Tyler's Benson 2/20 conserv.- pancreatitis- Basset

Tyler, welcome to Dodgerslist. Some immediate things to address

How much does Benson weigh?

His pain meds are not right, yet, so here are things to phone your vet and get adjusted over the phone 
---- Pain should be in control within the  hour and stay that way fully dose to dose...no pain at all surfacing.
--- Gabapentin, Tramadol and Robaxin all have short half lives so not  very likely to cover pain dose to doses UNLESS the vet Rx's for promptly giving every 8 hours.  
--- Tramadol is way undermediated at 50mgs 2xday.  My 13 lbs doxie took tramadol 50 mgs every 8 hours.  Advocate for the MAXIMUM analgesic dose for Benson.... have your vet look in his own Plumbs to confirm.
The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours.
---  Do you know how to express the bladder? tips and re-view video  www.dodgerslist.com/literature/Expressing.htm  
       if not and he has indeed lost bladder control, then a transport to the vet is worth the risk of too much movement to the disc.  Pad out the crate with rolled up blanket so his body will not shift as your drive, stop and corner.
          The only way for humans to know if there is bladder control is with the “sniff and pee test.” Carry Benson outdoors if you can with his size/weight safely.  Set him on an old pee spot to sniff. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. See if he will release urine on the old urine area. If urine comes out after sniffing, bladder control is is still there. Let us know what you observe.

--- He may not be eating due to pain OR it can be likely due to Prednisone doing damage to the GI tract. Often Pepcid AC  (0.44 mgs x weight of dog,  dosed 2x/day)  will do the trick. When there is any suspicion of emerging likely GI tract damage (nausea,  not eating, moving to vomit, diarrhea, bleeding ulcers, then SUCRALFATE is added. Advocate for this med and get a prescription. Read about sucralfate how it is used with Pepcid AC and food timing here:  marvistavet.com/sucralfate.pml

Is surgery an option for your family?  One of the times it might come under consideration is when it is the same disc having a problem each time and when there has been fast loss of neuro function. Hours matter.
The spinal cord is made up of nerve cells and fibers (axons). Nerve impulses travel along the axons of the spinal cord from the brain to the bladder, limbs, and vice versa. If portions of the spinal cord are damaged by the bad disc, nerve impulses are not properly transmitted in both directions. Crate rest is imperative to prevent worsening of the bad disc.

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.  Let u

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, dog leaks on you when lifted, can't pass the sniff and pee test.
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.
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. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. 

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Tyler, EXCELLENT news Benson still has bladder conrol! Getting his pain fully in control right up to the next dose and when Benson has to move such as at potty time is imperative. You can't care for him if he is in pain, and he doesn't want to move to potty or other stuff if he is in pain.

For a 56lbs dog tramadol has a SUBSTANTIAL increase in mgs to get to the max analgesic dose.  50mgs 3x/day is almost like not giving any tramadol.  Let us know what the vet prescribes for the Tramadol and getting the other two meds to a 3x/day dose.

How many times a day does he take prednisone. And for how many days will he stay on 10mgs (twice??? a day) before a taper to test for pain or neuro loss happen?

His tummy may be nauseous, so do advocate for a 2nd protecttor: sucralfate

Only a board certified neuro (ACVIM) or an ortho (ACVS) are qualified to tell you if a surgery would be a consideration for Benson.   Here is a page to help your mind sort out surgery vs. conservative when/if that time might come.  The information was provided by Dr. Isaacs, neuro (ACVIM) in helping our IVDD community to better understand things.  www.dodgerslist.com/literature/healingsurgery.htm

It sounds like Benson is doing well. Good news that he can potty outside.

He may be a bit constipated. The meds can sometimes cause constipation.

Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.

The amount of water in the diet makes all the difference.
--To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. Do this for Benson
-- To firm up the stool add 1 teaspoon pumpkin 1x a day to kibble and no extra water.

Let us know if the additional Robaxin is keeping Benson pain free.

Tyler, good news pain is fully at bay now!!!

That is the problem with switching food while on pred. and why it is not recommended. It is difficult to know if a drastic action should be taken due to the early GI tract signs of damage or if merely a temp thing due to food change.

