Lisa's Lucy 11/30 conservative NECK; GRAD 1/25/21

Lisa, I'm so sorry to hear the chain of events of a missed diagnosis. All is definitely not lost, and when or if a surgery for whatever reason is not in the cards, your best best for Ludy is the actual doing of real/ true conservative treatment.

We can best help you with Lucy when we are privy to all the essential details in the questions below:

❖1 Is there still currently today, now, pain?  Nearing next dose?  When she has to move?
◻︎ shivering-trembling        ◻︎ slow to move   ◻︎ tight tense tummy
◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground
◻︎ yelping when picked up or moved ◻︎ restless, can't find a comfortable position
◻︎ slow or reluctant to move much in crate such as shift positions
◻︎ not their normal perky interested in life selves
             + pain from neck disc:
◻︎ 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

Full pain relief is expected in 1 hour and stays that way dose to dose.
If the pain meds are not yet right, as the eyes and ears for your vet, please call your vet ASAP to report your observations so meds can be adjusted. Advocate for any of the pain meds be given 3x/day (every 8 hours) for round the clock coverage, dose to dose coverage.
— 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.

Neuropathic pain is not common but you should be aware of it. This kind of pain is abnormal, phantom pain sensations with severe spinal cord damage. Signs are obsessive licking of paw, leg, genitals, tail. Escalates to biting, life-threatening chewing off parts. Immediately put on an e-collar (or lengthwise folded towel around neck and duct taped closed) to prevent access to lower body. Contact vet immediately for Gabapentin or stronger Lyrica (pregabalin) for neuropathic pain. More info: dodgerslist.com/2020/06/10/neuropathy/

❖2 MED LIST
  What date did 5mgs prednisone start on?  For how many days will she take that dose/frequency?

❖3 GI Tract problems? —Eating and drinking OK? No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?

❖4 Please let us know that you're on the same page about strict crate rest.
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.

The body does have the ability to self heal a disc. The very STRICT rest part of conservative treatment is key to avoiding a disc relapse and potential for severe nerve damage. It is far easier to meet your dog's care needs if you understand things. Learn and scoop up all the good tips and ideas for doing conservative treatment here: dodgerslist.com/2020/04/22/healing-discs

Setting up a “recovery suite” with room service!
*
Ideas to deliver effective STRICT rest recovery during Conservative Medical treatment including recovery suite tips, how to set up the suite and more: dodgerslist.com/2020/05/14/strict-rest-recovery-process/

The very STRICT rest part of conservative treatment is key to avoiding a disc relapse and potential for severe nerve damage and to avoid a serious surgery. It is far easier to meet your dog's care needs if you understand things. Learn and scoop up all the good tips and ideas for doing conservative treatment here: dodgerslist.com/2020/04/22/healing-discs

STRICT means:
◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎no chiro therapy whys: dodgerslist.com/2020/04/22/chiropractic/
◼︎no dragging or 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.

Dr. Thomas, DVM, ACVIM (Neurology) teaches veterinarians why limited movement: "The most important aspect is cage rest. For the disk to extrude, the annulus must tear. The annulus is a ligament. So, just like a sprained ankle will often heal if you stay off it, the annulus can heal if we minimize the stress on the ligament. There is no medication that will speed this up. Medication treats only the symptoms, i.e., the pain. " ~Acute IVDD treatment. William B. Thomas, DVM, DACVIM

❖5 Can your Lucy specifically sniff and squat and then release urine which is bladder control – OR
       -- Do you find wet bedding or leaks on you when lifted which are indication of an overflowing bladder and loss of bladder control?
        -- Overflowing bladders need to be expressed to avoid UTIs. Review the video then get a hands-on-top-of-your-hands expressing lesson. dodgerslist.com/2020/05/05/bladder-bowel-care/

DOGs with BLADDER CONTROL: Carry to and from the recovery suite to the potty place and then allow a 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 a 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!

Acupuncture/laser light therapy
If there is great pain or severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering.

