Twyla's Reece 2/16 Conservative - Yorkie

Welcome to Dodgerslist, Twyla. 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.

**Disc disease is not a death sentence! ** Struggling with quality of life questions? Re-think things: www.dodgerslist.com/index/SDUNCANquality.htm

1.  First and most important, if you don't already have Reece confined to a recovery suite such as a crate or ex-pen, he must be immediately crated to protect his spine.  More info on strict crate rest below.  If Reece has been crated, please advise as to the exact date his crate rest started.

2.  The ER vet did not give Reece an anti-inflammatory dosage of Prednisone.  For a dog of Reece's weight, the anti-inflammatory dosage would be 5mg 2x/day.  Anything less than the anti-inflammatory dosage will not be effective on reducing the swelling that's pressing on the nerves of the spine.  Also he gave a very short course of the original Prednisone of only 3 days which is unlikely to resolve the swelling.  Please speak to your regular vet today about increasing the dosage to 5mg 2x/day for at least 7 days before tapering.

Prednisone. 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/article/drug-library/library/prescription/prednisone--prednisolone

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.

3.  When you speak to the vet about the Prednisone dosage and the amount of days before tapering, please also ask him what he prefers to do about the pain meds when the Prednisone starts to taper - does he want to also taper the pain meds or stop them completely.  When the anti-inflammatory is tapered, the pain meds are also tapered or stopped so a true test for pain can be made.  Pain = swelling = more time on all meds for a bit longer.  More info on the inflammation phase of IVDD here:  www.dodgerslist.com/literature/healingsweling.htm

4.  Yes, do speak to the vet today about starting Pepcid AC (Famotidine) to protect Reece from the side effects of the Prednisone.  We follow vets who are proactive in protecting against the side effects rather than allowing the damage to occur and then try to fix it.

5.  If Reece has in fact lost bladder control, you'll need a hands-on-your-hands demonstration on how to express his bladder today.  More information on expressing the bladder for you to review prior to your demonstration:  www.dodgerslist.com/literature/Expressing.htm  The only way to tell if a dog has bladder control is to carry him to a spot where he or another dog has peed before, support his hind end but not under the belly, let him sniff and see if he can release urine.  If he cannot, then his bladder needs to be manually expressed to avoid UTS.

Please check the dosage of the Methocarbamol.  That seems like a very high dosage.

It appears there have already been two vet visits (2/16 & 2/17) with a third visit scheduled today (2/18) and that the ER vet has suspicioned IVDD but is leaving it up to your regular vet to final diagnose.  Is that correct?  Please let us know more about the three visits.  Transport to vets involves risk of too much movement of the spine and must be kept to the very minimum and only the absolute necessary.  If you have not had a demonstration on how to express the bladder, you do need to bring in Reece today to get one.  Adjustments to pain meds should be made by phone and do not necessitate a visit to the office.  If you do need to transport Reece to the vet, be sure to secure his crate in the car and pad it well with rolled up towels/blankets to prevent his being jostled when turning corners or stopping the car.

Neuropathic pain is not common but you should be aware of it. This kind of pain is abnormal, phantom pain sensations with severe spinal cord damage. Signs are obsessive licking of paw, leg, genitals, tail. Escalates to biting, life-threatening chewing off parts. Immediately put on an e-collar (or lengthwise folded towel around neck and duct taped closed) to prevent access to lower body. Contact vet immediately for Gabapentin or stronger Lyrica (pregabalin) for neuropathic pain. More info: www.dodgerslist.com/literature/neuropathy.pdf

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.
Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/literature/CrateRRP.htm

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.

If there is great pain or severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering.

CAUTIONS: ~~ Laser light therapy is contra-indicated with tumors which are detected via x-ray.

~~ During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back can increase a disc tear and escape of disc material into the spinal cord . For an animal with very mild neuro deficits, the risk of transporting to therapy has to be carefully weighed against what benefit is to be gained. www.ahvma.org/find-a-holistic-veterinarian/

~~ Why Chiropractic is not recommended for IVDD dogs: www.dodgerslist.com/literature/chiropractic.htm


Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD soonest possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. Your dog will be depending on your ability to learn - excellent video series here: www.dodgerslist.com/literature/theater.htm
 PRINT OUT this link and tape to your fridge: www.dodgerslist.com/literature/healingpage.htm
 use the printout as your roadmap to avoid dangerous detours in your dog’s care
 make notes/highlight to keep yourself on track
 follow all the links in the next days to become the IVDD savvy pet parent your dog needs. Use the “search box” to easily locate topics over at our Main www.Dodgerslist.com website: www.dodgerslist.com/index/searchBOX.jpg

Healing prayers for Reece.

Twyla, if Reece was switched from Rimadyl to Prednisone without a 5-7 day washout period he needs double stomach protection immediately to prevent possible stomach problems including diarrhea and ulcers.

Pepcid ac or the generic famotidine reduces the amount of stomach acid produced.

Sulcrafate, a prescription medication, bandages any irritated/damaged stomach areas.

IVDD is not a reason to pts!

