Julie's Nala 10/2016 Conservative + ongoing arthritis pain

Since this episode is now presenting as IVDD and her neurologic functions are declining Nala's vet wants her back on Prednisone. Vet says after 24 hours of no Rimadyl it's OK to start Prednisone. Nala had

[13 lbs
Predniosne as of 10/10:  ?mgs  ?x/day for 8 days]
Rimadyl 25mg on  Saturday and Sunday [10/9] at 1p. Already on
pepcid AC.

Do I now need to add sulcrafate also? If so what's the timing again and for how long?
And she just got off crate rest for this issue 6 weeks ago. Nala has had surgery at 3 then many episodes of crate rest. If this doesn't resolve with conservative rest what can I do? Surgery again isn't financially possible and continued crate rest isn't a life. I just don't know what to do at this point. Nala was just pulling out of the last episode and know we're right back in it again.

Am going to try 8 days on Prednisone instead of 4 as this is Nala's second episode after crate rest just 5 weeks ago. Vet approved. Would longer crate rest make any difference? Also vet mentioned trying a low dose of Prednisone to keep Nala on. Thoughts? I want her to have a life outside of crate rest.

Thanks Romy. How long will I need to add the sulcrafate for? It's hard to do with my work schedule. She just had 2 doses of Rimadyl.

I looked up sulcrafate on marvista and it looks like I can give it 2 hours after a meal. Would that be ok if giving Prednisone with the meal? Also, is it supposed to be crushed?

Jullie, crate rest is to let the disc heal, that takes 8 weeks.

Prednisone is to reduce painful swelling the disc has caused by pressing against the spinal cord.

Prednisone would not prevent the disc from pressing against the spinal cord to ward off a future disc problem.

There are some dogs where surgery is not an option, but the painful swelling just can't be resolved after all 8 weeks of crate rest have been completed. Since at the end of 8 weeks the disc itself has healed, there just remains the problem for some few dogs that the offending disc/disc pieces have not been reabsorbed enough to no longer aggravate the spinal cord. THEN the vet may be able to find the lowest dose possible of pain meds and an anti-inflammatory drug so that the dog can live a pain free life via the miracle of modern medicines.

How long the course of prednisone should be is only a guess.  Some vets try a really short course like under 5 days whlle others choose something in the range of a 7 to 14 day course.    The taper of prednisone confirms wheter the guess was correct.  The taper goes below the anti-inflammatory dose. Owners job is to monitor for any signs of surfacing pain.  At the time of the taper pain-masking pain meds are stopped or backed off so there will be a clear and fast picture about pain.  Rule of thumb: pain means there is still swelling--- all meds are back on board for another course.

Let us know which hour vet wants on the pred taper-- backing off of pain meds or the stop of them.

When you get a chance do let us know the details about the med LIST: 

13 lbs
Predniosne as of 10/10: ?mgs ?x/day for 8 days then taper
Rimadyl as of 10/8: 25mg for 2 days
pepcid AC   ?mgs  2x/day
Sucralfate  ?mgs  ?x/day

Julie, I would imagine since there is a usual 4-7 day washout to make sure Rimadyl has cleared the system and that did not happen, that Carafate should be on board at minimum for 7 days. Do ask your vet, though, just to make sure.

It can be discouraging, but the thing to do is to make a concerted effort to find all the good things that happen in a day..be like Nala treasure the moment. Thwart the minds natural inclination to go to the dark side of things. Thank goodness you have a job that allows you the finances to help Nala. Wonderful that you know how to carry on crate rest to ensure the disc gets healed.

Does Nala still get excited when she sees you come home, when she gets a treat? Then she is loving living! Are you able to carry her to and from the potty place giving lots of kisses and sweet words to her, then you are loving living with Nala despite the disease she was born with. The disease will never resolve itself. The hope is that there will not be more disc episode....some dogs have just one their entire life while others have multiples. That is the nasty part of this disease, there is no predictability. Stay strong, keep the hope.... know that we are here when you need a shoulder.

Julie, I am so sorry to hear Nala is having another disc episode.. I know how that goes.. I think Tyler has had at least 5..  He bounces back every time..He doesn't let it get him down, no matter how many times it happens.. He's been off crate rest since late September.. and to watch him no one would know he has IVDD.. We are back to our stroller walks..  We'll just the enjoy the good times while we are in the midst of them.. 

Sending comforting thoughts and prayers for more good times for you and Nala! 

Julie, pred is used for the purpose of resolving painful spinal cord inflammation. If Nala WERE to be in pain then there would not be a need to try the test-for-pain taper of pred. However since you are reporting under pain meds she is not in pain, there would be only one way to find out if there is actually pain still existing. Often vet will make a guess to try a pred taper somewhere at 7-14 days. No one wants to use these drugs when the benefit has been achieved..then there would only be the adverse side effect that might happen. So on the pred taper often the vet will ask for either a backing off of pain-masking pain meds or the stop of them. Which did your vet want.

