PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Dec 4, 2018 12:54:29 GMT -7
Welcome, Martin,who is the one (?) writing! First thing to know it is VERY early in the nerve healing department.... better to think in terms of months rather than days/weeks for the body to self repair nerves. The 8 weeks of crate rest is for the purpose of getting the disc to form secure scar tissue. Nerve function may not come back in the short time it takes to heal the disc. Sometimes it does and many times it takes longer. So have patience with nerve healing. Pain is one thing you never have any patience with. If the shivering is not due to being anxious or cold, then it is pain. Seeing another sign of pain helps to confirm. Let us know more about that shivering.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 ◻︎ not their normal perky interested in life selves If the pain meds are not yet right, please contact your vet ASAP to report your observations so meds can be adjusted. Advocate for any of the pain meds be given 3x/day (every 8 hours) for round the clock coverage. — Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock. How often are you actually giving tramadol...every 8 hrs or every 12. You should be giving it every 8 from now on never on an as needed basis. EXPRESSING This is a new skill you are learning. Sounds like you may need another hands-on-top-of-your-hands type of lesson. First read and view the video at this page to get more out of another lesson at the clinic: www.dodgerslist.com/literature/Expressing.htm YOu can also express for poop to avoid accidents..are you doing that?
While on Pred, expect to express every 2-3 hours while learning. As you become skillful and she is staying dry right up to the next session, then move to every 3-4 hrs, then every 4-6 hrs. At night easily you can go to eery 8 hrs expressing so that you get a good night's sleep. Check our supplies list for using the baby wipes or brewed tea to keep fur/skin free of urine PLUS many other wonderful tips to help with crate rest: www.dodgerslist.com/literature/cratesupplies.htmUse unscented baby wipes for quick clean up on your doxie. 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.
You are right to be concerned about transports, risking too much movement and having a setback with the healing disc. Vets who know IVDD, understand this and your giving phone reports a bout pain, neuro issues can get meds adjusted by phone very often than not. Understand your job at home on the test taper of prednisone scheduled for Dec 14. Also why you'll need a Plan B inprep for the taper, which your vet wants.... backing off of pain masking pain meds or the full stop when the pred taper starts. Here is the information...let's chat if there is anything you'd like more detail on. LInk: www.dodgerslist.com/literature/healingsweling.htmOur emergency crate training page has some good pointers for you: www.dodgerslist.com/literature/EmergencyCrate%20Training.htm--- Some dogs like being up high to see more. Place recovery suite on a sturdy table. -- Important that the foot and water bowls are inside the suite attached to a side panel. Strict rest means only out for expressing and the most important of have to vet visits.
Bookmark a thread to receive an email alert when someone has replied 1. Go to your Profile> Profile Edit > Notifications: checkmark BOOKMARKS 2. Go to the your dog's Board: checkmark your dog's thread, then use the ACTIONS button to select bookmark]
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Post by Romy & Frankie on Dec 4, 2018 14:56:45 GMT -7
There is no reason to even consider euthanasia. It is very early on in Delphine's healing and a lot of healing will still take place. Many dogs recover using Conservative treatment. Recovery does take time as nerves are slow to heal. Even if Delphine does not fully recover, she can lead a happy life. When I think about dogs that do not regain full neuro functions, I like to think of this video: It is important to know that disc disease is not a death sentence! If you are struggling with quality of life questions for Delphine, re-think things: www.dodgerslist.com/index/SDUNCANquality.htmPain can sometimes be hard to determine. If Delphine is showing more than one sign of pain she is likely to be in pain. I am listing the signs of pain again here for your easy reference; 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. Delphine should be pain free now and in the future. The swelling in the spinal cord is what causes pain. The swelling will be reduced by the pred. It can take up to 30 days on the full dose of pred before the spinal cord swelling and therefore the pain is gone. During the time the pred is doing its job, the pain meds take care of the pain. There are a few dogs that will require long term meds to remain pain free. In that case, the smallest effective amount should be given. A dog should be pain free, paralyzed or not. Vets have many ways to address pain. Here is some information as to what to look for in a vet that treats IVDD along with a link to some member recommendations. www.dodgerslist.com/literature/VetchkList.htm
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Marjorie
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Post by Marjorie on Dec 5, 2018 5:22:15 GMT -7
Pain is most often seen when a dog moves at potty time and since you're seeing two possible signs of pain, shivering and making a sound when moving, I would err on the side of caution and notify the vet so Delphine's pain meds can be adjusted. You know your dog best but if you sometimes feel she may be in pain, get that pain completely under control. The vet has room to move up the dosage of the Tramadol to 50 mg 3x/day and Gabapentin can also be added. Please speak to your current vet ASAP this morning to speak to them about this. It can take 7-30 days for the swelling to resolve. It's that swelling pressing on the nerves of the spine that causes pain and can damage the nerves. Vets usually prescribe Prednisone for 7-14 days, then stop all meds to test for pain/swelling. If there's still pain upon the stopping of meds, then there is still swelling and still a need for the original anti-inflammatory dosage of the Prednisone and the rest of the meds. If there is no pain, then there is no need for further meds. The Methocarbamol has been prescribed for 10 days so that will have stopped by the time the Prednisone starts to taper. What you need to ask the vet is whether the Tramadol will also be stopped when Prednisone starts to taper. It should be stopped so you can do a good test for pain with no pain meds on board to mask the