Jenny's Mia 12/15 conservative - Maltese Mix; GRAD 2/9

Welcome Jennie!  Mia is an EXCELLENT candidate for a good recovery under conservative treatment, if you can commit to the true principals of conservative. What you need to know about the very STRICT rest recovery process:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/

Glad to hear there is no pain, meaning the one pain med is enough.

What is the date the prednisone taper is to start?
Make sure you are prepared with a Plan B, know your job at  home when the test for pain prednisone taper starts.
     Prednisone, like all steroids, is an unusual med in that it may not be abruptly stopped. Pred is a synthetic hormone which has the body thinking it no longer needs to make its own cortisol hormone which regulates life-giving body functions. The taper is to signal the body to again make cortisol.  That taper just happens to be a perfect test for painful swelling for IVDD dogs!  Here is how that "test for pain" taper works:
--- The vet takes a guess usually at the 7- or 14- day pred course that all the painful swelling might be gone.  
--- The vet calls for all the pain-masking pain meds to be either backed off of stopped.  Let us know which your vets wants on the date of the taper.
--- The vet also calls for the prednisone to begin a taper to a lower mg dose/ fewer times/day
--- Your job at home is to watch for any hint of pain and report to the vet at once.
-- With the report of pain, prednisone would go back up on the anti-inflammatory dose level (5mgs 2x/da) for a bit longer to try and get all painful swelling down.  All pain meds would be on board as well as Pepcid AC.
---  Getting all the swelling down can possible take from 7-30 days excluding any days that pred is at the tapering lower dose/frequency.
--  Always have a plan "B"  in place with the vet during a taper on what you should do should pain surface.  A plan "B" might be an Rx you could fill or having enough meds on hand should that happen over a weekend or evening when the Vet is closed, to save an expensive ER visit. 
--- The full details on how Prednisone, an anti-inflammatory works with a disc episode. Good reading to be able to ask the right questions and discuss treatment:
dodgerslist.com/2020/04/18/steroids-vs-nsaids/

Thanks for your response, Paula!
Her Prednisone is taken 1x/day starting today 12/19, then after 3 days would be every other day.

[Moderator's Note. Please do not edit
7 lbs    3 y.o.
prednisone as of 12/16 higher than anti-inflammatory dose:  5mgs 2x/day for 3 days
                      as of 12/19 anti-inflammatory dose: 5mgs 1x/day for 3 days, 12/22 taper test: _pain/_neuro 
Gabapentin formula ?mg/mL: ?mgs (30mL) 2x/day
needs GI tract protector, Pepcid AC, on board w/prednisone! ]

Regarding, limited movement, how much movement can she actually make that won't damage her disc even more?
She tends to circle around in her bed to find the right spot, which usually takes 2-3 mins.
And she also circles around to poop.

Sorry, I didn’t clarify earlier, her dose of Gabapentin is 50mg/ml - 30ML.
Thanks for mentioning her recovery suite. We are slowly transitioning  her rest area a little tighter with just her crate and pee pad to limit her movement. I also do want to mention that Mia has never been crate trained, and just the thought of her in one will really scare her. I can already guess, she will cry for hours— which will be very hard. 

And to answer you, yes, it did take her 2-3 minutes to reposition herself, I had it all recorded from an indoor camera. But lately, she hasn’t had that problem and could find her resting spot in less than a minute. It's just now she gets very bored so she just sits in one spot.

I have been doing a lot of research and I have a few questions regarding flare-ups/episodes/relapse?

1. When the 8-week crate rest is over, will the disc be fully healed? 
(I do understand that she could have another disc episode in the future and that only time can heal nerves)

2. Does disc episodes happen out of nowhere or usually from jumping/running/leaping?

3. How do stages work in IVDD? I've been reading that some dogs can go from Stage 2 to Stage 5 during the next episode, I'm not sure if it because of how hard the dog injured themself or you just can't ever tell

Thank you, I am trying to learn as much as possible so I can prevent Mia from another episode. You all have been very helpful!

Try to keep a happy voice and face around Mia. Dogs are very sensitive and pick up on our feelings very easily. Tell her everything's OK and that she's getting better every day. And you believe it, too!

Here are some tips to help calm your dog in the crate. If these do not help, it may be necessary to have the vet prescribe a mild sedative.