Twyla, danger to Reeces GI Tract. Summary of things to attend to to prevent bleeding ulcers due to no 5-7 days of washout from Rimadyl before using steroids.
-- Get the Pepcid AC (famotidine) into him asap now. Then from now on dose it every 12 hours.
-- Call back your vet and explain you are worried about even with one dose of Rimadyl (stays in the body for 5-7 days) can cause GI tract damage.
-- Do you best job of advocating for sucralfate in addition to the Pepcid AC which you now have in his tummy (right?) Read about sucralfate so you know why you are strongly wanting it on board marvistavet.com/sucralfate.pml Sucralfate has a timing with food and with Pepcid AC you will need to know about.

On my way to Walmart now.  I will give it to him..I gave him the prednisone at 1230 pm.  Is it too late for the Pepcid??

Twyla, I, too, am concerned about the likelyhood the  bladder is overflowing due to reflex. Please read what Marjorie has written you above about doing that sniff and pee test to obtain proof of not needing to express. Dogs who lack bladder control and are not expressed will very quickly in days develop a bladder infection. So very important to be expressing if Reece can't sniff, circle and then with his brain send a message to the bladder to release urine.  Overflowing is a reflex that when the bladder becomes overstretched, the bladder will release urine, but not all of it. The urine remaining becomes a breeding ground for bacteria.   At potty time only one dog (Reece) should be your focus of attention.  Please take Gotti out separately.

Anti-inflammatory 
Reece has only been on something that works on swellling for two days (one dose of Rimadyl and one inj of Dex).  Then a tapering dose of Pred was Rx'd for 2/18.  Taper doses do not work on swelling.

Please read so you have an understanding how anti-inflammatory drugs (steroids or NSAIDs) work:  www.dodgerslist.com/literature/healingsweling.htm
--  When the taper starts, pain meds are naturally stopped or backed down so you can correctly assess for pain. Right now pred is the taper but all the pain meds that mask pain are still on board!
    The point of using an anti-inflammatory is getting swelling down asap. Now no one knows what is going on with pain.  If pain is being masked, there is nothing on board that is working on the swelllig.  If all the pain is gone, then he's taking pain meds for no reason.
-- A two day course is quite short.  It may have done the job. But the more frequent expectation is that a 7-day or maybe a 14 day course is what it may take to resolve all  swelling. An anti-inflammatory dose of pred would be more like 5mgs every 12 hours.

Rule of thumb is:

pain = swelling = use the anti-inflammatory dose of pred, pain meds and Pepcid AC

FAMOTIDINE
This acid suppressor lasts in the body effectively during a disc episode for 12 hrs. That is why 5mgs for your Reece would be given every 12 hrs.  You wrote  5mgs 1x/day.  Please let us know you are giving  famotidine 2x/day

Keep up the good work of following up with the vet to make sure things are right for Reece! You are certainly playing an instrumental roll in his being able to heal his disc and given time all the potential to heal his nerve functions.  Reece certainly does not need other issues to happen on top of a disc episode (GI tract issues, bladder infection (UTI), lack of an effective anti-inflammatory dose if he would need it.

Summary
-- Gotti is taken out separately from time you need to focus on Reece
-- Is there still pain?  Ask for a proper prednisone taper test to give proof.  
-- During the prednisone test for pain, are pain meds being backed off or full stopped to afford you quick means to assess.
-- Famotidine 5mgs now given every 12 hrs (2x/day)?
-- 2nd GI protector, an Rx for sucralfate.
-- result of sniff and pee test to proove bladder control or need to express. Make sure the sling or your hands are not on the tummy area as that can press on the bladder.

Usually when the pred taper is begun the vet cuts back or stops the pain meds at the same time. The reason for this is that these meds can mask pain caused by swelling in the spinal cord. So there could still be spinal cord swelling which causes pain and the lower taper dose of pred is not treating it. When you speak to your vet please ask him if he prefers to stop or cut back the pain meds. If, when this is done, pain is seen there is still swelling and there should be more time on the full dose of pred and the pain meds and Pepcid.

For smaller dogs it is best to carry them to the potty spot and allow for a minimum amount of movement. A harness and 6 foot leash can be used 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!

Twyla,

Please keep a close watch on any signs of GI problems apparing.  EVEN one dose of Rimadyl is a problem when there is no 5-7 days washout before giving a steroid. The reason is, it takes 5-7 days for the Rimadyl to fully leave the dog's body.   So on Monday with the Dex injection Rimadyl was still in Reece's body!

Are you giving Famotidine 5mgs every 12 hours now.  Once a day dose is not enough protection in acid suppression!

Signs of  GI tract damage progression:
Nausea of not eating, lip licking, vomit, loose stool, bleeding ulcers, black or red blood in diarrhea, moving to deadly perforated stomach lining.

PREDNISONE
Pred was prescribed at a taper dose to start on 2/18, not up at the anti-inflammatory dose. Thus so far Reece has only been on an anti-inflammatory for two SHORT days (1 day Rimadyl,  1 days Dex injection.  Taper doses of Prednisone are not working on inflammation. IF t here is inflammation by not doing a real test for pain pred taper you and the vet are blind as to whethere there is a need to prescribe pred at the anti-inflammatory level dose of 5mgs 2x/day (every 12 hours). Reeces is getting a taper pred dose of 5mgs ONCE a day.

