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Post by Erin & Gracie on Aug 25, 2020 11:17:24 GMT -7
Mixed breed- 40lb German Shephard, Husky, maybe border collie. Adopted at 10mos. After an amazing recovery from spinal surgery to remove a ruptured disc in April, she is regressing. I took her to the vet twice last week & they gave her pain meds & muscle relaxers.
[Moderator's Note. Please do not edit 35-40 lbs 5y.o Rimadyl as of date? 8/24 pm Stop date Steroid switch to start on Fri 8/28: Gabapentin as of 8/26: 200-mg 3x/day methocarbamol as of 8/26: 500mg 3x/day needs GI tract protector, Pepcid AC, on board w/! Rimdyll]
And then a laser treatment & PT on Fri [8/21]. She isn't indicating much pain (meds could be masking) but is just so lethargic, visible hunched, & not moving her back legs well. Rigid. Dragging & knuckling her back toes some. Today 8/25 she's having trouble holding her bladder. I've been in contact with the vet, but solutions are wait it out with meds, or expensive imaging for possible surgery, which of course carries risks too.
So I am taking her again tonight for a laser treatment therapy. The vet wants to stop the Rimadyl & add the steroid, but can't start until Friday.She is also on gabapentin & methocarbamol.
She'll be 5yo in Oct.
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Mary & Mila
Helpful Member
FEMALE— DACHSHUND
Posts: 218
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Post by Mary & Mila on Aug 25, 2020 12:00:54 GMT -7
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 expressingLoss 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
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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 25, 2020 12:56:15 GMT -7
Erin, with loss of neuro function, many vets take the approach to preserve nerves by NOT DOING THE 5-7 days of washout from Rimadyl to the start of a steroid. The washout means not having any anti-inflammatory on board to help the spinal cord. EMERGENCY SWITCH to STEROID (no washout) When there is neuro loss, the lessor of the anti-inflammatories the NSAID such as Rimadyl, is not usually continued with. Usually a switch between a NSAID and a steroid requires a 5-7 day washout period. A vet can deem that a switch is medically necessary right now today. It can be done with with no washout. The safety is TWO stomach protectors protector, 1) Sucralfate PLUS 2) Pepcid AC (famotidine). Each protector works in a different way to protect the stomach lining. Call your vet today if there is indeed increased diminishment of neuro function. NO VET VISITS (laser) Limited movement of the back is key to prevent serious damage to spinal cord. --- STOP going into for laser. Choose a mobile vet who comes to your house. IT is just TOO dangerous to the damaged disc to move a large dog. --- IF there is pain, then phone the vet to get those pain meds adjusted. ONLY VET VISITS for a real health issue (i.e. expressing lesson) --- Leaking on you when lifted or a sling pressing on the tummy area is a sign of loss of bladder control --- Urine found in bedding is a sign of loss of bladder control --- It is a VERY serious health issue to be manually expressing a dog who has lost bladder control. Infection can set in the bladder in a matter of days. --- Read and watch the expressing video ahead of time, so you get more out hands-on-top-of-your-hands type of expressing lesson here: dodgerslist.com/2020/05/05/bladder-bowel-care/ FILL US IN: Could you give us a full picture of things to enable us to comment more accurately: --- Date she is began full 100% STRICT rest. (no trips into vet, no PT)? --- Date Rimadyl was stopped? --- Gabapentin: Dose in mgs and times per day? --- Methocarbamol: Dose in mgs and times per day? MONITOR NEURO LOSS: As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. yes Paws knuckle under 5. yes Weak/little leg movement, can't move up into a stand 6. ? Legs do not work at all (paralysis, dog is down) 7. ? Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. ? Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. A quick overview of conservative treatment vs. a surgery: dodgerslist.com/2020/02/10/surgery-vs-conservative/MONITOR FOR PAIN The pain meds are not yet right if you are seeing hunched back. Please contact your vet ASAP by phone to advise of the pain that you're seeing so meds can be adjusted. Advocate that any of the pain meds be given 3x/day (every 8 hours). —Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. 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. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock.
SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or moved ◻︎ slow to move ◻︎ tight tense tummy ◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves We anxiously await hearing your vet is managing the pain if pain meds need tweaking. And that you have discussed the option to double protect the stomach with Famotidine PLUS sucralfate in order to get a steroid on board if that is the approach your vet thinks best to halt nerve deterioration.
