Jaye's Dexter 7/29 Conservative-NECK

Welcome to Dodgerslist,Jaye!  First thing to know is that it IS in the cards for your Dexter to get back to enjoying life whether immediately walking during the short 8 weeks of conservative treatment it will take a disc to heal or waiting on more nerve repair - IVDD is not a death sentence. Find out why that is true: www.dodgerslist.com/index/SDUNCANquality.htm

Intervertebral Disc Disease (IVDD) is a disease a dog is born with and can involve all intervertebral discs whether in the neck or in the back. Although premature aging of the discs begins while the dog is still technically a puppy (by age one), most dogs will not show symptoms of a disc problem until they are between 3 and 7 years old.

The treatments for a disc episode are the same no matter whether it is a cervical disc or another disc lower down in the spine which is causing the problem: conservative treatment or surgery.  Due to the extremely high costs of surgery these days many dogs recover with conservative treatment.  

You are right about the pain being in control from dose to dose..  I would avoid that Vet and find another one that will work with you in helping Dexter. Only 3 doses of Tramadol is ridiculous.. That is only one days worth. That wouldn't even begin to help with a neck disc episode.   This article tells what to look for in a Vet treating your dog for IVDD.   dodgerslist.com/literature/VetchkList.htm

One reason he is still in pain is because his Dexmethazone is being tapered. Pain means the swelling is  not gone so the taper should not continue. Tapering doses do not work on swelling. He should be back on the  anti inflammatory dose twice a day until time for the next taper.  It can take from 7-30 days to get the swelling down for some dogs.   

Dexmethazone is very hard on the stomach.. I see no mention of a stomach protector such as Pepcid AC..

Stomach protection is a must: Phrase the question to your vet this very particular way: Is there a medical or health reason my dog may not take Pepcid AC (famotidine)? If there is no reason buy Pepcid AC at the grocery store. We follow vets who are proactive against not eating, vomit, diarrhea, bleeding ulcers by giving doxie-weight dogs 5mg Pepcid AC (famotidine) 30 minutes before the anti-inflammatory and thereafter every 12 hours. Source: 0.44mgs famotidine per pound twice a day www.1800petmeds.com/Famotidine-prod11171.html

What is the current dose of the Gabapentin?  You mentioned the previous dose he was on but not the current one that was added to..  Do fill us in on the missing med list information.

16lbs
Dex 0.5mg tab as of 7/24?: 0.25mgs 2x/day for 8 days, then 8/1 test-for-pain Dex taper begins
Methocarbamol 125mghs 2-3x/day  Which are you actually giving 2 or 3x/day?
Doxycycline 50 mgs am, 25mgs pm   Why was this antibiotic prescribed?
Gabapentin 100mgs 3x/day
Amantidine 1.4ml 1x/day
Fentanyl patch as of 8/3.  is this a 3-day or a 5-day patch?
Tramadol 50 mgs ?x/day

A disc problem in the neck can be more painful and may take longer to resolve because a dog moves its head with almost all actions and when any other part of the body moves. That constant movement means that healing can take longer because the neck doesn't get the rest to allow the disc uninterrupted healing.

These are additional things you can do to help with a cervical disc problem during the 8 weeks of 100% STRICT crate rest 24/7 with conservative treatment:

Make sure the medications are fully controlling pain from dose to dose with no break through in pain. Continued feedback to your vet is vitally important until the pain medications have been properly adjusted for your dog. There is no "one-size-fits-all" pain control.

Signs of pain are holding the head in an unusual position...head held high or nose to the ground, shivering/trembling, not wanting to move much or moving gingerly, yelping, tight/tense stomach muscles, holding leg up flamingo style...not wanting to bear weight on the leg.

Raise food and water bowls to head height to avoid bending down to eat and drink. [photo how to]

If you feed kibble, moisten each meal with equal parts water and kibble and allow to hydrate in the fridge overnight. Then warm slightly in microwave, just to take the chill off, before serving. This will eliminate pain from crunching kibble.

No chew treats or kongs during recovery. Chewing on those makes the head and neck move a lot and can deter healing and cause more pain.

Snuggle Safe is a commercial product that will keep warm the whole night. Wrap in a towel, piece of fleece fabric as a soft place for your dog to choose to rest the head or snuggle with. WARNING: only used with adog that still has feeling. As a dog can feel if it's too hot for them and move away from it. Snuggle Safe is available at pet shops or on-line.

