Chris' Taco 7/17 Conservative - NECK - Chi Cllpsd Trachea

Welcome to Dodgerslist. Is your name Chris? My name is Marjorie

You have a pain emergency that must be dealt with today ASAP. Contact either your vet or if not available, today, an ER vet to have pain meds adjusted. Neck injuries can be much more painful than back injuries and often require THREE pain meds given at aggressive dosages 3x/day. Speak to a vet about increasing Methocarbamol to 3x/day (every 8 hours). Speak to a vet about adding Tramadol as a general pain med (expect and advocate at least 50mg 3x/day). Speak to a vet about adding Gabapentin (expect and advocate at least 30-50 mg 3x/day) for nerve pain. Have no patience with pain as it does hinder healing and there is no reason for it with all the pain meds available.  There should be no sign of pain within one hour of giving new course of meds and pain should remain completely under control from one dose to the next - if not, contact vet again to adjust meds until pain is completely under control.

As Mary mentioned, speak to a vet ASAP today about adding BOTH Pepcid AC (Famotidine) AND Sucralfate. When a vet deems it a medical necessity to switch from a NSAID (Deramaxx) to a Steroid (Prednisone), such a switch can be made without a 4-7 day washout period with the addition of these TWO stomach protectors.  It's very important as Mary explained to get both stomach protectors on board ASAP to prevent GI distress, which can worsen quickly.

We are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet.

There are extra steps that should be taken with a neck injury, such as softening hard kibble, raising food/water dishes. More info here: dodgerslist.com/2020/05/05/cervical-care-tips/

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?

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.
Super tried and true tips for setting up the recovery suite, the mattress and more! —> dodgerslist.com/2020/05/14/strict-rest-recovery-process/

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 ◼︎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 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!

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?

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.

﹆1 Remove yourself from the dark scary unknown. Be in command of the 4 phases of healing, what to expect with pain, with swelling, disc and nerve healing. Get up to speed: dodgerslist.com/healing-the-disc/

﹆2 Two FRIDGE FLYERs to print out
a) Help all of your family recognize emergency signs and action to take.
dodgerslist.com/wp-content/uploads/2020/07/emergency-fridge-flyer2.pdf
b) Avoid dangerous detours with the Conservative Roadmap for your fridge:
dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf

﹆3 Excellent IVDD video playlist: www.youtube.com/playlist?list=PLGTcmjenJIkUNy9ke7IvPlFIMKFfjBSen

﹆4 At the MAIN WEBSITE, use the orange SEARCH bar feature to easily access the treasure trove of more IVDD information. You will feel so very empowered to help your dog! dodgerslist.com/

Please let us know what the vet says after speaking to them about adjusting the pain meds and adding both stomach protectors. Healing prayers.

Chris, please clarify is methocarbamol on board at 187mgs twice a day? Methocarbamol is the med that deals with muscle spasm pain. But it does not do the job when only Rx'd twice a day.  All pain meds need to be Rx'd for every 8 hrs.  Prednisone cantata 7-30 days to rid the body of the painful swelling. Not fair to WAY under medicate Taco, when there are meds to get him in comfort.  Find another vet who knows IVDD if you need to. 

The pain you write about is because the meds are not YET right.
--- The pain meds do not stay high enough even level unless the vet prescribes for every 8 hrs.  Twice a day for a neck disc is just not doing the job of round the clock pain relief.  Call the vet and describe what you report here.  
--Advocate STRONGLY to get Methocarmabol and tramadol at every 8 hrs.

TRAMADOL (general analgesic)
For a 16 pound dog a 25mgs dose is like not giving anything.  STRONGLY advocate for 50 mgs tramadol every 8 hrs.

Background readings on tramadol:
GABAPENTIN. 
  There is nothing on board to deal with nerve pain from a neck disc episode!  Advocate strongly to bring gabapentin on board also every 8 hrs.

SUCRALFATE
What is the exact dose in mgs that you give Taco?  How many times a day do you give?

Hope to hear back that Taco is in well deserved full pain control round the clock with your ability to successfully advocate for his needs.

Chris, in every case in life, the more we know the better we can do. So this is why we say knowledge is key in fighting the IVDD enemy and winning. Not all vets know IVDD. But you can know just one disease pretty well, and be able to recognize when things are not right, advocate when needed, be the voice for Taco and speak up to discuss things, hire the right vet to be on Taco's IVDD health care team if it comes to that.

If you report pain, then "feeling" the meds are enough is clearly not right thinking by any vet who knows their IVDD.  You know your dog, if you are reporting any of the  signs of pain, then the vet has a responsibility! This is especially so with the VERY painful neck disc. Your responsibility if vet will not attend to pain, is to fire them, and hire an IVDD knowledgable vet: strategies for finding and hiring:  dodgerslist.com/2020/05/10/find-ivdd-vet/

◻︎ not their normal perky selves  

Resource reading #1
Lloyd E. Davis, veterinary pharmacology researcher: "One of the psychological curiosities of therapeutic decision-making is the withholding of analgesic drugs because the clinician is not absolutely certain that the animal is experiencing pain. Yet the same individual will administer antibiotics without documenting the presence of a bacterial infection. Pain and suffering constitute the only situation in which I believe that, if in doubt, one should go ahead and treat."1
Davis Lloyd E. Species differences in drug disposition as factors in alleviation of pain. In: e-book: Animal Pain: Perception and Alleviation. United States, Springer New York, 2013 p 175.
====

Resource reading #2
Jessica Vogelsang, DVM: It wasn’t that long ago when people assumed pets didn’t feel pain as acutely as humans did. Some even thought that a little pain was good for a pet because it kept them from overdoing it during recovery from a surgery. It was a misguided approach, and modern veterinary medicine no longer works that way. Now, veterinarians are guided by the principle of “assuming pain.” That is, if a pet is experiencing something we know to be painful—an injury, a surgery, certain medical conditions—we should give a pet pain medication even if he or she isn’t outwardly crying or limping.

