Lindsay's Morris 4/9 conservative- Basset/dox mix GRAD 6/4

Welcome!   Hi, my name is Paula, what's yours? Oh my, you have a very full plate with a newborn, a young child, dogs and Morris and a hubby working out of town!

Sometimes it will take several attempts to taper off of pred before all of the painful swelling is fully gone.   If at some point surgery might be a consideration is it an option for your family?

PREDNISONE
The important part of prednisone are the days at the full anti-inflammatory dose.  Taper days are not included in the 7-30 days it might take to get rid of painful swelling.  For some dogs it might even take more than 30 days at the anti-inflammatory dose.  No vet Rx a 30 day course of pred. Instead they try one course (maybe a 7 or 14-day course) and with the taper they can see if another course is needed and then another test for pain/new neuro issues.  We'll need you to help us understand how many days has Morris actually been up at the anti-inflammatory level of pred.

For a 26 lbs dog the anti-inflammatory level is approximately 8mgs 2x/day.
--- For how many days has he been on 8-10mgs twice a day?  
--- What is the last date Pred went back up to the anti-inflammatory dose?  
--- For how many days was that Rx— and then a test taper again?(remember taper days are not included because the lowered dose/frequency is not effective enough to work well on getting inflammation resolved.)

REFERERENCE: Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily. Dr. Dawn Ruben Prednisone / Prednisolone www.petplace.com/DrugLibrary/prednisone-prednisolone/page1.aspx last accessed 12/6/18

PEPCID AC
  The idea is to be proactive when on Prednisone and take no chances with GI tract damage. STOMACH PROTECTION
      Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach.   Let us know that you now have Pepcid AC on board 10 mgs 2x/day.

REFERENCE: The usual dose during a disc episode is Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours.  Give the anti-inflammatory with a meal as added protection. www.1800petmeds.com/Famotidine-prod11171.html

BLADDER CONTROL
With Morris having bladder control, that is he CAN sniff an old pee spot and then make the decision to release urine there would be excellent.  Help us to verify he actually has bladder control.  
--- Do you see him sniff and then release urine?  AND you are not holding his tummy area with your hands, nor any sling pressing on the tummy area?
--- How often do you lift him and carry him to and from the potty place?
--- Does his bedding stay dry potty break to  potty break?


PAIN
When have you observed him shaking?  After moving, nearing next dose of pain meds? When is the last time you saw the shaking?  Any other signs of pain observed recently?
◻︎ not their normal perky selves  

POTTY TIMEs
  In keeping with the need to limit movement so that the disc may heal and not retear— potty time requires being a step ahead in protecting the disc.
  Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on and no way to escape!



ROM for the conservative dog
   The usual is to ensure all pain/swelling is resolved before very, very light least aggressive ROM is used. Swelling is a pressure to the spinal cord and in addiition to the disc pressure on the cord contributes to death of nerve cells.  The pred test for pain taper assess if at least the pressure of inflammation/swelling is gone or not, so we are interested to learn the date of the next taper from you.

NERVE REPAIR
The purpose of the 8 weeks is to ensure the disc has formed good strong scar tissue.

Can you tell us with the last escape or using the wheelchair (no dates were given) if the disc had re-torn/relapsed evidenced by observing increased pain/worsening of neuro function?  

Nerves may or may not self repair in the short 8 weeks the disc takes to self heal. Often we need to think more in terms of months rather than days/weeks.  No one can give you a time line for nerve repair. However nerves do typically heal in the reverse order of damage... it is a step by step process.  Let us know if Morris can do a happy tail wag if you specifically do some happy talk.  

Where do you observe Morris to be on this list:
1. 4/9 pain caused by the initial 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), no movement when trying to reposition in the recovery suite.
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, when it comes back no one can mistake the return of this nerve function!!
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. Take only the word of a neuro (ACVIM) or ortho (ACVS) for this very tricky  to identify function.
     A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservative

Look forward to increasing our understanding of Morris' disc episode with your answers to better comment.   
 

Lindsay, it would be best if you avoid tickling his paws or doing any sort of pinch test. Often it is only specially trained surgeons who are able to correctly identify the neuro pinch test and why we say only take the word of of neuro (ACVIM) 0r ortho (ACVS).  Ticklling paws is reserved for when he is off all meds and and clear of painful swelling/inflammation.

With the begin of the pred taper,  verify with your vet which he wants.
-- the backing off of  tramadol and gabapentin  OR...
-- the full stop of these two pain meds.

Pain meds mask pain and delay in getting accurate results of backwards steps in neuro function and revealing if any painful swelling still exists.

The kind of leg movement you would want to observe for is that outside of potty time. Legs can be caused to move by reflexes in conjunction with things going on then.

