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Post by Sherri & Molli on May 19, 2020 19:59:36 GMT -7
[Original subject line:Molli's IVDE dx 10 days post op for TPLO ]
Hi, Molli is an almost 13 yo jack russell terrier. She had TPLO on her left knee in May 2018. And her right May 5, 2020. She is a very active older dog. Quality of life to her is free roaming the house with access to furniture. And romping around the yard. She had luxating patellas her who life we since adopted her in 2009 but they were never bad enough to need surgery. Fast forward to July 2017. She was chasing a rabbit and tore her left CCL. We tried conservative management but she eventually damaged her meniscus and she had surgery at Colorado State University in May 2018. She recovered nicely with 5 month of PT at CSU. January 2020 - she tore her right. We tried CM but then she damaged her meniscus again and then COVID closed down CSU. We finally got TPLO on May 5th at a specialty clinic.
Then the past Saturday , she screamed when we picked her up. (Turns out we have been picking her up wrong for years.) Later that night we took her the emergency specialty clinic where she had her TPLO. She stayed overnight and was transferred to their neurology dept. She had an MRI on Tuesday [5/19] . Her dx IVDE [intervertebral disc extrusion] T12 T13. The Dr. said no surgery at this time. Meds and 6 weeks of crate rest/expen. What is IVDE vs. IVDD?
I was relieved no surgery but the more I read, I have to wonder at her age if surgery would be better now.
I told the doctor we did tplo at her age so she wouldn't be lame in expen half of the rest of her life. He said after the rest period if she returns to normal she can jump on and off the furniture (we do have little ottoman's she uses 80% of the time) just not high beds, etc He doesn't think 4 on the floor for the rest of her life is necessary at this time assuming she recovers.
☆ 1 maybe slight deficit on back left leg; no longer yips
☆ 2 14 lbs
Galliprant 10 mg every 24 hours;
Pregabalin 25 mg twice a day
(Adequen monthly)
PEPCID AC: NO
[Moderator's Note. Please do not edit
14 lbs LIVER, NSAID sensitivities
Galliprant as of 5/18: 10mgs 1x/day for ? days, then test stop for _pain/_neuro
pregabalin 25mgs 2x/day
Adequan 1x/month
needs GI tract protector, Pepcid AC, on board w/Galliprant!]
☆ 3 -- Eating and drinking, No nausea/not eating, vomit? Poops OK? -
All normal so far.
☆ 4 What breed? What is your dog’s name? Your name, too?
Jack Russell, Molli, Sherri
☆ 5 ACVIM, MRI IVDE T12 T13
☆ 6 What was the date you saw the vet for CONSERVATIVE treatment?
5/18/2020
☆ 7 bladder control? Seems to work fine.
☆ 8 She can walk good but it is wobbly from her TPLO- hard to tell what could be from the disc - she just started using her surgery leg the day it happened.
Thanks.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 19, 2020 20:53:27 GMT -7
Shari, welcome to the Forum, we are glad you are here. The more common way to refer to a disc extrusion (disc episode) is by the term Intervertebral Disc Disease. The neuro used the term intervertebral disc extrusion (IVDE). So glad to hear the disc episode was a mild one in symptoms of pain only and no neurological diminishment. The wobbly legs are due to TPLO. If you can scan or take a picture of the neuro report then we'd have all the details to best comment For how many days is she to take Galliprant? The single most important care you can give is the 100% STRICT crate rest 24/7 only out of the recovery suite for a very, very few footsteps at potty time. the limited movement is how the disc will heal and form secure scar tissue and hopefully prevent a surgery. Strong scar tissue normally takes 8 weeks til it is safe enough to graduate from rest and begin a slow re-introduction back to family life and activity. Supporting both ends when lifting and carrying is important in protecting her healing disc. Upon graduation, setting up ramps to her favorite chair and over outdoor steps can help to avoid impact to the back that jumping causes.  Setting up the Recovery Suite tips and ideas to help the 8 weeks of rest go smother for you and Mollie.  |
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Post by Sherri & Molli on May 20, 2020 6:13:37 GMT -7
She was on Galliprant (and Gabapentin)when she injured her knee again for about 2 weeks. Then off it until surgery for her TPLO. She was put on it for 5 days after tplo. Then only as needed so I stopped it until her back episode on Saturday I gave her one (as directed by the local emergency vet who thought it was her neck) and on Monday and Tuesday of this week. The Neurologist discharge paperwork says continue Galliprant as previously directed. So I assume that means if she doesn't need it for her knee, I could take her off of it. - I don't think she needs it for her knee. Should I stop it?
