|
Post by Larry & Sniddles on Dec 3, 2016 5:29:40 GMT -7
My dog Sniddles was diagnosed on Dec 1 with IVDD. He was in pain and wobbly. He had acupuncture and laser therapy on Dec 2. He has deep pain feeling. However, last night he can no longer pee or poo on his own and is no longer wobbly. He cant walk at all. A neurosurgeon is 3 hrs from me. I dont know if I should continue with conservative or if I should just go for surgery. Any help is appreciated.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
|
Post by Marjorie on Dec 3, 2016 6:14:34 GMT -7
Welcome to Dodgerslist, Larry. When neuro functions are lost to the point where leg function and bladder control are lost and surgery is financially feasible, surgery should be a consideration. The sooner the better. Hours can make a difference in the outcome. www.dodgerslist.com/literature/healingsurgery.htmAfter a dog is paralyzed, the existence of deep pain sensation is an indicator that surgery could STILL be successful. That window of time is 12-24 hours from losing deep pain sensation (DPS). Even after that window of time, surgery is often successful. The spinal cord is very fragile, the more hours after the window, the less chance of a complete recovery. Please let us know what is decided. Healing prayers for Sniddles.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
|
Post by Marjorie on Dec 3, 2016 8:20:13 GMT -7
You also need to strictly crate him to protect his spine from further damage until you see the neurologist. If you decide to go with conservative care, you'll need to get a hands-on-your-hands demonstration today on how to express his bladder manually. Here are tips on how to express for your review prior to your demonstration: www.dodgerslist.com/literature/Expressing.htmAlso if you decide to go with conservative care, he'll need an anti-inflammatory to reduce the swelling pressing on the spine (preferably a steroid), pain meds to mask the pain until the swelling is gone (Tramadol, Gabapentin and/or Methocarbamol) and a stomach protector to protect the GI tract from the side effects of the anti-inflammatory.
|
|
|
Post by Larry & Sniddles on Dec 3, 2016 10:55:30 GMT -7
He is currently on strict cage rest. He is on
weight? steroids, prilosec, tramadol, and a muscle relaxer.
I went to the vet this morning to learn how to express his bladder. We do have a pending referral to a neurosurgeon in Mandeville, La and at Auburn, Al. Neither are open, since it is the weekend. The vet said Sniddles will go to whoever can get him in first. I really don't have the money to do surgery, but will figure out anything I have to for my baby. I think we will choose surgery if at all possible because Sniddles is getting worse. The vet thinks it is the T13, but said he could be wrong.
|
|
|
Post by Romy & Frankie on Dec 3, 2016 14:41:05 GMT -7
If Sniddles is getting worse and you are considering surgery, no- or low-interest credit for veterinary costs can be obtained from Care Credit. www.carecredit.com/faqs/You find out online if you qualify. Prilosec is a good stomach protector but it can take three to five days to reach peak efficiency. You can also give Sniddles Pepcid AC until the prilosec reaches peak. How is the expressing going? Are you able to get a full stream of urine when you express?
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 3, 2016 15:32:21 GMT -7
Larry, it is important for us to know the exact details of the med list. It may be that you could advocate for your vet to do more than he is to prevent nerve damage you are seeing via medications. We wouldn't know unless you fill us in. What breed is Sniddles weight?
Any steroid injection? Date?steroids exact name. Date started ?mgs, ?xday. for X days then a taper dose? prilosec, ?mgs ?xdaytramadol ?mgs ?x/day and a muscle relaxer exact name ?mgs ?x/day
Is Sniddles pain fully in control with only two pain meds on board ( Tramadol and a muscle relaxer)? Are you on the same page as we are about STRICT rest? The hallmark component of conservative treatment is the crate rest part. With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. That 6 weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite: www.dodgerslist.com/literature/CrateRRP.htm PLUS further guidance on conservative treatment on our "All Things IVDD page: www.dodgerslist.com/literature.htmSTRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times. Carry to and from the expressing place. Good video and tips to reinforce how your vet's demonstration of expressing the bladder and expressing for poop. www.dodgerslist.com/literature/Expressing.htm and www.dodgerslist.com/literature/Expressing.htm#poop
|
|
|
Post by Larry & Sniddles on Dec 3, 2016 16:12:22 GMT -7
Sniddles is 15 pounds. Only out of the crate at the vet and for potty time. I am not good at expressing his bladder, I managed it once so far, but he was extra full. Still learning.
