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Post by Rachel & Ruby on Jan 31, 2018 15:19:41 GMT -7
[Original Subject Introducing Ruby]
My dog Ruby is a 4 year old mixed breed, bit of Maltese, bit of cavalier just a bit of lots of dogs really. On the 25th of October last year Ruby jumped off the bed and yelped, within 24hours she was paralysed bit did not lose her bladder or bowel control. Ruby had an MRzi that evening which showed significant disc herniation and severe damage and bruising to the spinal cord, on the 26th of October she had a hemilamectomy. Fast forward 3 months,she had 6 weeks crate rest, she has been having regular physio, hydrotherapy, acupuncture, and laser therapy. All has been going well and we have been very careful with her, she no longer sleeps on the bed, we lift her on and off the couch and never leave her on the couch unattended and we have installed a ramp to the dog door. On Monday [Jan 27] I have Ruby a bath the first since her surgery, directly after she was panting and shaking and on obvious pain I can only attribute this to her shaking the water off as dogs do. She was reluctant to stand and when she did I noticed she was unaware of her foot placement and her back legs were together as she good and was very wobbly. We took her strat to the vet and they notice her left foot was abit slower to respond to the Neuro test of flipping her foot over but her right foot responded immediately, her walking was wobbly and saw some instability. After X-rays I went back to pick her up and they explained they could see narrowing of her disc space in 3 places, the surgeon who is a specialist at another vet did the surgery as they are a referral vet and he had seen 3 other discs of concern on the MRI. So I was told to take her home and crate rest for 6-8 weeks. She is on meta cam half a mg tablet at night and 0.5 of trample. On Tuesday night she was in severe pain so I had to take her to the afterhours vet in which they gave her a shot of methadone and then some OxyCodone to take home and give her quarter of a 10 mg tablet twice a day. Ruby did not lose her function of her back legs she can walk I do sling her for extra support, she can stand, shake, scratches with both her back legs and doesn’t seem to be arching her back. My vet referred the X-ray to the surgeon and his response was
It's entirely possible that we could have a second disc herniation. Radiographs do not show (from what I can tell) any signs of fracture/subluxation, instability, osteolysis or abnormal conformation. At this point I'd recommend either more aggressive imaging plan (MRI with surgery to follow) or conservative management using strict cage rest and pain managmement for 4-6 weeks baseed off of your assessment of patient condition
So we are on crate rest again and all external services like physio etc have been stopped for now. We are carrying her out to toilet on a lead and straight back to the pen. My questions are. Should we be getting another MRI so we know exactly what we are dealing with, should we be putting her through surgery to fix this affected disc, which is close to the base of her tail. The mri would show wether we need surgery. If we crate rest for 6 weeks and she is no better or as soon as she is back to her normal self are we going to be crate resting her every few months if the disc continues to cause issues. I am torn and Confused in some ways I think should I be risking the crate rest or go straight for surgery. My questions are not based on cost it’s more the welfare and wellbeing of Ruby and what’s best for her. I have to note we are in New Zealand. Any help of info would be greatly appreciated.
