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Post by Melissa & Zero + Huck on Mar 21, 2019 10:40:21 GMT -7
Zero-Dachshund-Many IVDD Episodes Hello. Sadly I'm writing again about another one of our dachshunds, Zero. I have another thread re: our boy Huck. Thankfully he's doing great and I've updated that thread. Zero is a 12-13yrs long haired dachshund who started having IVDD episodes back in 2014. He's probably had three major episodes since (major meaning, starting with a lot of pain, yelping/biting when picked up, wobbly legs, yet always being able to walk and go potty) and we just had another one this morning. I went to take him out to go potty and he yelped and tried to bite my hands, poor baby. He has had ataxic legs for the last couple of weeks, so he's been rested more [not 100% rest??] and we've been doing comfort care, i.e. acupuncture, icing/heat. He can't run freely in the house ever as he has no boundaries and runs around too crazy. He also has some depth perception issues as he's blind in one eye so he will run into things when running and it's a recipe for disaster and hurt. He has been on Gabapentin and Methocarbamol due to neck discomfort for some time. The dosages are 1.5ml Gaba (50mg/ml = 75mg) 3x/day and 125mg Metho 3x/day. Until we see our vet tomorrow morning (he already had an appt), she's advised us over the phone to add Pepcid and Carprofen (1/2 tab of 25mg tablet) today, so he was given both of them this morning, Pepcid 1/2 hour prior to the Carprofen. [Moderator's Note. Please do not edit weight? Carprofen as of 3/21: 12.5 mgs for ? days, for ? days, then a test taper for issues: __ pain __neuro gabapentin 50mg/mL: 75mgs (1.5mL) 3x/day methocarbamol 125mgs 3x/day Pepcid AC ? mgs ?x/day ]She said to keep her updated on his pain level throughout the day to see if we should increase the other meds he's currently on - she's guessing yes. He seems very comfortable currently and is sleeping under covers in his crate. My biggest question is, given his many episodes and seeing as they've become more frequent, might it be time to have a consult for surgery? I worry about the surgery for his tiny body but I also want him to be a dog again and not always have to be confined for such long periods. It breaks my heart and I want the best for him. Anyway, vent done. Any words of wisdom/advice would be really appreciated. Thank you! Ok. Update already. Getting him in sooner today (instead of tomorrow morning) because he is in pain and I don't want to increase things without having him seen. Poor little man! Taking him out to potty was torture as him being held was painful for him and he just kept trying to bite. We will be seeing the doc for an evaluation and to discuss a different pain management regiment at 2:30pm. Any thoughts are still welcome and appreciated.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 21, 2019 11:52:09 GMT -7
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?
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Post by Melissa & Zero + Huck on Mar 21, 2019 12:16:31 GMT -7
I always hesitate to write because these replies always seem so aggressive and accusing, especially by you Paula. There are better ways to say what you are intending.
We've done 6 weeks of strict rest in a crate, only out to potty over the last several years. When his back legs are fine, he struggles with some neck issues and we don't do strict rest but instead he's out in a pen. The last few weeks since his legs were a bit wobbly, he's been in his crate. As far as taking him to the vet today, I'd feel better if he's assessed. He'll be transported in his crate with plenty of cushion surrounding him. We don't have any Tramadol left so I'll need to get some today.
He weights 10 pounds.
update post seeing the vet. it was not our normal vet as she had to leave early for a family emergency so I'll feel better when she responds (hopefully by email!) to confirm everything that was said is good, accurate and the best. Zero is still painful to be picked up so this vet wants to increase his Gabapentin to 4x/day vs. 3x/day. I was hoping to increase the actual dose from 100mg and keep it at 3x/day but she recommended to try this first. she said to stay at 250mg of Methocarbamol for 3x/day, keep giving the Carprofen but increase it to 18.75mg (3/4 of a 25mg tab) 1x/day and also add 12.5mg of Tramadol (1/4 of 50mg tab) but only 2x/day. Thoughts?
[Moderator's Note. Please do not edit 10 lbs. Carprofen as of 3/21: 18.75 mgs for ? days, then a test taper for issues: __ pain __neuro gabapentin 50mg/mL: 75mgs (1.5mL) 4x/day methocarbamol 125mgs 3x/day Tramadol 12.5mg 2x/day Pepcid AC ? mgs ?x/day ]
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Mar 22, 2019 5:29:35 GMT -7
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.htmA 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.
