Nikki's T Rex 2020 conservative -Chi

My dog exacerbated his back today. Screaming in pain, so awful to see. Gave him 1/4 of a 50 mg tramadol ehich seemee to kick in within an hour. I spoke to ver on phone and she states i can give him 1/2 tablet at next dose if i want.   Is this something i should do? He is 10 lbs
Side note:i was not able to grey him to take the 1/4 tablet of 25 mg novox that he was also prescribed. He was refusing and screaming

Tjank you, 
His  most recent xray was on 3/20/20 [Feb 20, 2020] and she just told me 2 narrowe spaces near the center of his back but did not specift which ones. She just told me that he is at risk for slipping a disc.

The tramadol and novox i have on hand leftover from his previous exacerbation. I was not able to get him to take the novox yet hit plan to give it in the morning when he wakes up if he will take it. He is currently in his recovery suite after laying oj his side for 1.5 hours on my bedroom floor, we were able to get him in there with only one small yelp. When i spoke to vet on phone she told me to increase the ▲tramadol to 25 mg at next dose which wouldn't be until 7am since he had the last dose at 7 pm and is on 12 hour increments.

[Moderator's Note. Please do not edit
10 lbs
dental Xray  Feb 20, 2020
pain 3/1 caused by jump off bed   
Norvox ? :   6.25mgs 2x/day  for ? days, then stop TEST for _pain/_neuro
▲Tramadol 25mgs 2x/day
needs GI tract protector, Pepcid AC 5mgs 2x/day, on board w/Norvox!]

If the xray was on Feb 20, 2020, xrays do not proove where a disc episode is. It may help to suspicion it.

Did he have a course of Novox on Feb 20? for how many days?
Had you been consistently doing 100% crate rest for an intended 8 weeks from 2/20 disc episode? Just trying to find the reason for pain surfacing on Mar 1.
Maybe now a different disc, a neck disc.
Was he holding his nose to the ground back on Feb 20?

Nikki, I hope you have TRex thread bookmarked so you can always post on his thread
  I just found a post you made to a new thread "Tramadol Dose" and have moved it back to

TRex' thread: dodgerslist.boards.net/thread/7347/nikkis-rex-conservative-neck-chi

QUESTIONS
If the xray was on Feb 20, 2020, xrays do not proove where a disc episode is. It may help to suspicion it.

Did he have a course of Novox on Feb 20? for how many days?
Had you been consistently doing 100% crate rest for an intended 8 weeks from 2/20 disc episode? Just trying to find the reason for pain surfacing on Mar 1.
Maybe now a different disc, a neck disc.
Was he holding his nose to the ground back on Feb 20?
What did TRex do today 3/1 to cause the pain ?

NIkki, understand that you may be tying the vet's hands IF this is a neck disc and you give the Novox.

Please understand the danger to give a steroid without a 5-7 days washout if you were to give the Novox. Hope the increase of Tramadol will see TRex thru the night in better comfort.

What trusting eyes our dogs have! Vets choose an anti-inflammatory during a disc episode to get painful swelling down in about 7-30 days. These powerhouse meds do wonders OR they can be dangerous. Vets who practice safe medicine and owners up to speed on medications make all the difference. Did you get all four questions right?

www.dodgerslist.com/literature/healingswelingANSWERS.htm

Nikki, THANK YOU for explaining the cause of this new disc episode. I fully understand the painic thing.

If you knew this was a NECK disc and the vet would prefer to use a steroid with a neck disc, then you would not give Novox. You would let the vet examne to confirm if a neck disc and precribe from one of the two classes of anti-inflammatory drugs.

Fingers crossed that TRex can get thru the night with increased tramadol and see the vet 1st thing in the am for the right diagnosis and the right combo of meds.

Please do keep us posted as we always worry to know if a dog is on the right meds to provide full comfort from pain.

The single most important care is the 100% STRICT crate rest 24/7 only out of the recovery suite for a very, very few footsteps at potty time. This kind of care allows the disc to heal and prevents that bad disc from worsening to the point it harms the spinal cord with more than just wobbly legs

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. TRex 3/1 p.m.: 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.
    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. So if surgery is an option for your family get to a neuro or ortho asap.
     A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservative

Setting up the recovery suite and lots of great tips to make it go smoother:  www.dodgerslist.com/literature/CrateRRP.htm

Nikki, good to hear he's at the vet to see exactly what the issue is and the appropirate treatment needed.

With any of these joint supplements: If your pocket book can afford it, if you think it helps, then giving of it likely would not be harmful for his knee/elbow joints for example.

Disc joints are a different type of joint than in the elbow and knee. You can do some reading/research about these "facet joints" aka "zygapophysial joints" in the spine to find out if oral joint supplements can reach that area. Here is what a facet joint in the spine looks like

Nikki your vet has given a very dangerous combo of NSAID injection ketofen (Ketoprofen) and followed up by a different NSAID Novox (carprofen)  Do not dally, get the Pepcid AC on board and phone your vet about your concern of GI tract damage if the Novox has already been dosed.  

Have you already given the Novox dose?

There is no mention about GI tract protection of Pepcid AC (famotidine).  TRex needs that Pepcid AC now!

