given that Izzy is on the smaller side, I would think that at least 2.5 mg 2x/day should be given.  But I'm not a vet - that's just based on what I've seen here.  The Prednisone must be given on an anti-inflammatory level to get the swelling down and I don't think she's been given an anti-inflammatory level yet.

An MRI is usually only done prior to surgery or to rule out any other problem if the diagnosis of IVDD is in doubt. With conservative care, it doesn't matter which disc is being affected as the treatment would be the same. Plus, MRIs are not done lightly as the dog needs to be sedated, meaning the trunk muscles that support the vertebrae and defend against further disc damage are out of commission. Sometimes on an x-ray, the vet can detect an inconsistency in the spacing between the discs, which may be what the vet was referring to. IVDD is usually diagnosed based on symptoms.

Be sure to get Pepcid AC on board today to protect from the side effects of the Prednisone.

It's an excellent sign that the vet's test revealed deep pain sensation and movement in her feet. I know how hard it is to stay positive but try to take it one day at a time. The main thing is to control her pain right now and to get that swelling down. Don't hesitate to get a second opinion from a Board-certified neurologist if your present vet won't be more aggressive about an anti-inflammatory. Not all vets are familiar with treating IVDD and it sometimes take a more experienced doctor to prescribe the right meds.

My prayers are with you and Izzy. Please let us know what the vet says after speaking to him today.

So your vet said Izzy has no health issues to keep her from using Pepcid AC? Then I would just give him a call to find out the dose for a 9lbs dog. We tend to follow the vets that prescribe the upper mg range of the 2x a day dose as the manufacturer says it is most effective for a 12 hour period. Background reading on Pepcid AC: www.petplace.com/drug-library/famotidine-pepcid/page1.aspx

Let us know what YOU observe regarding pain: shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy, head held high or nose to the ground, not normal perky self?

Let us know what the vet says about Pepcid AC.

Bleeding ulcers are also caused by stress just like with people! To dogs change in routine, pain, etc. are stress factors. North Carolina U. recognizes the high incidence of GI irritation in dogs with disc problems. NCU and 11+ hospitals working with NCU prescribe a GI protectant. Dogs presented to NCU with IVDD often develop GI upset whether they are given steroid medications or not.
www.cvm.ncsu.edu/vhc/tc/clinical_services/neuro/acute_disc.html

So, yes, we do follow those vets who are proactive in protection of the GI tract while on prednisone as it most certainly adds a potential for GI tract upset. Pepcid AC is a generally safe over-the-counter suppressor of stomach acid production for healthy dogs and good insurance. Not all vets are proactive with GI tract protection. Now you know so you make your own decision if Izzy has no health issues.... just keep your vet in the loop about it.

Dr. Nancy Kay, DVM, ACVIM highly recommends a new 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!" Self education allows you to step up to the important roll of team captain. I would not change vets over Pepcid AC. If he is supporting you and Izzy in getting the swelling down and she is not in pain, then I would stay with him. If he is open to you sharing what you learn here then you two can make a good team working together on Izzy's behalf.

JoAnn, good news on the nerve improvement!

Be aware you might be inadvertently training for unwanted behavior.  To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting.  So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward.  Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc.

Using any oral calmer in combination with a Pheromone diffuser seems to work best.  It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price

Place a DAP pheromone diffuser at floor level where the recovery suite is. Some brands to consider:
--Comfort Zone (DAP) wall plug-in diffuser 48ml www.petcomfortzone.com/dogs.html
--Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/

Use a diffuser with one oral calmer from below:

Oral calmers:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
www.vetriscience.com/composure-soft-dogs-MD-LD.php
3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com

Quickly read up on Pepcid AC to verify that as far as you know Izzy has none of the health issues discussed. If she has none, this relatively safe over the counter acid reducer should be given ASAP and then keep your vet in the loop in the morning. You may also need an ER visit to get an Rx for sucralfate in addition to Pepcid AC. Please read up on sulcralfate too at the Mar Vista Vet website: www.marvistavet.com/html/pharmacy_center.html

When things have settled please give us updated med list (name, mgs, and how often given) What was the date of the 2nd course of Pred, also.

