Diane's Bugs 6/11 conservative— JR/Chi/Dox mix; GRAD 8/6

Diane, so sorry to hear Bugs is appearing to have another disc episode.

If possible, hope when you find out more, your patience will allow you to post.

Basically you can post anywhere, we can find your post.

HOWEVER:
I think you will find it helpful if you could add a bookmark in your browser for Bugs' thread.

If using Safari browser (other browsers would be similar)
1. Click on Bugs' link: dodgerslist.boards.net/thread/7413/dianes-bugs-surgery-chi-dox

2. Your browser should open to his thread

3. Look to the top of your screen for the MENU bar to add bookmark

Diane, so glad you've been able to register and bookmark Bugs' thread.

Here are the extra things you can do at home for a neck disc and even if it turns out to be a back disc won't hurt.  www.dodgerslist.com/literature/cervical.htm

Monday is a LONG time to be in pain. Do you have enough pain meds from the April surgery you can give? Call back ER since they saw him and STRONGLY but politely advocate for pain relief til your neuro appt on Monday.  

First thing is to rule out other diseases that mimic a disc episode.  When a vet is highly suspicious of one of the other diseases, he may call for an X-ray or even an expensive MRI.

Imaging and diagnosing
Surgery is a procedure where exact location of the disc is needed to plan the procedure. Xray’s do not show the necessary detail of soft tissue (disc and spinal cord). Advanced imaging of a CT, MRI or myelogram shows hard tissue of bone as well as the disc and spinal cord.

Conservative treatment. Most often a disc episode is diagnosed by the vet by four things: 1) The dog’s history of a previous disc episode. 2) The way the dog acts at the vet visit. 3) If a breed prone to IVDD. 4) The hands on neuro exam. If there is a high suspicion another disease than IVDD, your vet will rule those out with an X-ray. I.E. dog fell and may have fractured vertebrae, a tumor, bone infection, etc. Xrays do not show soft tissue such as disc, spinal cord and thus can not prove a disc episode. Under conservative treatment all discs receive the same care of limited movement. Thus no need to know which disc.

If the big gun meds will be on board for a disc episode DO NOT use Arnica Montana.  We know the big gun meds work.  All supplements have side effects. 

If treating conservatively for a back or a neck disc diagnosis by Neuro #1, then with evidence of painful inflammation still going on, now would not be the time to taper off of Prednisone, the med that works on resolving the inflammation.

Up to three meds are normally used to provide full relieve from pain and given promptly every 8 hrs.
tramadol as the general analgesic
methocarbamol very typical for the muscle contraction pains
gabapentin for nerve pain

A stomach protector is an absolute must with any anti inflammatory drug on board.  Might well have two on board in light of past issues with anti inflammatories:  famotidine and sucralfate as was done after the surgery.

Please be explicit in exactly what signs of pain you are observing. The signs pretty much tell you where the disc is neck or back.
STRICT rest is more strict that what was done for post op surgery.


Conservative vs. Surgical crate rest


Decompression of the spinal cord

Surgery immediately removes the offending disc material and the pressure on the spinal cord.

Conservative depends on an anti-inflammatory to reduce swelling in the spinal cord. Some dogs can get the swelling down in a couple of weeks others need a steroid for more like a month. Glucocorticoids are synthetic versions of the body’s naturally occurring steroid, cortisol. Steroids are basically the most powerful anti-inflammatories when dealing with IVDD (e.g. generic: prednisone, dexamethasone, etc.) Most often used when there has been loss of neuro functions (i.e. legs, bladder control). NSAIDs (non-steroid anti-inflammatories) are also used most often when neuro functions are intact and there is pain only (e.g. Rimadyl® (carprofen), Metacam® (meloxicam), etc.)  PROBLEM is currently being on Pred, means a 5-7 day washout to switch to a NSAID.  Doesn't make sense, better to stick with steroids.


When surgery is a consideration

• If your dog can’t walk OR with STRICT crate rest, neurological functions worsen and are lost (legs and bladder control).
  STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns.
• If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and mix of pain relievers) yet the pain can’t be brought under control.
• if a dog is experiencing similar signs of neck or back pain, or mild neurological deficits for the 3rd or 4th time, meaning it may be the same disc is involved.

Robaxin® (methocarbamol)

So glad he is seeing a vet tomorrow Fri 6/12.

Pad out a crate with rolled up blankets to snug his body in the crate. This prevents his neck, his back from shifting as the car takes a corner or comes to a stop.

Hope the night goes well when you have the details of the med list,let us know.. we depend on details of mgs, times per day dosing in order to help

I'm in MST zone

I am happy to hear that Bugs is not in pain. A dog needs the minimum amount of medication that will keep him pain free. That being said, the amount of medication is not a lot for a dog his size. We have seen dogs needing higher doses of the pain meds to stay pain free.

I am happy to hear that Bugs remains pain free.

For how many days is the prednisone prescribed?

We haven't really heard about Sucralfate blocking absorption of other meds. If Bugs continues with the famotidine that may be enough protection for his stomach.

If you are going forward with conservative treatment an MRI would not be needed. That is because conservative treatment treats all discs at the same time. An MRI is usually only done right before surgery so a surgeon knows where to operate. If surgery is not being considered, then there is really no need for an MRI unless the vet suspects it may be something other than IVDD.

