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Post by Samantha & Zuzu on Jun 25, 2020 11:05:16 GMT -7
Hello there, [Original Subject Declining During Conservative Treatment]
My miniature dachshund, Zuzu, has been on strict crate rest for a little over 3 weeks. At the start of crate rest she had a little bit of a wobble and was considered stage 2. She is on pain meds, anti-inflammatory, and herbal pills. We also give her trazodone to help keep her calm, especially at night. She has also received weekly acupuncture and laser treatment since this all began. She has progressively gotten worse with each week, despite the strict rest, meds, and therapy, and is now stage 4. We decided, a few weeks ago, that we would not proceed with surgery. We got her a clip on sling/harness a week or so ago (when she first started having trouble holding herself up) to help her during bathroom breaks. She can currently use the bathroom but we’re told to be prepared as she may soon loose this ability. She has deep pain sensation in both hind legs but they had to use hemostats to get withdrawal/reaction. She cannot ▼ambulate (but could last week). With each vet visit we are told she has gotten worse. In your experience, does this often happen (steady decline), even with the crate rest, meds, acupuncture and laser? We are losing hope and are told it is very bad she is worsening considering what we are doing. Also, do we start the crate rest clock over each time she declines? Thank you. P.S. She is 6 years old and this is her first episode. |
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Post by Romy & Frankie on Jun 25, 2020 13:30:02 GMT -7
Welcome to Dodgerslist, Samantha. We are 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. It is important to know that disc disease is not a death sentence! Struggling with quality of life questions for your dog? Re-think things:
I am sorry to hear that Zuzu's condition continues to deteriorate. Are you currently practicing Very strict crate rest? I cannot over emphasize how important this is.
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 dragging or meandering at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment. Carry Zuzu 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. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!
How much does your Zuzu weigh?
Did you specifically get a diagnosis of IVDD, aka: a disc problem, a disc herniation, a bulging disc, slipped disc? —
Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho?
GI Tract problems? —Eating and drinking OK? No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?
What was the date you saw the vet for CONSERVATIVE treatment of meds and started crate rest?
If there has been a slow deterioration and not an improvement and then a decline (a relapse) the crate rest clock doesn't necessarily need to be reset but as long as there is any pain, any IVDD medication or any deterioration, crate rest for Zuzu is important. You can think of crate rest as a sort of comfortable, healing retreat and not any type of prison.
Please list the exact names of meds currently given, their doses in mgs and times per day given.
If on a steroid….what was the start date & dose? Date of steroid taper?
If on a NSAID, for how many days has it been prescribed for?
Often when a dog starts to deteriorate during conservative treatment, the vet may change the anti-inflammatory to try to stop the deterioration. Some anti-inflammatories are stronger than others. Has her anti-inflammatory been changed or adjusted? Please speak to your vet about this right away.
All anti-inflammatories cause excess stomach acid which can sometimes cause serious stomach damage. To reduce the chances of stomach damage a stomach protector like Pepcid AC is used. Ask the vet if Zuzu 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)
The usual dose in Doxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours. Give the Pepcid AC 30 minutes before the anti-inflammatory and thereafter every 12 hours for as long as she is on an anti-inflammatory. Give the anti-inflammatory with a meal for extra protection.
Is there still currently pain?
☐shivering, trembling
☐yelping when picked up or moved
☐reluctant to move much in crate such as shift positions or slow to move
☐tight tense tummy
☐can’t find a comfortable position
☐Arched back
☐ Holding front or back leg flamingo style not wanting to bear weight
☐head held high or nose to the ground
☐Not their normal perky selves?
Full pain relief is expected in 1 hour and stays that way between doses. If not in control your vet needs to know right away to adjust meds. At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.
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 as soon as 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 Zuzu
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Post by Samantha & Zuzu on Jun 25, 2020 16:46:35 GMT -7
Thank you for the response. We really appreciate your help. I would like to provide answers to the questions you asked! I also have a few more questions!
Zuzu’s first full day of strict crate rest was June 3. At this time she was a little wobbly with her left leg showing some weakness.
She was diagnosed with IVDD and our vet is a general DVM. We see another vet for acupuncture/laser as this service is not available at our regular vet.
