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Post by Angela & Sassafras on May 4, 2014 12:37:00 GMT -7
Princess Sassafras is my 7 year old miniature dachshund angel. She weighs 15 lbs. (Up 4 lbs in 2 years) She was diagnosed with IVDD in Jan. 2012. She is currently on meds and crate rest for the 2nd time. On 4/26 she saw a squirrel in the backyard and leaped off the deck rather than using her normal ramp. She immediately started dragging her back right leg. It was like she had no use of the leg at all. I brought her inside immediately and was freaking out started looking for the emergency vet #. In the 5 minutes of getting the vet on the phone she started to walk on the leg but was pretty wobbly. The vet and I decided to put her in her crate until I could get her into their office the next day.
Since this was the 2nd time in the last 3 years that Sassy has had problems with her back, my regular vet make a referral to the University of MN neurology department. In the meantime, she prescribed prednisone and tramadol. That was on 4/27. Sassy has been on strict crate rest since. I have noticed that she is shivering when I pick her up to go out to go potty. I am not sure if this is a sign of pain. She doesn't cry or yelp at all. The little I have allowed her to walk a few steps when going out to go potty I am seeing improvement although she is still a little wobbly with her back leg. She is eating, drinking and pooping okay. And that tail does nothing but wag.
-- What are the exact names of meds currently given, their doses in mgs and frequencies?
Prednisone - as of 4/27 Twice a day for 5 days, Once a day for 5 days, then Once every other day.
Methocarbamol - Twice a day as needed. 125 mg.
Our appointment with the U of M is on 5/7.
My question is how aggressive should I allow them to be at the U of M? I really don't know what to expect. I will do whatever is necessary to help Sassy, she is my baby, my first doxie, and the reason I fell in love with the breed. When I called to make the appointment they couldn't tell me anything without seeing her first but they did indicate that the cost of the MRI alone will be $2000. They won't know if she will need one until she comes in for the first visit. I want to do what is right for Sassy and if I need to pay for that or surgery or any other recovery treatments I am more than willing to do it. I will get a loan. But I don't want to just pay money for the sake of paying money. I would pay everything I have if I could guarantee that she never had to worry about IVDD again, but I know that there is never a guarantee.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 4, 2014 13:32:39 GMT -7
Angela, welcome to Dodgerslist. There are certainly times when surgery is a consideration and times when a consultation with a neuro is a good idea. Mostly it is when progress is going backwards, nerve functions are diminishing or lost or the pain just will not be brought under control with aggressive use of pain meds. From what you report it would seem Sassafras is a good candidate to heal her disc under conservative treatment she is going in a good direction of healing the disc and already nerves are beginning to function better. The big if on that is if you are willing to do some reading to understand the disease, the care and how the meds are used. This is a really great place to start and hopefully finish reading in the next couple of days so you can decide if this is the time for a neuro appointment and if it is be involved in a good discussion with the vet. www.dodgerslist.com/healingindex.htmUntil you have your readings completed let's see if we can get things right for Sassafras. We observe pain as: 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? We look for signs of pain nearing the next dose of meds indicating we are not giving them soon enough OR that the right combo is not on board OR not the right dose in mgs. It is always prudent to try the shortest course of a pred and do a test taper, lowering of the med, to see if pain still exists. Do not be dismayed if there would still be pain on the the taper. It merely points out the need to be back on the original dose for a bit longer. Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 7-30 days. When the vet guesses swelling might be gone there will be a taper. Usually the first course will be 5 or 7 days and then a test taper. The dose is lowered to less than the anti-flammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too. Rule of thumb is: pain = swelling = more time on Pred, pain meds and Pepcid AC needed. So seeing signs of pain such as shivering means her pain meds are not YET right AND it is not time to be in a taper. The vet needs to know this information asap. Your vet seems to be a little unsure about IVDD and thus has referred you to the University. So this is double the reason for the need to become a mini expert yourself. As long as a dog is walking surgery is not typically a consideration. If you keep the U of M appointment it is because you are likely looking for the correct med RXs that your local general DVM vet is not comfortable in using. It is possible if your vet is not comfortable in treating IVDD, not open to learning what you are learning here you'll need to hire a new vet. The kind of vet you are looking for is one you can team up with and work together in helpin Sassafras. Dr. Nancy Kay, DVM, ACVIM explains it perfectly. "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.pdfPain meds typically prescribed not on an as needed basis but punctually given: www.dodgerslist.com/literature/healingpain.htmApproaches to hiring an IVDD knowledgable vet: www.dodgerslist.com/literature/VetchkList.htmWas the orig dose of pred 5mgs 2x/day? What is the current dose in mg at 1x/day? |
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Post by Angela & Sassafras on May 4, 2014 14:55:10 GMT -7
Paula - Thanks for the wealth of information. I have been on this site reading everything I can for hours and will continue to do so. My gut was telling me that taking her to the neuro for a very expensive MRI was an uncalled for expense at this point. I think I will keep the appointment on Weds just to get her seen by the specialist but will really advocate for not performing the MRI unless absolutely necessary. Just getting her into their system and familiar with the specialist can be a good thing in the event of emergency care later. Also, you mentioned the meds and the dosage. Yes the pred was 5mgs 2x/day. But the regular vet did not prescribe Pepcid or anything similar as part of the regimen. I just left a message for the vet on-call to ask about the need for Pepcid. Everything I am reading says she should have been taking it along with her meds since we started. The fact that my regular vet did not mention it concerns me.
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Sabrina
Helpful Member 
My Charley-dog, a Dodger'sList grad enjoying life!
