Alix's Gretta Jul 2018 Conservative GRAD 8/31

Thank you so much, Pauliana!

I just called the vet's office and asked for Tramadol and Gabapentin and will discuss the Sucralfate with him when I hear back. I know our vet checks messages frequently even on the one day he's closed, so he should get the message soon. I'll split the next Pepcid and grab some pumpkin. (We just thought she pooped, but it was just gas.)

I was so afraid of progressive myelomalacia I've been in full-panic mode. Your site has helped so much.

Alix can you help us to understand what appears to be conflicting meds in the med list below

19 lbs
Dex IV on 7/6
Dexamethasone injections at home as of 7/6: for 6 days unknown mgs; 0.5ml 7/8 6am (last dose)
Prednisone as of 7/8: 5mgs 2x/day for 3 days then 7/11 taper to test for pain/neuro loss
Valium (dizepam) for muscle spasm pain: 2mgs 2x/day
Pepcid AC 10mgs 1x/day
Lactulose solution (laxative) as of 7/6 for 9 days

Did the neuro indicate the need for 6 days of  combo of  Dex IV,  Dex injections at home?

The laxative Lactulose which will loosen stools was prescribed for 9 days starting on 7/6 but never started until morning of 7/8.
You reported diarrhea (runny stools)  on 7/7 and 7/8 

Dex has big time notoriety in the medical community for the damage it very often will do to the GI tract. Pred is not as strong but it also can cause GI tract issues.   So runny stools runs up a red flag to us that Dex/pred maybe the cause as the laxatiive did not start til 7/8 morning. A very good idea to assume the steroid was the cause and advocate for a 2nd stomach protector on board:  SUCRALFATE. Do read the link so you know how it must be timed with food with Pepcid AC.   

Is Gretta basically staying drying in between your expressing sessions?  IF not you may need to express more often. While on Pred that would be every 2-3 hours because Gretta will be more thirsty and need to have her water bowl accessable in the crate.  Also you may need another hands on lesson to be able to find the bladder and feel that it is almost flat, pretty empty, if you are finding leaks in bedding.  This video will give you some good tips and help you get more out of the review lesson by watching first.  www.dodgerslist.com/literature/Expressing.htm  

Do you express for poop?  www.dodgerslist.com/literature/Expressing.htm#poop

Let us know more about how expressing is going for you.
 
Just the fact of leg paralysis or loss of deep pain sensation alone ARE NOT  signs of impending Myelomalacia.  

Diazepam is for the pain of muscle spasm pain. Let us know the details of tramadol mgs/frequency and of the gabapentin dose and frequency when you can. For full pain relief it would be expected those three meds would be Rx'd for every 8 hours to provide round the clock pain relief that every 12 hour doses likely would not.

Alix, since the diarrhea started BEFORE starting the lactulose (laxative), it most likely is a side effect of the Dexamethasone. Eating less and signs of nausea are red flag signs of GI distress, which can worsen rapidly. The lactulose should be stopped due to the diarrhea she had and you need to speak to the vet ASAP this morning to advocate for Sucralfate. Sucralfate works in a different way to bandaid the damaged mucus lining and also promotes a healing environment. 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

Pepcid AC should be given 5 mg 30 mins before the Prednisone and then every 12 hours thereafter for as long as Gretta is on the Prednisone. Prednisone should also be given with meals to help protect the stomach. I'm not sure when you said you gave it to her before bed whether she also had her meds before bed but give no more than 5 mg 2x/day.

Be sure to put a non-slip pad in the bathtub when expressing so Gretta doesn't slip and fall.  Expressing can take some practice to learn how to completely empty the bladder.  Please let us know how the increasing of the expressing times works for Gretta.

You're doing a great job caring for Gretta. Hang in there - it does get easier. We hope to hear this morning that Gretta's pain is completely under control with the new meds and that Sucralfate is on board. Remember to let us know the exact mgs/frequency of each med once prescribed.

Healing prayers for Gretta.

Alix, nice job in advocating on behalf of Gretta!

