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Post by Wyn & Dulcy on Jun 4, 2014 4:21:28 GMT -7
Dulcy is our 12 yr. old basset dx with slipped disc on May 30. She weighs 44 lbs, has use of her front legs, right hindleg, and appears to be comfortable on current meds. Her left hindleg is very weak and she won't stand for long on the hindlegs without support from a sling. We are senior citizens with health issues of our own and cannot lift her, so we use the sling to help her outside via the shortest distance possible. However, I fear that walking the 30 or so steps back and forth to the yard may be harming her. Many times, once we get her to the yard, she doesn't seem too interested in going potty. So, I am wondering if we would be better off expressing her bladder and bowels. Thanks you.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
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Post by Marjorie on Jun 4, 2014 4:36:48 GMT -7
Welcome to Dodgerslist, Wyn. Please let your dog know with your utmost confidence that things are going to be ok…because they will. 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. Here's the link www.dodgerslist.com/healingindex.htm100% STRICT crate rest 24/7 only out to potty for a full 8 weeks is the SINGLE most important thing you can do to help your dog-- it is the hallmark component of conservative treatment. Carried in and out to potty. 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). In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc. www.dodgerslist.com/literature/CrateRRP.htmYes, the walking is harmful and can cause the damaged disc to tear more, which could result in paralysis and will prevent it from healing. Will she go on a pee pad inside the crate or right outside the door of the crate? Caster wheels can be added to a wire crate so you can wheel her right outside down a ramp over any steps. Or leave her crate right near the exit door. If you have a deck, put some dirt there for her to go on. You have more of a challenge than those with smaller dogs but it is essential to limit her movement as much as possible. If she has bladder control (she can sniff and release urine on her own), then you shouldn't express her. Is she drinking enough water? If she has a urinary tract infection, which is common with IVDD dogs, it might be painful for her to urinate and she could be holding it. You should bring in a urine sample to your vet to have it checked to be sure. Can you give us a bit more in essential information about your dog: 1. When was the date you started doing the all important 100% STRICT crate rest 24/7? Was that May 30th? 2. What are the exact names, dose in mgs and frequency of all meds? 3. Pepcid AC should be given to protect your dog from the excess acid produced by the anti-inflammatory. Please get your vet's permission to give 5 mg of Pepcid AC (generic is famotidine) 30 minutes before the dose of the anti-inflammatory and thereafter every 12 hours). Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If your vet says your dog has no health issues such as liver, heart, etc to keep her from taking Pepcid AC, then do get it on board. 4. Can your dog sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up? 5. Eating and drinking OK? 6. Poops OK - normal color, firmness, no dark or bright red blood? Laser light therapy, acupuncture and electroacupuncture which sends a microcurrent of electricity to and from acupuncture points (which are really big nerve bundles), can be very beneficial at helping to re-establish the nerve connections in the body. Any one of these therapies can be started right away if in your budget... they not only help relieve pain and inflammation but will kick start nerves to begin regeneration. NOTE: Chiropractic is not recommended for IVDD dogs. We're here for you and Dulcy. Healing prayers.
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Post by Wyn & Dulcy on Jun 4, 2014 6:49:15 GMT -7
I will answer your questions in order given.
1. She was dx with slipped disc on May 30 and started strict crate rest on May 30.
2. A week to 10 days priort to May 30, we noted that she was experiencing pain, but she was walking, eating drinking, peeing and pooping fine and acting fairly normal. At that time the vet put her on 10mg prednisone 2 x day 50 mg tramdol 2 x per day. 75 mg of zantac. She started getting worse on the
28th and we had a rehab vet come to the house on the 30th. She was in extreme pain and wobbling on her hind legs. He put her on the following to break the pain cycle. 44 lbs 50 mg tramadol 3 x day Norco [hydrocodone bitartrate and acetaminophen] 10/350 tablet 3 x day Amantadine 100 mg 1 x day Zantac 75n mg 1 x per day He wants to eliminate the prednisone, so we are slowiy reducing it. She is currently taking 5 mg per day but will transition to 5 mg every other day starting tomorrow with an end date on June 16. He wants to eliminate the pred. so he can start other pain relievers and get her off Norco and Anamantadine.
4. We do not find wet bedding but she does not sniff and has a very hard time squatting. This is why we got the sling to help hold her up
5. She really has to be coaxed to eat. I get about 2/3 to 3/4 can of Royal Canine low fat food in her a day. She does drink, but won't bother to drink enough for her weight, so when she eats I coax her to take about 6 to 8 oz of water.
6. She had a normal stool 2 days ago, but then had some diahrea. She has not pooped in 36 hours, but we hope that she goes today. Again, it is very hard for her to squat.
