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Post by Delia & Holly on Oct 14, 2019 12:43:44 GMT -7
My name is Delia, and Holly is our precious, almost-15-year-old long-haired dachshund. She weighs 14 pounds. In August of 2018, she had a mild-to-moderate IVDD episode in her neck. The vet put her on Gabapentin, Methocarbamol, and Carprofen. She seemed to recover with no long term issues. Fast forward to yesterday.
Holly woke up out of a dead sleep at 2 am yesterday morning (Sunday 10-13) yelping in pain and paralyzed in her back legs. She held her head high in the air like her neck was hurting. We immediately gave her Gabapentin 50 mg, Methocarbamol 750 mg (1/4 pill), and Carprofen 100 mg (1/2 pill). Right after giving her the Carprofen, I realized that the vet would probably want to give her a steroid shot, so I discontinued the Carprofen after this one dose. Continued Gabapentin and Methocarbamol morning and night. Pain seems to have diminished considerably and she has more movement in her neck, but none in her back legs. We have carried her outside and put her in a sling, but she is unable to use the bathroom and we have been unsuccessful in attempts to express her bladder. She has peed several times in her bed. She has been on strict crate rest since the episode happened.
We brought her to the vet when they opened this morning (Monday 10-14) and had to leave her for xrays, evaluation and bloodwork. The vet called just a few minutes ago and said that she has no deep pain sensation in her feet. She was, however, encouraged that she was able to wag her tail a bit. Because of her age and a heart murmur, she said that surgery really wasn't an option. She gave her a steroid shot and she wants to keep her there for a couple of days to insure that she keeps still and to administer fluids and some laser treatments. She is continuing the Gabapentin and Methocarbamol and I think she said Tramadol. She is also adding Pepcid. She said that right now her main goal is pain control. She doesn't want her hurting at all (bless her.) Once that's under control, we can bring her home for strict crate rest and continued medication.
[Moderator's Note. Please do not edit 14lbs carprofen on 10/13 one dose Steroid shot on 10/14 no washout, no double GI tract protection! gabapentin 50 mgs ?x/day methocarbamol 750? mg tab: 187mgs ?x/day tramadol ? mgs ?x/day Pepcid AC ? mgs ?x/day ]
Honestly, at first she seemed a bit pessimistic . . . kind of like if Holly doesn't get her mobility and bladder control back we may have to think about saying goodbye. (She didn't actually say that, though.) She is not super optimistic that she will walk again. However, once she found out that this wasn't our first IVDD rodeo (our youngest dachshund had 2 ruptured discs and had back surgery about 10 years ago. I was on this site EVERY day! Heidi was on wheels for a while but now she toddles all over the place and even chases squirrels.) I explained to her that we had the pack and play recovery suite all set up, we have several slings, and even a set of Eddie's Wheels if all else fails. And we have no fear of the lack of bladder/bowel control. We've dealt with that in Heidi for years. After that her attitude changed to "this is great! I'm so glad to hear this!" I guess my biggest concern is her age of 15 years. She was very healthy and active for a 15-year-old dachshund, but I hope she has the stamina to recover well.
Thanks for being there for us again. I don't know what I would have done without Dodgerslist the first time, and I'm so glad you are here for us again on our go 'round.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Oct 14, 2019 14:50:12 GMT -7
Delia, I'm sorry to hear your Holly is having another disc episode in the neck. Call the vet and very strongly advocate for Holly to be on SUCRALFATE! Carprofen stays in the body for 5-7 days even if there has been one dose. That is the reason either to do a 5-7 day washout before giving a steroid OR when deemed an emergency to stymy increased nerve damage to then replace the 5-7 day washout with double GI tract protection (Pepcid AC + sucralfate) for the double jeopardy of having both carprofen in the body at the same time the steroid shot was given! Please do your homework by reading about sucralfate so you know why you are advocating for double GI tract protection with not only Pepcid AC on board but also the Rx item sucralfate: link to read about timing with food and timing with Pepcid AC: marvistavet.com/sucralfate.pmlCAVEAT about Pepcid AC to just double check on with your vet. Was she only given a steroid shot ( name please)? What is the vet continuing to give in the way of steroids....prednisone pills, more steroid shots, IV steroids? Just so you are in the know a bit of contradictory neuro report., this is how neuro function is lost and the order it can come back in. Very predictable step by step of loosing neuro functions. So if a dog can do a happy tail wag, then by definition they must still have deep pain sensation. 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. √ YES Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. Owner will need to manually express the bladder. 8. NOT YET: 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. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservative
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Post by Delia & Holly on Oct 15, 2019 15:21:20 GMT -7
Hi. I'm sorry it's taken so long for me to respond. I have had a debilitating migraine today.