[Moderator's note: please do not modify
6.4kg./ 14.11 lbs
Metacam 0.5 mg/mL as of Jan 17: 6kg dose 1x daily for approx 14 days, then stop to test for pain/neuro loss
Tramadol discontinued 1/30
Oxycodone 2.5mg 2X a day ]
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Post by Romy & Frankie on Jan 31, 2018 15:49:50 GMT -7
Welcome to Dodgerslist. EVeryone here has a dog with IVDD so you have come to the right place. We are glad you have found us. I am sorry that Ruby is having another disk episode. What is your name? I am Romy. Ruby is showing minimal neuro deficits so she would be a good candidate for Conservative treatment. Some dogs have multiple disk episodes over their lives others only one. There is no way to really tell. Ruby may never have another episode. X-Rays do not show herniated disks. They can only show calcified disks. Some dogs have calcified disks without any IVDD symptoms. Some dogs have IVDD without anything showing up on normal x-ray. Are the current meds now taking care of her pain? Signs of pain in a dog can be subtle. The signs of pain we look for are; 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, restless, can't find a comfortable position. Ears pinned back, arched back. Holding front or back leg flamingo style not wanting to bear weight, head held high or nose to the ground. Not their normal perky selves. Full pain relief is expected in 1 hour and stays that way dose to dose of correctly Rx/d pain meds. Any signs of pain should be reported to the vet right away. Pain will only slow the healing process. Did the vet say how long she would be taking the Metacam? Because Ruby is on Metacam, an NSAID she will need a 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 dogs Pepcid (famotidine) 30 minutes before the anti-inflammatory. The usual dose during a disc episode of Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. Give the Metacam with a meal as added protection. www.1800petmeds.com/Famotidine-prod11171.html☐ Let us know you are on the same page about crate 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.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 recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! www.dodgerslist.com/literature/slingwalk.jpgHow much does Ruby weigh? ☐ Is she eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood? Excluding an emergency of pain not being controlled or diminishment of nerve functions that require prompt vet help, we have excellent resources for many IVDD questions members have. Check out our "All things IVDD" resources for getting the recovery suite setup to an overview of just how Conservative Treatment works: www.dodgerslist.com/literature.htmHealing thoughts for Ruby. |
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Post by Rachel & Ruby on Jan 31, 2018 16:42:18 GMT -7
Hi thanks for the reply. I have discontinued the tramadol asper vet instructions. I have been given approx 2 weeks worth of metacam. I will most definitely ask about something to protect her stomach. She weighs 6.4kg.
Her bowel motions are normal, she is peeing also. Usually she pants and trembles in pain which she was doing very badly on Tuesday night which is what prompted the trip to after hours vet. Last night she was panting aswell not as bad but I think it was pain related even though she had the recommended two quarters of oxycodone. I have left for work today and left her with a friend and she was panting slightly when I left.
I must say it’s hard to know if the panting last night and today o pain or heat related as we are experiencing abit of a heat wave her in Christchurch. I iced packed her back last night.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Jan 31, 2018 20:01:38 GMT -7
Hi, my name is Paula, what's yours? Is Ruby pain fully in control now with just one pain med (Oxycodone) on board and only 2x/day? No sign of pain nearing the next dose. Nor when having to move such as the very few footsteps at potty time, when having to reposition her body in the suite? Could you look over the Metacam container for the correct dose in mgs. How many mgs are in one whole Metcam tab that you are cutting in half? Is there a more accurate length of time she will be on it. The day she stops it an important day to mark as that will be the stop to test for pain/neuro loss. Has there been any issue to getting her stomach protected? Pepcid AC (famotidine) 5mgs every 12 hours for as long as she will be on Metacam. It would be best to not touch her back or put anything on it. If there is pain the meds should be adjusted by the vet. Usually there would be two additional meds on board each working on a different sourse of pain and each Rx'd for round the clock relief at every 8 hours. --- gabapentin for nerve pain --- methocarbamol for the pain from muscle contractions. --- Oxycodone is serving as the general analgesic. Why was Tramadol stopped. How often were you giving 25mgs (1/2 of a whole tab)? Every 8 hours or ???. Since panting can be anxiety, being too hot or it could be pain. So you need to put on your detective hat to figure out which. Do you see another sign of pain when panting to help you confirm if panting is definately pain.
Signs of Pain: ◻︎ 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 A fan near the suite but not pointed at Ruby can help if it is heat panting. An ice cube to lick on is also cooling. In the end if you are still not sure, then the thing to do is with a disease that is painful, then to act like it is and advocate to use a combo of pain meds (multi-modal approach) to cover all the sources of pain. |
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Post by Rachel & Ruby on Jan 31, 2018 21:23:50 GMT -7
Sorry my name is Rachel.
The afterhours vet advised me not to give the tramadol. The dose for tramadol was 0.1ml it was a liquid. The metacam dose is full tablet 1 mg and she has half of that for a 24 hour period. I think her pain is under control but I will talk to my vet about getting a top up. After hours vet said if her pain was in managed they would admit her on a constant infusion of pain meds. She is not arching her back or whimpering she really only displays panting hard and trembling as pain so currently her treatment is
Metacam 0.5mg evening
OxyCodone 2.5 mg morning and 2.5 mg night
Crate rest, toilet only with a sling support even though she can walk and stand I’m doing the sling anyway.
