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Post by Bridget & Cooper on Dec 17, 2020 17:31:39 GMT -7
in desperate need of guidance
My Cooper is 8.5 years old, started to expierence mild IVDD flare ups in March, 2020. With the first flare up, I took him to the Emergency vet. They started him on an NSAID and gabapentin and he responded within 24 hours. Primary vet gave him carprofen for future flare ups and he seemed to respond well. Took him to a neurologist over the summer, was quoted 8-10k for surgery and I expressed I could not afford this but since he was still walking surgery was not necessary. Mild flare ups since then but then on Thanksgiving he had a little too much fun playing with other dogs and had another flare up. It started worsening and the primary vet gave me tramadol. By December 3rd, cooper went down with total hind leg paralysis. I took him immediately to the ED and the put him on prednisone which has since ended. (His paralysis simultaneously happened with the death of my father from covid so I had a lot going on and surgery was still not an option for me.) The ED told me to work with my primary vet on medication pain management in the future, my primary vet said he wasn't in any pain and that more pred would do nothing for him. I pushed because he was clearly trembling and she said he was cold and that there is nothing more to do with medication and to google wheelchairs. Currently working on a getting a new primary vet that will help. In the Nashville area if you recommended one. Based on other dog forums i'm apart of, I started cooper on cold laser and he has seen a rehab physical therapist. But, he is still in pain and needs medication and I don't know how to advocate for him when 2 primary vets, a neurologist and an ED vet will not.
☆ 1 Is there still currently pain?
X reluctant to move much in crate such as shift positions or slow, ginger movements
X shivering, trembling
Xyelping when picked up or moved
Xtight tense tummy
Xcan’t find a comfortable position, appears restless
☐ Arched back
Xhead held high or nose to the ground
X Holding front or back leg flamingo style not wanting to bear weight
X Not their normal perky selves?
☆ 2 Cooper is 13lbs, Currently taking: Tramadol (50mg) either full or 1/2 depending on pain every 12 hours, or as needed and Gabapentin (50mg) , 1.4ml every 8-12 hours.
B.. 12/16 prednisone stopped. 1/2 of 5mg tablet starting on 12/5 - twice a day for 3 days, 1 a day , than once every other day until 12/16
🔘 OR.... date of a NSAID stop? Carprofen stopped 12/2.
C Cooper does well with pepcid, he took 10mg, 20 minutes before every pred pill
[Moderator's Note. Please do not edit
13 lbs 8.5 years old
True very STRICT crate rest started 12/17
PT stopped 12/16
prednisone as of 12/5: 2.5mgs 2x/day for 3 days, then a 12/8 test taper for: √_pain / _neuro
as of date?; 2nd course of pred for ? days, then another test taper
tramadol 50 mgs 2x/day
gabapentin formula: ?mgs/1mL liquid: ?mgs (1.4mL) 3xPLEASE!/day
needs GI tract protector, Pepcid AC, on board with CARPROFEN or Prednisone! ]
☆ 3 -- Eating and drinking OK? Yes, eating normal (except when on the tram, tram makes him a zombie and typically eats less)(drinking less but putting chicken broth in food for more liquid)
No nausea/ no vomit. no vomit, no nausea that I can tell.
-- Poops once every other day or so....I try to get him to eat pumpkin to soften it up. It hurts when he poops. Poop color/feel/shape is okay. no diarrhea
☆ 4 Dachshund, Cooper, Bridget (owner)
☆ 5 diagnosis of IVDD
"suspected ivdd" - they said they can't confirm without MRI which is estimated 4k.
-- Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho? - not sure.
☆ 6 What was the date you saw the vet for CONSERVATIVE treatment?
I saw ED vet on 12/3 - did not offer conservative treatment. Saw primary vet on 12/14, she mentioned there was nothing more to be done. No one has mentioned conservative treatment.
☆ 7 He is hit or miss on expressing his own bladder. I believe that he realizes he needs to go and pops his head up from a nap. This cues me to take him outside but only 50% of the time does he actually when outside. If he doesn't pee when we are outside, he pees immediately when we get in. Maybe, I'm not giving him enough time outside? I've tried the sling method, with his penis, pee gets everywhere so we have better luck me just holding his legs up and him walking.
☆ 8 Currently can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk?
Complete paralysis of hind legs and tail. back legs criss cross
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 17, 2020 18:22:05 GMT -7
Bridget, we are glad you are here. I'm sorry you are dealing with a primary vet who does not know IVDD on top of grieving for your dad. All is not lost for Cooper. He just needs a vet who knows IVDD. Sounds like the ER vet knows IVDD.
It would be best if you can call the ER vet who has seen him so that over the phone you can get help. Also same if you can get your primary vet to help. Another vet will require a transport in before he can Rx. I'll look to see if I can find a Nashville area vet.
Right now can you call ER vet at this time of night to get things started for Cooper's pain? Another ER in same clinic can access Cooper files and also could over the phone Rx meds.
ADVOCATE for:
-- a longer than the 12/3 very, very short 3-day initial course of prednisone. Ask for a 7-day or a 14-day course.