pain that you need to see to determine if Prednisone is still needed. Always have a plan with the vet in place for what should be done during holidays. Please take a look at the following link so you have a good understanding of how the taper of the anti-inflammatory works: dodgerslist.com/literature/healingsweling.htmHow are you doing expressing Delphine? Finding wet bedding or does she leak on you when picked up? The goal is for her to stay dry between expressing. What is the reason for you to speak to another vet on Saturday? It would seem that your current vet is prescribing appropriate meds and hopefully will work with you on adjusting the pain meds once you advise of possible signs of pain. A new vet will most likely want to examine Delphine. Transport to a vet during strict crate rest is risky with the possibility of too much movement of the spine. The following link has some ideas on how to help Delphine adjust to the crate. Know that you're doing the right thing strictly crating her for 8 weeks. Think of the crate as a cast for the spine. That may help you accept it. Nerves can take a very long time to heal, months, even a year or more, but heal they can. So hang in there. It's obvious you care very much about Delphine and are doing what's best for her. Healing prayers for Delphine.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Dec 5, 2018 9:53:04 GMT -7
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 5, 2018 10:04:37 GMT -7
Martin, how often are you expressing? While on pred that would typically be every 2-3 hrs as your learning a new skill. As you find she stays dry session to session, then you can move up to every 3-4, then every 4-6. Overflowing is a bad thing. Not just the damage to it getting in her skin/fur and causing urine scald, but also more severe consquences. -- No baths while on crate rest for the 8 weeks. Are you using baby wipes and green tea to get urine off her skin? This tip and many other good ones comes including how to set up the mattress system from our supply list at the Main Dodgerslist web site. www.dodgerslist.com/literature/cratesupplies.htm Use unscented baby wipes for quick clean up on your doxie. 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.
-- Two other reasons overflowing is a bad thing. 1) Overflowing does not remove all old urine from the bladder, just some of it. The part that remains can very quickly in days become a raging urinary tract infection. Sometimes there are no obvious signs such as foul urine odor, leaking urine frequently, change in color. It would very likely be a good idea to get a urinalysis at the vet clinic, to make sure no infection is going on with three days of not expressing and then your learning to hone your expressing skills. The concern if infection is that is moves up to the kidneys where it becomes life threatening. 2) Overflowing happens at the point the bladder wall becomes so overstretched that reflexes kick in. Overstretching over time will ruin the tone of the bladder so it won't work when the brain can again send messages to the bladder. While on pred it is quite important to hire a vet. Pred is one med you want to be under the supervision of a vet. One you can call and alert to signs, helps you taper off pred as you monitor for pain during the test taper. You need vet support. Your self education helps you to zero in on the right vet to hire to be on Delphine's IVDD health care team. Methocarbamol is being stopped 4 days prior to the test for pain taper of pred starts on 12/10! This makes no sense. Pain meds are either stopped or backed off on the date the Test for pain pred taper starts. You need a vet who can support you through the taper. One who knows IVDD. This is how the taper typically works and is important reading in helping you get a sense if a vet knows IVDD: www.dodgerslist.com/literature/healingsweling.htmHiring an IVDD knowledgable vet today, getting another hands-on-top-of-your-hands type of lesson expressing lesson may just be quite a valuable visit to get more pointers on expressing, check into a urinalysis. First read and view the video at this page to get more out of the re-view lesson: www.dodgerslist.com/literature/Expressing.htm With knowledge you'll best able to hire the right vet, to dialog with your vet in a way that allows understanding a prescribed treatment (meds, rest, etc), and when you do not understand, the ability to ask good, pertinent questions on behalf of your furry loved one. image.ibb.co/dBfFbo/conserv_button5.jpgA great short summary to get a handle on conservative treatment in view of hiring a vet who will support it:www.dodgerslist.com/literature/healingpage.htm A handy little med reference card to carry with you. D/l here: www.dodgerslist.com/literature/MedCard.pdf and Marjorie's link to emergency crate training idea: www.dodgerslist.com/literature/EmergencyCrate%20Training.htm
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 5, 2018 18:58:01 GMT -7
Martin, not all vets can know every disease. Sorry this vet was not IVDD knowledgeable. At least you got pain meds so that all t hree sources of pain are covered and there should be no more shivering/trembling.
Gabapentin works synergistically with tramadol. It is very typical for vets who know IVDD to cover all sources of pain by Rxing three pain meds: tramadol, gabapentin and methocarbamol. Makes no sense to cease using tramadol and not have any general analgesic on board. Gabapentin is for nerve pain. Methocarbamol is for muscle contraction pain.
In all of Seattle there surely must be a vet who is knowledgeable about conservative treatment and the meds used with it. While you don't need a vet to tell you to how important crate rest is and no PT of any kind until all 8 weeks of rest has been completed, a vet who tells you that would just give greater confidence in their knowledge of IVDD.
Did you get to express Delphine in the clinic and have the vet or vet tech check your work...give extra expressing tips?
Look forward to the details on the meds. Preferable is not to go back an edit any of your past posts which have already been marked by one of the moderators.. Just make a new post so we are sure to no miss any new information.
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Post by Julie & Perry on Dec 5, 2018 19:02:51 GMT -7
First euthanasia is not necessary! Don't listen to that nonsense.
Second, only a trained neurologist can tell if deep pain is present.
One of my dogs supposedly had no deep pain according to a vet.
She's walking today.
It's waay too early to worry about that yet.
Delphine needs to rest and have time for her body to heal.
