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Post by Cassondra W on Jul 20, 2013 18:02:04 GMT -7
Spanky was diagnosed with a calcified disc on June 1st (L1 -L2). The vet prescribed Tramadol and Prednosone for two weeks and advised to keep him quiet. We also were advised to take him for chiropractic adjustments, which we did. The first time it seemed to help and then after that it seemed to hurt and he started to back slide. We stopped. He was still in pain, so the vet prescribed additional Prednisone and more Tramadol. On July 3rd, he was in a great deal of pain, more so than he had been. My vet had me go see a neurologist that day. They advised he needed an MRI and likely surgery. I advised that I did not have the funds to pursue that avenue. They prescribed Codeine and a low dose of Gapapentin (1ml 3 X a day, for a week, then 2x a day for a week, then 1x a day for the final week). They advised that if that didn't work, I should euthanize my dog if I could not afford surgery. I researched and found a vet that does acupuncture and other conservative treatments. Spanky can still walk, although, only slowly and he is wobbly in the hind end. He can poop and pee still, although, his blankets are stinky, so I think he is leaking urine in his bed. We currently have him on Tramadol (25mg) 3-4 times a day, methocarbamol (90mg) 3 times a day and Gapapentin (100mg) twice a day as well as fish oil & Dok's supplement. He has had laser treatment twice a week for the last two weeks, has had Aqua-puncture once during that time, and now electro-acupuncture twice. He is still in pain. Probably our biggest failing is that, in the beginning, we were told it would be better if he was allowed to move around a little, so we would allow him to walk around the house a little when he was having spasms. We carry him to and from his potty location and he is enclosed in a small area where he can only get to his food and water. At this point, we do understand he needs complete rest and is confined, but we cannot control his pain and wonder if there is anything else we can do, or if we have ruined any chances he has for recovery. We are trying to raise funds for surgery, if it comes to that, but right now, conservative therapy is our only option.
[Editor added this post from Facebook] I have a 4-yr old doxie that has a calcified disc. We have been trying to treat it for almost 2 months conservatively. I am not able to afford surgery, so we are trying everything we can, acupuncture (have tried the fluid injection kind and the electric kind), laser treatments, Tramadol, Gabapentin, Methocarbamol, and various other supplements. He has shown no improvement and we are at a point where we are not able to manage his pain. We fear there is only one answer. I know your site says otherwise, but the recovery time is not supposed to be them being crated and living in pain everyday, is it? Do you have any other recommendations for his pain?
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Post by Pauliana on Jul 20, 2013 19:42:11 GMT -7
Welcome to Dodgers List. My name is Pauliana, what is your name? :)I am so sorry that Spanky has Calcified discs and is going through an IVDD episode. Conservative treatment is a perfectly reasonable path of treatment and no one, not even a neurologist, can tell you how well any dog will recover - surgery or not! Here is some info about Calcified discs: www.dodgerslist.com/literature/CalcifiedDiscs.htmWhat date did you start crate rest? I am glad you have started Spanky on 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks, it is the SINGLE most important thing you can do to help Spanky- it is the hallmark component of conservative treatment. …. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM). Chiropractic is not recommended for IVDD dogs. In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc. The crate is the only surface that is firm, supportive for the spine, not inclining, always horizontal and keeps a dog from darting off at a TV doorbell and safe. The rest of the details of doing crate rest to ensure the best recovery in this excellent document: www.dodgerslist.com/literature/CrateRRP.htm and also this document tells how to set up the crate with an arrangement that is easier to clean. www.dodgerslist.com/literature/cratesupplies.htmThe purpose of crate rest is to act as a cast of sorts to let the disc heal… only limited movement of STRICT crate rest allows that to happen…there are no meds to heal a disc. Immediate neuro improvement may or may not come during the 8 weeks of crate rest… as nerves may take more than 8 weeks to heal. Since he is leaking urine, if it smells strong and is dark colored he could have a Urinary tract infection. If so take a urine sample to your Vet to be tested. Also leaking means he is overflowing. If he can go outside and sniff and release urine he still has bladder control.. Leaking can mean that he isn't going often enough or he is beginning to lose bladder control. If he fails the sniff and pee