Raise the crate up on a table so there is no need for your dog to to raise the head to look at you or watch the world from the crate.

The unknown is simply too scary a place to stay in. Are your ready to get up to speed on all things IVDD and fight the IVDD enemy? Excellent page to start with "Overview: the essentials" and then read all you can as soon as possible. Are you ready? Here's the link www.dodgerslist.com/healingindex.htm

Healing prayers.. 

Jane, some neuros know conservative treament and others have been trained to view a disc episode as only treated by surgery.

So it will be YOU who knows when to hire an IVDD knowledgeable vet for conservative treatment. It does not take a neuro, there are plenty of general DVM vets who know conservative treatment.

MOST clearly his pain meds are still not yet right. This is right when clearly someone who knows IVDD can presribe the right combo of meds right now.

 It would be most helpful if you can complete the med list so we have a full understanding of things. The use of a specific dates is better understood by us.

16lbs
Dex 0.5mg tab as of 7/24?: 0.25mgs 2x/day for 8 days, then 8/1 test-for-pain Dex taper begins
Methocarbamol 125mgs 2-3x/day Which are you actually giving 2 or 3x/day?
Doxycycline 50 mgs am, 25mgs pm Why was this antibiotic prescribed?
Gabapentin 100mgs 3x/day
Amantidine 1.4ml 1x/day
Fentanyl patch as of 8/3. is this a 3-day or a 5-day patch?
Tramadol 50 mgs ?x/day  How many times a day?

Here are the things I would advocate for.

--Dex is a very strong steroid well known for the stomach damage it can do. That is the reason for getting Pepcid AC on board asap today.  Advocate for prednisone at the anti-inflammatory dose.  Still you will want Pepcid AC on board with Pred.
-- Let us know you are  giving methocarbamol 3x/day NOT 2x/day
-- "Fentanyl patch In dogs, the onset time is 12-36 hours, with a 72 hour duration of effect."     www.vasg.org/chronic_pain_management.htm   If the patch is not yet at full potential, this is why  you are seeing pain AND thus the need for tramadol 3x/day
-- Advocate for a full prescription (not 3 pills worth) Tramadol 50 mgs 3x/day.  

Jaye, what is the name of the hospital? City/State? Did the lady neuro vet have the letters ACVIM in her title or only DVM?

Most often a disc episode is diagnosed by the breeds prone to IVDD such as doxies, the pain and neuro deficits. An MRI, xrays are used when there is a suspicion of another disease that might mimic a disc episode. Such as fracture from trauma, bone infection, tumor..... A vet wanting to take pictures needs to be forth coming why. Anesthesia puts the muscles to sleep which supports the spine. This leaves a dog with a disc episode more apt to further damage the disc. All discs are treated the same if this is a disc episode, so no reason to take expensive MRI to find out which disc with conservative treatment.

There is care credit. No or low interest credit. You find out on-line if you qualify. Available within the USA.
www.carecredit.com/faqs/applying/. Links to financial resources, expect they take time with applications, etc. dodgerslist.com/links.htm

Jaye, hope to hear the new more IVDD knowledgeable vet will have the at home pain meds properly adjusted for full pain control 

The information below is for your own background knowledge to monitor and advocate for Dexter--- not that you would be doing any self prescribing.

-- Steroid such as Dex or Prednisone.  It can take anywhere form 7-30  days to resolve spinal cord swelling. Often vets will try a 7 or 14 day course and then the  test-for-pain steroid taper. So far Dexter was prescribed a 7 days course and the taper revealed not all swelling had been resolved.  It may take several courses to take care of all painful swelling.

The typical especially with the more painful neck discs is to use three pain meds. All prescribed for every 8 hours as these pain meds have a short half life in the body.  Each pain med works on a different source of pain.
Methocarbamol 125mgs 3x/day for muscle contraction pain
Gabapentin 100mgs 3x/day works on nerve pain
Tramadol 50 mgs 3x/day works as the general analgesic. Tramadol is a synthetic narcotic

If pain is not in full control with above three pain meds then advocate for:
Fentanyl 3-day patch takes 12-36 hours to reach peak effectiveness. At the end of 72 hours it has worn off.  

Pain is a complicated issue. The Mar Vista vets explain the mysteries of amantadine which is NOT a pain reliever as such.  marvistavet.com/amantadine.pml 

Looking forward to an update today that Dexter is in comfort with the right combo of meds.