Diane, no reason for Bugs to be in discomfort.  Neck discs just can be a more painful thing than ones in the back.  So if by morning you are still seeing signs of pain/discomfort, there is no reason to be chintzy on pain meds.  More often than not neck discs take a 3-way combo of tramadol, methocarbamol and gabapentin. as the pain meds.

For a 10-11 lbs/ 4.99kg dog Bugs is on basically a tapering dose of pred for a disc episode @ 2.5mgs ONCE  day.   Anti-inflammatory doses are most typically at TWICE a day, then they taper to once a day same dose.  The idea is to get swelling down soonest. Nerves do not like being compressed.  Too much compression and they die.  We see that death as diminishment or loss of neuro function.  With the typical pred dosing, it can take 7-30 days to get the swelling gone. Taper days are not enough and do not count towards the 7-30 days. Taper days serve as an inidcator there is still swelling and the need to get back up to the anti inflammatory dose.

Monitor for pain, speak up (advocate) for pred 2x/day, 3rd pain med.

Yes, do speak to the neuro in the morning about increasing Predisone as Paula recommended, even if pain is under control now. The sooner the swelling is resolved by the proper use of Predisone, the better. Anything less than the anti-inflammatory dosage just will not be effective in reducing swelling.

Please let us know what the neuro says after speaking to him.

It can be a challenge getting the proper meds on board but you're doing a good job in advocating for Bugs.  Healing prayers for Bugs.

I am very glad that Bugs is not currently showing signs of pain. The pred 2x a day is an anti-inflammatory doses which can work on the swelling. Pred once a day is usually a tapering dose that does not really work on swelling.

Surgery is usually considered in the situations below:

• STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns
• If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and mix of pain relievers) yet the pain can’t be brought under control
• if a dog is experiencing similar signs of neck or back pain, or mild neurological deficits for the 3rd or 4th time, meaning it may be the same disc is involved.

Hi Paula,

I was unsure how to reply here so I just went to this posting.

My Bugs will be 3 weeks crate rest this weds. 7/1
He is currently on
2.5 mg pred 1x a day, decreased [another increased taper level] to every other day this Friday 7/3
5mg Famotadine 1x/day,
12.5 tram 3x a day(am weaning him off the tram) Tram be replaced by natural herb Corydalis Formula given to me by the holistic vet.
125 mg methocarbamaol 3 x per day.

After two weeks he progressed rapidly. He wants to charge everywhere(not allowed), he is feeling ing very well. I also had acupuncture on him twice.  He is still confined and out to do his business 4-5 x per day. 

When Can I start to reduce his other meds. When do you realize your dog is truly better and you can slowly start to change things. I have no point of reference here and I 'm not so sure he needs 8 weeks based on his behavior and lack of any discomfort.
Help here appreciated.

Read through everything you recommended again. I understand. We are three weeks today

I do not know however how to taper off the prednisone and the tram and the meth all at the same time. What are the dosages?

Tomorrow he goes from 2.5 mg pred daily to every other day for 14 days. 
I have already decreased the Tramadol to 1/4 3x a day. 1/4 tram perhaps 2x a day and 1/8 methocarbomal 3x a day? and then leave it for one week and do I decrease again the second week?

Also should acupuncture continue throughout this process? I am thinking yes.
Appreciate your time.
He is experiencing no pain at all at this time and I do realize it can be masked by the medications.

Crate rest 8 weeks - YES.

Paula thank you for the response. Let me start by saying that the tapering is [correction: had already started 6/13] starting and his [7/3] pain med taper also.  My regular vet is only involved when there is a problem. There have been none and Bugs doing better than I expected. I monitor him 24/7. 

I have a question regarding the following statement: "The "why" behind the above rule: Often it takes being at the anti-inflammatory dose level anywhere from 7-30 days. When the vet guesses swelling might be gone there will be a test. If NSAIDs, that drug will be stopped along with pain meds to give a clear picture whether all spinal cord swelling has actually been resolved".

When the vet guesses swelling may be gone? can you explain that please  AND

There will be a test?  Can you explain that please.

BUGS at 4 weeks CR this coming Weds. I have him scheduled for another Acupuncture the same day. I have them done weekly.

Thank you for your time and assistance 

Thank you for your reply. Obviously Bugs doing better than most. He is DYING to get out of his confinement. I do not relent. He is normal in all movement and has no pain for quite some time. He is  1 week remaining of Pred Taper every other day. NO OTHER MEDS! No tramadol, no methocarbamol, nothing.

One week from today WEDS he is off everything - can you please tell me what the next appropriate step is? 

This is WELL BEFORE your 8 week crate rest requirement. 

TODAY was 4 weeks......... Do you still recommend additional time "just in case".

Thank you

THANK YOU all Dodgerslist Moderators
I would like to inform you that as of today 8/5/20 BUGS has completed his 8 weeks of conservative treatment. He is pain free and doing very well. 

**

His life is different to be certain and he is settling in to the newer quieter routine.

With regards to his walks do you have a recommendation of length/time as far as increasing them. I do realize this will be very gradual. 

So far so good and we hope to keep the gain he has achieved.

I realize there is continued healing taking place and I still treat him as a disc waiting to happen. Taking no chances.