Angela's Rodney 2016 surgery 5 wks —AUSTRALIA

Hello, welcome to Dodgerslist. My name is Linda. Sorry to hear Rodney had to have surgery. Sounds like he is doing very well. We have a very good article on exercises for the post op dog. www.dodgerslist.com/literature/massagepassiveexercises.htm Please check with your surgeon to make sure he doesn't have any objections to trying these. Did you have a post-op check up yet?

Angela, how is Rodney today regarding pain and wobbliness? My upmost apologies in not finding your post until today. Rodney is now on the Conservative board where we can track things better.

Any time predinisone is on board, yes, Pepcid AC should be used to suppress the extra acids Pred causes.

-- What is the date you saw the surgeon and started 100% STRICT rest 24/7 for the full 8 weeks, only out for a very, very few footsteps at potty time. 
-- What is the exact name of the anti-inflammatory injection you mentioned and what date was that given?
-- For how many days are you to give Pred at the 5mgs 2x/day doses.
-- Which are you giving Tramadol at 2x or 3x/day? Let us know you are giving Tramadol 3x/day and NOT 2x/day.
-- How much does Rodney weight and what breed is he?

When observing two or more confirming signs of pain, you need alert your own vet or the surgeon in order to get the meds properly adjusted for Rodney's needs.  There is a lot more in a vet's medicine bag that he can do to get full pain control.

Pain Signs: shivering, trembling, yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy, can’t find a comfortable position, Arched back, pinned back ears. Holding leg flamingo style not wanting to bear weight, head held high or nose to the ground. Not their normal perky interested in life selves. Never have any patience at all with pain. When meds are correctly dosed for your dog’s body, pain is covered dose to dose and when having to move such as at potty time.

Hi, Angela are you in the US? In the US, Pepcid AC can be found over the counter at any drugstore. When you ask your vet about the Pepcid ask in this particular way: " Is there a medical/health reason for my dog not take Pepcid?" If there is no reason, we follow vets who are proactive against not eating, vomit, diarrhea, bleeding ulcers by giving doxie weight dogs 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory. It is really important to protect Rodney's stomach while he is on the pred. The excess acid associated with anti-inflammatory meds can sometimes cause very serious stomach damage.

He will be drinking a lot and peeing a lot while on the pred.  He may have to go out for potty as much as every 3 hours during this period. 

Is the tramadol he is taking now keeping him pain free? If 20mg 2X a day is not keeping him pain free, then, with the vets okay, give it 3X a day. Tramadol is a short acting medication and often has to be given 3X a day.

How many days has Rodney been on the 5mg of pred 2X a day? The taper is often done at the 7 day mark. But if Rodney is still showing any signs of pain, this is not the time to taper.

By keeping Rodney in his crate at all times except for potty and vet visits you are doing the best thing for him. It is very early in the recovery process and progress can seem slow but there is much healing that can still take place. 

Healing thoughts for Rodney.

Hi I am in Australia.
Not on invoice but it was the 8th Oct for inflammatory injection. Vet said it lasts about 3 days.
Prednisone began on monday 10th Oct. I was told to give 1 morning and night and then drop to one in morning and 1/2 at night after 3 days. I have kept him on 1 morning and night. Is that ok? I have not given him valium ,again but I have 2mg which I was told to hold off. Should I give it to him as I can tell he is pain, especially when I pick him up.
I will not be able to get pepcid until tomorrow as it is the weekend. Is there any substitute?

[15.87 lbs
Inflammatory injection name, on OCT 8: 
Prednisone as of Oct 10: 5mgs 2x/day for 3 days then taper
Tramadol 20mgs 2 x/day
Valium 2mgs 1x/day

He does yelp when I pick him up but not every time.
Slow to move but does turn around on his bed.
Definitely does not want to bear weight on back legs and they tend to semi splay out, but he will straighten and can still can walk a few steps.
He is not his usual perky self.
I almost feel like I should go back to surgeon but he is not paralysed.

Thank you. I will ask for an increase in tramadol strength and pepcid ac. will report on what I am given.

If you're seeing a worsening of condition, Rodney's vet/hospital needs to be notified ASAP so they are aware of this. Minutes/hours matter so the sooner the vet/hospital knows, the better. Continue with the meds you are now giving until you speak to the vet. The vet may want to change to the stronger anti-inflammatory, Dexamethasone.

