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Post by marthagraham on Apr 30, 2013 9:11:23 GMT -7
![]() --What is your dog's name? Martha Graham --What breed is your dog and did you specifically get a diagnosis of IVDD? He is a mini dachshund and no, we have not gotten a specific diagnosis. The vet is a little stumped. Graham is showing clear pain in his neck but is showing no other signs of IVDD. He is walking with all his faculties, wagging his tail, eating routinely, bathroom breaking okay. -- What was the date you saw the vet and started 100% STRICT crate rest 24/7? About 2.5 months ago. He has been on about 70% crate rest. -- Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy? Yes, he will yelp (sometimes) when picked up or put down. Or when he moves his neck left or right unexpectedly, he cries for 20, 30 seconds at a time. He is currently in a neck brace to limit his movements. -- What are the exact names of meds currently given, their doses in mgs and frequencies? Every 8 hours we are on the max dosage of: Gabapentin .05 ML (100MG), Pred (5MG), Tramadol (25 MG), and Methocarbamal (1/4th of 500 MG). Also we are coating the stomach with the Pecid protectant. -- Currently can your dog wobbly walk? move the legs at all? or wag the tail when you do some happy talk? He is waddling, not much different than normal but slower than normal. His tail wags profusely. -- Do you find wet bedding or leaks on you when lifted up? No. -- Eating and drinking OK? Yes. -- Poops OK - normal color no dark or bright red blood? Normal. Graham is 5 years old, 12 lbs dachshund. We have been on the pain medicine now for about two and a half months. I am hesitant to say he is "progressing" because we've had a few days where I'm in complete tears certain that he is not... then we have "good" days where he is not crying from pain at all. Some days every movement he makes seems to hurt him. Even IN his crate, he has bad days.
The vet has said the next step is MRI and surgery. She admitted that it's odd it's not an emergency situation.All the hospitals I called were a little perplexed too. Does anyone else have a case of routine pain without any of the other IVDD symptoms or is that symptom alone good enough for an IVDD diagnosis?
Thank you so much for reading, dodgerlist. This can be heart breaking and confusing. What a ride.
is it possible that maybe it's not IVDD but a pinched nerve in his neck or something? That would still need surgery I imagine? I'm just at a loss.
and also watching carefully for all the other symptoms that accompany this disease. I don't want to make him sound normal aside from a pinched neck - he is walking slower, protecting himself, hanging out far away from company (when he is out of his crate) and has some break-through pain (some days exhibits none).
Thanks for this forum!
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Post by Pauliana on Apr 30, 2013 9:47:53 GMT -7
Welcome to Dodgerslist Martha! Thank you for answering all our questions. Please read this link on Cervical IVDD and follow the tips to make Graham more comfortable in dealing with neck pain. www.dodgerslist.com/literature/cervical.htm Crate rest for 8 weeks, only out to potty, is very important to Graham's recovery to prevent worsening of his condition. He may be able to move around now but that can change in a heartbeat if he should move the wrong way, his problem disc or discs in his neck could herniate and bulge into his spine.. This needs to be prevented at all costs. The other consideration is his pain is not under control and his meds need to be adjusted until he pain free dose to dose. Once the pain is under control only then can he begin to heal. It looks like he is on all the medications used to treat IVDD pain.. In cases when pain can't be controlled then it is time for a MRI and surgery.. Please see the video on how a disc damages the spinal cord..and also see the video on how to lift and carry on this page. Lots of info here. www.dodgerslist.com/literature.htm |
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Post by marthagraham on Apr 30, 2013 10:04:28 GMT -7
Thanks for your answer! I will make sure he stays in the crate 100% of the time.
I read in other place on the site that 50MG of Tramadol can be given every 8 hours. Is that correct? Maybe this will stop the break-thru pain?