Once we are sure that her pain is under control, we plan to take her to the rehab vet for laser treatment, hopefully within a week. We are very concerned about lifting her into the car. As I said, we are senior citizens and it is very hard for us to lift her, but we hope to give it a try.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on Jun 4, 2014 8:46:12 GMT -7
Wyn, first off the not eating & diarrhea are very concerning when on Pred. Zanac is an older version of the new better Pepcid AC (famotidine) So I would get on the phone today asap and ask in this particular way: Is there any reason my dog can't take famotidine. Do your home work all meds your dog is on or you will be advocating for: www.marvistavet.com/html/pharmacy_center.htmlI would also strongly adovate for a 2nd stomach protector called sucralfate to be on board. It is an Rx item. It has a timing to it with famotidine and with food that you will want to read about. Sucralfate does not prevent ulcers nor reduce stomach acids as famotidine does, it works in a different way as a healing gel bandaid at any disruption of the mucous stomach lining. There are no safe anti-inflammatories steroids such prednisone nor NSAIDS. The safety is in blood tests to check organ health. A vet who anti-inflammatories in a safe manner and owners who read to know which meds are contraindicated, what to monitor for, etc. How pain control worksIs there still currently 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? Then the pain meds are not yet right. And this would NOT be the time to be in the middle of a pred taper unless there is a serious health issue going on. There should be NO pain dose to dose of the pain meds. Your vet needs your feedback to know if further pain med adjustment is needed. Dulcy is on an unusually light, not very aggressive use of pain meds. Pain can come from muscle spasms...to methocarbamol is used. Pain can come from general pain which is what Tramadol is for. Amantadine works synergistically with Tramadol the same as gabapentin. We see most vets using gabapentin. Gabapentin can be dosed 3x a day to keep the med up in the body. You will have to discuss/advocate if Amantadine can also be given 3x a day. I would advocate to get Dulcy off of Norco today and advocate for muscle relaxer (methocarbamol), a more aggressive dose of Tramadol than 50 mgs for a 44 pound dog. Tramadol reading: vasg.org/t_drugs.htm#TRAMMethocarbamol reading: www.petplace.com/drug-library/methocarbamol-robaxin-v/page1.aspxGabapentin reading:http://vasg.org/g_drugs.htm#GABAP How the anti-inflammatory worksOften it takes being at the anti-inflammatory dose of prednisone (10mg 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.
Switching to a NSAID requires 4-7 days with no help in the body to work on spinal cord swelling. If it is deemed an emergency for some health reason to get her off of Pred, the do make sure you understand double protection (sucralfate + Pepcid AC) needs to be on board. You may find this little card to carry with you at vet visits helps to keep all the meds straight as you discuss things with the vet. D/l here: www.dodgerslist.com/literature/MedCard.pdf A larger dog surely is more of a challenge at potty time than our little dogs. How about setting up a pee pad outside the recovery suite to limit footsteps. Scrounge up some old peed on grass to sprinkle on the pee pad for inspiration. Narcotics (tramadol and Norco) can slow the digestive tube down causing constipation. Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference. To loosen the stool, add maybe 1/2 as much water at each canned meal along with a TABLESPOON of plain canned pureed pumpkin 1x a day. To firm up the stool add 1 TABLESPOON pumpkin no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato. Because conservative treatment DEMANDS limited movement of the back, I would seriously reconsider taking her on vet visits unless absolutely necessary and that includes perhaps not doing any laser treatments unless the vet comes to your house. As Sabrina recommended your own self education on IVDD is going to be one of Dulcy best assets. Knowledge is to make sure the right things are being done for best recovery. And for yourself, knowledge lets you step out of a very scary place…"the unknown" and the toll it takes on your emotions. Get ready to fight this disease with this current episode and in the future by knowing all things IVDD. So you are savvy about conservative treatment this page is a wonderful place to get a good overview of each of the phases of healing: www.dodgerslist.com/literature/healingpage.htm Hope to hear you will be able to follow all the informative links and complete your readings in the next couple of days. Please let us know her stomach is being protected today with Pepcid AC and sucralfate. That pain meds have been adjusted to be more aggressive so there is NO pain at all. And that if there is not a health reason, she can stay on pred to get all the swelling down. It is good to understand exactly what "new" pain meds your vet is wanting to move to....does it include NSAIDs, what about washouts, etc. We look forward to hearing positive news for Dulcy.
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Post by Wyn & Dulcy on Jun 5, 2014 12:01:46 GMT -7
Thank you for your reply. I have been reading the website and feel better informed.
Dulcy is resting comfortably. Dulcy's diahrea stopped and she is eating a few bites of food on her own, but we are coaxing her most of the time. We got the Pepcid AC. The vet is coming to see her today to reassess. I plan to talk with him about the meds. and get the sucralfate, if he deems it appropriate.