She goes out about 4 times a day. 2x she walks about 50 feet to pee and poop and the other two times goes right away typically and only take a maybe 10 steps. I am not sure I can minimize any more.
Thanks.
Sherri
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 20, 2020 7:00:29 GMT -7
Sherri, Galliprant IS the anti inflammatory. It was developed specifically for arthritis. So not especially a good choice for a disc episode. But the ER Rx'd it! This kind of tied the hands of the neuro. As a switch to a more effective anti inflammatory that is used with a disc episode would mean : ---- stop the Galliprant for 5-7 days of washout before the start of a more effective NSAID (non-steroidal). That would leave Molli with nothing on board to work on swelling....not good. I highly encourage your getting an understanding what roll and how a NSAID is used for a disc episode. Owner knowledge is the power to ask good questions and do a good job in your roll at home as the eyes and ears for the vet. RECOMMENDED READING: www.dodgerslist.com/literature/healingsweling.htmAfter reading, you can understand why you and why we want to know for how many days is she to take the anti inflammatory Galliprant? What is the stop date of it?
Potty timeMolli's disc need protection of too much movement. She may only take the very, very fewest of footsteps to do her business.
Use poke in the ground garden edging fence or an ex-pen in the grass to form a 6 foot diameter area will let her know with the visible and physical barrier there is not going to be any sniff fests going on.
Otherwise with leash and harness on, you'd stand firm in one spot. Molli would be limited in footsteps by the length of the leash.
You would only need to use a sling if she is too wobbly in order that she would not tip over twisting her back.
GI tract protectionThere are many reasons the body produces stomach acids. Dogs being creatures of routine, with the need for changes and crate resting, changes up their whole world....stress and acid production. Surgeries are a big stress to the body.... stress. All anti inflammatory drugs increase acid production. Molli certainly does not need another problem of bleeding ulcers in addition to all she is going thru. Dogs do not speak up at the first signs of a problem as a person would. By the time we notice signs, damage has started!. Proactive vets don’t wait til there is lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. Pepcid AC (famotidine) blocks the production of acid. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours. Pepcid AC has a very limited potential for side effects. Ask if your dog has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
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 Let us know when you have Pepcid AC on board and what the dose in mgs is that you would give every 12 hrs while Galliprant is on board. And let us now what date the Galliprant was prescribed to stop. |
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Post by Sherri & Molli on May 20, 2020 7:55:35 GMT -7
Thank you. Molli can't take other NSAIDs. Over the years she has tried metacam, rimadyl, and one that starts with a P. She gets violently ill after 2 doses. She did the metacam with pepcid and actually got to 3 days before getting ill.
The neurologis doesn't want to take a chance of her violently vomiting. She lost her first home due to chronic diarrhea. She had undiagnosed crypto and giardia for a year and her digestive system is super sensitive. Also, one of her liver values is slightly elevated and her kidney function is ok now and but creeping into questionable territory. She has taken CBD (the brand CSU used in their studies and their unofficial guidance) for her knee and it helped so she does get [✙CBD] that 3 hours after her other meds.
[Moderator's Note. Please do not edit
14 lbs LIVER, NSAID sensitivities
Galliprant as of 5/18: 10mgs 1x/day for ? days, then test stop for _pain/_neuro
pregabalin 25mgs 2x/day
Adequan 1x/month
✙CDB oil
possible for Pepcid AC, on board w/Galliprant?]
I am extremely worried about her getting her tplo staples out on Friday. I worry they will twist her weird. I have called them to prepare them and they are the sister hospital with the neurologist. She had been going to CSU for the last few years for nodules on her liver and spleen (static for 3 years now), very early stages of a leaky valve, undiagnosed reverse sneezing/allergies? and her knees. She will be 13 on August 22nd but good or bad, she acts 3 normally. Part of me wishes she'd slow and enjoy the golden years but I don't think that is possible for a jack russell.
I am going to do a consult with CSU who was suppose to do her tplo until covid and PT. I just can't decide if I do it with neuro or ortho.