Unfortunately, many vets aren't familiar or comfortable with IVDD.
Tramadol and gabapentin actually work well together.
Tramadol works for general pain and gabapentin for nerve pain.
IVDD is painful and addressing that in more than one way works best.
Members here have dogs who have recovered completely, some with deficits, others who use wheels.
Dogs don't care if they're handicapped.
Even if Delphine doesn't completely recover she can have a very happy life!
Give her time and don't listen to people who recommend pts.
Hang in there.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 6, 2018 8:14:49 GMT -7
Martin, it would be best to NOT update old posts as we may miss important information. Just put the new information in a new post.
Trazodone is to help Delphine relax in her recovery suite IF, if, at times when she needs it. It is a good idea to give it when you can observe to see how long it lasts, if her behavior is more relaxed, etc. Then you can give it an hour before it is needed in the future with confidence.
It is good to know the range you can give gabapentin, but we need to know which you actually are giving every 8 or everty 12 hrs.
Was there a reason you did not express in the vet's clinic and have them check your work, give you tips or techniques? Learning to express is a skill to develop. The videos can be very helpful once you have had a lesson to let you know how much pressure your hands should apply...that really can't be described on a video. Also helpful for the vet/vet tech to help you find/feel the bladder as it gets smaller and escapes your hands to high up in the pelvic area.
Did the vet think there may be a possiblity of a UTI having already started since you were not expressing for the first couple of days and thereafter in the process of trying to get to a proficient level that she stayed dry session to expressing session?
What does no visible "improvements" on 12/5 mean? Improvement is too general a term when there are many areas that can improve: nerve function, pain, swelling, anxiety, etc.
A consult with a neuro (ACVIM) is not just for a surgery but can be because your local DVM vet is not comfortable in prescribing meds to fully keep pain at bay til Prednisone can complete its work of resolving all painful swelling. Getting pain in control is worth the risk of transporting to a new vet.
At the VSC, you may be seeing a general DVM, if you do not specifically have an appt with a neuro (ACVIM) speacilst. Would you be able to use this DVM as your primary vet, your new vet for Delphine? A primary vet who knows IVDD is your long term goal and for this disc episode.
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Post by Romy & Frankie on Dec 6, 2018 14:35:28 GMT -7
Glad to hear that Delphine is now cal and relaxed. Stale urine in the bladder is a health risk for Delphine. I am very surprised that you cannot get help in learning to express. I hope that going to VSC you will be able to find a regular DVM to take over Delphine's care. A urinalysis would tell if bacteria is present in the urine or not. It is a simple test. Then you and your vet would know for sure if Delphine had a UTI. Nerve healing takes time so not seeing any visible improvement after a week is common. We pet parents must be patient. I am not sure if you saw this page which gives some sample questions to ask.: www.dodgerslist.com/literature/VetchkList.htmPlease give us an update after you see the neuro
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 6, 2018 19:45:41 GMT -7
Martin, I know you are wondering if a dog paralyzed similar to Delphine ever walked again. I say you must take it step by step. The truth is each dog is an individual case. No one will be able to predict for Delphine. It will be mother nature and Delphine's body which tells the story. I think you will find it easier to have patience with nerve healing by knowing it is in the cards for Delphine to get back to enjoying family activities no matter if she is walking at the end of 8 weeks or needs an assist from a wheelchair while waiting on nerve repair to take place to the extent possible. Nerves are the slowest part of the body to self repair and may or may not come back in the short time it takes the disc to heal. Better to have in mind it may take months or even a year out rather than be checking every day and be disappointed or worried. I was interested in Dr. Spooner too. Here is what Googling his name came up with: Graduation Year: 2008 Erich M. Spoor, Denton :: graduated with honors in May as a doctor of veterinary medicine from Texas A&M University and is serving a one-year internship in animal surgery at Louisiana State University. He hopes to be awarded a three-year residency in neurology. He wishes to thank his professors at UNT [University of North Texas] for the excellent education that helped him survive veterinary school.
It's the season for matching prospective veterinary interns and residents with institutions and private practices. We're nearing the end of this interview process and will find out in the next week who may become a part of the VNC's Neurology Residency Program. Get to know our current neurology and neurosurgery resident, Dr. Erich Spoor, who is in his second year of our three-year program. VNC's FB page: Veterinary Neurological Center, February 3, 2017
Resident Name, Dates of Program, (Resident Advisor) Erich Spoor 7.6.15 - 7.6.18 (Laura Browand-Stainback)
So he finished his residency on July 6 2018. Why he does not have ACVIM after his name can be for many reasons. --- no one has updated the web page to include that now he is board certified in neurology (ACVIM) --- maybe he has not yet taken his board test --- maybe he did not pass the boards. Best is if you call and ask VNC. Dr. Spoor will likely not be your primary vet for this disc episode unless your pocketbook can stand $150 vet visits. You still need a local general DVM vet for Delphine, Dr. Spoor may be able recommend a vet who is on the controversy side of using steroids for a disc episode IF, if Dr. Spoor himself is not on the NSAID side of the steroid vs. NSAID controversy. THINGS TO DISCUSS WITH VET You need the neuro or his vet tech to watch you express and then check your work, give you pointers. Because she was not being expressed initially for a several days, she may have a UTI by now, infection could happen is a matter of days. So you want some guidance from the vet, maybe a urinalysis to get proof of whether antibiotics are needed or not. You need to know on Dec 14th taper day of prednisone whether your vet wants to back off all pain meds that day or do a full stop of the meds that mask pain. Unusual to cease methocarbamol on Dec 10th before the test for pain taper even starts....something to discuss If you are still not seeing any signs of painfulness, then the meds are now correct and need no adjustment. Delphine can finally heal her disc in comfort! Plus any other questions that come to your mind. You'll have a knowledgable vet in front of you who knows surgery well. ASK and learn, don't waste the chance. The type of answers also helps you to confirm if the vet in front of you knows conservative treatment as well as the training he got in surgery...two different things.
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Post by Julie & Perry on Dec 8, 2018 1:25:17 GMT -7
Martin, doctors often state the worst case scenario.
Uti's are treatable. Myelomalacia is not evident.
It's very early in the healing process.
As long as Delphine is comfortable and pain free I'd just love her and give her time to heal.
Dogs can surprise you. It's still possible for Delphine to recover.
And as long as she's loved, Delphine will have a great life.
Just settle in and take it day by day for now.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Dec 8, 2018 6:24:36 GMT -7
I completely agree with all that Julie said, Martin. Three months after my Jeremy had his first IVDD episode, I was told by his neurologist that he would never walk again but he did walk again three months later. We have seen many dogs surprise their vets. The neurologist does say that "we are hopeful that Delphine regains feeling in her legs" so you and your wife be hopeful, too. Even if Delphine never regains use of her legs, she can have a wonderful life. My Jeremy never regained bladder/bowel control so I've been expressing him for the last 8 years and it's just become a very normal part of our life and has not created a problem for us. I'm glad you were able to get a bladder expression demonstration and hope that goes easier for you. A UTI can make it difficult to express the bladder so hopefully once the bladder infection gets better, that will also make expressing easier. Just give it some time - things will get better.
The report says that all current meds other than the Methocarbamol remain the same. Does that mean that Prednisone will still start to taper on 9/14 or is the full dosage to continue until the 2 week recheck? Diazapam is a sedative but can sometimes have the opposite effect and excite a dog so do be aware of that. What directions did he give concerning the Trazadone, which is also a sedative? There may be too much sedation is Trazadone is given along with Diazapam.
There are some areas where Dodgerslist's recommendations based on years of observation differ from what the vet has told you.
1. We have seen dogs that have done less than 8 weeks of strict crate rest sometimes have a relapse so we do recommend a full 8 weeks of strict crate rest to allow the damaged disc to heal and form secure scar tissue.
2. We do not recommend any type of passive range of motion exercises during conservative care while the dog is still on any meds. Until all meds have been stopped and there is no sign of pain, there may still be swelling pressing on the nerves of the spine. Some vets are concerned about loss of muscle tone if no passive ROM is done but we have seen that muscle tone comes back very quickly once strict crate is completed and that it's much more important to protect the spinal cord and allow the damaged disc to heal rather than be concerned about muscle loss. The purpose of the ROM icon on your profile is to remind us to give you info concerning what passive exercises can be done once all meds have stopped.
3. We have seen dogs have a relapse due to too much movement when transported to vets' offices. Most vets will agree to getting a telephone update rather than transport to the vet for a re-evaluation. Of course, should you see any worsening of condition, that would necessitate a transport to the vet. Otherwise, there should be no need to re-examine during strict crate rest. You should be able to advise the vet by telephone as to any sign of pain which would necessitate any type of adjustment to meds. Nerve function may or may not return during crate rest and that doesn't make a difference as to prescription of meds or treatment.
We are not vets. However, we are in a position to have watched many thousands of vets world wide, watched the effect their treatments have. Over the years since 2002, this group has been observing and a clear pattern established itself on what works and what does not. We have consulted with neuros and have done our own additional reading and research into medical literature.
Get some rest and do take care of yourselves, too. I know how draining all of this can be at the beginning. You're doing a great job with Delphine. Hang in there. And congratulations on the upcoming birth of your child!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 8, 2018 9:40:43 GMT -7
Martin, I echo Julie and Marjorie's excellent points made in above posts. I can see why your take away might mistakenly be construed as no good news. In truth, that is not that case at all! --- You have prevented a life threatening situation of UTI moving up to kidneys with getting that antibiotic --- You got help in easing expressing— Diazepam and Prazosin to aid in relaxing the sphinter muscle. Make no mistake you are learning a new skill to prevent damaging over stretching of the bladder when urine overflows by reflex! Expect you would express every 2-3 hours UNTIL she is staying dry session to session, THEN you move up to every 3-4, then every 4-6 even 8 hrs. If she is not staying dry, you may need another refresher. Expressing he vet's office and have them check your work and get more tips. --- The 10% myelomalcia is the same stats neuros provide. Good news Delpine shows no signs! --- Surgeon comments there is hope..... to that end THEN YOU MUST give Delphine every possibly opportunity possible to heal that disc and go on to heal her nerves. You do that by VERY strict restriction of movement to the disc. Hold off on all PT til off of all meds and no pain to do that very, very, light, least aggressive range of motion (ROM) and massage. The little yellow icon under Delphine's photo reminds us to tell you about the video and directions when you signal off of all meds. --- Carefully weigh the benefit of all vet visits vs. risk of too much disc movement. Advocate for phone updates vs risky transport. Two weeks to expect nerve repair could be premature. So if a neuro exam would show nerve repair or no nerve repair...what benefit was that risky transport to the healing of the disc? What risk was the disc subjected to in a transport? --- Cleanliness is very important. Weigh the risk of baths/shampoos to the disc. Opt for baby wipes, green tea damped cloth for fur/skin as a means to limit movement of the back over washing. Dogs will shake wet fur! On Dec 14th pred taper day which are you to do back off of pain meds (tramadol,and gabapentin) or full stop? Diazepam, also a muscle relaxer is being used to aid in expressing so it would not be stopped.Let us know with the change from methocarbamol to Diazepam, Delphine still remains pain free right up to the next doses of her meds.Are you giving Diazepam every 8 hrs like the methocarbamol was given or lowering it to every 12 hours?What about trazadone, you got the OK to continue with for anxiety/calm? Diazepam (brand name Valium) is also prescribed for it's calming effects. Although for some dogs it may wire them up instead. So monitor for that. Mar Vista Vets can aid in further understanding diazepam including "Diazepam may have a stronger than expected effect if used in conjunction with... omeprazole (an antacid more commonly known as Prilosec®)": Link to Diazepam reading: marvistavet.com/diazepam.pml
