Erin's Gracie 8/25 conservative -Grad 10/20 -GS/Husky

Hello, 

Welcome to Dodgerslist.  Glad you've joined us. 
What's your name? Mine is Mary. Is Gracie blue your dogs name?

I'll give you tips and advice for now, but do check back again for when one of my moderator collegues picks up your post. They'll give you more specialized advice. 

So for now it unfortunately sounds like she is having a disc/back issue, especially when you say she is dragging and knuckling her back toes, these can be signs of disc damage. Also not being able to control her bladder would be another sign. 

It would be very important to restrict her movements as much as possible, understand she is a large dog so perhaps confine her to something like an ex pen if possible.  Anytime when she can move about freely is an opportunity for an already damaged disc to tear even more and become more damaged. 

dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite/

As you say she is currently on Rimadyl, you need to contact your vet and ask if there is any reason she should not be given the tummy protector Pepcid AC. Pls read info in the link below. 

dodgerslist.com/2020/05/06/stomach-protection/


There are two therapies that help dogs with back pain:

Acupuncture 

Laser Light Therapy

These two therapies can help stimulate nerves to self repair.

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 especially a LARGE dog  the risk of transporting to therapy has to be carefully weighed against what benefit would be gained.  Pain med deal with pain.

Bladder expressing
Loss of bladder control means the need to go for a hands-on-top-of-your-hands type of expressing the bladder lesson. First read and view the video at this page to get more out of the lesson:

dodgerslist.com/2020/05/05/bladder-bowel-care/

Dogs who do not have bladder control may leak when lifted because that lifting pressure to the tummy is sorta like the pressure to the tummy area for expressing. Loss of bladder control means the brain no longer connects/sends messages to the bladder to wait until in an appropriate place. Instead reflexes will kick in when the bladder is filled to the stretch point. This allows the dog to overflow. Overflowing will not remove all urine. What remains can quickly develop into a urinary tract infection (UTI). Let us know if your dog can currently pass the sniff and pee test.

The only way for humans to know if there is bladder control is with the “sniff and pee test.” Take her outdoors, set her on an old pee spot to sniff. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. See if she will release urine on the old urine area. If urine comes out after sniffing, bladder control still remains. You should continue to do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe.
 
kind regards, Mary

Thank you Mary & Paula. Sorry for the delay. I am a busy mom of 4 kids & working from home. I also was trying to figure out how to navigate this site. 

My name is Erin. The dog's name is Gracie (middle name, Blue) She has beautiful blue eyes from her Husky genes. She is 35-40lbs. 

Gabapentin 100mg, 2-3 pills, 3x/ day
Methocarbamol 500mg, 3x/ day
She was given both of these meds [8/26!] at about 7AM today. 
She will start a steroid (have not picked it up yet) on Friday.

She had laser therapy yesterday around 6PM on her spine. The PT felt it was best to bring her in for the treatment, despite the risk of moving her. Gracie has been a very good dog in that she just lays on her bed when she is not feeling well.

She really does not need to be confined- she is making no attempts to jump up or walk around. She is still able to move a bit, to shift her weight to sit comfortably, or to try & squat to pee outside (with assistance), for example. She just wants to feel better. I am hoping that the steroid on Fri will act as a magic bullet. 

As for pain... She is not whining or panting, so pain seems to be under control. She is in bad shape for sure- weakness in back legs, but can still stand when assisted to flatten her paws, back hunched [pain], & some trouble toileting. But I saw her in even worse state prior to her surgery in April, so I have hope yet. The vet gave her less than 40% of walking again, even with surgery, but we did it. $7k- I am still paying off about $2.5k on a credit card. I simply cannot put her or us thru that again. A CT scan costs $2400-2800, too. This is a roller coaster. One moment I think I have to put her down, the next, I think she may heal. It seems to be something I have to wait thru. The PT said once she starts the steroid on Fri, I should see improvement by Monday, or we need to re-evaluate. Ultimately, if she has bowl & bladder control, I will continue to work with her. But if her life will be no control & in a wheelchair, I will have to let her go. 

Thank you for your input & feedback. 

Erin, thank you for providing more valuable information to help us have the full picture.  Would you round out the picture for us with:
   How much does Gracie weigh? 
   Which do you actually give?  2 or 3 gabapentin pills 3x/day?
   What is happening today with the two pain meds on board regarding pain. If you still are seeing pain (hunched back, reluctant to move much) then the pain meds are not get right!!   CALL and report pain to the vet. The vet can RX and make adjustment over the phone without having to bring Gracie in.
     -- Methocarbamol 500mgs 3x/day is in a good range to control muscle spasm pain.
    -- Gabapentin should be given at the max dose Rx'd:  300 mgs (3 pills) 3x/day to control nerve pain.
     -- Tramadol be added as the overall general analgesic 3x/day
     -- It often takes that 3-way combo cocktail of pain meds 3x/day to provide full comfort.

