Sofie's Charlie 1/23 conserv- h20 Diabts Pap/Yrk GRAD 3/20

Welcome Sofie. We are glad you have joined us.

The single  most important part of the care during conservative treatment is the VERY strict rest for 8 week so the disc can heal.
  Please confirm that Charlie is allowed ONLY the very fewest of footsteps, very minimal footsteps (no walking around to poop).
   Each time the vertebrae in the back move they can pressure the early healing disc to tear and wreak havoc on the spinal cord to cause leg paralysis and loss of bladder control.  VERY STRICT rest is how the disc will heal.

The test stop of carprofen on 1/31 is to find out if all the painful swelling in the spinal cord is gone.  On 1/31, the pain meds gabapentin would have been stopped or begin backing it off by less frequency and/or less  mgs.  It is not clear which is going on with gabapentin. What date did gabapentin reduce from 3x/day to now 2x/day? Please clarify.  Highly recommended you have an understanding of how NSAIDs are used with a disc episode.   
     Excellent reading about use of anti-inflammtories during a disc epidode. Learn  how long carprofen could take to rid the body of all painfully inflamed and swollen tissue around the spinal cord.
1) dodgerslist.com/in-the-right-place/
2) dodgerslist.com/2020/04/18/steroids-vs-nsaids/

The yelp when lifted 1/31 is high suspicious of the need for another course of carprofen to get all the painful inflammation resolved in the spinal cord.
   
     Did you report the pain to your vet?  What did he say?

POTTY TIME
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 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!  
      Is there a reason, Charlie must be taken on a drive to potty? Is there any way to avoid the risk of a vehicle transport? Place a pee pad adjacent to his recovery suite and encourage him it is ok to pee and poop there if you do not have any grass outside your home? There are other options top, once we know what is available just outside your home.

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What kind of recovery suite are you using (Pack N Play, wire crate, Ex-pen)?  Do you have food and a water bowl attached inside of the suite?

It is really good news to hear his back leg neuro function is healing. With attention to very STRICT rest til graduation day, conservative treatment can work!

Thank you for revealing all his health issues and meds. Let us know there is a need to be careful with drugs that may not work well with Desmopressin.

IF there is still pain and a need for another course of carprofen, please ask if there is a specific health reason that famotidine can't be taken?

Sofie when possible do use dates.

What date did gabapentin reduce from 3x/day to now 2x/day?  Jan 25?

There is one way to know for sure if there is a need for carprofen.  At the stop of it on 1/31, then gabapentin should have  been  stopped (some vets will prefer to back off of gabapentin.)    Let us know what your vet wants during the test stop of carprofen for signs of pain (such as yelping when lifted).

I'm sorry you were not able to access the info on how long carprofen would be used at  dodgerslist.com/2020/04/18/steroids-vs-nsaids  Could you help us understand what the difficulty was:
  --- page loads too slow to access?
  --- page difficult to find information?
  --- other?, please explain.  Thank you for helping US!

HOW LONG TO USE - Carprofen test
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.
    NSAIDS: At the end of a 7-day or 14-day NSAID course, pain meds are also either stopped or backed off. The owner’s job is to observe for surfacing pain and alert their vet for another course of the NSAID. Pain = another course of NSAID.

Do all you can to make sure you are not driving Charlie around to  go to potty and when a vet visit is something that might well be handled over the phone. 

VET VISITS
 If all is going well with Charlie, that could be conveyed via a phone call to your family vet.  Why do you think your vet is thinking it it necessary to risk damage to an early healing disc with a transport in?  Always good to know the specifics reason a phone update may not do the job and what would be the job when transported in.

Charlie needs protection from himself.
Protection knowledge is something thinking humans have that dogs and kids do not.  We can understand things-- suppose a child wants to take an uncomfortable cast off his broken arm. It simply would not be allowed. The same with a disc episode. Humans can understand that Charlie can't possibly put two and two together about how important very STRICT rest is required to allow a disc to heal.  It simply can't be allowed for him to walk about for 10 m(inutes) to poop.  A tragic setback, relapse to an early healing disc could mean more pain for Charlie. It  could well mean leg paralysis. It could well mean a very expensive surgery. 



Let us know which of these ideas could work for you and Charlie:

1) Roll a wire recovery suite over to the sliding door by adding casters. Then it is just a few footsteps to potty on the deck. Put some dirt, snow, straw, etc to potty on. Fence in with an ex-pen so your dog knows there will be no darting off or sniff festing.

Castors about $10:

2)  If you do not have a deck/sliding door, then consider this idea. Obtain an ex-pen to use at potty times where you would open up some folded panels of the very small recovery suite area just a bit. Lay down a pee pad WITH the addition of urine from another dog or from your dog on top. Always save a used piece of pee pad in a ziplock bag to use at potty time. Your dog can learn it is ok with you to pee on the pee pad, be sure to use the command “go potty” and when he does give lavish praise.