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Post by Erin & Gracie on Aug 26, 2020 6:05:36 GMT -7
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.
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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 26, 2020 6:57:08 GMT -7
Moderator Paula is currently reading your post and preparing to reply. Refresh your browser to see the post. Bookmark a thread to receive an email alert when someone has replied
Go to the CONSERVATIVE Board 1. Look for your Gracie's thread and checkmark it. 2. Look for the white ACTIONS button towards top. 3. Select “Notification Options" from the pull down menu — check mark “NEW POST” change from never to INSTANT email — press the SAVE button. Click the “x” to close the window 4. Next choose the “Bookmark” See the tiny book symbol now!** i.postimg.cc/GhKYTNg7/Bookmarking.jpg
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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 26, 2020 7:59:10 GMT -7
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.pdfKNOWLEGE 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.
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Post by Erin & Gracie on Aug 26, 2020 12:38:28 GMT -7
Thank you for the feedback....
-- She has not had Rimadyl since Monday [8/24] around 6-9PM -- Gracie is 35-40lbs. I am not sure. I can carry her under my right arm & open doors with my left, when necessary. -- Today [8/26] I have been giving her the ▲gaba @ 3 pills, 3x/day.
[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: gabapentin as of 8/26: ▲300mg 3x/day methocarbamol as of 8/26: 500mg 3x/day will need GI tract protector, Pepcid AC, on board w/! a STEROID ]
Do you suggest these dogs pee in their pens then- do not take them outside to pee? As far as 100% strict rest.
I think that was all of the questions asked....
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Post by Romy & Frankie on Aug 26, 2020 13:35:39 GMT -7
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
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Post by Erin & Gracie on Aug 26, 2020 16:47:50 GMT -7
Thank you very much, Romy.
I really appreciate all of the insight & suggestions.
I am curious as to when this group would feel that euthanizing is the solution?
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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 26, 2020 16:48:07 GMT -7
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.
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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 26, 2020 16:50:25 GMT -7
Disc disease is not a fatal disease. Dogs live many happy years. Mine lived 10+ years after the disc episode with aid of a wheelchair until cancer took him.
What is running through your mind that you think you should cut your dog's life short?
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Post by Erin & Gracie on Aug 26, 2020 17:53:37 GMT -7
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.
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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 26, 2020 19:32:12 GMT -7
Good! The sucralfate and Pepcid AC (famotdine) would be started same time the steroid is started on Friday. Let us know what changes are made tonight to help get Gracie in the full comfort from pain she deserves. With the stop of Rimadyl (non-steroid anti-inflammatory) on Monday there was no longer any anti-inflammatory working on the painful swelling. Pain meds should have been upped on Monday knowing there would be increased pain. Also a dog that has bladder control will not like anyone expressing them. They might even bite because they do not like it. If expressing was tried after the stop of Rimadyl when there was no pain med Rx increase, then of course Gracie was in pain! Then of course you can't properly care for a dog in pain. They may bite. So, having the facts surrounding what expressing is and lack of proper pain meds on board for Gracie, will help you to see: --- When a dog is properly medicated for pain from the inflamed spinal cord , the owner is able to care for the dog without causing them pain during the disc healing time. After graduation from STRICT rest where the disc has heal and all inflammation is truly gone, the owner still expresses a dog's paralyzed bladder and the dog is comfortable during the session. I expressed my paralyzed dog for over 10 years. He never bit me, never indicated he was uncomfortable. In fact, it is just the opposite, expressing releases the built up uncomfortable pressure of an over stretched bladder filled to the top with urine. Likley, Gracie does have bladder control and therefore would NOT go for anyone expressing her bladder even if her pain were being fully managed by the correct level of pain med Rx's. I do question why urine leaks in bedding. Are you carrying her to and from the potty place every 4-6 hours as a normal dog would want to be let out to pee? There is a concern if she has developed a bladder infection, it may cause her pain (a burning sensation) upon release of urine. So she may be avoiding having to pee. And also bladder infections will cause urine dribbles. A urinalysis is the way to rule out a urinary tract infection (UTI) and prevent it dangerously moving up in to the kidneys. An antibiotic Rx kills the bacteria should a urinalysis show a raging infection going on. Did you discuss a urine sample with the vet by describing what you observe regarding urine leaks in bedding but still able to squat to release urine outdoors? What did the vet say? I hope you will have time to up your IVDD knowledge at the main www.dodgerslist website. Knowledge helps you to rid your mind of misinformation rummaging around up there that could harm Gracie. Getting up to speed on IVDD allows you to focus on the truth about living many happy years ahead with an IVDD dog.
