knr
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Posts: 6 
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Post by knr on Apr 14, 2013 19:57:01 GMT -7
Hi all I'm Rob and my better half, Keri.
Our little girl (in the avitar) is Amilea. She is 5 now, 12 lbs.
Since about 2 weeks prior to 4/10 she would yelp every so often but seemed fine, running, playing walking etc... we thought maybe a tooth or something with her nose? was bothering her, it seemed sensitive.
The day of April 10 she seemed a little more aggiated, it seemed her neck was bothering her. She still walked fine, ate did all her noraml stuff. We flew home from LA that night and when I went to get her out of her Kennel, that was under the seat, she cried, and cried and hunched her back. I took her right to the emergency room.
The vet kept her overnight, took some xrays, gave some heavy duty Steroids, pain meds etc. The vet said she has IVDD and has two calcified disks in her neck. The vet said its grade one, as she only has pain, and no other symptoms. Have not seen a specialist yet. The vet said she would improve with the following regiment :
We took her home Thursday eve 4/11 with :
1/4 tab Metocarbamol - 2X day for 3 weeks
1 20mg Tramadol 1x day for 10 days
1 tab 5mg Prednisone 2x a day, then after 3 days taper to 1x day for a week
250mg Cephalexin, no infection however
From what I've read this seems to be a lower dose's than normal?
Today, 4/14 she is doing ok, a bit more lively, she even barked and kinda growled at the stairs. Then she moved on her temper pedic mattress (crate size) and cried for the first time all day. That lasted about 20 seconds then she laid down again.
She is going potty ok, but is of course not her usual self. We DO NOT pick her up as she yelped once, we let her out of her crate, to the potty pad, and back in the crate.
Today she really seemed a little better, not much though. She eats like a horse and walks fine, but is very ginger.
Monday 4/15 we start the taper to one pred a day. I am thinking if she is better by wed. or so will start laser theropy?
I am someone who is known to "over research" everything, but for some reason, I feel like after reading, googling, talking, etc. about IVDD I feel very uneducated. I hate feeling like I am throwing darts at this hence this post.
BTW this is a fantastic website, kudos to the creators and contributors!
Thoughts?
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Post by Pauliana on Apr 14, 2013 20:42:31 GMT -7
Welcome to Dodgerslist! Rob and Keri, Amilea is very fortunate to have you and Keri researching IVDD, you will make wonderful advocates. You are right to be concerned that she is being under medicated for pain. Neck disc problems are extremely painful and Tramadol should be given every 8 hours. Here is a link that explains about Cervical disc episodes and what pain medications work best. www.dodgerslist.com/literature/cervical.htm I see that she isn't being given Pepcid AC 30 minutes prior to to the Prednisone to protect her stomach. She doesn't need stomach acid problems or Ulcers on top of IVDD. It is far better to protect her in advance. Please ask your Vet if there is any medical reason why she shouldn't take Pepcid AC. Here is a link to our healing page so you can read about the phases of healing: www.dodgerslist.com/healingindex.htmVery glad she is being crated 24-7 for 8 weeks, only out to potty, you are off to a great start..Here are some more tips on crate rest: www.dodgerslist.com/literature/CrateRRP.htmIt is very overwhelming at first, so much to learn but I know you are up for the job. Tell Amilea that everything is going to be ok, because you will make sure she gets the best of care. |
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knr
New Member
Posts: 6
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Post by knr on Apr 14, 2013 21:19:47 GMT -7
Thanks for the reply, I asked the vet about pepcid and he said it was not nessecary given her dosage. Im sure pepcid can only help, but I am wondering why the vet said it was not required?
Thanks again.
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Post by howardandshawna on Apr 15, 2013 7:30:00 GMT -7
KNR,
Thank you for your prayers, we will also keep amilea , you and your better half in our daily prayers. FYI we are from the other end of the US a little town in Louisiana near the military installation of FT POLK (I'm retired military). We are the same in the fact that I do not like to be without knowledge of what's going on around me. especially when it deals with my family. I think that in the last two days, we looked (wife and I) looked for two things,
1. how do we take care of our little girl. what we need to do and what is the best route to take.
2. Reassurance that everything is going to be ok. that one is for our own piece of mind.
we go to our regular vet today for initial follow up I just hope that he has the knowledge about this to be able to treat her in the very best way.