Thank you so much.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 30, 2013 10:19:30 GMT -7
Martha, often with a neck disc the only signs are of pain (shivers, yelps, holds head in unusual position, won't put weight on front leg(s). When care is not taken to preserve the spinal cord with 100% STRICT crate rest 24/7 only out at potty times for 8 weeks, then nerve damage can progress to severe loss of neuro functions in legs, etc. Graham has been done a great disservice with the neck brace it is not substitute for the requirement of 100% STRICT rest 24/7 inside a recovery suite. There may be a chance at getting the disc healed if you commit now to STRICT rest asap, starting today. I have set your subject line to show true conservative treatment is starting today. Can you be specific in the dose of the meds in mg and how often you give them. Has there then a recent reduction of Prednisone, a taper. Please give us the complete details of when pred started, if there have been attempts to taper and what the current dose in mg and frequency you give it is now. Did your vet take xrays initially not for the purpose of proving a disc episode but to rule out other maladies that mimic a disc problem (tumors, fracture, etc.? Surgery would be a consideration possibly at this point, because the disc has not been allowed to ever heal or that something else is going on to mimic a cervical disc problem that a board certified neuro (ACVIM) may be able to diagnose and get the correct treatment started. Also it may be a possibility that if you can commit to 100% STRICT rest, and this is a disc episode the disc may be able to heal... there are no meds to heal a disc. The meds are for a different purpose. This information can explain better than I could ever do in a post.... I highly recommend to read it so you can quickly get up to speed on disc disease. www.dodgerslist.com/literature/healingpage.htmI know how heartbreaking it is... we are here to support you whether your decision is surgery or conservative treatment. Let us know if you decide to get a 2nd opinion from a board certified neuro lots of info here: www.dodgerslist.com/literature/healingsurgery.htm But most importantly, until you get a firm diagnosis of a disc episode you err on the side of caution to protect the spinal cord with STRICT rest... meaning no laps, no couch, no sleeping in bed with you, no sniff fests during potty times. No baths, no chiro (aka VOM). In other words do everything you can to limit the vertebrae in the neck and back from moving and putting pressure on the bad disc. The crate is the only surface that is firm, supportive for the spine, not inclining, always horizontal and keeps a dog from darting off at a TV doorbell and safe from other pets and kids from bothering them. The rest of the details of doing crate rest to ensure the best recovery in this excellent document: www.dodgerslist.com/literature/CrateRRP.htm |
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Post by marthagraham on Apr 30, 2013 10:49:10 GMT -7
Thank you for your quick response.
We have had a disc episode with Graham before (affecting his back legs - not totally paralyzed but he started buckling) and conservative treatment helped us the last time around. This was about 2 years ago. I didn't take the 100% crate rest approach with him before now because the injury felt totally different than what we went through the last time around. I see now that was an ignorant decision. I did ask the vet if I should crate rest, but more on that conversation later.
X-rays were taken but we couldn't tell much by it. That means that there were no fractures or tumors, etc.
As far as medication goes: Every 8 hours we are on: compounded Gabapentin .05 ML (100MG), Pred (5MG), Tramadol (25 MG, i'm cutting 50 MG's in 1/2), and Methocarbamal (1/4th of 500 MG) and 1/2 a Pepcid 2 a day.
Should I ask my vet if we can up the Tramadol to 50G every 8 hours? When I mentioned this before she said, "We're really on the maximum w/ the Tramadol" -- so i didn't push it. But I think I could re-bring this up since he is having breakthru pain about every other day give or take. We are not having "good" days consistently in one direction nor are we having "bad" days consistently in one direction. She has said that the next step is surgery or putting him to sleep. That latter stuff is crazy talk and not an option for me, assuming I find funding for this surgery (which I will).
We began Prednisone on March 20th. He has been on it and weaned off of it and still exhibited pain, twice. We are on our third round. I am thankful because I am mistaken on the previous amount of time I mentioned that has passed, we have only been dealing with this for a little over a month. Hopefully that helps with a better picture of this. I will admit I didn't expect such a detailed response. Thank you. Feels like longer!
Graham was put in a neck brace because I told the vet that even in his crate he is reacting to every sound. Knocking, doorbell, me scooting back my desk chair. He hears a noise and he sits up alert (instinctively) and the poor guy goes into a yelping fit for 20 seconds. I live in a loft and keep him close by to me in his crate. He's 3 arms length away from me right now. So, the vet offered to brace him. Tomorrow he has been in his brace for a week, and the vet says she feels comfortable keeping him in it another week, and then off it goes to see where we're at. It does provide him with stability. I asked if he needed 100% crate rest and she said he would probably be okay without it so long as i'm making certain he is not jumping off furniture. 4 feet on the ground at all times, she said. I told her that I was crating him anyway about 70% of the time. Today obviously, I will stick with the 100% for 8 weeks+ the neck brace for another week, assuming there's not a case that I don't know yet to remove the brace. It does seem to be helping him.
Thank you so much for your interest. I am calling around to Vet Hospitals to get price quotes, and asking the questions that you've provided me with. On average here in Los Angeles it is aout 4,000-6,000 dollars. As I understand it, the MRI happens and the surgery immediately follows suit. It seems that you do not commit to the MRI without committing to the surgery. I will keep preparing for surgery and see what 100% rest gets us. Thank you.
