Brittany's Elton 9/2020 Conservative-Libby; vet:Kalispell

Hi Brittany. 

Welcome to Dodgerslist, thank you for joining us. 

Sorry to read about Elton's added issues. 

The most important thing at this moment is to put Elton on strict crate rest.
If it is a disc issue, which it sounds like it is, crating him will prevent unnecessary movement and further damage/tearing of the disc. 

Crate rest and conservative treatment.
The hallmark component of conservative treatment is the very STRICT crate rest part which means no PT and very little movement.
With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal.
Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc.
100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.
Super tried and true tips for setting up the recovery suite, the mattress and more! —>
dodgerslist.com/2020/05/14/strict-rest-recovery-process/





STRICT means:

◼︎No laps
◼︎No couches
◼︎No baths
◼︎No sleeping with you
◼No chirotherapy - why not? dodgerslist.com/2020/04/22/chiropractic/
◼︎No dragging or meandering at potty times.
◼︎No PT for conservative dogs during 8 weeks to heal disc
◼︎Laser or acupuncture for severe neuro damage is best at home via a mobile vet. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.

Obviously you will have to transport him to the vet today for assessment. Take care to protect his back on the trip.  Take care when going round corners and avoid sudden braking, it you have a crate for him that pad it out with rolled up towels or pillows, anything that supports and cushions him and limits movement. 

Be sure you support his back when carrying him out to potty.





When you speak to the vet and get a diagnosis please come back to us and let us know.
Also if you can provide us with a list of the names of medications for him, when they are to be given and the amounts to be given. 

This info is very important to help us to help you. 

kind regards

Mary

The meds needed for an IVDD episode are:

An anti-inflammatory to work on the swelling pressing on the nerves of the spine, either a NSAID or a steroid.

Pain meds to mask the pain until the swelling is gone. We usually see Tramadol as a general pain med, Gabapentin for nerve pain and Methocarbamol for the pain of muscle spasms. All of these meds need to be prescribed 3x/day to cover pain all day/night.

Pepcid AC (Famotidine) as a stomach protector to protect against the excess acid from the anti-inflammatory.

More info on meds given during an IVDD episode:
dodgerslist.com/meds-used-during-disc-episode/

Brittany, I'm in Flathead Valley near Kalispell. What's your city?

Most surgeons will not operate on a dog who can still walk even if wobbly. They want to try the least invasive of treatments--- conservative treatment.

PAiN must be in control NOW, today.  Prednisone is an anti-inflammatory they will take 7-30 days to get the painful swelling down in the spinal cord. In my book that is not a  pain reliever.  Elton needs pain relievers NOW, asap, today.
   
Action to take
--- phone your vet to report signs you reported here (reluctant to move, not wanting to bear weight on leg, arched back).  
--- phone because transport will increase risk of too much movement and increases potential to further tear disc, further cause neuro diminishment.
--- Advocate for all sources of pain to be addressed.
    1 Tramadol as the general pain reliever promptly every 8 hrs
    2  gabapentin for nerve pain  every 8 hrs
    3  methocarbamol every 8 hrs for pain from muscle contractions.
    
PREDNISONE
   for a 9lbs dog 10mgs of prednisone 2x/day is quite high!!!!  Higher doses than anti-inflammatory level do not work faster, but DO  highly increase GI tract damage.  Discuss using the anti-inflammatory level dose 2x/day with your vet. And getting Pepcid AC on board if there are no health reasons.

Depending on the dosage, steroids can be replacement steroid hormone in dog not able to make suffiennt hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive effects for other diseases.

Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily.  Dr. Dawn Ruben  Prednisone / Prednisolone www.petplace.com/DrugLibrary/prednisone-prednisolone/page1.aspx   last accessed 12/6/18

PEPCID AC vs. Omeprazole

Pepcid Ac acts in 30 mins.  Omeprazole takes 3-5 days to reach peak effectiveness. Omeprazole is not the best choice when it is today Elton needs acid suppression.  Learn more:  dodgerslist.com/2020/05/06/stomach-protection/?highlight=pepcid%20ac


  Choices for surgery are several when the time is right. My dogs went to  Washington State University in Pullman.
  review on Veterinary Surgical Specialists  in Spokane dodgerslist.boards.net/thread/4580/vet-recommendations-spokane-washington-idaho

HOW TO MONITOR for NEURO DIMINISHMENT
As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.
1. √ Pain caused by the tearing disc & inflammation in the spinal cord
2. YES Wobbly walking, legs cross
3. ? Nails/toes scuffing floor
4. ? Paws knuckle under
5. 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.  

