Dave's Mr. Pickles 2018 Conservative

Pickle Update - Monday Sept 17

While supporting him to baby wipe his rear, I always place his feet in a normal posture as if to stand. Today when I did that, while wiping, I felt Pick get lighter in my hand! Pick was trying to support himself!!!! Of course I didn't let him and placed him back into a sitting position when I was done cleaning him, but yep, more improvement!

Dangit.... I was hoping to avoid this. Pick has some "diaper" rash. The vet siad to soak him in an epsom salt bath which I just did... sooo I have to ask, when should I see this redness calm down and is there anything else I should use on it?

During a disc episode baths are simply a no no...the spinal cord takes absolute top priority in protection over baths.  Does that make sense to you?  So being able to come up for discussion with ideas that are thinking outside the box are often needed to protect Pickles from those offering unintentional but harmful advise. Always question things.

Use unscented baby wipes OR Epson Salt solution OR  tea damped washcloth to daub urine from fur and skin-- no baths, just dabbing, rinsing cloth and re dipping in solution of Epson or tea.

This tip below comes from the supplies list as well as other useful tips: www.dodgerslist.com/literature/cratesupplies.htm

TEA
Marjorie's tip: boil and cool decaf green tea to dampen a washcloth. It is mild with acidifying, antibacterial properties to neutralize urine on skin and fur to avoid rashes from urine scald + leaves aclean earthy fragrance.




White vinegar in a spray bottle to disinfect and remove the urine ammonia smell from floors, etc.

No Zinc BARRIER OINTMENTS can help to keep urine from the rash area.
Aquaphor Baby or Aquaphor regular Healing Ointment contain same ingredients:  Petrolatum (41%)           
Inactive Ingredients: Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol
aquaphorus.com/categories/



AND

Bayer's A+D® Original Ointment
Active ingredients: Lanolin 15.5%, Petrolatum 53.4%


Keep an eye on the rash that it does not move to broken skin, an open sore. Staph bacterial infections are the concern because they are difficult to get rid of.  There are antibotic ointments you vet can prescribe or perhaps even OK one from the grocery store shelves.

This is one of the reasons we do not support use of diapers, they create a moisture environment inside the warm dampness of the diaper that invites bacteria breeding.

 If there is no UTI to cause dribbling and the need for a diaper, then increasing your expressing skills would be the very best thing for Pickles.
--  express often enough ---can eventually move to every 2-3, then 3-4 hours and longer once you see he is staying dry.  How often are you now expressing?
-- Are  you able to feel the bladder with your fingers/hands as it get smaller urine is released? Can your fingers find the smaller bladder when it escapes your hands and bring it back out from the pelvic area so you are able to apply pressure again?
--Let us know details of how you are expressing and how that is going. Another hands-on-top-of-your-hands type of lesson is never a bad idea. Review here: www.dodgerslist.com/literature/Expressing.htm

The leg movement sounds good. Let us know if you are also seeing confirming signs such as maybe using his back legs to move/reposition his body in his suite.

Let us know with the addition of methocarbamol if the pain is fully in control now.

Dave, baths are potentially a VERY dangerous situation for the healing disc.  Wet dogs are slippery. Dogs like to shake off water. The act of removing him from a safe healing environment should be only for the most important of things...like expressing the bladder to keep the bladder healthy.
      I did a quick Google search to find out how Epson salt (Magnesium sulfate) would clear up rashes and did not come across any medical reason why this would work.  If you feel it works why not use a safer idea of no soaking baths, and instead dampen a washcloth and apply the epson salt solution to skin/fur?

Are you using a non-zinc barrier cream just as used on babies to avoid rashes from urine?

Expressing is to protect the bladder wall muscles from ruin so that when the brain can again connect the detrussor will still be able to function.  Dr. Fingeroth is a renowned ortho specialist (ACVS) educating veteriarians why the need to pay attention to a parlayzed dog's bladder.  