She is on the following medications:
Meloxicam (0.4 ml once a day when she eats her dinner at 5pm)
Gabepentin (100 mg once per day at 8am)
Double PII (0.2 g twice a day - 8am/pm)
Trazadone (50 mg once a day to calm her down in the evening so she will sleep soundly in her crate as she wants to sleep in the bed with us - 10pm)
[Moderator's Note. Please do not edit
13 lbs
6/25 weekly trips for acupuncture/laser- continued setbacks due to too much movement?
Meloxicam as 5/24: for how many days?
gabapentin 100 mgs 1x/day
Double PII
Trazadone 50 mgs 1x/day
needs GI tract protector, Pepcid AC, on board w/ Meloxicam! ! ! ]
Eating and drinking is normal. Peeing and pooping seems good (but she does require a sling since she will otherwise drag her feet - the dragging began a little over a week ago). She sometimes pees twice when we take her out). She is not showing any signs of pain since being on the pain meds and anti-inflammatory.
She has been in her crate aside from quick bathroom breaks and her weekly trip to the therapy vet for acupuncture/laser. We sometimes open the door to gently pet her and give her kisses. Is this still ok to do? Also, when she hears the neighbourhood dogs barking, she sometimes responds. We are trying to control her barking, as much as possible, but do find it a challenge if she hears a dog barking outside. Can some occasional barking be damaging? Any suggestions would be appreciated. We play spa music but it only muffles outdoor noise so much and a very rambunctious dog lives next door.
We had good intentions with taking her for the therapy but I think we had better hold off on any type of travel [CORRECT!] unless it’s an emergency. Do you recommend any at home laser therapy tools we could purchase online? I don’t think I would feel comfortable doing the acupuncture myself.
Also, we will speak to our vet about switching the anti-inflammatory and possibly increasing the dose.
Also, what does PT stand for? I’m guessing physical therapy but want to be sure!
Thank you again.❤️
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 25, 2020 19:30:17 GMT -7
Samantha, very unusual to hear progressive neuro worsening. Seems like its gotta be excessive movement with trips in to vet. PT is physical therapy and not anything Zuzu should be dong at t his point in time. Not much can be found about Double PII. With big gun med Meloxiam on board, would be quite wary to have my dog on Double PII. We know anti-inflammatories work. Just may not be on the right class of anti-inflammatory drugs....more on that below. Most vets when there is nerve damage move to the most powerful of the two classes of anti-inflammatory drugs — the steroids such as Prednisone. When deemed an emergency to stop further neuro diminishment, the usual 5-7 days of washout from the Melociam would be subbed out for TWO stomach protectors on board. The vet doesn't even have the one usual one (Pepcid AC) on board! Advocate for Pepcid AC as per the info Romy gave above. You will need to bone up in order to do your best job of advocating and protecting Zuzu. 1) Mar Vista Vet is excellent to learn meds he's on and which ones you will be advocating for: www.marvistavet.com/pharmacy-center.pml Here's one of them you can look up the others: SUCRALFATE to know the timing with Pepcid AC and with food: marvistavet.com/sucralfate.pml2) Learn more about the use of anti-inflammatory drugs with a disc episode: www.dodgerslist.com/literature/healingsweling.htmQUESTIONS - how much does your dog weigh? - What date did meloxicam start? For how many more days is the Rx for? The most important thing right now is 100% STRICT rest and perhaps getting the more powerful Prednisone steroid on board PLUS stomach protection of minimal Pepcid AC tomorrow. |
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Post by Samantha & Zuzu on Jun 26, 2020 8:55:50 GMT -7
Thank you for your response. She has been on Meloxicam for 4 weeks.
I have to double check her weight but believe it is 13 pounds. I will double check on this. Our vet is in surgery at the moment so I haven’t had much luck reaching him this morning.
Also, just to confirm, when I speak to my vet - I am asking for a stronger anti-inflammatory such as Prednisone? And so we do not have to wait the 5-7 days (for the washout), I am asking for two stomach protectors (such as Pepcid AC and Sucralfate)? If this is correct, can the stomach protectors and prednisone be started on the same day?
Thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 26, 2020 10:54:19 GMT -7
IF deemed an emergency by the vet to prevent further deterioration of leg function caused by nerve cells dying, THEN
--- he, without any washout days, could stop Meloxicam today and start Prednisone today. Steroids are the most powerful class of anti-inflammatory drugs. Prednisone is most often Rx'd.
