Courtney's Lily 9/5 Conservative - NECK- Grad 10/31

Try to keep a happy voice and face around Lily. Dogs are very sensitive and pick up on our feelings very easily. Tell her everything's OK and that she's getting better every day. And you believe it, too!

Here are some tips to help calm your dog in the crate. If these do not help, it may be necessary to have the vet prescribe a mild sedative.

To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him/her. It also creates a den like feeling that dogs love.

Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price.

Place a DAP pheromone diffuser at floor level where the recovery suite is.
Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones

Use a diffuser with one oral calmer from below:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba)

Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc.

Consider some of these ideas:
-- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising. More details on strollers: www.dodgerslist.com/literature/strollers.htm

--Caster wheels can be added to a wire crate so the crate can be wheeled from one room to the next so your dog can stay with you.

-- Put a garment you have been wearing and have not washed in the crate.

-- Nan Arthur, CDBC, CPDT, KPACTP writes:
"According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day.
Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.]

-- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from on high.

-- Play classical music or one of the wildlife TV shows.

If a dog is jumping up at the sides of the crate, you can lower the ceiling of the crate. Cut a piece of cardboard the size of the top of the crate, punch holes in the corners and tie the cardboard down into the crate to the level of the top of the dog's head when standing. Or cover the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he/she jumps up, he won't be able to see anything. That may discourage him/her from jumping up.

dodgerslist.com/2020/05/14/strict-rest-recovery-process/

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

Seek Pepcid AC (only one ingredient of FAMOTIDINE) 10 mgs 2x/day for 17 lbs dog.

Double PII Sore Bod Cervical Care should not be on board with BIG GUN prednisone. Has that stopped?

Glad to hear having meds adjusted and Pred added has made so much difference in pain relief.

Could you fill us in: 

✙prednisone as 9/4: 5mgs ?x/day for ? days, then a test taper for: _pain / _neuro
✙methocarbamol ?mg 3x/day
?Pepcid AC (famotidine only!) 10 mgs 2x/day

One day on the full dose of pred, 5mg 2x a day is much shorter than we usually see prescribed. We usually see the full dose prescribed for 5-7 days before a taper is tried. Tapering doses do not work on inflammation. We have more detail about the anti-inflammatories and how long to use them here:
dodgerslist.com/2020/04/22/healing-swelling-inflammation
and here
dodgerslist.com/2020/04/18/steroids-vs-nsaids/?highlight=anti-inflammatory

Hi!

My apologies for the delayed reply. I actually was going to reply that the 500m of Methocarbamol is the whole pill-its split into quarters. (sorry, yesterday was 2 hour sleep brain.)

We have had a really good 24 hours. As my hubby says, we are treating her like veal. We talked about it and decided to keep her on the full pred dose (5mg 2 times a day) and talk with our vet about it on Tuesday.

[Moderator's Note. Please do not edit
17lbs
prednisone as of 9/4: 5 mgs 2x/day for 1 day, then 9/5 test taper for: √9/5 pain / _neuro
                         as of 9/5: 5mgs 2x/day for ? day, then test taper for: _pain/_neuro
methocarbamol 125mgs 3x/day
gabapentin 100mgs 3x/day
tramadol 50 mgs 3x/day
Pepcid AC (solely famotidine!) should be 10 mgs 2x/day
homemade diet]


The screaming has not occurred since yesterday [9/5] morning and she's been sleeping like a rock. Within the last few mins though, her sassy personality is showing as she wants out of her crate. We received our small pack n play today and she seems really happy in there. When she goes outside, she is on a leash and we are really limiting her steps. (She doesn't really like that but we are the boss--haha!)

We have done 4 laser treatments since yesterday--hoping that is providing some relie as well.

The medication worksheet is super helpful. Thank you so much for your help! We want her back to 100% and feeling better

Courteny, then Saturday 9/12 is the begin of the taper test.  

So that you will not be blind folded for the pred taper test for pain, which does your vet want:
  -   A full stop of the three pain meds (Methocarbamol, gabapentin, and tramadol)?  or ....
  -  The backing off of three pain meds on Saturday. 

Since your vet may be closed when the taper starts, do you and your vet have a Plan B of enough meds to resume back the original dose until your vet opens again?

Very good to hear the meds on board are fully covering any pain  and that she is happy in her new Pack N Play!

Tell us about the new homemade diet she started on Sep 4th. What are the ingredients?

Pepcid AC (only famotidine  active ingredient)  how many mgs do you give each dose and are you giving it every 12 hours?

