Sharon's Dusty 6/16 Conservative NECK Australian Shepherd

Welcome, I am so glad you found us at Dodgerslist but so sorry to hear what has happened! Your dog seems to have been through a lot during the past days but please know it is possible for him to recover and get back to enjoying life. Do not give up hope - we see dogs recover from many different stages of IVDD. What you need to do now is to educate yourself on this disease, for example chiropractic treatment is NOT recommended on IVDD patients, whereas acupuncture and laser therapy are recommended. Light physiotherapy, such as the very lightest massage is recommended for paralyzed dogs but only according to specific instructions and ONLY when off all medications and there is no more signs of pain. It seems your vet is not knowledgeable about this nor the absolutely essential crate rest. But do not worry, you will learn all this and we will help you walk through everything, step-by-step so that you can ask the right questions from your vet, and even if you need to find another vet, this site can help you (we can come back to this if needed).

Now, let's start with the essentials. Please answer these questions so that we can help you more:

► Your dog's name? Your name, too.
► What were the dates you saw the vet(s)?
► Did you specifically get a diagnosis of IVDD (aka "a disc problem", "a disc herniation", "a bulging / slipped disc"?)
► What was the date you started the all important 100% STRICT crate rest for this current disc episode? This is a must, meaning 24/7 rest in a crate, only out to potty, absolutely 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 your dog currently in pain? Any 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. For Prednisone + steroid shot (name of it?), what were the start doses, planned date of taper? Have you included 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 to take Pepcid?" If there is no reason, proactive in stomach protection is ensured by giving Pepcid (generic name 'famotidine') 30 minutes before the anti-inflammatory. The correct dose will be based on your dogs weight.
► When was the last date your dog wobbly walked? Does he now move his legs at all? Wag the tail when you do some happy talk? As mentioned, with paralysis, the very, very lightest least aggressive range of motion and leg massage is necessary during conservative treatment but only 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 still 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, we strongly recommend it. And, as mentioned, note that chiropractic treatment is NOT recommended for IVDD dogs.

Once you have answered to these questions and sent your reply to us, be sure to go to our main web page and start educating yourself by first reading: "Overview: the essentials" - and from thereon, read all this site has to offer as soon as possible. Here's the link: www.dodgerslist.com/healingindex.htm

We also suggest you to order a comprehensive $3 DVD on IVDD www.dodgerslist.com/store/DVDorder.htm . It is a simple way for friends, family and those who will be caring for your dog to get an understanding of the situation. Also, tape this flyer to your fridge so that everyone will know what constitutes an emergency: www.dodgerslist.com/literature/FridgeInfo81907.pdf

Looking forward to your answers.

Love, Lola

Thank you so much for your response. I was losing hope until I found your sight.  My name is Sharon Scriven and my dogs name is Dusty.  He is an Australian Shepherd-American Eskimo mix.  Around mid May we noticed that he was tender when you barely touched his nose other than that he was totally normal. Then a few days later he yelped when he looked up from a laying position and a few days later started the wobbly walking. So took him to his first vet visit which was on May 24.  He was examined and diagnosis was severe neck pain and very tense muscles on both sides of neck and reduced range of motion to his head and neck.  The following medicines were prescibed  (he weighed
63 pds)
Methocarbanol 500mg, take 1 every 12 hours. 
Metacam 100ml oral  1.5mg/ml every 24 hrs. [as of 5/24] for 10 days. 
Tramadol 50mg. 1-2 every 8 to 12 hours as needed for pain.

Home care instructions were restrict exercise with no running or jumping for 14 days.   Two days later he seemed to be doing a lot better and was walking normally and took off running before I could stop him.  Next day noticed he was somewhat wobbly again.  Would get up to go out to potty or move to one part of the house to another. Each day from that point he got more and more wobbly and when try to get up front left paw would knuckle and he would go down or take a few steps then go down. Then to not getting up at all. 

Took back to vets on June 4 and they diagnosed: decreased pain perception in his left front and left rear legs.  Bloodwork was done and no significant abnormalities.  Xray of spine showed no significant abnormalities. and are treating for herniated disk and Dusty needs to lose 15-20 pounds. He then received his first acupuncture, laser therapy treatment and Myofascial massage to treat neck and spine areas.