CAUTIONS:
~~ Laser light therapy is contra-indicated with tumors which are detected via x-ray.
~~ During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back can increase a disc tear and escape of disc material into the spinal cord. For an animal with very mild neuro deficits, the risk of transporting to therapy has to be carefully weighed against what benefit is to be gained. www.ahvma.org/find-a-holistic-veterinarian/

❖6 Currently can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk? 

❖8 — Was the ER vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho? 

Look forward to quickly learning about your Lucy so we know best how to help.

What date did pred start on? For how many days will she take 5mgs pred 2x/day?

What is the dose of gabapentin that is give 2x/day?

What date did strict rest inside of a recovery suite begin?

Is all pain in control dose to dose, when she has to move, nearing next dose of pain two pain meds? That is no pain surfaces at all with every 12 hrs dosing?

Clarify expressing, please
1 Can Lucy be placed on an old pee spot and then sniffs and choses to release urine? OR....
2 Are you taking her outdoors. Lay her down and then when YOU press on her stomach area to express, urine will come out?
3. Do you find urine leaks in her bedding? Does she leak on you when lifted?
4 How often to you express every 2 or every 3 hours or .....

Sorry so slow to respond y’all. Just overwhelmed and exhausted. 
Lucy is a 6 year old dachshund weighing 18 pounds. Her treatment started on Monday 11/30. Consisting of strict rest which only includes bathroom time. Meds are as follows with no stop date or change-
Prednisone 5mg- 2 X daily
Methocarbamol 125mg- 2 X daily
Gabapentin 100 mg- 2 X daily
Pepcid 5mg- once daily.

[Moderator's Note. Please do not edit
18 lbs 6y.o.
date STRICT rest started?
Prednisone as of 11/30: 5mgs 2x/day for ? days, then a test taper for: _pain / _neuro
methocarbamol 125mgs 2x/day
gabapentin 100mgs 2x/day
Pepcid AC 5mgs 1x/day]

She returns to her veterinarian on Friday [12/4]to be re- evaluated and to adjust her dose of prednisone. She is not able to bear weight at all since starting meds but prior to meds she was only able to hold weight in her front legs. Back legs are knuckling in paws but still feeling painful stimulation. Her meds have made her very groggy however she is easy to wake up. She does slowly wag her tail if offered a treat. She is eating and drinking well. I am continuing to struggle emptying her bladder. I stimulate as per video and vet instructions and it feels like she is holding her urine but then right afterwards when I lay her down on a puppy pad she empties. I am no longer taking her outside because it has snowed. She hasn’t had a bowel movement yet but I am starting mira lax and pumpkin tonight. Thank you!!

Also she attempts to reposition however I stop her and do it myself. She seems free of pain, no crying or any other signs of distress.

Actually we did a facetime visit with the vet [12/2]this evening and she wants to keep Lucy on 5mg of prednisone 2 times daily, the vet will do another facetime visit with us and assess all of her meds at that time. I increased her dose of ▲pepcid to 10mg 2 X daily. Lucy is able to move her front limbs and I can’t currently see any issues with her front legs.

She attempts to pull herself with [front legs]
them (I stop her from doing this immediately) her
back legs are unable to move.

but do respond to pain (if I wiggle a toe nail she cries). She  does wag her tail. I feel like she probably does have bladder control, but because of her pain and holding urine I am afraid this could cause her to develop a UTI. She is not leaking urine, it’s either a large amount or none. I hope this makes more sense. Thank you

It is 2:00 AM and my sweet girl has not pottied in over 12 hours. I’ve spent the last 2 trying to express her bladder with no luck. Not even a drop. I am in tears and desperate. I’ve watched a dozen or more video, poured warm water over her, wiped her peri area, and tried every technique I watched. She tenses up her abdomen and whimpers each time. Any ideas?

[Moderator's Note. Please do not edit
18 lbs 6y.o.
date STRICT rest started?
Prednisone as of 11/30: 5mgs 2x/day for 7 days, 12/7 test taper: _ pain/_neuro
methocarbamol 125mgs 2x/day;
gabapentin 100mgs 2x/day;  
Pepcid AC ▲10mgs ▲2x/day]

For how many days does the vet want Lucy to continue on 5 mg 2x/day?