Can you go for a 2nd opinion on getting help in expressing Pickles? A consult with a board certified neuro (ACVIM) can help to deterimine where the spinal cord damage is, what/if meds can help leaking which a general DVM vet may not be as knowledgeable about.

Using this search tool for specialists there may be others with a further search than this one 35 miles away from you: find.vetspecialists.com
Allison Haley DVM, MRCVS, DACVIM (Neurology) 2100 W Silver Spring Dr
Glendale, WI 53209

A dog's nose is so much more powerful than a human's. Dog's often can smell an infection in the urine and want to lick it--- a clue we should follow up on to confirm.      A follow-up UA really needs to be done before the end of the antibiotics to verify this leaking/dribbling is not still bacteria infection related. If the antibiotic is the correct match for the bacteria, bacteria should clear up within the first 24-48 hours so by the last few days of the prescription the urine should show NO indication of infection.  
      The urine culture results on 9/8 named the bacteria. Could be a couple of reasons to follow up on if there might still be an infection going on. Perhaps the Amox/clav dose and length of use were not correct if there is still infection. A clone of the original bacterium developed with a different requirement to kill it. Might be a missed underlying cause for infection not cleared up such as bladder stones.

Update, Mr Pickles has now been off the Amox/Clav antibiotic for a few days now. The vet wants to wait a few more days before doing another urine culture to make sure the UTI is gone. I'm going to have the vet do a full work up so we can see how his innards are holding up to the barrage of medications... A UA, urine culture, blood panel and a CBC. We can then compare the results to the results from when this all started - pre medications.

Mr Pickles is also whining a lot now. Boredom definitely, but also, he's pointing to the door. Thinking he had to go potty, thinking maybe his bladder control is coming back, I took him outside. Before anyone freaks out with this.... I was very careful not to move his back and I did not let him scoot while outside. When I placed him in the fresh cut grass, he sat there for a minute or two, in the sun, looking around, smelling the air, he looked very relieved and relaxed. He then took the pose of his pre-IVDD self when he would urinate - he stuck his neck out, nose forward and remained like that for about the duration of a usual urination. When I picked him up, there was a pretty good size wetness under him.

So, now comes the question.

Do I take him outside on a schedule now? The amount of movement to take him outside has far less movement than trying to express him... which he very much dislikes.

Second question.

How do I check to see if he still needs the Tramadol, Methocarbamol and Gabapentin? I'm asking this because he seems so comfortable now with the meds and the fact that a couple days, I was not home for when he was scheduled for a Tramadol and a scheduled Gabapentin, when I came back home both times, it was too close to his next scheduled doses, but yet, there was no quivering or shaking and he looked bright and happy yet.

He's on 50mg Tramadol 3x daily, 100mg Gabapentin 2x daily and 500mg Methocarbamol 2x daily.... as well as the 10mg Prednisone 2x daily with 10mg Pepcid AC 30 minutes before the Prednisone.

[Moderator's note: please do not edit
18.5 lbs.
Meloxicam as of 9/5??? for one day- stopped on 9/5
No stomach protection for NSAID to steroid switch!
Dexamethasone sub-q injections ?mgs in one mL as of 9/6: ?mgs (4.25mL) 3x/day for 1 day
                                                as of 9/7: ?mgs (0.4mL) 2x/day for 5 days then 9/12 taper to test for pain/neuro loss
Prednisone as of 9/13: 10mgs 2x/day for 7 days,
                       as of 9/20 anti-inflammatory dose: 10 mgs 1x/day for ? days,  then a taper to test for pain/neuro
Tramadol 50 mgs 3x/day
Gabapentin 100mgs every ▼2x/day
Methocarbamol 500mg tab: ? mgs 2x/day 7 days worth!?
Pepcid AC 10 mgs 2x/day
Lorazepam (tranquilizer) 0.25mg 2x/day]

Should I try a staggered 1x daily ( like a 6am Gabapentin, 12 noon Tramadol, 6pm Methocarbamol kind of schedule???) for a few days to see how he reacts? The Prednisone and Pepcid AC -- that would remain the normal 2x daily schedule.