63 pds
He was  given an injection of Dexamethasone s/p 4mg/ml per ml and another
injection of Famotidine 10mg/ml per ml.    
Amoxicillin 500mg every 12 hours for 14 days. This was prescribed because at the time of visit his temp was 103. ( No fever since then)
prednisone tablets 20mg to be taken 1 1/2 tablets morning and night for 14 days then 1tablet morning and night for 7 days then 1/2 tablet morning and night for 7 days then 1/2 tablet every other day for 7 days.
Tramadol as needed for pain.
40mg Pepcid a day

At home I was instructed to do physical therapy exercises of encourage him to stand and walk with assistance 4-5 times daily.  For home he was also prescribed
Synacore to sprinkle on his food once a day and
   

Two days later he walked unassisted for about 100 ft.  Had 2nd acupunture,laser, therapy appointment.  Next day walked about 20 feet on his own next day about 8 feet by evening made a couple of attempts to stand and couldn't.On June 9th had 3rd accupuncture and laser therapy treatments and massage on his neck by vet.  That night he seemed to be in pain and crying when I would try to get him up to walk.  For rest of day I decided to let him have full rest so this would be in the afternoon on June 9th. For the next 3 days I noticed some improvement each day  1st day was movement of his back left leg, 2nd day was movement plus he was getting up on his hind haunches he and lifting his rear a little.  The 3rd day same as day before plus hews showing feeling when pinching his back left paw and moving his leg. The next day June 13th had his 4th accupuncture and laser therapies. Vet got good reaction in feeling pain on his back left leg and then she did chiopractic on his neck and he yelped she repeated it and he yelped again.  The next day he was back to no leg movement and no pain feeling. Not much improvement since then.  He doesn't seem to be in pain normally but did notice him in pain after trying to get him to get up and turning over. He wants to stay on his left side and if I roll him over to other side he stiffens up and lays like a dead dog for awhile.  He eats and drinks good.  He controls his bowels well, we have to carry him out on a bed to his spot outside that he uses for that purpose and he will go within a few minutes.  For wetting he seems for the most time to be aware that he is going to as he gets squirmy. I keep pee  pads under him for him to go on.  haven't seen the tail wag for a few days now.   Not sure what to do next the closest vet to our house is about an hour and half drive. And she is the only one in the area that I know of that does accupuncture.  He has another appointment for this tomorrow but I don't want her messing with his neck.  Not sure if it would be better to wait on another treatment and just let him rest at home with his meds.

Also I forgot to mention the pepcid I asked the vet about that and she said they usually don't do that until the dog has been on it for a long period but if I wanted to I could give him one  40mg Pepcid a day

Thanks again for your help.  In reading the articles it really upsets me that I wasn't aware of all this sooner. I feel that if he had been confined from the beginning he would be well on the road to recovery now.  I am afraid that instead while trying to care for him we have only harmed him more. I am worried that by his exercise that his disc has ruptured to that point of sending fluid into his spine.  Does that mean that it will not be able to scar and heal the same as if it hadn't ruptured?    He has been always laying on his left side. The stiffening pain that he has is when I would roll him to lay on his right side.  And now today earlier he got himself with his legs both under him and next thing I knew he had rolled himself to his right side.  He has been laying on that side now.  He has sat his head up and gotten up to resting on his elbows to drink water and I tried to get his back legs under him again so he could stretch out back on his left side but he cried out when I tried to rotate his bottom to the left so I didn't want to touch him further. And he ended up laying back on his right side again. So I gave him 2 pain pills and now he is resting.  I think he would be more comfortable if he would roll onto his other side but I don't know and I don't know what to do. This was the first time that he himself got himself on his other side. And I have been worried about him always laying on the same side before.   He is to heavy for me or my son to lift and carry.  We carry him outside by lifting him on a blanket then set him on a hard plastic crate bottom then carry him outside.    His bladder functions seem to be that for most of the time he is aware that he is going to pee and when we take him out to his spot he does pee as soon as he gets there  then he does his other business to.  He only poos when we take him out but he does pee quite often where he is laying on the pads.  Happy talk is getting a tail wag even tried again just now and got one.   I live in northern AZ in a little town called Seligman. Not much here and the closest vet that does surgery is in Phoenix about a 3 hr drive.
I would like to get the surgery for him and spoke with the vet there but the cost they said would be from 4500 to 8000 dollars.  I applied for care credit and was only given 2300.00 and have used a 1000.00 of it up already on vet so far   and don't have any other financial resources to get more. I am so grateful for the help and knowledge that you are giving me and for the support that I have someone to help me through this as my faith in the vet is in question.

