Carlos' Duke 4/23 conservative GRAD 6/18

Single most important thing is STRICT REST.  Duke walks!!!  Crate rest is the way to go.  No  more MRIs, X-rays.  STRICT REST

UNDERSTAND all your options, when a surgery might be a consideration.

Most disc episodes are diagnosed by a hands on neuro exam. X-rays do not proof a disc episode. MRI's are for when a surgery or to rule out other disease that a vet may also be suspicious of.

Without full info from you, it is hard to comment on. So for right now please read

Dr. Isaacs answered alot of questions we've had about surgery: dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/

More excellent info to help with conservative vs. when surgery decisions:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

QUESTIONS
It will help us work together with you and avoid offering ideas that could cause harm or lead the discussion in the wrong direction delaying help for your dog — please share a bit more detail with us:
☆ 1 Is there still currently pain?
☐ reluctant to move much in crate such as shift positions or slow, ginger movements
☐ shivering, trembling ☐yelping when picked up or moved
☐ tight tense tummy ☐can’t find a comfortable position, appears restless
☐ Arched back ☐head held high or nose to the ground
☐ Holding front or back leg flamingo style not wanting to bear weight
☐Not their normal perky selves?
Full pain relief is expected in1 hour
and stays that way dose to dose.
If not in control your vet needs to know asap to adjust meds.

☆ 2 A.. Update the meds currently given, their doses in mg’s and times per day given.
      carprofen stopped due to GI damage and no stomach protection
      gabapentin 100mgs WHICH? 8 or 12 hrs?
      diazepam 5mgs WHICH? 8 or 12 hrs?
      tramadol ?mgs ?x/day
      sucralfate 1000 mg (1gram) tab: ?mgs ?x/day
      needs GI tract protector, Pepcid AC+ sucralfate, on board w/carprofen! 

C.. PEPCID AC: Phrase a simple question that you expect a simple "yes "or "no" to it. Does my dog have 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).

(NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. www.1800petmeds.com/Famotidine-prod11171.html )
thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg **

☆ 3 -- Eating and drinking OK? No nausea/not eating, no vomit?
       -- Poops OK - normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?

☆ 4  Your name?
☆ 5 Did you specifically get a diagnosis of IVDD, aka: a disc problem, a disc herniation, a bulging disc, slipped disc?
      -- Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho?

☆ 6  CONSERVATIVE treatment
      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 dragging or meandering at potty times.
- no PT - no chiro therapy
Why Chiropractic is not recommended for pain for an IVDD dog: dodgerslist.com/2020/04/22/chiropractic/

☆ 7 DOGs with BLADDER 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!
i0.wp.com/dodgerslist.com/wp-content/uploads/2020/04/Potty-leash-harness400-19kb.jpg **

☆ 8 Currently do his paws knuckle under? Wobbly walking?
 
NEURO FUNCTION
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. 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.
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.  A happy tail wag is something anyone can correctly identify.
      A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Has a follow up with UC Davis Nurology..
On June 2. 10 am .
 He is doing well, it's almost as if he's good. He is so bored. And frustrated,but he's so smart . Got the potty thing down in a day or two.
We are talking about a Dog that will not poop on his property/ Home yard. We would have to walk him.that has been the routine for 6 years. So I am amazed.
Thank You.

[Below is Duke's 4/28/21 discharge report from UC Davis with meds

[Moderator's Note. Please do not edit
28.66 lbs/ 13 kg 9 y.0.
3/12 bloodwork, X-ray normal at Blue Pearl ER
carprofen as of 3/12: for 1 day, GI damage, STOPPED 3/14
gabapentin 100mgs WHICH? 8 or 12 hrs?
diazepam 5mgs WHICH? 8 or 12 hrs?
tramadol ?mgs ?x/day
sucralfate 1000 mg (1gram) tab as of 3/14: 1000mgs 3x/day
omeprazole as of 3/14 10mgs 2x/day
4/23/2021 2nd Xray + MRI]

[moved from profile area to Duke's thread]: 
date written by Carlos re: UC Davis discharge 4/28/2021: IVDD is mild strict cage rest at this Time. Gabapentin 50 mg/ml 2.5 ml every 8/12 hrs traZODone"