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 8, 2018 12:28:24 GMT -7
Martin, there may be muscle atrophy. But ya know, when it is safe (off all meds and no pain), you can then begin the needed light, least aggressive of range of motion (ROM) and massage to keep the joints flexible and the muscle circulation up. After all eight weeks to make sure that disc has healed by affording Delphine every single opportunity that it not retear during the healing time, then it will be safe to begin a more aggressive PT therapy. In my book preserving an opportunity for the spinal cord to self heal is paramont over keeping muscles in tone which will come back when it is safe to do more physical activity. The difference between Dr. Spoor and here at Dodgerslist is perspective. Here we NEVER give up on nerve repair potential. Dr. Spoor, it seems, gives those very typical neuro pronouncement if after "1 of 2 weeks " weeks, we see no deep pain sensation, then not likely to ever walk again. I don't know about any neuros who follow up on clients much past the last after crate rest is complete. .I've been here since 2007, members will come back and update periodically after graduation. WAY TOO MANY dogs who didn't hear the dire procouncment, just go about healing nerves to the degree possible and many end up walking. How long did that take....well alot more than 1 or 2 weeks! Some walked in month, some even a year out. That is why you simply can't give up. Why to do every single thing possible to allow the disc to heal and give time for mother nature and Delphine's body to work on nerve repair.. She'll be back to enjoying life. Believe me, if/when walking happens it will be the icing to an already most wonderful cake. No one can know how close to self repair in reaching that 10% of descending nerves mark--- no one can know the length of time for the body to self repair to reach 10% WORK SCHEDULE 1) Mattress with catch basin: www.facebook.com/ultimatehealthypetbeds/app/251458316228/ The Ultimate Healthy Pet Bed. As for the review of the above mentioned bed.... I am using the inner layers in the bottom of her crate. On the occasion she has to pee, the urine immediately seeps through the material and goes to the plastic tray of the crate. This way she isn't sitting in urine. It is machine washable and dries quickly in the dryer. I am also lining the crate tray with a pee pad hoping that it will lock the urine. The inner layers that are part of the bed aren't something you can just buy, or at least I can't find a source anywhere else. I plan to buy a couple more of these as backups. They originally come with a cover but I found it wouldn't allow the urine to seep through fast enough, this defeating the purpose Jan 13, 2015 at 7:30pm dodgerslist.boards.net/thread/2176/marcies-trixie-10-conservative-neck?page=42) A raised mesh bed You can buy a bed, there are many brands. Or no-sew make yourself, if handy www.columbusdogconnection.com/elevated-dog-beds.html Brand name "Coolaroo" mesh fabric yardage or the pre-made replacement covers is one choice for good drainage mesh fabric. Tightly surround to enclose the elevated mesh bed with an ex-pen and a collection pan underneath. This would be for those times you are not at home. 3) While baby diapers are generally not recommended, while it may be not the best option but is an option for Delphine. Good quality brand diapers have the stuff that wicks moisture away and jellifies (is that even a word?). Use a non-zinc barrier cream to protect from urine scald. 15lbs dog might take size 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/ OR.... Bayer's A+D® Original Ointment Active ingredients: Lanolin 15.5%, Petrolatum 53.4% With Dec 14 begin of pred taper and when she is off it fully, she will not be drinking as much water and thus overflowing. A Onsie helps to keep the diaper in position 4) Hire your neighbor or friend who is able to stop by for mid day expressing. I found my next door neighbor was willing to learn how to express! My vet even offered for her to come by anytime for a refresher lesson. Check into hiring: dog walker, a vet tech from any nearby clinic who may be close to your house to do a mid day express on their lunch hr. Ask around you never know who is willing to learn, willing to help. For the short term depending on what kind of job you have, some employers will allow you to bring your dog to stay under your desk or in the work room. MED CHART Yes, indeed, keeping track of med doses, cause and effect notes, etc. all demands a proper med chart. You may be able to adapt your timeline or may like to make one similar to this med chart: D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Dec 9, 2018 6:07:57 GMT -7
If you need to rant, Martin, this is the place to do it. We do understand what you're going through and know how hard it is. But please, please know that it will get better. You will find a routine that works for you and your wife. The beginning is very hard. I well remember those early days with my Jeremy and how I thought that I couldn't handle it, but I did and have had many wonderful years with Jeremy. It all worked out fine despite all my initial worrying. I now look back and wish I hadn't put myself through all of that. I know it's hard but try to take it one day at a time and not worry about tomorrow since you don't know what that's going to bring - none of us do. Try to enjoy being with Delphine again. She's still the same dog. Give her kisses when you take her out to express her. Talk to her and connect with her. She's still with you and still loves you and still is your companion. Keep a happy voice around her and a smile on your face and tell her every day that she's getting better and you believe it too! If you feel that Delphine is in pain (shivering when moved is a sign of pain), than please