Posts: 471 
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Post by Sabrina on May 4, 2014 19:49:37 GMT -7
Hi Angela, I'm Sabrina! I'm so glad you've found Dodger'sList and are learning all you can for your Sassy's best recovery! You can get through this! An MRI would typically be done in preparation for surgery. I hope the specialist you see is confident treating disc episodes Conservatively (meds and crate rest) so that s/he can be a great resource for you. Do you know if the specialist is board certified? --- Veterinary Internal Medicine (ACVIM) is the official organization of the veterinary specialist of neurology among several other specialties. --- American College of Veterinary Surgeons (ACVS) veterinarian who has been board certified in veterinary surgery and is called a specialist in veterinary surgery While many vets who are not board certified do call themselves specialists, board certification is the good standard by which to measure competence and training About the Pepcid AC: At Dodger'sList, we see so many dogs who develop GI trouble from anti-inflammatories - that's why proactive stomach protection is such a big deal here! Lots of vets are rather lax about stomach protection, but with you and Sassy already having to go through so much, if a GI problem is preventable that's they way to go! Glad you have a call in to the clinic. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" (Lots of vets say, "it's not necessary" - so want you want to verify is that there is no medical reason Sassy shouldn't take Pepcid AC) If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. Pepcid AC is a generally safe over-the-counter suppressor of stomach acid production for healthy dogs. Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach. We ask that all members read about each med their dog is on or may take as a safety measure. This directory is in alpha order: www.marvistavet.com/html/pharmacy_center.htmGlad to hear that Sassy was on the anti-inflammatory dose of pred - has the vet ok'd you to stay at the 5mg 2x/day? Is she still on Tramadol? If so, what is the frequency/mg? Tramadol has a very short half-life, and typically needs to be given every 8hrs to cover all the pain. Do speak with whoever you can at your vet's about Sassy's pain tonight - pain hinders healing, so it needs to be addressed asap. www.dodgerslist.com/literature/healingpain.htm))Hugs!(( |
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Post by Angela & Sassafras on May 11, 2014 8:29:26 GMT -7
Update on Sassy:
Sassy is doing really well on crate rest and meds. We did go to the U of M on Tuesday and I have to say, there is a great staff there. They were very caring, knowledgeable, and professional. Since this is a teaching hospital the 4th year vet had three 2nd year students with her. They were all so very kind. They walked through every minute of the visit, they were very thorough with her medical history and her exam. Sassy loved them and didn't shy away at all.
When the neurologist, Dr. McVey came in, he was awesome. He poked, prodded, and did the full neurological exam from Sassy's head to tip of the tail. She is still just a tiny bit wobbly in the rear but has improved so much through her conservative treatment plan. He said there was no need for an MRI at this time. MRI's are typically done before surgery and there is no need to have the costly procedure that requires anesthesia just for the sake of it. Basically he said she is a dog with a bad back and this will happen from time to time. He felt that she will heal through crate rest and meds. He did tell me that if the episodes happen more frequently 6 months or less between, or if she goes completely down that he might recommend surgery at a later date. But for now we are to continue to monitor her progress. He agreed with the medication regimen that she is currently on. He did prescribe Pepcid. We have started to taper her dosage and she is currently down to one dose of ▼steroids every other day. She is taking her pain meds twice a day. Dr. McVey did let me know that the meds could be masking the problem so I need to watch her carefully to see if she shows signs of pain or doesn't seem to be improving as she should. He indicated that if that happens he would put her back on the steroids for another round to see if she just needs more time to heal.
I feel so much better knowing that she is now in their system and they are her primary caregivers from this point on for any back related problems. My greatest fear is she will go down in the middle of the night and I will need to get her into emergency vet care. Knowing that they are available and they have knowledgeable staff on hand 24x7 who will be familiar with her case puts me at ease a little.
Sassy is now on her 3rd week of crate rest and I think she is honestly enjoying it. She goes right into her crate and seems to enjoy the comfort of her own little space. Now it is rest, love, and hope that she will fully recover.
Thank you ladies for the wealth of knowledge and all of the materials on this site. I felt educated when speaking to the vets. He also made a comment about how refreshing it was to see someone who had done their homework and knew the proper treatment and importance of caring for a dog with IVDD. That was all thanks to Doger'sList.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 11, 2014 10:56:08 GMT -7
Angel, I can imagine how nice it is for a vet to team up with an owner who knows about their dog's disease. So the kudos go to you, gal, for investing time to be that knowledgeable pet parent. Of course whenever someone says they find our informational materials useful our hearts sing! Thank you. Hope you general DVM vet will see with his own eyes and gain experience to know staying the course with conservative treatment has a good chance to work if aggressive pain control is in place. We'd like all members to tell their vet about this Forum and share how Dodgerslist has helped you care for your dog. Just ask Linda for some free literature. Our brochure for your vet would make an excellent addition to his toolbox for educating future clients. Don't leave the house w/o the small cards… you never know when you meet an owner of breeds prone to disc disease (Dachshunds, Beagles, Poodles, Spaniels, Shih Tzus, Pekingese, and Chihuahuas are most affected) order here: www.dodgerslist.com/literature/litorder.htmI would discuss about backing off or stopping the pain meds on the taper. (What are the pain meds?) As the neurologist, Dr. McVey said pain meds mask pain and thus you do not have a clear picture on the state of swelling. Backing off pain meds gives immediate feedback if you would see any hint of pain. Then you and your vet waste no time in getting back up on the anti-inflammatory level of Pred and back on pain meds. Right now Sass is on a less than the original anti-inflammatory dose |
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