Christy's Carly 3/18 relapse conservative GRAD 5/13

If there is any suspicion that Carly is having another disc episode, then you need to immediately crate her to protect her spine from further damage (great that you've done that!) and get her to a vet ASAP. Until you get a diagnosis from a vet, you need to carry her in and out to potty, allowing only a very few steps to do her business. If she's reluctant to go up a step (which she shouldn't be allowed to do anyway), then you should have a vet check her out. Not all disc episodes exhibit with pain, though she may have some pain which is making her reluctant to go up the step.

Any dog with IVDD should never again be allowed to go up and down steps or jump up or down from furniture so she shouldn't have been allowed to do that since her graduation from her crate rest in September.

Should this be another disc episode, you've caught it early and that's a very good thing. Whether it's a mild episode, which she may now be having, or whether it's a severe episode with paralysis, a full 8 weeks of strict crate rest is needed to heal the damaged disc and to allow scar tissue to form.

Prayers that this isn't another disc episode. Please keep us updated after the vet exam.

At this point, Carly is still walking and is an excellent candidate for conservative care should this be another disc episode. Most surgeons would not operate on a dog that can still walk. As you've learned from her last episode, dogs can recover with conservative care even if they can't walk. Just make it clear to the surgeon that you are only looking for a diagnosis and getting the proper meds on board.

SURGERY
The purpose of surgery is to take the pressure off of the spinal cord by removing the disc material causing the compression. Surgical decompression allows a normal blood supply to return to the compressed spinal cord and for neurologic recovery to begin by the body self-healing nerves.

CONSERVATIVE
Seeks to relieve swelling/compression of the spinal cord with an anti-inflammatory. Over time the hope is that disc material where it should not be will shrink back enough so that pain resolves and nerves can start to self repair.

More excellent details about the difference between conservative vs. surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Christy maybe the 5K included MRI + a surgery???

Be aware that a 3-day course of prednisone may resolve all pain.  However, often for most dogs it does take in the range of 7 to 30 days of pred. Any days of tapering do not count. The taper days are a time to test if pain reveals it still exits and at the lowering of pred causes an increase (worsening) of neuro functions. So it would be a good idea to know your job and have a plan B worked out ahead of time with the surgeon now before the taper starts on Wed. March 18.

Good reading to understand how prednisone, an anti-inflammatory, is used during a disc episode and the part you play:  dodgerslist.com/2020/04/18/steroids-vs-nsaids/


Let us know what you and your neuro's plan B is?
Let us know which your neuro prefers on the 3/18 test for pain taper:
   --- backing off of pain  relievers gabapentin and tramadol?
   --- or a full stop of the two pain relievers on 3/18?

How much does Carly weigh now....stil 21lbs?

The length of the prednisone course is a guess any vet must make. Guessing as to how long it may take to resolve the swelling around the cord that may contribute to nerve damage you reported of not able to use back legs. Nerve damage needs no meds to assist in repairing damage. The body can self heal nerves just as the body can self heal the disc.

No one wants a dog on prednisone any bit past the time of the benefit that all swelling is gone. Prednisone, as do all anti-inflammatory drugs, carries with use some adverse side effects. This is why vets use one course and then the test taper for pain. Another course if needed due to existing pain. Owners are blindfolded when trying to assess for pain when there are pain masking meds on board. Make sense? This is why the pain meds are either full stopped on the date of the pred taper. There could be reasons a vet would prefer to back off pain meds by dose, by frequency.

Are you still in TX? Which hospital is your current neuro at?

Christy, the name of the game with a disc episode it to get meds on board in a timely manner.  To get prednisone, for example, on board quickly at the anti-inflammatory level. There are other things that may have cause "not better." Absent a full picture with detail, comments are kinda general and may be missing something important to share with you.  So looking forward tomorrow in learning more about Carly.

QUESTIONS

1) What were your specific observations that indicated not better? "Carly did not get better after the 3 day pred with taper.''

2) What date(s) did you observe not better things? Was it only on the final pred taper day of 3/25 you saw "did not get better?"

3) Have you been very conscientious in doing the STRICT rest since crate rest and meds on 3/14? 


