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Post by Lily Chiweenie on Apr 4, 2020 13:41:23 GMT -7
[Original subject line: What to do?]   Our 3 yo Doxie mix started having problems 4/2 evening by 4/3 morning she was drunkenly walking. It is a Saturday and there are no specialists around so they will not do a scan or mri bc there is no one to read it. We called around. This seems to be the case everywhere. We brought her to the emergency clinic to be assessed. Due to her extreme separation anxiety, they had us take her home to monitor for any changes most specifically loss of pain sensation. We are worried that we may be losing precious time. Nothing has changed, but she has not has not peed since last night (unless she went in the office)(she was just hand fed while I was typing but otherwise it was about 24 hours) . We were not permitted in the building--COVID 19 Is there anything else we can do aside from crating?
☆ 1 pain?
x reluctant to move much in crate such as shift positions or slow, ginger movements
x shivering, trembling until settled and when picked up or moved
x can't find a comfortable position, appears restless
☆ 2 7 pounds
A..Gabapentin 50ml oral suspension; give .75ml 2x daily as necessary for pain B.. prednisolone 5mg 1/4 tablet daily for 5 days then 1/4 every other day for 5 days
C.. PEPCID AC? Didn't see to ask but might. Idk if the stores will have any meds-#COVIDhoarders
[Moderator's Note. Please do not edit
7lbs
Prednisone as of 4/4?: 1.25mgs 1x/day for 5 days, then 4/9 test taper for _pain/ _neuro
Pepcid AC should be on board with Presnisone]
☆ 3 -- Eating and drinking OK? 24 hours since last meal. was able to hand feed, but in general she is not interested in food. Last poop 11 hours ago--normal
☆ 4 Your name, too? Chihuahua doxie mix; Lily
☆ 5 suspect disc disease (IVDD)
-- Is the vet a general DVM? DVM
☆ 6 CONSERVATIVE treatment? 4/4 7 am
☆ 7 No wetting yet, but she also has not gone on her own yet
☆ 8 Neuro damage?
wobbly walk, she is not happy so can not assess the tail
walking drunkenly, kind of dragging one leg
Thank you for any help or thoughts!
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Post by Romy & Frankie on Apr 4, 2020 14:40:40 GMT -7
Welcome to Dodgerslist. We are 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!
What is your name? I am Romy.
Lily can still walk, so she is an good candidate for conservative treatment. You did the very best thing by crating her right away. It is important to monitor her and if her neuro condition deteriorates let the vet know immediately. Strict crating will lower the risk of that.
Conservative treatment for IVDD consists of 8 weeks of very strict crate rest, anti-inflammatories, stomach protection and pain meds if needed. IVDD is usually, but not always, painful. 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. www.dodgerslist.com/literature/CrateRRP.htm
STRICT means: - no laps
- no couches - no baths
- no sleeping with you - no chiro therapy
- no dragging or meandering at potty times. Carry her 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.
Prednisone is a commonly prescribed anti-inflammatory for dogs with IVDD. The dose prescribed for Lily (1.25 1x daily) is lower than what we typically see for a 7 pound dog . 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/DrugLibrary/prednisone-prednisolone/page1.aspx last accessed 8/13/2014 Dr. Reuben's information on prednisone is in line with what we see many, many vets on this Forum using for a disc episode. That would make a typical dose of a dog Lily's size 7lbs x.3 = 2.1 mg twice daily. Since pred comes in 5mg tablets, often vets prescribe a half of tablet 2.5mg 2x daily. Speak to your vet about increasing her dose to the full anti-inflammatory dosage.
We are not vets and do not know the specifics of each dog's health. We are making these suggestions based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet.
Since Lily can still walk, it is unlikely that she has lost bladder control. It is more likely to be a reluctance to urinate because of pain when moving. I know that you are not seeing any of the signs of pain right now, but keep an eye out for the typical signs that you mentioned in your post and let the vet know right away what if you are seeing anything that indicates Lily is in pain. The pain meds work best when given on a schedule and not as needed. It is easier to keep pain at bay with the meds than relieve it when it starts.
How many mgs of gabapentin is in one mL of the liquid?
All anti-inflammatories cause excess stomach acid. This excess acid sometimes leads to serious damage to the GI tract. We can lower the chances of this damage by giving our dogs a stomach protector like Pepcid AC. Not wanting to eat is a sign that stomach damage is already starting. The stomach protector we usually see Is Pepcid AC. I know the stores are out of many things but it may be possible to get a generic which would contain just one ingredient famotidine. If you cannot find Pepcid look for Prilosec, generic name omeprazole. Prilosec is a good stomach protector but it works more slowly. It can take 3-5 days to reach peak efficiency. Pepcid works in 30 minutes. It is important to protect Lily's stomach. Our IVDD dog have enough to deal with without adding stomach issues.