We understand about the movement. We have been too liberal in that regard. Note taken.
Dukes medications
1. Tramadol   50 mg  Vets indications are One capsule Every 8 to 12 hrs X day.  Duke takes 1/2 that amount  twice a day
2. Gabapentin is a oral solution  and he gets 2.5ml in the am and pm.
3. Diazepam 5 mg. is not in use
4. Sucralfate 1000mg is dissolved into a slurry, and given 1 hr.  before pain meds .
5. Dukes gait is good , at times a little tentative. 
6. His appetite is good, and he no longer snubs his food. Today he got a small marrow bone. He usually get 2 or 3 per week. However that was discontinued because of his injury.
7.Hello I am Carlos, Christine is my wife.
8. I have been trying to upload the MRI Images from our Phone.  We are in Northern Nevada currently.
9.Duke will bend his front knuckles in his bed. His nails will drag.  On occasion and will drag the nails of his Rt rear leg, also on occasion. Its very sutil .
 He had not lift his rt hind leg to pee. He has gotten better about lifting his rear legs to pee. for some time he would only lift his left rear to pee . Last couple day he has lifted the right rear also.
10. About the  Vets certification's , that have seen Duke I can not attest to. however at UC DAVIS he was seen 
by Several Vets , One Tech ,  One a Fourth Year Student ,and a Resident Clinician Dr. and A  Faculty Clinician, and has a follow up on June 2 2021 with the Neurology Department at UC DAVIS , Davis Ca.
10. Duke has been Prescribed the TRAZADON because He always displays extra joy , happiness when he see's me if i leave for any amount of time. he wiggles jumps makes vocalization, and I requested a little extra medication to curtail this behavior , We are actively trying to correct this behavior, So as to save him from further Injury.
Thank You  for helping educate us on how best to take care of Duke. I would like to share the MRI Images  ,but  at this time I can only email. Mine address is [in the Profile]

Your Expertise on Back braces . My wife would like us to get Duke a custom made Back Brace it would come in handy for when I leave. He gets so excited like he is going to shake himself apart. It has come to the point that for the last 2 months we have not been apart for more than a few hours. I know I am Blessed by this sweet Boy , he can be positively Ferocious at times he is a rescue so i am unclear about his previous owners . All i know is that they had several pitbulls and he was kept tied to a fence . he did not know what Grass was and still avoids it when walking. He had never been to the Beach. In San Diego we have Dog Beach , and fiesta Island his favorite spots. I have given Duke the best that I can, and will continue too , along with infinite love . 
Best Regards
Carlos 

  

Hi Carlos and Christine! Be sure to scroll up for Jessica's excellent comments this morning.

Don't worry about uploading MRI. Reading them is not our area of expertise. We depend on the vet to read and diagnosis which is reported in the UC Davis document you shared.

1) What about omeprazole? ?mg ?x/day or has it been stopped?
2) Sucralfate 1000mgs and is it 3x/day?
3) trazodone ?mg ?x/day

So very happy for Duke that YOU are "in the know" how important STRICT rest is for disc healing for 8 weeks with graduation on June 18.
   What, then, do YOU think is the benefit vs. risk of a vet appt on June 2?
   If nothing is worse on Je 2, why risk movement and damage to healing disc with a vehicle transport when a phone call to report all is good would suffice. Question for a phone update maybe week of 5/10, is when can all pain meds (gabapentin & traMADol) be stopped? Back them off or full stop them? Vets who know IVDD, will adjust meds over the phone. 

Keep us updated on when the pain meds can be stopped or backed off. No one wants a dog on pain meds if there would be no pain. 

Carlos, the date of the disc episode happened on April 23. 8 weeks from that date would mean graduation day is on June 18. I fully read the report ER vet Jessica Jones, DVM - Resident I wrote and looked up her credentials.

Have you vetted us?  Who do we align with?  dodgerslist.com/2020/04/20/education-team-ivdd
       Not all vets know IVDD. Most DVMs in a general practice see many different species- hampsters, cats, all breeds of dogs, reptiles, birds, maybe even farm animals. They practice many specialties in the course of a day: pediatrics, dentistry, surgery, internal medicine. Is it surprising, that keeping current and indepth knowledge of each and every disease for every species is probably not likely? However YOU can easily become a mini-expert on one very-important-to-you disease.
     Veterinary school gives a vet a vast knowledge base. Everyone graduates with individual knowledge gaps and different abilities to apply that knowledge efficiently. A vet adds to their knowledge base with every new case. If they don't see enough IVDD cases in their practice then IVDD may not be their strong point, YET!

If Duke is too rowdy inside of his recovery suite, then you would need to use the traZODone plus other re-training for unwanted behaviors. Did you get a chance to read Jessica post above and all the links she gave you? Let's talk about any of the ideas presented if you would have some questions about them.

 QUESTION:
3) trazodone ?mg ?x/day are you actually giving?

I think that Duke is comfortable now and able to rest calmly. Muscle atrophy can occur during the 8 weeks of strict crate rest. But muscle tone is very quickly regained once the dog gets back to regular activity.

