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Post by Shana & Emma on Oct 3, 2020 20:13:37 GMT -7
★1 Emma weighs 14.59 lbs as of October 1, 2020. She is currently taking the following meds: Gabapentin 100mg Every 8 hours
Methocarbamol 125mg Twice daily
Prednisone 5mg Once a day
[Moderator's Note. Please do not edit
14.9lbs
Prednisone as of 10/2: 5mgs 1x/day for ? days, then a test taper for: _pain / _neuro
gabapentin 100mgs 3x/day
methocarbamol 125mgs 2x/day
needs GI tract acid suppressor, Pepcid AC, on board w/Prednisone ! ]
★2 Emma is a mutt, but mostly beagle & doxie. My name is Shana.
★3 We have not gotten a specific diagnosis of IVDD for Emma. She was taken to the doctor on Thursday, October 1, 2020 for what was thought to be a pulled muscle, and by Friday, October 2, 2020 had developed ataxia. Her vet is a general DVM.
★4 As stated above, I took Em in on Thursday, October 1, 2020 for what we thought was a pulled or strained muscle. I had the week off, but was doing a little work in my office. Normally, Em jumps on the bed to hang out while I'm working. She would stand at the bed and looked like she wanted to jump up, but couldn't/didn't. She was also using the stairs that I have at the couch for my other doxie. When I took her to the doctor, there was no indication that this was anything more than a pulled muscle. She had some tenderness in the lower part of her spine, but her reaction was almost unnoticeable. The doctor prescribed 50mg of gabapentin and crate rest for 2 weeks. Emma spent all of Friday, October 2, 2020 in her crate, resting. When I took her out at approximately 5PM to use the bathroom prior to eating, her back end was noticeably wobbly [October 2]. I called the doctor before the facility closed at 5:30PM. She opted to prescribe a higher dose of gabapentin, and add prednisone and methocarbamol to the list. She also wants to add tramadol, but as it is a controlled substance, i guess only the owner of the practice is able to call in prescriptions to outside pharmacies? So Emma began that regimen on the evening of Friday, October 2.
★5 she does appear to have a little bit of pain, not really wanting to adjust her position in the ex-pen, stiffens when I pick her up to take her outside
★6 Eating and drinking OK? She is eating and drinking as normal - maybe a little more drinking. She is able to pee and poop on her own, and her poop remains normal.
★7 Currently can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk? She is currently walking very wobbly - she will have moments where she walks normal, but those are few and far between. She also is still wagging her tail.
★8 She is currently having no issues with urinating on her own.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,535
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Post by PaulaM on Oct 3, 2020 20:53:03 GMT -7
Shana, welcome to Dodgerslist Forum. Sounds like Emma is going to be a good candidate to heal her disc under conservative treatment. The 8 weeks focus on disc healing may or may not be too short a time for nerve healing to repair the wobbly legs. Time will tell. TRAMADOL and METHOCARBMOL Do stay on top of getting tramadol on board. There is no reason for Emma to be suffering with pain when the addition of tramadol can bring full comfort. Also when following up on the tramadol, and report the signs of pain you are seeing, advocate for methcarbamol to be Rx for 3x/day. The pain meds last for about 8 hours and that is why every 12 hours may not provide the full comfort Emma deserves. PEPCID AC 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 anti-inflammatory drugs cause. 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. 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).
HEALTH ISSUES: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.” marvistavet.com/famotidine.pml 100% STRICT rest 24/7 Please confirm that we're on the same page as to conservative care. The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, 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/ Knowledge is key! Owner understanding ensures proper conservaitve treatment principals: ▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/healing-the-disc/▶︎ Roadmap for your fridge so the whole family is on board. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf STRICT rest means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/ ◼︎no d\ meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture for severe neuro damage is best. 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. POTTY TIME strictness Carry your dog to and from the recovery suite to the potty place and then allow a very, very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! **  STEPs STAIRs Ramps avoid the impact to the spine that steps and stairs cause. Take a look at the discussion on ramps and see how you might move to using ramps now for your other doxies and after graduation day for Emma dodgerslist.boards.net/thread/867/ramps |
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Post by Shana & Emma on Oct 3, 2020 23:44:28 GMT -7
The prednisone is 1 tablet daily for 7 days, then 1/2 tab daily for 7 days, then 1/2 tab every other day for 7 days. [Moderator's Note. Please do not edit
14.9lbs
Prednisone as of 10/2: 5mgs 1x/day for 7 days, then 10/9 test taper for: _pain / _neuro
gabapentin 100mgs 3x/day
methocarbamol 125mgs 2x/day
needs GI tract acid suppressor, Pepcid AC, on board w/Prednisone ! ]
Yes, we are adhering to the strict 24/7 crate rest. She has an ex-pen with a bed and blanket, then rolled up towels to fill the extra space. I have a blanket draped over part of the ex-pen as Emma does better with a covered crate. I have been feeding her in the crate, and only take her out to potty. I have a winter scarf that I am using to hold her back end up. I will be purchasing a ramp for the couch as soon as possible. I will be calling the vet first thing Monday morning to get the Tramadol on board, as well as discuss upping the methocarbamol and adding famotidine. I'm not going to lie; this seems daunting. But I'm also dealing with serious gallbladder issues with my elderly doxie, so I feel like when it rains, it pours. These things never happen after one wins the lottery, do they?  |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Oct 4, 2020 5:22:54 GMT -7
Is there any way that you can get the necessary med adjustment before Monday, Shana? Emergency number for the vet, local ER? Dogs are very good at hiding their pain but Emma is telling you of hers by the signs she's showing. Getting her pain under control shouldn't wait until Monday, allowing her to remain in pain all day today.
