Tony's Molly 7/4 conservative GRAD: 8/29

Thank you for your reply. Talked to the doctor today she told me Molly is comfortable and has the ability to stand on her back legs. She is eating and drinking and was able to urinate on her own. She is scheduled for a MRI tomorrow between 4 and 9 am then doctor will call me to confirm extent of damage and course of action. We discussed both options of surgery or treating with medications and rest. I’m told the MRI will be the deciding factor.
It is so hard doing this over the phone and not having a face to face conversation with the doctor.
My son has a friend who has a dachshund who had operation on his back at the same hospital about a year ago and his dog is doing great so I am hopeful. He built a recovery suite for his dog with wheels so he was able to move it different rooms. He has agreed to build me one for molly.
So waiting for word tomorrow
Thank you

So received good news from the vet after the MRI. Her injury doesn’t warrant surgery and move forward with medical management.

She was diagnosed with multiple mild thoracolumber intervertebral disc herniations. A neurological exam localized the problem to the thoracolumber spinal cord T3-L3 myelopathy. MRI revealed multiple mild herniated discs along her back. She was discharged and was able to walk out but a bit wobbly.

At home now in her recovery suite.

Medications: Hemp mobility oil 6 drops every 12 hours for 7 days. Gabapentin 100 mg every 12 hours. Tramadol 50mg 1/2 tablet every 8 to 12 hours.Omeprazole DR 10 mg Caps 1 capsule every 24 hours. Prednisone 5 mg 1/2 tablet every 12 hours for seven days.

[Moderator's Note. Please do not edit
16.5 lb
steroid in  hospital: name how many days?
Prednisone as of 7/7  :  2.5mgs 2x/day for 7 days, then 7/14 test taper for: _pain / _neuro 
gabapentin 100mgs 2x/day
tramadol 25mgs  2x/day
omeprazole 10mgs 1x/day]


Strict rest fro about 4-6 weeks. She goes back for follow up visit in 1 week.
Hoping for a good good recovery.

Picked up molly at 5 pm yesterday. Yes she did walk out of the door into the waiting room, wobbly with tail waging. I picked her up immediately and discussed the meds with the vet. Drove the 1 and half back home due to the bad weather in north New Jersey yesterday. Stopped at the park near are home carried molly to a spot she likes , she sat then lifted herself and peed . Took her home and put her in a small playpen with her bed.

As to the med questions
The prednisone treatment began yesterday at 8am , my med sheet said it was day one of treatment.
It seems everything is given on a 12 hour basis on the 8 o’clock hour with the exception of the tramadol which I was told to give her next dose at 11 last night with intervals of 8 to 12 hours .
It was a rough night with her doing quite a bit of lite crying. She is use to sleeping in our bed. So I slept in the couch next to her recovery suite.
Again thank you for your insight on these issues.

Tony, I just wanted to add a few comments. Omeprazole can take a few days to reach peak performance as a stomach protector, which is why we prefer Pepcid AC (Famotidine). However, if Molly has been taking Omeprazole for a few days now, it should be fine to counter against the side effects of the Prednisone instead of Pepcid AC.

Transport to a vet involves the risk of too much movement of the spine and too much movement of the spine can cause the damaged disc to tear more, with the possibility of more nerve damage. Vets who understand the importance of strict crate rest with conservative care will agree to phone status updates rather than office visits during the 8 weeks of strict crate rest. I, too, live in NJ and am familiar with Red Bank Animal Hospital. Any of the vets there can pull Molly's records when you call them and can discuss any changes that might be needed to her meds. Should Molly be showing signs of pain today, please call and discuss giving the Gabapentin every 8 hours. Since you have the OK to give Tramadol every 8 hours, please do so. If that is not sufficient to bring her pain completely under control, Methocarbamol, which works on the pain of muscle spasms, can also be added. Also discuss having a phone consult in a week rather than a return visit.

I had a bad experience with Garden State Animal Hospital, another local vet hospital, when my Jeremy had his first disc problem.  Jeremy only had symptoms of pain when I brought him to the hospital, no loss of neuro function.  They walked him down a long hall just to get weighed and also through the building and out through the parking lot to see how he was walking. The next day Jeremy's hind legs were completely paralyzed, no deep pain sensation and he required emergency surgery. It took over six months for him to walk again, though his walk was never again normal and he's never regained bladder control. So be very, very firm about doing a phone consult rather than a return visit in a week, especially in light of the fact that they walked him out to you. Not being able to go in to the exam room with Molly gives you no control over how much movement they allow Molly once in the hospital. Not all vets understand conservative care completely.

I was also given incorrect advice as to what strict crate rest should be. STRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: dodgerslist.com/2020/04/22/chiropractic/?highlight=chiropractic  ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc

Carry 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 a 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!



I've also been told that conservative care is required for 4-6 weeks but please do be aware that it takes a full 8 weeks of strict crate rest for a damaged disc to heal and form secure scar tissue.

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 - excellent video series here: www.youtube.com/playlist?list=PLGTcmjenJIkUNy9ke7IvPlFIMKFfjBSen
 PRINT OUT this link and tape to your fridge: dodgerslist.com/wp-content/uploads/2020/05/emergency-fridge-flyer.pdf
 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 www.Dodgerslist.com website.

Great news on bladder control!  Healing prayers for Molly.

Oh dear,Tony, my sincere condolences to you (father passing from covid related). Way too much unexpected heart wrenching back to back days! I'm so sorry.

Good news is Molly's pain meds are keeping her pain free. She is such a beautiful girl.