I should clarify about Holly's heart murmur . . . it was barely detectable. They did a dental a couple of years ago on her and since then they haven't been able to detect it at all. But it is still listed in her chart, of course. I'm not sure right now what the steroid shot was, but I'll find out the name tomorrow. I do know that the vet is giving her TWO separate medications for gi tract protection, Pepcid is one of them, but I can't remember the name of the ✙second one. I'll find out what the other one is, and if it is not Sucralfate, I'll ask that she be switched to that.
[Moderator's Note. Please do not edit 14lbs carprofen on 10/13 one dose Steroid shot name? on 10/14 no washout gabapentin 50 mgs ?x/day methocarbamol 750? mg tab: 187mgs ?x/day tramadol ? mgs ?x/day Pepcid AC ? mgs ?x/day ✙ #2 GI tract protector name? ? mgs ?x/day ]
I must have misunderstood what they said about deep pain sensation. When they squeezed her foot, she did not respond by pulling away. But the vet tech said that there WAS a response to deep pain stimulation. After reading your list I agree that she has not reached step 8 or 9.
Is there anything else you can think of that I need to bring up to her vet tomorrow?
Thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Oct 15, 2019 16:24:44 GMT -7
Sorry about that migraine! When you can, please provide the detail about the med list. What's in pink is missing and valuable information enabling us to best comment.
Steroid shot name? on 10/14 no washout Name of steroid pills to take at home: ? mgs ?x/day for how many days prior to a taper gabapentin 50 mgs ?x/day methocarbamol 750? mg tab: 187mgs ?x/day Delia, double check the size of a whole tab tramadol ? mgs ?x/day Pepcid AC ? mgs ?x/day #2 GI tract protector name? ? mgs ?x/day
Is pain fully in control dose to dose, round the clock for Holly. iF not, a phone call is in order to see about getting pain in control. With the missing info in pink, would be able to make a clearer comment about the medications. Did the vet give you and Rx for steroid pills to take at home starting 10/15. That steroid shot does not last long depending on which steroid was used....so pill form is used for at home.
How are you doing with manually expressing the bladder? Are you expressing every 2-3 hours while on the steroid?
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Post by Delia & Holly on Oct 16, 2019 12:47:26 GMT -7
Holly has been at the vet since I took her there early Monday morning. She gets to come home today at 4:30 after her last laser treatment, so I should be able to fill in all of the missing information tonight. I am concerned about expressing her bladder because I always had so much difficulty with her little sister years ago. They are going to give me a refresher on how to do it when I pick her up.
Thank you so much!
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Post by Romy & Frankie on Oct 16, 2019 13:13:26 GMT -7
I am very happy that Holly is coming home. Dogs do better at home. Learning to express is a skill and has to be practiced. Get the hands on refresher lesson from your vet and do your best. I had to have several hands-on lessons from the vet and vet tech. But I practiced and I learned. You will learn too. In the beginning, express frequently because you may not be getting all the urine out. Once you become proficient at expressing you can go much longer between expressing. We have a list of typical discharge questions here. You can add your own to these. www.dodgerslist.com/literature/dischargequestions.htm Please keep us updated on how Holly is doing.
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