The usual dose of Pepcid AC in dogs is 0.44mg per pound every 12 hours. Give it 30 minutes before the anti-inflammatory and thereafter every 12 hours.
If Lily is to be treated conservatively and the vet is confident it is IVDD a scan may not be necessary. An MRI is usually done right before surgery so the surgeon knows where to operate. Conservative treatment treats all disc equally.
We encourage you to register and become a member of the Forum. That way it will be easier for you to reply and make it easier for us to track your dog and give the best of comments and support. Tips on registering: www.dodgerslist.com/forumads/RegisterFORUM/register.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 We have an excellent video series here:
PRINT OUT this link and tape to your fridge:
--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 website:
Healing thoughts for Lily
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Post by Lily Chiweenie on Apr 5, 2020 6:01:00 GMT -7
Thank you so much for your detailed answer! It was very helpful and made us feel a little more relaxed.
I know we should be watching for any declines, but is there any rough amount of time where we should be concerned if there is not any improvement?
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 5, 2020 6:37:29 GMT -7
Hi, my name is Paula, what's yours? Would you be able to help us be more effective in working with you? The guest board is a temporary Guest courtesy to get immediate help until you can register. I encourage you to register and login. That way all the features of the Forum are available to you, making it faster to reply and get an email alert about replies. It also makes is far easier for us to track your dog and give the best assistance. Illustrated what to expect during registration: www.dodgerslist.com/forumads/RegisterFORUM/register.htmNo one would be able to give you a timeline with a date about how long it takes for nerve repair to happen or for neurological diminishment to happen. All that is known is a typical order these things happen in. There are 4 phases of healing during a disc episode. The other three do each have differing lengths of time and also have different needs to support healing. Here is a quick summary to help you make sure each is properly being covered and if not, then giving feedback to your vet to get things right for Lily.
Here is the summary link: www.dodgerslist.com/literature/healingpage.htm 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. back ✓?Left __Right Nails/toes scuffing floor 4. back ✓?Left __Right Paw knuckles under 4a back ✓?Left __Right leg drags 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#surgeryVSconservativeQUESTIONS~ How many mgs of gabapentin is in one mL of the liquid?
~ What date did prednisone start on? 4/4?
~ IF at some point a surgery might be something to talk about, would a surgery be a consideration for your family?
~ Has she peed on her own this a.m? |
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Post by Lauren & Lily on Apr 5, 2020 7:30:02 GMT -7
Hi, my name is Lauren. I just registered. Thank you again for all of your help and guidance! Your responses and this site have definitely helped us keep a little of our sanity during this scary time.
gabapentin? 50mg in are one ml and we are giving .75ml.
prednisone ? We started immediately on 4/4 about 7ish in the morning.
If she deteriorates, we would be open to surgery. However, we do not know where or who to go to. We have been working on researching that. From what we have found, the best choice would be someone who specializes in nuero and I did check your helpful list and found that there are two on the island. We live on Long Island [New York?], so right now everything is pretty much on lock down. She is only 3 [y.o] and we have not found a general vet we truly trust yet. We have the one we were directed to go to when we got her. She seems great, but EVERYTHING else about there is a problem. We just recently (within the last year) went to a new vet that seemed somewhat promising, but I was not in love with her bedside manner and she did not seem to like little dogs. She is due for her shots. We were going to go back to her to try again, but then this pandemic hit. The emergency vet office that we took her to for the IVDD, is probably the vet we have been to the most, (She has a habit of eating anything she finds on the ground, often quicker than my husband can stop her) but it is someone different every time. They always seem to be kind and knowledgeable.