Hi Chris


Thank you for checking in and keeping us updated. 

Good that they had determined the pain is in Taco's back and not his neck. 

It seems like pain is still breaking through though,  there should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing.
I know it may be difficult for you to call them up and again request more pain relief but that's what you must do, for the sake of Taco.  it sounds like he is under medicated where pain relief is concerned. 
Pain medications work to relieve pain in an hour when correctly prescribed for your dog’s needs.
dodgerslist.com/2020/02/24/healing-pain/

Tell them what you are seeing and tell them how long after the last dose of pain medication it is happening, they need to increase the dose of general pain reliever tramadol and make it 50 mg 3 times a day i.e every 8 hours as Paula said. 
Look for your dog to be acting their normal, perky self when pain is fully under control round the clock.


Laser and Acupuncture

These two therapies can help stimulate nerves to self repair.
Chris be very careful if you are thinking about this. 
It will always be available after Taco's crate rest. 
CAUTION: During conservative treatment, anytime out of the recovery suite is a dangerous time for the early healing disc. Movement of the back/neck can increase a disc tear with escape of disc material into the spinal cord . Pain again and the need to start from square one. For an animal with very mild neuro deficits, the risk of transporting to therapy has to be carefully weighed against what benefit would be gained.

dodgerslist.com/2020/02/24/healing-pain/

kind regards

Mary

Chris, the prednisone taper test for pain was scheduled for today (7/22).
     Since Taco is still experiencing painful swelling in the spinal cord, did the vet prescribe another course of Pred, maybe a 5-7 day course or longer?  Taper days of pred will no longer be working on the swelling.  It can take 7-30 days (excluding any taper days) before pred will be able to get the painful inflammation completely gone. 


What is the dose in mgs for the added gabapentin  3x/day?

If still having pain this morning, during the day/night, then advocate strongly to actually use an aggressive pain med approach that should have happened at the get go of the disc episode.

-- Tramadol is WAY, WAY under medicated for a 16lbs dog! Advocate for 50mgs tramadol promptly every 8 hrs as per  Plumb's in my Jul 20, 2020 at 7:48pm post
-- Methocarbamol  is undermedicated at only twice a day. This med lasts a short time in the body at the needed analgesic level.  Advocate for a promptly every 8 hrs (3x/day) dosing schedule.
-- Prednisone.  Was Taco prescribed another course at 5mgs 2x/day? For how many days?

Fully  agree with Mary and Marjorie in their above posts, the way to go is stay at home in the recovery suite and avoid further damage to the disc with a risky transport and for unnecessary laser/acupuncture.   What is needed is to use an actual aggressive pain management plan:  All pain meds (tramadol, methocarbamol) 3x/day. Increase Tramadol dose to the MAX ANALGESIC dose as per Plumb's.

Please let us know you presented a compelling advocacy for getting those meds adjusted properly and that pain is now in control within an hour and it remains in control right up to the next dose of pain meds.

Vets who are uncomfortable in their knowledge of IVDD, are not prepared to know about aggressive use of pain meds and other things about IVDD.

Is there another vet in your town or nearby to call to get in for a quick PAIN EMERGENCY?


QUESTIONS to answer. Full information allows us to understand what is gong on. The full details of a med list provide us with a HUGE amount of information.. otherwise we are in the dark to give proper comments.

---What is the dose in mgs for the added gabapentin 3x/day?
-- Prednisone. Was Taco prescribed another course at 5mgs 2x/day? For how many days?

Chris, I'm glad he is in good hands at KSU. The surgeon at KSU would be the one to know if CT and surgery would be a problem. That is something we here at the Forum we would not be knowledgable about.

Please keep us updated as you learn more about how Taco is doing at the hospital.

The very best way to get quickly to Taco's thread is to make a bookmark in your browser for: dodgerslist.boards.net/thread/7568/chris-taco-conservative-cllpsd-trachea

Currently his thread is on the CONSERVATIVE board. You can look down the list of threads and find Taco's that way also.

It is a heavy and broken heart that I share with you that Taco passed away this morning. He had surgery Monday to repair a disk in his neck and had trouble breathing (as I feared due to the collapsing trachea). He was heavily sedated the day of surgery and this morning he passed as they worked to take tube out. Thank you for all of your input as I struggled to get him adequate pain relief. RIP little buddy!

Chris, my heart breaks for you in reading this awful news about Taco. I am so sad that things did not turn out differently.  The pain of losing a loved one is beyond difficult.  It deserves your attention and time to process.  Another member, Carmen, wrote about the grieving process when very unexpectedly she lost her sweet one.  May her writings help you:  dodgerslist.com/2020/07/28/tears-heal-grief/