The Epsom salt soaks, that dried up that rash real quick. We have been putting the A and D ointment on him and have the rash under control. An occasional red spot, but really nothing like there was. If I can get him on a schedule to go potty outside, I think we might be able to eliminate this whole pee pad/rash/fleece wicking layer thing completely.

It's been a while since I posted an update so here goes. Its well past 8 weeks now...

Mr Pickles is off all medications, has been off for 2 weeks now. He seems to NOT be in pain although he does start shaking one in a while after getting excited and bouncing about like when we would come home after a few hours out. The shaking quickly stops after holding him with a bit of a hug so I think the shaking is just anxiety.

As for walking... no, nothing yet. The legs twitch, they sometimes push back with resistance, they move about when he's in the wheel chair, but not coordinated like walking motion... but no walking or lifting his rear. At times he whines like he wants to go outside to go to the bathroom. Its now basically winter here so taking him outside is a real challenge. We put him in the wheel chair and he'll scoot around. We have not noticed if he urinates out there, he's kind of sneaky with that. After scooting around he does poo... it does not really matter if outside or inside, he just does it. Again, I don't know if its under his control. Its about every 4-6hrs.

We put him in a baby sleep-sack with a belly band so its easier for him to scoot around on the hardwood floors in the house. Cheaper than getting a dragbag.

We change the bedding in his play pen about every 6 hrs unless he makes a big poo mess ... then its sooner. That consists of a pee pad with a layer of fleece over the top, then a fleece blanket clipped to the rails of the play pen to make a tent like spot for him to cuddle up in. With the sleep-sack / belly band thing, its easier and cleaner to have him join us on the couch or on the bed like he usually would... buried under the pillows. but that is under supervision. If we are going to bed or occupied with something, he goes back in his pen to stay safe and not fall off.

I have run across a bit of an issue. The skin where it would be in contact with the fleece, most of the time urinated on, he's getting blackish spots and his heels , the fur is turning black - again where it would be in contact with the urine/fleece. He gets wiped up with scent free Huggies wipes every time we change his bedding. The last change of the night he gets slathered with A&D ointment and at least once a week he gets a quickie bath. Little to no redness or rash... he gets a little from the belly band elastic but that is it. I'm not sure what to make of these blackish spots about the size of a pencil eraser. It reminds me of mold/mildew.

The only other concern is his licking of his urine. We hear him doing it and we interrupt him, but when we are not looking he does it, when we are away or sleeping, I'm sure he's doing it. His urine had been getting a strong smell... I would expect it would if he's "recycling" the waste product. We have been interrupting that waste / toxin recycling with the use of belly bands to absorb it before he can lick it. Other than a belly band, if there any other suggestions... "no-chew" bitter apple spray on his -thang-?

Dave, congratulations in having Mr. Pickles do all 8 weeks of rest to heal his disc.

You do not mention the single most important care for bladder health for a dog who does not yet have bladder control — expressing his bladder every 4-6 hrs goal when you are proficient at expressing.  Please  let us know you express Mr Pickles and how often you are expressing
          Expressing review:        < www.dodgerslist.com/literature/Expressing.htm >
 
OR tell us you are observing he does have bladder control but you are not consistently able to let him doors to pee  outside.