--- HOWEVER wiith no washout days, he MUST double protect the stomach lining at same time with two protectors.
--- Protector #1 is an acid suppressor: over the counter: PEPCID AC (famotidine) 5mgs 2x/day
--- Protector #2 works differently to immediately bandaid any disruptions (damage) to the stomach lining by a gel coating over those areas. Rx item: SUCRALFATE
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Post by Samantha & Zuzu on Jul 10, 2020 15:23:30 GMT -7
Hello there,
I wanted to provide an update on Zuzu and also seek more advice. You can see my previous posts above to get more of a detailed history but I will provide information on her history here too as they relate to her current situation and my current questions.
Currently, Zuzu is on day 38 of crate rest (about 5 weeks). At the start of crate rest, she was [6/25] wobbly walking and able to hold herself up.
She has been on pain meds and anti-inflammatory meds for 6 weeks and is currently taking them (see above posts for specifics). For the first three weeks of crate rest, she was going to weekly acupuncture/laser therapy.
two weeks ago, we [6/25ish?] stopped her therapy because she was continuing to deteriorate, and were worried the car ride was causing unnecessary stress and movement. At her worst, she was unable to hold herself up and was ▼dragging both back feet but still had deep pain sensation. The therapy vet told us she would likely become fully paralyzed and lose bladder function soon since she was deteriorating with meds, crate rest, and therapy. As mentioned, a little over two weeks ago, we STOPPED therapy to tighten up on her crate rest.
A little over a week ago, since tightening up on her crate rest, shestarted holding herself up again and is [7/1ish?]▲no longer dragging her back feet. She uses her back feet (no curling of the toes) and can walk with assistance (we use a harness during bathroom breaks). We have not attempted letting her walk on her own but based on how she is walking with support during bathroom breaks, I suspect she would be wobbly and would potentially lose balance after a few steps. She seems to be growing more confident with her stride. When we return inside, after a bathroom break, we often see her back leg muscles trembling (or spasms). It lasts a few minutes upon returning inside and she doesn’t seem bothered by it. Is this a good sign or a bad sign? These spasms/muscle trembles have coincided with the return of the use of her back legs and we have only noticed it immediately following a bathroom break.
We were losing hope but with this improvement, we are feeling much more optimistic. I live in Nova Scotia, Canada and can only get x-rays here (which I know are not overly informative). We did have one done but it doesn’t tell us specifics. When we had it done early on (when she first started to lose her balance and wobbly walk), we were told there appeared to be three bulging discs but that w/o the mri/ct it was hard to know for certain. We would have to travel many hours to a neighbouring province to get the scans done (mri, ct, ultrasound) that tell us more. The borders were closed at this time. A few days ago, the borders finally opened, so we CAN now travel to the province where such scans are available, but do not want to put unnecessary stress on Zuzu since eliminating travel has seemed to help.
I am very curious if her previous deterioration during crate rest was due to swelling increasing/not going down or was it due to further damage to the disc(s)? Is there a way to tell w/o the scans? If her disc(s) herniated or exploded, would we know w/o the scans? If this is what happened, and it wasn’t just the swelling causing the decline, how do they heal on their own during crate rest? I read that scar tissue develops around the injury but want to understand it more.
I am ALSO wondering when we should resume therapy treatments? Since she deteriorated during crate rest, but is now showing improvement, I’m not sure if I should extend her rest/hold off on therapy beyond the eight weeks?
I appreciate your recommendations. Also, thank you for encouraging me to hold off on trips to the vet for therapy.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jul 10, 2020 19:21:26 GMT -7
Samantha, what outstanding news! Doing very STRICT rest has allowed the disc to heal again and for nerve repair to have brought back leg neuro function! I believe the Roadmap to Conservative Treatment will be immensely helpful to you in avoiding anymore dangerous detours to Zuzu's healing. Knowledge about IVDD is alway the key to fighting this enemy and winning. Print it out for your fridge: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf**  Please update us on her med list, so we are not commenting in the dark. EXACT days avoid confusion.-- Specifically we want to know the date she 1st started the anti-inflammatory, meloxicam?
-- What date if any did she stop Meloxicam and then what date did she restart it? -- Did she ever go to a steroid? What date? What dose? how many times a day? -- what is the stumbling block to getting an acid suppressor such as Pepcid AC (famotidine) on board? PLease look at the list and note which have have stopped. changed mgs or frequency,
CURRENT MED LIST?