Taper days do NOTHING about the swelling, they are the time to see if there is swelling and then if there is painful inflammation still get back up on the anti-inflammatory level of 5mgs every 12 hours. A total of several courses may add up to 7-30 days on pred before all the swelling will be gone. So Rxing a pred course and test tapering is to see if another course is needed or not. This way dog does not stay on pred any longer than necessary---a safety practice vets use.
-- pain med used at the aggressive dose a disc episode demands
1) tramadol 50mgs PROMTLY every 8 hrs-- never as needed!.
2) methocarbamol every 8 hrs for the muscle spams pain associated with disc episodes.
3) gabapentin for nerve pain PROMPTLY every 8 hrs.
-- Stop going for any PT/rehab during the 8 weeks it takes to heal the disc.
PT may have caused a relapse to the early healing disc.??? and/or the pain can be due to the pred taper telling everyone who knows IVDD another course was needed.
-- Disc healing happens when there is 100% STRICT rest 24/7. Only out of the recovery suite for potty times and most urgent of vet visits. Laser therapy if you want it should be by a home visit to eliminate unnecessary vehicle transports that can be too much movement for a healing disc.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 17, 2020 18:30:44 GMT -7
PEPCID AC (famotidine) for the duration of any anti-inflammatory drug (steroid or NSAID) Dogs don't speak up at first signs of stomach damage like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach. Proactive vets don’t wait til there are red flag signs of: 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. www.1800petmeds.com/Famotidine-prod11171.html 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). thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg 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 Excellent reading about use of anti-inflammtories during a disc epidode: dodgerslist.com/2020/04/18/steroids-vs-nsaids/ |
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Post by Bridget & Cooper on Dec 17, 2020 19:00:00 GMT -7
Thank you for your help. I've taken your advice and called the E[mergency]D, and unfortunately, the ED cannot prescribe any medication without a visit. And my primary vet doesn't think there is a problem, I just saw her earlier this week where she told me Cooper cannot feel a thing and to stop all medication INCLUDING THE PRED. I didn't listen to that advice and I refuse to go back. I believe that to get the help I need, I will need to shop around for vets until I land on one that understands what to do and how to help. I don't know if I have that kind of time.
I do have left over Carprofen- is it wise to give the pred a few days to wash out and then start him on that? At least I know it's an anti inflammatory... I'm just desperate and can't understand how 4 providers have not once mentioned conservative treatment.
I will stop PT. They were actually advocates for Coop and that was one light of positivity we have had in this entire journey. But, I understand that it cannot be good for him.
We also have to travel for Christmas - we need to be around family for the holidays since my dad's passing. Any tips of making an 8 hour comfortable or possible for him?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 17, 2020 20:10:14 GMT -7
Do NOT switch from one class of anti-inflammatory (such as from a steroid pred to a non-steroidal NSAID carprofen. Requires a 5-7 days washout. Cooper is in pain now. That just can't be. I'm sorry ER doctor is being obstinate...he has access to Cooper's file at same ER clinic Cooper was seen on Dec 2??? Please always use dates as it is very confusing and time consuming to try and figure out event sequences etc without a date. We don't want to make any mistakes in our comments. If you must, then you must go tonight and get those meds right as outlined above 1) Prednisone course of 7 or 14-days, then pred pills to carry out the pred taper. 2) Three pain meds to address each source of pain. Given PROMTLY every 8 hrs. 3) Pepcid AC (famotidine) to protect the stomach. With properly compliment of RXs, Cooper will be out of pain within an hour and he can travel with you inside of a recovery suite (wire crate). Secure the crate in back seat. Pad out any extra space in suite with blankets snug up to his body. This keeps the back from shifting has you corner or come to a stop. Specialists are not just for the purposes of a surgery. They deal with pain every day. They know meds that local vets may be uncomfortable in using. Explain your dog is a lot of pain and you financially can't do a surgery. You need help tonight or with an a.m. appt. Cooper needs help with meds because you local vets are uncomfortable in their knowledge about IVDD. Board-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals or private practice. Directory for Veterinary surgeons (ACVS) and neuro surgeons (ACVIM) is here : find.vetspecialists.comDistance from Nashville, TN: Nashville Veterinary Specialists and Animal Emergency Hospital Nashville, Tennessee, United States (615) 386-0107 3.8 mi away Nashville Veterinary Specialists Nashville, Tennessee, United States (615) 386-0107 3.8 mi away BluePearl Veterinary Specialists Franklin, Tennessee, 15.1 mi away Harpeth Valley Animal Hospital Nashville, Tennessee Within 1 mi What date do you start your 8 hr trip? |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 17, 2020 20:20:34 GMT -7
SWItCHING from Pred to Carprofen It is possible to do right away tonight without 5-7 days of washout. BUT ONLY IF a vet prescribes sucralfate in addition to your using over the counter Pepcid AC (famotodine). This is the necessary double stomach protection for not doing a washout. Read about sucralfate and how it gel coats over the damaged area of the stomach lining. Know the timing of it with food, with Pepcid AC: marvistavet.com/sucralfate.pmlUnderstand Pepcid AC and how it works to suppress the acids before they can damage the stomach: marvistavet.com/famotidine.pmlExcellent reading Anti-inflammatory use with PEPCID AC: dodgerslist.com/2020/04/18/steroids-vs-nsaids/Since you can find no vet to Rx without going in for a visit, it would be better to stick with Pred as it is the strongest of the two anti-inflammatory classes. No washout to deal with |
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Post by Bridget & Cooper on Dec 18, 2020 7:08:46 GMT -7
I took Cooper to Nashville Veterinary Services this morning (12/18) to the Emergency room. Again; they pushed surgery. I explained that surgery is not an option, esp after being paralyzed for 2 weeks. The doctor basically told me if we can’t manage his pain then we need to rethink of quality of life. And I pushed for prednisone , anti-inflammatories, anything. The [Kelly Himeback, DVM] doctor said that it would be best to get another neurologist consult - so Cooper is staying at NVS and awaiting the ER doc and Neuro to look at him and get a treatment plan. Based on my initial conversation with the ER vet, I have lost all hope. No one believes in conservative treatment, no one believes he can be pain free. |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Dec 18, 2020 7:39:11 GMT -7
Please don't lose hope. You have the new knowledge about IVDD that you have gained and you know you're on the right track for Cooper. I'm so sorry you didn't find a more knowledgeable vet in the ER but hopefully the neuro will come up with a good treatment plan for Cooper. Stay strong and be a strong advocate on behalf of Cooper. I know it's not easy when faced with such conflicting advice but do hang in there.
Far too many vets are taught that surgery is the only option. Far too many vets are not taught how to treat conservatively. Far too many vets believe that a dog cannot have a good quality of life if they can't walk or that there's little hope of the nerves healing with time. We have seen many, many vets who have had quite a surprise when they learn just how much healing can and often does occur with conservative care. Vets can learn a thing or two, too. That's why Dodgerslist does the work that it does - not only helping members here on the forum but also reaching out to vets with educational material.
Do let us know what the neurologist says after the exam. Stay strong, stay positive and never give up hope! You're now armed with the knowledge that you need to advocate for the correct medical treatment Cooper needs. Prayers for you, Cooper and the vets.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 18, 2020 10:21:34 GMT -7
Bridget, excellent comments by Marjorie above.
Let me chime in with resources about conservative treatment. There is still hope that the failure for correct treatment by previous vets can be turned around by a vet who knows IVDD. Fingers crossed Cooper will get the chance he deserves to heal by the vet he sees today.
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Post by Bridget & Cooper on Dec 18, 2020 14:16:01 GMT -7
Thank you everyone!! The neurologist [Williams,DVM, ACVIM] today (12/18) was VERY helpful. The neuro still pushed surgery and estimated over 90% recovery with surgery and only 60% recovery with strict crate. I still am on the crate rest path as surgery is not financially feasible.
The neuro did say he had VERY sight deep pain sensation which is GREAT to hear.
Medications:
Continue ▲tramadol 50mg and ▲gabapentin 1.4ml every 8 hours a day.
Start:
✙diazepam 5mg for 1 week
✙Amantadine 10mg once daily until other wise as directed
▲Prednisone 10mg, 2x a day for 7 days, then once a day for 7 days, then every other day for 7 days (will give Pepcid before for tummy)
[Moderator's Note. Please do not edit
13 lbs
PT stopped 12/16
True very STRICT crate rest started 12/17
12/18 Neuro identifies slight DPS
prednisone as of 12/5: 2.5mgs 2x/day for 3 days, then a 12/8 test taper for: √_pain / _neuro
as of 12/18: ▲10mg 2x/day for 7 days. 12/25 test taper : _pain / _neuro
tramadol 50 mgs ▲ 3x/day
gabapentin formula: ?mgs/1mL liquid: ?mgs (1.4mL) ▲3x/day
✙diazepam 5mg ?x/day
✙Amantadine 10mg 1x/day
✙Pepcid AC ?mg ?x/day
All medications were available except for amantadine, which I had to order from the pharmacy I got express 2 day shipping. Starting the rest at 4pm today.
I feel like we are finally making progress. Any other concerns for my Cooper? Any additional tips to get him through these crate days? He is like a zombie on all these drugs which makes it so hard on me. He refuses to lay fully down, keeps his head up for as long as possible. Should I be concerned?
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Post by Romy & Frankie on Dec 18, 2020 15:05:23 GMT -7
I am glad that you neuro visit was helpful. Working with a vet you have confidence in makes a big difference. Cooper having Deep Pain Sensation (DPS) is very good news. DPS is an indicator (only an indicator) of future healing.
Cooper keeping his head up can be a sign of pain if he is keeping it up because otherwise it hurts. Head held up is more common in neck disc issues. Are you getting a sense that it is pain related or is he wanting to keep an eye on what is going on. does he seem restless or unable to find a comfortable position? If you think it is pain related the change in pain meds may help but if not, let the vet know so the pain meds can be adjusted.