PS to be clear - he is no longer jerking his head in his crate and yelping. After the brace, and w/ the addition of Gabapentin (which was added to the routine just a week ago as well), his yelps are few and far between. this also depends on the day. Yesterday he did not yelp in pain at all. This morning, when he walked from his crate to his puppy pad, he let out yelp for about 20 seconds. But afterwards (and before he was just put in his crate for 100% rest), he was walking around fine without yelping. Oy.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 30, 2013 11:12:41 GMT -7
Martha, could you give us a few more details about his meds. As you will see we are a group who LOVE details. LOL Graham does need to be pain free in order to heal. So any yelps are not good, are they nearing the next dose of pain meds (tramadol, methocarbamol, gabapentin)? Possibly now that you are committed to true conservative treatment and are implementing all the ideas Pauliana gave you in the link to cervical he may be able to get his pain under control. www.dodgerslist.com/literature/cervical.htm As that article states Tramadol has a very short half life...do discuss that with your vet. How many mgs are you giving currently for each of his meds and also how often are you to give them. |
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Post by marthagraham on Apr 30, 2013 11:34:27 GMT -7
No problem! thanks for caring about the details.
Lets call Graham 13 pounds to be safe.
Gabapentin 100MG- .05 ML/ every 8 hours
Pred 5MG - 5mg/every 8 hours . began on March 20th. 2 tapers. We are on our third round.
Tramadol 50mg - 25 MG/ every 8 hours
Methocarbamal 500mg - 125mg/ every 8 hours
Pepcid- 5mg/2x daily
So I can call my vet and ask her if it's okay to up The Tramadol to 50 MG every 8 hours?
And yes, the yelps tend to come about 6-7 hours after the dose of medication, so when that happens I give him the next dose early. . .but never TOO early (maybe an hour max, usually a half hour early), and never more than 3x a day.
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Post by Pauliana on Apr 30, 2013 11:55:55 GMT -7
Call the Vet and ask if you can up the Tramadol dose for the break through pain.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 30, 2013 12:35:05 GMT -7
just to clarify Martha, you HAVE been giving Tramadol every 8 hours or you are wanting to give it every 8 hours. How often are you actually giving tramadol? Are you very certain that you are giving 5mg of Predisone every 8 hours for a total of 15mg currently every day? Did your vet actually prescribe Prednisone every 8 hours? Dr. Isaacs explains that not every dog deals with pain the same way…. while giving Gabapentin at the same time as Tramadol makes each med work better, some dogs may respond if the meds are staggered. You are giving all the meds every 8 hours from what I gather. Discuss staggering, maybe the methocarbamol with your vet. It takes communication with your vet to find the exact right combo of dose in mg, the frequency and the staggering of meds to get it just right for Graham. Tramadol can also be given every 6 hours so that is something to discuss… being aggressive in pain management now that you are doing true conservative treatment in the effort to avoid surgery if possible. One criteria for consideration of surgery is that pain can't be brought under control when you have been doing 100% STRICT rest. Readings: www.dodgerslist.com/neurocorner2/timingmeds.htm [Dr. Isaacs on med timing] vasg.org/t_drugs.htm [Veterinary Anesthesia & Analgesia Support Group] |
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Post by marthagraham on Apr 30, 2013 14:28:43 GMT -7
Hey everyone -- The Vet Tech just let me know that the proper dosage for Tramodol is 4 MG per KG and that Graham is pushing the maximum at 25 MGs every 8 hours.
They bawked at my suggestion to give the dog 50 MG 3x a day. Said no way. What now ya think?
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Post by marthagraham on Apr 30, 2013 14:31:16 GMT -7
Sorry Paula. I misspoke. I have only been giving the Pred ONCE a day.
and yes i am giving half a Tramadol (50 MG is the pill so when i 1/2 it, it's 25MGs) every 8 hours.
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Post by natureluva on Apr 30, 2013 14:55:01 GMT -7
Hi Martha, just a suggestion - you could ask your vet if you could give 25 mg of Tramadol every 6 hours instead of every 8 hours. ~Lisa
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Post by marthagraham on Apr 30, 2013 15:14:28 GMT -7
Paula (andNatreluva) - Good idea. I will ask if we can stagger the meds and if we can do the Tramadol every 6 hours instead. Have you all had experience giving it every 6 hours at 25MG?
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Post by marthagraham on May 2, 2013 22:32:20 GMT -7
Hello All - I go back to the vet tmw morning to pick up more meds. Yesterday was a very good day with no yelps and breakthru pains. Today would have been good too except for he screamed when I was gently placing him down after his potty break to go back into the crate. He cried for a good 10 minutes in his crate, and for the next half hour whenever he moved I would hear him scream in pain.
His brother, Gator (also mini dachshund) freaked out today for the first time ever in this process. With every yelp Graham let out Gator ran up to me shaking and scratching at me with his paws. I eventually held him close to my chest and walked around with him to sooth him. He was holding tight, very scared for his brother. The two haven't been a part a day in their lives, from the same litter and everything (they are now 5).