Jaye, I am so glad to hear that Dexter is doing better after his impatient stay at the hospital and this Vet is working with you in changing some of his medications.. How is he doing now that he has been home?  Is he staying pain free from dose to dose with the changes in his medications? 

Glad to hear how well Dexter is doing, Jaye.

I see that Dexter is now on a taper (lowering of dosage) of the Dexamethasone. This is basically a test for pain. Should any pain at all reappear, then you would need to immediately alert the vet so Dexter can be returned to the original dosage of all meds. Pain indicates that there is still swelling pressing on the nerves of the spine and still a need for all original meds for a bit longer.

You mentioned that he is "less spasmatic". Does that mean he still has some spasms? If so, you need to immediately call the vet and advocate for a return to the original dosage of all meds. It can take 7-30 days for the swelling pressing on the nerves of the spine to resolve.

As Paula mentioned, Dexamethasone is the strongest anti-inflammatory that can be prescribed. It's so very important to protect Dexter's GI system while on such a powerful anti-inflammatory. Please include the all-important stomach protector such as Pepcid AC. Phrase the question to your vet 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.

Healing prayers for Dexter.

Jaye, if it would be possible to give us some detais, we can best follow along. And should you have a question we'd be better prepared to give a meaningful comment.

Is Dexter on Pepcid AC while on tapering doses of Dex?

"less spasmatic". Does that mean he still has some painful spasms? The test-for-pain Dex taper is the time to observe for pain.  If pain, then Dex going back up to the anti-inflammatory level, in other words another dex course, maybe another 7 day course.  The taper no longer is working on painful swelling.

Dexter is on a taper (lowering of dosage) of the Dexamethasone. This is basically a test for pain. During this time we usually see the pain medications Gabapentin and Amantidine stopped since this is a test for pain.  Should any pain at all reappear, then you would need to immediately alert the vet so Dexter can be returned to the original dosage of all meds. Pain indicates that there is still swelling pressing on the nerves of the spine and still a need for all original meds for a bit longer.
If NO pain happens  while off the pain meds that means the swelling is gone, just continue the Dex taper to completion and after that no further Dex or pain meds would be necessary, just finish out the remaining crate rest days..

Dogs aren't normally kept on IVDD meds for the entire 8 weeks.  They should only be on the steroids and pain meds until the swelling is  gone.. Leaving them on the meds beyond the necessary point just exposes them to needless side effects.  

Discuss this with your Vet.   

I am glad Dexter is doing so well.. Thanks for the update. 

Jaye, is Dexter still on pain meds (Gabapentin and
Amantidine on the test for pain Dex taper? If still on pain meds, where they lowered so you can get proof if all the pain is gone?

Jaye, we are so happy to get your update and hear that Dexter is doing well post conservative treatment. Don't be a stranger, we LOVE to hear how all of our Dodgerslist family is doing even a year out. We like followup updates!

Happy and healthy holidays and the New Year!

Jaye, sorry to hear a danged abscessed tooth is getting in the way of how well  Dexter is doing.

All the people involved with a dental would have to know your concerns to be on the same page about how important keeping the back horizontal to the ground, supporting both ends when lifted. Vet techs, dental tech, and the vet.

If the antibiotic is not doing the job and if you must consider a dental.....

5 Things to know about dentals:  dodgerslist.com/2020/06/26/ivdd-precautions-anesthesia/

Ask to speak with the vet tech and vet who are going to do the work to explain how precious your dog is to you and to speak to your questions or concerns.

As long as all who will be working in association with the dental (vet tech, dental tech, vet) are well briefed and understand the need to keep the back well supported, for two people to rotate his body keeping it on one plane- no twisting, during the teeth cleaning.  
    Apparently it is common for dogs to have rather sharp, repetitive head movements to one side or the other while coming out of the effect of the anesthesia. There have been reports dogs "come to" from the anesthesia Sevofluorene much more gently and quickly with a smooth waking up-- no flailing around, etc), the dental can work.  Something to discuss with the vet.
    Infected teeth can have bacteria traveling to the heart and other places in the body causing harm so the infection does need to be dealt with in some manner.

Behind the scenes, teeth cleaning what that looks like:

I hope that Dexter will be feeling better soon. Please do keep us updated.