Hope you have a wonderful day
Howard and Shawna
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Apr 15, 2013 8:21:27 GMT -7
Rob, these are the concerning things you have written yesterday and really need to be addressed today. She is still in pain! The pain meds are not yet right for her and with pain it is evident there should be NO taper yet. Pain IS yelping when picked up, walking gingerly and these are other signs of pain shivering, trembling, tight hard tummy, holding leg flamingo style not wanting to bear weight? Often it takes being at the anti-inflamamtory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going by observing for pain. Since she never had her pain under control, this is why you need to get with the vet asap this am and let them know. Rule of thumb
Swelling = pain = more time on pred needed as well as adjustment of pain meds.
Be assertive but nice in being persistent that pain be brought under control if you are seeing pain. Double check what you wrote for Tramadol. It comes in a 50mg tablet. Are you supposed to give 20mg 1x a day? Tramadol has such a short half life of 1.7 hours that given less than every 8 hours is not likely to control pain. Often with neck issues, vets have to be more aggressive in pain control. Many vets are finding very good pain control success by adding in gabapentin to the Methocarbamol/Tramadol mix. Amiliea may be a good candidate to recover with conservative treatment IF, if you are doing 100% STRICT crate rest 24/7 only out at potty times for 8 weeks. And IF you can get pain fully under control. Neck discs are more painful and can take longer to heal as the head moves when other parts of the body move. Not all vets are proactive in stomach protection. There is no need to wait til there are signs of bleeding ulcers... be proactive yourself... Ask specifically if Amilea has any medical issues to prevent her from taking 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. North Carolina U. recognizes the high incidence of GI irritation in dogs with disc problems. The reasons are that pain and body changes are stresses. Just as humans can experience ulcers when under stress, dogs can also. 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.htmlA consult with a board certified neuro (ACVIM) is never a bad idea. In particular if you feel your vet is not being aggressive in pain control or on several attempts to taper pred and yet the pain will not go away. MRIs and other advanced imaging are used to plan a surgical procedure or when meds and strict rest do not help to see what other malady may be the actual problem. You can learn a good deal more by checking out the surgery article: www.dodgerslist.com/literature/healingsurgery.htm If Amilea is doing well with conservative treatment then having a $1000+ MRI to pin point the specific disc would not change the treatment of 100% STRICT rest. Let us know pain is under control, if pred has been extended back up at the anti-inflammatory dose and that you do have Pepcid AC on board now. |
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knr
New Member
Posts: 6
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Post by knr on Apr 15, 2013 11:44:36 GMT -7
Great posts thanks!
I called the vet today and will discuss all this again with them. An MRI is more for me than anyone. I would like to know exactly what's going on, while the treatment maybe the same.
20mg tramadol once a day is right. I know that there "mini tabs", which means there specifically made for the specific pet hospital so maybe the dosage is predicated on that?
She is just sleepy today so far, ate well and then hit the pee pad.
Do you think the vet is not being aggressive enough? I know it's pure speculation but thoughts? It seems that you think 8 weeks crate rest and longer pred and pain meds are required and I agree it can't hurt, but why don't ALL vets subscribe to that?
Is there some benefit to taking the dog off the meds earlier? Or crate resting for 4 weeks? I'm of course going to be very conservative with crate rest and pain meds, just wondering if this is a one size fits all regimen.
Also, is pain regression the only way to conclude a healthy recovery?
Thanks again!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Apr 15, 2013 12:19:08 GMT -7
An MRI is not something to be lightly done. The patient’s primary defense against further disk extrusion is dependent upon adequate control over the trunk muscles – this defense is eliminated with anesthesia that an MRI requires. Knowing which exact disc is problematic makes no difference in doing 100% STRICT rest 24/7 only out for potty for 8 weeks... the treatment remains the same if the disc is in the back or in the neck...high up in the neck or low down in the neck. If you are seeing signs of pain, then yes, the pain meds are not yet being prescribed aggressively enough to control pain. Pain should be controlled in an hour with the right meds and thereafter dose to dose of the pain med. Can you tell us if you are today seeing any of these signs 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? Rob different things heal at different lengths of time and with different approaches during conservative treatment. The very best explanation has been laid out for you to understand what can initially seem confusing as to what exactly is healing. So do read this link to understand what heals with time and how much time and what heals with medications. www.dodgerslist.com/literature/healingpage.htmThe taper off of pred is required for health reasons to signal the body to again make its own steroid hormone. It just happens the taper is a perfect window for IVDD dogs to see just how swelling of the spinal cord is doing. Pain would show not all the swelling is gone, thus the need for an extension of Pred. If there is no pain on a taper, then you finish the taper and no meds at all are needed...no more pred, no more pain meds, no more Pepcid AC. |
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