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Post by Grace R on Sept 8, 2017 19:48:17 GMT -7
  Hi, my name is Grace and my Moose is an 8yr old 15.5lb doxie. He was diagnosed as having IVDD by an ER vet on 9/6. I came home from work (we let him have free roam of the house with steps up and down our bed but free access to the couch) and noticed he was acting funny. Kind of wimping and looking at me funny. I took him outside for a walk and his rear legs gave out and he was falling over trying to walk. I picked up immediately and noticed he kept pointing his neck up. It was one of the scariest things I have ever seen. I took him to the ER, where they triaged as him being a non-emergency. Living in Chicago, with only 2 ER vets I sat there with him for 4 hours before being seen. The ER vet said it looked like IVDD from his rare leg weakness but couldn't pinpoint a spot along his spine that was painful for him. She said the only way to know for sure is through a consult with an on call neurologist and an MRI. She said we had two options. Neuro consult, MRI, and a surgery cost of around $8,000 or try conservative therapy of crate rest and no movement except for potty for 4 weeks. She also said that we had to watch him closely because if we noticed deterioration in his condition we had to bring him in right away. They gave him a shot of methadone at the office, along with a dose of prednisone, and gabapentin. Prescriptions given by ER vet: Prednisone: 5mg tablets (1 by mouth in AM and 1/2 tab in PM for 5 days, then 1 tab in AM for 5 days, then 1/2 tab in AM for 5 days) Gabapentin: 0.7mLs every 8-12 hours I stayed up all night sitting next to his cage reading everything I could and then found this website. I decided I needed to get him a prescription for the tramadol and methocarbamol as well. I got an appointment with his primary vet the next day and got the prescriptions. It took a day to get the tramadol due to the vet with DEA license being able to call it in so that was started 2 days after his injury. It is day 3 and along with the prednisone and gabapentin he is taking: Tramadol: 50mg (1/2 tablet every 8 hrs or as needed) Methocarbamol: 500mg (1/2 tablet every hours for 14days) Pepcid AC: 10mg (1/2 tab twice a day) [Moderator's note: please do not modify
15.5 lbs
Prednisone as of 9/6: 5mgs am /2.5mgs pm for 5 days, then 9/11 test-for-pain Prednisone taper
Gabapentin 100mg/mL: 70mgs 3x/day
Tramadol 25mgs 3x/day
Methocarbamol 250mgs 3x/day
Pepcid AC 5mgs 2xday] The first 2 days he could potty but not without assistance of a scarf to hold up his rear. Today he can potty without this assistance and even though a little wobbly tries to take off running if we do not hold on to him securely. My concern is that his back is now very arched. His crate is large enough for him to stretch out if needed and to turn around. He isn't crying like he is pain when we touch him and his appetite is good, potty is normal. Is this back arching only temporary/pain related or is this something permanent. I am worried that from spasming, this put his back into some weird position. Will this work itself out after PT if he fully recovers? is it swelling? Should I put him in a back brace or is that after he has healed? My other question is can a dose of these meds be given all at the same time? I was worried about mixing tramadol, gapentin, and methocarbamol but she didn't tell me I couldn't combine any of them. So he has been on strict bed rest in his crate for 3 days now and I am seeing some improvement besides his increasingly arched back. I know that acting better does not necessarily mean hes healed. I am interested in trying acupuncture or another form of alternative therapy. When could this be started? I have an appointment for a follow up in 2 weeks to see if meds need to be changed or added. Also, should I be supporting his hind legs still even if he can somewhat use them. Any advice, support is appreciated. Again, I am so thankful to have found this site. I knew what I needed to do to help my Moose as best I could! |
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PaulaM
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Post by PaulaM on Sept 8, 2017 20:24:20 GMT -7
Grace, glad you have joined us and taken it upon your self to get up to speed on disc disease. The 100% STRICT rest 24/7 for the full 8 weeks, only out for a very, very few footsteps at potty time is how the disc is going to heal. Wth time the arch will likely go away. Confirm you do not see any signs of pain. as the there is still room for a vet to make adjustments by your callin on the phone to report your observations. Look for pain signs nearing next dose of meds indicating they are wearing off too soon. When having to move such as to reposition himself in the crate or having to move a very, very few minimal footsteps at potty time: ◻︎shivering-trembling ◻︎yelping when picked up or moved ◻︎slow to move ◻︎tight tense tummy ◻︎arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎slow or reluctant to move much in crate such as shift positions ◻︎looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves How many mgs of gabapentin are in one mL of the liquid?Which do you actually give gabapentin --- should be every 8 hours!How many time a day do you give methocarbamol?Prednisone, Prednisolone, Dexamethasone, etc are involved with stimulating gastric acid secretion causing GI upset of not eating, vomit, red or black bloody diarrhea which can quickly lead to bleeding ulcers or life threatening holes in the stomach or intestine. Phrase the question to your vet in this particular way: Is there a medical/health reason my dog may not take Pepcid AC (famotidine)? If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5mg Pepcid AC 2x/day. Give steroid with a meal for extra protection. Knowledge about each med your dog takes is the added layer of protection. Good link to bookmark and read about Pepcid AC:
www.marvistavet.com/pharmacy-center.pml
Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients. marvistavet.com/famotidine.pml D/l and print from here a sample med chart: www.dodgerslist.com/literature/crateRRP/medchart.pdf EAch pain med works on a different kind of pain. So yes, the most often is to give pain meds at the same same. These IVDD pain meds are not likely to give full round the clock pain relieve if they have not been prescribed for promptly on time every 8 hours--- NEVER as needed. Let us know Moose is not showing any pain. I encourage you to learn as much and as fast as you can in the next couple of days over at our webpage where our treasure trove of all things IVDD is housed: www.dodgerslist.com/healingindex.htm Your knowledge will be the power to fight the IVDD enemy and win! Understanding the upcoming prednisone taper is important to know your roll and how the test-for-pain Prednisone taper works: www.dodgerslist.com/literature/healingsweling.htmDid the vet say it was a neck disc? Then this page offers very important extra things you can do at home to help: www.dodgerslist.com/literature/cervical.htm |
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Post by Grace R on Sept 9, 2017 11:52:41 GMT -7
Thanks so much for your reply. The gabapentin is 100mg/mL and I am giving him the prescribed 0.7mL every 8hrs. Do you have any recommendations on how to get him to take this medicine? He absolutely hates it and I'm not sure if he's getting the full dose. Doesn't want to eat it mixed with peanut butter or pumpkin puree, and I don't like squirting it in his mouth because it makes him squirm and I'm afraid that is bad for his back. The methocarbamol 500mg I am giving him a 1/2 tab every 8 hrs. It is reassuring to know that these meds can be given at the same time as he's so far on a schedule as far as dosing. And I have been setting an alarm at night to re-dose. I am surprised they don't knock him out though. I will make sure to give him 5mg of Pepcid with meals before his prednisone for a total of 10mg/day. He is between a 1-2 on the list.
[1. √Pain caused by the tearing disc & inflammation in the spinal cord
2. √Wobbly walking, ? legs cross
3. Nails/toes scuffing floor
4. Paws knuckle
5. Weak/little leg movement, can't move up into a stand
6. Legs do not work at all (paralysis, dog is down)
7. Bladder control is lost
8. Tail wagging with joy is lost
9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. ]
He wants to run so badly but doesn't quite realize he doesn't have the coordination or full support yet. When I open his crate door he tries to run out but I also don't want to take the top off as I honestly think he would try to jump out. Is a back brace something that can be used now or only after he has healed? |
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Sept 9, 2017 13:43:13 GMT -7
Due to the fact that you're dealing with a neck injury and don't want Moose to be jerking his head when given the liquid Gabapentin, I think you should speak to the vet, explain how difficult giving Moose the liquid med is and ask that the pill form be prescribed. Most all pharmacies carry a 100mg capsule. Just call around your local pharmacies for the best price and have your vet call in the Rx.
The gabapentin powder can be placed with a tiny spoon into the well of a small mashed banana ball, a cream cheese ball, liverwurst ball or inside of a sticky marshmallow and sealed so no gaba powder is on the exterior. Use the three treat method. 2 treats with no meds inside PLUS the med ball. Give plain treat while holding med ball in front of eyes. The idea is your dog will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so he will hurry to swallow the med ball to get to treat #3.
Give the 5 mg of Pepcid AC 30 minutes before the Prednisone and then give the Prednisone with a meal. If you only feed Moose once a day, then given the second dose of the day 12 hours after the first dose.
Do all that you can to limit the movement of Moose's spine. He's a good candidate for conservative care if you can limit the movement of his spine to just a very few steps at potty time. Carry him in and out to potty. Use a 6' leash and harness and stand in one spot to limit his steps. You can add caster wheels to a wire crate and wheel Moose to a small room (maybe bathroom) where he can restrict him from running when you open the crate door. Put his harness on in that small room and then carry him out to potty.
Orthotics such as a back brace should require an Rx from a board certified neurologist (ACVIM) who is well educated in disc disease. An ill fitting product that is not custom made can do more harm and the Rx would be for a specific reason.
Dodgerslist has consulted with several neuro and rehab specialists. The overriding concern is that owners may buy a brace on their own thinking it will be instead of strict crate rest or think it would prevent a future disc problem.
During a disc episode these are the concerns:
- Getting them on without causing any more pain or damage to the spine is on top of the list. Too much movement to get the brace on is not good for a dog that you are trying to limit movement of the back.
- Additional muscle atrophy in the spine is another big concern as muscle strength is very important to maintaining spinal health.
- Unnecessary discomfort, pain and anxiety caused by having to wear this device tight enough to limit movement… adequate limited movement is supplied with owner commitment to safe and effective 100% STRICT crate rest 24/7.