I know it is disconcerting when our dogs seem zonked out from meds, but it is a small price to pay if he needs those meds for pain relief.
I am not sure if you have seen these tips on caring for our dog at home: dodgerslist.com/nursing-care-during-the-disc-episode/ |
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Post by Bridget & Cooper on Dec 18, 2020 17:17:07 GMT -7
I don’t see any obvious neck pain. He is able to move it around when it’s time to eat. It may just be an effect of the medication. He just sits straight up but you can tell he is falling asleep. Maybe scared /anxious- especially in the crate. If it persists I’ll let the vet know. It’s just odd because I know he is tired but he is resisting sleep.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 18, 2020 17:24:01 GMT -7
Bridget, I'm over the moon in your fabulous ability to advocate for what Cooper needed! Good job! MED LIST DETAILS 1) How many mgs of gabapentin are in one mL of liquid? Should be written on the bottle. 2) How many times a day do you give diazepam 5mgs?3) How many mgs and how many times a day are you giving Pepcid AC? Should be 5mgs 2x/day.PREDNISONE
The 7-day course of pred will taper on 12/25. Your job will be to monitor for any surfacing pain or increased/new neuro issues and alert the vet so that another course of pred could be started. ____ What is the plan B you and the neuro came up with in case you would see pain or increased neuro diminishment during the taper? Do you have extra pills to give til the surgeon or your own vet can Rx more meds. Do you have the Specialist's phone number so your primary vet can learn about IVDD, can conference w/ neuro to help Cooper. Or are you done with the family vet and only now seeing the specialist? ____ Would you confirm the size of the prednisone tablet in mgs.
____ Confirm if you are to give a whole tablet or half a tablet 2x/day.PAIN MEDS Once meds are on board as neuro prescibed, expect within the hour holding head up, not wanting to relax will subside. I think those pain signs you are seeing. Amantidine works for many dogs. Hoping for Cooper it will be a good add. Read up on this med so you understand it as well as you understand all his meds: The Mar Vista vets explain the mysteries of amantadine www.marvistavet.com/amantadine.pml Would you consider helping another in your neck of the woods to find a vet who knows IVDD by adding to our DIRECTORY of vet recommendations for this neuro who will do conservative treatment even if he first explains surgery! Here is where you can post about your IVDD neuro vet: dodgerslist.boards.net/board/13/member-reported-surgery-costs-recommendations vet recommendations: Name of Vet: _____ Name of Clinic: Nashville Veterinary Services Street Address: City: Nashville State: TN Type of vet: Neurology (ACVIM) Comments: Neuro specialist will use Conservative Treatment; additional comment:______ How about warming up a blanket in the dryer and surrounding Cooper with some cozy, sleep inducing warmth? |
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Post by Bridget & Cooper on Dec 19, 2020 10:19:27 GMT -7
Thank you all for your help.
Gabapentin is 50mg bottle, dosage is 1.4ml every 8 hours
Diazepan is 5mg tablet every 8 hours for one week
I give the 10mg of Pepcid every 12 hours, 20-30 minutes before giving the Prednisone which is also every 12 hours.
[Moderator's Note. Please do not edit
13 lbs, 8.5 y.o.
PT stopped 12/16
True very STRICT crate rest started 12/17
12/18 Dr. Williams, DVM, ACVIM identified slight DPS
prednisone as of 12/5: 2.5mgs 2x/day for 3 days, then a 12/8 test taper for: √_pain / _neuro
10mgs tab as of 12/18: 2.5mg 2x/day for 7 days. 12/25 test taper : _pain / _neuro
tramadol 50 mgs 3x/day
gabapentin 50mg/mL : 50mgs (1.4mL) 3x/day
diazepam 5mg 3x/day
Amantadine 10mg 1x/day - starts ?
Pepcid AC 10mg 2x/day for 13lbs dog should be 5mgs 2x/day]
How will I know to advocate to continue the prednisone? If is pain continues or if he is showing NEW pain?
I actually never spoke with the neuro. All information came through the ER doc [Kelly, DVM] that Cooper initially saw. I could not go inside due to COVID, all information was relayed over the phone. There is no plan B per se. I will make a follow up appointment with the neuro in 3-4 weeks or sooner if any concerns arise.
For medication, I have no extra pills. The emergency vet (nashville vet specialist) does not refill medications. They recommended to work with my primary vet for continued medication treatment or refills. However, my primary vet is awful and I need to find someone that understands his needs and knowledge to increase medication if necessary. I will call the specialist to see if they recommend a primary vet, the ER doc and tech that discharged us could not make this kind of recommendation.
Prednisone dosage: 10mg [tab] - give 1/4 tablet by mouth every 12 hours with food for one week, 1/4 tablet by mouth once daily for one week, 1/4 tablet by mouth every other day for 1 week.
I will do my best to call for the below information since I don't have much:
Name of Vet: Dr. Kelly Himeback [newly DVM] was the ER doc (I believe)
Name of Clinic: Nashville Veterinary Services
Street Address: 2971 Sidco Dr, Nashville, TN 37204
City: Nashville
State: TN
Type of vet: Neurology (ACVIM)
Comments:
Neuro specialist will use Conservative Treatment; additional comment: DO NOT HAVE RIGHT NOW
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Post by Jessica on Dec 19, 2020 11:19:23 GMT -7
Thanks for providing all this information, Bridget.
Cooper will hopefully be feeling pain free with the new medications. Let us know when you are able to start the Amatadine in addition. Getting him to a comfortable spot will make things clearer with determining if more prednisone will be needed in the future.
The first tapering down day begins the test for pain. For Cooper, this will be 12/25, when you reduce the mgs of prednisone. Taper days are no longer working on swelling. Pain meds are also typically stopped or backed down at this point to enable the owner to quickly assess whether there is remaining pain and alert the vet right away.
Your job at home will be to assess just how well reduction of swelling is going by observing for any hint of pain (▪︎shivering ▪︎trembling ▪︎yelping when picked up or moved ▪︎reluctant/slow to move head or body ▪︎tight hard tummy, ▪︎holding leg flamingo style not wanting to bear weight).
Rule of thumb is:
pain = swelling = another anti-inflammatory course, pain meds and Pepcid AC
No Pain= (if on a steroid complete the taper to conclusion). Complete the 8 weeks of crate rest for the disc to heal.
So, if you notice any new surfacing pain or decreased neuro function during the taper period - this would be when you would alert your vet concerning a new round of prednisone.
This also shows the importance of a plan B if you see new pain during the taper, especially while traveling. I understand, though, the difficulty you are having with some of the vets. Paula's idea of a conference call between the neuro specialist and your primary vet is worth asking about. They may be able to come up with a plan to have back-up meds available for you, just in case. Or, can you ask to speak with the neuro specialist directly to ask about a plan B during the taper period? Everything is especially difficult during this time, but you are doing a great job!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 19, 2020 11:39:30 GMT -7
Bridget, Jessica makes some very good points with her explanation of how to monitor for pain/neuro issues. Issues means you will need to quickly alert the vet and advocate for another course of prednisone, all pain meds back on board and of course Pepcid AC.
Pepcid AC for a 13 lbs dog is only 5mgs (1/2 of a 10mg tab) every 12 hrs. Let us know you are making this correction.
You will want to be aware of the credentials for any person at a vet clinic or anyone you speak with over the phone. This way you understand their qualifications and can better judge their comments, ability to prescribe, etc.
---- a receptionist has no veterinary credentials. They can relay your questions to a vet. The vet might call you back or relay through the receptionist his answer.
--- a Veterinary Assistant/Technician may not prescribe any medications.
--- A DVM is a 4 year program of study to be a general veterinarian who can prescribe
--- specialists have the extra credentials after DVM to show certificaition in a specialty. With IVDD that can be either an ortho (DVM, ACVS) or a neuro (DVM, ACVIM). They can prescribe. Only specialists can be trusted to correctly identify DPS.
It appears from a very quick internet search that Kelly Himeback is a veterinary assistant/technician.
When I visit a clinic/hospital, I always ask for a business card at the receptionist desk for each of the persons who treated my dog. Veterinary personnel also usually have a credential tag on their coats so you know who you are speaking with. I understand due to COVID, it can be more of a challenge to learn those important credentials, so do not be shy to ask the person who is speaking to you.
Would you be able to take a picture of the Gabapentin bottle so we can read how the formula is written on the bottle?
The formula should be specific in indicating number of gabapentin mgs per mL of liquid.
EXAMPLES: 50mg/mL, 250mg/5mL , etc.
Any of the above examples would allow US to do the math to verify the actual mg amount of gabapentin you are giving.
