Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Mar 30, 2021 21:21:20 GMT -7
[Original subject line: Shanti’s Sprocket- 12yo terrier mix 3/31- Japan] Sprocket- 20 lbs, 12 year old schnauzer mix. Living in Japan. Has had 2 short lapses of spine and hind leg pain over the past 5 years. All resulted in pain meds and rest and full recovery within 3 days. This time is different. Trying for conservative approach but vet is leaning towards surgery if CT scan provides more info. Currently on day 2 taking the following prescribed meds as of March 29: * Prednisolone: 209 [?] mg daily *Vitamin B2, b12 (octotiamine) 900mg (?) * Amoxicillan hydrate) 250 mg 2x daily Prior to that, March 15- was given the following meds after first episode of pain and limping in hind legs: * Previcox 57mg. * gabapentin 100mg 2x daily * Flexpro (dosage unknown). [Moderator's note: please do not edit 20 lbs. 12 y.o. 3/15 crate rest 3/22 relapsed: slipped, lost back limb function 3 27 bladder control lost Previcox - STOPPED 3/29 Prednisolone as of 3/29 : 5 mg (taper dose!) 1x/day for 7 days, test for √3/30 pain/_neuro 3/30 can move back legs, but not walk unaided gabapentin - STOPPED Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark! needs GI tract protector, Pepcid AC, on board w/prednisolone! ] DVM diagnosed intervertebral disc herniation/slipped disc after X ray, ultrasound and observations. Ultrasound found some inflammation of lymph nodes so antibiotics prescribed. Vet recommends surgery if still no progress or ability to urinate by April 2nd. -V et recommended strict crate rest March 15. Dog began to feel much better and s lipped while going out to pee on March 22nd- slowly lost ability to walk and stand on all fours. -Currently not exhibiting pain, s ometimes winces when we attempt to pick him up or move him. Reluctant to move much in crate, tight tense tummy, not wanting to bear weight on hind legs, can hold legs up momentarily and can walk a few steps but falls. Cannot move hind legs unless held up and asked to walk, then can bear a little weight and hold weight but very shaky and not for long. Not his normal self. Lethargic- no tail wagging. - Cannot specifically sniff and squat and then release urine. Unable to urine on his own and doesn’t urine when vet or myself tried to hand express bladder so has had catheter used to remove urine twice. [date of bladder control loss?]-Eating and drinking OK. Poops OK but limited control. (Will attempt to move and get up urgently- which we know means he needs to poop. Often poops mid pick up before we can get him outside. Urine dark but OK. Unable to urinate on his own.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Mar 31, 2021 5:11:06 GMT -7
Welcome to Dodgerslist, Shati. So glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you. Know more about us and how we team up with veterinarians: dodgerslist.com/about-team-dodgerslist/Disc disease is not a death sentence! Struggling with quality of life questions? Re-think things: dodgerslist.com/2020/04/18/hope-quality-life/You have a pain emergency that must be taken care of ASAP this morning. Wincing when moving, reluctance to move, tight tense tummy are all signs of pain and Sprocket is not on any pain meds. Prednisolone is not a pain med but rather is an anti-inflammatory to work on the swelling that causes the pain. That swelling can take 7-30 days to resolve so until the swelling is gone, pain meds are needed. Please call the vet ASAP to advise of the signs of pain that you're seeing and advocate strongly for pain meds. Pain hinders healing so have no patience with it. Often to get the severe pain of IVDD completely under control, three pain meds are needed - Tramadol as a general pain med, Gabapentin for nerve pain and Methocarbamol for the pain of muscle spasms - all need to be given 3x/day. When an anti-inflammatory such as Prednisolone is given, stomach protection is also given. Here on Dodgerslist we recommend Pepcid AC (Famotidine). That may be called Blostar M or Gaster in Japan. 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). i.ibb.co/DCN9611/91x-Aj-s00z-L-SY355.jpgDoxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours. NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.htmlWas a 4-7 day washout period given when switching from Previcox (NSAID) to Prednisolone (steroid)? If a washout out period was not done, please speak to the vet about also adding Sucralfate. Switching from a NSAID to a steroid without a washout period requires TWO stomach protectors, both Famotidine and Sucralfate. Sucralfate works in a different way from Famotidine and helps heal any damaged area of the GI system. What was the exact date that Prednisolone was started? For how many days will Prednisolone be given until a taper is started? Please check the dosage of the Prednisolone. 209 mg does not sound correct. Incontinence of the bladder often results in urinary tract infections due to urine laying for too long in the bladder. You also mentioned that Sprocket's urine is dark. UTIs can be very painful and can make expressing difficult. That may well be why you and the vet are having a hard time expressing Sprocket's bladder. He has been on Amoxicillan for only a couple of days. If his urine doesn't clear up in a couple of days or if the bladder is still difficult to express, do speak to the vet about performing a urinalysis to see if Sprocket has a UTI. If Amoxicillan doesn't help the UTI, then a urine culture can be done to determine the exact type of bacteria so the correct antiobiotic can be given. Amoxicillan is a broad-based antibiotic that can first be tried. The only way we humans know whether there is bladder control is to do a sniff and pee test. The fact that Sprocket can let you know when he has to poop, though not in time, may mean that he also has some bladder control. Carry him to a spot where he or another dog has peed before, support his hind end but not under his belly, allow him to sniff and see if he can release urine on his own. If not, then his bladder needs to be expressed for the health of the bladder. Tips that may help you express Sprocket's bladder can be found here: dodgerslist.com/2020/05/05/bladder-bowel-care/Bladder control may or may not return by April 2nd. Nerves are very, very slow to heal. Think more in terms of months, even a year or more, rather than mere days. Here is more information for you to read to help you in your decision regarding surgery versus conservative care. dodgerslist.com/2020/02/10/surgery-vs-conservative/ dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/ The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). 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. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite, the mattress and more! —> dodgerslist.com/2020/05/14/strict-rest-recovery-process/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. If and when you determine that Sprocket does have some 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! dodgerslist.com/wp-content/uploads/2020/04/Potty-leash-harness400-19kb.jpgIf 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/~~ Why Chiropractic is not recommended for IVDD dogs: dodgerslist.com/2020/04/22/chiropractic/?highlight=chiropracticKnowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD soonest possible. Owner understanding ensures proper conservative treatment principals: ▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/in-the-right-place▶︎ Roadmap for your fridge so the whole family is on board. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf Please let us know what the vet says after speaking to them this morning regarding Sprocket's pain, need for stomach protection and the possibility of a UTI. We're here for you and Sprocket and will help you through his recovery, whether through conservative care or surgery. Healing prayers for Sprocket.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Mar 31, 2021 16:14:04 GMT -7
Thank you so much for this helpful suggestions and review of Sprocket’s condition. To answer your questions: -Prednisolone dosage is 5mg 1x daily . There was no wash out dare and it was prescribed and given March 29th. Prednisolone asked to give for 7 days. -Urinalysis was conducted at initial vet visit and no UTI was found. They plan to check him again tomorrow morning when they help him release his urine- likely with a catheter if hand expressing doesn’t work. I will try to carry him to a good pee spot and see if he will sniff and pee. - we still have the pain killer Gabapertin (100mg daily), but was told to stop on March 25th when all new meds were prescribed. I will call the vet once they open this morning but would it be okay to give to him again in conjunction with his current meds? - I will call and ask about the Sucalfrate for his stomach and will purchase Pepcid AC if they say that is allowed. Blood work was done prior to giving him meds on March 25th and kidney and liver was all normal levels. *Question: Is it ok to give ✙ Pepcid AC 30 minutes after the anti inflammatory as I gave it to him first thing this morning before seeing your response. [Moderator's note: please do not edit 20 lbs. 12 y.o. 3/15 crate rest 3/22 relapsed: slipped, lost back limb function, 3/27 lost bladder control Previcox - STOPPED 3/29 lacking double GI protection with no washout days! Prednisolone as of 3/29 : 5 mg (taper dose!) 1x/day for 7 days, test for √3/30 pain/_neuro 3/30 can move back legs, but not walk unaided gabapentin - STOPPED Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark! ✙Pepcid AC ?mg ?x/day needs GI tract protector, SUCRALFATE, on board w/no washout days!! ]Thank you again so much.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Mar 31, 2021 16:50:05 GMT -7
Shanti, there is pain because Sprocket is on a taper dose, not an anti-inflammatory level dose of prednisone for a 20 lbs dog. CLARIFICATION: 5mgs once a day IS/was the first dose Rx'd? If your dog is not getting the anti-inflammatory level of prednisone, call and strongly advocate for its use. 0.3 mg pred per pound = 0.3 mgs pred x 20lbs = 6mgs twice a day. Because tabs come in 5mg size, the vet will usually call for a 5mgs prednisone dose 2x/xday. All vets must guess on the length of the pred course. Usually they pick 7-day or 14 day course, THEN the pred begins to taper. Taper doses do not work on swelling. It may take 7-30 days of anti-inflammatory pred before all swelling is gone. Depending on the dosage, steroids can be replacement (prednisone) steroid hormone in dog not able to make suffiennt hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive (prednisone 1 mg/kg every 12 hours) effects for other diseases. All steroid need to be tapered down rather than abruptly stopped. Taper days do not work with the painful swelling of a disc episode, they are to also test to see if another course of pred is needed. With the call in about adjusting pred, do strongly advocate for an Rx to Sucralfate. Pepcid AC (famotidine) is given 30 mins before pred to help suppress acids pred makes. Sucralfate works in a different way to protect damages in the stomach lining. Read to know how to time with food and with famotidine: marvistavet.com/sucralfate.pml A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdfWhat date was there loss of bladder control? Back on 3/22 when he slipped? The very usual pain med coctail includes a med for EACH of the three sources of pain. gabapentin for nerve pain tramadol as the general analgesic methocarbamol for the pain of muscle contractions. Prednisone is NOT a pain reliever in my book as it may take 7-30 days to get all swelling resolved. Pain meds work in one hour! EMAIL ALERTS Register to enable receiving email alerts when someone has posted. Timely communications is needed when helping your dog. How to register and set up for email alerts: dodgerslist.boards.net/thread/7353/register-bookmark-dogs-post-thread
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Mar 31, 2021 17:03:36 GMT -7
Loss of bladder control occurred March 27th, a few days after crate rest began and initial hind leg weakness occurred.
I will call the vet and advocate for the cocktail of pain meds and Sulcafrate + [pred and anti-inflammatory level!.]
Thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Mar 31, 2021 17:13:32 GMT -7
Be sure to discuss and advocate for the all important anti-inflammatory med. Prednisone used at the anti-inflammatory level of 5mgs 2x/day. Otherwise there is nothing on board to work on painful spinal cord swelling over the course of 7-30 days. How to monitor neuro functions and have an idea when it is time to quickly get in to see a neuro if that is a consideration for your family. Seems your vet is not entirely comfortable with his knowledge of IVDD. 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. 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. 3/22 Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. 3/27 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. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. A quick overview of conservative treatment vs. a surgery: dodgerslist.com/2020/02/10/surgery-vs-conservative/A disc episode compresses the spinal cord and causes a lot of bruising, swelling, and inflammation. -- Surgery immediately relieves the pressure with severe paralysis by removing offending disc material. -- Conservative treatment relieves pressure with an anti-inflammatory drug and takes 7-30 days. Just as with any traumatic injury, the body can self heal nerves and the disc. -- The disc heals under Conservative treatment with very STRICT limited movement and time of 8 weeks. -- Damaged nerves in the spinal cord heal with time after a surgery or conservative treament. Best to think in terms of months rather than days/weeks for this slowest part of the body to heal.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Mar 31, 2021 17:26:18 GMT -7
Thank you. We are very open to surgery and considering getting a second opinion at another vet to find the best neuro and surgery/post surgery rehabilitation for Sprocket ASAP.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Mar 31, 2021 17:46:22 GMT -7
If Sprocket can no longer give you a happy tail wag when you specifically do some happy talk or he sees you or a treat coming, then seek a neuro or ortho consult asap tonight or tomorrow. only a specialist can be counted on to correctly identify deep pain sensation or lack of. Finding a specialist: directory: find.vetspecialists.comMore on emergency things: dodgerslist.com/2020/02/24/emergency-find-a-specialist/
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Mar 31, 2021 18:03:33 GMT -7
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Mar 31, 2021 19:16:17 GMT -7
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Mar 31, 2021 20:13:31 GMT -7
Unfortunately was unable to find a neurologist or specialist nearby using the link you sent. We are on an island (Okinawa), so limited vets and specialists. I am waiting for a vet to get back to me about their neurologist and specialist which was recommended by another vet here so hoping to hear back today.
I also have a Japanese friend who is searching on her end today as my Japanese is limited and definitely a hinderance when trying to find vet support.
Update: Sprocket has an appointment to do CT scan tomorrow AM and also another appointment with another vet who has some experience with IVDD rehabilitation but not clear if they have experience with the surgery. I plan to advocate for the aforementioned pain medication and stomach support. The vet told us to give him the ✙Galapentin today and that we would discuss more pain meds tomorrow at appointment. Gave him the meds and he quickly relaxed and slept and looked more comfortable.
[Moderator's note: please do not edit 20 lbs. 12 y.o. 3/15 crate rest 3/22 relapsed: slipped, lost back limb function, 3/27 lost bladder control Previcox - STOPPED 3/29 lacking double GI protection with no washout days! Prednisolone as of 3/29 : 5 mg (taper dose!) 1x/day for 7 days, test for √3/30 pain/_neuro 3/30 can move back legs, but not walk unaided ✙4/1 has bladder control ✙gabapentin -100mg 2x daily Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark! Pepcid AC ?mg ?x/day needs GI tract protector, SUCRALFATE, on board w/0-days washout!! ]
This evening thanks to your advice we got him excited for a walk, noticed his penis pushing through (this happens when he is overly excited or right before he wants to pee), and then carried him out to our dogs’ favorite pee spot. Our foster dog peed and then we placed Sprocket near the spot and he attempted to lift a leg, managed to somewhat stay up and had a loooooong pee (Yay!). Grateful that he won’t need to be cathetered to remove urine tomorrow.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 1, 2021 5:33:39 GMT -7
Such wonderful news, Shanti! You now have proof that Sprocket has bladder control. You'll need to carry him out to potty every 2-3 hours while he's on Prednisolone as Prednisone causes increased thirst and urination. Having bladder control proves that he has deep pain sensation. And you had mentioned before that Sprocket can move his legs and take a couple of steps so he does have some leg movement which also proves he has deep pain sensation. Possibly the lack of a happy tail wag is due to the pain he has. Yes, speak to them about the pain meds and stomach protection (both Famotidine and Sucralfate due to no washout with switch from NSAID to steroid) but be sure to also speak to them about upping the anti-inflammatory Prednisolone to the anti-inflammatory dosage of 5mg 2x/day. That's also very important. CT scans are usually only done just prior to surgery so if you're still considering proceeding with conservative care due to the nerve healing that you're now seeing, hold off on doing that. Since you say that you plan on speaking to the vet about the meds indicates that you may now be considering conservative care since those are the meds given during the 8 weeks of strict crate rest. If surgery is done, the meds may be different afterwards. CT scans require anesthesia which poses risks to a dog going through conservative care as it relaxes the core muscles supporting the spine. If and when surgery is decided upon due to symptoms and amount of loss of nerve function, then Sprocket would be put under, the CT scan would be done to let the surgeon know exactly where to operate and then while Sprocket is still under anesthesia, surgery would then proceed. Here are the links again to our pages on conservative v. surgery for your knowledge. dodgerslist.com/2020/02/10/surgery-vs-conservative/dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/Prayers for you and the vets as decisions are made today on Sprocket's behalf. We'll be awaiting an update from you after the exam.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 1, 2021 5:57:32 GMT -7
[Okinowa time: Thursday, April 1, 2021 at 10:00 pm]
Thank you for this info. Prior to scheduling the appointment for Sprocket I had told them he was unable to urinate on his own hence the plan to use the catheter. I will still bring him into the vet for his appointment and discuss all the meds and plan of action. I do suspect that they may not push for surgery seeing that he was able to urinate on his own today- but we shall see and I’ll continue to advocate for him. I would prefer a conservative approach but will keep an open mind and also appreciate you informing me of the CT scan process and what it entails related to anesthesia.
Thank you again. Heading to bed and will update in the morning (your late afternoon/evening).
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 1, 2021 7:35:52 GMT -7
Shanti, vets who know IVDD, understand the importance of VERY STRICT rest. Transports into the vet can cause too much movement to the back causing damage to the early healing disc. Vets who know IVDD, will take a phone call update about having bladder control and thus has deep pain sensation. Your list of pain observations in order to adjust pain meds. Call your vet asap in the morning and advocate for adjustments to meds over the phone if you are still seeing any signs of pain. "More comfortable" is not good enough, you want full pain control dose to dose round the clock: -- Prednisolone at the anti-inflammatory level of 5mgs 2x/day for a 7-day or a 14-day course -- gabapentin Rx for promptly every 8 hrs dosing. -- tramadol Rx fro promptly every 8hrs dosing -- methocarbamol Rx for promptly every 8 hrs dosing -- Pepcid AC are you giving 5mgs every 12 hrs? -- also needs GI tract protector, SUCRALFATE, on board w/0-days washout from previcox!!
Having bladder control and if pain can be fully in control with an appropriate, typical aggressive approach to covering each of the kinds of pain, means conservative treatment can be a good approach.
If you are not going for surgery at this point in time because you have confirmed knowledge of deep pain sensation in existence with bladder control, then there is risk in transport to a CT scan appt. These advanced imagings are used just prior to a surgery as a planning aid.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 1, 2021 18:09:06 GMT -7
[Okinawa time: April 2 Fri 10:00 am www.timeanddate.com/worldclock/meetingtime.html?month=4&day=2&year=2021&p1=75&p2=179&p3=248&iv=0]
Thank you. I just spoke with them and they would like to see him in person before prescribing any additional pain medication. J apan is very strict about prescribing pain medication and I will be required to bring my passport and sign a document about my knowledge about pain meds and not to abuse them myself That being said I plan to do my best to not move him much during transport. I will advocate for each of the medicines you mentioned and dosages. Thank you- will update soon.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 1, 2021 18:39:32 GMT -7
OK, you have to do what is necessary to get the right meds on board for Sprocket. Roll up blanket or towels to fit snug about Sprocket's body. This will keep him from shifting his back unexpectdly as the car takes a corner or comes to a stop. Let us know what the vet Rx (mgs and frequency) when you get settled in back home again.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 1, 2021 19:10:26 GMT -7
Finishing up at the vet now. Was able to transport him comfortably in a crate and with towels and he didn’t move much at all. He peed on his own and pooped when put in the grass outside before we left. Thanks for that helpful infographic.
The vet has prescribed him ✙sucralfate and gabapentin as well as upped his Prednisolone to 2x/day. However they do not offer the other two pain meds I requested. They said it is possible another vet in the city’s capitol may have it but other vets in the area do not.
[Moderator's note: please do not edit 20 lbs. 12 y.o. 3/15 crate rest 3/22 relapsed: slipped, lost back limb function, 3/27 lost bladder control Previcox - STOPPED 3/29 lacking double GI protection with no washout days! Prednisolone as of 3/29 : 5 mg 1x/day for 7 days, √3/30 pain/_neuro as of Fri 4/2: 5mgs ▲2x/day for 5 days, Wed 4/5 taper test: _pain/_neuro 3/30 can move back legs, but not walk unaided 4/1 has bladder control gabapentin -100mg 2x daily Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark! Pepcid AC 5mg 2x/day ✙sucralfate ?mg ?x/day ]
They recommended he have the surgery at a specialist clinic in the city and are giving me their contact information and will give me all of Sprocket’s files and information to give to them if we decide to proceed with a check up there. They stated that this hospital has done surgery for 2 of the 10 patients they referred there and the 2 pets had positive outcomes with IVDD.
The cost of the surgery is not an issue for us, but I will need to review the information you shared about conservative vs surgery approaches before we make a decision.
Any other recommendations? Thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 1, 2021 19:48:57 GMT -7
Shanti, when you have time please fill in the missing info in pink: Prednisolone as of 3/29 : 5 mg (taper dose!) 1x/day for 7 days, test for √3/30 pain/_neuro as of Fri 4/2: 5mgs ▲2x/day for ? days, then taper test gabapentin -100mg 2x/day Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark! Pepcid AC ?mg ?x/day✙ sucralfate ?mg ?x/dayDoes not look like any new change to the gabapentin you had given at 100mgs 2x/day ???
With pred now up at the anti-inflammatory level, the swelling will now be attended to. Today's Rx of pred 5mgs 2x/day (what is it 7-day course, 14-day course) may show you some improvement in nerve function when the cord is less under pressure of surrounding swollen tissue. Shanti may feel better pain wise too.
Options: If opiate tramadol is not available AND you see Shanti is still not in full comfort, call in and ask the vet about another opiate he may have access to. --- "BUPRENORPHINE (Buprenex) can be compounded into a gel to be applied on the inside of the ear flap(pinna). BUPRENORPHINE should not be compounded into an oral prep as significant first-pass effect renders it inactive." www.vasg.org/chronic_pain_management.htm
If methocarbamol for muscle contraction pain is not available, try diazepam. "Diazepam is an excellent muscle relaxant, but in dogs reaches inconsistent and generally poor blood levels after oral administration. More effective is injectable or rectal administration. The former, if given intramuscularly, can cause pain at the injection site. More frequently used are drugs such as methocarbamol (orally or parenterally). The exact mechanism of action of methocarbamol is unknown." January 2006 Surgery James M. Fingeroth, DVM, DACVS Veterinary Specialists of Rochester, NY Consultant - Veterinary Information Network dcavm.org/06jan.html
Having a consultation with a neuro is not just for the purposes of a surgery. When the local family vet can't/won't prescribe the proper aggressive approach with pain medications, then consulting a special who uses these kinds of meds every day would be beneficial. Do you homework on surgery. Your vet may be saying between the lines, he is not comfortable with conservative treatment and thus rightly so refers you to a higher authority, a specialist.
** Dr. Isaacs answered alot of questions we've had about surgery: "Surgery needs to be a decision an owner enters into recognizing the risk, but also recognizes the benefit. This way if something unforeseen occurs an owner can be comforted and at peace with the fact that surgery was the right decision and they did all they could for their dog." You will find it worthwhile to read the rest of his answers about surgery: dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/
conservative vs. surgery decisions: dodgerslist.com/2020/02/10/surgery-vs-conservative/ If you need a neuro consult make clear why you are there (surgery consideration or to pursue conservative but with necessary pain med adjustments to provide full pain relief that local family vet can't provide.)
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 2, 2021 2:12:35 GMT -7
[Posted: Okinawa time Fri 4/2 7pm ]Hello! Answers to questions in pink here: Prednisolone as of 3/29 : 5 mg (taper dose!) 1x/day for 7 days, test for √3/30 pain/_neuro as of Fri 4/2: 5mgs 2x/day for 5 days, then taper test gabapentin -100mg 2x/day Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark! Pepcid AC 5mg 2x/daysucralfate ?mg ?x/day 14x/day- Not sure of dosage as it is already crushed and individually packaged in a syringe and says to add water...will call and ask them tomorrow. Sprocket has an appointment with a specialist at a larger clinic tomorrow [Sat 4/3] at 3:30pm Japan time [EST Fri 4/2 2:30pm]. I spoke with them and they made arrangements for us to come in as soon as possible and said they will prioritize him. I’ll be doing research tonight to decide if we want to go the conservative route or the surgery route so that the specialist is aware once we arrive for our consultation. I will also ask them about the alternative pain med availability- Thank you. Our current vet called later to check on Sprocket- they shared that of the 10 patients they’ve seen with similar condition, they referred 2 of them to this specific clinic and those dogs ended up having the surgery. The other 8, they told to try conservative approach at home with strict rest and meds. I am taking this as them insinuating that they referred us to this specialist because they believe surgery is the best approach. Japanese culture is not very direct, but this is the most direct I have heard from a doctor or professional. ( I am a birth Doula and spend a lot of time in hospitals with Japanese medical staff so am familiar with the cultural differences in medical care) I will take this into consideration as I research more tonight and discuss with my partner. Hope to update tomorrow late evening your time after Sprocket’s appointment. Thank you again!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 2, 2021 8:02:27 GMT -7
I hope all goes well at the exam, Shanti. We'll be awaiting an update when you get a chance.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 3, 2021 6:57:31 GMT -7
[Posted: Okinawa time: Sat 4/3 9pm ]
Update: Sprocket was seen at a larger animal clinic by a vet familiar with IVDD. Vet did some neurological testing to test for deep pain sensation as well as EKG and another X Ray and blood work. Based on testing, vet believes Sprocket is grade 3/4. Since he has some control of his bladder as he was able to sniff and pee the past 2 days but doesn’t seem to be emptying his bladder fully. The vet recommended CT scan and surgery tomorrow. All blood work came back normal and EKG was normal as well. Upon careful consideration and research I’ve decided to proceed with CT scan and surgery [Sunday 4/4] tomorrow. The vet was very informative and explained what the CT scan would entail and how based on results from the scan what surgery would look like if a slipped disc were found. He provided a 3-d model of the spine, drew pictures and explained the whole surgery and explained possible complications very thoroughly. He has performed similar surgeries before and believed despite Sprocket’s older age, with surgery and rehabilitation and care he has a good chance of regaining ability to walk. I’ll be bringing Sprocket there in the morning and will provide an update after CT scan. Question- should I make a new post/thread in the surgery board or ....? Thank you for your help.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 3, 2021 7:42:01 GMT -7
Shanti, we will be waitiing to hear if the CT confirms a surgery. Once Sprocket is in surgery, his thread will be moved into the Surgery Board for you.
Thank you for the update and we will be awaiting your next one.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 3, 2021 23:18:38 GMT -7
Not great news after the CT scan today [Sunday 4/4]. The vet noticed two things:
1. Found no herniated disc. Instead found a bone in the spine that seems to be “dissolving” and which he believes is caused by tumor of the bone. He’s not sure if it’s primary or metastatic. A biopsy would be required to know for sure and due to the placement of the bone being quite deep, it would require drilling and a metal plate placed there to ensure the spine did not move more. The doctor said he could do the surgery but it would be complex and there is a chance of it reoccurring on another area of the spine if it caused by a tumor. Sprocket did well under anesthesia but did see high blood pressure at the beginning of it but then went back to normal shortly after. Sprocket was eating and drinking well and able to sniff and pee but the vet is concerned that he isn’t fully emptying his bladder and that this is overflow.
2. The CT scan showers an adrenal gland mass on the right side. Also believed to be a tumor. Usually this would be recommended to be surgically removed however the mass is too large and too close to the vena cava so surgery is risky and not recommended. Blood work was done and will be sent to a lab to be tested to see what hormones are being produced by the enlarged adrenal gland. The results will take 1 week as they must be send to a special lab on mainland Japan. Based on those labs the vet will decide on treatment. However Sprocket hasn’t exhibited any signs of Cushings Disease even prior to his injury. Due to the size of the mass and proximity to the vena cava the vet is concerned about possibly high blood pressure or internal hemorrhage or possibility of more tumors arising elsewhere in the body.
In summary the vet doesn’t recommend surgery for either of these issues and suggested crate rest and pain meds (gabapentin 2x daily) and stopping the Prednisolone.
[Moderator's note: please do not edit 20 lbs. 12 y.o. 3/30 can move back legs, but not walk unaided 4/1 has some bladder control 4/4 CT and Diagnosis: bone tumor; adrenal mass. Not a disc episode gabapentin -100mg 2x daily Amoxicillan as of 3/29: 250mg 2x/day; 3/30 urine still dark!]
This was obviously not the outcome we were hoping for and I’m quite mentally and emotionally drained and saddened by this news. QOL is key and we want to do what is best for Sprocket. The vet said because he’s eating and drinking well and still some ability in his hind legs,
crate rest and meds to treat adrenal gland issue and pain is best, along with a harness to allow some mobility once he can move more comfortably.
Any advice would be helpful. Thank you.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 4, 2021 5:15:46 GMT -7
I'm so terribly saddened to hear of this diagnosis, Shanti. As for advice, we here on Dodgerslist only know one disease - IVDD. We are very hesitant to give advice as to any other disease as we wouldn't want to give any misinformation. Once you have a firm diagnosis from the blood work, possibly you could find a supportive forum specifically pertaining to that disease. We can help with mobility issues as that is something we do have knowledge on. How many weeks of crate rest was prescribed? Just until the blood work comes back and more is known? You mentioned a harness to allow some mobility once Sprocket can move more comfortably. There is a discussion at this link by other members as to harness recommendations that may be helpful: dodgerslist.boards.net/thread/1564/footwear-harnesses-scooting-garmentsWhen he is released from crate rest and if a wheelchair/cart is allowed, you can find helpful information on what to look for and recommendations here: dodgerslist.boards.net/thread/2133/wheelchairsAs for Sprocket's incontinence, the fact that he can sniff and release urine on his own indicates that he does have some bladder control. That proves there is some nerve connection between the brain and the bladder. Overflow of the bladder is seen when you find wet bedding or the dog leaks when picked up. If you are finding dry bedding, then Sprocket has enough control that he can hold his urine until he's taken outside. If there is not complete bladder control and Sprocket is not able to completely empty his bladder, then you should try to express his bladder after he goes on his own to help prevent urinary tract infections. I know you and the vets had difficulty expressing Sprocket and often when a dog has bladder control, they resist expression. Taking Sprocket out more often to sniff and pee on his own will help keep the urine from lying for too long in the bladder. Urine lying in the bladder is what can lead to UTIs. More info here: dodgerslist.com/2020/05/05/bladder-bowel-care/My prayers are with you and Sprocket. Blessings to you both.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 4, 2021 11:33:01 GMT -7
Shanti, my heart is painful to hear the Surgeon's diagnosis. Excellent points Marjorie shared with you. I would just add if some light and not aggressive range of motion and massage would be helpful during the number of weeks the surgeon has recommended would not only feel good to Sprocket but help to keep the back leg joints flexible and comfortable. Please check with the surgeon if some light passive exercise from you would be of help: dodgerslist.com/2020/05/26/range-of-motion-massage/%E2%80%8B?highlight=very%20light%20range%20of%20motion%20and%20massageThinking of your family as this journey has taken an unexpected turn. ((Hugs))
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 4, 2021 20:02:35 GMT -7
Thank you. The vet suggested 4 weeks crate rest and meds to see how he does. I am unsure if just the gabapentin is enough tor his pain and other issues, so will be speaking with the vet today to see what they prescribe so that he can be pain free and comfortable.
He hasn’t peed or pooped on his own since yesterday midday after picking him up from the vet- he had a very long sniff and pee outside but since then has been tired and not able to stand on his hind legs long enough to pee or poop. Hoping he gets some of that sensation and strength back today.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 5, 2021 4:57:07 GMT -7
The use of a sling would be very helpful in supporting Sprocket's back and spine when going potty. You can use a long winter scarf, ace bandage or belt. Most male dogs do not like the kind that touch the penis area. They much prefer a figure-8 sling. – Here’s one you can make from an old sweatshirt www.lyonpuffpetsit.com/htmlslp/sling.html– Kristen’s figure 8 sling made from two leashes I do hope that all of the appropriate meds will soon be on board to ensure that Sprocket can rest comfortably.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 7, 2021 2:40:46 GMT -7
Thank you for this sling information! We’ve been using a scarf until the special harness lead we ordered arrived later this week. It has really helped him go out to poop and pee and I’ve been able to help express his bladder while he pees to make sure he fully empties it.
He is doing well, eating and drinking, peeing and pooping and seems to have more energy although still weak in the hind legs. The two options for acupuncture are not available but there is a massage rehabilitation clinic that does home visits and experience with spinal issues and IVDD and pain management. So I’ll be trying to get them to come for a visit and first check.
Thank you again for being such a great resource.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 7, 2021 6:49:01 GMT -7
Shanti, good to hear Sprocket is doing well.
So the gabapentin 2x/day is controlling pain now? Gabapentin stays in the body for about 8 hrs. So if pain were to be surfacing, do discuss with the vet about gabapentin 3x/day dosing.
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Shanti & Sprocket
New Member
MALE-terrier mix. treatment: Tumor, Adrenal mass
Posts: 23
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Post by Shanti & Sprocket on Apr 7, 2021 23:40:04 GMT -7
Hello. Yes it seems to be helping him with the pain and he’s more energetic lately. I am considering taking him to a different US based vet here for pain meds to see what they may be able to provide different from the gabapentin and other alternatives you suggested.
He has been peeing well on his own and his new walking harness just came in today. We will let him rest a few more weeks before trying to walk with him using it. He hasn’t been able to poop as regularly though and basically struggles in his crate to tell us he’s going to poop and sometimes we notice and are able to take him out in time or other times he poops in his crate and feels very sad and guilty as he’ll hide and keep his ears down. His poop is quite hard. Is there something to help soften it? Or is a harder poop ok right now?
Thank you for checking in.
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