13 lbs6/25 relapse of disc due to excessive transport movement.
Meloxicam started on what date?: for how many days? Then stop test _pain/_neuro any stop dates? any restart dates?gabapentin 100 mgs 1x/dayDouble PII
Trazadone 50 mgs 1x/dayneeds GI tract protector, Pepcid AC, on board w/ Meloxicam! ! !
Samantha, you have just witnessed just why the single more important care is the 100% STRICT rest is so very important. Zuzu has been incredible lucky that you moved to STRICT rest. With a relapse to the disc, more spinal cord swelling. Nerves do not like being pressured. People see that pressure translated into nerve death and from the outside, loss of neuro functions. Zuzu's disc could then begin all over again to try to self heal. The damaged nerves (knuckling, dragging legs) had a chance then to self repair and return function. All because you took seriously the need to be STRICT about movement of the back. The disc is cartilage type tissue. A sprained ankle ligament is also cartilage. Stay off your ankle and it will self-repair. Only thing is ankle/bone are surrounded with blood rich nutrients. The disc is pretty much without a blood supply and the reason it can take twice as long as a broken bone to self repair. Xrays do not prove which disc. Xrays are used to rule out other disease such as from falling a fracture vertebra, a tumor, or a bone infection. Xray must always be used for a very good particular reason in mind and explained to you why. Not in general just to see. MRIs also use anesthesia, so they are used not to just look, but to have a very particular reason to look. Such as a surgery needs to know exactly which disc. Conservative treatment does not need to know which disc tore. Where the disc/ disc material pushes into the spinal cord, the cord could develop scar tissue. Reading References: With improvement in neuro function in conjunction with very STRICT rest, you have your answer, very likely a disc a disc episode. With conservative treatment all discs receive th same very STRICT rest. There is no need to try and figure out which exact disc, then. We have noted the date the disc relapsed was on June 25 when you wrote. So it is 8 weeks from that relapse making graduation day on Aug 20. Had she had any worsening of neuro function or increased pain after June 25, then the relapse day would be that date? READ the ROADMAP Let us know if you intend to give Zuzu every chance possible to heal the disc right up to graduation day on Aug 20. It would be heartbreaking to cause another relapse and have to start from square one yet again. POTTY TIME Let us know you are not allowing any walking around during potty time. You restrict her to the very fewest of footsteps to take care of business. Scroll back up to read Romy's post of June 25 explaining either control her with leash and harness or use an an expensive. The sling is back up so that she does not fall or twist her back. Please visit the main website dodgerslist.com Check out the "Knowledge" menu topics to increase your IVDD knowledge quotient. Use the orange search bar to locate specific gems in our treasure trove of IVDD information. Look forward to your next post to learn the answers to questions above. And to hear how Zuzu continues to do on STRICT rest. Would not be surprised at some point you tell us that she can move up in to a stand position all by herself and eventually taking the very fewest of footstep at potty time that less wobbly. |
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Post by Samantha & Zuzu on Aug 7, 2020 19:25:09 GMT -7
Hello! I wanted to provide an update on Zuzu. She continues to be on strict crate rest and is almost ready for graduation. We have one week and a bit to go. Her graduation day is August 20. She sometimes stands in her crate on her own (especially when excited or happy like when it’s dinner time) and she stands and walks during her bathroom breaks though we are still using the harness and limiting her movement. She squats and stands back up without issue. When she sees the neighbour’s cat, from time to time, we need to keep her at bay because she wants to run. We are fairly confident that she could walk on her own if we allowed her to (but she may be a bit awkward/weak as she has appeared to lose some muscle mass). We haven’t tested it out yet and will wait until graduation to let her try walking on her own during bathroom breaks. I don’t think she will do AS well on wood floors though so we have special boots to help with traction, as well as mats. Dog gates are also installed at the stairs. She has never been a jumper on and off furniture but will not leave her unsupervised on furniture.
We have a therapy appointment booked for her first week out of crate rest. We still have her on meloxicam and gabapentin (which she began on May 25). She has never had a break from these two meds and we decided not to pursue steroids (we were seriously considering it at one point when she was unable to hold herself up and dragging her back legs). Since her relapse mid/late June, she has not been to the vets so we will be taking her for an appointment her first day off crate rest to get more advice and recommendations. I think we can probably take her off the meds now but will wait until end of crate rest. Do you suggest stopping the meds early or should we continue for the duration of her crate rest? The last two weeks have been a challenge as we can tell she really wants out and is feeling spunky! Since she had a relapse, her crate rest has been about ten weeks so far so she is itching to get out and has been quite vocal at times. We are looking forward to giving her some more freedom soon like snuggling on the couch and bed. We were wondering if there are specific exercises we could try with her to help strengthen her hind legs once graduated? We hope she will do well when walking on her own and will keep you posted. I think she may have some trouble on wood floors so if you have any recommendations please let me know. Thank you for all of your help. It is greatly appreciated.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 7, 2020 21:53:44 GMT -7
Samantha, Zuzu should not be graduating until off of all meds for at least a week and you are not observing any signs of pain.
The pain meds should have been stop tested LONG ago maybe around July 9th. Was that ever done? No dog should be on any anti-inflammatory one bit longer than having had all painful inflamed tissue resolved. So this is why vets who know IVDD Rx a 7-day or a 14 day course of Meloxicam and then a test stop to see if yet another course is needed or not.
We are at kinda of a loss to discuss specifics as the med list was never completed...so we are in the dark.
You have already done some good prep for graduation day with booties, rugs, gates. We do have a sample schedule on how to gradually re-introduce family activities and physical activity to strengthen legs to share with you when off all meds, no pain. Let us know when you can stop Meloxicam, gabapentin, Double PII in order to get an accurate assessment without blindfolds about pain.
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Post by Samantha & Zuzu on Aug 8, 2020 6:52:04 GMT -7
Zuzu started both meds (gabapentin and meloxicam) on May 25.
We will stop the pain meds to see if there is any pain. Typically, how long should she be off the pain meds for us to tell if there is any pain?
Also, once we know there is no pain, should we stop the anti-inflammatory (unless you think we could stop both right now)?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 8, 2020 10:00:21 GMT -7
Samantha, has Double PII also been stopped? It should be.
Best results in assessing for pain on the TEST STOP of Meloxicam:
--- Stop all pain meds at the same time Meloxicam is stopped so you are not blindfolded about pain.
Some vets prefer backing off of all pain meds. Which does your vet want? Let us know. Call your vet to find out.
Discuss your concern on why Zuzu is still on Meloxicam, your wanting to know if all swelling is actually gone.
-- Meloxicam can stay in the body for 5-7 days at some level. If there is swelling, then pain could re-surface at any point in the body's lowering of the Meloxicam's level as it lowers and leaves the body.
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Post by Samantha & Zuzu on Aug 8, 2020 10:51:13 GMT -7
Yes we stopped Double PI one week ago [8/1].
[Moderator's Note. Please do not edit
13 lbs
6/25 weekly trips for acupuncture/laser- continued setbacks due to too much movement?
Meloxicam as 5/24:
as of 6/25 relapsed disc: now over 1 month on w/o a test stop
gabapentin 100 mgs 1x/day
Trazadone 50 mgs 1x/day
needs GI tract protector, Pepcid AC, on board w/ Meloxicam! ! ! ]
We will check with the vet to see about their preference re. stopping meds and why she is still being prescribed meloxicam.
Do most stop both pain and anti-inflammatory at the same time?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 8, 2020 11:03:17 GMT -7
Vets who are IVDD knowledgable do the test stop by stopping all pain masking pain meds at the same time the anti-inflammatory such as meloxicam is stopped. Vets want to know ASAP if there is still swelling and be able to call for another course of meds. No vet who uses meds in a safe way would want a dog on an anti-inflammatory if there is nothing for that drug to work on. No work means the dog is just subjected to the several serious side effects these drugs have have.
When a dog has been on a pain med fo ra long time there are considerations a vet may have to take. That is why we ALWAYS ask what your vet wants full stop of pain-masking pain meds or the backing off in frequency and/or dose in mgs.
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Post by Samantha & Zuzu on Aug 19, 2020 15:41:44 GMT -7
Hello! Zuzu graduates from crate rest tomorrow and I would love some suggestions and advice on what we can do to transition her to some more activity. She has a therapy appointment in a few days but I’m wondering if there is something we can do at home, as well. She can stand and walk (but is wobbly, at times). She has been off her meds for a week.Thank you for your help. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 19, 2020 18:31:43 GMT -7
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