- Braces would require monitoring for pressure (rub) sores. Also, if not properly fitted (not covering from thoracic down to tail) there is the potential to create a fulcrum. It is hard to immobilize the entire back and not end up creating a fulcrum that stresses out adjacent disks.
- A brace would not be a preventative measure. Disc disease is the cause of prematurely aging discs…a disc problem happens at the point the disc has hardened too much. Any activity such as turning to lick a paw or putting on and off a brace could be the last straw for a disc that is no longer flexible.
At this time there isn’t enough research on them for Dodgerslist to support their use with an IVDD dog.
We encourage you to register and become a member of the Forum. That way it will be easier for you to reply and make it easier for us to track your dog and give the best of comments and support. Tips on registering: dodgerslist.boards.net/thread/406/login-registering-help
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Post by Grace on Sept 10, 2017 0:59:14 GMT -7
Thank you for the advice on a brace. I couldn't find much information so I'm glad I asked. Moose developed diarrhea during his last two bowel movements yesterday. Could this be related to his meds or the variety of new treats being introduced to help him take down his pills? I'm making sure he drinks more water. Should I be making him white rice and boiled meat for his next meal or anything else that helps with diarrrhea?
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Sept 10, 2017 6:48:12 GMT -7
Diarrhea is caused by the Prednisone, it's known to cause GI tract problems. You're already giving the Pepcid AC but with some dogs, that isn't enough. You'll need to contact your vet ASAP to get Sucralfate on board. Sucralfate works differently than Pepcid AC. It bandaids and helps heal any damage that has been done. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/html/sucralfate.html
Pumpkin can help firm up stools, Add 1 teaspoon pumpkin to kibble per day.
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Post by Grace on Sept 10, 2017 12:53:42 GMT -7
Thank you Marjorie. I called the vet and the vets assistant told her that moose was having diarrhea. The vet's orders were to stop the prednisone for now and that she would call me when she's out of surgery. I feel bad because I had given him his dose this morning not knowing it could be the cause since I thought the Pepcid will help protect from the effects and was also thinking it could be related to a change of diet with addition of some soft foods he may not have been used to. I will make sure to ask about the sucralfate. I'm wondering if it's also possible he is having acute stress colitis? It was kinda mucousy and I read that acute stress can cause this. He still has an appetite as well but I am giving him small amounts of white rice with some boiled chicken I hope to hear back from vet soon as he is supposed to have a half dose of his prednisone tonight before tapering to just one dose per day starting tomorrow.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Sept 10, 2017 13:05:39 GMT -7
Grace it is probably ok to begin the taper a bit earlier as the vet tells you. Now if the taper starts earlier, just be on the watch for pain surfacing.
IF pain is to surface, likely adding sucralfate to the pepcid AC (doublling stomach protection) would allow staying on pred for another course.
Let us know what the vet says
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Post by Grace R on Sept 12, 2017 13:18:19 GMT -7
The vet prescribed him 4 doses of sucralfate for use 1-2 hours after his meals/meds yesterday. The diarrhea still has not stopped but he is still eating and drinking. He can move around ok. The arch in his back even seems to have gone down some. The vet is overbooked today so they want me to take him in tomorrow morning. I am thinking it is stressed related. His pain seems to be well controlled. He is just very stressed when in his cage. We have tried changing the location of his crate in our house to be wherever we are and we sleep next to him in his crate at night but he will still cry. I think he has been improving besides the diarrhea. I will provide another update tomorrow. |
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Post by Romy & Frankie on Sept 12, 2017 14:02:51 GMT -7
I am glad that overall Moose is feeling better. I am also concerned that he is still having diarrhea. Have you been timing the Sucralfate with the other meds? I see that you are giving it 1-2 hours before meals which is great because Sucralfate needs to be taken on an empty stomach. When are you giving the Pepcid? Pepcid should be given at least 30 minutes after the Sucralfate and 30 minutes before the pred. The pred is given with a meal for best protection. I am not sure if you had the chance to look at this site which talks about Sucralfate and timing with other meds. www.marvistavet.com/sucralfate.pmlLet the vet know that Moose is still having diarrhea. Many dogs get anxious in the crate. Sometimes just placing a blanket covering the top half of crate which creates a den-like feeling can help to calm: www.dodgerslist.com/literature/EmergencyCrate%20Training.htmUsing an oral calmer in combination with a Pheromone diffuser. works well for some dogs. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. with. Of course ALWAYS keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price. Place a DAP pheromone diffuser at floor level where the recovery suite is. Some brands to consider: --Comfort Zone (DAP) wall plug-in diffuser www.comfortzone.com/dogs/products--Adaptil (DAP) wall plug in diffuser www.adaptil.com/us/Adaptil/Adaptil-DiffuserUse a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed: us.virbac.com/product/behavior/anxitane-chewable-tablets2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.phpBenadryl can sometimes be used for calming in the crate. You must get the dosage from your vet. The wrong dose can have dangerous side effects, so your vet needs to prescribe the proper amount for your dog. |
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