MEDICATION DETAIL
   What date did Rimadyl stop? THIS IS AN IMPORANT QUESTION. IF no Rimadyl in the body the pain meds should have been increased at the stop date so Gracie would not be in the pain she is in! There is nothing to work on the painfully swollen cord if Rimadyl was stopped.  
     It would be a good idea to keep a med chart so you can see cause and effect patterns, be able to give dates with observations. Details are important in conveying things to a vet when you speak up to advocate for Gracie.
 

D/L the MED CHART
Print out  sample + a blank form to use with your Gracie's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf

KNOWLEGE IS KEY
Erin you have a PT person who does not understand IVDD. It really falls to you to be able to identify any person who is not comfortable in their IVDD knowledge and be able to protect Gracie with a polite "no thanks" to treatments that are harmful.  To be able to do that will take a bit of quick reading to get the 4 phases of healing planted in your mind. Gracie has a lot ov living and loving to do. You can be instrumental in her having many happy years ahead with her family and be able to heal her disc.


Print the Roadmap to Conservative treatment  dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf and tape to the fridge.
      Avoid any dangerous detours people my be trying to convince you of, stay the course with the tried and true conservative treatment principles that will give Gracie the top chance to heal the damaged disc. 
      Know the timeline for expected nerve healing (don't be discouraged by those who tell you "improvement by Monday" if nothing changes). Which phase of healing is that person referring to? It can only be the "Swelling Phase" and that can take 7-30 days to resolve the  painfully swollen spinal cord (know how to properly test if all swelling is really gone).  There are no medications that can heal nerves, the body does that on it's own.

Anytime Gracie is out of her recovery suite, is a danger to the healing disc. Any vet who knows IVDD would not want to risk a laser appt when proper RXing of pain pills would keep Gracie out of pain.  Everything in life is based on risk vs. the benefit.  Are you willing to risk more damage to the disc with moving a heavy dog into car, out of car, getting her into the clinic, the vet/staff there moving her onto the exam table and the reverse of going back home?  OR does it seem prudent to have Gracie remain quiet in her recovery suite while you give her a pain pill?  Vets who know IVDD use pain medications appropriately to provide full comfort from pain.
      
RECOVERY SUITE
An ex-pen can be an excellent suite. The suite lets Gracie know she will not walking around or going off her mattress. Movement jeopardizes the healing disc. The ex-pen would only be large enough area that Gracie can fully stretch out her legs and turn around easily. The safety factor for the disc, is the owner is one step ahead of when Gracie feels good enough to do too much. She NEEDS to be in the suite now so her disc is safe from further damaging the spinal cord. Perhaps permanently damaging the cord and potentially loosing bladder control.  Keep that disc safe so no setback to nerve function happen.

100% STRICT Rest Recovery
The essential tips and ideas to carry out the rest period for the healing disc
dodgerslist.com/2020/05/14/strict-rest-recovery-process/

Erin, stay strong, stay positive and do not give up on Gracie.


REVIEW OF QUESTIONs
-- What date did Rimadyl stop?
-- How much does Gracie weigh?
-- Which do you actually give? 2 or 3 gabapentin pills @3x/day?

SCROLL up to previous post today to learn how to set up an email alert anytime someone posts to Gracie's thread.

It is a shock when our dogs lose function because of a disk episode and very scary. Dogs can heal from this but it takes time. Nerve healing is very slow. Think in terms of months and not days or weeks. With correct pain meds a dog will have no pain and can recover comfortably in the recovery suite. It is important that Gracie stay in her recovery suite because it is the immobility enforced by crate rest which allows the disc to heal. This is why crate rest during conservative treatment is much stricter than post-surgical crate rest. Our dogs can move suddenly when we least expect it if they hear a noise or see a movement. This can further damage the healing disc.

Pottying is the only time the dog should be out of the recovery suite but movement should be minimized then also. You can carry her outside to her usual potty area and support her back end with a sling if she is wobbly. As an alternative you can use a pee pad right outside the crate. When my dog Frankie was regaining bladder control I did this. I lived in an apartment and there was no way he could make it to the elevator and out the front door. At first he was reluctant to use it he did not want to go in the house if he could help it. I got a paper towel with another dog's urine on it and put the towel on the pee pad. After that he would use it.