If you believe that Lucy still has pain and is holding her urine due to pain, then you must immediately contact the vet to advise of the pain so the vet can adjust the pain meds. What signs of pain are you still seeing? Both Methocarbamol and Gabapentin have a short half life and work best when given every 8 hours (3x/day). Tramadol as a general pain med can also be added.

Please do not wiggle her toes as that could cause her to pull back her leg and that might be too much movement which could cause the damaged disc to tear more or even rupture, causing more nerve damage. The less movement, the better. It's very hard for even vets to determine deep pain sensation so that will not tell you anything. The fact that she can still move her tail is a good sign that she still has deep pain sensation.

A dog that has bladder control will not want to be expressed and it will be very difficult to do so. UTIs can cause pain when pressing on the bladder. Or spinal pain could be made worse when trying to express. Has she urinated since you posted 8 hours ago? Once her pain is completely under control, you should both have a much better time with pottying.

On what date did strict crate rest start?

You are providing excellent care to Lucy. It comes through in your posts. Learning to express is tricky and many of us have struggled before we learned how.

When my dog Frankie was regaining bladder control I wanted him to use a pee pad outside his crate to avoid too much movement. Frankie was not having it. I got him to use the pad by getting a paper towel with another dog's urine on it (my son's dog was happy to contribute). I put this on the pee pad, Frankie sniffed it and peeded.

Dogs always like to go where other dogs have gone. If you haven't tried it consider it.

Lisa, please look back at Paula's very detailed explanation on 12/2 of how the taper of the Prednisone works.  It does not appear as though your vet is familiar with treating IVDD.

1. The taper off of the anti-inflammatory (Prednisone) is the time when a test for pain/swelling is made. Should pain appear at any time during the taper, that means there is still swelling pressing on the nerves of the spine and still a need for the original dosage of the anti-inflammatory for a bit longer. It can take 7-30 days for the swelling to resolve and until then, the Prednisone is needed. The taper dosages do nothing to resolve the swelling - only the anti-inflammatory dosage works on the swelling. It's that swelling pressing on the nerves of the spine that causes pain and can lead to nerve damage.

2. At the same time the Prednisone is tapered, the pain meds are also tapered or stopped completely. Having pain meds on board as your doctor has prescribed makes it very difficult for you to determine whether there is still pain/swelling and still a need for the original anti-inflammatory dosage of the Prednisone. Please speak to the vet ASAP as to which he wants to do - taper the pain meds today or stop them completely so a true test for pain/swelling can be made.

3. It is completely baffling as to why your vet is planning on starting a NSAID such as Meloxicam or an arthritis med such as Galliprant after the taper of Prednisone. Should pain arise during the taper of the Prednisone and pain meds, Lucy needs to be returned to the original anti-inflammatory dosage of Pred and all pain meds for a bit longer. Should pain not arise during the taper of the Prednisone and pain meds, that means the swelling is gone and no anti-inflammatory or pain meds are needed.

As Lucy's advocate, you need to have a good understanding of the instructions your vet is giving you and the reasons why he is giving them. And learn all that you can about IVDD so you can tell when you are given incorrect advice.

If Lucy does in fact have bladder control, she will not allow you to express her. How did the vet confirm that Lucy has bladder control? What type of test was done? Is Lucy able to pass a sniff and pee test (carry her to a spot where she or another dog has peed before, support her hind end but not under her belly, allow her to sniff and see if she can release urine on her own). Finding wet bedding or if she leaks on you when picked up indicates that her bladder is overflowing due to reflex, not bladder control.

Panting can be a side effect of the meds. A fan near but not pointed at the crate will help. Also a rice sock from the refrigerator can help them cool by laying their tummy along side of it. Fill a sock with 1-2 cups of rice and tie the end of the sock closed. Try a frozen broth ice cube to lick on. Or it can be from anxiety. Or it can be a sign of pain. If a fan helps, then it is most likely a side effect of the meds. If you see other signs of pain with the panting such as shivering, trembling, yelping, tensed up tummy, then the panting could be a sign of pain. Dr. Isaacs discusses this issue: www.dodgerslist.com/neurocorner2/panting.htm

Please advocate strongly today with the vet that he either taper off of the pain meds today or stop them completely so a true test for pain/swelling can be made. Have a Plan B in place with the vet should the taper show signs of pain so Lucy can be immediately returned to the original dosages of all meds for a bit longer, maybe another course of 7 days.