To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him/her. It also creates a den like feeling that dogs love.

Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price.

Place a DAP pheromone diffuser at floor level where the recovery suite is.
Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones

Use a diffuser with one oral calmer from below:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba)

Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc.

Consider some of these ideas:
-- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising and only inside during conservative care. More details on strollers: www.dodgerslist.com/literature/strollers.htm

--Caster wheels can be added to a wire crate so the crate can be wheeled from one room to the next so your dog can stay with you.

-- Put a garment you have been wearing and have not washed in the crate.

-- Nan Arthur, CDBC, CPDT, KPACTP writes:
"According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day.
Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.]

-- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from on high.

-- Play classical music or one of the wildlife TV shows.

-- Fill a Kong with soft dog food and freeze. Put part of the dog's total daily dinner kibble in the Kong to lengthen time to consume dinner. Good low cal snacks are carrots, apples, or frozen green beans, licking a frozen low sodium broth ice cube. Good thick low salt/no fat chicken broth is full of cartilage-building proteins and amino acids. Freeze it up into cubes for easy access as you need it. Fun and keeps the body hydrated: place cubes in a bowl for licking.

If a dog is jumping up at the sides of the crate, you can lower the ceiling of the crate. Cut a piece of cardboard the size of the top of the crate, punch holes in the corners and tie the cardboard down into the crate to the level of the top of the dog's head when standing. Or cover the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he/she jumps up, he won't be able to see anything. That may discourage him/her from jumping up.

dodgerslist.com/2020/05/14/strict-rest-recovery-process/

dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite/

The reason for stopping or at least tapering the pain meds (Gabapentin) is so you have a clear picture of whether there is still pain or not. Pain means there's still swelling. If there's still swelling, then there should be no taper of the Prednisone and another course of Prednisone needs to be done. If no pain arises, then the taper can continue to the end and no meds at all are needed any longer. Pain = swelling = more time on all meds for a bit longer. It can take 7-30 days for the pain/swelling to resolve so it's common for there to be more than one taper to occur. Please speak to the vet this morning about stopping or at least tapering Gabapentin so a true test for pain/swelling can be done. With the holidays here and vets' offices closing, please sure to get their permission to return Mia to the anti-inflammatory dosage of Prednisone and the original dosage of Gabapentin should pain occur when they're closed. The anti-inflammatory dosage for the Prednisone for a dog of Mia's weight is the 5mg 1x/day that I believe is currently being given.

Pepcid AC (5mg) should be given 30 mins. before the Prednisone and then every 12 hours thereafter for as long as Mia is on any dosage of Prednisone (5mg 2x/day).

In looking at the photo of Mia's recovery suite, there are a couple of concerns. The door to the crate needs to be closed at all times except at potty time, at which time you can open the door to allow Mia to come out to potty, then go right back into the crate to rest and heal. Food and water need to be in the crate. Here is a bowl holder that can easily be made to hold her dishes so they don't spill:



You can clean Mia with unscented baby wipes. Possibly dampen a sponge or cloth and hold it for a bit on the poopy spot if it's hardened to allow it to soften for removal. It may be necessary for you to clip the long hair around her butt area to help keep it clean during the crate rest. If she gets urine on her, and it can be used for poop, too, brew up a pot of decaf green tea, let it cool, dampen a cloth and gently wipe her legs and belly with that. Green tea neutralizes the acidity of urine and leaves a nice clean scent.

Please let us know what the vet says after speaking to them this morning.

I spoke to the vet again today [12/27] via text messages.

Dr. Cruz said I should continue giving Mia Gabapentin(50 mg/ml - .3ml) 2x/ day and Prednisone (5mg) every 48 hours until she is back to normal . "If she is not then she might need this meds for months".

He also mentioned that as long as I don't see any bad side effects then I should continue Gabapentin for another 2 weeks of 2x/day. "Gabapentin has a effect on helping the neurological system."

Quotes are directly stated by Dr. Cruz

Also, I have started giving Mia ✙Pepcid AC yesterday.