test then it would be necessary to learn how to express his bladder. www.dodgerslist.com/literature/Expressing.htmI am glad you have been taking Spanky for Laser light therapy, Aqua acupuncture and electroacupuncture which sends a microcurrent of electricity to and from acupuncture points (which are really big nerve bundles). This can be very beneficial at helping to re-establish the nerve connections in the body. Any one of these therapies can be started right away if in your budget... they not only help relieve pain and inflammation but will kick start nerves to begin regeneration. Find a holistic vet here: ahvma.org/Widgets/FindVet.html www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] NOTE: Chiropractic is not recommended for IVDD dogs Here is a great place to start your reading - becoming a reader is going to be yours and Spanky's best defense against this disease. www.dodgerslist.com/healingindex.htmYou should contact your new Vet about Spanky's pain control - he should not be hurting at all, and if he is showing signs of pain as you approach his next does of pain medication, then it needs to increased in dose or frequency. He can't heal as long as he is pain and there is still room in those dosages for increases. He also needs Pepcid to protect his stomach. You can buy this at the drug store over the counter. We follow proactive vets and give our approx 13-20 lbs doxies 5mg 30 mins prior to Prednisone. Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If he is still in pain and not on Prednisone, he should be started again on it to deal with the swelling.. The rule of thumb is pain=swelling and more time on Prednisone is needed. Some dogs need to be on it longer than two weeks, some require a month to address the inflammation in the spinal cord. Later on a taper can begin along with the elimination of pain meds and that is when you watch for signs of pain. If there is no further pain after the Prednisone is stopped, then no more medication is needed. Try not to despair - you are not alone anymore and we will do everything that we can to help you.. My Tyler is currently going through IVDD episode..and is on conservative treatment and crate rest for 8 weeks.. He We'll get through it and so will you and Spanky!! Sending healing thoughts across the miles! |
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Post by jochs311 on Jul 20, 2013 21:02:27 GMT -7
Hi welcome to Dodgerslist. My name is Jen. What's yours? I'm sorry to hear about Spanky. I'm happy to see that you have been very proactive in Spankys recovery until you found us and can educate yourself more on how importaint 100% strict crate rest is. This site has done wonders for me. The best advice I can give is to do as much reading as you can here. The knowledge that you will receive here is a godsend and will really help to ease your mind.
I was a mess when I found our Tucker dragging himself to greet me at my arrival home from work 4 weeks ago. Have you looked into accupuncture? Tucker had progressed great with accupuncture. I highly recommend it. The good thing is that it can be started at any time. I look forward to hearing about Spankys progress with conservative treatment. Positive thoughts and healing prayers sent your way.
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Post by Cassondra W on Jul 20, 2013 21:54:46 GMT -7
My name is Cassondra. We have started the STRICT crate rest just this past week. Before that, we thought it was okay to allow him to walk around a little bit in the evening when we were home. The rest of the time, he was confined to a very small area with a doggie bed. So, with crate rest, can he have blankets or padding in the crate? We currently have him in a doggie bed.
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Post by jochs311 on Jul 20, 2013 22:17:35 GMT -7
Hi Cassondra,
We use a flat bed that fit Tuckers crate that was wrapped in a garbage bag and taped to ensure no leakage because Tucker had lost bladder control. The garbage bag wrapped bed was them wrapped in a pee pad. Then a fleece blanket. Too much pillow could allow Spanky to move to much trying to get comfy. We also put blankets and clothing up as bumpers almost like a baby crib to make it more cozy. Putting a shirt or other article with your scent in the recovery suite makes it more relaxing.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 21, 2013 11:05:25 GMT -7
Cassondra, I'm so sorry to hear of Spanky's journey so far with this disc episode. Both not crating and chiro treatments have been a great disservice in getting the disc to heal and for cutting the time to get pain in control. Not every vet can know all diseases in detail…but you can know just one disease. Do take the link Pauliana gave so you are up to speed on Spanky's disease and can safely guide him to recovery!!! He is still a good candidate to recover under true conservative treatment!! jochs311 and Pauliana have give you some great suggestions on doing the hallmark component to recovering with conservative treatment: 100% STRICT crate rest 24/7 only out at potty times for 8 weeks. How much does he weigh? Good to see you do have a range to give 3-4 times a day. Are you now giving it every 6 hours (4x/day)? Again depending on his weight your vet may be able to increase the dose of methocarbamol and he may be able to prescribe gabapentin in smaller doses but more often. Pain control requires feedback to the vet so he knows more tweaking of meds is needed to get it just right for Spanky. Your vet is not comfortable in treating disc disease. You will have to be a strong advocate for the right meds. You may even have to hire another vet to give you and Spanky the proper support. www.dodgerslist.com/literature/VetchkList.htmYour current list of meds does not have prednisone on it. Pain meds do nothing to resolve inflammation/swelling in the spinal cord. Prednisone is the anti-inflammtory. Please get on the phone and advocate for it to be back on board. Often it takes being at the anti-inflamamtory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. Spanky's disc has not been allowed to heal with the Chiro and no crating..so he is kinda starting all over again. Rule of thumb is: pain = swelling = more time on Pred needed. Please let us know: 1. Prednisone is back on board. What is the dose in mg and how often you give it? 2. Pepcid AC is on board with Prednisone 3. Pain meds have been adjusted to give complete pain relief dose to dose. Please update the list above if changes were made. 4. YOu are doing 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks …. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM). The focus during conservative treatment is to limit the vertebrae in the back from moving and putting pressure on the bad disc. 5. You have brought in a sample of urine for a urinalysis. Ruling out a UTI is a good idea since you are finding urine leaks in his bedding. YOu will find a world of difference, once you get pain control managed now that you are doing 100% STRICT rest…. Spanky can heal!!!! |
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Post by Cassondra W on Jul 21, 2013 11:28:35 GMT -7
Thank you. Spanky was on Prednisone. I forgot to mention that one. He has been on that from the beginning. We have been tapering him off slowly. Tomorrow is his last dose. He started out the first two weeks on it, back in June, when he went off, he got worse,so we started him over for longer treatment and a longer tapering off time. I will talk to my vet to see if we should re evaluate that.
How often should I attempt to take him potty? We were just doing every few hours, but if being quiet is the key, is there a rule of thumb on this? He doesn't seem to go very often. It is difficult with him as his routine is to wander a bit before pooping or peeling.
Oh, and his weight is very good, he is approx 8 pounds
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 21, 2013 11:40:52 GMT -7
The less than anti-inflammatory dose of Pred explains the pain. The swelling in the spinal cord is clearly not all resolved. Please call the vet, ER today and get help for Spanky's pain. He need to be back on pred and perhaps even have his pain meds further adjusted. Have no patience with pain.
This is how the taper of pred works in general. Spanky is a different case because he has been deprived of the proper environment to heal in… poor crate rest and chiro.
During the time on the anti-inflammatory the pain meds do need to be adjusted so that there is no pain surfacing dose to dose of pain relief medications. Pain deters healing.
Often it takes being at the anti-inflamamtory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going by observing for pain and giving immediate feedback to the vet if you see pain. To have a clear picture on a taper, pain meds are also stopped or back off too.
Rule of thumb is:
pain = swelling = more time on Pred needed.
If there is no pain on the taper then it goes to completion. Then no meds at all are needed any longer.
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Post by Cassondra W on Jul 24, 2013 19:51:47 GMT -7
Spanky is back on the▲ Prednisone 2x daily again as of yesterday. I also purchased some Pepcid AC pills for him. Yesterday was a rough day for him as he had an episode of panting and some shaking. He was between doses of Tramadol, so there was not much I could do for him. He is better today and seems more relaxed. Our biggest challenge with him is potty time. He wants to walk and walk before he goes. We do have him on a leash, but he seems to need to walk around a little before he can poop or pee. I am trying to limit it as much as I can, but if he won't go, not sure what else to do. He had another laser treatment and electro acupuncture treatment this week and we see the vet again on Saturday. Hoping he remains in a comfortable state.
Are there some dogs that simply won't heal or become pain free on crate rest? I am assuming yes, since many choose surgery for their dogs, but curious about your experiences.
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Post by Pauliana on Jul 24, 2013 20:49:52 GMT -7
Hi Cassondra, As far as the walking and walking to get Spanky to pee, my Tyler was like that so we had to carry him to his most favorite potty to encourage him to go quickly. Once we started doing that, he went, we carried him back to his crate. That seemed to work the best for us. The other thing you could do is set up a puppy pen out in the yard and make it a limited size so he can't wander around.. Put it somewhere that is a favorite potty spot.. Don't allow him to walk except a few steps.. The important thing is to limit the movement of his back so his disc can heal. By the way take him every 2 to 3 hours while on Prednisone, it makes them very thirsty and therefore increases the need to urinate.. We decided on surgery for Tyler because he lost the use of his legs and was in extreme pain. They gave us a 95% chance of a normal recovery if he had surgery right then and since the Vet teaching hospital we took him to had a reasonable surgery rate, we went for it. Tyler recovered very well.. But 6 months later he is having a much milder episode and is on conservative crate rest for 8 weeks. He had his NSAID and Pain meds for a week and is now off of them and is pain free. Now he just has to rest in his crate.. Many dogs do recover on conservative care.. But if pain can't be controlled and they lose the use of their back legs, surgery is recommended. However as long as pain is under control, many dogs that have lost the use of their legs do recover on conservative care.. Getting pain under control is the most important step towards healing. Please read some of our success stories.. www.dodgerslist.com/monthstory.htmHopefully another course on the full anti inflammatory dose of Prednisone will get the swelling in his spinal cord down.. that is the source of the pain, once Prednisone gets that under control the pain will stop. |
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Post by Cassondra W on Jul 31, 2013 20:51:20 GMT -7
I believe we have Spanky's pain under control for the most part. He is still currently on his full dose of meds: The Tramadol, Gapapentin, Prednisone, methocarbamol and pepcid. We have him on crate rest and for a couple of days after being back on full strength Prednisone, we saw some improvement. Now, he seems to be declining again. His shoulders seem like they are getting swollen again. His pain seems okay, but he is getting very weak in the back end and wobbly. We had electro acupuncture done last Saturday and he is scheduled for another this week, but I don't really know if it is helping or not. Is my dog on the way to being paralyzed, or is this pretty typical for them to go in and out of the weakness? His appetite is good and he still has control of bowels and urination. I feel so helpless watching him go through this.
We are still struggling with the potty part because he has to walk a little bit before he can have a bowel movement. It hurts to push, so he has to walk around a little before he can. Sometimes he will go like 4 times in one session. I had to recently start giving him a little pumpkin because he was constipated. I know you have strict instructions to not let them walk more than a few steps, but I can't get him to go if I don't let him walk a little bit. I'm not talking like a 15 minute walk or anything long and drawn out, but he does have to walk around the yard a little bit to get it going.
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kimkiernan
New Member
Poppy walking well and gaining strength. Able to walk 30 minutes now.
Posts: 24 
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Post by kimkiernan on Aug 1, 2013 1:36:02 GMT -7
Hi Cassondra. I'm glad Spanky's back on the pred and his pain is getting better. Is he having problems assuming the proper position to poop? Does he still squat to poop or does it just fall out more or less as he is standing? What helped me with Poppy's pooping issues is to stimulate the bowels to move. Pumpkin is a great addition to his food. I find that works very well. www.dodgerslist.com/literature/Expressing.htm will show you how it's done. Sending my prayers for Spanky's recovery. I know how hard it is to watch him suffer. |
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Post by Cassondra W on Aug 1, 2013 6:28:42 GMT -7
He is able to still squat to poop. When he pees, he squats to start, but then walks and pees at the same time. The squatting is getting harder to do for him as he is getting so wobbly and weak.
He also seems to want to lay down less. Seems to want to be in sitting position mostly.
Thank you for your kind words, this whole thing is breaking my heart.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Aug 1, 2013 11:09:53 GMT -7
Cassondra, pain needs to be fully under control dose to dose of his pain meds. It does not sound like it is… relunctant to lie down, remaining in a sitting position is likely to be pain. Can you fill us in:
How many mg's of Pred do you give 2x/day?
How often do you actually give Tramadol 3 or 4 times a day. Have you been punctual in giving it?
Are you seeing any pain nearing the next dose of pain meds? Does he have pain after moving, say at potty times?
Your vet needs to know his pain is not under control YET. Gabapentin can be given 3x a day so your vet has options still to get the pain controlled. He needs your feedback…have you been in touch with him today? Be persistent.
Tell us more about his shoulders being swollen…what do you observe?
Are you giving extra water with the pumpkin? Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. 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. To firm up the stool add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.
