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Post by Nina & Theodore on Mar 11, 2020 10:09:51 GMT -7
[Original subject line: Introduction-Theodore-Nina]
1.) Theodore currently weighs 32lbs. He is currently on PredniSOLONE 5mg tapering (3 pills first 3 days, 2 pills next 4 days, 1 pill last 4 days) He is currently on day 5. He is also on Methocarbamol 500mg ½ pill every 8 hrs, Codeine 30mg ½ pill every 6-12 hrs (we are currently every 8 hrs), and Gabapentin 100 mg 1 pill every 8 hrs.
[Moderator's Note. Please do not edit
32 lbs
Prednisolone as of 3/7: 15mgs 1x/day for 3 days
as of 3/10: 10mgs 1x/day √3/11 am PAIN!
methocarbamol 250mgs 3x/day
codeine 15mgs 3x/day
gabapentin 100mgs 3x/day
needs GI tract protector, Pepcid AC, on board w/Prednisolone! ]
2.) Theodore is a French bulldog. My name is Nina
3.) Yes, he has a diagnosis of IVDD. Read below explained story too, this is 2nd severe episode. 1st episode we did surgery, this time we had to opt out due to costs.
4.) 1st episode that resulted in surgery to L1-3 discs was 5/18/2019. He had surgery and came home for strict cage rest for 8 weeks. We then did physical therapy and continued that until this last episode. We slowly increased walks to 2 times a day for 20 min. we carried him up and down stairs, he was strictly on rug portion of home, and we didn’t allow on couch or any sorts of jumping. He occasionally got overexcited with our 1 year old and would burst out in a run, but I kept that at a minimal.
This 2nd episode was 3/7/2020, it just came out of nowhere.
5.) He still seems he is in pain. He is resting and sleeping a lot and seems comfortable when left alone, however when we take him out to go to the bathroom, he either takes a few steps and goes, or he just stands there. This morning when I went to pick him up to bring back in he yelped in pain. He seems to shiver a bit when we take him out to bathroom in the morning, but is fine the rest of the day.
6.) He is eating and drinking, hasn’t pooped yet since morning of 3/7.
7.) He is able to squat and pee.
Theodore turned 4 this January 2020. Some time in 2018 I took him to the vet because I saw him limping coming inside one day. The vet said she thinks he may have IVDD, but until serious to treat it like authritis. So we gave Rimidyl for pain and immflammation. In May 2019 we went to PA for a family wedding and another dog jumped on Theo. He yelped and showed the same back pain as before. We gave him Rimidyl and kept him confined to a room for resting for that day and the day after. The 3rd day he woke up and was dragging his legs and yelping in pain. I rushed him to the closest vet and they said I need to go to the hospital. I rushed to the hospital where they did a CT scan and called and said it was inconclusive but probably a ruptured disc and I would need to get an MRI and surgery, but since it was Friday evening the other hospital willing to take him will most likely not do anything until Monday. I started researching and saw that something like this in a dog needs to be addressed within 24 hours so I called our hospital back home in MD and they said to transfer him with IV port and pain meds immediately. So that is what we did.
The hospital admitted him and the oncall neurosurgeon said they will be doing surgery in the morning and will call me after. All said and done, we had a great recovery story with Theodore, he was up to 2 20 min walks and mastering all PT, however,
3/7/20, he now has ruptured another disc. I was told that the lumbar spine is usually a reoccurring area. He started to have paralysis in back legs again this past Saturday and I rushed him to er. They said everything I heard before, however we do not have another $10k for the mri and surgery.
They sent me home with all the meds mentioned above and told me if he doesn’t get better we would have to have the “quality of life” talk. This is just so heartbreaking!! We are currently on day 5, 3/11/20, and he has the ability to take some steps and still has deep pain, but if moved I can see he is still in pain. I have a follow up appt with the vet this Monday, 3/16/20, but I have so many questions. Will the lumbar spine keep rupturing? What happens if yes? Can we talk wheelchair? What kind of life is this for him to be caged consistently? He has so much life in his face and is still eating, drinking, going to bathroom, do I really need to have that “talk”? after 10 days of steroids, should I try another dose? Will he decline after steroids are out of system? Recovery says 30-40% chance if no surgery for stage iv (I believe he was in between stage 3 and 4), but what does that mean? Does that mean he wont walk again, or will he be in so much pain and decline that we have to make a decision? The list goes on!!!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 11, 2020 10:10:43 GMT -7
Suggestions -- Do bookmark this thread so you can get back here easily. -- Registering opens the handy feature of getting an email alert a reply has been posted! 1. Go to your Profile> Profile Edit > Notifications: checkmark BOOKMARKS + "instant" email 2. Next, go to the XXX Board: checkmark your dog’s thread, then use the ACTIONS button to select "bookmark" **  -- While waiting you could refresh your browser to check when reply has been made |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 11, 2020 10:26:51 GMT -7
Nina, you have an emergency to get that pain under control now, today. Do not wait til your Monday apppointment. Codeine may or may not be effective. We don't see alot of is used for pain relief Adovcate with your regular vet for 3 things: 1)--- getting back up an anti-inflammatory level of pred 2x/day. The taper is a test for pain. Meaning another course or pred. Not clear how many days 3 or 7 days on an anti-inflammatory level — how many mgs dose? ?x/day. it may take 7-30 days on pred to resolve swelling (taper days do not work on swelling) Learn all about pred and how it works with a disc episode...important reading for you: www.dodgerslist.com/literature/healingsweling.htm Prednisone: We see vets knowledgeable about a disc episode using the higher end of the prednisone range and at 2x/day. 2)--- tramadol at the max analgesic dose 3x/day 3)--- Pepcid AC (famtodine) anytime pred is in use! 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  QUALITY OF LIFE Vets making comments about quality of life means they do not understand IVDD...discount ignorance. Disc disease is not fatal except for vets who offer to kill (put to sleep) that dog!!! Nerve healing can take time. It is only the dog and mother nature who will reveal how long that might be. First order of business is to get the disc healed. With conservative treatment some strong scar tissue needs to form. 100% STRICT crate rest 24/7 only out at potty times for 8 weeks is how the disc heals. Nerve healing may or may not come back in the short time it takes the disc to heal. HOPE is in the cards for each dog to get back to enjoying life after crate rest  |
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Post by Nina & Theodore on Mar 11, 2020 10:59:03 GMT -7
Thank you for all this advice! I just moved his appt to tomorrow. I asked to have the dr call me because I really do not want to transport him. We know that this is a rupture and I dont want them tryong to get him to walk or pushing on the spine! They told me they cannot change or add meds unless I come in to be looked at. What do you suggest I do. I am going to go in, but I do not want them causing more pain than he already has!