[Moderator's note: please do not modify
6.4kg./ 14.11 lbs
Metacam 0.5 mg/mL as of Jan 17: 6kg dose 1x daily for approx 14 days, then stop to test for pain/neuro loss
Tramadol discontinued 1/30
Oxycodone 2.5mg 2X a day ]
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Post by Rachel & Ruby on Feb 1, 2018 4:48:40 GMT -7
I feel today has been a good day, she is not indicating that she is in pain,
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Feb 1, 2018 5:02:20 GMT -7
The panting and trembling have now stopped, Rachel? If not, do be sure to let the vet know ASAP this morning so the pain meds can be adjusted. Have no patience with pain as it does hinder healing. There should be no sign of pain from one dose of meds to the next. She certainly should not need to be admitted to get pain under control, just would need to have her pain meds adjusted. Usually we see Tramadol given as the general pain med, Methocarbamol given for the pain caused by muscle spasms and/or Gabapentin for nerve pain.
And do speak to the vet today about getting Pepcid AC on board. We've seen dogs start to have serious side effects from the anti-inflammatory with no warning. Ruby is dealing with a lot and doesn't need that problem, too.
Healing prayers for Ruby.
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Post by Rachel & Ruby on Feb 2, 2018 3:11:36 GMT -7
Ruby is doing well, no signs of pain so I feel we have this under control. She had a loose BM today and I spoke to after hours vet about this and they think it may be the metacam so they have advise that I speak to my vet tomorrow and see if they want to change that particular medication, they are not too concerned at the moment as it is a one episode so far.
We have an appointment with the surgeon on Wednesday so he can check her out and see if there is any need for an MRI or surgery. I’m feeling like she is ok, she has full function of her back legs so I’m not expecting surgery would be needed. The OxyCodone is definitely keeping her in a sleepy state, after her surgery 3 months ago she hated being in the pen and now she’s not protesting at all she’s just sleeping all the time...I know pain medication is good for them but gosh I hate filling her with all these drugs.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 2, 2018 9:11:21 GMT -7
Yes, the loose bowels would be due to the Metacam. Ruby is on NO stomach protector. She should have been started on a stomach protector as soon as she started Metacam. Metacam is a NSAID which is known to cause GI distress. They SHOULD be concerned - we've seen GI problems worsened very quickly. Now that loose bowel movements have started, she needs to be immediately started on Pepcid AC AND Sucralfate. 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 This cannot wait until tomorrow. Was the prescription for Metacam extended when the Oxycodone was started? Since there was pain just a few days ago, it's unlikely that the swelling has resolved yet so there's still a need for Metacam. Metacam can be continued with the addition of the two stomach protectors, Pepcid AC and Sucralfate. Most vets would not operate on a dog that can still walk so there's no need for an MRI (which is dangerous for a dog having an IVDD episode as it requires anesthesia which relaxes all the core muscles supporting the spine) or a follow-up appointment with the surgeon. Transport involves risk to the not-yet-healed disc. While on conservative care, transport should only be done for emergencies, such as diminishing of neuro function, which is not the case here. An exam to see improvement is not necessary since it's way too soon to expect to see improvement. Nerves are very slow to heal - it can take months, even a year or more, to see improvement in the nerve damage. Please let us know what the vet says after speaking to them today about adding the two stomach protectors, Pepcid AC and Sucralfate and continuing with the Metacam for awhile longer. |
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Post by Rachel & Ruby on Feb 4, 2018 1:14:22 GMT -7
We were back at the AH vet last night. A new problem has emerged where I thought Ruby may have a uti due to her excessive licking in that area. She is obviously sore as when I have taken her outside to toilet she refuses to stand or take any steps and when she does she stops abruptly and starts licking that area. Vet checked her over and said there is nothing obvious apart from what looks like slight irritation, they queried spider bite or bee sting? Gave her a shot of antihistamines which did not stop it, I have an cream to put on the area which is neo sooth. I asked about Pepcid and vet advised to carry on with losec stomach protector. I’m so disheartened at the moment also the $900 a mth we have been spending on her rehab is basically down the drain as I can already see the muscle wastage happening in her back legs. She was only wobbly for a very short time after this particular episode, but every time I take her out to the toilet I see she’s getting a little worse each time 😢
[Moderator's note: please do not modify
6.4kg./ 14.11 lbs
Metacam 0.5 mg/mL as of Jan 17: 6kg dose for approx 14 days, then stop to test for pain/neuro loss
Tramadol discontinued 1/30
Oxycodone 2.5mg 2X a day
Losec (Omeprazole) ?mgs ?x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Feb 4, 2018 7:57:25 GMT -7
Rachel, what is the exact name of the antihistamine shot?