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Post by Melissa & Zero + Huck on Mar 22, 2019 11:57:00 GMT -7
Thanks for the reply. It took some time but I think Zero's pain is under control. He seemed uncomfortable through the night so early this morning we up'd some of his meds to the following after speaking with our vet: 150mg Gabapentin 3x/day, 250mg Methocarbamol 3x/day, 25mg Tramadol 3x/day and 18.75mg Carprofen 1x/day. It has been about 4hours and he seems way more comfortable then last night. He couldn't settle in his crate and seemed restless in addition to a ton of twitching. Now we're left with another issue as he seems to have diarrhea. He is on 5mg of Pepcid 2x/day (started this yesterday 03/22 prior to give his Carprofen). I have a call into the vet to see what she advises. He did eat a ton of treats that he's not used to when we were at the vet's yesterday so it could be that as his stomach is super sensitive OR the Carprofen. I hope it's not the ant-inflammatory because I don't know what we'd do. He has been on it before and been fine. He had some gastro issues with Metacam about 3yrs ago. Any thoughts on this would be welcomed and appreciated. As far as the strict crate resting, I'd like to say for the record to begin this yesterday, i.e. 03/22/19. Thank you.
[Moderator's Note. Please do not edit 10 lbs. Carprofen as of 3/21: 18.75 mgs for ? days, then a test taper for issues: __ pain __neuro gabapentin 150mg 3x/day methocarbamol 250mgs 3x/day Tramadol 25mg 3x/day Pepcid AC 5mgs 2x/day]
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Post by Romy & Frankie on Mar 22, 2019 13:16:44 GMT -7
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
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Post by Melissa & Zero + Huck on Mar 22, 2019 14:13:45 GMT -7
yes, perfect! my vet said the very same thing. currently the stool is just soft so i'm going to give it a day or two and hopefully it will resolve. thanks so much for the reply and insight.
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Post by Melissa & Zero + Huck on Mar 23, 2019 13:59:11 GMT -7
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!
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Post by Romy & Frankie on Mar 23, 2019 14:28:33 GMT -7
I am very glad to hear that Zero's diarrhea has resolved and his pain is under control.
Muscle twitching or spasms are common, particularly in neck disc episodes and are usually treated most effectively with Methocarbamol. There are other meds that can be tried for muscle spasms. We sometimes see valium prescribed as a muscle relaxer. But if these twitches/spasms do not seem to be causing Zero pain there may be no need to try a different medicine, instead just keep an eye out to be certain that these twitches do not start to seem painful.
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Post by Melissa & Zero + Huck on Apr 13, 2019 20:37:15 GMT -7
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]
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 14, 2019 5:54:12 GMT -7
Yes, crate rest can cause a worsening of wobbliness or leg weakness due to inactivity. It's similar to our legs feeling weak when standing after sitting for too long. Atrophy of muscles need not be of concern since muscle strength comes back quickly once the full 8 weeks of crate rest are over. Do you see any other worsening of neuro function such as paws knuckling or hind legs crossing? Am I correct that the Carprofen has not started tapering yet?
Carprofen doesn't need to be tapered but can be stopped completely. We usually see vets just stop it to test if there is still any pain/swelling. What instructions has the vet given concerning tapering or stopping the meds during the taper of the Carprofen? The stopping of the Carprofen is a time to test for pain/swelling. Having pain meds on board will make it difficult to determine if there is still swelling and therefore still a need for all meds for a bit longer. Swelling can take 7-30 days to resolve. Please do speak to the vet about stopping or tapering the pain meds so a true test for swelling can be made. Should you see any sign of pain or worsening of neuro function (paws knuckling, hind legs crossing) then you would need to immediately alert the vet so all meds can be started again for a bit longer. If there is no sign of pain returning, that means the swelling is gone and there is no longer a need for any meds.
Please let us know what the vet says after speaking to them.
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Post by Melissa & Zero + Huck on Apr 14, 2019 9:35:07 GMT -7
Zero 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?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 14, 2019 9:54:33 GMT -7
It is a vet's call as to whether on the stop of carprofen the pain meds are either backed off (methocarbamol, gabapentin, tramadol been stopped?) OR they are full stopped at the full stop of carprofen. Only steroids require a taper. Non-steroid anti-inflammatories (NSAIDs) such as carprofen do not require tapering. On the full stop of carprofen and backing off or full stop of the meds that mask pain your job will be to monitor and report to the vet: SIGNS OF PAIN surfacing: ◻︎ 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 Neuro function to monitor for on the stop of carprofen As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. Pain still reveals itself when pain masking pain meds are stopped/backed off 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. Paws knuckle under 5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Help Zero maintain balance with possible wea legs due to confinement with a sling at potty time. A sling (long winter scarf, ACE bandage, etc) is used as back up to catch a wobbly dog's butt and prevent twisting the back. Any sling needs to be accompanied by a front harness and leash to control speed to the very slow minimal footsteps at potty time especially during conservative treatment or the post-op crate rest period. A figure 8 DIY sling works especially well for the male dog anatomy at potty times. The figure 8 slings will also avoid the fulcrum effect to a dog's spine. Let us know how things are going and what the vet says on Monday morning when you call in your update to him.