To truly tell if a dog is peeing requires observing them sniff an old pee spot, releasing urine there.  Then you verifying an empty bladder by doing a quick  express check.  
What you report sounds very much like reflexes are expelling both poop and urine. Reflexes for poop is not a health issue.  Not expressing a dog who has no bladder control and instead allowing reflexes to release urine is a dangerous road for Mr. Pickles in two ways as Dr. Fingeroth explained:
1) Continual over stretching of the bladder wall such as to cause reflexes to kick in and release urine (overflowing), will ruin the tone of the bladder. Then when the brain is able to again send a message to the bladder, the bladder won't work anymore!
2) Reflexes can't void all the bladder. The urine remaining quickly becomes a breeding ground for bacteria. The concern of not treating an infection is the infection can move up to the kidneys where it become life threatening.
----What is the last time Mr. Pickles has had a urinalysis to see if bacteria are the cause of the strong odor?
----Not all UTIs will have things you can observe such as strong odor, change in color, dribbling urine, fever, painful burning as urine is released. A urinalysis is the way to proove infection or no infection.
----Expressing for poop is to avoid Mr. Pickles being anxious in finding poop in his bedding. Watch this video and read the tips to learn this easy skill:  
         www.dodgerslist.com/literature/Expressing.htm#poop

Is Mr. Pickles licking his penis?  
--- could well be because he can smell the infection in his urine OR 
--- licking penis can be a sign of neuropathic pain (phantom nerve pain).
Everyone has experienced numbness or pins and needles tingling in your legs when sitting in a bad position for too long a time.  Your dog can be feeling abnormal nerve sensations that are mild pins and needles to quite painful burning, on-fire feeling that makes them bite to stop the pain. These are abnormal signals explaining why a paralyzed dog can feel this neuropathic pain.  

You would need to stay on top of observing for any more signs of chewing on body parts as this can lead to death.  Immediately put a e-collar on or a lengthwise folded towel and secured closed with duct tape.  Get to a vet for a medicine that can help to control these very painful sensations.  The name of the drug is called gabapentin.


forum.greytalk.com/index.php/topic/220138-create-your-own-surgical-collar/



What does your vet say the black spots on the skin is?
Let us know about these very serious things:
---are you expressing, how often?
---Did you ever get a lesson on expressing urine?
--- Can Mr. Pickle spass the sniff and pee test to prove he has bladder control?
-- What is the last time he has had a urinalysis to prove no bladder infection (UTI)?
-- is Mr. Pickles licking, chewing, obsessing on any other part of his body...leg, tail that would lead to the possible conclusion ofneuropathic pain and the need to get gabapentin on board?

Hi Dave,

Good sign of Pickles moving the one foot correctly and perhaps you did see him urinate on his own outside.. Sometime during the day take him outside to one of his favorite pee spots and see if he sniffs and then releases urine..   Be sure to do a quick express to make sure he's empty..    A dog shows signs they are having a UTI by paying extra attention to licking that area..  Let us know the Urinalysis results..  


Glad Mr Pickles is showing signs of nerve healing!  

Gabapentin and the NSAID Meloxidy can be used for many reasons besides for disc episodes. What is the reason your vet gave? Did it make sense? IVDD savvy pet parents don't blindly follow anything....we want to know the details, the reasoning behind all treatments our dogs receive. That puts us in position to decline well intentioned but harmful advice.


If getting back on these drugs is related to his current disc issue, it would not make any sense at all. Pick is not in pain since being off of those meds--- meaning Meloxidyl has finished its job. To use it when there is no swelling to work on just means exposure to ALL the serious risks but no benefit to take advantage of--- pretty one sided risk but no benefit! Meloxidyl has nothing to do with the body's ability to self heal nerves. In fact off of Meloxidyl, youve reported improved neuro signs of pushing with leg, not knuckling with left paw!

The reasons for using during a disc episode are:
Meloxidyl is used until all painful swelling of tissue in the spinal cord area is gone.
Gabapentin is used to help quell painful nerves
Neuropathic, phantom pain

If there is any reason to believe Pick is back in pain because of a new disc episode, then back to 100% strict rest most certainly when pain meds and NSAID are on board. As he'd feel better and overdo things. Crating is to protect the spinal cord from severe, permanent damage.

Please let us know more about the why and the reason behind the why of going back on meds.

ALL anti-inflammatory drugs (NSAIDs or steroids) cause extra stomach acids. Pepcid AC suppresses stomach acids.