What is the name of the cream?
What date did Losec begin?
Do you have a firm number of days to be on Metacam vs. "approximate 14 days" before Metacam's stop to test for pain/neuro loss? Has metacam been stopped, if yes, what was the exact date?
It makes it difficult to understand Ruby's treatment, things you report without all the details about the meds. The med list provides a wealth of information.
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Post by Rachel & Ruby on Feb 4, 2018 15:54:50 GMT -7
I don’t know exactly the name of the antihistamine shot and I did list the name of the cream as Neo soothe so her meds as as follows just to be clear
✚Neosoothe cream which is these ingredients
Neomycin Sulphate 5mg
Hydrocortisone 5mg STEROID
Lignocaine HCL 5mg
OxyCodone 2.5mg 2x daily started FEB 2 1/2
Metacam NSAID 0.5mg once daily (total of 20days worth started on JAN 29 29/1) bearing in mind I’m in NZ so 1 day ahead of rest of the world and we write our dates as dd/m/y
Losec 10mg 1x daily
[Moderator's note: please do not modify
6.4kg./ 14.11 lbs
Metacam 0.5 mg/mL as of Jan 17: 6kg dose for approx 14 days, then stop to test for pain/neuro loss
✚NeoSOOTHE 50 gram tube; 5mg/1gram: Hydrocortisone
Oxycodone 2.5mg 2X a day
Losec (Omeprazole) 10mgs 1x/day]
Unrelated to her spine she was previously on apoquel 3.6 mg 1 x daily for a itch in her right paw which has been ongoing for two years with all diagnostic avenues explored and atopic dermatitis is what is being treated
This morning a new drug for the atopic dermatitis
was given as it’s said to be less side effects than apoquel
Cytopoint 10mg injection
Other than these drugs a supplement of deer velvet has been given but not in the last 7 days
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Feb 4, 2018 16:25:43 GMT -7
Thanks for the update on things. Yes, agree there is confusion about dates. So how about we write them out such as JAN 29. The neocream contains a steroid Hydrocortisone. Metacam is a non-steroid (NSAID). It is pretty typical that steroid should not be used at the same time as a NSAID. From the manufacturer's package insert : Can Metacam Be Given With Other Medicines?
Metacam should not be given with other NSAIDs (for example, aspirin, carprofen, etodolac, deracoxib) or steroids (for example, cortisone, prednisone, dexamethasone, triamcinolone). Package insert: animaldrugsatfda.fda.gov/adafda/app/search/public/document/downloadLabeling/8 |
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Post by Rachel & Ruby on Feb 4, 2018 17:15:18 GMT -7
UPDATE.
neosoothe no longer being used as per vet instruction. Replaced with white vinegar and water solution.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,538
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Post by PaulaM on Feb 4, 2018 17:29:32 GMT -7
Thanks for the update. Hope Ruby has no abrasion, raw skin areas, acidic vinegar would sting quite some.
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Post by Rachel & Ruby on Feb 4, 2018 19:20:32 GMT -7
No it’s very diluted, her licking the area is what we need to avoid because the twisting of the spine when she does so is not ideal
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Post by Rachel & Ruby on Feb 4, 2018 22:39:10 GMT -7
Update
Urine testing revealed urine infection and small amount of blood. Ruby is now on antibiotics . Half a 25mg tablet 2xday of ✚ clavulox
[Moderator's note: please do not modify
6.4kg./ 14.11 lbs
Metacam 0.5 mg/mL as of Jan 17: 6kg dose for approx 14 days, then stop to test for pain/neuro loss
Oxycodone 2.5mg 2x/day
Losec (Omeprazole) 10mgs 1x/day
✚Clavulox 12.5 2x/day]
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