Have you stopped the laxative lactulose? Since she had diarrhea she may be "cleaned out" for a few days before food has been processed and ready for pooping. If you notice that sucralfate is making poop too firm, then try the route of using a high fiber food to regulate.
Plain pureed canned pumpkin is easy to give, alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe.
--To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day.
-- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble.

Give a teaspoon of pumpkin for every 10 pounds of body weight,

Bananas with bright yellow skins, a very few brown speckles contain electrolytes and other nutrients. Diarrhea tends to deplete these nutrients. By eating bananas, some of those nutrients are restored. Green bananas are hard to digest.

FYI: Signs of steroid or other anti-inflammatory drug damage progresses in this manner:
nausea (lip licking), not eating, vomit, loose stools, bleeding ulcers, black or red bloody diarrhea, perforated stomach lining.

You could give valium and gabaentin together. You could give both of these pain meds at the same time as prednisone

The taper of prednisone is to begin on 7/11. With pain meds just now on board, it may be a premature guess that all pain would be gone now in just two more days. With any test-for-pain pred taper to see if another course is needed, always a good idea to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free!

Pain= another course of prednisone + all pain meds, protectors back on board.
No Pain= go to pred conclusion...just finish out the 8 weeks of crate rest for the disc to heal.

In order for you to have an accurate test for pain, naturally pain masking meds still on board would not yield accurate test results. Vets either back off the pain meds at the start of the prednisone taper or they will just call for a full stop on the pain meds. Let us know what your Plan B is and which your vet wants re: pain meds on the taper to test for pain/neuro loss this Wednesday 7/11.

Alix, having lactulose on board is confusing if Pepcid AC and the sucralfate are doing the job of turning around GI tract damage of loose stools. Seems better to wait til you confirm there is actual constipation identified and then take action— use the mashed sweet potato. The diarrhea  may have cleaned her system out and may need time to generate new feces.  Does that make sense to you?

What does "Her body is responding to attempted bowl expression" mean?  It is better if you give specific observations so we understand
--- Does your stroking have your fingers feeiing the crown (tip) of the feces as it just begins movement down the rectum towards the anus?
--- ????

Expressing is a new skill, where your fingers will be learning to feel for the bladder in all its various shapes and hiding places. When the bladder is full, expressing is a piece of cake. Just the act of lifting Gretta could put enough pressure on the bladder to kinda express her and have her leaking on you! So expressing a full bladder doesn't take much more that pressing on either side of the tummy area as the bladder is filling most of the tummy area as pictured green in the graphic below. As the bladder gets smaller and smaller as it empties it may be the size of an apple> a lemon> a small plum. Your fingers will be learning to feel the bladder in all its sizes. The last size is quite flat, meaning the fingers of one hand can almost feel your other hand. Another tricky thing is as the bladder gets smaller it tends to slip out of your hands dropping lower and back more into the thigh/pelvic area. You will need to go find it again by using your fingers to feel around more back into the pelvic area. Picturing the anatomy can help your mind guide your fingers to that hiding spot. Retrieve the smaller bladder with both hands moving it back to where you can best squeeze it.

Hi Alix,

I have a cat... The best way to comfort a cat is to pet and talk to her in a soothing tone.. My cat is very affectionate to  me and she likes lots of touching and petting.. Some cats don't.. Depends on the cat's personality.. She misses being able to cuddle with Gretta?..Try cuddling with her, she likely misses her cuddle buddy.. 

Of course you miss that tail wag, Alix, and I do hope you see it again soon!

Both cats and dogs can be very sensitive to changes in the household, especially illness. Giving Pippa extra love is just what the doctor ordered!

Glad to hear Gretta ate something. The sucralfate should start working soon to heal the damaged areas.

Continued healing prayers for Gretta.

Hi, Paula. 

We've been trying the two methods in the video, I tried the lubricated q-tip out of desperation. She wasn't having anal contractions the first day we tried, then she was, and now she isn't again (we just tried again and she contracted fine even though still no pooping - I’m just lousy at this apparently). Her last stool was the diarrhea the morning of 7/7. 

She has a couple red spots or her belly, I'm guessing urine scald from overnight. I gave her a thorough bath [?] this morning. I'm so mad at myself.