So sorry to hear of the medical issues that your elderly doxie is experiencing.
Healing prayers for Emma.
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Post by Shana & Emma on Oct 4, 2020 9:25:02 GMT -7
I will call the ER. She is now ▼not able to fix her paws if they are flipped. Still eating, drinking, peeing, and pooping normally. Is it common for things to progress like this? Or am I doing something wrong?
[Moderator's Note. Please do not edit
14.9lbs
Prednisone as of 10/2: 5mgs 1x/day for 7 days, then 10/9 test taper for: _pain / 10/4 √ neuro!
gabapentin 100mgs 3x/day
methocarbamol 125mgs 2x/day
needs GI tract acid suppressor, Pepcid AC, on board w/Prednisone ! ]
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Post by Jessica on Oct 4, 2020 9:40:47 GMT -7
Shana - Definitely let the ER know right away of Emma's inability to correct her paws when flipped. Keep with the strict crate rest and minimize her movement. This is not anything you are doing wrong. Dogs have different responses and it can be very scary! Please do contact them, stick to the strict crate rest, and keep us updated.
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Post by Ann Brittain on Oct 4, 2020 10:29:37 GMT -7
Hi Shauna,
It is overwhelming, but patience is the key to healing for a dog with back or IVDD issues. You seem to be taking the right steps by keeping Emma crated and allowing movement only at potty time. Generally, as the medication kicks in, you will see signs of improvement which will help you understand you're doing the right thing for her.
As Marjorie posted, getting Emma's pain under control is key to helping her recover. Hopefully you'll be able to discuss this with a vet today.
You mentioned getting a ramp which is a good option once she is completely healed. However, she does need to complete the eight weeks of crate rest before using it.
Sending you and Emma positive thoughts for a full recover.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,535
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Post by PaulaM on Oct 4, 2020 10:59:23 GMT -7
Emergency info for Shawna to read.
We all will wait to first hear back from Shana before adding a post. Thnx.
Shana, advocate for the higher end of the anti-inflammatory dose of Prednisone. The higher end is what is typically used with disc episode.
-- Advocate for 5mgs prednisone every 12 hours (2x/day).
-- Get Pepcid AC (famotidine) 5mgs every 12 hours to prevent bleeding ulcers. Verify about any health issues e.g. heart murmurs, etc. that famotidine should not be used..
PREDICTABLE ORDER OF NEURO FUNCTIONS
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. 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. 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/
A disc episode compresses the spinal cord and causes a lot of bruising, swelling, and inflammation.
-- Surgery immediately relieves the pressure with severe paralysis by removing offending disc material.
-- Conservative treatment relieves pressure with an anti-inflammatory drug and takes 7-30 days.
Just as with any traumatic injury, the body can self heal nerves and the disc.
-- The disc heals under Conservative treatment with very STRICT limited movement and time of 8 weeks.
-- Damaged nerves in the spinal cord heal with time after a surgery or conservative treament. Best to think in terms of months rather than days/weeks for this slowest part of the body to heal.
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Post by Shana & Emma on Oct 4, 2020 11:03:30 GMT -7
The emergency vet will not prescribe the Tramadol. They also told me that, based on her presentation, that I need to get a CAT SCAN and surgery. My other vet told me Em would need surgery too. I'm really trying to keep a positive attitude here, but I would be lying if I said I wasn't freaking out about her needing surgery. I absolutely can't afford $5,000 for surgery...I just can't help but feel like I'm failing my baby...
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,535
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Post by PaulaM on Oct 4, 2020 11:12:12 GMT -7
Shana, not everyone can afford surgery. Not every dog who is knuckling requires surgery either.
Make it clear you do not have funds for a surgery.
STRONGLY advocate on the phone with any vet you can get to help Emma.
-- Right now the prednisone NEEDS to be up to the ACTUAL anti-inflammatory dose that is used with a disc episode. 5mgs of prednisone promptly every 12 hours (2x/day) NOT once a day!
-- methocarbamol 125mgs move up to every 8 hrs.
Emma is not at the paralysis stage. A lot of vets just are not confident in their knowledge of IVDD and quickly refer to surgery. Stay strong, be positive and keep hope. It IS in the cards for Emma after 8 weeks of rest to get back to enjoying life!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,535
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Post by PaulaM on Oct 4, 2020 11:29:21 GMT -7
Hours matter in getting the inflammation down, try to get pred 2x/day on board soonest today. While risking a transport in to a vet is not the best idea....do it if required to obtain --#1 priority Prednisone 5mgs every 12 hrs -- methocarbamol 125mgs moved up too every 8 hrs -- tramadol as the general analgesic 3x/day -- Option to tramadol: 1. Buprenorphine Transdermal gel for inside of the ear flap: "Buprenorphine should not be compounded into an oral prep as significant first-pass effect renders it inactive), but its lipophilic nature lends itself to absorption across skin or mucous membranes. Compounding pharmacies can produce a PLO (pleuronic lecithin organogel, or transdermal gel) for application on the inner surface of the pinna or shaved skin on the neck in dogs and cats." www.vasg.org/chronic_pain_management.htm--- Pepcid AC (famotidine) 5mgs 2x/day to suppress acids to avoid bleeding ulcers. |
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