~ peed this a.m? Yes, she went almost 24 hours without peeing. I called the vet around 9 last night to see how long she could safely go without urinating. They told me to check her around 3am to see if she is restless. If she was restless and did not go then we were to bring her back otherwise we were told she could wait until the morning. As if she knew, she started whining around 3 am and was able to go on the pad. She can not get into the squatting position and does not want our help. I believe this is part of the reason. The other reason is she is an independent pad user. She does not really go on command except when it is time to go to bed, but even then you tell her and you have to walk away. The stinker will not go while you are watching. Because she is an independent user, she is not used to telling us when she has to go either and she can hold it for a long time in general.I think all of these items are compounding the issue of why she is not going. I started measuring her water today so that I will know how much she takes in and we will be recording when she goes. We are rounding about 24 hours since she has pooped though, so we will have to keep an eye on that.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 5, 2020 8:04:59 GMT -7
Lauren, thanks so much for registering. You will receive a message when Lily's thread has been moved over to the Conservative board.  Bookmark a thread to receive an email alert when someone has replied 1. Go to your Profile> Profile Edit > Notifications: checkmark BOOKMARKS + "instant" email 2. Next, go to the CONSERVATICE Board: checkmark your dog's thread, then use the ACTIONS button to select "bookmark" Shots should be held off. Shots work only on a heathy dog and right now Lily's immune system is compromised with a disc episode. So Lilly had been in the habit to use her pee pad. That is great as you will not need to take her outside. The crate should have a mattress that is pretty flush with the floor and then a small area for the pee pad. The idea is she is not going to be able to take more than a 1-2 footsteps to get to the pee pad. That she is not having to hop down/up from the mattress or over the side of a dog bed either to get to the pee pad. She may be in pain and thus not wanting to get into positon to poop. Poop always comes out on its own, so not the concern as if she were not peeing every 4-6 hrs as she would normally do. The longer urine remains in the bladder, gives the chance for bacteria to multiply and reach infection state. So holding urine for a long time is not a good idea. QUESTIONS~ Which back leg has the neuro diminishment. Left or back leg? ~ Since being on pred any nerve function worsening or betterment of that back leg? Truth is nerves are very slow to heal and often we ought to think in terms of months rather than days/weeks for nerve repair. ~ Any luck in securing a generic? Maybe option to get a vet Rx that has a better chance of you obtaining the pills? Acid Suppressants that work in 30 minutes
Pepcid AC (famotidine) new generation, best
Zantac (ranitidine)
Acid Suppressants that take 3-5 days to become effective
Prilosec (omeprazole)
Prevacid (Lansoprazole)
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Post by Lauren & Lily on Apr 5, 2020 8:50:26 GMT -7
We are not even considering shots right now or leaving the house any more than we must during this time. Plus, we wanted to find out which shots she could do a titer for--since had an allergic reaction to one of the batches.We have been using her crate with her bed in it and lifting and carrying her to the pad. She does not settle for long when we have given her anything other than one of her beds, so we figured the more settled the better. (Her not settling is based on many sleepless nights of trial and error. ;o))
Holding the urine is definitely an area of concern for us, so we are keeping an eye on it. We have been bringing her to the pad every few hours to try. We are hoping we can get her in a routine or she will be able to squat and this will no longer be an issue.
It has been affecting both of her rear legs, but I would say maybe her left rear more than the right.
nerve repair. We have not noticed much in either direction. The only change we saw was last night she was attempted to scratch her ear. We are still trying to make sure they are positioned in a natural looking position when we put her down.a generic stoamch protector? I will inquire withe the vet today.
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Post by Ann Brittain on Apr 5, 2020 9:16:06 GMT -7
Hi, I'm so sorry you're going through a disc episode with Lily. She looks like such a sweet girl, and I know how difficult it is to see your dog in pain.
Keeping her comfortable and confined is the most important thing during crate rest. If using her favorite bed helps her settle, that's the thing to do as long as it doesn't allow her to be too active. it is important that she empties her bladder to avoid UTI's (urinary tract infections). Hopefully as she heals and starts to relax Lily will begin to pee normally. If not, this is a topic you should discuss with the vet. Giving her ample time to pee regularly might help, but as others have said, moving her around should be limited.
Patience is the key in these first few days and that is the most difficult part of IVDD care. Wishing you both a full recovery for sweet little Lily. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 5, 2020 9:34:09 GMT -7
Lauren, agree with Ann wholeheartedly! The only thing one can't have any patience with is pain. Gabapentin 2x/day sounds as if it allows these signs of pain you reported: reluctant to move much in crate such as shift positions or slow, ginger movements shivering, trembling until settled and when picked up or moved can't find a comfortable position, appears restless With a disc episode, pain meds are more typcially Rx'd for promptlyu every 8 hrs as that is how long they last best in the body to mask pain. Call your vet and advocate for every 8 hrs. And also ask that the two other kinds of pain be covered as well at every 8 hrs: - TRAMADOL as the general analgesic - methocarbamol for the pain from muscle contraction good place to get up to speed on all meds your dog takes: Mar Vista Veterianry drug directory www.marvistavet.com/pharmacy-center.pmlHELP US? I recommend you reply to a post by going to the " Quick reply" typing area and NOT clicking the "Reply" link. Quick reply allows you to scroll up and down to a previous post and then back down to the "Quick Reply" typing area to continue your own post. Thus you do not need to repeat the entire question. Instead answer with a bit of the question and then your answer. There is then no need to have your answers in red or any other color. This saves us lots of time in changing everything to black and allow us to mark your post with the use of red and bold for our in-house use. Thanks so much for your help! Let us know what changes the vet makes today to get Lily in full comfort from pain |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 5, 2020 10:20:34 GMT -7
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Post by Lauren & Lily on Apr 6, 2020 12:21:37 GMT -7
Paula, sorry-I did not realize that was a spot to reply, ha! Thank you for the vaccine information. I did not know that that her breed was more susceptible to reactions on certain vaccines. Why don't they tell you these things?!