When surgery is a consideration

• If your dog can't walk OR with STRICT crate rest, neurological functions worsen and are lost (legs and bladder control)
• STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns
• If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and mix of pain relievers) yet the pain can’t be brought under control
• if a dog is experiencing similar signs of neck or back pain, or mild neurological deficits for the 3rd or 4th time, meaning it may be the same disc is involved.
www.dodgerslist.com/literature/healingsurgery.htm

As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.
1. Pain caused by the tearing disc & inflammation in the spinal cord
2. Wobbly walking, legs cross
3. Nails scuffing floor
4. Paws knuckle
5. Legs do not work (paralysis, dog is down)
6. Bladder control is lost
7. Tail wagging with joy is lost
8. Deep pain sensation, the last neuro function, a critical indicator for successful surgery.

You mentioned that Rodney had soiled his bed during the night. Was he able to urinate on his own when you've taken him out today? Are you still finding wet bedding or is he leaking when picked up?

Pain needs to be completely under control with no sign of pain from one dose to the next. The fact that Rodney yelped this morning when picked up means that the pain meds are not yet correct. You need to immediately speak to the vet about the sign of pain that you saw so they can adjust the pain meds. The Tramadol dosage can still be increased and Gabapentin can be added. Methocarbamol can be substituted for the valium.

Please let us know what the vet/hospital says after speaking with them.

Angela, you will need to find a vet who is comfortable in treating a disc episode by conservative treatment. Your local vet is telling you he is not IVDD comfortable if he is not willing to give another course of prednisone and do something aggressive with the pain meds.

-- Pain is a signal that there is still spinal cord swelling. Prednisone is an anti-inflammatory drug that works on resolving swelling. It can take anywhere from 7-30 days to do so. It is prudent to try a pred course and call for a test-for-pain taper. A vet simpley guesses how long the course should be. Usually that is 7 to 14 days. If there is pain before the taper is scheduled then, it is obviously not time to taper.  If pain would re-surface on the taper, that is another signal another course of pred, pain meds, Pepcid AC is needed and then another taper.

-- Because pred can take somewhere in the neighborhood of 7-30 days to get rid of painful spinal cord swelling, an aggressive use of pain meds is required so that an animal need not suffer.

If you are not able to seek out and hire a vet who knows IVDD, then you may have to resort to a surgery. The indicators for surgery are having tried to taper off of pred several times (several courses) and the pain will not resolve, surgery can be an option even if a dog can walk. Most surgeons, do not want to operate on a dog who can walk.They prefer to try the least invasive treatment....conservative treatment.  So far true conservative treatment has not be tried... tapering pred with pain still existing is a NO NO!

MRI, CT or myelogram are used for preping for a surgery. With conservative treatment there is not a need to know which disc as all disc received the same treatment with conservative....limieted movement of the back.

Right now it is 11:30am Monday Oct 17, (in the USA it is Sunday evening) let us know the details of your success in getting help.

Option 1 fastest help:
With nerve damage HOURS matter. The next day is too long. Rodney needs vet help today, now to get back on a steroid, to get the proper combo and dose of pain meds AND a stomach protector. Do you have an ER vet facility you can get to?

Option 2
Speak with your surgeon and explain you do not want to do surgery. You want to continue with conservative treatment. You need a consultation with him to get the right pain meds on board your local general vet is not comfortable in using. You need another course of prednisone to work on the painful swelling. If bladder control has been lost then this is an increase of neuro function diminishment. The surgeon may want to use a more powerful steroid, Dexamethasone. You will need a lesson on expressing the bladder to prevent a bladder infection.

Option 3
Find another local general vet who knows IVDD. You would hire such a vet based on the reading you are doing to quickly get up to speed in understanding how meds are used with a disc episode.
These three pages can give you a great refresher on how an anti-inflammatory drugs & pain meds work during a disc episode plus a quick review of conservative treatment:
Anti-inflammatories: www.dodgerslist.com/literature/healingsweling.htm
Pain Meds: www.dodgerslist.com/literature/healingpain.htm
Conservative review: www.dodgerslist.com/literature/healingpage.htm

If this were a child or another member of your family in these painful straights, I have no doubt you would be a squeaky but polite wheel to get proper help. Put that same strength into getting help for

Angela, if he is still able to walk a few steps and has bladder control he is a good candiate to recover under conservative treatment.