I secured funding today for surgery -- I feel better about the whole thing now that I know there's a fall back plan.
aside from an update, here is what made me log in today -- Graham is very lethargic. His nose is dry. I hear him snoring louder than usual. It's probably normal because of all the medicine he is on, yes? Just want to be sure. Thanks to all for your support.
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Post by natureluva on May 3, 2013 6:56:41 GMT -7
Martha, since pain cannot be controlled with medication, I suggest you please take Graham to a Board Certified neurologist or orthopedic surgeon for a surgical evaluation asap. It sounds like his disc may be herniating. If finances are an issue, consider applying for Care Credit. They offer no interest or low interest financing for veterinary costs. You can apply online and be approved the same day. Here’s the link: www.carecredit.com/faqs.html. Here are two links to help you locate a Board Certified neurosurgeon (ACVIM) or orthopedic surgeon (ACVS): www.acvim.org/websites/acvim/index.php?p=3# and www.acvs.org/AnimalOwners/DiplomateDirectory/. Please let us know how the appointment goes. Best wishes, ~Lisa |
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Post by marthagraham on May 3, 2013 7:46:28 GMT -7
Hi lisa! Why do you say a disc is herniating? Him being vocal about pain if I put him down the wrong way is not a new occurrence, nor is his pain consistently unmanageable.
I am worried about the meds making him drowsy, is this normal?
THanks for the information on funding, i do have carecredit and we are prepared to go to the hospital at a moments notice if needed. I am not under concern that this is an emergency situation, we are trying conservative crate treatment for the time being.
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Post by Pauliana on May 3, 2013 8:03:57 GMT -7
Hi Martha, Believe me, a dog screaming in pain for 10 minutes is an emergency. Even if it's not constant, it is a signal to pay attention to. Neck disc episodes are very painful. When medications aren't working for the pain from dose to dose, it is time to consult with a board certified Neurologist or Orthopedic surgeon, they won't force you to do surgery but their advise is invaluable. Here is a video that shows a disc herniating.
Yes it is normal for the meds he is on to make him drowsy.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 3, 2013 11:00:30 GMT -7
Martha, I agree it is time to get a specialist's help. Your local DVM vet is clearly not comfortable in aggressively treating the pain. Pred 5mg at 1x a day is NOT an anti-inflammatory dose. The screeming for 10 minutes could have been a further tear in the disc. Tears are quite painful. It could also be his pain meds are just not aggressive enough and his Pred is not at the anti-flammatory dose to work on getting swelling down. It is time now to get with a neuro specialist (DVM, ACVIM) as first preference as this is a neuro problem to see if conservative treatment with an aggressive pain med program and getting on an anti-inflammatory dose could possibly make conservative treatment work. One of the reasons for surgery would be that pain just can't be brought under control even when you are doing 100% STRICT crate rest 24/7 and you have instituted all the extra things with a neck disc episode outlined here: www.dodgerslist.com/literature/cervical.htmMy dog's neck disc pain could not be brought under control with a very aggressive pain med program as much as we wanted conservative treatment to work. Hours after surgery, she was able to move about with no pain, it was like night and day. The meds he is on should not be making him lethargic. He needs to have his temperature taken to make sure he does not have a fever. (normal rectal temperature is 100.5 to 102.5 degrees Fahrenheit) Please let us know about your 2nd opinion consult..... |
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Post by marthagraham on May 3, 2013 23:08:20 GMT -7
We had a very good day today with no signs of any breakthru pain. His (little) movement when he is out to pee seems to be equal to what it was before . He is crying to get out of the crate, but not in pain. It's nice to see him with energy. His tail wags a million miles per second.
yesterday he was sluggish, especially towards bedtime. Today his nose is back to being wet and he just seems irritated that he has to wear a neck brace. we go in to get the neck brace removed on Wednesday. We picked up more pain meds today from the vet as well.
We have not had more than one good day at a time. We have also not been on strict crate rest in combo w/ the meds unitl now. If tomorrow goes well I will feel more hopeful. If the weekend does not prove fruitful, we will for sure head to a neurologist early next week.
Thanks for all of your insight!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 4, 2013 8:56:37 GMT -7
Let us know if there have been any changes in meds, dose in mg & frequency from the list above. Did the vet put Graham back up on an anti-inflammatory dose of Pred?
That is good there is no break-through pain. Hopefully with aggressive pain meds and starting with 100% STRICT crate rest 24/7 Frankie can go on to recover under conservative treatment.
Do let us know how he is feeling pain-wise this morning.
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