immediately contact Dr. Spoor's office and advise them of that so her pain meds can be adjusted. Has this started since Dr. Spoor stopped the Methocarbamol? If so, then he needs to return her to Methocarbamol immediately. He also has room to move up on the Tramadol to 50 mg 3x/day. How often are you giving the Diazapam - 2 or 3 times a day? Since the vet said you could give it three times a day, do give it that often as it will help with any muscle spasms Delphine may be having. Have no patience with pain as it does hinder healing. Diarrhea is a side effect of the Prednisone or it could be due to the antibiotic and must be addressed ASAP this morning. Advocate strongly for the addition of Sulcralfate which works to bandaid damaged areas of the GI tract. Sucralfate will require timing with other meds…so do your homework here: www.marvistavet.com/sucralfate.pmlPumpkin can help firm up stools. To firm up the stool, add 1 teaspoon pumpkin to kibble1x a day. Note alternatives for constipation: really ripe mashed fresh pear, just take off the peel; microwaved and mashed peeled sweet potato. As for expressing, it does take practice. It took me weeks to learn to completely empty my Jeremy's bladder. Once I did, things became so much easier. What was happening with me was that the bladder was slipping away from my fingers so I wasn't completely emptying it. As the bladder empties and gets smaller, it can slip away and you need to find it again, usually back by the pelvic area. I've learn to keep my fingers slightly behind the bladder as a cup as I express to keep it from moving backwards. As it gets smaller, I push it ahead of my fingers. Are you getting a good stream or two each time you press on the bladder? Keep pressing until the bladder feels flat like your fingers are almost touching and you only get a dribble of urine out. Here's our page on expressing again with some tips that may help: www.dodgerslist.com/literature/Expressing.htmBladder infections can cause some leakage but the bladder infection is something that will heal and is not a permanent thing. You do not need to get up in the night to express Delphine. Withhold her water for two hours before bedtime and express until her bladder is completely empty right before bedtime. She should remain dry the rest of the night. We don't usually recommend diapers or belly bands but that may be helpful until you become proficient in expressing. I used a belly band at night on Jeremy at first and then was able to dispense with them. You need to sleep! If the Diazapam is not quieting Delphine enough that she can rest during the night, then do speak to Dr. Spoor about prescribing something else. Or ask if you can still use the Trazadone while you're giving diazapam. Trazadone is a sedative and is just a temporary thing during crate rest. I'll give more calming suggestions in the next post. Can you put another crate in the room where you sleep so Delphine can be near you? If you're using a wire crate, caster wheels can be added so Delphine can be wheeled from room to room. Please do keep in mind that much of this is temporary - the bladder infection will heal, you will become proficient in expressing, the worrying will get less and less as you see this all working out, the crate rest will be over. And please don't give up hope that Delphine will get bladder control back and hopefully walk, too. Stay strong, stay positive and never give up hope. We're here for you and Delphine and will help you through this. One day at a time, OK?
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 9, 2018 6:10:14 GMT -7
Here are some tips to help calm your dog in the crate. If these do not help, it may be necessary to have the vet prescribe a mild sedative. To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him/her. It also creates a den like feeling that dogs love. Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price. Place a DAP pheromone diffuser at floor level where the recovery suite is. Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones Use a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. 3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba) Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc. Consider some of these ideas: -- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising. More details on strollers: www.dodgerslist.com/literature/strollers.htm-- Put a garment you have been wearing and have not washed in the crate. -- Nan Arthur, CDBC, CPDT, KPACTP writes: "According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day. Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.] wholedogtraining.com/images/stories/Are_all_dogs_trainable.pdf -- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from on high. -- Play classical music or one of the wildlife TV shows. -- Fill a Kong with soft dog food and freeze. Put part of the dog's total daily dinner kibble in the Kong to lengthen time to consume dinner. Good low cal snacks are carrots, apples, or frozen green beans, licking a frozen low sodium broth ice cube. Good thick low salt/no fat chicken broth is full of cartilage-building proteins and amino acids. Freeze it up into cubes for easy access as you need it. Fun and keeps the body hydrated: place cubes in a bowl for licking. www.dodgerslist.com/literature/EmergencyCrate%20Training.htm
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Post by Merriem & Spike on Dec 9, 2018 20:17:20 GMT -7
This is the best place to rant, and it helps. You are so right about getting into a routine. A year ago I didn’t think we could get through all of this, but we did. just hang in there and things get better. Speaking of routines, we get up at 5:15 and take both of the dogs out. They both get on their beds and curl up and we enjoy our coffee. My husband has been taking Spike for walks in his cart in the afternoon and wow do the ladies come from far and wide to see him. Just take a white dog in a cart and they flock to him. Seriously it is very hard work, but it will get better. Spike still is trying to push himself up when he goes outside. We never give up that one day he might walk again, however we have all grown from this experience.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 10, 2018 12:52:51 GMT -7
Martin, advocate strongly for ALL pain meds to be used at the max aggressive usual dose. You need to contact your vet, report your dog’s symptoms, and discuss adjusting the dose. The correct amount to administer can depend on several factors including your dog’s breed and medical history.