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Post by Melissa & Zero + Huck on Apr 14, 2019 17:13:02 GMT -7
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.
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Post by Julie & Perry on Apr 14, 2019 18:47:12 GMT -7
Can you you possibly go to the emergency vet? Neurological deterioration isn't something that can wait until Monday.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 15, 2019 8:52:16 GMT -7
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.
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Post by Melissa & Zero + Huck on Apr 15, 2019 9:20:48 GMT -7
Zero hello all! so last night and this morning at potty time, he was "normal". wobbly in the hinds but not falling over or twitching. perhaps he moved too much in his crate to create a relapse? we do struggle at feeding time to have him not get so crazy. he tries to bash his head around barking from excitement. we usually do kongs with him during meal prep however since his episode started we don't give him a kong for obvious reasons. I am going to start prepping his meals ahead of time to avoid any ridiculous neck movements on his part.
he has NOT started the tapering/halt of Carprofen. we were supposed to on Friday (04/12) but because i noticed these new symptoms i kept him on it. happy i did. we will be seeing our vet today at 11am.
[Moderator's Note. Please do not edit 10 lbs. Carprofen as of 3/21: 18.75 mgs 2x/day for 25+ days , then STOP to test if neuro/pain issues surface Relapse? 4/14 w/front and back leg increased diminishment gabapentin 200mg 3x/day methocarbamol 125mgs 3x/day Tramadol 25mg 3x/day STOPPED Pepcid AC 5mgs 2x/day]
thank you all for responding. i didn't want to take him to the vet last night because the symptoms lessened AND truthfully the er vets who we've seen so much in the past with our ivdd babies have only scared us. at the onset of any episode we've had more times then not they have said to go see a specialist to discuss surgery. had we needed more meds or had the symptoms not retreated i would have taken him immediately last night.
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Post by Melissa & Zero + Huck on Apr 16, 2019 20:28:36 GMT -7
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.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Apr 17, 2019 4:56:08 GMT -7
Melissa, if your vet feels that it's medically necessary for Zero to switch from a NSAID (Carprofen) to a steroid (Prednisone), that switch can be made without a washout period with the addition of TWO stomach protectors - Pepcid AC AND Sucralfate. Sucralfate requires timing with other meds - more info here: www.marvistavet.com/html/sucralfate.html.3corrected link: marvistavet.com/sucralfate.pmlHave you seen any sign of pain returning since the stopping of the Carprofen? Did the vet exam reveal that neuro function has indeed worsened (slower to correct paws when turned over, etc.) and/or did he find that there is still spinal pain? Or is he continuing the anti-inflammatory solely based on your observations? Hopefully, there will not be a need for the surgery consult with the neurosurgeon and that the Pred tapering will be able to conclude with no pain returning or increase in neuro function. What is the dosage of the Trazadone?
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Post by Melissa & Zero + Huck on Apr 17, 2019 9:19:45 GMT -7
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.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 17, 2019 9:43:49 GMT -7
Melissa, has/had the tramadol 25mg 3x/day been stopped?
If a dog can walk then the toe pinching thing to test for deep pain sensation (DPS) is not needed. As by definition, of course the dog would have to still have the very last neuro function to be lost DPS.
As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. Paws knuckle under 5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about the often tricky to correctly identify DPS.
Let us know what your vet says about being able to start pred with the addition of a 2nd GI tract protector to the Pepcid AC.