I am disappointed that we cannot find an accupucturist who will come to the house in our area. I have a TENS machine that I used for pain and healing after hip replacement surgery. It was helpful and I wondered if it might help Dulcy. The TENS delivers a mild electrical current to the affected area, so I could put it on her spine by the affected discs.
I will let you know what the vet says.
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Post by Wyn & Dulcy on Jun 5, 2014 14:52:30 GMT -7
The doctor just left. He saw a decline in Dulcy and put her back on 10 mg pred twice a day and is phasing out the Norco. Still using the Tramodol. She was dehydrated, so he gave her a bag of fluid. Due to her decline he does not see good hope of her regaining use of her back legs, however, wants to see how well she does in 24 hrs. Prior to reducing the pred, she has some use of her back legs. On this low dose, she just cannot stand on them. With the new meds we hope to see her appetite pick up and hope that she gains some strength.
I have to say that if there is little hope of her regaining use of her back legs, we will most likely put her down. She is 12 years old, has had a great life and would never want to spend the rest of her life lying down.
I would appreciate your opinion on any hope of recovering the use of her back legs. I know that it is impossible to say with any certainty, but have you known of dogs that decline due to a poor medical decision and then rebound with proper treatment.
Thank you so much for your help.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jun 5, 2014 16:32:57 GMT -7
Dearest Wyn, no one, not your vet, not a neuro specialist, no one of this forum, should ever tell you that there is little hope of her regaining use of her back legs. No one can say how much nerve recovery there will be or when it will occur. To say that he wants to give her another 24 hours to see if there is improvement is just ludicrous. Nerves can take months to heal, even a year or more. The high dose of the Prednisone most likely reduce the swelling enough that it wasn't pressing on the nerves so she improved. When the dose was lowered, the swelling increased so she appeared to "decline". As Paula had mentioned, due to the fact that there was still pain present, that indicated that the swelling had not gone down yet so a taper of the Prednisone should NOT have been done. Just because the vet inappropriately reduced the steroid when he shouldn't have and then saw a "decline" is no reason at all to be thinking of euthanasia. The higher dose needs to be continued for a bit longer (a week or so, not 24 hours) and then a taper could be tried again to see if there was still swelling. It's not uncommon for several tapers of a steroid to be necessary before getting to the point where there is no pain upon the taper, which means the swelling has resolved, and all meds can then be stopped. Yes, of course there is still hope of her recovering use of her legs. My Jeremy had surgery and didn't regain use of his legs for six months afterwards. But he was a happy dog, loved his cart and his life. I thought he would remain in a cart the rest of his life but in 6 months, he was walking on his own and continued to improve for more than a year after surgery. He had a second episode from which he recovered on conservative care. It isn't even a week yet for Dulcy. It can take the steroid a week to a month or more to get that swelling down. In my opinion, you should look for a vet who is more knowledgeable about IVDD. The fact that this vet tapered the steroid when there were signs of pain and then was so negative about her regaining use of her legs indicates that he is not comfortable treating IVDD. Having the right doctor and the right treatment will make all the difference to Dulcy's recovery. As far as Dulcy not wanting to spend the rest of her life lying down, there is absolutely no reason she would have to, even if she doesn't recover use of her legs (and it's far, far too soon to think that she won't). My Jeremy took to his cart the first day, ran like the wind in it, even took it right into the ocean. As long as a dog has love and good food and a home to call its own, they will be happy. They don't understand the term "handicapped". It's people who look at not being able to walk in such a negative way. Please read this link for some encouraging words - www.dodgerslist.com/index/SDUNCANquality.htm - and also these success stories - dodgerslist.com/monthstory.htm. Please, please don't consider putting your sweet girl down without giving her time to heal. Learn to live as your dog Dulcy does - in the moment - and try not to look ahead. Just enjoy each moment you have with her. Blessings to you both.
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Post by Wyn & Dulcy on Jun 5, 2014 17:43:36 GMT -7
Thank you for your reply. I really want to give Dulcy a chance! My husband does not wish to 'prolong her agony' so we have a conflict, but he will go along with me for the time being. I just know that prior to the pred taper she was able to wobbly walk on her back legs. So, if being on pred for a week heads her in that direction, then I think that my husband will get on board. I would love to get my husband to take her to an IVDD vet, so if she improves, maybe he will. She has to start eating and drinking, so hopefully the pred, prevacid and the other drug you recommended will help with that. I'll keep you posted.