Thank you so much for help.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 20, 2020 9:12:09 GMT -7
Sherri, we are blindsided when all medicines, diseases are not revealed at the beginning. Thank you for revealing more about Molli so we are in the loop and can make appropriate comments. Galliprant® package insert does indicate GI issues can happen. www.elancolabels.com/us/galliprant-with-tear-offSo with her NSAID sensitivities, it may be prudent to discuss possibility of Pepcid AC in light of LIVER issues. Read about meds humans should not take with CDB oil. Research for dogs is on-going and may in the future line up with the meds for humans that are contraindicated with CDB oil. www.healthline.com/health/cbd-and-drug-interactions-what-you-need-to-know |
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Post by Sherri & Molli on May 23, 2020 5:25:46 GMT -7
Molli woke up this morning [5/23] and had a slight whimper. She did have her staples removed yesterday and knee which checked out great. I can tell she is in pain. I thought maybe it was her stomach because sometimes in the morning is queasy until she eats so I gave her some food. She was still eager to eat. While she was eating she did lightly whimper a few times. It doesn't seem to be her T 12/13 area.
It seems more like her neck. The neurologist said her neck was fine. When they did the MRI, I asked about adding her neck and he thought it would be a waste of money. Neurologist is open in 30 minutes. I will call immediately.
Thanks again. I just got a call from the neurologist and her spinal fluid test came back with no protein and inflammation. They said she may only need to be on complete rest for two weeks (don't worry - I am super paranoid and will do it longer). We will know more at her re-check. She will be in the expen for at least 10 more weeks with her knee.
I will ask about adding the pepcid for the galliprant. The CBD has really done wonders for her and I am using with guidance (unofficial) from her ortho docs at CSU. One thing it does not do that I wish it did, was keep her chill. I do worry about the galliprant keeping her bone from healing faster but I do want the inflamation treated. Thanks so much.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 23, 2020 11:08:54 GMT -7
Sherri, MRIs required anesthesia. The dog's main defense from further disc damage depends on controlling their trunk muscles. Anesthesia puts those muscles to sleep.
If a dog is going to be treated medically with conservative treatment, then knowing the precise location of the bad disc is unimportant. All discs (neck or back) receive the same limited movement treatment that allows disc damage to heal under conservative treatment. These are the extra things you can do at home whether if truly a neck disc or if a back disc: www.dodgerslist.com/literature/cervical.htm |
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Post by Sherri & Molli on May 23, 2020 12:15:33 GMT -7
OMG. The neurologist says he can't find neck pain, he thinks it is her shoulder.
Muscle relaxants. I am heading back to pick her up. I hope he isn't just making that up because of the MRI debacle.
Even though she is a current active patient at the neurology clinic and they have hours today, they made me bring her in through emergency at the their sister hospital. That vet confirmed it is her neck. So last week when the neurologist did the MRI on her T12 T13 area, I ask if we should also do her neck since she has been diagnosed with neck pain earlier in the day and in the past. He said it would be wasting my money. Well, now she has a neck pain and the emergency vet suggested an MRI. I almost lost it. He said she wasn't that bad that it was an emergency and we could see how she responds to the muscle relaxants. The neurologist will see her later day for another $250 evaluation fee.
The vet tech was so amazing. She said 90% of dogs that come in with neck or back pain never get an MRI or surgery due to financial limitations. So I should not feel bad if it comes to needing and MRI and we don't do it. Molli is walking fine. In fact, before we left I took her in the yard and she seems fine sniffy around. The emergency vet said she seemed to have no pain in her T12-13 area. I guess that is good news. I could kick myself for not insisting on the neck area. I sure hope if an MRI is necessary he will cut us a break. It is bad enough risking the anesthesia again.
I just can't believe this all happening at the same time when she is already on restrictions for knee.
I do have a consult with the neurology dept at CSU so she can start PT.
Thanks.
Sherri
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Post by Romy & Frankie on May 23, 2020 13:09:40 GMT -7
If you still suspect IVDD, the most risk free thing to do is to continue crate rest. Both the neck and back discs would be treated with crate rest.
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Post by Sherri & Molli on May 23, 2020 15:56:03 GMT -7
Thanks. She does seem better since I picked her up and she in on a muscle relaxant.
I just don't how she could have injured her shoulder while on crate rest. He suspect she has an intermittent soft tissue issue. He said shoulder and neck injuries are extremely hard to tell the difference and many vets assume neck because they yelp when getting the neck examine. I hope he is right.
She is still set for acupuncture and laser on Wednesday and then another neuro consult and PT the following week.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 23, 2020 16:30:09 GMT -7
HELP US when you post:
• Use exact names of all meds
• Give the dose in mgs.
