Elisa's Coconut 2021 conservative- Fr Bulldog GRAD 9/2021

Welcome Eiisa! I'm sorry  to hear your little Coconut has had such a time of things.  Things are still not right, requiring you to take action in the quickest way possible.
  1)  Pain is not yet managed round the clock dose to dose: (slow to move, can't get comfortable, holding paw up not wanting to bear weight.)
  2) The best pain medications control is using more than one approach to address pain from multiple fronts (traMADol-general analgesic, methocarbamol (every 8 hours). These meds stay in the body only about 8 hrs. .  
  3) Resolution of spinal cord inflammation/swelling provides the relief from pain in a week or longer. It can take an anti-inflammatory (steroid or a non-steriodal NSAID) a range of 7 to 30 days before all swelling is gone. 
      These powerhouse meds do wonders OR they can be dangerous. Vets who practice safe medicine and owners up to speed on medications make all the difference. Did you get all four questions right?
After you have been successful tomorrow am in getting pain meds adjusted, Pepcid AC (famotidine), and an anti-inflammatory drug on board, please fill us in more:

1. Did the ER vet say it was a neck disc or a disc in the back?
2. Which paw(s)  front or back and left or right does Coconut hold off the ground not wanting to bear weight?
3. Does Coconut now walk wobbly with back or front legs?  Do the paws knuckle under or can she right the paw(s) properly on the ground?

Hoping to hear back from you early in the morning, meds are on boar that should be and the details on the meds (mgs, frequency)

Good that you have gotten the Pepcid. Our IVDD dogs have enough to deal with without adding stomach problems. Since Coconut is 22 lbs her dose should be 10 mgs every 12 hours. If she has liver or kidney problems, the dose may need to be reduced. In that case, speak with the vet about the appropriate dose.

Elisa,  here is what to monitor regarding loss of neuro functions. We have still not been able verify with you what Coconut's neuro funcitons are today.  This list may be able to zero in on exactly where her neuro status is for us.

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.  yes 7/30 Pain caused by the tearing disc & yes 8/5 inflammation in the spinal cord
2.  yes 8/5  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 (DPS), 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 (DPS). 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 good quick overview of conservative treatment vs. a surgery you should have under your belt in case of an emergency you'll best be able to discuss things with a surgeon.:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

QUESTIONS

1) Can't really picture what you are seeing "buckles after standing for a bit".  How long is "a bit"?   
     Do the legs just gradually loose ability to hold her up and her butt lowers to the ground?
    When out for potty is the sling lightly in place as a back up should her butt start to tip over?  
    When she wobbly walks with the sling do her back legs move in a walking motion? In other words can she wobbly walk with her back legs with ?

Every day you write, we are very interested to have an update on pain control and neuro functions.
2) After getting Rimadyl started 8/5 but no pain meds (why?), is pain fully in control dose to dose?
 
With any change to the meds list we are very interested to have all the details. When we are fully up to speed about all things Coconut, we can offer best assistance.
3) Rimadyl for how many days is the course?  Often vets try a 7-day or  14-day course. What is Coconut's Rx?
4) You have Pepcid AC with only one active ingredient?
    How many times a day are you giving it?
    How many mgs are in one dose?

5) Thank you for registering!  Have you been able to set up EMAIL ALERTS?
    Timely communications are needed when helping your dog. How set up a bookmark for your dog's thread for email alerts when you have received a reply: dodgerslist.boards.net/thread/7353/register-bookmark-dogs-post-thread

6) Will be anxiously awaiting tomorrow am to find out if proper pain meds are on board and all the detail of mgs and times per day doses.  Don't understand why she did not get med adjustments this morning. Which kind of vet (ER vet or your family DVM?) Rx'd the Rimadyl?

Elisa, looks like even thinking about a surgery at this point in time should not be on your mind. If you can commit to the very STRICT principles of limited movement, Coconut has great potential to not only heal the damaged disc but also to self heal her pretty mild nerve damage with time.