More information here on how meds work with an IVDD episode here for your education and in speaking to the vet: dodgerslist.com/2020/05/30/pain-medications

Lisa, at home have you witnessed a happy tail wag if you specifically do some happy talk or show Lucy a yummy treat coming?
    Did your local family vet observe if there was any back leg movement, attempt at walking motion during the house call?
    Have YOU seen any back leg movement such as attempting to scratch an ear, using back legs to reposition in the suite?

Which vet confirmed a C-1 disc? Local family vet or the neuro on a phone consult with your family vet?

Nerves heal typically in the reverse order of the damage to the spinal cord:
1. Deep Pain Sensation: the first neuro function to return. DPS is the critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about this very tricky to correctly idenfiy neuro function.
2. Tail wagging with joy at seeing you or getting a treat or meal.
3. YES Bladder and bowel control verified with the "sniff and pee" test.
4. ? Leg Movement, and then ? ability to move up into a stand position, and then ? wobbly walking.
5. Being able to walk with more steadiness and properly place the feet.
6. Ability to walk unassisted and perhaps even run.
More info: www.dodgerslist.com/literature/healingnerves.htm

Very excellent that your local family vet made a house call to avoid a risky to the healing neck disc transport!

What are PRP treatments?

ANTI-INFLAMMATORY (NSAIDS)
The only job of an anti-inflammatory drug is to rid the body of all painful spinal cord swelling. Generally that will take in the range of 7-30 days for most dogs. Because no vet would want a dog on a NSAID or a steroid past the point of the benefit, a 7-day or maybe a 14-day course will be first given. Then a test for pain to find out if another course is even needed.

Staying on a NSAID daily for 8 weeks would be a 56-day course. Please refresh yourself on anti-inflammatory drugs so that you can ask the right questions and protect Lucy from being on serious drugs if the benefit had been achieved much, much earlier than 56 days. FDA reports "An informed dog owner is the best defense against serious side effects from NSAIDs."

Recommend these readings to have important concerns at the forefront of your mind as you advocate for Lucy:
--- Learn why a NSAID is not a pain reliever for a disc episode, how long it could take to rid the body of all painfully inflamed and swollen tissue around the spinal cord.
dodgerslist.com/2020/04/18/steroids-vs-nsaids/
--- FDA Readings: FDA information:
    1. "What Veterinarians Should Tell Clients..." Includes: brand names, washout info when switching,
www.fda.gov/animal-veterinary/resources-you/what-veterinarians-should-tell-clients-about-pain-control-and-their-pets
   2. "Treating Pain in Your Dog" Includes side effects, safety precautions to take, immediate actions to take if you suspect a side effect  www.fda.gov/animal-veterinary/animal-health-literacy/treating-pain-your-dog
   3. FDA NSAID pkg inserts: animaldrugsatfda.fda.gov/adafda/views/#/nsaidLabels

If the other dogs will be relaxed and quite near Lucy's recovery suite and not get Lucy all excited, then they can be in the same room when you are there to observe. Or maybe select your most calm dog to be the one to keep Lucy company. Let us know if that works out.

Was the antibiotic was stopped after one dose? doxicycline 100 mg 1x/day

Lisa, some very confusing stuff, can you clarify?

How many more days will  she be on the steroid Pred 5mgs2x/day?  Then a taper (lower dose/less frequency) where YOU will observe if there is any pain surfacing or worsening neuro functions.  Should there be pain, then not  time to taper but to get back up on the anti-inflammatory dose of Pred (5mgs 2x/day) for another 7-day or longer course.
   Most dogs end up on Pred for 30 or less days at the anti-inflammatory level to achieve all swelling gone. The all that is left  is to finish the pred taper. Finish the rest of 100% very STRICT rest til graduation day.