Pee pad could also be placed just outside of the recovery suite.

Another idea is to used an ex-pen as the potty area attached to the recovery suite. At potty time open the suite's door so your dog may take a couple of foot steps out to the potty area:


Where there is a will, there is surely a way to ensure Charlie has a safe recovery.  Failure to protect Charlie's healing disc is just not an option here at Dodgerlist.

We can come up with more ideas, if you let us know your particular home/backard/deck circumstances.

Usually when the anti-inflammatory (Carprofen) is stopped the pain meds, in this case, gabapentin are also stopped or cut back. The anti-inflammatory treats the spinal cord swelling. Swelling of the spinal cord is what causes the pain and neuro deficits of IVDD. If, when the anti-inflammatory is stopped, pain arises, the swelling is not gone and more time on the anti-inflammatory is needed. If a dog is still on pain meds when the anti-inflammatory is stopped the pain meds may mask the pain of the swelling. That makes it difficult to tell if all the swelling is really gone or a second course of the anti-inflammatory is needed. You can check with your vet about stopping the gabapentin at this point to make it clear if Charlie needs more time on the gabapentin.

Sofie, it appears when you reported the vet said to give carprofen for 14 days, that is how long the course is for.  Maybe  he gave extra pills, should the test stop on Feb 19 reveal not all pain yet gone.  

So at the stop of this new 14-day course of carprofen, vets who know IVDD do one of two things with the pain meds:
--- Either the IVDD knowledgeable vet would call for a full stop of gabapentin on Feb 19th so you have the ability to clearly monitor for surfacing pain.

The full details on how carprofen, 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/

---  OR if a vet feels long term use of gabapentin MAY, maybe, might cause rebound pain or side effects from an abrupt stop, he will ask that you back off of gabapentin on Feb 19th.  He would tell you exactly how often to give and how to lower the mgs.   How to deal with pain meds on the test stop of carprofen is something a vet needs to decide on.  So please do your reading about anti-inflammatory drugs. Write down your questions, and then make a phone call to discuss your concerns.

Thank you for clarifying 10m. Since you are in CA, just did not cross my mind you were using meters.  10meters/33 feet is way, way too much walking and movement pressure to the early healing disc. Think minimal footsteps at potty time.  Take Charlie out and give him a minute to poop/pee when you know he should have to pee. If nothing, then lift and carry him back to the suite.  Give him another try in 30mins to an hour. 

Which of the ideas presented in my previous post, do you think may be worth trying to prevent damage to his healing disc?  Key to conservative treatment working is the very STRICT limitation on walking-- only a few minimal footsteps are allowed.

Update on Charlie (NOW 4 WEEKS ON BED REST)
It seems like he is not putting down his left foot completely flat
He sometimes wobbles or lowers his back or falls
He has a harder time walking on hard wood floors
At times he can be hard to keep quiet, he wants to play or walk

The meds were stopped on 2/20/2021 and there seems to be no change, he seems comfortable. 

[Moderator's Note. Please do not edit
8.6 pounds
carprofen as of 1/23: 6.25mg 2x/day for 9 days, then 1/31 test stop: √1/31pain/_neuro
as of 2/5: 6.25mg 2x/day for 14 days, then 2/19 test stop: _pain/_neuro]

We requested a consultation with the Neurologist about plans since our vet does not seem to know much, neither does other regualar vets. She called back and gave us following plan:

Since Charlie is doing better we can start to gradually increase his daily walks over the next two weeks.

This week 5 to 10 minutes per walk.
Next week 10 to 20 minutes per walk.
If all goes well over the next two weeks, then he can go back to normal activities.

He is allowed to walk around at home as long as he is not running around and jumping on the furniture. Maybe we customize this recommendation with socks and carpet to help him walk.

If during the next two weeks he gets worse, then call and get a consultation with Dr. Vitale, the neurologist.

Pain medication can be given if necessary.

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Happy that he can start getting mobilized a little again and hopefully he will fully recover...
I think we will start buying him the socks and just let him get around inside. He is not allowed in furniture, so he will never be jumping up or down. 
But of course I am a little nervous since this group is very strict on the 8 weeks bedrest. But I guess the neurologist is modifying specifically to his improvements. 

This was a vet at the Neurologist office that called us with this plan after the Neurologist told her the plan for Charlie. The Neurologist examened Charlie [date?] on the second visit to the ER. I have not heard of any other diagnosis. I guess his symptoms has been on no 2 with Wobbly walk (which is now much less, we only see this sometimes now).

It is very confusing with the mixed messages from the expert, which is a neurologist that has examend and got all the info about Charlie and the 8 weeks strict crate rest from this group.

Yes, I definetely want to be probably in between the two recommendations then. We walked him 4 minutes yesterday and he pooped twice. On the grass he looks totally normal. On the sidewalk you can tell that he is tip toeing a bit on the left leg (not knuckle under).