Modalita's Willie Mar 2020 Cnsrv Hrt-Cushngs Germany GRAD5/9

With a non-steroid anti-inflammatory (NSAID) the stomach will need protection from the extra acids.

marvistavet.com/famotidine.pml  

Do update us on what your vet prescribes and that there is continued full pain relief round the clock with gabapentin alone at 2x/day.

The only restriction I've ever seen as to meds used with Cushing's is that they shouldn't take a steroid. I'm not familiar with vets holding off on giving a pain med such as Methocarbamol due to Cushing's. Do know that pain hinders healing and Willie's pain needs to be brought completely under control ASAP with no sign of pain showing from one dose of pain meds to the next. If you do see any sign of pain, do get the Methocarbamol on board as soon as the vet will allow it. Pain should be completely under control within one hour of taking a new course of meds so I'm not sure how waiting a day or two will be of any benefit. An hour after taking the new course of meds should be enough to know whether the second pain med (Methocarbamol) will be needed.

If the vet is concerned about overloading Willie's kidneys with too much medication, the dosage of the methocarbamol seems high in that we usually see that dosage given 3x/day, not 4x/day. I don't recall ever seeing Methocarbamol being prescribed 4x/day. Was that a typo?

Methocarbamol (Robaxin) Initially, methocarbamol is dosed at 7 to 20 mg per pound (15 to 44 mg/kg) up to three times daily. The dose of methocarbamol should not exceed 110 mg per pound (300 mg/kg) per day.
www.petplace.com/article/drug-library/library/prescription/methocarbamol-robaxin-v Written by: Dr. Dawn Ruben Last Modified: August 11, 2015

Did you speak to the vet about adding a stomach protector as Paula recommended? It's very important that Willie be protected against the side effects of the Meloxicam. See Paula's last post for this information.

Modalita do verify with your vet about Pepcid AC and heart murmurs as mentioned below. There are different kinds if heart issues. So you want to confirm if Willie's will allow Pepcid AC.

HEALTH ISSUES: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.”
marvistavet.com/famotidine.pml

QUESTION
For how many days is Willie to be on Meloxicam?

I really don't understand the neurologist's opinion about CT scans. A CT scan is a definitive test in which to diagnose IVDD. It's even more puzzling as it's known that Willie does have IVDD and many times, IVDD is diagnosed based on breed, history and symptoms alone. When my Jeremy had his first IVDD episode 9 years ago, the neurologist chose to do a CT scan as it was quicker than an MRI and Jeremy had loss of deep pain sensation so they wanted to perform surgery ASAP.

Do check with your vet prior to getting Pepcid AC on board since Willie has a heart murmur and Pepcid AC may not be the best stomach protector for him.

For how many days has the Meloxicam been prescribed for?

Modalita, if the CT was taken 6 mos ago, that was the situation 6 mos ago, not a picture of what happend on March 14 with wobbly walking.. Could you provide the date of the CT scan so we have better clarification on things.

A new neuro diminishment on March 14, means something is pressing on the spinal cord. Until you know this is not a disc episode, it is prudent to act as if you are dealing with a disc problem. To not do so, means if it would be a disc problem, you'd be exposing his spinal cord to too much movement, further tearing of the bad disc and a potential to be paralyzed, loose bladder control, etc.

With a 12-day course of Meloxicam, then the test stop of it to find out if painful swelling still exists or if there would be any new neuro dimishment will start on Saturaday, March 28. Are you prepared with an understanding of what your job is? A plan B if you identfy a problem when your local DVM vet is not open. Emergency vistis are expensive, plan B's are free.
This valuable page has all the things to get you prepared for the March 28 test stop of Meloxicam: www.dodgerslist.com/literature/healingsweling.htm
--- Let us know what the plan B you have worked out with your vet will be
--- Does your vet prefer a full stop of all pain masking meds or a backing off of them on March 28?

I went through the posts for the original disc episode and have some questions from back then as your updates did not continue through the entire conservative care.

1. Why was Prednisone continued from October through January?  Was that due to the continuation of the trembling?

2. There was a time during the first crate confinement where Willie was allowed on the couch, approx. 10/7-10/11. Were a full 8 weeks of strict crate rest done with a graduation date of 12/6?

3. After crate rest finished, was movement very slowly reintroduced over a period of several weeks?

4. With the first episode, there was only one day of drunk walking and trembling. Were there any other signs of neuro loss during the first crate confinement until you returned to the forum in March?

To get back to today, since the CT scan was taken 6 weeks ago and showed no sign of IVDD, what do the vets feel is causing Willie's symptoms? The fact that Willie's motions were without constraint and he was able to jump on his hind quarters does not in and of itself rule out IVDD. Sometimes with IVDD there are no signs of neuro loss but only pain. However, the fact that the CT scan showed no sign of a back issue is puzzling. The CT scan should have confirmed IVDD if in fact this is IVDD so do they suspect something else?

