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Post by Claire & Harvey on May 8, 2014 12:57:23 GMT -7
Hi, my dog has epilepsy and fell onto his back. He was very unsteady on his front legs, falling over, holding his head high and panting with pain. I was seeing a vet for approx 2 weeks before they would give him tramadol and steroids, and only after I insisted. They felt he had a brain tumour (the unsteadiness and the epilepsy) and I couldn't afford an MRI. By this point he was unable to stand at all. It is now 2 weeks later and he has had cage rest and is very gradually improving day by day. I have changed my vet as I was unhappy with them and today saw the new vet for the first time. She felt that he should be improving more quickly and again hinted at an MRI. She said that soft tissue should heal on its own anyway, without the steroids. I said I want to continue the cage rest, tramadol and steroids for a further 2 weeks as he has gone from not being able to stand at all to being as to walk, all be it unsteadily. He is brighter in the eyes and generally happier. I thought it would take 6 to 8 weeks to recover. Should I be worried after just 2 weeks?
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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 8, 2014 20:03:10 GMT -7
Claire, welcome to Dodgerslist. The very best way to be able to make good decisions about your dog is to be fully educated on this disease. Without out the investment in reading and learning your mind can worry you to death, you won't recognize harmful advise, etc. There is no better place to start and have some very good learning under your belt within a couple of days.... your dog depends on you: www.dodgerslist.com/literature/healingpage.htm What is your dog's name? I'll ask you a few questions so we can better support you: --What breed is your dog and did you specifically get a confirmation diagnosis of IVDD from the new vet? -- Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy? -- How much does your dog weigh? Would you list the meds currently given, their doses in mg's and frequencies? Has there been a recent change in dose of the steroid? Anti-inflammatories can increase GI tract damage. Phrase the question to your vet this particular way:" Is there a medical/health reason my dog may 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 and thereafter every 12 hours. This directory very good for learning about each of your dog's meds: www.marvistavet.com/html/pharmacy_center.htm -- Eating and drinking OK? How are poops today- normal color and firmness, no dark or bright red blood? -- Currently can your dog wobbly walk? move the legs at all? or wag the tail when you do some happy talk? Keep in mind the very, very lightest least aggressive range of motion and leg massage will be necessary for paralyzed legs during conservative treatment once off all pain meds and no more signs of pain The information highlighted in PINK pertains to a dog who can't walk . www.dodgerslist.com/literature/massagepassiveexercises.htmOften it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) anywhere from 7-30 days. When the vet guesses painful 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 level. Your job at home would be to assess just how well reduction of painful swelling is going by observing for any hint of pain (shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy, holding leg flamingo style not wanting to bear weight). 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 the steroid prednisone, pain meds and Pepcid AC needed. If there is no pain the taper goes to completion. All IVDD meds carry with them adverse side effects and no one want to use them one bit longer than necessary. Once there is nerve damage there are no meds to heal nerves it may or may not happen during the 8 weeks devoted to letting the disc heal. With nerve healing think in terms of months rather than days or weeks. We look forward to learning more about your dog with your answers. |
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Post by Claire & Harvey on May 9, 2014 1:17:59 GMT -7
Hi, many thanks for your reply.
My dog is a five year old shih tzu called Harvey. He is 8.5kg [18 lbs.] I live in the UK and have not been able to find a vet with any significant experience of IVDD. My original vet ignored the poor walking and focused on the epilepsy. As the epilepsy is unusual (he only has seizures when he is asleep). When the neurologist saw and examined Harvey he diagnosed IVDD in his neck. I am unable to afford an MRI scan or long term treatment with the neuroligist so I went back to the original vet for treatment.
On going back to the vet it took an extra 4 days for them to eventual give him pain medication and steroids, and this was only after I insisted. 2 weeks ago today Harvey started taking
8.5kg [18 lbs.]
25mg of tramadol 3 times a day and
5mg of prednisolone (half a tablet twice a day). For his epilepsy he takes
60mg epiphen a day and
325mg libromide. The seizures are not completely controlled yet but are much better.
Before he becan taking the tramadol he was holdng his head high, panting and refusing to move. He had a very tight tummy and an arched back. He held his front legs completely stiff and had no flexibility in them. At his worst he was unable to stand at all and had to lean against something to sit up. I could also see spasms in his back. Hi back legs aren't too bad, it effects his front legs.
He has been gradually improving over the last 2 weeks, some days are better than others. He is now able to walk, but is very wobbly. He can stand and balance to cock his leg which he was unable to do last week. He is in much less pain, but was panting and holding his neck up last night after we got back from the vet as she had made him walk, examined him, etc. He seems better this morning.
His tail is very waggy and he has more flexibility in his front legs. He also feels less rigid when I pick him up. His right front leg is more unsteady than his left, and he can lose his balance at times. He is much brighter in himself generally, but occassionally does seem still uncomfortable.
The new vet, although having more knowledge of medication, still didn't seem up to speed on IVDD. She was concerned he wasnt improving fast enough and he should have healed in 2 weeks. I asked her to leave him on the same medication and see how he is in 2 weeks time.
I was concerned because she said that soft tissue injuries should heal on their own in a couple of weeks, but i have researched IVDD a lot over the last couple of weeks and from what I can see it is much more long term. There are no other vets in my area. I don't want to appear as though I am telling the vet what to do but want to make sure she understands Harveys condition when I go back in two weeks. I think part of the problem is that she didn't see him at his worst so can't see the improvement.
I would be grateful for any advice.
Many thanks.
Claire
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on May 9, 2014 4:41:03 GMT -7
Hi, Claire. Neck injuries can be much more painful than back issues and can take longer to heal. The fact that Harvey showed signs of pain after his examination indicates that his pain is still not under control. You mention that he feels "less" rigid when you pick up him, which seems to indicate that you still do feel some tenseness when he's picked up. That's also a sign of pain. Pain needs to be completely brought under control today. For his weight, he's on a low dose of Tramadol - the vet can move that up. Gabapentin works very well with Tramadol and can also be brought on board. Methocarbamol is given for the pain of muscle spasms, which is very common with neck injuries. Often, all three medications are used to get the difficult pain of neck injuries under control. Please contact your vet today and strongly advocate for more pain meds. Also, an anti-inflammatory dose of Prednisone is needed to get the swelling down. Swelling is causing the pain and is pressing on the nerves of the spine. Anything pressing on the nerves can cause nerve damage. An anti-inflammatory dose of Prednisone for a dog of Harvey's weight would be 5mg 2x/day. Harvey is only on half of that. Please also speak to your vet about that. It's most important to bring that swelling down. Please be sure to also speak to her about adding Pepcid AC to protect against the side effects of the Prednisone as Paula recommended. Since you're dealing with a cervical issue, here are some helpful tips, such as raising the food and water dishes so your dog doesn't have to bend his neck down to them, moistening hard kibble, etc. www.dodgerslist.com/literature/cervical.htmNerve damage, such as wobbly walking, can take a long time to heal. Think more in terms of months. Wobbly walking is a mild symptom so Harvey is a good candidate for conservative care. A full 8 weeks of strict crate rest, being carried in and out to do potty with very few steps at potty time, is essential to heal the disc and allow it to form scar tissue. At this point, his pain needs to be brought under control so he can heal in comfort for the remaining 8 weeks. An MRI is not necessary with conservative care and is only necessary if surgery is a consideration, which is not so in Harvey's case. Possibly the neurologist could be consulted with just to get the proper meds on board. Please let us know what the vet says after speaking to her today. Healing prayers for Harvey. |
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