Please read so you are up to speed on how anti-inflammatory drugs (steroids or NSAIDs) work: www.dodgerslist.com/literature/healingsweling.htm

Thank you. I will voice all of these concerns that you have brought to my attention to my vet this evening. They are available via chat 24/7. All chat feeds are forwarded to the primary vet the next morning. I will ask about the prednisone dosage and what his plan is moving forward.

Regarding the Pee Test:  Reece was in his crate and he became fidgettity like he does when he has to potty.  This was a first since his episode.      We put the sling on him in the house, carried him out to the sniff spot, and then put him down.  We let him take a few steps.  He sniffed  and he did pee. There is very little pressure on the sling and on the belly.  I told him to potty thinking he would poop but he didn't. 

Reece had a busy day today.  He used his hind legs today, standing on them for about a minute or two before he would flop down. He barked when Amazon delivered a package and he was happy to see my mom! I took him outside and I supported his hind legs without the sling. He urinated and he pooped.  We've got snow here and he's never liked being out in the snow!  He did have a pretty goodnight. Thank you all for the support. I will continue to send updates!

Good Morning!  

I want to give a quick update on Reece but I want to address your questions first!

  Yes, I am giving him [▲famotidine] 5mg, one when we first wake up in the morning which is between 6:30 and 7:00 am,and the other 12 hours later.

We started the taper mode for the Prednisone on Thursday, Feb. 20th as his team prescribed.  He has three left, his last dosage on Feb. 26. I have pain meds and presently I'm monitoring his progress, and looking for signs of pain.  

[Moderator's note: please do not edit
Weight: 18.2 lbs
Rimadyl 2/16 by dog’s DVM, Stopped on 2/17 by ER
Dex injection 2/17 at ER due to loss of back leg function
  TOTAL Days: 2 on an anti-inflammatory (taper days do not work on swelling !
Prednisone as of 2/18 at ER taper dose: 5mg 1x/day;   last taper dose 2/26
Gabapentin 100 mg 3x/day by ER 2/18?
Methocarbamol 125 mgs 2x/day by ER 2/18?
Lactulose by Dog's vet 2/18
✙Trazodone 50mgs 2x/day
famotidine 5mgs ▲2x/day]

There are currently no signs of pain.  He's still on the Methocarbamol and Gabapentin, same dosage.  His vet didn't tell me to taper the meds but to look for signs of pain.  Should I start tapering those meds also, and are there any signs of pain that I should be aware of and that can possibly be overlooked?  He's not tightening up like he was when this first started, nor is he shying away when I reach for him.

Update:     He is now standing on both hind legs, wagging his tail, also in his potty pen that I created outside in the yard, he can lift his leg to potty and he is defecating.  He gets really agitated when he hears cars pull up, other dogs barking, etc., and he's whining, pacing in his recovery crate.  His vet has prescribed ✙Trazodone-100mg-0.5 tablet every 12 hours. He will start taking that today, Feb. 22, 2020.

Thank you.  I do have a concern about giving the Trazodone.  His vet said that he didn't want Reece too active in the event he may re-injure himself.  He also stated for me to watch for signs of pain and administer the Gaba as needed.  Since giving him the Trazodone, he's truly sedated.  Is there cause for concern? 

Update on Reece:

He went to the vet on February 29th.  The vet was impressed with his progress.  He didn't expect to see him standing alone and walking. 

He is no longer on the Predisone (last dosage was given on Feb. 26) but will start Rimadyl-37.5mg-1x per day after the 7-day wash-out period.

Reece isn't exhibiting any signs of pain.  He wants to take off running.  He's still on strict crate rest.

▼Gabapentin-100mg-2x per day
Methocarbamol-125mg-2x per day
Trazodone-.25 tablet-1x per day

[Moderator's note: please do not edit
Weight: 18.2 lbs
Rimadyl 2/16 by dog’s DVM, Stopped on 2/17 by ER
Dex injection 2/17 at ER due to loss of back leg function
      TOTAL Days: 2 on an anti-inflammatory (taper days do not work on swelling !
Prednisone as of 2/18 at ER taper dose: 5mg 1x/day; last taper dose 2/26
Rimadyl to be  3/3: 37.5mgs 1x/day  for ? days.
Gabapentin 100 mg ▼3x/day by ER 2/18?   PAIN MASKING pain med!
Methocarbamol 125 mgs 2x/day by ER 2/18  PAIN MASKING pain med!

Hi i don't know the proper term but his hind paws were still bending slightly, even though he's standing, walking, running, attempting to jump, the vet said that his CP ( I can't spell the full name of it) is not fully there yet.  This was last Friday.  I have noticed that he's no longer doing that with his  back paws so I will call the vet today and let him know.  As far as giving the Rimadyl, he wants to ensure that the swelling has gone down completely.  Is there a way that I need to rephrase what I need to ask?  He doesn't appear to be in pain..just agitated to get out of his crate.