When did you change to the wet food. Did you do it gradually to allow the gut to adapt over the course of several days of meals? What was the reason that you switched to wet.

Ask your vet about Gas X and Little Tummies (contains simethicone to alleviate gas) from the grocery store to help.

Tyler, anytime Benson is out of his recovery suite can be a danger to the still healing disc. So that makes transporting to vet visits also a potential risk to the disc. Each vet visit has to be weighed for the benefit vs. potential risk. Vets who know IVDD understand the problem of transporting and when at all possible to handle things like med adjustments over the phone.

Today is the first day of the pred taper where you are to assess if there is still spinal cord swelling. You will NOT know if there are any signs of pain surfacing. Right now you CAN'T DO YOUR JOB! You will not have anything learned about pain (or no pain) to accurately report to the vet! Pain masking pain meds (gabapentin and robaxin are still on board.

---The only reason to continue with prednisone is if there is still work for it to do of resolving painful spinal cord swelling.
-- Prednsione does not help the body self repair nerves. Nerve healing is quite slow and more expected to take months rather than days or weeks.

So that a real, true test for pain can begin today, please call your vet
--- advocate for the full stop of gabapentin and robaxin so you have the ability to monitor for any hint of pain surfacing.
--- advocate for the idea of you reporting pain via phone tomorrow to avoid a risky transport.
--- advocate IF, if pain should surface at any point during the pred taper, that you will phone so that another course of pred can resume (10mgs 2x/day). A 7-day course is short, many can get the painful swelling done, but many also require a 2nd course. It is always prudent for a vet to try one course, then test for pain. No one wants a dog to be on pred any bit longer than necessary.

When the benefit of a vet visit outweighs risk of transport, pad out the crate with rolled up towels. You want no extra space in the crate where his body might shift as you take a corned or stop.... every effort to prevent the back from movement.

What exactly is delayed with the DPS check? Do you mean his paw is knuckled under and eventually he can right it?
             Most general vets just do not have the practice nor training to correctly identify what they have observed with a neuro test re: DPS. So if it is you who is pinching toes, etc. likely youwill not learn anything meaningful by that. Best to NOT cause his legs to kick out, etc....too much potential for unnecessary back movement.

Correct, stop meds that cover up pain (gabapentin and Robaxin) when you are doing a test to assess if there is still pain. make sense, now?

If there is still painful swelling in the spinal cord you do not want to dink around learning this fact. The sooner pred get back up on the level that is actually working on inflamation the better for nerves. Taper doses of pred are no longer working on inflammation. You just have no idea due to being blindfolded with pain masking pain meds on board.

Nerve cells die when they are pressured. We see that death as loosing of nerve function, like bladder control, use of legs, no happy tail wags. This is why you do not want to delay learning if pred needs to be back on board PRONTO if there is still painful swelling (pressure) to the cord.

Thanks you for that information.  

Benson cannot wag his tail. He moves his tail at times but it likely is more reflex like when he’s getting ready to go potty outside. His tail does not respond to excitement. He does have bladder control. He holds his bladder until he gets to his normal smelling spots and then releases his urine. He also notifies me as usual when he needs to go potty by doing the stare and gets fidgety, groans, etc. I usually first try to pet him to make sure it’s not just attention seeking. 

He is not currently using his back legs for itching or moving them except for an occassional
instance in which he stretches (toes move). He does move from side to side and readjusts himself for comfort. However he cannot move his legs readily. I typically will notice he’s laying on a leg and adjust for him so it’s not in an awkward position. 

That’s good news to hear. Luckily my partner and I both work from home more than 50% of the time so we can be around to monitor him and allow him to relieve himself when he needs to.

I do have one other quick question/observation. This morning I noticed that Benson has began licking his back feet pretty aggressively. He’s not chewing or gnawing at them but just licking. Almost like he does when he has bouts of allergies in the spring and fall. He’s doing it to the point his back paws are soaked in slobber. Do you think he’s having some sort of weird sensation in his back paws?

Hi Tyler. In answer to your question about recovery after multiple episodes, every dog is different.

My Nala has had many episodes unfortunately. However, she has recovered enough to walk and have a happy life.


Hopefully Benson will be lucky and won't have more episodes.

I'd suggest educating yourself about IVDD and knowing what to do. Read as much as possible. Take all reasonable precautions.

Then once Benson is better try to "live like a dog" and stay in the present. Worrying about future episodes won't help.

God bless.

Tyler could you be specific in detail when you speak to meds using dates, mgs and frequency of giving?

With cutting meds in half what does that mean for Gabapentin, Robaxin. How many mgs now and how often do you now give?

Why was pred  10mgs 2x/day extended....on Feb 27 date? Did you report increased or new pain, more neuro loss? Pred deals with those two things. Nerve repair is something the body does not prednisone. Very confusing about this extension of pred.

Tyler, thanks muchly, now we get the picture. Fingers crossed that when all pain meds have been stopped on the pred taper you will have evidence all swellling is gone when no pain shows!

Tyler,

Wonderful Benson is attempting to scratch his ear and correcting his knuckling paw.   More evidence of nerve healing..  Thank you for the update!!  

Tyler, those are big improvements! It takes quite some time for nerves to connect and then bam we see something. What you describe will likely lead to even more nerve connection, and more neuro function to return. When it is safe after graduation, Benson will be able take up some PT to help him relearn the art of walking again. Kinda like a stroke victim needs time and practice to re-learn the complicated coordination of muscles with brain directives and the strength to accomplish. Keep up the good care you are giving Benson!

Thanks for the update, Tyler. Dragging and knuckling are two different things so we'll need a bit of clarification as to what you're seeing. Dragging is dragging legs and feet behind him. Knuckling is placing feet incorrectly, the foot knuckles like in this photo:



You had mentioned that Benson was swinging his legs in the sling when out for potty.  Did he at one point knuckle his paws when swinging his feet that has now progressed to dragging his legs?  Has he been dragging his legs in the sling and that has now worsened a bit?  In what way has it worsened?

A determination needs to be made by the vet whether a relapse has occurred due to too much movement of the spine at some point, causing the not-yet-healed disc to tear more resulting in a worsening of neuro function.  If that is the case, then there is again inflammation pressing on the nerves and therefore once again an immediate need for an anti-inflammatory, pain meds and a stomach protector.  The 8 weeks of strict crate rest would also have to be restarted.  Are you seeing any sign of pain again?

It could be that the loss of muscle tone and strength from being on strict crate rest for 6 weeks has caused the dragging to worsen a bit.  If he has gone from knuckling to dragging, that would indicate a worsening of neuro function and a possible relapse

If this dragging of his feet a bit more is due to a relapse, an improvement may or may not be seen in just two days.  Nerves can take weeks or months to heal.  Even if it's due to inactivity and loss of muscle strength, you may likely not see an improvement until activity is once again gradually reintroduced.  If the vet feels that Benson has suffered a relapse and is showing new signs of neuro loss (knuckling progressing to dragging), then the anti-inflammatory, pain meds and stomach protection shouldn't wait two days but should be started immediately.

To answer your question about dragging after crate rest, yes, if Benson is dragging his hind legs once crate rest is over, he would be allowed to drag himself around the house.  There are garments that can be used to help protect his skin when dragging.  We can direct you further about that once crate rest is over.  You would need to determine whether he dragged with his legs behind him, needing a cape that would go under his legs or whether he dragged sitting down with his legs in front of him, needing a bum pad.

It may be too soon to start water therapy in three weeks since that is only one week after crate rest is over.  Laser therapy would be fine.  Benson's stamina and muscle strength need to be very gradually built up over the course of several weeks following strict crate rest.  If he does too much too soon and his muscles become sore, it would be difficult to determine whether the soreness was due to doing too much or due to another disc episode.  More information on how to gradually build up muscle tone after crate rest here for your preview and consideration:
www.dodgerslist.com/literature/AfterCrateRest.htm

Please keep us updated.  I do hope that the dragging a bit more is due to loss of muscle tone and strength and not due to a relapse.  Continuing healing prayers for Benson.