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Post by Jean & Mimi on Jun 6, 2014 6:02:27 GMT -7
Wyn, my husband was very similar to yours when my Mimi had her episode of IVDD. He hated seeing her suffer and wanted to "do the right thing". I became her advocate and eventually brought him over to my side. Mimi went through several tapers and like Dulcy, lost function after one unsuccessful one (She could wobble walk on both rear legs and then after the bad taper, lost complete use of her left rear leg). I had to battle for her not only to go up to the level she was on the steriod before the taper, but I worked with my vet and advocated to get an even higher dosage, which was her turning point. She went from the leg just sticking out with obviously no sensation at all, to being more conscious of it (not weight bearing but would make sure it was sort of tucked in when she was laying down), to being able to walk on it. Is she 100% now? Nope, still has a stiff gate, and when she runs she uses her back legs together kind of like a hop, but she has NO CLUE there was ever anything wrong with her. I know how hard this is, and this whole process is a challenge, especially when you see other dogs seeming to go through the recovery smoothly. But be Dulcy's support and do not give up hope. You are only 8 days into her recovery, we had to extend Mimi's crate rest for 2 additional weeks. Just keep focusing on allowing Dulcy to heal, pain free. That is her job and your job. Give her affection in her crate, talk to her, make sure she feels you being positive. That's the best thing you can do for her.
Do not be afraid to look for another vet. My vet has 3 in the practice and there is now one I work with mainly, another I will use if she is not available and the 3rd I would prefer not to see again. The first two really get IVDD and worked with me on helping Mimi heal. The third just wanted her off steroids after three days and didn't want to work with us at all. You are the most important member of Dulcy's care team, your vet is there to work with you.
((((HUGS)))) and keep strong.
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Post by Wyn & Dulcy on Jun 6, 2014 6:35:09 GMT -7
Thank you Jean. Both of us were encourage by Dulcy's attitude and demeanor this a.m. after putting her pred back up to 20 mg per day. So, my husband is more on board for giving her at least a week. Prior to the pred reducation she could use her right hind leg, but not her left. Now both hind legs are down. She does have a lot of strength in her front legs and her pain seems to be reduced with just upping the pred for one night. Her bladder and bowel control is quite good too.
This a.m. she ate and drank on her own; something she was not doing the past 2 days. She can only sit on her own so we hand feed her but at least she is taking some food eagerly. She will not eat dog food right now, so any suggestions on people food that is good for her would be appreciated. I'm still trying to train her to use the pee pads indoors so she doesn't have to walk, so any suggestions there would be appreciated.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on Jun 6, 2014 7:39:00 GMT -7
Wyn, you are seeing the good work that prednisone does on reducing inflammation. For each dog it is a different amount of time to get all the swelling resolved -- typically 7 to 30 days. So we've got our fingers cross that this 2nd course of pred will do the trick. Did the vet say how long of course before the taper starts?
Try soaking her kibble meals in an equal part of burger broth overnight in the fridge. Sprinkle a tablespoon or two of the boiled burger on top. Right now she has alot of repair jobs to do and needs full minerals, vitamins and protein. To make broth boil up a hamburger patty. Let cool and remove the fat disc at the top. Slightly warm the soaked kibble before feeding to make it more fragrant and delicious.
Have you tried placing a small saved piece of pee pad in a ziplock bag. Place that piece on a new pee pad to give Dulcy inspiration at potty times.
Let us know if this med list is now the current one. 44 lbs 10mg 44 lbs 10mg prednisone 2 x day 50 mg tramadol 2 x per day. 10mg Pepcid AC 2x a day Amantadine 100 mg 1 x day Norco ? now stopped?
Never give up, stay focused, stay postitive and stay strong! You and Dulcy will get through this bump in the road of life.
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Post by Wyn & Dulcy on Jun 6, 2014 8:04:43 GMT -7
Thank for the suggestions. I'll try the burger and broth. I did get her to go on the pee pad with great effort, but she did it. Praised her and gave her a treat. She has a very hard time standing on her back legs so pottying is hard. She likes to lay on her side most of the time but I try to get her up for food and water.
The med list is correct except the Norco has been reduced to 1/2 pill 3 x a day to taper her off and perhaps get her on something else. I'd like to see the Tramodol upped with some muscle relaxer. Do the muscle relaxers make them lethargic? too relaxed?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on Jun 6, 2014 8:39:01 GMT -7
It is better to be slightly relaxed with a muscle relaxer if she is suffering with pain. Muscle spasms are not always observable such as an exterior twitch, etc., but all the same muscle contractions can be a very painful thing. Like when you get a crick in your neck from sleeping the wrong way...it hurts alot to move. Methocarbamol is one relaxer drug that is often used with disc episode for this kind of pain. So if you are still observing 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), a muscle relaxer is one med that could be started today while Norco is being tapered off. Let us know what you feel about Dulcy's pain level.
Good job on encouraging Dulcy to pee on the pad!
This idea on making a sling is a good one... of course it goes without saying that our IVDD dogs would never be allowed to do stairs or steps. Perhaps this sling would be easy to slip under Dulcy while she is in the prone position and then helping her to raise upward to stand???
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