What needs action right away on your list is making sure Coconut is provided the necessary full comfort from any pain with the right compliment of pain meds Rx'd for round the clock freedom from pain (every 8 hrs dosing)

Good job in get her stomach protected from stomach acids Rimadyl causes with Pepcid AC 10 mgs 2x/day. Be sure to keep your vet in the loop about all things you give Coconut.

A 10-day course (from left over family vet Rx ok'd by ER vet) just may do the job of ridding the body of inflammed and painful and swollen tissue around the cord.
     With the start of Rimadyl on Aug 5 (is that correct?) then on Aug 15 will be her first day w/o Rimadyl.  Sunday, Aug 15 is kinda of a test stop to find out the truth about painful swelling. The test only works, though, when you are not hindered from observing if pain exists:
--- All pain meds that blindfold you about pain pain are stopped or backed off (vet's decision which) on Aug 15. Let us know  which your vet wants.
--- That you observe for any surfacing signs of pain and have a plan if prooved painful swelling still exists.

With any STOP test, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script in hand you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free!

Being  fully informed on the nature of anti-inflammatory drugs with a disc episode puts you in a very strong position to understand your vet's treatment, be able to voice good questions and bring ideas up for discussion. 
--- The full details on how non-steroidal anti-inflammatories work with a disc episode. :
dodgerslist.com/2020/04/18/steroids-vs-nsaids/

Elisa, we only know one disease.  Not sure what a pop sound is caused by.  Sounds good that Coconut's pain control is appears to be working if she is more her perky interested in life self and you are not seeing any other pain sgns.  

We can't do our job in providing good assistance if we don't receive answers to our questions.  I put my questions in PINK so you can easily find them:

--start of Rimadyl on Aug 5 (is that correct?)

--- All pain meds that blindfold you about pain pain are stopped or backed off (vet's decision which) on Aug 15. Let us know which your vet wants.

IF there are no signs of pain surfacing nearing the next dose of pain meds and no  pain surfaces round the clock, then pain meds are correct.  You only ask for pain med adjustment when you alert your vet of the pain you observe happening:

Elisa, there have been some very few dogs where Pepcid AC caused nausea/vomiting. You started Pepcid AC on 8/5. So this could be a possibility.

Call your vet and discuss the use of a different kind of an acid supressor called omeprazole.

The GI problems (which could be caused by Rimadyl as of  8/5)  would progress like this:
nausea (lip licking) not interested in eating, vomit, loose stool, bleeding ulcer, red/black blood in diarrhea, perforated stomach lining.

A change in food can also cause vomiting, but is normally temporary until the body gets used to the new food.

Let us know what your vet thinks is most likely cause of the the vomit could and what he recommended.

I am glad that Coconut is sleeping well and now has normal poop. She does seem to be feeling better.

Please let us know about the stomach protector when you hear back from the vet.

Elisa, good news on no longer vomiting. And such good news to hear her paws no longer knuckle under. Now that's nerve healing, a very good thing! Thank you for such a happy update.

We all are glad to hear from you our support is helpful. That makes our day.

Elisa, yes, do mark your calendar for graduation day of 9/25.

Every day Coconut IS definatly healing.

Some kinds of healing we can't observe from the outside. The disc is self healing every day with the target date of 9/25 to have good strong scar tissue.

Nerves self heal and we don't see any evidence until there is enough nerve healing to allow a connection to the brain, such as the day you observed Coconut is no longer knuckling under paws and can now place them correctly on the ground.

You are doing a very good job in caring for Coconut with your diligence of STRICT rest! Keep up the good work.

I hear you Elisa! When they begin to feel better, it's a challenge to keep them to limited movement so the disc can heal.

MENTAL STIMULATION
 For dogs mental stimulation can be just as tiring as physical activity would be but not allowed right now.. 
    Choose only the activities that can take place inside the recovery suite. Choose activities that do not exceed the demand for 100% STRICT rest for the back. Your dog will be lying on the stomach or maybe quietly sitting. Use your dog's daily food rations as the rewards. Adapt each activity so that it takes place inside of the recovery suite while you sit on the floor in front of the suite's open door. Stop if your dog is getting over excited and displaying rambunctious behavior of too much back movement.