[15 lbs] Prednisone as of 12/1: 7.5mgs there after 5mg twice daily for 4 days, then 1 a day for 7 days, then 1/2 daily for 2 weeks. No injection, but his first dose of prednisone at the vet was 7.5mg. Tramadol 50mg 1/2 tablet every 12 hours. This was not cutting it and the vet told me I could go every 8 hours instead. This has helped a lot. Methocarbamol 500mg 1/4 tablet twice a day for 10 days. It is pepcid, 20mg: 1/4 5mgs twice a day. not prilosec, I was wrong.The vet said that he has feeling to pee and poop, but refuses because of pain. Not sure if that is true or not. I tried a sling, but he won't deal with it. He is very well potty trained and independent. I think my biggest problem is that he doesn't want to drink water. I have started mixing it into his food and home making broth for him just to get liquids in him.
Sorry, he is a dachshund!
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 3, 2016 17:32:05 GMT -7
Larry, your dachsie is on the level of an anti-inflammatory dose of pred....so that is good. This is what you want to monitor in regards to neuro function. 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 nerves to be able to self heal after surgery or with conservative treatment. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Do know most general DVMs do not have the training nor the practiced eye to correctly interpret what they see regarding DPS. Only trust the work of an ortho or neuro specialist. 9. Do know that there have been many dogs who were able to self heal nerves when there was loss of the last neuro function DPS. So if surgery is something that stretches the budget so tight that it puts a family into dire financial distress, not being able to care for their dog, one has to consider such an option. Do read over the pros and cons of surgery that Marjorie gave and make your decision based all the facts: www.dodgerslist.com/literature/healingsurgery.htmLet us know if you specifically see a happy tail wag when you either do some happy talk or he sees you about to give him a treat. Can you confirm for us if you are observing any of these signs of pain: 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. Most often it takes 3 pain meds not 2 to give full dose to dose relief. Expressing is a new skill and may take getting another hands-on-top-of-your-hands type of lesson. After several days of expressing every 2-3 hours while on pred, you will get a sense of the shape of the bladder and when it is pretty much flat/empty. www.dodgerslist.com/literature/Expressing.htm The only way for us humans to know if there is bladder control is with the sniff and pee test. Carry outdoors, set on an old pee spot to sniff it. See if urine is then released. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. If urine comes out after sniffing, bladder control still remains. Let us know what you observe.
|
|
|
Post by Larry & Sniddles on Dec 3, 2016 18:12:48 GMT -7
The sniff and pee test is too much. He sits like a statue outside and looks at me with sad eyes. I did just take him out and expressed him with success! He does shiver when I pick him up. Yesterday was the last time he wagged his tail. He does not move in his crate at all. He just lays still until I sit him up to eat or drink or use the potty. Since his Tramadol was increased, he hasn't had a tight stomach or trembling. He seems to clearly know his limitations and self crated as soon as his episode started. He is playing with his toys while laying still. A lot of squeaking.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 3, 2016 18:27:33 GMT -7
Good job Larry on the expressing. If you've gotten his bladder fully voided he will stay dry until the next expressing in 2-3 hours During the dar hours of the night the body produces less urine so you may or may not need to wake mid way of the night to express.
Sounds like pain is fully in control if he is playing with toys! Could he if he wanted to raise up on his front legs to sit on his butt? Or are the front legs suffering with neuro loss also?
|
|
|
Post by Larry & Sniddles on Dec 3, 2016 19:38:40 GMT -7
His front legs are fine. He can't sit up well on his own, so he just waits for me to do it for him. Hopefully I will get better at the expressing, I feel awful for him. The neuro appointment can't come soon enough. I will feel better if I just know what is really going on in detail.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
|
Post by Marjorie on Dec 4, 2016 5:45:42 GMT -7
I completely understand all of your concerns and fears, Larry. The unknown is simply too scary a place to stay in. While you're waiting to see the neuro, take this time to get up to speed on all things IVDD and fight the IVDD enemy. That way, you'll have the knowledge that you need when you speak to the neuro. Excellent page to start with "Overview: the essentials" and then read all you can as soon as possible. Here's the link www.dodgerslist.com/healingindex.htm
|
|
|
Post by Larry & Sniddles on Dec 6, 2016 7:19:43 GMT -7
We saw a neurosurgeon at Auburn University Small Animal Teaching Hospital. They wanted $5500 for surgery. We decided not to go that route. He has no deep pain sensation in his left leg, but he does have it in his right leg. We will be going back to our vet tomorrow to come up with a treatment plan. The vet will be adding Gabapentin and do a Glucosamine injection. We will start laser therapy, acupuncture, and tens therapy. After 8 weeks of crate rest, he will do water therapy. I feel good about the decision now that I have more facts.