Let us know:
the name of the steroid given in the hospital. How many days was it given?
Prednisone-- what date did that start? 

By day three omeprazole should be  doing a good job in suppressing acids.

Take care and when you are up to it do  stop in to let us know how Molly continues to do.

Hi Tony, 

Thank you for keeping us updated. 
I'd also like to express sincere condolences on the loss of your Dad.  Very sorry to read that news. 

Regarding the paperwork and the steroid, if you can't find it you could give the hospital a call - they'll have a file on Molly and it will name every med she was given,  any vet there would have access to this file. 

Well done on using the sling! It's a huge learning curve and you're doing a great job so far and Molly is in good hands. 
I love her photo, she is beautiful. 

Mary.

I am very sorry to hear about your loss (father passing from covid related). Please accept my condolences.

Tony, seems information is missing on prednisone. She was sent home on a tapering dose of pred at 2.5 mgs 2x/day.  The anti-inflammatory dose for a 16 pound dog would be approx 5mgs prednisone every 12 hours.  Most vets choose a 7-14 course and then call for the test for pain pred taper.


16.5 lb
Prednisone as of 7/5 in hospital : ?mg ?x/day for 1 day
                 on discharge 7/6 taper dose: 2.5mgs 2x/day
gabapentin 100mgs 2x/day  Mask pain
tramadol 25mgs 2x/day       Mask pain
omeprazole 10mgs 1x/day

-------------------------
STEROIDS: The first tapering down day begins the test for pain. Taper days are no longer working on swelling. Pain meds are also stopped to enable the owner to quickly assess whether there is remaining pain and alert the vet right away.

Pain = another course of steroid back up at the “anti inflammatory” level. 
-------------------------

It is really not clear if at the  hospital Molly received one day of prednisone pills at the anti-inflammatory level. OR maybe did she get a shot, an IV of a different steroid such as dexamethasone, methylprednisolone or another steroid?

The thing for you to be aware of is that the pain meds would be stopped or backed of by the vet to allow you to assess if all the spinal cord swelling is really gone or still there and needs the help of prednisone up at the anti-inflammatory level.  Be watchful of pain to alert the vet.  

When are the two pain meds to be back off (lowered) or full stopped so you will no longer be blindfolded about existence of painful spinal cord inflammation gone or not?

I realize the last days have been very overwhelming for you and probably hard to focus on any details.  So  just be alert for signs of pain appearing and the need then to advocate for a longer course than the possibly one day of pred at the hospital. 
     Pred up at the  anti-inflammatory level of around 5mgs 2x/day for a 7-14 day course would be the expectation IF, if there is any pain still.  Fingers crossed there will be NOT be pain and all that remains is to let her disc heal with the necessary time of limited movement.

It is confusing to be on a pred taper which does not work on resolving spinal cord swelling. Thus the time to test if there is actually any existing cord swelling. Pred is used for other diseases/reason at different doses, than at the anti-inflammatory level for a disc episode.

With pain meds on board masking pain, then how can YOU be monitoring for pain when blindfolded.

Do you have an understanding from the vet as to what the pred is treating along with pain meds that mask pain?

All owners deserve to be informed about treatments, expectations. Owners can best comment to a treatment, be the eyes and ears at home for the vet when they are part of the team in understanding things.

Are you observing any hint of pain popping thru near the pain med dosing time? IF so then you would want to discuss going to an anti-inflammatory level course for 5-7 days or longer, then an other taper test.

Fingers crossed for continued no signs of pain. And no pain when the pred and all pain meds are stopped. Then all that remains is to let her disc heal with the necessary time of limited movement.

Tony, very good to hear that you are not seeing any pain.

Do know you are not actually getting an accurate prednisone taper test, becuase the two pain masking pain meds (gabapentin, tramadol) are blindfolding you to the true information if any painful swelling still exists. In other words you are delaying finding out if another course of pred is needed or not.

Did you ask your vet which he wants on the test for pain prednisone taper that started on 7/14? Now a week later you still don't know what's going on. Most vets choose either:
--- to full stop the pain meds at the begin of the pred taper or...
-- to back off with less mgs or given fewer times a day

Which does your vet want in regard to the pain masking pain meds?

See what you can do to to help her relax in the recovery suite for the next eight (8) weeks it takes to heal the disc. dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite/

Many members have found a pet stroller to help also so they can stay by your side in the house. dodgerslist.com/2020/05/17/pet-stroller-conservatve-treatment/

Tony, now is not the time to start a diet. The reason is nutrition is never more important than during healing. The body actually needs additional protein and nutrients because the body is calling upon its reserves to fuel all the many repair jobs that have to be performed so that healing can take place. Now is no time to be restricting and denying the body that badly needed nutrition by reducing portions just because because of inactivity. Cut out commercial hi-cal treats and sub for low cal small pieces of apple, carrot or frozen green beans, frozen broth cube to lick on.

When it is safe for the healed disc to resume activity, you can over the course of a several of months bring her back down to a good weight if she has gained.

After graduation, check out diet strategies if you need them, evaluate her kibble by knowing how to read the dog food bag and more information about proper total nutrition:  dodgerslist.com/2020/05/22/diet-nutrition/

Tony, wonderful news all painful spinal cord swelling is gone and off all meds. Keep up the good work of protecting the disc as it continues to heal with a graduation date of Aug 29th.

We'll have some good ideas on how to safely and slowly introduce her back to family life. Please keep in touch as you approach graduation day.