And if you've given the Novox then a 2nd GI protector on board that is a prescription item:
SUCRALFATE. You will need to strongly advocate for getting an Rx from your vet for the sucralfate. Read about it so you know why you are advocating for it.
   SUCRALFATE link:  marvistavet.com/sucralfate.pml
---

SUCRALFATE .... absorption of ciprofloxacin, a fluoroquinolone, is reduced by 96% when given with sucralfate; if ciprofloxacin is given 2 hours after sucralfate, absorption can still be reduced by less than 50% but is less impaired (about 17%) if ciprofloxacin is given 2 hours before sucralfate.4,5 The exception is H2-blockers, for which sucralfate slows but does not decrease the extent of absorption. In humans, sucralfate and H2-blockers are given simultaneously without loss of efficacy6; this may apply to dogs and cats with suspected or documented gastric ulceration.
4. The effect of sucralfate pretreatment on the pharmacokinetics of ciprofloxacin. Nix DE, Watson WA, Handy L, et al. Pharmacotherapy 9:377-380, 1989.
5. Combined use of ciprofloxacin and sucralfate. Van Slooten AD, Nix DE, Wilton JH, et al. DICP 25:578-582, 1991.
6. Sucralfate. McCarthy DM. N Engl J Med 325:1017-1025, 1991.
www.cliniciansbrief.com//article/drug-interactions-polypharmacy

■ All NSAID package inserts carry this similar FDA required warning as for Previcox: "PREVICOX should not be given with other NSAIDs (for example, aspirin, carprofen, etodolac, deracoxib, meloxicam, or tepoxalin) or corticosteroids (for example, prednisone, cortisone, dexamethasone, or triamcinolone).." www.fda.gov/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/ucm050105.htm

■ NOVOX package insert for the veterinarian:  
   Can Novox® be given with other medicines?
Novox® should not be given with other NSAIDs (for example, aspirin, deracoxib, etodolac, firocoxib, meloxicam, tepoxalin) or steroids (for example, cortisone, dexamethasone, prednisone, triamcinolone).  animaldrugsatfda.fda.gov/adafda/app/search/public/document/downloadLabeling/42

■ The primary cause of adverse effects from NSAIDs is incorrect dosing (eg, concurrent use with corticosteroids or another NSAID, changing NSAID without a suitable washout).8 Washout period (dogs, 5–7 days 2
2. Guidelines for safe and effective use of NSAIDs in dogs. Lascelles BD, McFarland JM, Swann H. Vet Ther 6:237-251, 2005.
8. Systematic review of nonsteroidal antiinflammatory drug-induced adverse effects in dogs. Monteiro-Steagall BP Steagall PV, Lascelles BD. JVIM 27:1011-1019, 2013.

■ It is important to realize that subclinical gastroduodenal ulceration is likely to be present in dogs with type 1 disk extrusions, even without the administration of potential ulcerogenic drugs (e.g., NSAIDs, glucocorticoids), so the use of such drugs should be minimized if at all possible. Curtis W. Dewey, DVM, ACVIM Neurology Cornell University.
A Practical Guide to Canine and Feline Neurology 2nd ed Blackwell Publshing 2008 Chapt 10 "Myelopathies: disorders of the Spinal Cord"; By Curtis W. Dewey p331-332. books.google.com/books?id=evMCYYOdVCkC&pg=PA387&lpg=PA387&dq=canine+disc+conservative+treatment&source=bl&ots=5iT4JrOD4z&sig=ZV5AkrVodF_iBWkzh4MyQgKbCog&hl=en&ei=vFUETdTVIYbknQfm48jlDQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDoQ6AEwAjgK#v=onepage&q=canine%20disc%20conservative%20treatment&f=false

Nikki, I hope with the readings I sent you can CLEARLY see this vet made a very poor choice in use of NSAIDs. It puts TRex at unnecesary risk to his GI tract.
--- change in routine of being crated causes extra stomach acids
--- NSAID causes extra stomach acids
--- Using another NSAID without the needed 5 to 7 days of washout causes DOULBE jeopardy for more stomach acids.

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.

There was no reason to put TRex in jeopardy by using injection of Ketofen injection. Novox should have simply been started so that there was no need of double GI tract protection (Pepcid AC/famotidine, an H2 blocker,  PLUS sucralfate which works in a different way to double protect the GI tract.

Having TRex go through a 5-7 days of safety washout after Ketofen injection would leave TRex w/o anything to work on swelling. In order to have an anti-inflammatory on board (Novox) in lieu of using a 5-7 days safe washout, it is the double protection of two protectants that are needed. There was no need ot put TRex thru this.   Now the owness is on you to be up to speed on IVDD things so that you have in the back of your mind to double check every thing this vet does re: IVDD.

If your vet does not support double stomach protection of famotidine + sucralfate, it is time to hire another vet who practices safe medicine! Some vets are good at every days things, but not the more complicated meds/treatment for IVDD.

There are no "safe" medicines.
The safety factor comes with a vet who uses drugs in a safe manner and calls for a blood panel test to see the health of organs. The other huge safety factor are the owners to read up on each of their pet's meds. They learn what benefit is to be expected, what the serious adverse side effects are to be on top of vs side effects that might normally come with a med. And what other meds would be contra-indicated. Personally, I love the Mar Vista Veterinary website for their drug directory: www.marvistavet.com/pharmacy-center.pml

Did the vet believe the disc was in the Neck or the back?
Let us know that all pain is in control. There is only one pain med on board (tramadol)
For how many day is the Novox Rx?

Fingers crossed that all will turn out well for TRex. Would you let us know when Pepcid AC and sucralfate are on board. we worry about the stomach with an IVDD dog.

She said it is in his back.
He has not yet started novox, that starts tomorrow. 
His pain is currently under control and i will get him.on pepcid ac tomorrow when he starts novox. He has eaten and drank well for ke since coming home as and he seems quite comfortable.

How do you know when it is a flare up vs a disc episode? Is it because he jumped from the bed and it is not j it st him being sore from everyday activities?i ddont know what to do as i have already spent alot in xrays and exams and i lf i go to s new ve5 know ill have to start all over