|
|
|
Post by Julie & Perry on Dec 6, 2016 9:04:51 GMT -7
Happy to hear you're getting some good advice for Sniddles. It feels good to have a plan in place. Sniddles is a lucky dog to have you. Best wishes.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 6, 2016 10:55:48 GMT -7
Larry, glad you now have in your mind that 8 weeks of rest to let the disc heal is doable. Having deep pain sensation in one legs bodes well that more nerve repair is a very good possibility. Have patience with Sniddles as his body works on nerve repair, the slowest part of the body to self repair. Thinking in terms of months rather than examining every little movement daily for confirmation can make you bonkers.
As you probably already guessed, we are a group who LOVE the detail. When you have a chance do let us know the details of the change in the med list. Did the neuro detect some painful swelling still going on you were not able to observe at home and thus the reason for gabapentin? The taper of pred below the "anti-inflammatory" level was scheduled for Dec 6. The taper is a test for pain to see if another course of Pred would be needed. Can you fill us in on the details...is the taper going forward or was another 5+ day Pred course added when the pain med gabapentin was added?
|
|
|
Post by Larry & Sniddles on Dec 7, 2016 16:38:11 GMT -7
The Prednisone taper is going forward. Sniddles is now on 1 a day. The vet added Gabapentin 100mg 1 tablet twice a day for 10 days. The vet gave him an Adequan Injection as well.
[15 lbs Prednisone 7.5mgs on 12/1 as of 12/2: 5mg 2x/day for 4 days, then taper below anti-inflammatory dose. Gabapentin added 12/6: 100 mgs 1x/day Tramadol 25mgs 3x/day Methocarbamol 125 mg 2x/day Pepcid AC 5mg 2x/day]
Sniddles had laser therapy and an electric pulse acupuncture. The vet advised me to buy a tens unit for home use. He also gave me some crate exercises to do daily with Sniddles to help with atrophy. I think today is the day that I have finally figured out how to express the bladder with ease. Yay!
I meant to add that the Neuro said that his pain was still significant and that maybe Gabapentin should be added.
|
|
|
Post by Pauliana on Dec 7, 2016 23:23:30 GMT -7
Larry,
With Sniddles being in pain, that means swelling is still ongoing so the taper shouldn't continue. Speak with your vet about going back to the original dose of the Prednisone for another course to get the swelling down.. It can take some dogs 7-30 days to get the swelling down.. so it isn't unusual to have to taper more than once..
Once the swelling is gone, the pain will be gone too!
Healing thoughts and prayers!
|
|
|
Post by Larry & Sniddles on Dec 8, 2016 6:13:36 GMT -7
I wanted to ask about the tail wagging. He wags his tail when I am talking to him during trying to express his bladder. I can't tell if its a bladder thing or because of my talking.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
|
Post by Marjorie on Dec 8, 2016 7:25:50 GMT -7
The tail will sometimes move when expressing the bladder, Larry. The tail will usually move when you hit the "sweet spot" of the bladder and urine starts to flow. Try talking to him in a happy voice when you're not expressing him or see if he'll wag his tail when given a treat or someone he cares about walks into the room.