It is not easy to express in a wheelchair. In a pinch you could certainly do it. My concern is always expressing in a cart may mean one is not fuly able to void the bladder thus inviting a UTI.

Dave, anti-inflammatory drugs and pain meds do nothing to prevent a disc episode. They work at the time of a disc episode to reduce inflammation and provide comfort from pain. When the pain is gone, the inflammation is gone and no need of any medications. There is no such thing as "maintenance" use of anti-inflammatory drugs to prevent a disc episode.

The testing for the ability to recognize noxious stimulation (deep pain sensation) is a totally different thing than a dog suffering in pain such as during a disc episode. Take only the word of a board certified neuro (ACVIM) or ortho (ACVS) about deep pain sensation (DPS). The testing for this last neuro function is a very tricky one. Most general DVM vets do not have the training, nor the practiced eye to pick up on the subtleties to give correct identification about DPS. Right now knowing is not even an important thing as it will come back if possible on its own..only time will tell. BUT it would be very, very important to know if there would be another disc episode in the future and deciding on a surgery.

No one can make a mistake about the next neuro function to return after DPS would return....the happy tail wag IF Pick saw, hear,d or smelled you approaching with a yummy treat!  Can he do that, give you a happy tail wag as a greeting or anticipation of a treat?


Now that Mr. Pickles has graduated, and should still be off all meds, can travel with safety with his now healed disc, you may wish to spend $150 for a consultation with a board certified neuro specialist (ACVIM). The consult would be to educate yourself as you seek to hire an IVDD knowledgable general DVM vet to be in Pick's IVDD health care team. While your vet may be very good with the everyday things, he has shown by several examples including at the outset a dangerous use of Meloxicam and Dex to not be up to speed on IVDD. No vet can know every disease in detail. You, however, can read and learn just one disease enough to monitor, hire and protect Pickels. Either you received a great deal of misinformation in the last visit OR not yet being fully up to speed on IVDD, information was bewildering and hard to make sense of.

It is plain that you love your Mr. Pickles so much in all your devotion to caring for him. I hope you will be able to "up" your IVDD knowledge with either a Neuro consult or delve more into the information at this link: www.dodgerslist.com/healingindex.htm

With IVDD knowledge you will be confident in your ability to qualify those who offer advice and treatments, hire the right IVDD vet. You can qualify us by seeing what other veterinary professionals say about us and who we align with at this link:    www.dodgerslist.com/index/education.htm

Too much fiber can cause constipation.... avoid givein 1/4 cup pumpkin.  Use a teaspoon ot measure pumpkin puree.

Plain pureed canned 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 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 two teaspoons 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.  Since Red weighs 20 lbs that would be a max of 2 teaspoons of pumpkin or one of the other high fiber foods mentioned above.

Are you soaking his kibble meals in equal part of water?

Ok, thanks for the info on the pumpkin. I was under the assumption that fiber will create bulk poo and long with the moisture contained within, that will help him stay hydrated if he is in fact getting dehydrated for whatever reason.

In the past we have tried water in his kibble. He refused to eat it.

So I'm thinking on kibble and chicken stock or chicken broth. Leaning towards the chicken stock since it has more fat.


A little more update info on Mr Pickles:

Pickles really plumped up in the last year. He's not this lean, meaty, muscular dachshund anymore.... he's a thick round, lump. 20lbs now, easily. He scoots in his chair, he scoots without his chair outside, Pepper wrestles with him which Pickles fiercely rrrarws back and chases Pepper the best he can. Its just not enough exercise. We have cut back his food, he's pretty much bare minimum food amount, but he's always hungry...

Movement:
Pickles can flip his left foot around to a more normal sitting position, sometimes he can move his right foot around to being forward also instead of dragged backwards. His right side is very weak though. We are able to help him stand and every now and then he can stand up on his own for a couple seconds. But being a year now of having no real muscle exercise, his leg muscles are weak and he can only stand with balance assistance for 15 seconds or so before slowly squatting down to a sitting position. When he is in his wheelchair, that left foot is kicking right along trying to walk with his motion. The right foot is more or less uncoordinated movement and typically has to be slung up so it does not drag.