Can you confirm what person (credentials?) who said Cooper: "had VERY sight deep pain sensation? We can only trust this info if the Neuro Specialist's eyes had been on Cooper to give this DPS comment.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 19, 2020 12:08:59 GMT -7
Bridget, good charts to print out for Cooper's file you take with you for the trip. Chart of pain signs resurfacing to monitor during prednisone taper test. SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or moved ◻︎ slow to move ◻︎ tight tense tummy ◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions ◻︎ 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 ◻︎ not their normal perky selves Chart of neuro diminishment to monitor during prednisone taper testAs 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. Would you updated us on Cooper's bladder neuro function (reflex overflowing OR can pee with purpose on the right spot)? Whether he is auto overflowing due to reflexes or can control evidenced by ability to sniff an old pee spot and decide to release urine there? Leaking on you or urine in bedding is often by reflex called overflowing bladder. Prednisone causes extra thirst and more often need take outdoors to pee. Or if lost bladder control, needing to be expressed every 2-3 hrs when first learning. Moving up to every 6-8 hrs with practice and proficiency improvement: dodgerslist.com/2020/05/05/bladder-bowel-care/ |
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Post by Bridget & Cooper on Dec 19, 2020 12:27:34 GMT -7
I can alter his pepcid amount. I was giving the 10mg dosage because the instruction by the first ER doctor, Dr. Elliot [DVM] from Blue Pearl Franklin, that we visited on 12/3 recommended this amount when prescribed the 3 day prednisone. I just called Nashville Veterinary Specialists to get the names. Dr. Kelly Himeback [DVM] is a new ER doctor there. Dr. Williams [DVM, ACVIM] is the neurologist. Dr. Williams is the one who said he had light DPS. I also requested DR. Williams to call me when she gets in the office on Monday 12/21 to discuss plan b options and recommendations for primary care vet. How soon after the prednisone is tapered will he show symptoms of pain? Should I expect to see these immediately on the taper day or after a 24 hour period? I'm not sure I know how to upload a picture on here. But as it is written on the bottle: Gabapentin (gen) 50mg/mL/mL Give 1.4ml(s) by mouth every 8 hours for 10 days or as directed by your veterinarian professional. The gabapentin in liquid and I use a tube for dosage. This prescription was continued from my primary vet. I will be using an online pharmacy for future refills and should expect a 90 day supply in the mail soon. I feel like there are a lot of moving parts with our journey that make it more complex than necessary. Appreciate all the help and quick replies!! Most of the time he does the overflow reflex in sleep/napping. I try to take him outside every 2 hours or so - but it's challenging living in an apartment complex during COVID. I would say 50% of the time he pees when outside. I do believe he cues me that his bladder is full. For example, when he wakes up from a nap and gets agitated, I know that he has to go and get him to a pee pad in the apartment. I'm noticing that he usually goes twice. Will pee an initial amount and then within minutes go again. I've tried expressing but it's really difficult. I've read all of the tips on dodgerslist and have watched youtube videos but just can't find the spot. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 19, 2020 13:28:13 GMT -7
Bridget, yup getting ready for your trip has so many moving parts cause you don't have the support of a good local IVDD vet. Still you are making good headway!
What is the date you start the trip?
I don't know the reason why The ER DVM wanted such a high dose of Pepcid AC. The many 1000's of vet Rxs you see on this Forum kinda stick to the usual dose:
Thank you for the gabapentin formula as printed on the bottle:
Gabapentin (gen) 50mg/mL no need for a picture now.
Dogs vary in length of time they might show signs that not all swelling is gone. Depends on how fast each dog's metabloism is. Some may show pain or neuro diminishment the same day the taper starts while other can be days down the line.
A pee pad adjacent the suite is just fine.
It is good to hear he has the ability to not release urine til you set him down on the pad. BUT have you seen him take a sniff if you place a bit of old stained pee pad in the new pad? Best way is to confirm bladder control is "Sniff then pees" to be sure his brain can send a message. The reason we are persnickety on this issue is that a bladder not expressed when a dog really doesn't have bladder control can quickly develop urinary tract infection and can move up into the kidneys. Cooper doesn't need another serious health issue needing an antibiotic on board on top of his disc episode. Something to keep an eye on:
--- Not all UTIs will show these usual signs: foul odor, change in color, blood in urine. When in doubt a dog has bladder control, a urinalysis can prove bacteria or not.
At potty time on the pad, can you let him do the initial urine release. Wait a minute or so and then set him back down on the pad for the 2nd release?
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Post by Bridget & Cooper on Dec 19, 2020 14:22:51 GMT -7
I start the trip tomorrow. Cooper knows this ride very well and usually sleeps the entire time, so I'm praying for that tomorrow. However, he usually lays in a canvas car seat, not in a crate. Even now, when he is crated at home - he uses his nose/front paws to try to dig his way out. Him stressing in the crate and doing his body more harm is what worries me.
I'll keep an eye out for the sniff test. A UTI does scare me and Dr. Williams made notes of this on the discharge form as well as provided a handout on bladder expression. So, I am sure to look out for one. Right now when he needs to pee, I'm assisting him and holding his back legs (the belt/scarf trick doesn't work for us) while he walks. Is this okay movement? He walks very minimally and not for long but that has worked best for him when he needs to potty.
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Post by Romy & Frankie on Dec 19, 2020 14:36:28 GMT -7
If Cooper takes a few steps at potty time that is okay as long as you keep in mind the goal is minimal movement.
Supporting his legs while he pees his fine but rather hard on your back. Have you tried using a figure 8 sling? I used this when I needed to sling walk my dog. He did not like any other type of sling. You can make one out of two leashes. We have info on that here: dodgerslist.com/2020/05/14/strict-rest-recovery-process(Information on this sling is located on the right side of the page under "Potty Time")
You might find that the movement of the car helps Cooper sleep. My dog would almost always sleep in the car (my kids also). |
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Post by Bridget & Cooper on Dec 21, 2020 9:27:04 GMT -7
The drive up went well. He did sleep most of the car ride and I made extra stops for him to potty more frequently. Luckily, he is used to this house (it's my family's lake house and he has been here countless times) and he has his own crate here but we are still working on getting a routine down in a new environment with more smells, dogs, people, etc.