It's such early days in Sniddles' healing. IVDD is a disease of patience as it can take a very long time for nerves to heal, more like months than weeks. I do hope you'll see that happy tail wag soon. Meanwhile, try to take it one day at a time.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 8, 2016 9:54:50 GMT -7
Larry what is your understanding for the thinking behind the vet's RX to go off the med (pred) that works on painful swelling and add in another pain med? Cause we do not understand this treatment at all... unless Sniddles has some disease you did not mention or ....???? What is the reluctance to use Pred. Does the vet want to move to a lessor anti-inflammatory a NSAID to get rid of all the swelling? The single most important care outside of getting swelling resolved and pain in control is to protect the spinal cord! With the disc still in the early stages of healing, STRICT rest is the watchword. PT is reserved for when he is off of all meds and you have proof there is no more swelling. THEN at that point some very, very light least agressive range of motion and massage can be started. That is what the yellow ROM icon under "current treatment" reminds us to tell you about. Muscles will bulk up quickly after crate rest is completed and it is safe to do physical activity. Please let us know you ARE NOT doing anything strenuous, not causing the back to move. Here is a video and how you go about performing this very, very light least aggressive movement of joints and massage: The information highlighted in PINK pertains to a dog who can't walk . www.dodgerslist.com/literature/massagepassiveexercises.htm
|
|
|
Post by Larry & Sniddles on Dec 8, 2016 17:28:07 GMT -7
Oh no, he isn't doing major movement. Just toe pinches and leg massage, which I can do without even moving him. Sniddles is so much better with pain today. He has started sitting up on his own and when I got him out for potty break, he tried to drag himself out of the crate. Of course, I stopped that nonsense, but he definitely has pain under control now. The vet wanted to get the Neuro's notes before changing up the meds. I ordered a stroller because Sniddles cries when I leave the room and I thought a stroller could be used like a portable crate. Maybe even get him outside to feel the wind and sun.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 8, 2016 18:22:11 GMT -7
Larry, very good to hear pain is in control and masked with pain meds. What worries me is days of nothing working on the painful swelling during a pred taper while the notes are waiting to be accessed by your general DVM vet. Swelling, pressure on the spinal cord is something to not delay in getting it resolved. Nerves do not like pressure..they react by dying. We see that death as loss of nerve function. Many members have found a stroller to really help keep their dog calm and with them as they move around the house. Save rolling outdoors until crate rest is over as there are curbs, bumpy parts of the ground... all not good for the healing disc.. If the weather is still warm in your neck of the woods. A short easy ride to your deck to sit outside with our for a bit would be just fine. Actually it would be best to NOT do any toe pinching right now as that could well generate too much movement for the back. Do watch the video to see a safe way to stimulate the toes: www.dodgerslist.com/literature/massagepassiveexercises.htm
|
|
|
Post by Larry & Sniddles on Dec 10, 2016 8:31:04 GMT -7
I took Sniddles out this morning and he pooped on his own. I was using a sling. My question is, if he knows when he has to poop and does poop appropriately, does he also know when he has to pee and could he potentially do that on his own? I have been expressing because he shows no interest in peeing. I can tell when expressing that he is using muscles to help.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
|
Post by PaulaM on Dec 10, 2016 10:31:50 GMT -7
Larry, poop will come out all on its own. With control a dog can wait til in the appropriate place to release rather than poop just plopping out. My dog doesn't have poop control. He apparently feel it moving towards the exit and he get agitated. That's when I know I've waited too long to express for poop... I scoop him up and off we go to the toilet so it can plop there.
Bladder/ bowel control usually come back fairly close in time. If Sniddles has control to keep poop in til outdoors on a consistent basis so that you are not finding any poops in his suite, then perhaps he does now have bowel control. Keep trying the sniff and pee test, perhaps bladder control will be the next to self repair. With the sniff and pee test to make sure the sling is not pressing on the bladder.
|
|
|
Post by Larry & Sniddles on Dec 10, 2016 12:39:46 GMT -7
He has poop control. I have found that if I express his bladder and start the process and then quit squeezing after he starts peeing, he continues to pee on his own and empties his bladder. Does this mean he can pee on his own? Or is just getting started impossible?
|
|
|
Post by Larry & Sniddles on Dec 10, 2016 13:05:50 GMT -7
He refuses to try the sniff and pee test. If I am standing next to him, using a sling, he will not move to even try. If I sit him down and move away, he will not try because his legs don't work.
|
|
|
Post by Romy & Frankie on Dec 10, 2016 14:00:37 GMT -7
If Sniddles cannot sniff and pee he does not have bladder control yet. The fact that you are feeling his muscles working when expressing is a good sign that he is moving towards bladder control. Keep trying sniff and pee regularly.
As Paula mentioned, bowel and bladder control usually return close together. However, this is not always the case. My Frankie did not regain bowel control until months after bladder control returned.
|
|
|
Post by Larry & Sniddles on Dec 10, 2016 16:54:55 GMT -7
He is feeling something. He told me he needed to go out. He did try to squat and pee, but couldn't get it started. I started to express his bladder to get it started and then he finished on his own. Then he pooped on his own. This is a great day!
|
|
|
Post by Pauliana on Dec 10, 2016 21:57:35 GMT -7
Larry, that is wonderful news! Keep on doing a quick express check after he pees to make sure he is empty until you are sure he is doing that on his own.. Getting bladder and bowel control back is a great sign of more neuro healing to come!
|
|
|
Post by Larry & Sniddles on Dec 11, 2016 12:13:05 GMT -7
Sniddles has peed on his own! I have been starting for him and checking at the end, but this time he started all by himself! I have cut his ▼tramadol back to twice a day and ▼gabapentin once a day. I am seeing no pain, so far so good. I got a stroller and he seems much happier.
|
|