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Post by Erin & Gracie on Aug 27, 2020 7:42:42 GMT -7
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.
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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 27, 2020 8:07:39 GMT -7
Erin, good job on advocating for Gracie with the addition of tramadol. Let us know the mgs and x/per day the Rx is written for. Prilosec will take 3-5 days to become fully effective. So it is not a good choice with a disc episode when a steroid is starting. Pepcid AC, on the other hand is fully effective in 30 minutes and lasts for 12 hours. Did you ask if Gracie has any health issues and got a no health issue answer? --- IF you are to use priolsec then start it right now (today) to get a head start in effectiveness. --- If you know Gracie has no heart issue OR would not need mgs adjustment due to kidney or liver issues, then you can start Pepcid AC 30 mins before the steroid on Friday. 0.44mgs famotidine per pound = Gracie's dose of 15mgs famotidine 2x/day for a 35lbs dog. --- Know your stomach protectors overview: dodgerslist.com/2020/05/06/stomach-protection/When Gracie was last in at the vet, they did not weigh her? Meds are given by exact weight of the dog. Would be good to ask what weight they have on file for Gracie.
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Post by Erin & Gracie on Aug 27, 2020 8:17:28 GMT -7
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.
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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 27, 2020 8:48:46 GMT -7
Erin, very smart of you to have a copy of her records for your own files. With the change in meds, having a place to note cause and effect with meds, is a good reference when updating the vet and having details to support when you want to advocate for something. Do you have a med chart in use now? www.dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf
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Post by Erin & Gracie on Aug 28, 2020 11:14:14 GMT -7
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!
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Post by Romy & Frankie on Aug 28, 2020 14:02:49 GMT -7
I am very happy to hear that Gracie is feeling more comfortable today because of the addition of tramadol to her meds. Disc disease is typically very painful. Gracie should be able to heal in comfort.
I hope that I am wrong, but I think expecting improvement over the weekend may be unrealistic. Nerves heal very slowly. It may take months not days for her to regain function. My dog was paralyzed for about three months before he regained his ability to walk. Other dogs have regained function in six months and in rare cases even a year.
I am concerned that you mention euthanasia. If you are mostly concerned about her being in pain, know that vets have many, many ways to treat pain and when the meds are right she will have no pain. If you are concerned about your ability to care for her, you have been doing a good job so far and it becomes easier over time. Things that seem difficult now will become routine. This episode only began about a week ago and no one can tell when and how much function will return. Please give your Gracie time to heal and put euthanasia completely out of your thoughts.
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Post by Erin & Gracie on Aug 29, 2020 6:09:22 GMT -7
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.
