Melissa's Zero RELAPSE 2019 conserv. NECK

Melissa, let us know you HAVE been doing 8weeks of 100% STRICT crate rest 24/7 only out for a very, very few footsteps at potty time EACH time there has been a new or repeat disc episode. When you write you crate rested him "more" while on gaba and methocarb for "sometime" that does not sound like 100% STRICT rest.

Why can't you call in and get those pain meds adjusted by any vet who has access to Zero's file? Transports are risky in too much movement for the damaged disc.
--- add in a general analgesic such as Tramadol every 8 hrs.

How much does Zero weigh?

Hi, Melissa. Whether a damaged disc is in the neck or in the spine, if surgery is not done then 8 weeks of strict crate rest needs to be done. Whether there is loss of neuro function (wobbly legs, knuckled feet, crossed legs, etc.) or whether the only symptom is pain, 8 weeks of strict crate rest needs to be done. Otherwise, if too much movement of the spine is allowed, the damaged disc will not heal correctly.

From what you've told us, you're only crating Zero this time for neck issues because he also has wobbly legs. It may well be that his neck issues have never healed correctly since strict crate rest for 8 weeks wasn't implemented prior to now. He still had neck pain and has been given pain meds which indicates there has still been swelling in the neck. Neck injuries can actually be harder to heal than back issues. By keeping him on strict crate rest this time, I do hope that Zero's neck will heal completely.

As for your question about doing surgery, I think it’s more a question of getting his neck issue completely healed this time.

What was the exact date that strict crate rest started?  You had mentioned that it was during the last few weeks but we like to put the exact date in the subject thread so we can keep count along with you.

There are a few other things that you should do to help the neck heal, such as softening hard kibble, raising food/water dishes so he doesn’t need to bend his head – more tips here:
www.dodgerslist.com/literature/cervical.htm

A playpen or ex-pen is fine to use as a recovery suite during conservative care if Zero is more comfortable in one rather than a crate. Just be sure to pad any extra space with rolled up blankets or towels. The space he's in should only be large enough to stand up, turn around and lie down with his legs comfortably extended. You probably already know this but just to clarify - Carry Zero in and out to potty with very few steps allowed at potty time. Use a leash and harness to limit steps.

Some thoughts on the 6 weeks of crate rest that you've previously implemented. We see dogs doing less than 8 weeks of conservative crate rest often have a relapse to the early healing disc. We do also see that some few dogs whose owners prefer less crate rest do fine with fewer weeks of rest. There is no way to tell ahead of time which category the dog will be in. At Dodgerslist we are very cautious and follow the vets who do recommend 8 weeks of rest having seen too many dogs on the Forum re-injure a disc with less crate rest ending up with more pain and may need a $4000-8000 surgery. 8 weeks of rest is of course not scientific proof, just an observation over many years and many, many 1000's of dogs. The focus of the 8 weeks is getting the disc to form good secure scar tissue.

As for the new course of meds, if Zero’s pain is completely under control with no sign of pain arising from one dose to the next, then the meds are correct. If you do still see any sign of pain, then you’ll need to let the vet know so she can adjust the pain meds again. Tramadol works most efficiently when given 3x/day so if still pain, that can be increased to 3x/day and the dosage can be increased to 25 mg.
We are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet.

Signs of pain to be aware of: ◻︎ restless, pacing, can’t find a comfortable position ◻︎reluctant to move much in crate such as shift positions ◻︎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 ◻︎looks up with just eyes and does not move head and neck easily.
◻︎ not eating due to pain of moving jaw with a neck disc or pain of back disc
◻︎ holds front or back leg flamingo style not wanting to bear weight
◻︎not their normal perky selves

Please let us know what the dosage of Pepcid AC is and frequency given so we can have a full med list.

Please let us know if Zero’s pain is now completely under control. Healing prayers for Zero.

I am very glad to hear that the change in meds currently has Zero's pain under control. Now he can heal in comfort.