We've got our fingers crossed on the pred taper you will not see any pain surface..meaning Pred completed its job.


"improvement" is a very general term. Wth a disc episode there are 4 phases and specific improvements for each. What specific phase are you thinking about. Here is a quick review of each of the phases and what is expected as far as healing go for each: www.dodgerslist.com/literature/healingpage.htm

Julie, Nala can no longer give you a happy tail wag if you specifically hold a yummy treat in front her her eyes or that you do some really happy talk to her? Has she been doing anything excessive to account for more pressure to the spinal cord. What about pain, is that surfacing? She is still on the original anti-inflammtory dose...taper is not beginning til Tues 10/18?

IV steroid (also known as steroid blasting/shock dosing) is used in an effort when there is a new loss neuro function and may include a several day stay. It is said that this therapy needs to be used within 8 hours of loss. With high doses of steroid, there would need to be double protection of the GI tract with sucralfate and Pepcid AC. Another option is to move to a more potent steroid, Dexamethasone (a shot at the vet and/or oral Dex pills to take at home). Dex is 10x more powerful than prednisone.

The only vet you can depend on to give an accurate reading of what he observed regarding deep pain sensation is a board certified specialst (ortho ACVS or neuro ACVIM) General vets including ER vets often incorrectly read the existance of deep pain sensation.

Julie, when there has been a loss of neuro function, time definitely matters. The more time the swelling/ruptured disc material presses on the nerves, the more chance there is that the nerve damage will become permanent. The vet or ER hospital needs to be made immediately aware of loss of neuro function.

Please let us know what the vet says after speaking to them. Prayers for both you and Nala.

What reason did the ER vet say he would not give Dexamethasone?. There is no need of washouts when switching within the steroid class? Let us know hwa your vet says, of course.

Did the ER vet concur there was loss of happy tail wag? Did he attempt to identify if there was still deep pain sensation with the toes pinch test even though we do not trust any but a specialist on this difficult to identify correctly neuro function?

Julie, I hope your own vet be able to tell you the thinking behind any of his treatments or not choosing a treatment. Do ask those kinds of questions. Your knowledge is very important. When my vet sees me coming, he knows I will have lots of questions. He is an exceptional vet who takes the time to explain things. The more I know the better I can help my Clark.

Yes, indeed, deep pain sensation can come back if the spinal cord has not been too severely damaged. Unfortunately only a specialist can be trusted to correctly identify if deep pain sensation has been lost. IF lost is it a matter of time to see if it can come back.

If you are seeing a happy tail wag that is quite good news that deep pain sensation still exists. We'll be waiting for an update after the vet visit and what your vet thinks.

Which did your vet think a new, different disc problem on 10/10 or on 1016? It is also possible that the same early healing disc due to compensation was receiving too much stress/pressure with the few footsteps she had been taking and it relapsed. There is no way to know for sure whether a new disc or same disc without a very expensive MRI which is usually reserved for prepping for surgery.

Look in the phone book for a holistic vet, they are the ones who offer things like acupuncture and laser light therapy (cold laser).

So then, there was no change in the taper, to continue to start it on 10/19  and the vet did not thinks Nala currently was in any pain--- thus no adjustment to tramadol?

Which does your vet what on the start of the test-for-pain prednisone taper?
--- backing off of all pain meds (gabapentin, tramadol and methocarbamol)
--- or the stop of the pain meds at the start of the pred taper

Thats a good price, we were first charged $40 a visit then we shopped around to other vets and got it in a package price for $29 per visit...  It worked  for our guy,  make sure your wearing protective eyewear for your dog and your self during the sessions...  We went for 21 sessions.... he enjoyed it , so we kept going....  good luck

We did 10 weeks crate rest, Marley was a great crate dog so it made it easy with him, then we also extended his therapy a extra 2 weeks took it slow and easy . In my mind 8 weeks or 10 weeks is a blip in the dogs life, since he was 7 yrs old at the time....

I think you have covered the important questions.  When my Frankie was having his disk episode, during crate rest, he had about 8 sessions of laser therapy.  I think it helped him.

Hi Julie!

Laser light therapy really helped Tyler.  He was a bit nervous about it the first time but it really helped him heal faster than the episodes he had without having Laser therapy..  It also made him very relaxed afterwards, he would sleep for quite a while after we got him home.  He had two treatments a week for 3 weeks.  We were lucky because our local Vet is a 5 minute drive away and she offers Laser..

Healing prayers for dear Nala!  Comforting thoughts for you too!