• Give the frequency of dosing 1x/day, 2x/day, etc.
• Use the date rather than Tuesday, last week, etc.
Sherry has there been a change in thought that this is not a disc episode which needs 8 weeks of limited movement of the back/neck so that the disc can heal? Graduation day would be July 13.
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Post by Sherri & Molli on May 24, 2020 17:12:34 GMT -7
What can I do for the whining? She feels 100% better and getting too feisty. I don't want to give her the lickmat and frozen broth because of her shoulder injury which miraculously seems to be gone. She whines and barks non-stop in the evening waiting for dinner. I hate scolding her not that it helps.
I won't know for sure what the neurologist says for 2 weeks but she will be in her expen for 8 more weeks regardless with her knee. I am curious what CSU neuro will say. She ideally would start rehab for knee in 4 more weeks. She should be doing short walks. I am not doing anything except acupuncture and laser and the neuro consult at CSU and whatever PT the want to start.
She is feeling better, sassin' and whining for supper.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 24, 2020 20:15:45 GMT -7
Do you have the prescription details for the muscle relaxer so we can update her med list? The emergency crate training page has several strategies to change behavior, tire them out including some callers. Here is the link: www.dodgerslist.com/literature/EmergencyCrate%20Training.htmHow about an appetizer before dinner, so she is not so hungry? Small pieces of low cal apple, carrot, a frozen no salt, no fat broth ice cube to lick on? |
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Post by Sherri & Molli on May 28, 2020 17:18:57 GMT -7
She is taking 125 mg (1/4 of a 500 mg pill) of methocarbamol every eight hours. I have been waiting since Monday for them to get back to me about trying to start backing off any of her meds. Her recheck is now scheduled for June 8th for both her back and her shoulders. She is too much of a busy body for acupuncture - the needles kept falling out but she did get a laser treatment yesterday. Since she didn't seem painful, we aren't considering medicating her for acupuncture. She is still going to CSU on June 3rd for a neuro consult and PT plan for all her ailments. She seems to be 100% ok now and very grumpy about the being in the expen. Thanks!
[Moderator's Note. Please do not edit
14 lbs LIVER, NSAID sensitivities
Galliprant as of 5/18: 10mgs 1x/day for ? days, then test stop for _pain/_neuro
pregabalin 25mgs 2x/day
Methocarbamol 125mg 3x/day
Adequan 1x/month
CDB oil
possible for Pepcid AC, on board w/Galliprant?]
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Post by Sherri & Molli on May 29, 2020 15:42:33 GMT -7
So the neurologist said she no longer needs her galliprant as far as he is concerned. In his mind she was on it for her knee and she longer needs it for knee. She is two weeks from her back injury and still on pregabalin and the methocarbanmol (for her shoulder). I have enough galliprant thru Saturday - does it sound reasonable to stop this on Sunday and see how it goes?
Thanks.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 29, 2020 18:45:22 GMT -7
Sherri, because Molli has so many things going on PLUS you are the person who communicates directly with veterinarians, I'm encouraging you to please re-read the typical manner in which going off a NSAID works with a disc episode. Mollie is a special dog and she is going to need your special skills to speak with your vet in navigating all of her ills. No one wants a dog on galliprant, pregabalin and methocarbamol if there is no work for these meds to do. Thay all have side effects. This is the basic jist: 1. Stop the NSAID and stop the pain masking pain meds. 2. Observe if painful swelling signs stilll remaining or not. Rule of thumb is: pain = swelling = back on NSAID+ pain meds + Pepcid AC
Please re-read the full article to have better in-depth info to converse with your vetwww.dodgerslist.com/literature/healingsweling.htm
Let us know how you and your vet will be handling finding out if any meds at all are still needed.
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Post by Sherri & Molli on May 30, 2020 7:15:47 GMT -7
The communication with the neurologist is limited. I asked about her meds on Monday and finally got an answer late Friday. They act like she never needed galliprant as far as they were concerned. I think this neurologist is extremely talented but the the time waiting for answers it not how I operate. Another reason I am glad to have a second opinion at CSU. They just aren't open for a lot of services yet. I will let you know what CSU says on Wednesday. Thanks.
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Post by Sherri & Molli on Jun 3, 2020 17:29:56 GMT -7
So today [6/3] Molli went to CSU Veterinary Teaching Hospital Ortho/Mobility dept to get her started on PT for her back, knee and shoulders. The head of physical therapy department did an assessment and said she had no pain on T12/13, no neck pain, slight shoulder pain and stiff hips. Her tplo knee also looked good. She had laser therapy and some passive motion stuff. Her at home exercises include mostly massage/myofascial on her back.