He is sniffing and peeing which sounds like it's a good sign! He seems to go about every 2-3 hours. Sometimes when he needs to use the bathroom, his "red rocket"/ protuberance comes out. Is this normal?
Still waiting on the amantadine to be shipped, will this medication make a huge difference? His pain is being controlled without it [Amantadine]. But worried when the pred tapers... If I need to advocate for more pred, how much steroid is too much? I worry about him needing another round and it hurting his tummy.
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Post by Jessica on Dec 21, 2020 11:00:32 GMT -7
I'm glad to hear the ride was successful, Bridget. Hopefully, Cooper will be able to settle in well and get his rest in. If there is too much excitement in your new location, there are a few tips that you may be able to adopt in your new location. You could cover the top of the crate with a towel to give a cozy feeling, add a garment you have been wearing but not washed into the crate, and fill a Kong with soft food to freeze. More ideas can be found here: dodgerslist.com/tag/calmers. Prednisone causes increased thirst and urination. Taking Cooper out every 2-3 hours while on a steroid is often appropriate. Have you noted he's doing a deliberate sniff and then pee on a spot each time as of recently? Have you noticed any leaks on you or bedding lately? Does his penis stay out, or is it just prior to urination? If it's for an extended time, or seems uncomfortable, you can try a splash of cool water to make it retract. KY jelly, or similar may help the penis more easily slide back in the sheath. Neuro corner Q&A here: dodgerslist.com/2020/08/20/penis-comes-out-of-sheath-treatments/%E2%80%8B?highlight=penis%20out%20of%20sheathI'm glad to hear his pain seems well controlled with his current regimen. It's good to have the Amantadine on hand when it comes in, but you can check with the neurologist if/when it should be administered. Make sure the medications are fully controlling pain from dose to dose with no break-through in pain nearing the next dose. It's possible what you have now is sufficient and all that's needed. It can take anywhere from 7-30 days (totaling several courses) for a steroid or a non-steroidal to resolve all swollen tissue around the spinal cord. A vet must take an educated guess on how long it might take to resolve swelling. Often the first course will be a 7- or 14-day anti-inflammatory course. Additional course(s) if there is still pain. Your job is to monitor for any new emerging pain after the taper and alert the neurologist. If Cooper needs to continue with the prednisone, you can continue with the 5mg of Pepcid AC 30 minutes prior to before the steroid and thereafter every 12 hours. Do you notice any signs of GI upset? Is Cooper eating and drinking OK? No nausea, no vomit? Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea? These are things you can discuss with Dr. Williams during her call back today - what to do if pain resurfaces, thoughts about the Amantadine, and if additional stomach protection is recommended if a new course of prednisone is required. |
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Post by Bridget & Cooper on Dec 22, 2020 10:02:37 GMT -7
This vet process continues to be a nightmare. Dr. Williams had not called me back yesterday (12/21) so I called NVS and again, asked to be called. Today (12/22) I was called back by a tech who obviously had no knowledge of my dog or our situation. I demanded to be called back my Dr. Williams but apparently the consultation from Dr. Williams [ACVIM] on 12/18 did not mean that Cooper was not her patient. I don't understand how this is even possible. The tech on the phone said that Dr. Himeback could call me back to discuss a plan B. Apparently, Dr. Williams was consulted with Cooper but Dr. Himeback [DVM] ultimately prescribed the medication. But, I paid for a neurology consultation so I'm trying to understand. I'm losing it and I demanded that Dr. Williams call me to give me answers and recommendations.
Again, I feel like because I can't afford surgery I am treated unfairly. It's maddening.
I do not understand how this is possible.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 22, 2020 11:10:38 GMT -7
Himeback, DVM, has learned from Williams, Neurology (ACVIM), from what he recommended for Rx's. Himeback should be able to address your concerns over the phone about Plan B if pain should surface during the tricky time beginning on 12/25 through the holidays. Explain due to a death in the family you have had to travel to a city where you do not have a vet and don't want to have to start all over things with a new vet who may or may not know IVDD.
Also the hospital where Williams works, maintains a file on Cooper. That means should Himeback be on holiday, then another DVM vet in that hospital can access the file to see see the comments neuro Williams made. Thus another vet can adjust meds with file information without a requirement to have an exam first. Any new vet from a different clinic would need to first examine before Rxing. That is the rub that now you are in a new town.
This all has been way more of a challenge re: vets than it should have been. I feel your frustrations. Please do keep us posted on which credential vet (DVM, or neuro) you are able to make contact with. Fingers crossed you will get your answers before offices close on 12/24.
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Post by Bridget & Cooper on Dec 22, 2020 13:45:04 GMT -7
This forum has given me the knowledge to advocate and ask the right questions. While I still have not spoken to a neurologist, the tech/care coordinator of the neurology department was able to relay my questions to Dr. Williams. The middle man seems unnecessary but I'm trying to understand the busy season for Dr. Williams. Although, it is beyond frustrating for me as a first time doxie owner.