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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 29, 2020 8:29:36 GMT -7
Erin, good news to learn that nerves are self healing that you could observe all the back legs walking on their own with some knuckling and some wobbliness. The concerning news is that she escaped her recovery area! Please watch her like a hawk today to make sure you are not seeing that any damage happened to the early healing disc's weak scar tissue. Fingers crossed she dodged a dangerous bullet. Please keep us updated today that you are not seeing any signs of pain nearing the next dose of the three pain meds and that you do not see any neuro diminishment or worse knuckling or worse ability to move the back legs. The safety factor for the disc, is the owner is one step ahead of when a dog feels good enough to do too much. Wonderful to hear you will now have her in safely an actual enclosed recovery suite. Please do not support Gracie at potty time by holding the tail! She is not to do any PT until after graduation day. Thus no holding the tail any more. Give her proper support with a sling. Any time out of her suite is potential danger to the healing disc. POTTY TIME IF not possible to carry her to and from the potty place anymore, then rethink the potty time place. She should only be allowed the very fewest of footsteps (no walking— just a few footsteps to protect the disc's still weak forming scar tissue). --- Move her recovery suite near the door. Make a place on the deck a few footsteps away from the suite to be the potty area. Romy's suggestion to lay down a pee pad on the deck as she did for her large dog is a good idea. Scent the pad with another dog's urine or some of Gracie's to help her learn this is the new potty place. Always save a used piece of pee pad in a ziplock bag to use at potty time. Your dog can learn it is ok with you to pee on the pee pad, be sure to use the command “go potty” and when she does give lavish praise. ----Roll a wire recovery suite over to the sliding door by adding casters. Then it is just a few footsteps to potty on the deck. Put some dirt, snow, straw, etc to potty on. Fence in the new potty area with an ex-pen so your dog knows there will be no darting off or sniff festing. OR use a leash, harness (for control) & sling to prevent more than a few footsteps or any ideas to dart off at the sight of a bird, strange noise, etc. Be one step ahead of anything dangerous Gracie may think of doing to her healing disc. Castors about $10 from local pet shop or on-line: Another idea is to used an ex-pen as the potty area attached to the recovery suite. At potty time open the suite's door so your dog may take a couple of foot steps out to the potty area: STAIRS/STEPS Put a ramp over the 2 step/stairs she needs to take. Ideas for ramps: dodgerslist.boards.net/thread/867/rampsGRADUATiON Upon graduation we'll have lots of tips and ideas to have fun with Gracie in a safe way. How to implement building up to 1+ mile walks. How to encourage running the proper safe way to build up those core muscles needed to support the back. MED LIST Would you fill us in on the details so we are prepared to offer educated comments: -- prednisone as of 8/28: ?mg ?x/day for ? days, then test taper for _pain/_neuro 1) How many pred mgs and how often do you give? 2) For how many days is the pred course before the Pred taper test begins for pain or increased neuro deficits? -- tramadol ?mg ?x/day
-- Prilosec as of 8/28- not fully effective til 8/30 to 9/2: ?mg ?x/day 1) How many mgs each dose? How often do you give it? 2) Let us know if you see any early red flag signs of GI tract damage progressing to dangerous bleeding ulcers: lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool. It can take 3-5 days for Priolsec to reach full effectiveness in suppressing acids caused by three things: prednisone, stress, and damage to the spinal cord.Please keep us updated, fingers crossed there will be no setback to the healing disc and no GI, stomach issues will surface while Prilosec is reaching full effectiveness in the next days.
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Post by Erin & Gracie on Aug 30, 2020 8:10:06 GMT -7
-- 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.
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Post by Ann Brittain on Aug 30, 2020 8:23:07 GMT -7
Glad to hear Gracie is pain free this morning.
Some medications can affect appetite and cause loose stools or diarrhea. Hopefully this will settle down as she adjusts to the meds. A tablespoon of pureed pumpkin, plain without spices or sugar, at meal time may help to settle her stomach and improve her poop issues.
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Post by Erin & Gracie on Aug 30, 2020 8:28:14 GMT -7
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.
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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 30, 2020 10:52:51 GMT -7
Erin, you are seeing RED FLAG signs of GI tract damage. nausea> √not eating> √loose stool> vomit> diarrhea leading to serious bleeding ulcers> red or black blood in stool. Take no chances. Call the special animal hospital to see if you can get Sucralfate Rx added today. Act now that signs do not progress to danger of bleeding ulcers. Pumpkin does not fix the problem of too much stomach acids due to Prilosec not yet having reached full effectiveness in the range of 3-5 days by 8/30 to 9/2. And according to current thinking Prilosec is not being dosed adequately for Gracie. update for twice a day dosing: Verify with your vet that for 40lbs/18.14kg Gracie:-- 1mg Prilosec (omeprazole) X 18.14kgs = 18.14 mgs Prilosec -- Round up 18.14 to 20mgs = Prilosec 20mgs every 12 hours (2x/day) In addition --- feed a meal just prior to a prednisone dose as a bit of added protection. --- Ask for an Rx for a 2nd stomach protector in addition to the Prilosec. 1. Prilosec works to suppress acids 2. Advocate for sucralfate which works differently. It bandaids with a gel coating over any already damage to the stomach lining. LEARN MORE so you can best advocate for SUCRALFATE. You will learn the timing with food and with Prilosec at that blue link--valuable reading!