Thank you so much I don't know what I would do right now without the help this group is giving me.  Thank you for your encouraging words.  And I so appreciate the advice.

I've have good hope for Dusty to be able to regenerate the damaged nerves with the information you have shared that he can still wag with happiness and can hold urine til outdoors! Now that you know better, are better informed you will be able to do better in protection of Dusty...that is a BIGGIE you should be full of encouragement. So do as we all have done, we learn from the past to be better able to do better in the now and the future.

These are the things we'd like to hear back from you today that have been accomplished.
-- Dusty's pain meds are not yet right.
Tramadol should be given at an aggressive dose to have full pain control. Are you giving 100 mgs tramadol 3x/day?
Methocarbamol. Is this med, that works on the pain from muscle spasms, still being given? It could be given more than 2x a day something you need to discuss with the vet.
Prednisone is scheduled for taper to begin on 6/18, today?  Obviously with pain still occurring all the swelling in the spinal cord has not been resolved and thus there should be no test taper to determine if there is pain.  Rule of thumb:  pain = more time on pred, pain meds and pepcid ac.  Your vet needs to know about the pain and should prescribe staying on the original pred dose for a bit longer to ensure all the pain is gone. Use of pred can be anywhere from 7-30 days...each dog is individual.  

  Let us know if this is the correct med list:
63 pds
Amoxicillin 500mg every 12 hours for 14 days. 
prednisone [as of 6/4] tablets 20mg to be taken 1 1/2 tablets morning and night for 14 days
Tramadol 50mg. 1-2 every 8 to 12 hours
40mg Pepcid a day
methocarbamol  500mg, take 1 every 12 hours.

The focus on crate rest is to allow the disc to form good strong scar tissue.  Nerve repair may or may not come during those 8 weeks. Nerves are the slowest part of the body to self repair...often we think more in terms of months rather than days/week for nerve healing. Because Dusty can do a happy wag and seems to have bladder control, it is very hopeful he will be able to self repair his nerves.

See what you can do to limit movement of Dusty's back at potty time.  Perhaps you can set up a pee pad on the floor near his crate.  Place a piece of used pee pad on the new one as inspiration for him to pee inside the house?  How often are you taking him out to pee?  Is it every 2-3 hours?  My concern: is he actually by choice peeing while lying in his crate because he has not been let out in time or does he have some nerve loss to not be able to choose to wait til you help him outdoors?   Most dogs abhor releasing body waste where they sleep if there is anyway they can avoid it.  Let us know more about that.

Hang in there and have good hope for Dusty!

 

Let us know about staying on the original dose with your 2nd opinion vet.

This vet page will give you information to discuss using an aggressive 2x a day Pepcid AC dose: www.1800petmeds.com/Famotidine-prod11171.html

We are a group who LOVE the detail. LOL The reason is, we are not there to read medication bottles, see what happens at potty time. You are our eyes the same as you are the vet's eyes so he knows what adjustments to make based on your observations. So here go my questions....

-- His pain meds are still not right, they never have been since you posted on June 16.. Did you find a new vet today to get gabapentin added in? Did you find out about methocarbamol 3x a day?

-- What about Prednisone... did it go to a taper? Obviously it should not have...what did the vet say? Did he extend the anti-inflammatory Pred dose for a bit longer time to get all the pain resolved before trying a test taper?

-- Leaking could be a sign that bladder control has been lost if you no longer see he can sniff an old pee spot and then release urine. A UTI (bladder infection) can also cause leaking. Did you bring in a urine sample today to see if antibiotics need to be on board?