After that visit, the neurologist looked at her and said her back T12/13 was good but she had neck pain. OMG. Half the vets that see her say she has neck pain and half say she doesn't it is her shoulder. She has violent sneezing episodes that are so bad you'd think it might cause neck pain but she doesn't yip or anything and she sneezes so much she is having a CT scan on [6/9] Tuesday to see what might be the cause. I put a call in to see if we could add her neck to the CT scan since her first neurologist said it would a waste of money to add it too her MRI.
Can a CT scan show anything in her neck? I know an MRI is ideal but I really don't want to pay for another MRI on top all of this already or put her under more anesthesia. She is showing no signs of neck pain. The doctors and PT department I trust the most are the ones saying she has no neck pain. No signs of pain at home since stopping the galliprant on Saturday. Recheck with original neurologist on Monday and CT scan on Tuesday. Thanks.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jun 3, 2020 18:14:17 GMT -7
Here is a good article on the types of advanced imaging at the Dodgerslist.com website: www.dodgerslist.com/literature/MRI.htmHope the advanced imaging help to correct pinpoint the problem with the neck/shoulder. |
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Post by Sherri & Molli on Jul 14, 2020 13:12:04 GMT -7
Update. So Molli's n eurologist released her after two weeks of rest at her recheck. We had to keep her on restrictions for her knee surgery so she is only getting access to the house with no slippery floors and all furniture blocked. She started PT and so far they think her back is great. Her knee too is healed. The PT will hopefully build her muscles some before she has more freedom. She was diagnosed with nasal cancer on June 9th (one day after our other dog was diagnosed with a brain tumor and he since tore his ccl chasing a rabbit!) Both dogs had stereotactic radiation (SRT) at CSU and hopefully we can manage the knees and back as the SRT could buy them good quality time. When they did the [June 9th?] MRI for her nose they checked her neck and although she the neck of a 13 yo dog, they are now fairly confident it was shoulder pain she experienced not neck pain. Thanks!  |
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Post by Sherri & Molli on Sept 7, 2020 8:47:49 GMT -7
So I finally saw a copy of Molli's [June 9th?] MRI for nose and neck. This is what the MRI said - MRI Results - Imaging through the cervical spinal axis reveals multilievel ventral extraduaral attenulations overlying the intervertbral disks C2-C3, C3-C4 and C4-C5. All lesions are of low signal on all weighted acquistions. Compression is felt to be minimal to moderate with the largest region of change at C4-C5. Contrast enhancing lesions are not identified. Assessment – mild annual extrusions
The neurologist said this typical for a 13 year old dog and not concerning at this time. Does that sound right? She has been doing well from original T12-13 extrusion. Thanks.
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Post by Romy & Frankie on Sept 7, 2020 12:06:17 GMT -7
IVDD causes discs to age and weaken earlier in life. The annulous is the outer ring of the disc. The nucleus is the inside of the disc. When the outer ring (annulous)weakens it may allow the nucleus inside the disc to protrude into the spinal cord. That is what the assessment of mild annular extrusions meant.
In Molli's case the vet said the compression (of the spinal cord) was minimal to moderate and the extrusions were mild. Still, any compression of the spinal cord could cause pain and neuro symptoms.
Was this the MRI done in May?
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Post by Sherri & Molli on Sept 14, 2020 7:08:42 GMT -7
Yes in May. She is having a CT scan soon for her nose which will include her neck. Since she is 13 with nasal cancer I wouldn't do surgery. I fear my husband would want. She is still a spit fire. She has an appt on Saturday for another assessment.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Sept 14, 2020 7:37:43 GMT -7
Sherri, how would the CT scan aid in treating nasal cancer, if surgery is not a consideration?
All imaging that requires anesthesia, puts the muscles to sleep which support the vertebrae. Control over muscles helps protect IVDD discs.
Best wishes in caring for your sweet little spit fire.
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Post by Sherri & Molli on Sept 15, 2020 17:01:27 GMT -7
I meant I wouldn't do surgery on her neck or back at this point. Her congestion is back. It could the tumor breaking down, irritated nasal lining or the tumor growing already. It has only been 3 months since her 3 stereotactic radiation treatments. If it is growing we would make changes to her protocol for the nasal cancer. I will let you know we find. Thanks.
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