Also, just to be clear from last message, I should be asking for a non tapering dose of steroids, or ask for a 2 week supply and then taper. But i want a steroid that is 2 times a day. And ask for a 3x day tramadol and to discontinue the Codeine.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 11, 2020 12:21:25 GMT -7
Nine, the whole purpose of using prednisone is to get the swelling down. Nerves in the spinal cord do not like pressure of swollen surrounding tissue! Nerves react to swelling by dying. We see from the out side that death happen in a predictable stepwise path. Can you call back your vet and get squeezed in asap, Now not many hours later by tomorrow morning (BAD!!) Use of pred up at the anti-inflammatory level dose is to keep mild nerve damage symptoms mild and not progressing to spinal cord damage. NO vet will Rx meds without first having examined the dog themselves. It is unfortuate, but Theo needs to be seen. The only other option is the ER vet or one that works there who can read Theo's file could Rx pred back up to the anti-inflammatory level. Let us know if there any signs of neuro diminishment are going on: wobby walk, legs cross, slow to place back paw correctly on ground or can no longer do that (called knuckling) 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. 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 with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. CRATE REST for conservative treatment is STRICTER **  So we are not confused, please tell us the important pred information: --- How many pred mgs given on 3/7 at the start. How often did you give? For how many days, til a change -- what was the next change: ?mg ?x/day for how many days? --- |
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Post by Nina & Theodore on Mar 11, 2020 13:20:07 GMT -7
The vet isnt able to get him in any sooner than tomorrow morning. I move the ▲codeine 30mg 1/2 a pill to every 6 hrs. I have extra Pred. that I can give until I see doc tomorrow and can do the math of what he should be on, I just dont want the vet to then not give me more and I dont have enough to taper. (I am not leaving tomorrow with out more Pred. though!)
Here is dose of Pred given.
3/7 5mg Pred. 3 tablets once a day
3/8 5mg Pred. 3 tablets once a day
3/9 5mg Pred. 3 tablets once a day.....(was seeing great progress)
3/10 5 mg Pred. 2 tablets once a day...(this morning he was shaking in pain before switching to 2 tablets)
3/11 5 mg Pred. 2 tablets once a day...(not shaking but did yelp when i went to pick him up from using the bathroom)
I am supposed to give 2 more days of 2 tablets and then 4 days of 1 tablet.
[Moderator's Note. Please do not edit
32 lbs
Prednisolone as of 3/7 low end of anti-inflammatory level dose:
15mgs 1x/day for 3 days;
3/10 taper test for pain √3/11 am PAIN!
methocarbamol 250mgs 3x/day
codeine 15mgs ▲4x/day
gabapentin 100mgs 3x/day
Pepcid AC (NOT one single ingredient: FAMOTIDINE 10mgs 2x/day
also contains calcium and Magnesium ]
I am going to tell vet I want Pred for one to 2 weeks max dose twice a day. Then after we can reeval and either taper or keep the same. I also want to switch codeine to tramadol max dose every 8 hrs. I added Pepcid 10mg when I read your original reply. My Pepcid is not just Famotidine, it also has calcium carbonate and magnesium hydroxide in it (i have given this to him last time), is this ok? And how long do you reccomend to continue the Gabapentin and Methocarbamol? I ahve a 10 day dose. Are they something I want to continue for 30 days or more, or just the 10 days?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 11, 2020 16:54:28 GMT -7
Nina, thank you for all the detail on pred. Basically on 3/7 Theo was placed near the high end of the anti-inflammatory dose. Typically pred is dosed 2x/day. The high end calls for 10mgs every 12 hours not quite the total in a 15mgs dose once a day. Discuss with your vet about using the high end of the anti-inflammatory range to most quickly get the swelling down. It is the vet who must guess how long the anti-inflammatory course must be. Most often the guess will be a 7-day or a 14 day course. With pred being in the taper, it is no longer working on swelling currently (it has been in the taper since 3/10, that is the reason pain showed up and pain meds increase is needed to provide comfort. Test pred test for pain taper revealed the need for another course. Too bad the ER vet did not explain how pred works, what your job at home was, etc. Many vet do not explain the treatment and thus why we have this info for you to get up to speed on anti-inflammatory drugs: www.dodgerslist.com/literature/healingsweling.htmPain meds are either backed off or full stopped on the begin of the pred test for pain taper (its is the vet's call which-- backing off or full stop) Your job is made possible then without pain masking pain meds on board to quickly and accurately asses for any hint of pain surfacing. Famoditine Find the correct Pepcid AC at the grocery store. It contains only one active ingredient (famotidine) in a 10mgs tablet for 2x/day dosing. |
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