A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Brittany, have things changed since last night? Now at 8am vet appt your Elton has further neuro diminish that he can no longer wobbly walk?

Please update us on the neuro status:
3. ? Nails/toes scuffing floor
4. ? Paws knuckle under
5. ? Weak/little leg movement, ? can't move up into a stand
6. ? Legs do not work at all (paralysis, dog is down)

Let us know you are doing the single most important part of Conservative treatment care — the 100% STRICT rest 24/7 inside of a recovery suite. Only out of the suite for potty time and the utmost important of transports into a vet worth taking a risk of further damage to the disc. Vets who know IVDD and have done the hands on exam, will do things like adjust meds over the phone.

Brittany, very good on your part to look in to adjusting the prednisone to the more typical anti-inflammatory level dosing for a 9 lbs dog 5mgs 2x/day with your own vet. Good job!

What about an acid suppressor? Is Pepcid AC 5mgs 2x/day now on board with the prednisone?

The requirement for the recovery suite is to be large enough to only easily turn around and when lying down to  fully stretch out the legs. And of course that they can't chew out of it, or otherwise escape. So if the small puppy  play pen works that is good.

Do you have his food and water bowls at  head height in the suite?



let us know you do not observe any yelping, any reluctance to move or gingerly moving. No tight tummy.  In other words round the clock or when lifting Elton you do  not see any of these signs of pain:
◻︎ not their normal perky selves  

NEURO
Does Elton knuckle under his paws? Can he right them if he does knuckle?
www.dodgerslist.com/literature/healing/Knuckling.jpg




POTTY TIME
Elton just may not be given any opportunities to fall over twisting his vertebrae, possibly further damaging nerve in the spinal cord.   Let us know you are using a sling for the rear as a back up to prevent any falling. That a harness and leash are used to control speed and thinking he can dart off at the sight of a squirel, dog, etc.

UPDATE - Having trouble getting pain meds on board due to distance from vet. Regular vet suggested vet source, however delivery would be 4-8 days. But when it rains it pours doesn’t it?

I was taking Elton out with his sling, and must have startled my Sr. chihuahua Zorky (14) and he yelped. I got Elton situated in his pen, and Zorky started yelling incessantly. Now both boys have their own recovery suite. Gave them each 12.5 mg of Tramadol prescribed to Zorky quite some time ago.

Have calming music playing, feeling over whelmed keeping up with my new opened business. Not to mention, I’m 5 months pregnant. I’m in a pickle and trying so very hard to stay positive. When Zorky yelps, Elton goes crazy. Barking and worried for his older (smaller) brother. To add to this, Elton has had anal gland problems. Before the neuter, he would obsessively growl and chase his tail. So keeping him from doing that today, has been a definite struggle.

Did get some good news. I spoke to a neurologist at WSU this afternoon, she did not think surgery was appropriate, but rather conservative approach with strict cage rest. She wants me to watch for knuckling over and loss of function of his legs. Should he regress, he would be an emergency case.

Zorky the chihuahua has an appointment Monday. I will pick up the gabapentin for Elton then.

Trying to stay positive. With two hurt dogs, I’m needing some relief and a miracle for my sanity frankly.

ELTON

Brittany, you do have a very full plate with all that is going on!!

Waiting til Monday to get pain meds for Elton is not right! Are you able to step up to the plate by being a very squeaky but polite wheel.  Call whichever vet can get those Rx's called into the pharmacy of your choice near you in Kalispell.

If the meds are going out to be compounded into liquid, that is why it takes time of days. This is TOTALLY unfair to Elton. Use the tabs and capsules readily available in your local Walgreen, Smith's (I use them), Costco, etc. to get the Rx filled today, this evening.

There are a number of 24 hr pharmacies in Kalispell. What is the issue with the vet calling in an Rx to one close to you for the pain meds needed?

Gabapentin comes small size of a 100mg capsule of powder. Easy enough to open capsule and divide powder to match Rx mgs.  


Tramadol comes in 50 mgs tabs. Those are easy enough to split to match the Rx.

Methocarbamol comes in 500mg tab and that too can be split.

Do you express Elton's anal glands yourself normally?

Please update us on Elton's current as of today neuro status. Where is he on list below?
3. ? Nails/toes scuffing floor when taking footsteps
4. ? knuckle under but can right them quickly, ?  Paws knuckle under, or they 
5. ? Weak/little leg movement, ? can't move up into a stand
6. ? Legs do not work at all (paralysis, dog is down)
----------

ZORKY
Brittany would you make a new post only speaking to Zorky's issues?