For a plan B: Dr. Williams will provide an additional regime of prednisone [if pain is seen during taper], if when tapering, Cooper is still in pain. As of today (12/22) he is not showing any GI problems and his pain is continued to be managed. Cooper continues to eat and drink ALOT. Sniffing and peeing too. His bowel movements, while sporadic, have been soft due to pumpkin I've added to his diet, but they are healthy. Color is good and there is no blood.
Cooper's follow up appointment was suppose to be in 3-4 weeks but due to availability, the first opening was Jan. 28th. The gabapentin and amantadine should last me until then and if I need additional prednisone, I can pick it up at NVS, should Cooper need it.
I also explained the stress of crate rest for Cooper and Dr. Williams has prescribed ✙trazadone for anxiety which I will pick up as soon as I return to Nashville (either Saturday 12/26 or Sunday 12/27). Right now, we are doing our best in the crate. A blanket over the crate and me staying VERY quiet in another room downstairs has worked best. This makes it difficult to monitor him but I make sure to check everything during bathroom breaks.
Amantadine has finally been shipped and should arrive to me tomorrow.
[Moderator's Note. Please do not edit
13 lbs, 8.5 y.o.
PT stopped 12/16
True very STRICT crate rest started 12/17
12/18 Dr. Williams, DVM, ACVIM identified slight DPS
prednisone as of 12/5: 2.5mgs 2x/day for 3 days, then a 12/8 test taper for: √_pain / _neuro
10mgs tab as of 12/18: 2.5mg 2x/day for 7 days. 12/25 test taper: _pain / _neuro
Cooper travels out of town 12/21-12/26
tramadol 50 mgs 3x/day
gabapentin 50mg/mL : 50mgs (1.4mL) 3x/day
diazepam 5mg 3x/day
✙trazadone as of 12/26
Amantadine 10mg 1x/day - starts 12/23
Pepcid AC 5mg 2x/day; for 13lbs dog should be 5mgs 2x/day]
This support has been necessary to my sanity and Cooper's life/recovery. MANY THANKS TO ALL.
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Post by Romy & Frankie on Dec 22, 2020 14:24:14 GMT -7
I am glad that the neuro has agreed to prescribe more pred if pain is seen during the taper. Pain during the taper means that there is still inflammation of the spinal cord and there is still work for pred to do.
The eating and drinking a lot is almost certainly a side effect of the pred. Once Cooper starts the taper his appetite and thirst should start to return to normal.
Trazadone works well to decrease crate rest related anxiety in many dogs. The blanket over the crate is a good natural method of calming. There are other natural methods using Dog Appeasing Pheromone (DAP) diffusers and oral calmers. I am not sure if you have had a chance to take a look at the tips on the page below. It contains more information about these natural calmers and other ways to keep a dog calm in the crate. dodgerslist.com/tag/calmers |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Dec 22, 2020 16:27:22 GMT -7
Bridget, this is good to hear if another course of pred should be indicated with pain appearing on the taper, neuro Williams will Rx.
At the begin of the taper on 12/25 if pain is to show it could show on 12/25 or even many days later. Just can't tell because each dog is different, each dog has their own rate of metabolism. Fingers crossed this 7-day pred course will do the trick of resolving all spinal cord swelling.
Normally at the begin of a pred taper, all pain meds (tramadol, gabapentin, diazepam and amantadine) would be either:
-- Backed off by dose mgs and/or how often given on 12/25.
-- OR all pain meds.... Full stoped on 12/25
-- this is the judgement call of the neuro and his choice.
Pain meds naturally would block your ability to correctly identify existence of resurfacing pain if there would still be remaining inflammation and painful swelling needing prednisone back on board.
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Post by Bridget & Cooper on Dec 26, 2020 20:48:18 GMT -7
I will call Dr. Williams now that Cooper and I are back in Nashville. On the last call they said to continue Gabapentin, Tramadrol and Amantadine until the follow up appt. But, this doesn't make sense if I am monitoring his pain while the prednisone is tapering. I continue to look for signs of pain now that the prednisone is tapering. The only time he looks to be in pain is during bowel movements. But after he completes, the pain subsides.
He also stood up on all paws on Christmas - a true Christmas miracle! He stood up for about 30 seconds all on his own. He doesn't do this all the time or that often but he definitely tries to walk and stand in his crate. Any tips on what to do and how to manage this? He doesn't try all day but I worry this will ruin his recovery as he can fall over.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 27, 2020 6:52:42 GMT -7
The fact that Cooper is showing pain when having a bowel movement means that the taper of Prednisone should NOT continue and Cooper needs to be immediately returned to the anti-inflammatory dosage for a bit longer (2.5 mg 2x/day). Has the vet given you permission to immediately start that dosage at the first sign of pain or do you have to get in contact with him? It's common for more than one test taper to be done before all signs of pain/swelling are gone so this is all part of healing.
Wonderful news that Cooper stood on all paws. Was he able to get up to a standing position by himself? It's OK if he tries to stand up and turn around to reposition in his crate as long as he then lies down and rests.
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