[Moderator's Note. Please do not edit
7 lbs 3 y.o.
prednisone as of 12/16: 5mgs 2x/day for 3 days
                           as of 12/19 anti-inflammatory dose: 5mgs 1x/day for 3+2 days, 12/24 taper test: _pain/_neuro
Gabapentin 50mg/mL: 15mgs (0.3mL dose) 2x/day
✙Pepcid AC,  ?mg    ?x/day 

Hey Paula!

I do understand that there are no meds that can speed up her healing process which is why
I was just as shocked as you to hear that he wants Mia to be on the meds for months. (if she’s not back to normal)
and to clarify, what he meant by “Normal” is Mia’s ability to walk again. - I mentioned to him that Mia was still wobbly.

Dr. Cruz is a DVM Family vet.

I'm trying to educate myself as much as possible but with the information that was given by Dr. Cruz, I feel like I'm just more confused than I should be.

Can you give me a suggestion as to what I should do next?
Should I lower her dose of Gabapentin to every 24 hours?

Thank you

Hi all- I have a question, today I noticed Mia has been putting less to almost no pressure in her back legs/paws. I noticed this when she was sitting in her crate. And also, one of her back leg was in between her front legs while she’s laying down.

It this something I should worry about?

I let her out the crate to pee and she’s able to walk (not perfect) and stretch.

is the not walking perfectly something increased today?

What does "not perfectly" encompass exactly and note if new or increased issue
--- paws knuckle under
--- wobbly
--- crossing back legs

It is all about seeing the patterns, the date with the relationship to changes in meds and changes in neuro or pain. 

Crying and whining can be a sign of pain but can also be requests for attention. What is more likely a sign of pain is the reluctance to move. When we are trying to determine if our dogs are in pain we often look for a second, confirming sign of pain. I am putting the signs of pain again here for your easy reference; shivering, trembling yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy, can’t find a comfortable position, arched back, holding front or back leg flamingo style not wanting to bear weight, head held high or nose to the ground, not their normal perky selves?

If you are seeing any of the other signs of pain, it is quite likely like Mia is in pain,  Is the reluctance to move something recent that could be related to the change in meds or is she usually relatively still in the crate?   If the reluctance to move is new, and you are seeing any other sign of pain, please let the vet know. Pain would mean that there is still swelling in the spinal cord and more time on the original anti-inflammatory and  pain meds are needed.

You have a good question. Knowing the answer ensures the ability for owners to make sure the disc has healed.

During conservative strict rest treatment, if the dog does too much movement, then the disc has the potential to re-tear. That is a new tear to the early healing disc. With a tear, the new or increased pain will happen. The re-torn disc can then lead to painful swelling in the spinal cord.  A tear takes 8 weeks to heal from the date the tear happened.   Swelling takes an anti-inflammatory to get it resolved.

On the test taper for pain that started on 12/24, then if pain were to surface it would be related to less pred in the body as it tapers and leaves the system...signaling the need to get back up to the anti-inflammatory level to finish working on painful inflammation in the spinal cord.


Is Mia ok? Are you seeing new pain?

I am so happy to hear how well Mia is doing without any meds.

Have you tried any of the calmers, Marjorie suggested? That could help with the crying for attention.

The weakness in the legs are a sign of the nerve damage. Time may heal this. My dog Frankie slipped a lot after his IVDD episode. I put down a lot of carpet runners. He had much more traction on the carpet than the bare wood.

Jenny, dogs always do the unexpected in a blink of an eye. Something floats past a window, the TV door bell rings, etc. Critical to the disc's ability to heal is limited movement of the spine the recovery suite provides. Failure to provide a dog a safe place to heal in is not an option!

We see reports all too often that go something like this…..was doing amazing until I let her lay with me on the carpet to watch a movie! I got up to close the front door and within a second she tried to go up the doggie stairs to the couch! She screamed in pain! I feel so responsible for her going backwards in the healing process when I was warned. Just didn’t believe my little girl could/would do this!.

I hope you see the importance of not being outside the protective environment a recovery suite provides. Only out of the suite for a very few footsteps at potty time and only for vet visits when of the utmost important that a phone call can not do. Graduation day from very STRICT rest that a recovery suite provides is on Feb 9. I know I would be heart broken to read any thing bad had happened to her still healing disc, of a relapse and the need to start all over again with getting pain in control, more vet bills, and restarting the count for 8 weeks of rest.