Are you using a sling at potty time to keep his rear from tipping over. Have you set up a fenced 6 foot diameter area in the grass with an ex-pen or some of the poke in the ground garden edging fence. That will let Spanky know that he will not be doing any sniff fests.
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Post by Cassondra W on Aug 1, 2013 16:19:39 GMT -7
yes, I have been in constant contact with my vet. We email back and forth almost daily. His meds have been on a very regular schedule. He was getting the 25mg of Tramadol every 6 hours, but now we cut out one of the doses, so he gets them ▼ [tramadol] 3 times a day at an 8-9 hour interval. He is still getting the Prednisone twice daily. He gets half of a 5mg tablet. I am supposed to drop him down to one time a day, starting today, but I am taking Spanky to the vet tonight and will discuss that with her. Spanky gets 1/8th of a 750mg Methocarbamol tablet three times a day. He gets Gapapentin 2x a day and they are 100mg's each.
I have not been using a sling as he was handling things pretty well on his own up until the last two days. I will have to begin doing so, although, not real sure how he is going to take to that.
I would say his pain is after potty times mostly. He was spending most of his time in his bed, but now he seems to prefer the floor instead. His bed has about a 2 inch thick egg carton foam mattress in it and sometimes he would sit his butt on the edge of it and put his feet on the floor. It must offer some sort of relief to sit like that, I am guessing.
Spanky's shoulder swelling seemed to be getting better and he was seeming happy on the first couple of days we put him back on the Prednisone, but now it seems that it is getting rounder around his shoulders again. He used to cry every time you even tried to touch his back or pet him in any way, and when you pick him up but he doesn't do that anymore, for the most part. But he still doesn't seem happy. We really only got a good result from the renewed course of Prednisone for a few days. And now, his back end is failing, getting progressively worse each day.
When I give him his fish oil and supplements in soft food twice a day, that is when I add the pumpkin and I add low sodium beef broth to it. He has free choice water and hard kibble all day. I give him most of his pills in Pill Pockets.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Aug 1, 2013 20:15:12 GMT -7
Cassondara, Spanky's pain is simply not under control YET if he is not happy, pain after potty time.
1. You cut back on his pain med Tramadol down to 3x a day form 4 times a day. Why?
2. When there is pain that is not the time to taper off of prednisone as there is still swelling that is going on this drug needs to work on.
3. When you told your vet about your observations of pain, why did he not adjust the meds…Gabapentin could be given 3x a day, why did he tell you not to lower the dose of tramadol?
Is Spanky's recovery suite only enough room to stand up, lie down and fully stretch out his legs, and to turn around in? Or is it bigger. How does he sit with his butt on the mattress and then have room to put his feet on the floor?
We look forward to hearing what the vet says.
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Post by Cassondra W on Aug 1, 2013 20:58:04 GMT -7
I cut back on the tramadol per discussion with the vet. My vet advised that Spanky is already on a high dose of Gabapentin at 100mg 2x a day and did not feel he needs more. She feels that is why he is now walking wobbly, as that can be a side effect of that particular med. She was able to completely palpate him without him wincing or crying and he had normal reactions to her testing his reflexes. She has not been able to do that up to this point without him reacting. Spanky's recovery area is made up of an xpen with his bed in it and a small area for his food and water. His bed is pretty small, but yes, he can lay down and stretch out in it.
The reality of the situation is that my husband and I work full time. I am able to medicate him in the morning, my sister comes and gives him his mid day meds and I care for his meds before bed. I also believe that Spanky is depressed being locked up. I may be misinterpreting his unhappiness as pain when really it may be that he is just depressed. It is very difficult to watch his every move and try and interpret it.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Aug 1, 2013 21:15:20 GMT -7
You and the vet do need to agree that Spanky is not in pain. We can only go on what you report. You know your dog best, if his pain is actually under control. The proof of whether all the swelling is really gone is on the taper, where pain meds are also backed off to get an accurate picture if pred should be continued or go to completion of the taper.
Gabapentin would cover pain better if given 3x a day at even a less dose. 100mg doses 2x a day is a very high dose for an 8 pound dog. My 13 pound took 33mg spread out 3x a day.
Prednisone can make them feel warm and that could be a reason he finds coolness on the floor.
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