It may be that Zero's diarrhea was caused by eating different treats. If this is the case it should go away very soon. The diarrhea could also be caused by the Carprofen. This is particularly likely if he has had problems in the past with an anti-inflammatory.. Sometimes Pepcid AC is not enough to keep stomach issues at bay when a dog is on an anti-inflammatory. In those cases, Sucralfate can be added to the Pepcid for additional stomach protection. Sucralfate forms a gel-like webbing over ulcerated or eroded tissues and acts like a bandaid for the Stomach. You can speak with your vet about adding Sucralfate to Zero's meds. Sucralfate will require timing with other meds. You can get this information and more about Sucralfate here:
www.marvistavet.com/sucralfate.pml

hello! Zero's pain seems to be greatly managed which I'm so happy about AND his poop is normal today so it's safe to say his soft stools yesterday were from the abundance of treats he's not used to. question today involves his twitching. he's twitching a lot in his neck, upper body while resting. it's more then just normal sleep twitching. he's at the max Methocarbamol per our vet (250mg 3x/day) however I wanted to mention this in case anyone thinks I could be doing something different/more. perhaps this is normal. not sure. again he seems perfectly comfortable, just not sure if the twitching is par for the course given his cervical issues. thank you!

Ok, this is reassuring! Thank you!

hello all. I wanted to update you on where we're at with Zero and also express some concern with his condition. it's been three weeks since the start of Zero's episode. the nonstop neck spasms stopped after about a week (around 3/28-3/29) we wanted to start weaning off the Carprofen about now (our vet suggested to give it every other day for a week and see how he is), however he's been more wobbly in his hinds for the last couple of days. going out to potty right now he actually seemed to have his hinds give out completely. he got back up but it was worrisome. it's like the hinds are getting worse. to refresh, he's about 10 pounds, on 200mg of Gabapentin 3x/day (that's been the full three weeks), 125mg of ▼Methocarbomal 3x/day (he just went down from 250mg this week since his spasms subsided) and 18.75mg of ▼Carprofen 1x/day. could it be that he's muscle atrophied and just really wobbly? he's been strictly rested in his crate, carried out to potty and on a harness/leash when outside while he does his business. any insight would be really appreciated.

[Moderator's Note. Please do not edit
10 lbs.
Carprofen as of 3/21: 18.75 mgs 2x/day  for 24ish? days,
                      as of 4/13ish: 18.75mgs ▼every other day for 7 days, then a test stop for issues: __ pain __neuro
gabapentin 200mg 3x/day
methocarbamol ▼125mgs 3x/day
Tramadol 25mg 3x/day  STOPPED
Pepcid AC 5mgs 2x/day]

Yes it's seemingly weakness. Yesterday was worrying as it seemed he feel down a couple of times, so worse then wobbly. No knuckling however it felt like a leg was weaker then another. He would fall to one side, get back up then fall to the other. It makes sense that the muscles weaken as he's so confined. I will talk to our vet tomorrow about stopping the Carprofen completely. You are correct that there has been no tapering as of yet. Should we also stop all the pain meds at the same time for the ultimate test of pain? 

Zero
ok he's definitely getting worse. we just went out to potty and he fell over. couldn't stand up on his hinds, then on his fronts so fell to the side. i picked him up right away, gave him a minute and tried again and he walked wobbly. ugh. why after week three would he be getting worse? this is horrible.

If the taper of the Carprofen has started, then a worsening of neuro function means that there is still swelling pressing on the nerves of the spine and still a need for the original dosage of the Carprofen and all meds.

If the taper of the Carprofen has not started, then it would appear that Zero has had a relapse and is showing a worsening of neuro function, possibly due to too much movement. Can you recall any time where he may have moved too much, took too many steps at potty time, etc.? Neck injuries can be difficult to heal since it's hard to keep the neck from moving. If he's had a relapse, then unfortunately the 8 weeks of strict crate rest will need to start over.

Either way, since his neuro function has worsened, it's not time to taper or stop the Carprofen and he needs more time on all meds.

Have you contacted your vet yet about this? Julie is absolutely right that deterioration of nerve function is something that needs to be addressed ASAP. Please let us know what your vet says.

Zero
update: it's a very stressful time. our team of vets assessed that we should switch our Carprofen to Prednisone. after our visit yesterday morning 04/15, it was decided that since being on Carprofen for 3 1/2 weeks, it be best to switch to Prednisone. however, everyone is aware of the washout period and in addition the looming intermittent symptoms of neurological diminishment so we are playing it day to day. they advised to do a 3-5 day washout period, so ideally to start the Pred somewhere between 04/18-04/20 as 04/15 was the last day of a Carprofen dosage.

[Moderator's Note. Please do not edit
10 lbs.
Carprofen as of 3/21: 18.75 mgs 2x/day for 27 days ,STOPPED 4/15 to switch to Pred
Relapse? 4/14 w/front and back leg increased diminishment
Prednisone To be given 4/18-4/20:  ?mgs  ?x/day for how many days, then test taper
gabapentin 200mg 3x/day
methocarbamol 125mgs 3x/day
Tramadol 25mg 3x/day STOPPED
✙Trazadone  12.5mg 3x/day 
Pepcid AC 5mgs 2x/day]

it's heart wrenching to wait and worry that his symptoms may get worse. looking forward to hearing from you all. we have a surgery consult [on 04/30] with the neurosurgeon who did our other dog Huck's surgery last year and we've timed it to be scheduled for the end of the Pred tapering for Zero on 04/30. as of this moment, he's walking wobbly but did have more issues standing this evening. the last time he had issues standing was on Sunday, 04/14. at what point do we say the side effects of possible gastro issues are worth it to start the Prednisone sooner? we also started ✙Trazadone in hopes to make him more quiet and sedated since he can get a little crazy in his crate, specifically around feeding times.

hi Marjorie. I will talk to our vets about the Sucralfate addition. since we saw our vet on Monday, he had already had his dose of Carprofen as well as Gabapentin and Methocarbamol, so his pain management was great, i.e. he felt comfortable as he has been. the only symptom/concern is his neurological function has worsened, i.e. wobbly gait, crossing hind legs, front legs shaking sometimes when standing to pee. again this is not consistent. out of the 4-5 times we go out to potty, he might be worse 1 out of those times. the rest is just a slightly drunken walk. his reflexes are still good which is promising. (toe pinching, knuckling test, etc) the dosage of Trazadone is between 12.5mg to 25mg, depending on his reaction. 1/4 tab (12.5mg - 100mg tablet) has been seemingly doing the trick 3x/day.

ok new issue: trembling, so seemingly pain? this is new. my poor little man. i'm going to get the Sulcrafate and will reassess all his meds with the vet asap. any/all insight would be appreciated.

ok. she's prescribing the Sucralfate and I'll be picking them up shortly. any advice on administering? the link above didn't work.

Yes we stopped the tramadol as our vets think it's more for sedation then pain, despite what's been said here, so we opted not to give it any longer as it wasn't doing the job of sedation. he can walk, though not well. i only mentioned the neurological tests because Marjorie asked specifically. i'm definitely anxiously waiting to hear from my vets about the addition of the Sucralfate.

Trembling can be anxiety and it can be pain, can be cold. Put on your detective hat to figure out.
--- warm towel from drying help with being chilled and trembling
--- Sitting by or being near and talking, does it help with anxiety trembling
--- Is trembling occuring after moving, repositioning in crate, nearing next dose of pain meds? With a washout you would expect up up pain meds in expectation without carprofen on board its going to be more pain. You see other signs of pain to help you confirm pain.

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
◻︎ looks up with just eyes and does not move head and neck easily.
◻︎ not eating due to painful chewing or in too much overall pain
◻︎ holds front or back leg flamingo style not wanting to bear weight
◻︎ not their normal perky selves

Tramadol 25mgs 3x/day is not likely to help with pain...it's undermedication
The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours.

Plumb's is considered the "drug bible" of the veterinary world.
Tramadol dosing in dogs varies, ranging from 2 to 5 mg/kg every 8-12 hours. The highest dose for maximum analgesic effect in dogs is 10 mg/kg every 8 hours.   “Tramadol”. Plumb DC. In Plumb DC (ed): Plumb’s Veterinary Drug Handbook, 7th ed—Ames: Wiley-Blackwell, 2011, pp 1002-1004.

Hope with the Rx of sucralfate, pred can be started today to get back to working on swelling in the spinal cord area that is the cause of pain and of neuro issues.

Melissa,

IVDD is such a traumatizing experience, I totally understand how scared you are..  I have been through it so many times with Tyler but he always recovers well and we wish the same for your Zero..

What is the dosage of the Prednisone and what are the tapering instructions??

Healing thoughts and prayers..

The prednisone Rx is a 3-day course, rather short. Most Rx's are for 7-14-day courses.  You will begin to monitor for revealed pain and new neuro issue to surface on a Sunday 4/21 taper when the vet is not open!  Do you have a plan B should pain or neuro diminish occur?

With any taper, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free!

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


How many mgs of sucralfate do you give and how many times a day?

Please do keep us posted on the twitching and weakness in his front legs to roll over from a sit or collapsing at potty time.