-- What dose of Pepcid AC in mgs is now being given...an aggressive dose 2x aday?

We expect healing to go in a forward direction might be small baby steps but always forward.... backward steps means something is not right.

Pain is not acceptable and not anything to have patience with. In one hour when the combo of pain meds is right, pain is in control and stays that way dose to dose.

You have the list in a previous post listing the order of reduced nerve function. Your vet needs to know if truly there is no longer wagging due to happy talk and if there has been loss of bladder control.

Look forward to learning the details of today and any changes to meds.

Now is definitely not the time to start a taper of the Prednisone since you are still seeing signs of pain and worsening of neuro function. Dusty needs to stay on the original anti-inflammatory dose for a bit longer as there is still swelling that needs to be addressed. It can take 7-30 days for that swelling to resolve.

Please let us know how your discussion with the vet goes.

63 pds
Tramadol, 100mg 3x/day, 
methocarbamol 500 mg  3x/day
Prednisone 20 mgs tablets:  1 1/2 tablets 2x/day
Pepcid AC 20 mg 2x day
gabapentin 300 mg capusule 1x/day

The reason to to express the bladder is for two serious health reasons.   Can you express his bladder?  Can you express him every 2-3 hours so that his bladder does not overflow.  Overflowing means reflexes allow some urine to escape. The urine that remains in the bladder becomes a breeding ground for infection.  I think he may already have a UTI and definately needs to have a urinalysis on a urine sample.

The other problem with overflowing is it only happens when the bladder is filled to the stretch point.  All that stretching can permanently ruin bladder tone.  

See if you can express Dusty while he is in the prone position so you may not have to lift him.
www.dodgerslist.com/literature/Expressing.htm   Cathing would be a last resort if you are not able to manually express the bladder. Cathing can be done at home once you are shown how to do it.... again another issue to discuss with your new more qualified IVDD vet.

You can also express for poop while he is lying down.  

Your expectation is that with the new Rx's for meds that the pain will be in control in a matter of an hour and stay that way dose to dose. Let us know the details on the gabapentin.  If pain is not staying in control it may well be your new vet will see he still has options to get the pain meds tweaked more to be perfect for Dusty.... so don't know what in the world this vet's statement of 3 days has to do with anything.

Let us know how the new meds are working re: pain.  Got our fingers crossed they will do the trick!

Hi Sharon,

Research has shown that Gabapentin tends to work well with Tramadol by enhancing each others' inflammatory pain control effect. This suggests you could try giving them together at the same time, for example 11:30PM before Dusty goes to bed - that way you could all sleep better through the night and be sure he will not be in pain. But please keep in mind that not all dogs respond the same way to pain medications. Some respond better when staggering pain medications. Also, I'm not sure if 1 capsule every 24 hours is enough to keep the effect - please talk to your vet if you see any pain resurfacing 12 hours after giving the Gabapentin and before the next dose.

Regarding the bladder issue, there will and should be a lot of urine coming out as Prednisone makes dogs very thirsty. (Nevertheless, you need to keep constant access to water.) How often are you now expressing him? He should be expressed every 2-3 hours minimum while on Prednisone. Also, did you take in a urine sample to see if antibiotics need to be on board? A straight through flow of urine suggests he might have a UTI which needs to be treated with antibiotics straight away!!

Lola

Sharon, based on how we observe vets dosing gabapentin 3x/day plus the readings Marjorie pointed you to,  do discuss keeping the level of gabapentin more even in the system with a 3x/day dose.  

Capsules can be openend and powder divided depending on the dose your vet wants.

As an example IF.... Rx'd approx 100mg of gabapentin 3x/day then,
 Divide the 300mg capsule powder into 3 equal parts by dumping into a creased pieced of paper and with a razor blade move the powder into 3 equal piles.  Store the remainder of the powder piles in one of those 7 day pill boxes with a lid for each day.  NOTE: both tramadol and gabapentin are very bitter tasting. Make sure you do not transfer any dust from your finger to the outside of the pill treat.  I mash a piece of banana, form a ball, make an indentation.  Spoon powder dose into well and close up. If necessary drape a piece of thin deli meat around ball for further tastiness!