What was there reason for the 2nd pred course... pain, loosing leg movement, or ?

I took a stool sample in this morning. They said it could possibly be from the Methocarbamol? I took Izzy back to the vet last week Tuesday because she wasn't herself again. This time in addition to her back he said she was having neck issues. Izzy has only throwing up once but her diarrhea is terrible. I made her boiled lean hamburger this morning with rice. I also started to give her pepcid ac 5mg a half before her predisolone in the morning.

Hello, the vet office just called back and said that Izzy has a overgrowth of bacteria and that's causing her diarrhea. They said no meds are needed for this and she should stop the Methocarbamol. I am so frustrated!!!! I asked about new muscle relaxer & pepcid ac??? She said they would get back to me. I dont know what to do anymore!!!!

Hi JoAnn, In your April 21st post, you did state the vet gave you Pepcid AC. Is this still correct? When you say you talked to the clinic, did you talk to the vet directly? If not, I would call back and ask to talk to the vet directly and tell him you do not understand and are confused as to why no meds are needed and exactly what you can do.

JoAnn, we are kind of at a loss to comment without a current med list from you. What did the vet prescribe on Tues May 13 when you brought her in and they said she also has now a neck disc?

9 lbs
Prednisone: how many mgs and how often?
Pepcid AC: are you giving 5mg 2x/day? And are you giving Pred with a meal?
Any antibiotic?

If the stool sample was raging with bacteria, then what is the vet doing about that? An anti-biotic?

Can you tell us if on Tuesday or even today that Izzy holds her head stiffly, head up up high or nose to the ground? Does she hold a front paw up, not wanting to bear too much weight on it?

As of May 13 med list:
9 lbs
prednisolone 2.5 mg 2× daily for 3 days. Then one time daily for 10 days then every other day until gone.
Methocarbamol 125 mg 2× daily. [took her off]
DID NOT GIVE HER AN ANTIBIOTIC.
pepcid ac 2.5mg Are you giving 2.5mg 2x a day?  Giving Pred with a meal?

OK, then the above is the current med list?

 You need a vet who has the time to have a conversation so you can question, bring up your concerns, can relay your observations. You need a vet who works WITH you as a part of Izzy's health care team. IF this vet is not that kind of vet, you need to hire a new one today.

Something is causing the symptoms of diarrhea. There could be many reasons.  A vet is the one to help you figure out the cause and prescribe the right treatment.
-- The pain reliever that addresses muscle spasms is should have been stopped to give a clear picture of pain on a pred taper.  Adverse effects associated with methocarbamol include drooling, sedation, vomiting and stumbling. www.petplace.com/drug-library/methocarbamol-robaxin-v/page1.aspx  Have not read this med causes diareah.  Did you come across otherwise when you googled this med?
--If she has an infection caused by bacteria, then an antibiotic may be the approach.
-- If she ate something, changed foods, that could account for loose stools.  It is with vomiting that food can be withheld for 12 hours to let the tummy settle and then begin small amounts of bland foods slowly.
--if now on the taper of Pred at 2.5 mg 1x per day and it is the pred that is causing GI tract upset, then adding a 2nd GI tract protector, an Rx item called  sucralfate is the prudent thing to do

Dehydration is a concern with continued diarrhea. Check for dehydration:
Gently pull up her skin between her shoulders. It should snap back right away when you let go. Pull up her lip and press gently on the gum which is normally pink. When you press down it will turn white and when you release the pressure it should turn pink again right away.

Is Izzy taking/drinking water on her own?

Have you tried 1/2 - 1 teaspoon of plain pureed pumpkin 1x/day to help reduce the diarrhea symptoms?

Let us know how the conversation with the vet goes, what he believes is the cause of the diarrhea and then what does he prescribe.