Maria's David 1/22 Conservative — UK GRAD 3/18

Welcome to Dodgerslist, Maria.  Sorry to hear that David is having another disc episode but so glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you.

Please give us more information about the steroid injection.  What was the name of the steroid given?
Was it a long acting steroid?  If so, for how long is it expected to last?  If it was not a long acting steroid, David should be on oral steroids to be given at home for a week or two to work on the inflammation which is pressing on the nerves of the spine.  Is there a reason why oral steroids have not been prescribed?  It can take 7-30 days for the swelling to resolve and until then, an anti-inflammatory is needed.  It's important to get the swelling down ASAP as the pressure of the swelling on the nerves of the spine can lead to nerve damage.  More information on the inflammation phase of IVDD here:
www.dodgerslist.com/literature/healingsweling.htm

An IVDD episode is usually very painful, yet David is not on any pain meds.  David doesn't need to be in major pain to require pain meds.  Any sign of pain would necessitate the addition of pain meds.  It sometimes take three types of pain meds to get the pain of IVDD completely under control:  Tramadol as a general pain med, Gabapentin for nerve pain and Methocarbamol for the pain of muscle spasms which often accompany IVDD.  Should you see any sign of pain at all, you should immediately contact the vet to advise.  Signs of pain to look for:  ☐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 ☐can’t find a comfortable position ☐Arched back ☐ Holding front or back leg flamingo style not wanting to bear weight ☐head held high or nose to the ground ☐Not their normal perky selves? Full pain relief is expected in 1 hour and stays that way dose to dose. If not in control your vet needs to know asap to adjust meds.

PEPCID AC: Anytime a dog is taking an anti-inflammatory, stomach protection must be added.  A long acting steroid injection can cause more pronounced side effects than their oral counterparts.  Ask if David has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). canigivemydog.com/wp-content/uploads/2011/10/can-i-give-my-dog-pepcid-ac-300x300.jpg 
Doxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours. NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.html

Please refrain from pinching David's feet.  He has deep pain sensation as he still has bladder/bowel control.  It takes a Board-certified neurologist to correctly determine deep pain sensation so you won't be able to determine anything by pinching his feet.  That could cause David to pull back his leg and that might cause too much movement of the spine.

Is a vet available to come to your home to do laser therapy?  Transport to a vet is risky as it could cause too much movement of the spine.  The safest place for David is in his crate.

Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho?

Although David did strict crate rest before, I don't see that you've been here on Dodgerslist before so I'd like to share our recommendations regarding strict crate rest.  The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.

STRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: www.dodgerslist.com/literature/chiropractic.htm ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.

Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. 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 a 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! www.dodgerslist.com/literature/slingwalk.jpg

Healing prayers for David.

Thanks for the clarification, Maria. Do you currently see any of the signs of pain that I listed above? If so, then there is still swelling pressing on the nerves of the spine and still the need for an anti-inflammatory and pain meds. The vet has a very antiquated belief when she says not to give pain meds so the dog won't move too much. To keep a dog in pain to prevent movement is not a good approach at all. Pain hinders healing and why should a dog remain in misery? The crate prevents movement, not keeping him in pain.

IF you see any sign of pain at this time, then you do need to speak to the vet about getting David on an oral anti-inflammatory (a steroid, not a NSAID, since such a switch would necessitate a 4-7 day washout period) and pain meds. If you do not see any sign of pain, then that would indicate that the swelling has now resolved and no meds are needed. The Pepcid AC would only need to be added if an anti-inflammatory is being given.

If there is any current pain and you need to speak to the vet about adding pain meds, there are three pain meds that we see commonly given with IVDD: Tramadol as a general pain med, Gabapentin for nerve pain and Methocarbamol for the pain of muscle spasms.

The safest way to transport a dog to a vet would be to secure his crate in the car and pad it well with rolled up towels/blankets so he doesn't jostle around too much when you brake or turn corners or a car cuts you off and you slam on your brakes. The very safest way to do the laser treatments would be to have at at-home administration of the treatments if possible.

A harness and leash should be used when taking David out to potty with a sling to support the spine as shown in the photo above. He sounds like a calm dog and you know him best but the concern is that he might try to take off and drag himself if he sees or hears something exciting, like a squirrel or another dog. Too much movement and the damaged disc could tear more, causing more pain and more nerve damage, possibly permanent. Any time out of the crate is a dangerous time for a dog going through an IVDD episode so all care needs to be taken to prevent further damage to the spine.

Please let us know what you observe as to any sign of pain. Hopefully the swelling has now resolved.

Maria, what wonderful news to hear that nerve repair has happened in such a short time! When he has graduated from the 8 weeks it takes the disc to heal, he can safely do more. With more exercise allowed after graduation I bet you'll see even less wobbliness in those legs.

Can't wait to hear what you report in your next update. David is really quite inspiring for newbies wondering if conservative treatment can work. Mark your calendar for a March 18 graduation day. We'll have lots of information to help you slowly over a couple of months ease him back into familty activity and ideas for living with an IVDD dog.