Let us know if you have brought in a sample of urine so your vet can rule out a UTI or get antibiotic on board. The danger of not dealing with a UTI is that it will move up into the kidneys where it then becomes a life threatening situation.

Let us know how often you are manually expressing his bladder.  Does expressing while he lying down work for you?  The every 2-3 hours schedule is a suggestion.. you will have to figure out if you need to express more frequently.  Do let us know what you have figured out.
  

Because we are not vets we do not prescribe doses. So that you have a basis of discussion the Veterinary Anesthesia & Analgesia Support Group can help: vasg.org/g_drugs.htm#GABAP

We can't assume he has bladder control nor can we assume all the urine is voided. You either need to confirm he does have bladder control by seeing with your own eyes that he can still sniff an old pee spot and then make the choice to release urine. If you can't confirm he has bladder control, then what you are seeing is release of urine due to reflexes. This is called overflowing and it is a dangerous thing. Reflexes do not release all the urine and UTIs develop rapidly in a matter of a days. I'm very suspicious he already has a UTI.

Yes, there is a wide range of dosing mgs per pound with gabapentin
e) Dosage Information
i) Dogs
(1) 2.0 to 40 mg/kg (1.0 to 20.0 mg/lb) BID to TID PO

The math for 1.0 to 20.0 mgs of gabapentin per pound would go like this:

63 pounds x 1.0mg = 63mgs BID (2x/day) to TID (3x/day) at the low end of the range
63 pounds x 20 mgs = 1260 mgs BID or TID at the upper end of the range.

I have noticed that many vets seem to be using a dose on the lower end of the range. So you will have to discuss with your vet what is the right dose for Dusty's needs in light of the half life and the unusual bioavailablity of this med that Marjorie pointed you to.

Sharon, hugs and kudos to you for getting gabapentin on board. You did a good job advocating for Dusty's needs. So the vet also believes a UTI may already be in progress with the amoxicilin?

Dusty needs time for his disc to finish healing...he needs to complete the rest of the 8 weeks. Nerve healing can well bring back function. How long will that take is not something anyone will be able to tell you . All we know is that nerves do repair themselves if not fully damaged in a predictable order. Functions come back in the reverse order of the damage to the spinal cord:

1. Deep Pain Sensation (Only correctly identified by a specialist.)
2. Tail wagging with joy at seeing you or getting a treat or meal.
3. Bladder and bowel control verified with the "sniff and pee" test.
4. Leg Movement, and then ability to move up into a standing position, and then wobbly walking.
5. Being able to walk with more steadiness and properly place the feet.
6. Ability to walk unassisted and perhaps even run.

Now about when to give up... do we give up on someone in the hospital because things are as comfortable as being back at home? No, we nurse them, adovocate for their needs. Remember dogs do not think the same as we do about abilities. Probably foremost in their minds is good food, love and attention from their owners and a nice warm place to sleep in.

Rememeber, Dusty was done great harm and disservice by the unknowing. He needs his chance to heal, it is still early just since June 16 that the right things just began to be done for him.

So please do keep us updated on the pain situation now with gabapentin on board. There is still options to improve gabapentin...that is to give the total of the daily 600mg divided into three equal doses.

The reason for going for a consultation with a specialist is because you find your local vets not well versed in using pain meds we already know they are weak on the idea of crate rest. Or you if you are suspicious something else going on beside IVDD. Neuros have a very well practiced eye in just doing the neuro exam that many general vets do not have. The consultation would mainly be to take advantage of the huge amount of training and practice in controlling pain a boarded neuro specialist has. So if you would make an appointment you would explain upfront you will be doing conservative treatment for this IVDD episode and you want a specialist to consult with about medications. The rest of conservative treatment you are now well educated in... it is 100% STRICT crate rest 24/7 only out to be expressed.

Do tell us more about expressing how is that now going?

Hang in there with Dusty, he deserves a real chance and the time to heal. All of us are here to support you.

Even though Travis had surgery he had a great deal of nerve damage to repair: www.dodgerslist.com/monthstory/TravisVilardi.htm There are many other stories on our main web page: www.dodgerslist.com/monthstory.htm