How much does Zorky weigh?
Crate rested as of 9/24
Tramadol 12.5mgs ?x/day
Vet appt on 9/28

Do you express Elton's anal glands yourself normally? No. I take him
In to the a local vet for nail trimming and anal glands. His anal glands were expressed 9/18. He was scooting heavily on Sunday [9/20??]. I have complained of this and tail chasing to numerous vets. They offer no explanation other than frequent anal gland expression.
He meets none of this criteria today. He is above 3.

Elton has not drank water on his own since the neuter procedure. Only drinks with water mixed into his food.

1. YES Pain caused by the tearing disc & inflammation in the spinal cord
2. YES Wobbly walking, legs cross
3. NO Nails/toes scuffing floor when taking footsteps
4. NO Paws knuckle under

Elton has some evidence of pain - shaking and hunched back.
And wobbly walking, legs cross when picked up. Appears not to have too much feeling in legs. He is able to take assisted steps, and would be able to walk some steps on his own.

I will definitely be learning how to express on my own once he is out of the woods. He was scooting heavily on 9/20. I’m a little worried about how he will get anal glands checked/express in the meantime, since the

local vet here in Libby will not see him since he’s having an IVDD episode.

Tried that on Monday 9/21 AM - his vet attempted to call to pharmacy, but that was for rimadyl when it was thought it was surgery pain. I will try to call the pharmacies (there’s 2) myself tomorrow to see if they have the gabapentin.

I will regroup in the morning. But, I believe they were going to initially prescribe the Medi melts, not the liquid. So, that couldn’t be called in to a pharmacy. But I will do my best to get a pain med on board before the weekend. Elton will have access to additional doses of tramadol in the meantime. My parents could drive to Kalispell to get the meds-melts Friday afternoon if the tramadol did not suffice until Monday afternoon.

I will need to call around and see what I can accomplish. Perhaps, the Bonner’s vet has medi-melts. That is a one hour (one way) drive instead of two. Nonetheless, I will see if any pharmacy here carries just the capsule form of gabapentin; I could handle dosing until Monday for the medi-Melts. I wish vets cooperated more with each other, example - why wouldn’t kalispell vet contact Libby’s vets to determine if they had any truly needed meds? I’m sure there’s reasons. Just expressing my frustrations. This amplifies the cons of small town living.

Update: had it all arranged to pick up in Libby. Then his vet called and said that our local pharmacy didn’t have proper dosing. Even more frustrating - as they are capsules. But Got it arranged to be compounded at pharmacy in Kalispell. 1.5 hour drive my parents are taking for me. Couldn’t be more appreciative. Just waiting for the call that the order has been received. Burning daylight here.

Tramadol made him reactive. He barked on and off all day and night. I withheld the tramadol this morning. It seemed to do more harm than good. He is shivering, but no wimpering. A bit nervous of the affects of gapapentin. I’m always nervous to give meds though. Any negative effects anyone has seen in their precious babies?

UPDATE: Elton is doing very well. He has started to taper the prednisone. It is the weekend, so I don’t have any direction from his regular vet. Do I taper the Pepcid too? Or continue The 5 mg 2x a day until he has completed the prednisone? The vet did not give any direction on this whatsoever. In fact, they haven’t even called to check on him.

[Moderator's Note. Please do not edit
8.8lbs
Prednisone as of 9/23: 5mgs 2x/day for 7 days, then 9/30 test taper: _pain/_neuro
tramadol ?mg    ?x/day   STOPPED?
gabapentin ?mg    ?x/day 
Pepcid AC 5mgs ▼1x/day as of 9/30 10/3? ish diarrhea! ]


He had a bit of diarrhea at his last bm. Wondering if it could be because I stopped giving the second dose of Pepcid, as I was giving with the prednisone.

Please see above for Marjorie's answer about maintaining Pepcid AC

Since Elton was seen by ER in Bonner’s Ferry, Idaho, Elton's record is there. Hopefully another vet in the building this Sunday could call in an Rx for sucralfate to a pharmacy more accessible to you in Libby or Kalispell?  Worth giving it a try with any vet Elton has seen to get an Rx for sucralfate today.

Bring us up to date on the very important med list. What has Elton been taking (tramadol, gabapentin with their  mgs and frequency given)?  
    On the 9/30 test for pain Pred taper, pain meds should be either backed down in frequency/mgs  OR.... full stopped. This is the vet's decision full stop or backing off of pain meds.  Your job on the Pred taper is to watch for signs of pain. Pain meds blindfold your ability to observe if there would be existence of painful spinal cord swelling and delay if there would be hidden pain getting back to the origianal doses.