I would continue giving Lily the Sucralfate as directed as well as the Pepcid AC since you're seeing a sign of GI distress (loose poop). Also let the vet know of the loose poop as that may cause her to decide to taper off of the Pred more quickly.

You'll need to be on the lookout for signs of pain returning at any time during the taper of the Pred - until Lily is completely off of Pred. If at any time during the taper of the Pred, pain again returns, you'll need to immediately notify the vet so Lily can be returned to the original anti-inflammatory dosage of the Pred. Anything less than the anti-inflammatory dosage will not be effective in getting the swelling down. It can take 7-30 days for the swelling to resolve.
dodgerslist.com/2020/04/22/healing-swelling-inflammation/

That's why, as Paula mentioned, it's important to also either taper off of the pain meds or stop them completely when the Pred is tapered so you can quickly determine whether there is still pain/swelling.

I'm quite a fan of Dr. Pitcairn myself and have several of his books. I should probably look into doing this homemade food for my Jeremy since he has allergies.

Please let us know what the vet says when you hear back from her.

Don't be discouraged if the first round does not get all the swelling. It is quite common for dogs to try the taper more than once.

Prednisone may NOT have an abrupt stop. Prednisone MUST be tapered. Follow the directions by your vet to begin a test for pain prednisone taper.

Likely IF you have the two protectors on board (Pepcid AC and Sucralfate) it will allow the CONTINUATION confutation of the prednisone course that is supposed to go to a taper dose on Sat 9/12.

If your vet wants to speed up the pred taper test to today, then the pain meds would be stopped as well to verify if there is still painful inflammation going on.

If there is inflammation there normally needs to be an anti-inflammatory on board. Pain meds do nothing to resolve inflammation. Pain meds mask painful swelling. Painful swelling takes an anti-inflammatory drug like prednisone 7-30 days to resolve the swelling.

Again Prednisone may not be abruptly stopped. Prednisone MUST be tapered off for health reasons to signal the body to again make its own steroid hormone to run body functions.

PRED is always tapered
Pain meds can be stopped or back off - that's the vet's choice.

It would be best to NOT change her diet at this point. Diet changes can also cause same symptoms Prednisone can cause...confusing the issue. Better to withhold food for 12 hrs or so— but do NOT withhold water. Then gradually reintroduce small amounts of food to see if she holds it down before offering another small amount an hour later and so forth.

Hope this information will hold until you can get in touch with your vet.

Thank you for the tips! Lily's tummy issues are good now. I spoke with the vet [9/11] Friday AM and she had me give her some ✙flagyl just to be safe. I had some on hand which helped! 
The vet had me decrease her pred to 2.5 mg once every other day. Yesterday was her first day without. Our vet advised that we taper off the ▼pain meds as well, vs a test stop. For one week, we are giving her the ▼pain meds/▼muscle relaxer twice a day. Then going to once a day for a week then stopping entirely. I have plenty of meds on hand if we have to go back up on the pred. Vet said if she seems to be in pain to let her know and we can go back up in dosage. 

[Moderator's Note. Please do not edit
17lbs
prednisone as of 9/4: 5 mgs 2x/day for 1 day, then 9/5 test taper for: √9/5 pain / _neuro
                          as of 9/5: 5mgs 2x/day for 7 days, then Sat 9/12 test TAPER for: _pain/_neuro
methocarbamol 125mgs ▼2x/day, 9/18 next backing off 1x/day for 7 days
gabapentin 100mgs ▼2x/day, 9/18 next backing off 1x/day for 7 days
tramadol 50 mgs ▼2x/day, 9/18 next backing off 1x/day  for 7 days
✙Flagyl (antibiotic) on 9/11
Pepcid AC (famotidine!)  10 mgs 2x/day
sucralfate 500mg 2x/day ]

She's still in her pack n play (we actually purchased a second so we don't have to haul it upstairs during the workday! That was kind of a pain LOL.) She's definitely perked up and her appetite is back as well! 1 week down, 7 to go!! 

Hi Marjorie!

So far, no signs of pain. (Happy dance!) She's down to 2.5 mg of ▼pred every other day.

All other meds, 2x a day and tapering to ▼1x next week. Her peppy personality is coming back. She's still on crate rest. Will be calling the vet here in a few days to see about totally tapering off the pred and what she would like to do there.

Thank you again for all the advice and tips!!

Thank you Paula! We are hopeful that we are on our way. I will keep you all posted and am looking forward to 10/31!!

Hi there!
Lily is doing fab. She’s back to her peppy and silly self. We are thrilled that conservative tx worked for her!

Graduated on 10/31