1. √ Deep Pain Sensation (Only correctly identified by a specialist.)
2. √ Tail wagging with joy at seeing you or getting a treat or meal.
3. √ Bladder and bowel control verified with the "sniff and pee" test.
4. ?  Leg Movement, and then ability to __move up into a standing position, and then   __wobbly walking.
5. Being able to walk with more steadiness and properly place the feet.
6. Ability to walk unassisted and perhaps even run.
More info: www.dodgerslist.com/literature/healingnerves.htm

For us humans to be able to distinguish between reflex and brain directed, we have to see some sort of head level involvement with the tail, with a limb or with release of urine so we know the movement was done with purposeful thinking.
--- Sniff (head level nose) then release of urine would be brain directed.
--- Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail movement during potty time can often be a reflex
--- Itchy sensation at at neck and then tries to scratch would be purposeful movement. 
--- Desires to move his body, back legs try to reposition his body.

Let us know what you observe regarding leg movement excluding anything observed during potty time.

Got my fingers cross as pain meds are stopped or backed off with the pred taper begining today you wll not see any pain surface!   Keep us posted!

Lindsay, when all the pain meds have been stopped only then will you know if it is a good idea to begin some very, very light ROM. See the little yellow ROM icon on the left under treatment? That is a reminder to us to explain how to do when the time comes.

A cart is to wait until he is off all meds and has graduated. It takes quite some movement to the back, neck getting in and out of a cart...not a good idea at all until he has graduated.

Hi! Morris is 13 weeks post injury. He is completely off all pain meds and steroids. We weaned him off prednisone first. The last dose was June 14th. The next week we took him off tramadol (June 17th through the 22nd we did tramadol once daily instead of twice daily and ended on the 22nd. Then on the 23rd of June we gradually took him off the Gabapentin going from twice daily to once a day and ending the last dose on June 28th. I have been taking Morris every other day for laser therapy still. I figured it won’t hurt and he really enjoys it. I got an exercise pen like you said to get. And he still stays in it all day and all night with the exception of going outside to urinate every 3-4 hours.
Morris doesn’t seem to be in any pain at all. A few weeks ago my vet wanted another X-ray if Morris’ spine. He actually has 2 calcified discs, not just 1. I believe it’s T12 & T13. It wasn’t very evident on the first X-ray in April apparently.
Morris is playing with his tennis balls a lot in his X pen and the other dogs when I let them in with him. He’s eating and his overall mood is back to old Morris.
He has started to bring his back end up a lot but usually ends cross legged and down he goes. I have been doing light range of motion exercises with him and the days I don’t have him in for laser therapy, I put him in the tub where he does really well. He stands flat footed mostly on the left foot. The right foot knuckles under some. He can control his back end a lot better. Before whenever I put him in the tub, his back and was like a buoy. Now he’s able to “walk” from side to side in the tub. I haven’t put him in the cart again. Do you have any recommendations on exercises? Can I put him in the cart now?
Thanks so much!

Update on Morris- He's doing pretty good.  He has actually started to walk here and there but not all the time.  I noticed the importance of constant range of motion exercises. Two weeks ago I noticed he wasn't trying to walk much anymore or stand.  I haven't stopped the laser therapy at all.  I'm still doing 3 times per week, but I had slacked on doing actual range of motion exercises, once I started those back up he's starting to walk some.  We ended up taking him to an orthopedic specialist a couple months ago because my veterinarian said he may benefit from them going in and chipping off some calcification off the discs and the specialist said at this point he wasn't a surgery candidate, but gave us continued hope and said he has seen dogs with severed spinal cords walk again and dogs walk after a year. He recommended Elle Vet chews and Dasuquin advanced chews, I've been giving Morris them for a couple of months now.  I don't really see much difference with them but I'm still continuing them. Thanks for your support!!

I don’t think there is any underwater treadmill close to me, Unfortunately!

When I help him stand I sometimes have to flip his feet to stand on his paw pads because he will occasionally knuckle.
I find that when he’s outside and sees the neighbor dog that he’d like to chase he will get up and his legs are straight and stiff when he walks, sometimes he hops, sometimes he strides, but again, very stiff legged.

Some days he will get up and walk a lot of I’ll catch him randomly standing. Other days he doesn’t really do anything.

I notice that from his hocks to his paw pads - when I flex that area while exercising, it’s seems flaccid. After watching the treadmill video you shard, it said when the water his at the hocks they are 91% weight baring. Do you know of anything I can do to strengthen that area more? We do a lot of sit to stand exercises. Also- what are your thoughts on hock braces?

In your experience is it better to keep him confined most of the time still in his Xpen? Is it possible that he gets lazy and just doesn’t bother to get up because he can just scurry around faster?

Yes, now that it’s colder where we live, we use my garden tub for exercise which he does really well with, he can support himself when the water is a little below his flank area. I probably only do that once to twice weekly. I’ll try and get more of that in. I do range of motion exercises everyday now.
     He is crated when I’m at work. We do let him free roam and he definitely plays and hangs out with the other dogs. I was just worried with him scurrying around the house that he would hurt himself, but he hasn’t so far these last few months.