TRAMADOL
METHOCARBAMOL Adovocate with a vet for returning to methocarbamol 3x/day. Ask if it is permissible to use both diazepam and methocarbamol.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 10, 2018 13:38:43 GMT -7
Which kind of vet (general DVM or neuro (ACVIM) adjusted meds? Best always to know which kind of vet.
Let us know that pain is fully in control right up to the next doses of the pain meds (tramadol, gabapentin)
Sorry, can't remember which are you giving diazapam every 12 hrs or every 8?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 10, 2018 16:01:07 GMT -7
Martin, just stay on top of observing for pain, reporting to the vet UNTIL the pain meds are finally adjusted perfectly for Delphine's needs. Fingers cross you will tell us this adjustment fully works. IF not there is still tweaking a vet could do.
How are you finding expressing today...going better in fully voiding the bladder at each session?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 10, 2018 20:21:05 GMT -7
Martin, the thinking and the action to take is to move in a positive direction.
It can take 7-30 days (excluding any taper days) for prednisone to resolve all the painful swelling around the spinal cord -- Delphine has not even been on it for the full 14 day course. IF there is still evidence of pain nearing the 14th, then it means another pred course needs to be prescribed.
It can take further tweaking of the pain medications so that there is full comfort. -- Your job is to alert the vet in the am to signs of pain and get those meds further adjusted.
Discuss with the vet if there is over sedation and the reason for not moving or is it a sign of pain. --Detective work is imperative for both you and the vet. Work together to help Delphine.
Excellent progress you have made in expressing. -- You wife will also follow suit with a bit more practice and be good too.
I had dachshunds as a kid growing up too, they never had any disc problems. -- As an adult, 3 my of 6 doxies have had a disc episode.
What is important to focus on is the "now" with Delphine. ---She can read both of you like a book. You know how smart she is...she studies your body language and your face and voice. She needs to have positive vibes from both of you to let her know you are on it and things are going to get better. Whenever you are around her use a happy voice and smiling face.
Are you getting better sleep? --- As care givers it is necessary to have a clear and positive mind to think properly and do properly.
NEVER GIVE UP on the idea that Delphine after crate rest is over can get back to enjoying her family. No matter if she is walking at that point or waiting on more nerve repair. She will be the same loving girl you adore!
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Post by Julie & Perry on Dec 10, 2018 22:22:41 GMT -7
Martin, I've been there and I know how difficult and exhausting it is.
As Paula said getting good sleep is crucial to your good health and caregiving.
Please push to get aggressive pain control in place.
Delphine can be completely comfortable from dose to dose.
If your vet isn't comfortable I'd find another.
My Nala was in the same spot Delphine was some years back.
I too wondered if I was being fair to her and if I needed to end this fight.
Wound up going to a neurologist 2 hours away who added a med that turned things around.
Keep fighting!
God bless you and your family.
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Post by Romy & Frankie on Dec 11, 2018 14:19:30 GMT -7
If Delphine is still in pain when the taper is due to start, it is not the right time to taper. More time on the pred at the full dose will be needed. It can take cumulatively up to 30 days for the pred to eliminate all the swelling in the spinal cord.
Is she showing signs of pain today?
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Post by Romy & Frankie on Dec 11, 2018 14:44:11 GMT -7
It is very frustrating not to get call back from the vet. I think it is a good idea to keep politely calling and make it clear that you are expecting to receive a call back.
Is Delphine on tramadol 50mg 3x/day or is she still on 25mgs in the afternoon?
It may be possible to go up on the gabapentin. You can ask the vet about that when he returns you call.
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Post by Julie & Perry on Dec 11, 2018 16:30:14 GMT -7
Good for you for being so persistent! Pain isn't acceptable in humans I don't understand why some people think it's OK in dogs.
If Delphine is still having pain it isn't the time to start a taper of Prednisone.
When all of the spinal cord swelling is gone there won't be pain.
Since Delphine is still hurting obviously there's still swelling.
I'd call back and give details about continuing pain and say Delphine is not ready to taper.
I remember you said it was hard to get sleep. Could you arrange another recovery suite in your bedroom also?
Or at least a cot in the basement?
I know, I camped out on the couch!
If you really can't get your vet to work with you, I know it's a pain, but I'd recommend getting another one.
Hang in there. It will get better.
Feel free to vent anytime. It's lonely in the trenches sometimes!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 12, 2018 11:35:02 GMT -7
Martin, sorry to hear Delphine is not sleeping through the night longer periods of time.
At each time she woke up, was the pee pad wet with urine? If Amox/Clav is the correct match for the bacteria, then the frist 48 hrs you should see improved signs of not having to pee so often due to UTI, she should feel more comfortable. Remind me the if change in anti-inflammatory was due to getting a urine culture that identified which bacteria strain and the matching antibiotic to deal with that bacteria?
Yes, it is true prednisone can leave the body with not being able to fight off infections as well. UTIs are pretty common expecially as owners are just learning how to express. I can't recall any vet, general DVM vet or a specialist ACVIM or ACVS taking a dog off of pred when/if it is still needed. The vets simple Rx the correct antibiiotic and pred stays on board til it is no longer needed. So how does a vet know when pred is no longer needed? --- if there is still pain not being managed, or pain surfacing before the next dose, then clearly pred would not go into a taper nor continue on with the taper. Instead another course, maybe a 5-7 day course and then a taper.