Do you today see any other sign of pain other than the trembling? Signs of pain include: ◻︎ restless, pacing, can’t find a comfortable position
◻︎reluctant to move much in crate such as shift positions
◻︎shivering-trembling ◻︎yelping when picked up or moved
◻︎slow to move ◻︎tight tense tummy
◻︎arched back, ears pinned back ◻︎ head held high or nose to the ground.
◻︎looks up with just eyes and does not move head and neck easily.
◻︎ not eating due to pain of moving jaw with a neck disc or pain of back disc
◻︎ holds front or back leg flamingo style not wanting to bear weight
◻︎not their normal perky selves

So sorry that Willie continues to have trembling issues. I'm not aware of a neuro here that could assess Willie's CT Scans. But my guess is that one of the moderators could give you some advice on this issue.

Modalita, with your providing dates to go with events, meds, etc that helps us tremendously. I believe we have the sequences correct now. Would you double check the below med list for correct dates, dose mgs, frequency and what type of stomach protector is on board in light of heart murmur?

MED LIST (please check that all is accurate)
11-12 lbs  13 y.o.
Feb ACTH test Cushings not pred caused
3/14 ER vet visit for drunk walking and delayed paw placement, no NSAID Rx'd!
Meloxicam as of 3/16: 1.5mg 1x/day for 12 days, Sat 3/28 a test stop for: __pain/ neuro
gabapentin 100mgs 2x/day
methocarbamol 125mgs 2x/day
No stomach protector on board with Meloxicam!]

Let us know
1 )what you have worked out with your local general vet regarding a Plan B for the upcoming Meloxicam stop on Saturday 3/28.

2) what changes to the med list your local DVM vet will prescribe to see if pain can be brought into control better to eliminate trembling after movement at potty time.
3) What type of stomach protection is on board for the duration of Meloxicam?
4) Today what do you observe re: neuro diminishment- if still delayed paw placement, if nails graze the floor due to not picking up paw correctly.  Any other pain than trembling after potty time moving? 

I agree with Marjorie's prudent advice in her above post to err on the side of caution this is a disc episode. The 3/14 episode of nerve diminishment (delayed paw postiioning/ wobbly walk) + tenderness (pain) of pressuring the back was caused by something placing pressure on the spinal cord.  Erring on the side of caution to crate for a bad disc prevents worse neuro damage to the cord.

Keep up the good work of informing us with use of actual dates rather than yesterday, last week, etc.  It really helps us more quickly sort out things. 

Modalita, there are many cases of a disc episode where there is no neuro diminishment...that is to say. the owner was able to prevent symptoms from escalating beyond pain only. So not seeing (or no longer) seeing neuro diminishment is not an indicator this is not a disc episode.

The goal with the anti-inflammatory Meloxicam is to get all pain resolved well before the end of the weeks the disc heals. That is the reason for the test stop of Meloxicam on Sat 3/28.
       The stop lets you know if all pain is really gone and no need of any more Meloxicam or gabapentin/methocarbamol.
      Prior to the test stop there should be no pain because an aggressive use of pain meds had been on board. Aggressive means 3x/day dosing and often it means a pain med for each source of pain. Those things had not being done. Those things can be advocated for over the phone. Vets who know IVDD know the importance of protecting a healing disc.
      Will the local German vet take an phone update from you today/tomorrow about being aggressive to get all pain in control? Will he work with you in a Plan B, if over the weekend should the Meloxicam test stop reveal another course of Meloxicam is needed and to bring all pain meds back on board?
      During a Meloxicam test stop for pain, naturally it makes sense to be stopping all pain med at the same time as Meloxicam stops to get an accurate assessent about pain and to do it quickly.


The focus on 8 weeks of crate rest is to let the disc heal. There is always the potential neuro healing might happen in the short 8 weeks it takes a disc to heal. Most often though we observe that nerve healing can take longer more like thinking in terms of months not days/weeks. It is good to hear that Willie is no longer knuckling under his paw nor slow to right it.

Unless you are getting advanced imaging of a new current CT or MRI on 3/31, no one (not you nor the vet) will have poove of a disc episode going on. An xray on 3/31 would not be useful to proove if this is a disc episode. Xray's show hard tissue of bones not soft tissue of disc and spinal cord.

Trips into a vet appointment need to be carefully weighed as to the importance of that trip vs. the potential with any transport of too much movement when there a suspected disc episode.

What is your assessment of what would be learned or attended to (the "benefit") making it important for a 3/31 visit vs. potential setback or damage to a suspicioned damaged disc (disc episode)?

Are all of these kinds of stomach protectors sold out?
1_ Pepcid AC brand name contianing on single active ingredient:  FAMOTIDINE.  There are also brand X's containing famotidine

2_ Proton Pump Inhibitors:   brand names and brand X's
Prilosec (generic ingredient omeprazole)  over the counter in USA, but may be prescription in Germany?

3_ Sucralfate  a prescription item.

Hi Paula,

We will stick with crate rest and slow return to duty after May 9.

Willie is still showing shivering today- no other IVDD Symptoms. Foot instantly returns to position when I knuckle it (when he isnt fighting me on it).

I still have plenty of meds to keep him going drugged up to minimize pain on the same plan as before. I will speak with my local base vet tomorrow on a plan for the next month.