What date is there for using a NSAID?  What date is rehab to start.  It takes 8 weeks of little movement to heal the disc episode of 11/30.
-- Is the NSAID to start prior to graduation date of Jan 25, 2021?  
-- Is the suggestion of a NSAID jumping the gun, as that would not happen til graduation day in Jan 25 when rehab can start.

What neuro function do her front legs have?  any purposeful movement observed— what specifically?  Or or front legs basically paralyzed?

What timeline or  date is steroid injection with pain med buprenorphine suggested for?  Why? Is Lucy still in pain

The NSAID Galliprant created specifically to target arthritis pain and tested only for arthritis, not tested for disc episode.   Read the phamplet that goes in the Galliprant pkg as all owner should:   www.elancolabels.com/us/galliprant-with-tear-off
   Find other NSAID pkg inserts here: animaldrugsatfda.fda.gov/adafda/views/#/nsaidLabels

Sounds like there is a push to start using a NSAID very soon. WHY?  Very, very  confusing info you relay. Focus right now is getting the disc to heal and getting the spinal cord swelling down with Pred.    

Again when will be the tapering down from pred 5mgs 2x/day so that YOU can assess for pain any worsening neuro function? 
   Having pain meds on  board at the start of the pred taper naturally blind folds you to assessing pain.
   -- which does your vet want on the taper start:
       1.  back off the pain meds with dose/frequency   OR....
       2. Full stop of both pain meds (gabapentin and methocarbamol)?

I'm glad to hear that Lucy is not showing any sign of pain at this point of the taper from Prednisone. However, the fact that she is still on a full course of pain meds means that the meds may be masking any sign of pain so it's difficult to determine whether swelling is gone or not. All anti-inflammatories, whether a steroid or a NSAID, can cause serious side effects. The goal in giving anti-inflammatories is to only give the anti-inflammatory dosage (5mg 2x/day for a dog of Lucy's weight) for only as long as absolutely necessary to get the swelling down. It can take 7-30 days to get the swelling down. Once that swelling is gone, the pain is also gone, and NO MEDS are needed any longer. Doesn't it make sense that during the tapering of the Prednisone, all pain meds are also tapered or stopped completely to see if pain/swelling is really gone? If at any time pain resurfaces during the taper, all meds would then be immediately restarted at the original dosages for a little bit longer, maybe another 5-7 days, before another test for pain taper is tried. Once a taper of the Prednisone test for pain is successful with the prednisone being tapered and all pain meds stopped with no sign of pain resurfacing, then you have proof that the swelling is gone and meds are no longer needed. To keep a dog on all meds for several months without testing to see if the swelling has resolved is overuse of meds.

As for being on meds for months being beneficial for rehab at the end of January, Lucy will need to be very gradually reintroduced to movement once the 8 weeks of crate rest are finished. Her muscles and stamina need to be very gradually built up again and rehab should not start until a couple of weeks after graduation from crate rest. Even then rehab needs to be gradually introduced to prevent sore muscles, otherwise it will be difficult for you to know if she is sore from too much exercise or was having another disc problem. Certainly NSAID and pain meds are not necessary for rehab.  

Thank you for the link to the article on the epidural that is being considered.  In looking at this particular article, I see that this type of treatment is recommended when there are sign of root signature pain. As far as I can see from what you've told us, Lucy is not showing signs of root signature pain. One of the main symptoms of nerve root signature pain is holding up a leg flamingo style. With nerve root signature pain, something is irritating the nerve root as it exits the spinal cord to travel down the leg.  What is leading the neurologist to believe that Lucy is suffering from nerve root signature pain and which leg does he see that in?  More info on nerve root signature pain here:
dodgerslist.com/2020/08/20/nerve-root-signature-pain/

I am very glad to hear that Lucy is pain free and happy.

We have not seen many dogs on this list treated with epidural injections, although this is quite common for humans. Please be careful that Mia does not move too much and re-aggravate the healing disc. When our dogs feel better they often want to start moving. They think they are fine. This is the time we pet parents have to be extra careful.

Her active range of motion is in the bathtub with her life jacket. She is not allowed to stand or bear any weight but just to move her legs and arms. Do any of you have a recommendation for a good joint supplement? The vet indicated we should start one but said any of them are good. Happy New Year!