I used an ex-pen as a recovery suite because it was easier for me to move him this way. Since Gracie is on the larger side an ex-pen may work for you also.

Healing thoughts for Gracie

Thank you for the med list info.

--Is the pain she has been in now fully in control with  gaba increased to 300 mgs 3x/day? You are no longer seeing reluctance to move, to shift sides, to get up to take permissible very, very fewest of footsteps at potty time?

--Have you read about Pepcid AC (famotidine) and are prepared to ask your vet in this very particular way: 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).
     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 ALL anti-inflammatory drugs cause (NSAIDS or steroids).
        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.

I will call the hospital tonight & ask about adding Tramadol, sucralfate & pepcid. 
I absolutely do not want to cut her life short. I know what a happy life looks like to her & a life of having her bladder & bowel expressed is definitely not it. She actually tried to bite [in pain!— due to insufficient pain meds on board!] people when they've tried to express her bladder- myself included. She is never a mean dog. I am confident she still has that control for now though. Even though she is having accidents, she still attempts to squat when we go outside, as she is a very clean & delicate dog. 

Hello again-

I just spoke to the vet. He is ordering Tramadol. He recommended I add prilosec tomorrow morning with the steroid.

[Moderator's Note. Please do not edit
35-40 lbs 5y.o
Rimadyl as of date? 8/24 pm stop date
4- day washout steroid switch to start on Fri 8/28
name of steroid as of 8/28: ?mg  ?x/day  for ? days, then test taper for _pain/_neuro
gabapentin as of 8/26: 300mg 3x/day
methocarbamol as of 8/26: 500mg 3x/day
tramadol on order as of 8/27:  ?mg    ?x/day 
will need GI tract protector, Pepcid AC, on board w/! a STEROID ]

As for her peeing- she has always been a pee-happy dog. When I walk her, she pees every few feet. We have a little bit of land behind our house & Gracie is usually outside with me. She is my shadow. So it is hard to tell how often she usually pees- it is a lot. I have been working from home since March, so she has not had to hold her pee much more than 2-3 hours in the past several months. And of course, I was rehabbing her from surgery for the first two months since working from home, from about mid-April to about late May when she really was rehabbed I'd say to like 75%. Currently, I am taking her out more like every 2-3 hours. I think that because I have actually been working SO HARD to take care of her, she may be drinking a lot of water. She has never been a big gobble down water or food dog. She is very gentle. I have been feeding her chicken & water & treats, basically offering her to eat & drink as much as possible- I want to make sure she does not get dehydrated since she is not getting up to go after her food & water. Quite frankly, I am usually going without, bc when I have a lull in work, I make sure she is taken care of rather than myself. Like I said, that is her norm. I could not tell you how much she usually eats or drinks in a day, because she is usually very kinda sly about it. Often, typically, my husband & I would hear her eating when we lay in bed. 

Thank you Paula. I have not been able to accompany her much thru everything. As you know, COVID 19. I am sure they weighed her. I have been paying a LOT of money & traveling an hour to take her to this special animal hospital away from my home. I will call them & ask them to email me all of her records. 

Hi All-

I have been reading over Gracie's records & thought I'd share the notes (some typos) from her surgery back in April of this year:

Surgical Notes:
A dosal approach was made to the spine from the caudal aspect of L2 to the cranial aspect of L 6.  Muscles were dissected off of the dorsal spinous prcess from L3 to L6. The articular facets of L3-L4 were removed with ronguers and a high speed burr was used to creat a bony window into the spinal canal over from L3-L4. blood clots and a small amount of disk materail was removed from the site. A dorsal laminectomy was perfomed from caudal L4 to the cuadal aspect of L5 to continue to remove disk material. A large amount of disk material was removed from the spinal canal along with blood clots. The wound was flushed with a large amount of saline and a fat pad placed in the bony defects. The wound was closed with 3-0 pds and 3-0 nylon. A biogaurd bandage was placed over the incision.
 
[Moderator's Note. Please do not edit
35-40 lbs;   5 y.o
Rimadyl 8/24  stop date
✙ prednisone as of 8/28: 10mg 2x/day for 14 days, then 9/11 test taper for _pain/_neuro
   gabapentin : 300mg 3x/day
   methocarbamol: 500mg 3x/day
✙ tramadol  50mg 3x/day
✙ Prilosec (Omeprazole) as of 8/28- fully effective  9/3 to 9/2:  20mg    1x/day  ]

With the addition today of ✙Tramodol & finally some ✙Prednisone (and 
✙ Prilosec- I double-checked with the vet & he recommended Prilosec over pepcid), Gracie seems much more comfortable today. Really crossing my fingers & praying that she improves this weekend. 