I spoke to the vet this morning and was able to get some ✙Pepsid. Her pain seems to be managed ok right now. She has some difficulty getting settled, but it is not like it was before the meds. It seems like she just can't get her body to do what she wants--like when she is trying to squat for the bathroom. Her whimpering is minimal and I think it is more about her not wanting to be in the crate. She seems to slow down with the whimpering after about 20 minutes. We are literally sitting next to her all day.
While talking to the vet, he inquired about her condition. When we told him there were not any real changes in Lily's state, he suggested we meet with a surgeon to get a scan and figure out if she needs surgery and the we should do it sooner than later. I was content when the doctor I researched was the one he recommended. Unfortunately, she is out until next week and Lily should not wait that long. I was able to get appointment with a different doctor that a friend recommended but not until Wednesday. They said they would call if they had any cancellations. Hoping someone cancels.
Once again, thank you so much for help Lily and aiding in keeping my sanity!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 6, 2020 19:03:02 GMT -7
Lauren, oh dear! Referring a dog for surgery when the legs still work, there is bladder control and pain is being fully managed, sounds like a vet not very sure about IVDD. Please do you own homework to know for yourself what the indicators for seeking a neuro to consult about a surgery so you are eduated to know what to monitor for and information under your belt to discuss with a neuro should the time come. Dr. A. Isaccs, ACVIM (Neurology) gives answers very pertinent in forming questions to ask and things to consider in these two articles: -- Conservative vs. surgery decision making: www.dodgerslist.com/literature/healingsurgery.htm-- About a surgical procedure: www.dodgerslist.com/literature/surgery.htmCurrently Lily is a good candidate to heal her disc under conservative treatment. -- NERVES: You report no worsening neuro functions. -- PAiN: You report her pain is correctly being managed. -- DISC: You are giving the body a chance to form scar tissue and not have it discupted by being careful about limited movement of her back. -- NERVES: "Real changes" about the nerves healing may or may not take place during the short 8 weeks it takes a disc to heal. Most often owners need to think more in terms of months not days/weeks. When a trip into a vet is of upmost importance and worth the possible risk to an early healing disc of too much movment: -- Pad out the crate with a rolled up blanket. -- Fit the blanket snug to the dog's body. This prevents the back from shifting when the car corners or comes to a stop. |
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Post by Lauren & Lily on Apr 9, 2020 11:36:33 GMT -7
 Well, I think he was doing what he thought was best. The emergency dr was a DVM, and he felt at the very least we should see a nuero to ensure diagnosis. We were not using their services and he didn't really give us someone to go to so I don't think he had anything to gain. She had decreased response to pain and her legs were not really usable. If they did not improve, we would have to look into other ways for her to get around. We made the appointment, mostly bc we wanted to confirm the diagnosis and the severity of it. We found out that she had 3 herniated discs and calcification. 2 that were causing the most trouble were right next to each other. He [neuro] said there was a 40 % blockage. We also found out that she had several others that should be watched. They are not a problem at the moment, but it is good that we are aware. We elected to do the surgery. I am not 100% on the decision. It was challenging to decide given the fact that we were racing the clock and the non-intimate way we had to deal with the vets. There are only 3 nueros on the island and 2 of the 3 were not available. Who knows how much longer this person would have been available with the virus and all. It was not an easy decision. Hopefully she will heal from it. Right now, we are told she is able to sit up, but not stand yet. She received her first laser treatment while she was still groggy. They are expressing her bladder which does not surprise me given her training and persnicketyness. Although I am shocked she is not doing harm to herself flailing around while they do that, bc she does not like to be touched.If once she can stand she is not going on her own, then I will be concerned. Hopefully we made the right decision. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 9, 2020 12:02:33 GMT -7
Lauren, all decision are based on the information at hand and the situation at hand. Sounds with all the factors you mentioned, the decision was a good one.
Which Island do you live on. That information can also relate how we comment.
What date was the surgery?
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Post by Lauren & Lily on Apr 9, 2020 12:10:06 GMT -7
We live on Long Island. She had the surgery yesterday afternoon 4/8.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 9, 2020 12:17:20 GMT -7
Lauren, I bet your mind is a flutter with with all kinds of thoughts. A disc surgery is a major procedure. May this idea help you to start a list of questions. That way on discharge day no answer will go unanswered: Here's a starter list of questions to which you can add some of your concerns to ask your surgeon: www.dodgerslist.com/literature/dischargequestions.htmThis page is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT and discharge day. www.dodgerslist.com/literature/surgery.htmSee if there are any other things you would like to employ during the post-op crate period. Supplies and Tips List: www.dodgerslist.com/literature/cratesupplies.htm |
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