[Original subject line:I'm guessing its been 5 years of IVDD, but now cancer. ]  

Why? We are good attentive dachshund parents. Mr Pickles is a good pup... why does so much bad happen to one little dog.

Mr Pickles is our first dachshund, we had the hard lessons in IVDD because he is our first. Within a couple months of Picky going down, our other dachshund Red, he also went down with IVDD, probably because we did not know of the IVDD prevention measures until after Picky went down.  But Red had it worse and wound up injuring himself to the point where we had to put him down. With Picky, IVDD slowed him down, but didn't stop him. He never gave up. Within a year after going down with IVDD, he relearned to control his bladder and butt. Over the years some feeling came back to his tail and feet,over the last year or two he's been moving his legs, sometimes deliberate, other times involuntary. But within the last few months Picky had been pushing with one leg to scoot around. Now, cancer is in the picture. 

About 8 months ago he got a urinary tract infection. It cleared up easily. 6 months later he got another UTI. We and the vet just assumed its because his "unit" is always down on the floor or in his playpen on the fleece and because he is overweight from being a couch potato... A different antibiotic with a little longer of a dosing schedule to try and get anything that might be hiding deeper. The UTI cleared up easily and quickly again.

2 months later, Last Friday, he went back to the vet with another UTI. The Vet was going to cath him to get a clean catch to do a culture, but when they put the ultrasound on him, they saw a mass on his bladder. The vet says it appears to be TCC - Transitional Cell Carcinoma, about half the size of his bladder. The vet explained in detail what was what, what to watch out for and what will eventually happen and sent Picky home with an antibiotic for the infection and Vetprofen for any pain. She also said that Vetprofen may slow the progress of the cancer. 

After loosing our two big dogs last year, our girlie dog who was the "mama" of the whole bunch, she had a series of strokes and the other big dog passed of old age, now Picky developing cancer, this is getting very hard, very emotional, very trying.

Picky is a very happy and determined 12yr old pup. He gets a new stuffy squeaky or two, every day, he pops the squeakers with his hard play and "sings" while he's squeaking them. He also has a very large collection of JW rubber squeakers, every week he gets a new one. Picky loves his chopped carrots after his meals and makes a big scene if you are late with it. He use to get a few whole baby carrots but his teeth are getting bad so we now use a -SlapChop- to chop the baby carrots for him. He gets carrots because the carrots keeps his poo manageable without the need for any laxatives, oils or supplements. He plays VERY loudly with the young punk Mr. Pepper - he's 3yrs old, Picky helped soooo much raising Peppy from a pup. Those two are like brothers. Now that it is warmer and the snow is gone, Picky goes outside and enjoys nature in the backyard. I doubt he knows what is happening but we do and it hurts so much.

I have a couple questions. 

Vetprofen ( Carprofen ) , Picky is a 27 lbs and gets 50mg once a day. That drug is an NSAID. Should I be giving Picky Pepcid AC with this NSAID? Its been so long since he was on any pain meds, I cannot remember what he was on so that is why I'm asking about the Pepcid.

Does anyone have any tips for dealing with a pup with bladder cancer?  At this time we are monitoring his urine output so we can have a heads up if the cancer starts blocking the flow. I know what its like to have kidney stones so I know the pain if the ureter would get restricted and start backing up into the kidney... If the urethra gets blocked, we would be able to feel the distension of the bladder... either situation, we would need to put him down. Is there anything we can do to slow down the progression? Since we don't have a series of imaging to gage the speed, the vet is saying 1 to 6 months. 

Thanks




 

Big Picky and his sidekick Peppy.... lazy morning.

Dave, thanks for sharing. What fun to watch Picky having such fun destroying his new toy.