The practice of medicine is just that.... is it has no formulas, there is effort to go by scientific evidence, there is the personal experiences that can be different for each vet. So therefore you will find with a handful of vets, all different levels of training, different kinds of disease cases over the years, different continuing education classes means you may find a handful of different approaches to the same disease! As humans, we take no truck with a physician who is not helping us, we keep seeking until we find the one physician who can help us with our disease. Same with veterinary diseases and vets.
You are in some tight situation with the taper to start on a Saturday. Doesn't leave much open hours for you to try and find a new vet IF, if Delphine is still in actual pain and you can't successfully advocate for and other short course of pred.
So IS Delphine still in actual pain or problems with the UTI of not feeilng well, too much urine leaking.
What is the last time of night you express and do you actually feel the bladder going rather flat? What is the last drink of the night?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,795
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Post by PaulaM on Dec 12, 2018 12:52:44 GMT -7
Martin, you are still in need of a local general DVM vet who knows IVDD to be on Delphine's health care team. It is total guess work of how long a course of pred to prescribe. Most vets will try a 5-7 course and others a 14 day course. The guess was to try a taper on Friday Dec 14th after a 14 day course. To get the fastest and most accurate of results, the pain meds which mask pain need to be either stopped or backed off on the begin of the pred taper. You need to know which is the most preferred for Delphine's case. I would not hurt to see if possible to do a phone interview today-Fri (not wait til last minute of next week) with a potential DVM vet. Tell the vet you are seeking to find a primary vet for your dog's current disc episode. Ask how they would treat a dog who doesn't walk (NSAIDs or Pred) Yours is on pred, can they help? Feel them out for how long for crate rest as a means to compare and feel out their IVDD experience. Would they use stomach protection, which one? By now with you own IVDD self education, you know how to interview with pertinent questions. Realize a new vet never having seen Delphine or by any other vet at the same clinic, means bringing Delphine in. finding a new vet: www.dodgerslist.com/literature/VetchkList.htmKeep us posted, please.
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Post by Romy & Frankie on Dec 12, 2018 14:27:01 GMT -7
When we had to go back to work after Frankie's surgery we were concerned about expressing his bladder during the day. The dog walker who came to walk Frankie mid day prior to his surgery was willing and able to learn to express him. He learned to express faster than I did.
A number of our members who needed to have their dogs expressed during the day were able to find someone on the Rover website. Some people on that site have experience with sick or disabled dogs.
If you could find someone to help express Delphine during the day, it would make things easier for you.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 12, 2018 14:55:31 GMT -7
Martin, have you tried to contact the ER hospital where Delphine was first seen and who prescribed the round of Prednisone? We have seen many members, myself included, whose dogs were seen by ER vets and who can follow up with them on meds prescribed. You wouldn't have to speak to the exact same vet who saw Delphine that day. Any of the doctors at the hospital should be able to look up Delphine's records and advise as to meds. Just tell them that she has recently had pain, the taper begins on 12/14 and you would like a back-up plan as to what to do should pain re-appear over the weekend (or is this a 24-hour ER hospital where you could reach someone over the weekend?). You shouldn't try to prescribe the Prednisone or taper it yourself - that's one med that should have a vet in control of.
My Jeremy's regular DVM won't treat him for his IVDD as he doesn't feel comfortable treating spinal problems. He tells me to take him to the ER hospital. When Jeremy has had problems, it's always off hours so I get whatever ER vet is on duty though they do have neuros there but only during the day time during the week. The ER vet prescribes the necessary meds and I've always been able to follow up with them. Once I got a vet there who wouldn't give Gabapentin even though Jeremy still had pain so I turned to the regular DVM, the hospital sent him the records and he prescribed the pain med without seeing Jeremy - I guess he's comfortable enough in treating pain but nothing else. Jeremy also has a holistic vet for acupuncture/laser. So sometimes it takes a team to get the job done.
I forget now what you said about whether you can give the Trazadone with the Diazapam. Have you tried giving Delphine the Trazadone before bedtime if the last vet said it was OK? Hopefully that would relax her enough for her to rest throughout the night and give you some rest, too. If the Trazadone doesn't work well, there are other sedatives that could be prescribed. Do take the water out of the crate two hours before bedtime. I know she's more thirsty while she's on the Pred but it would hopefully help her rest if she's not wetting her bed during the night.
Once the swelling resolves, then there will no longer be a need for any meds and things will get much easier. It can take 7-30 days for the swelling to resolve. Hopefully when you start the taper on Friday, no sign of pain will reappear which will be proof that the swelling has resolved. I know it's only a couple of days away but hopefully that will be enough to get the swelling down.
Prayers that things will get easier soon for all of you. Hang in there. This can all turn around for the better soon.
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Post by Romy & Frankie on Dec 12, 2018 15:24:54 GMT -7
Although long term use of pred is associated with UTIs, the bladder infection is more likely to be related to stale urine in the bladder while you were learning to express.
You are right that it makes sense to continue the pred while there is pain because the pain is caused by inflammation in the spinal cord. The pred works on this inflammation. If there are no anti-inflammatories on board there is nothing working on the spinal cord inflammation.
As long as Delphine has free access to water during the day, taking the water away two hours before bed should not be a problem.
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