HOW PREDNISONE WORKS
  Worthwhile to re-read the full article:  dodgerslist.com/2020/04/18/steroids-vs-nsaids

  -- A vet must always take a guess on how long the prednisone course should be.
  --- At the end of the X- day pred course, taper days begin. The taper test is to determine if pain or any new or worsening neuro signs will appear.
--- At the first day of taper the pain meds are either reduced or full stopped.        The idea is for the owner to be able to quickly and accurate see if there is still painful swelling and the need for another prednisone course.
 ---  Pain meds were not backed off or full stopped when taper began on 3/18. Assuming pain was not revealed until the end of the pred taper or you would  have alerted vet to pain ASAP? 

prednisone as of 3/15: 5mgs 2x/day for 3 days, 3/18 taper test began
                                                                                        3/25 √pain/_neuro  

The same concept applies for the March 25th  4-day pred course. Taper days are no longer working on painful swelling. Having pain meds on board means a delay in finding if there is a need to quickly get back up on the original dose (the anti-inflammatory).
   At the end of this 4-day prednisone course you have no idea if all the pain is gone. Neither you nor the vet will know for sure if all the painful swelling is really gone until you do the prednisone taper WITH either a full stop of pain meds and or backing off of gabapentin and tramadol.
   Pepcid AC is to suppress stomach acid production.  Carly should take Pepcid AC til she is off of prednisone.

⚠️NOTE: Prednisone is a hormone and may not be abruptly stopped!
       ---  Prednisone must always be tapered.
       --- Prednisone must always be used exactly has has been instructed by the vet.

Please stay in touch as frequently as you are able to update how things are going for Carly during the taper.  Fingers crossed this taper will allow you the necessary ability to quickly and accurately assess pain during the pred taper test.

Christy, providing all the details of dates and your observations, paints an entirely different picture for us.

It sounds as though the 3/17 shaking fur thing with the yelp of pain could very well have caused a relapse to the early healing disc of new 3/18 neuro diminishment. The 3/18 leg diminishment while at the start of the taper meant there was no anti-inflammatory level pred to be able to work on swelling.

A relapse spells a restart of crate rest so the disc can begin the re-healing process. It means the 4-day course of pred is actually the first course Rx'd for the relapse.

Just to clarify, what was the mg dose during the 4-day course of pred? Was it 5mgs 2x/day?

What do you observe about the neuro diminishment as it looks today?

As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.
1. √ 3/17 yelp: 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.

So with the end of a short 4-day course for the relapse on 3/18, you may find not all the swelling is gone or that neuro functions may worsen on the taper.

Please advocate that there NOT be a delay in finding out the answer. 
--- Advocate for both pain meds to be stopped with the 3/29 taper
--- Maintain Pepcid AC til fully off of pred
--- Discuss with the vet if he wants to change his guess of a 4-day course to  a 7-day course or longer.  Again this is the vet's call.
--  The bottom line is whatever is decided on, it is on the pred taper test for pain/neuro  where it is important to take off the blindfolds of having pain meds on board.  Quickly resuming the original anti-inflammatory Pred level is important to not delay if there would be any signs of pain surfacing or worsening neuro function.


Let us know what your vet wants. Hopefully you can get in a call first thing Monday morn.  See if you can contact via phone to avoid a risky trip into the vet. Too much movement can cause  relapse. Vet's who know IVDD most often adjust meds via a phone call because they know the critical nature of limited movement of the neck and back.

EMAIL ALERTS
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Christy can you bring us up to speed since you last wrote on 3/28?
-- Approximatly how many weeks/days has she been off of all meds?
-- How old is Carly?

If she had been off of all meds for at least a week now, then graduation day is now (5/17). Actually 8 weeks from date of disc relapse would have been 5/13.

If Carly, is a senior girl, stiffness after being imbole with a night of sleep, could be arthritis.  Usually with arthritis, once the body starts moving the stiff joints can ease up and be less painful making less stiffness.  Let us know what you observe surrounding morning stiffness.

Arched back could be some arthritis in the joints of the back.
Has there always been an arched back during the use of prednisone?  
Arched back during the prednisone taper and continued to 5/17?

When figuring out if pain is due to still remaining spinal cord swelling existing see if there is more than one sign.   Tell us which you observe: