Marjorie
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Post by Marjorie on Oct 7, 2020 4:53:15 GMT -7
Yes, since Amber is still limping, no taper of the Prednisolone should be done now as pain indicates that there is still inflammation. Also, since limping is a sign of pain, you need to speak to the vet ASAP today to advocate strongly for an adjustment in the pain meds to get Amber's pain under control. You mentioned that you thought you saw muscle spasms in her back. Methocarbamol should be added. That's a muscle relaxer that works on the pain of muscle spasms. Tramadol can also be added. Have no patience with pain as it does hinder healing and there's no reason for Amber to still be in pain with all the pain meds available. And as recently discussed, the addition of Pepcid AC and Famotidine need to be done.
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Lindsay & Amber
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Post by Lindsay & Amber on Oct 13, 2020 12:31:49 GMT -7
Just a little update. We extended ambers prednisilone a week. Prednisilone taper started today and she seems to have improved from last week.
[Moderator's Note. Please do not edit 9.08 kg / 20.02 pounds Prednisolone as of 9/15: taper dose: 5mgs 1x/day for 21 days; final taper dose 10/19 Gabapentin 200mg 3x/day Amantadine 3.6 ml 2x/day cytopoint allergy shot 10/13: for allergy lasts for 4 to 8 weeks, Pepcid AC (famotidine) is Rx in the UK! ]
Shes had her ✙cytopoint shot to. And i know this is not IVDD related but her ears are also infection free for several weeks running which is a big relief. Things were getting pretty bad with her ears for a while and we were heading down the route of surgical ear flushes or ear canal removal.
Pain is less than last week and only had one more episode of muscle spams [date?].
Shes still a little weaker on back left and limps at times ive been told this could be permenant neuro defecits or potentialy nerve related. We are going to continue as we are untill crate rest is up.
I bought amber a second crate and another orthopedic bed and i think as its firmer she is more comfortable and it also means i can keep her near me when im working as ive changed working arrangements to. Its helped her be more settled and i think she is getting more rest.
Its tricky because her vets never ever see what i see at home. I just have to keep getting videos which ive managed to show to her vet. Her primary care vets examined her [on what date?] and is also convinced related to her spine one way or another.
So far it looks like remainder of crate rest and then MRI in decemeber if she is still showing intermittent lameness/ neuro defecits.
Providing nothing changes when steroids are stopped. Im hopeful that she will just continue to improve and the MRI wont be neccessary and we may get the pain Meds back down again providing she doesnt have as much pain.
Once again thank you for all the advice the extra week of prednisilone made a big difference.
Calling neuro in 2 weeks and back at her normal vets in 4.
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Post by Romy & Frankie on Oct 13, 2020 13:24:59 GMT -7
I am sorry that your Amber is still having some pain. Our goal is not pain less than last week. It is no pain. What signs of pain are you currently seeing? Please let the vet know that Amber is in pain and ask for the pain meds to be adjusted. Pain only slows the healing process.
One leg weaker than the other is seen quite often in dogs recovering from an IVDD episode. The hips swinging to the side and paw scraping all seem like signs of nerve damage. My dog Frankie swung his hips to the side for a long time after his episode. In the beginning he also scraped his paw, so much we put little booties on him to provide some protection.
Nerve damage can not be treated by medication. The only thing that heals the nerves is time. Nerves are slow to heal but heal they can.
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Lindsay & Amber
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Post by Lindsay & Amber on Oct 13, 2020 17:26:35 GMT -7
Maybe she isnt in pain. So i guess its when i see her arch her back. Tail tucked underneath her and reluctance to move. When she cant get comfortable and is groaning on moving. Her hunched posture. I see a glimpse of pain free when she comes out of her crate at times. Which is what makes me realise something changes.
Ive asked [on date?] her general vet about pain meds but doesnt feel like there wasn't enough pain on exam to justify an inscrease in meds. Didnt display any of the odd gait abnormalities. Other than a slight skip. Which makes me second guess what im seeing. Vet cant establish the reason she would need more pain relief. But will revisit in 4 weeks.vet (DVM) advised video looked like neuro defefits. I could try her neurologist and explain what im seeing again. I might get the same outcome. It just happened that i was at her vets [Oct 13] tonight anyway. I dont think they see IVDD very often.not a criticism they do help as much as possible but not the same as neuro
Hope that makes some sort of sense. Ive had so many conversations about pain meds with her vets the last 4 months i just dont really know where im at with it anymore. I just feel like the only way forward to get a bit more info is MRI which i dont want to rush into equally i dont want her in pain.
great idea about the booties. Ive thought about getting some for ambers back paws.