Duke has no difficulty getting comfortable in either of his recovery suits, in the outside one he will move from two beds in the pen area one in the shade and another in the sun, (this dog loves the sun shine), depending on if he gets to warm in the sun, he will take a drink, and move into the shaded bed. in the afternoon he comes inside he does shift positions. He does not seem as alert, We have a chiweenie Lola , who is acting up , she is not allowed to get Duke Excited, orf sleep with him ,No play time. any how Duke just seems lethargic the ejes move ,the ears perk up , but unless there is someone at the door he wont move. This morning he was way past his am pee time and he did not want to get up,he would roll onto his back, and nudge my hand with his snute , this mean rub my belly, keep petting me.He was just snoozing until 10 am . Usually he has to go about 730/800 am . My wife says it is the medication. He is settling in nicely to his new reality. I guess I am not .

Hello Ladies
Duke is recovering , all though i have never seen my dog more MISERABLE , and Honorary , he almost bite me the other day. Guess he is going through some withdrawals, Dr. recommended that we cut his Tramadol,we did manage a refill on the gabapentin . The Dog is anxious to get a little freedom. He is annoyed, about not having those extra 10 to 12 steps at potty time. Oh well I'm looking forwards to Hydrotherapy. Any thoughts ?
Carlos & Duke

[Moderator's Note. Please do not edit
28.66 lbs/ 13 kg 9 y.0.
3/12 bloodwork, X-ray normal at Blue Pearl ER
carprofen as of 3/12: for 1 day, GI damage, STOPPED 3/14
gabapentin 100mgs WHICH? 8 or 12 hrs?
diazepam 5mgs WHICH? 8 or 12 hrs?
tramadol ?mgs ?x/day
sucralfate 1000 mg (1gram) tab as of 3/14: 1000mgs 3x/day
omeprazole as of 3/14 10mgs 2x/day
4/23/2021 2nd Xray + MRI]

I am pleased to post that Duke and I are in our first week of graduation.
We did attend a Neurology exam at UC Davis to check his progress . Fiscal therapy starts this next week.

He waddles... how can i best describe his gait. he sashes... he prefers to slow trot rather than walk . once he gets going that seems to work best for him. i believe this is due to him losing some of the coordination of his back legs. His nails are long, He does not like his feet touched at all and a Hoyer's lift and myself to get him from wiggling/ biting the groomer.

back to his gait his spinal does not move side to side as much when he trots .as it does when he just walks... he is doing what feels better for him I am Guessing.
Any ways just wanted to thank you Paula,for all your grate advise. You were/are instrumental in our Recovery. Thank You All. Duke and Carlos

Carlos, congratulations on Duke's graduation day!

Do check out the excellent link Romy gave above on nail cutting. It would be a good thing for you do to the work of desensitizing Duke about not liking his paws/nails touched. Then when your groomer does clip nails it will not be so utterly stressful to Duke that he wants to bite! Look read the nail section on "Desensitize your dog"   Plus try out some of these ideas from the pro trainers in desensitizing. The best time to do this training is after Duke has had some exercise and is a bit tired out (what is the name of the PT he will start?):
    1) The clicker marks the exact moment the dog is doing a behavior you wanted. The word “YES!” could be used instead of the clicker.
    2) Your dog learns: Trims equal Treats conditioning


GRADUATION, A SLOW RE-INTRODUCTION
Determine how you are going to ease back into more normal activity at graduation at home. The idea is to gradually give more freedom under controlled conditions. Not free riegn of the house and yard immediately! LOL
   You don't want to be confused if there would be pain. Is it just having overdone exercise soreness  VS.  may be a sign of a new disc episode.

Take a look at our information and then come up with a plan to gradually increase activity over about a month's time following the end of crate rest.
   Sample schedule to slowly introduce your dog back to family life and physical activity: dodgerslist.com/2020/06/15/back-friendly/?highlight=sample%20schedule

Make your home back friendly:
Avoid stairs or steps. Use ramps indoors with furniture and on outdoor steps to help decrease impact on the spine. How to build your own ramps and furniture blocker ideas

Prevent jumping up or down from furniture, those activities increase impact on the spine. Teach Duke to use a ramp: dodgerslist.com/2020/06/16/training-to-use-ramps/

We are so glad to hear that you've had a great experience! We are always striving to make the Dodgerslist Forum the best it can be to help owners and their dogs. Thank you for taking time to let us know our comments for you and Duke were a benefit in his road to recovery.

Carlos, don't be a stranger. Periodically when you have time we'd love to hear how Duke is doing. Which kind of ramp and furniture blockers you've chosen. That may help another member!