Thank you all for your input!

Good Morning-

My husband got out of bed this morning. Gracie got up & went to the back door. She peed a little in the kitchen, but I hurried to get to her & didn't have time to grab the towel to support her. She went outside walking- both legs! A little unsteady, knuckled on the left maybe half the time. I supported her with her tail like the PT showed me, but she totally walked! Of course I am trying to keep her at her bed, but this is very exciting. When we adopted her 4 years ago she was totally crate trained. We weaned her out of the crate about a year ago, because we preferred that she walk & sleep freely throughout the house. However, I think I am going to put the crate back in my room for her again. So she has an enclosed place to relax & not worry when people come up behind her.

Our house is basically all 1 level. Gracie has at most 2 small stairs to navigate to get outside. Any suggestions for keeping this from reoccurring? In retrospect since her surgery in April, things I will definitely do differently if this turns into a full blown second change with her-
- Absolutely no running, meaning as a partner with me, but I also will have to protect her from herself, which means calming her when I see that "I am about to go for zoomies in the yard" look in her eyes.
- No jumping off the beds or couch or out of the car
- No long walks. If we get out of the woods here, I will take her for 10 min walks like the vet said, but even will a full recovery, I am never taking her for more than a mile.

Any other suggestions?

Thank you all, again.

-- prednisone as of 8/28: 10mg 2x/day for 14 days; then [9/11 pred taper test for pain]:  one tab, once a day for 14 days; then 1 tab every other day until gone

-- Prisolec OTC 20mg once/day

-- Tramadol 50mg 3x/day

She may have less of an appetite this morning. She looks happy & pain free. She had one loose BM this morning, too. Light brown in color with some solid, but the end of it was more liquid in consistency. She has been whining a little when I walk away this morning. I am not sure if something is bothering her, or if she is bored because she wants to get up & go & I won't let her. Typically, she is always my shadow.

Thank you, Ann. I did give her some plain pumpkin after I noticed the loose BM, but thank you for reminding me. Gracie has always been a picky eater. She is not a dog who loves to just gobble down food. She would always eat her kibble very gently & usually in private, once most of us were in bed. We are a family of 6 (4 kids) with lots of noise all day. It always seemed that Gracie prefers to shadow us all day, keep an eye on the kids (I think she believes they are hers), & then eat at night in peace. 

I am going to the pharmacy to pick up Sucralfate now.

Post by Erin & Gracie  48 prior:
I am on the phone right now, on hold. Waiting to talk to a vet.
I really appreciate the insight this page provides, which is why I keep coming back. However, this is very frustrating. Every time I post an update, I learn more about what I am doing wrong.

How long are you all recommending I keep her completely locked down in her crate...8 weeks??

I printed out the med sheet & filled in all of Gracie's meds- it looks like I will be up at 5AM & not sleeping until after 11PM. I started her on the ✙sucralfate.

[Moderator's Note. Please do not edit
35-40 lbs; 5 y.o
Rimadyl 8/24 stop date
prednisone as of 8/28: 10mg 2x/day for 14 days, then 9/11 test taper for _pain/_neuro
gabapentin : 300mg 3x/day
methocarbamol: 500mg 3x/day
tramadol 50mg 3x/day
Prilosec (Omeprazole) as of 8/28- fully effective 8/30 to 9/2: 20mg 1x/day
✙sucralfate:  1gram  3x times per day]


The vet did not agree that the Prilosec needs increased (current 20mg once a day). I will ask her regular vet when he calls me tomorrow- I left him a message this weekend.

She had a soft, but solid BM this evening, with a little liquid following. I scooped it all up & viewed it closely with a plastic fork on a white paper plate. It was the exact color of pumpkin puree & I did not see any red or black blood. She is still being a bit pickier than usual with eating (as I said before, she is picky though), but she did eat some hamburger & dog treats a few hours ago. I am hoping this med sheet helps me keep this all straight. This is extremely stressful for me. Thank God she is not in pain & she is comfortable, but the worrying & wondering if her belly is being harmed is extremely stressful to me. I am considering holding off on the prednisone dose in about an hour here, bc I am so scared it is hurting her. Also, the sucralfate is very difficult to administer, as far as crushing & adding to a tsp of water.It does not seem to dissolve very easily.