For me i guess this all is about her not having to be in pain. I dont think she will let anything stop her from enjoying life once i know she is safe to walk again even if her left leg doesnt always return to normal. But trying to get her pain meds right is a real challange.
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PaulaM
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Post by PaulaM on Oct 13, 2020 19:08:15 GMT -7
DATES clarify things and is an essential piece of information for good communication. Lindsay it would help us here, too, if you would use dates. Very hard to know if you are repeating a previous past event OR if "primary care vets examined her" took place the date of your 10/13 post. Using dates to go with events, also clarifies things best for a vet or neuro to understand the big picture when you advocate over the phone on behalf of Amber.
PATTERNS explain things. Do you keep a med chart so you can see if there is a pattern of date of pain occurring whether nearing next dose of meds? Date of Pain if it happens when you move her or she moves herself. Does pain surface/increase the date prednisone goes to next lower taper level?
EXISTING NERVE HEALING may take many months. Do not expect nerve healing to happen in days or weeks. Action: no need to report existing nerve damage. Only report exact observation when there would be nerve improvement, include the date NERVE DIMINISHMENT that is new/increased is a sign to get back up on the anti-inflammatory dose of prednisone dose twice a day. Action: Alert the vet via phone to adjust meds Example: Increased dragging of back left leg, new thing of left back paw knuckles under, or paw is now slower to right itself.
PAIN CONTROL Full comfort from pain happens with the correct combo of pain meds. Pain can resurface when prednisone tapered down.... an indicator of the need to go back up to the anti-inflammatory dose twice a day. Action: immediately report observation to the vet, advocate for med adjustment. Example: had one more episode of muscle spams [date please]. arch her back. reluctance to move. cant get comfortable
IMPROVE means what? she seems to have improved from last week. Nerve function can improve. Pain now fully in control is the improvement goal. Less pain is not good enough. Any pain is due to still inappropriate pain meds...the goal is full pain management.
Hope these thoughts will help you put on paper, an organized, clear approach for communicating with your vet.
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Lindsay & Amber
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Post by Lindsay & Amber on Oct 14, 2020 0:33:42 GMT -7
Thank you. Sorry about the confusing post I guess my own confusion is all spilling out in writing. But your comment really will really help me explain.
Went to the [family] vets on [Oct 13] 13/10 not neurology.
Keeping a chart was going to be my next step.
Nerve healing, no real change there. Shes exactly the same at home i know that takes time. Muscle spasms was on [Oct 8] 8/10 havent seen any further since.
I guess my thought of improvement is that i see pain less. All her signs of pain mentioned were as of yesterday [Oct 13] 13/10. Throughout the day. Ill keep a chart and see if its as pain meds run out.
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PaulaM
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Post by PaulaM on Oct 14, 2020 10:17:06 GMT -7
Thank you for using dates, gives great clarity! On Oct 13, you made a trip with Amber in to your family DVM vet? Your vet did not observe any signs of pain and would not adjust meds. He did not feel your observations of arch her back. reluctance to move. cant get comfortable where signs of pain? Pets are often very stoic and not willing to reveal signs of pain at the vet visit. Vets ask owners what they observe at home as owners see them all day long. The vet sees them for 15-20 minutes at the visit. Amber is currently in a prednisone taper with the concluding days of the taper to end on Monday, Oct 19. Amber is to graduate 8 weeks of crate rest to heal her disc on Nov 9. --- While on crate rest, if there is pain, then there needs to be appropriate pain meds to fully put Amber in comfort right away. Prednisone reduces swelling in the spinal cord but can take up to 30 days when on the anti-inflammatory dose. --- For a 20.02 lbs dog the anti-inflammatory dose is more like Pred 5mgs TWICE a day. The fact that Pred as of Sep 15 started out at a less than anti-inflammatory dose, could explain why spinal cord swelling is not getting taken care of. 9.06kg Amber X 0.6 mgs pred = 5.4mg pred. Vets will round down to pred 5mgs 2x/day that the pills come in. ---Ask what would it hurt try a little test if all pain signs you observe could be fully covered. 1) to use a pred 5mgs 2x/day anti-inflammatory dose for maybe a 7-day course. 2) to use a more typical multi pain med approach 3x/day (methocarbamol for muscle spasms, tramadol for the general analgesic and gabapentin for nerve pain)
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Lindsay & Amber
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Post by Lindsay & Amber on Oct 15, 2020 15:23:46 GMT -7
Yes 13/10 [Oct 13] we went to family vets(DVM) i described symptoms.
Vet advised does sound like pain and confirmed based on my video amber is different in the vets. I possibly wasnt very clear about what i was seeing when and for how long. But above post will help me communicate better. We had a lot to cover at appointment.