He is NOT getting conservative treatment right now. What can you do to stronlgy advocate for:
--- another course of steorid
--- proper pain meds : tramadol, valium and gabapentin to cover EACH source of pain. Rx's at the appropriate dose 3x/day so that there is no pain at all. His pain meds are wearing off too soon.
--- stomach protection: Pepcid AC (famotidine)

Angela, please copy/paste the med LIST updating to what is now prescribed with your next post.

Pain meds generally do not cover pain fully unless Rx'd for ever 8 hours (3x/day) What adjustments to the pain meds did the surgeon make?

We count the total number of days on prednisone (excluding all taper days).  As I understand you never tapered pred, so he's had 5mg 2x/day since Oct 10.  For how many more days at the 2x/day did the surgeon extend the anti-inflammatory dose?

15.87 lbs
Inflammatory injection name, on OCT 8:
Prednisone as of Oct 10: 5mgs 2x/day for 7 days now + additional  ? days  then taper           
Tramadol 30??mgs 3x/day
Valium 2?? mgs 2x/day
Pepcid AC (Famotidine) to protect stomach ?

Hi Angela,

The usual dose for a dog of Rodney's weight is 5mg every 12 hours.. Give 30 minutes prior to Prednisone and always give Prednisone with a meal for added tummy protection. 

Mylanta and Gaviscon would not be effective enough..

Here is an article that will tell you how to find a better Vet for Rodney.. He needs one that knows how to treat IVDD.. It is not time to taper if there is still pain!  Pain slows down healing!   dodgerslist.com/literature/VetchkList.htm

Here is some info on pain control:  dodgerslist.com/literature/healingpain.htm

Healing prayers!

Yes, Prednisone increased thirst and urination. While he's on Prednisone, he'll need to be taken out more often - every 3-4 hours. He may be wetting his bed just because he can't hold it any longer. Try taking him out more often.

Please do all that you can today to find a vet who is more knowledgeable about IVDD. The taper of the Prednisone that your vet has suggested is less than the anti-inflammatory level and will not be effective in resolving the swelling. Rodney may experience increased pain and possible worsening of neuro function if Prednisone is tapered at this time since there is obviously still swelling pressing on the nerves of the spine.

Continued healing prayers for Rodney and prayers for you as you search for a vet today.

Hi Angela!

What are the changes with the med list? Please correct the list below adding in the new meds or changes to the current meds..  

[15.87 lbs]
Inflammatory injection name?, on OCT 8:
Prednisone as of Oct 10: 5mgs 2x/day for 3 days
                 as of what date did you start ▼ 5mgs am and 2.5mgs pm?
Tramadol 30mgs 3x/day
Valium 2 mgs ▼1x/day
Pepcid AC (Famotidine) 5mg 2x/day? 

☐ If there is great pain or severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering. CAUTIONS:

----- Laser light therapy is contra-indicated with tumors which are detected via xray.

----- During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back can increase a disc tear and escape of disc material into the spinal cord . For an animal with very mild neuro deficits, the risk of transporting to therapy has to be carefully weighed against what benefit is to be gained.

www.ahvma.org/find-a-holistic-veterinarian/

----- Why Chiropractic is not recommended for IVDD dogs: www.dodgerslist.com/literature/chiropractic.htm

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. Find a holistic vet here:

www.ahvma.org/find-a-holistic-veterinarian/
===========

Laser Light therapy:

"Clinicians at UF's Small Animal Hospital began using the procedure routinely after results from a year-long study showed the laser's effectiveness in patients with intervertebral disc disease... The study is the first ever to compare dogs with intervertebral disc disease treated postoperatively with lasers to dogs not treated with lasers, Schubert said. He called the results "revolutionary."

veterinarypage.vetmed.ufl.edu/2011/09/19/laser-treatment-helps-dogs-with-spinal-cord-injury/ [UF 1 yr study] or tinyurl.com/78eh4ew

Info on Acupuncture and Laser light therapies:     dodgerslist.com/literature/healingacupuncture.htm

I hope Rodney is feeling better tonight!