-- Try some training to give the brain a mental workout..brain work can be tiring but a good thing.
      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 food reward.
     [NOTE: for crate resting dogs, shift your body a bit to change your angle] .... 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.Lo-cal treats are tiny pieces of apple or carrot. To dogs the size of the treat matters not. They work just as hard for a big piece as a tiny piece.]

Adapt the lip licking activity so that it takes place inside of the recovery suite while you sit on the floor in front of the suite's open door. Stop if your dog is getting over excited and displaying rambunctious behavior of  too much neck/back movement.

As long as your dog does not have a neck disc and will calmly use a kong, it can provide your dog with a job during crate rest.... to work at eating dinner via a kibble meal frozen into a Kong. Licking and eating will now take alot more time & effort and it is stimulating. Be sure to subtract what's in the kong from the daily kibble allotment so as not to gain weight.

What/how to stuff and training tips:

It is common for our IVDD dogs to have some days better than others. As long as Coconut has been on strict crate rest, I don't think there is a problem. Healing is not strictly linear, so you will likely continue to see some days when she is more energetic and some days when she is less so.

Elisa you are jumping the gun.

First step is the stop of RIMADYL. The result of the STOP indicates the next step to take.

It is good you have extra pills on hand should it be indicated more time on Rimadyl is needed to get all the pain resolved.

TODAY 8/15 the 10 day course of Rimadyl ends. 

The pain mend gabapentin should be either stopped for backed off so you can correctly observe about pain surfacing.  Call the ER and ask how THEY want gabapentin handled (stopped today or backed off (they will tell you how to back off if that is what they want).

Keep us posted on what ER says.


MED LIST/HISTORY-
22 lbs 3.9 y.o
Rimadyl leftover family Rx; as of 8/5: 25mgs 2x/day for 10 days, the 8/15 test STOP for: _pain/_neuro
gabapentin 100mgs 3x/day
traZODone 50 mgs 8-12 hr for anxiety
Pepcid AC (famotidine) 10mg 2x/day for the duration of Rimadyl

Elisa, that makes no sense to stop the med that works on eliminating all spinal cord swelling (Rimadyl) so you are able to assess quickly and accurately if the swelling has really been taken care of BUT leave gabapentin which covers  up nerve pain on board for a full 8 weeks (56 days).

To say Coconut needs gabapentin for a the full 8 weeks without proof there is indeed still pain is even more bizarre.  Conservative dogs VERY, very typically get all painful swelling eliminated in a range of 7 to 30 days.   

Covering up nerve pain (gabapentin) means you are working with a blindfold on while attempting to learn if all pain is really gone.

Some vets will chose to full stop gabapentin on the stop of Rimadyl.

Other vets may choose to back off gabapentin (less frequency and or smaller mg dose) when a dog has been on a meds for a long time.  It is the vet who knows the dog, can best determine which method to get off of pain meds upon the stop of Rimadyl.  Coconut has been on gabapentin for 19 days.  We do not have qualification to prescribe because we are not vets.  You do need the advice of a vet for Coconut's case whether you can full stop Gabapentin or if he needs to have it back down.

Is it possible to call the clinic where your out-of-town vet works and maybe get a sense about dealing with gabapentin on the stop of Rimadyl.   I know no vet at that clinic has examined Coconut for this disc episode, but they do know all about Coconut's health history from his file there and hopefully could give you a sense of how to deal with getting off of Gabapentin.

traZODone is an anti-anxiety med to help Coconut relax in her recovery suite.

Elisa, since 7/31  what good improvement in nerve improvement —no longer wobbly and no knuckling under paws!  With a real test for pain/neuro issues upon the stop of Rimadyl and hopefully soon information how to do gabapentin, you will have proof if Rimadyl as done its job to  eliminate swelling of tissue.