Vet did orthopedic and neuro exam [OCT 13] (13/10)
said she reacted on exam of spine (she always does). and possibly slight skip of left leg. Suggested may be nerve pain. Didnt think meds should be changed at this time. But will reavaluate at next appointment. Orthapedic exam was fine.
Ill ask about trying as suggested putting her back on a complete set of medication again and muscle relaxant. I,ll speak to her vet.
Thank you!
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Lindsay & Amber
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Post by Lindsay & Amber on Oct 29, 2020 7:28:30 GMT -7
Just thought id share a little update.
Amber is now off steroids
As of this week from 27/10/20 ambers left hind leg seems to have returned to normal function. Will hopefully improve further when we can resume physiotherapy.
She is much happier in herself and much more alert.
Ive noticed a link between loud clicking which sounds like its coming from her spine and sudden pain down her left hind limb so im going to raise this again with her vets.
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Marjorie
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Post by Marjorie on Oct 29, 2020 7:38:49 GMT -7
In looking back through the posts, I see that the last dose of the tapered Prednisolone was 10/19. Have you see any sign of pain since then, including the sudden pain down her left hind leg?
Is Amber still on any pain meds at this time?
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Lindsay & Amber
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Post by Lindsay & Amber on Oct 29, 2020 9:18:37 GMT -7
Last dose of prednisilone was [Oct 24] 24/10/20. Was agreed to give it to her for an extra week before taper doses.
I saw signs of pain down her left leg yesterday [Oct 28?] 28/9 on one occasion and she over reacted kicked out that leg when my other dog sniffed it today. Thats not a normal reaction for her. She also over reacts to any sort of touch to that leg from me. She rests comfortably its toilet time when I have seen this.
Shes on Amantadine 3.6ml 2x daily every 12 hrs Gabapentin 200mg every 8hrs 3 x per day.
[Moderator's Note. Please do not edit 9.08 kg / 20.02 pounds Prednisolone as of 9/15: taper dose: 5mgs 1x/day for 21 days; final taper dose 10/24 Gabapentin 200mg 3x/day Amantadine 3.6 ml 2x/day cytopoint allergy shot 10/13: for allergy lasts for 4 to 8 weeks,]
Ive been in touch with neurology so should hear back early next week.
UPDATE 29/10 [Oct 29] just an update shes lame again this evening pretty sure its pain related. Clicking a lot. I should have taken the pain yesterday as a sign i needed to have a word with our local vet practice.
Starting to wonder if the clicking is a sign she has something else going on. I know its pretty normal for a dog with IVDD to be clicky after surgery but i only ever hear it in conjuction with signs of pain or issues with her back legs.
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PaulaM
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Post by PaulaM on Oct 29, 2020 15:47:55 GMT -7
Hope you would be able to get some vet help for pain prior to waiting til early next week. Can you phone and get some med adjustment help?
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 2, 2020 10:52:12 GMT -7
It looks like my options are MRI now or MRI beginning of december. Insurance kicks in early decemeber and amber isnt declining so should be ok to wait.
Neurologist said this could be paresthesia im seeing. Im going to send this video over of amber
Just to give her neurologist some idea of what i see at home. Even though its a little older about 4 weeks and doesnt capture everything. I dont have any up to date videos. With dark nights and mornings here its impossible to capture anything at toilet time.
Feeling like there is not a great deal i can do for the time being other than keep her as rested as possible. The more she rests the less pain I see. Part of me is terrified the MRI will show something that genuinly needs surgery to correct and the other part is terrified it will show nothing and she will end up suffering with unneccesary pain.
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Post by Jessica on Nov 2, 2020 11:07:50 GMT -7
Thanks for the update, Lindsay. Did you make any adjustments to medications since Oct. 29? Have you noticed any changes in pain level?
I'm sure the videos are appreciated by your vet. They do tend to have a different response at home and at the visits at times. Rest is very important - good job for keeping up on this. For the MRI, I can understand your concern both ways. Take it one step at a time, and continue to keep us posted.
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 2, 2020 11:35:55 GMT -7
Thank you No pain meds adjustments
[Moderator's Note. Please do not edit 9.08 kg / 20.02 pounds Prednisolone as of 9/15: taper dose: 5mgs 1x/day for 21 days; final taper dose 10/24 Gabapentin 200mg 3x/day Amantadine 3.6 ml 2x/day cytopoint allergy shot 10/13: for allergy lasts for 4 to 8 weeks,]
i dont think thats going to happen untill after her MRI depending on the outcome. I think at this point its believed the best route is further imaging. She is allowing me to apply heat near her back which i think is also helping.