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Post by Melissa & Zero + Huck on Apr 17, 2019 11:18:16 GMT -7
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.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 17, 2019 12:39:57 GMT -7
Melissa, something to add to your IVDD knowledge base. The more we know, the more we can (fill in the blank) our dogs. 1) Dallas Veterinary Surgical Center educates veterinarians and owners about giving the DPS neuro test: “Pain perception is tested in animals by pinching the bone of a toe with hemostats. It is not necessary to pinch the toes of dogs" with neck or back pain w/o neuro deficits, wobbly walking, or knuckling paws, can still move legs but can’t move up into a standing position. 2) Making Sense of the Neuro Exam Phil Zeltzman, DVM, Dipl. ACVS: The last step is loss of pain sensation, or nociception. It is tested by using a hemostat to pinch a toe. Though nobody enjoys performing this test, doing it correctly is critical. We are trying to cause a painful reaction by stimulating the periosteum of the phalanges. The order of these four stages is fixed. They occur in the same order and always return in the reverse order. Therefore, there is no need to crush a toe in a patient who has motor function. If he has motor function, he has deep pain by definition... Patients may go through these four stages very slowly—over weeks or months—or within days or even hours. 3) January 2006 Surgery. James M. Fingeroth, DVM, DACVS. Veterinary Specialists of Rochester, NY . Consultant - Veterinary Information Network "Note that there is a sequential nature to this. For example, if a dog is still walking to some degree there is no reason to ask the subsequent questions about voluntary motor function or about sensation. . So, when you are doing your neurologic exam, you need not worry about verifying the presence of nociception unless the dog has lost all voluntary motor function, since this can be presumed to be intact if the dog is still moving the limb. " Sucralfate Sucralfate requires stomach acid in order to form its protective gel. ~Ideally give Sucralfate on an empty tummy at least 1 hour before feeding or 2 hours after feeding ~If possible, it should be given 30+ minutes prior to the administration of Pepcid AC. ~Give Pepcid AC 30minutes before Prednisone ~Give prednisone with a meal. Pred could be given along with pain meds IF also due at that time. resource: marvistavet.com/sucralfate.pml There are other timing options, if you need them this link: marvistavet.com/sucralfate.pml
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 17, 2019 12:46:39 GMT -7
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.
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Post by Melissa & Zero + Huck on Apr 17, 2019 20:10:42 GMT -7
thank you for all that info. the trembling has stopped but there is twitching associated with movement. twitching when moving the neck, twitching when he stands on his fronts. he is a twitchy dog at rest and certainly an anxious dog however this is definitely not his 'normal". we put him back on ✙Tramadol, doing 50mg and will continue that 3x/day. we did the Sucralfate/Pepcid/Prednisone dosage and he is now resting. he had trouble getting up on his hinds at potty before dinner. i have a sling ready to go for the next time we go out. he also rolled over from a sitting position which was bizarre. 'm just hoping and praying the Pred will start doing its job and bring down some of the inflammation he's experiencing. i'm truthfully terrified. [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 as of 4/18-4/20: 5mgs 2x/day for 3 days, then Sunday 4/21 test taper to reveal if pain or neuro issues gabapentin 200mg 3x/day methocarbamol 125mgs 3x/day ✙Tramadol 50mg 3x/day Trazadone 12.5mg 3x/day Pepcid AC 5mgs 2x/day ✙Sucralfate 250 mgs 3x/day ]
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Post by Pauliana on Apr 17, 2019 21:28:43 GMT -7
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..
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Post by Melissa & Zero + Huck on Apr 18, 2019 8:45:17 GMT -7
ZERO thank you Pauliana. I know everyone here fully understands. the prescription for Prepnisone is 5mg 2x/day for 3 days, 5mg 1x/day for 3 days, 2.5mg 1x/day every other day. he was walking on his hinds well this morning, better than he's been since Saturday, 04/13, however he still has pain/weakness in his fronts. he'll potty and when it gets too much he twitches and looks like he wants to collapse. luckily he finishes potty'ing quickly and I help hold him up with the harness. moment by moment. hoping it's not something more then IVDD at this point. will continue to keep you all posted. thank you again for being here.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 18, 2019 9:04:46 GMT -7
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.
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Post by Melissa & Zero + Huck on Apr 18, 2019 9:15:52 GMT -7
yes, i agree the prednisone course seems odd/short. i see our vets tomorrow morning as we're going with our tripod pup. i will mention that i'd like to re-evaluate the prescription, especially since tapering will happen when their office will not be open this coming Sunday. we are doing sucralfate 3x/day, 1/2 hour before the pepcid and an hour prior to feeding. they are 1mg tablets and the instructions say to do 1/4 tab with 3ml of water mixed.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 18, 2019 9:56:52 GMT -7
Melissa, can you take another glance at the sucralfate bottle. Is a whole tablet 1 GRAM (1000mgs)?
Let us know what you and your vet work on for the pred taper at the vet visit tomorrow.
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