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Post by Erin & Gracie on Aug 30, 2020 12:22:59 GMT -7
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??
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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 30, 2020 13:20:56 GMT -7
Erin, I'm proud of you. Presented with information, you do not dally but swiftly report what you see and discuss things with your vet and voilà you have an Rx for sucralfate. Good work! Learning anything new is not an overnight process. You learn what can be improved and then you apply the information. The process of learning piano is not going to hurt anyone if you get the wrong note. That process with IVDD can be a danger to the dog if things are not learned promptly. The Forum is here to help you identify things to discuss and advocate for in a more speedy approach for Gracie's sake until your learning IVDD has kicked in to a good level. Every vet has different level of experiences with various diseases for all the farm animals, cats, dogs, birds they see. Owners often think their vet knows everything about every single disease for every species. Heck, even our own doctors who treat just one species (the human one) will refer you to another doctor when they don't know your disease that well and we are OK with that. If you like your vet, we hope they are open to learning and working as a team together with you in providing the best of care for Gracie. It seems to be the case. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated so we have enough knowledge to hire the right vet to be on the IVDD team and abilities to communicate important points in discussions. Your dog only has one advocate— you. Our hope is you will have a chance to delve into the readings on our Main website www.dodgerslist.com and be the prepared savvy owner advocate your dog needs. We don't expect you will memorize that vast treasure trove of IVDD info. We do hope you will learn how to search for a topic in the orange search bar. Learn how meds work, STRICT rest etc.. Kinda know what's under each menu bar. Things will stick in your mind..." I know I read something about ___ " So you will go back to search for the page. She is your friend, your partner, your defender, your dog. You are her life, her love, her leader. She will be yours, faithful and true, to the last beat of her heart. You owe it to her to be worthy of such devotion. ~Author Unknown
ROADMAP to the STRICT 8 weeks of rest with conservative treatment -- Avoid dangerous detours with the Conservative Roadmap for your fridge. -- Make sure all members of the family are engaged in avoiding danger exits for Gracie's disc. Teach them. Point out the 4 orange bars (the 4 phases of healing). Point out how long each phase takes to heal. Which phases will need meds and which phases Gracie will heal on her own. -- VIEW the full map, DOWNLOAD to print the roadmap from here: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdfHere is what the RoadMap will look like taped to your fridge: Let us know if/what the vet changed the Prilosec dose and times per day. Let us know you hopefully are not seeing any further progression of stomach damage with sucralfate on board and a change in the Prilosec dosing.
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Post by Erin & Gracie on Aug 30, 2020 18:55:09 GMT -7
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.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Aug 31, 2020 6:15:26 GMT -7
Erin, I well know how stressful IVDD can be but do know that you're doing a great job in caring for Erin, advocating with the vet and in quickly learning more and more about IVDD. Kudos!
Please don't hold off on giving Gracie the Prednisone as she really does need that to get the inflammation down ASAP. It's that inflammation pressing on the nerves of the spine that is causing the pain and can also lead to nerve damage so it's very important to give her the Prednisone. You have the Sucralfate on board now no worries about the Prednisone.
We have seen vets prescribe Sucralfate as a pill so speak to the vet about the difficulty you're having in giving this med.
If you'd like to share your med sheet with us, possibly we could help you work out a better schedule.
Stay strong and stay positive. You're doing great and we're here to help you in any way we can. Healing prayers for Gracie.
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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 31, 2020 10:21:24 GMT -7
Very good points Marjorie writes to you in the above post. Beside to read.
The typical sucralfate tablet comes in a 1 gram size. Is that yours?
Do you give the full 1 gram tab, if not, what part of the tablet do you give?
How often do you give?
In a perfect world crushing in liquid is done prior to administering. If you are having a problem administering that way, then you could give, whatever the Rx'd partial tablet is, wrapped in a slice of yummy deli meat as you do for her other meds. That is how many folks do it.... and how I've done it.
The timing with food and with Prilosec is the most important part. Do share your med chart, the parts regarding Pred, Prilosec and sucralfate especially. Pain meds do not need any specific timing with sucralfate, prednisone nor Prilosec
Prednisone is one med that just may not be stopped abruptly. Dose exactly as prescribed by your vet.
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