All thoughts so far have been nerve pain, paresthesia or neuro defecits. So i think i just have to wait and see.
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PaulaM
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Post by PaulaM on Nov 2, 2020 11:50:30 GMT -7
If you believe she is in pain, then waiting for pain relief til early December is a long time for a dog in discomfort.
Check in to laser or acupuncture as a means for alleviating pain.
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 2, 2020 12:49:21 GMT -7
Thank you we will do. Your completley right a month is a long time. Not helped by the full scale lockdown we are about to head into.
Ill book her in for laser and accupuncture hopefully they will see us as we are already registered. Im also thinking of just going ahead and purchasing one of the higher rated at home lasers. I know they arent meant to be as effective but if it gives her any relief it will be worth it.
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PaulaM
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Post by PaulaM on Nov 2, 2020 13:44:46 GMT -7
If going the route of laser light therapy, might be best to wait til after crate rest on graduation day Nov 11. Laser light therapy is contra-indicated with tumors which are detected via x-ray. To get good X-ray pictures, sedation is often used. Sedation puts the muscles which support the back to sleep. A dog’s primary defense of a disc is dependent upon adequate control over the trunk muscles – this defense is eliminated with anesthesia. Acupuncture is different in that it uses needles to relieve pain.
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 2, 2020 16:08:15 GMT -7
Thank you we will definitely wait. My main reason for holding out on the laser originally was lack of Mri/ xrays to rule out things like tumours even though it would be unlikely. Im hoping we can get her an accupuncture appointment.
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 10, 2020 12:54:01 GMT -7
11/9/2020 Disc episode GRAD 10/10 torn her cruciate ligament diagnosis Hi just thought id pop by and give an update, we have been to the vets today. Its now believed amber has unfortunatly torn her cruciate ligament. So may need surgery on both knees. Really gutted for her. They are going to xray and refer her back to orthopedic specialist if needed based at the same practice as her neurologist is based. Terrifying the thought of another 1/2 surgeries but we gave her the best start with 8 weeks crate rest. We now have NSAIDS to add to her meds which im really relieved about. Going to try another 4 weeks crate rest. I just also want to say thank you for all the advice and support i feel like ive been much better prepared this time. Ive already done my reading so was able to have an informed conversation with amber vet about what our options are. Ive learnt a lot here. Fingers crossed we are on the right path for a pain free dog now.
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Post by Romy & Frankie on Nov 10, 2020 14:21:14 GMT -7
I am sorry to hear that Amber will need surgery on both knees. Just to make sure I understand, the vet thinks the pain and lameness is related to her knees and not another IVDD episode?
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 10, 2020 16:04:06 GMT -7
Thank you
Hope its ok if i just repeat what i was told as im not 100 percent sure if im honest.
Vet said today (10 nov) she reacted to examination of her left knee, its painfull and swollen, and she was clearly lame at todays appointment.
believed it is a CCL partial tear in left knee but recommends x rays to confirm. She had x rays in june so they will be able to compare. Believed it may have gone in the last 4 weeks as at her last appointment 4 weeks ago knee appeared stable, not swollen or painfull. Her vet is aware ive had her on crate rest.
Ive asked if after 4 weeks more crate rest issues are ongoing she can be refered back to the practice where she had her IVDD surgery for any further treatment. At least i know that way any imaging or diagnostics can be seen by both neurology and orthopedic specialists if neccesary.i dont know if that means she needs x rays first or if because or the recent IVDD surgery we skip the referal stage all together im not sure.
Im thinking of calling her neurologist and updating as i was going to book an MRI for december. It Would likely be more cost effective for me to go straight to the specialist vet practice than have xrays at our local practice if its possible.
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PaulaM
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Post by PaulaM on Nov 10, 2020 16:49:09 GMT -7
I'm glad you have done your homework on torn knee ligaments to best work with your vet in determining the best treatment.
Just be sure all who would be involved in the taking of X-rays & MRIs and those caring for her while under anesthesia etc understand the need to keep the back on one plane, horizontal to the ground in order to not twist the back.
Amber is fortunate to have you in protecting and caring for her— hope the pain from the knee is well served by the addition of the NSAID. And Pepcid AC has been added as well?
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Lindsay & Amber
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Post by Lindsay & Amber on Nov 10, 2020 20:44:57 GMT -7
Thank you, we are starting the NSAIDS tomorrow so that she can have them through the day hoping it will give her some relief.
Ive also already raised my concerns over anesthesia and ive been reasured her regular vet will do them and make sure she is supported correctly. im going to make sure they are definitly neccessary to.
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