She's eating good - we're getting 1tsp of mashed sweet potato in her twice a day with her normal food (www.thefarmersdog.com) plus some shredded chicken breast. The gabapentin seems to start wearing off around 5pm so we're going to [?]need to ask for a second dose/day. Waiting to see how the taper goes today. This is her first morning without a dose of anti-inflammatory. 

We’ve noticed her.... I’m not sure what’s going on - it looks like hiccups? Night before last and again this morning. She’ll be resting peacefully and then, well, it looks like a hiccup... and then another 30 seconds later or so. Happened about 15 times the first time, and then just a few times this morning. 

The bath was after we were expressing this morning - we were already in the tub, so I sprayed her undercarriage with the shower head. All the other clean ups have been wet wipes and green tea on towels. 

I've contacted the vet and let him know that I am seeing:

-tight tense tummy
-holding head up more often
-more depressed/less engaged as the day goes on 

on the gabapentin in the morning only.

I also asked to hold off on the taper.


I'll let you know what I hear back. 

Hi, Alix. Long-term use of steroids can possibly lead to diabetes but the amount of time that Gretta has been prescribed steroids is not considered long term. The first course of the anti-inflammatory dosage of steroids was very short. Hopefully this course will get that swelling down so she can get off of all meds.

The Prednisone will be tapered in five days, yet the vet has prescribed Valium and Gabapentin for 20 days. One purpose of the taper is to test for pain/swelling and if Valium and Gabapentin are still on board during that taper, it will be difficult for you to determine if there is still pain/swelling and still a need for the original anti-inflammatory dosage of the Prednisone. You'll need to speak to the vet prior to 7/18 about stopping or at least tapering the Valium and Gabapentin when the Prednisone starts to taper so a true test for pain/swelling can be made. Pain = swelling = more time on all meds. More info on pain/swelling here:
www.dodgerslist.com/literature/healingsweling.htm

If there is great pain or severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering.

Please let us know whether the new course of meds brings Gretta's pain completely under control today. Pain should be completely under control within one hour of giving the meds and there should be no sign of pain from one dosage of meds to the next.

Alix do you you have her mattress system set up and layered to help wick away moisture?

Mattress enclosed in a trash back and taped shut
A pee pad on top of the enclosed mattress
A 100% synthetic fleece (no cotton!) blanket tucked in all around the mattress to keep the pee pad in place?

The pred makes or dogs very thirsty. Gretta needs to have free access to water during the day, but you can give her a last drink a few hours before she goes to bed. That may help keep her drier.

Generic famotidine with no other active ingredient is fine.

Hi, guys. 

gretta is starting to get scabs all over her body and her fur is falling out. I'm not sure if this is stress (she was off the valium a full 24 hours)? Allergies (green tea? wet wipes?)? Prednisone side effect? She's not doing it to herself - there are spots on the sides and back of her neck, too, which means it's probably not the laundry soap, either. I'll talk to the vet about it on Monday [7/16], but I thought I would ask you brilliant people.

After having a couple decent poops, she's now had a few bouts of very watery diarrhea - the first last night around 7pm, one overnight, and one this morning around 10am. No stool since then. She's still tinkling fine and seems okay other than bored/tired and maybe a little nausea after drinking most of a bowl of water. I let the vet know about this today, but did not hear back, so I don't expect to hear anything until Monday. 

Yes to still taking pepcid and sucralfate.

The middle bout of diarrhea looked brown but there was some red in the water when rinsing out the pad. The last bout was brown and more solid/less watery, but there was a tiny bit of brown-pink on the wet wipe when we cleaned her up after expressing her bladder at 5pm tonight. The 7am expression clean up was fine, though.

She doesn't seem to be itchy at all. The scabs started on her neck, so I thought maybe it was where I dripped some of the sucralfate slurry, but now it's all over. It is very like the reaction of a cat I had that was allergic to fleas. I think I've identified all the spots right now and we've stopped the green tea on the wet wipes to see if it gets better. At this point she's drinking so much her tinkle is clear and odorless anyway. 

Thanks for all the help. ❤