Jessica's Laura Aug 2021 conservative- GRAD 10/3/21

Jessica, sorry you learned your vet is very uncomfortable with his IVDD knowledge.  You need a new vet who WILL support you with conservative treatment. YOu can do the 8 weeks of rest w/o vet help, but you need a vet who will prescribe more anti-inflammatory drug if needed and pain meds if pain would exist at some point.
--  Carprofen ( anti-inflammatory) will take 7-30 days to resolve painful swelling.
-- YOur  may need more than the one ER Rx'd course.
-- for how many days did ER prescribe carprofen for on 8/8?
-- Double check your bottle of methocarbamol!  For a 15 lbs dog the dose is typically 125mgs 
--  What is dose in mgs for gabapentin.  Which do you actually give every 8 or 12 hrs?
-- If Laura has no health issues, get Pepcid AC (famotidine) on board asap from grocery store.  Stomach damage progression is: loose stool, vomit, bleeding ulcers, red or black blood in diarrhea.

thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg

Romy gave you the link to questions to ask at the interview in above post plus lots of other great info.

Get a sense of the answers by boning up as fast as you can tonight on the principles of conservative treatment. Helps in discussing with the new vet how he will assist with Laura's case.
     Here are the details of how conservative treatment is done (meds, STRICT rest, Stomach protection)
dodgerslist.com/2020/05/14/strict-rest-recovery-process/

You will get more out of a hands-on-top-of-your-hands type of expressing lesson by first reading and viewing the video at this page: dodgerslist.com/2020/05/05/bladder-bowel-care/   Note you can also express for poop. It is so easy you don't even need a lesson— just watch the video.

To get a handle on the overall disease itself go thru this 10 min Shortcut Thru IVDD.  dodgerslist.com/2020/06/26/time-and-ivdd/   You'll be set and ready for tomorrow's vet appt!

We'll be watching for tomorrow's post to update us on changes to meds, how the expressing lesson went and your new vet.

Good job with learning to express! It will make it much easier to care for your Laura Lane.

Let us know what the vet says when you have a chance.

We did like the vet we met. She had a much different attitude, big relief for us! She was hopeful with what she saw with Laura at the visit. More expressing practice. Not sure where we are we will find a IVDD specialist type in our city but im still researching. We were very prepared with lots of questions and she answered them all and heard our concerns and we didn't feel rushed. She wants updates as well as we see them or not. I feel like we have a path at least.

Laura is now on
Gabapentin oral solution/ 50 mg 1ml by mouth 8-12hours
Rimadyl 25mg chewable 1/2 tablet twice daily
methocarbamol 125mg half tablet given twice daily
(a little confusing on how to word how much for the rymadyl because they didn't cut pills for us and whole amount of mg/pill without cutting is on the bottle. )

I will follow the advice of 8 hours
Before we were staying in the range of 8-10 hours

She said she hasn't advised Pepcid before but said it wouldn't hurt her.
    Is that 5mg before eating? 30 minutes before? or just every 12 hours and doesn't matter about food
We started 8.12 with pepcid, only one active ingredient.

She prescribed ✙Trazadone as needed. Ok? 50mg 1/2 tablet 8-12 hours as needed for times we know she would get stressed.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 4 y.o.
ER Rx'd carprofen, metho & gabapentin
carprofen 25mgs tab as of 8/8: 25mgs 2x/day for 10 days, then 8/18 test STOP for: _pain / _neuro
methocarbamol 500mg tab:  125mgs 2x/day
gabapentin 50mgs/mL:  50mgs (1 mL dose) 3x/day
✙Trazadone 50mgs tab:  25mgs as needed for anxiety
✙Pepcid AC (famotidine) as of  8/12: 5mg 2x/day]
  
Are there any other supplements that would be helpful? She hates being in the kennel, I think I saw a thread on tips that I will be reading.

Thank you for everything, this is a true blessing to have found.

REMOVING long QUOTED text down to ONLY THE OWNER'S words:
1. the formula  [gabapenitin] 50mg/ml.   1 mL dose promptly every 8 hours? yes
2. [Rimadyl] whole tablet 25mg.  give half twice a day
3. Methocarbamol whole tablet 500mg.  1/4 tablet.  it says 8-12 hours. Should we wait the entire 12 hours?
5. Did the new vet give you a hands-on-top-of-your-hands type of expressing lesson?
    Somwtimes, I'm still struggling and others I do just fine.

6.  Pain seems to be in control, no panting, she shakes a bit when we get her out but seems to be excitement to getting out. She does cry in her kennel but she would do that normally, she always wants to be with us, we're trying different strategies to keep her content, kennel by us...during the night she is quiet and sleeps as she always did.

Also, I took her outside to see if she would sniff and pee/express outside and noticed when I put her down with scarf trick she seemed to move both back legs to walk but her feet still stayed flipped under. I picked her up because she wanted to keep going and from what I understand just let her do a couple steps?

Thank you!

Also, Daily food and water portions.
How much daily water to make sure she gets? She will not drink her fresh water, I have to water down her food to get her to drink water. This is new since her injury. She always has water in her crate. I make sure she is getting 2 cups a day. Enough?

How much food is enough to keep her nourished and not too much? She is on wet food and a little pumpkin puree

I try for 2 cups/day

Our vet did not do a hands on lesson of expressing just demonstrated and gave anatomy pictures. I have improved a lot over the last couple days and feel like we are getting into pattern. Is there a typical or average time frame that pottying on her own will return if it is going to. When outside in her pen she doesn't smell around seems too distracted with being outside and every else around her.

She does wag her tail outside of potty time. When excited

update: yesterday and today [8/18] Laura has been standing up on her own and keeps her toes from flipping under. She has done this in her kennel as well as potty her potty area. She does fall back on her back legs some but is able to correct it on her own to a standing position again. This morning she did potty outside on her own as well.   Thank you!

Laura has continued to potty outside and has stayed dry in her crate in between pottys.

The vet called for an update [date?] and I asked about meds. She said she would like Laura to stay on all meds  for at least 3 weeks and then probably the anti inflammatory longer. So Laura would begin to taper off 8.30.21 Does this sound right? About how long for anti inflammatory? How do you know when to stop?

[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 4 y.o.
ER Rx'd carprofen, metho & gabapentin
carprofen 25mgs tab as of 8/8: 25mgs 2x/day for 10 days, then 8/18 test STOP for: _pain / _neuro
                      as of 8/22 vet wants to stay on carprofen for 3+ weeks, stop to be 8/30
 
as of 8/22: Vet wants to stay on pain meds for min 3 weeks, stop to be Sep date ?
  methocarbamol 500mg tab: 125mgs 2x/day
  gabapentin 50mgs/mL: 50mgs (1 mL dose) 3x/day
Trazadone 50mgs tab: 25mgs as needed for anxiety
Pepcid AC (famotidine) as of 8/12: 5mg 2x/day]


Thank you!

Had an appointment with the vet today 8.25 to discuss the meds further and a ongoing action plan. The vet wanted to see her before changing meds in any way

After seeing Laura, the vet was impressed with her mobility and her movements and especially the difference from her last visit 2 weeks ago 8.12. The vet did say that she thought laura's middle back still felt tense so she would like to keep her on all meds the same for the next two weeks as she has been doing since 8.12 at Laura's first visit with the new vet. We did discuss that at home, there is no sign of pain.

8.25 Laura is still prescribed for:
Rymadyl 25mg/day giving half tablet twice a day
methocarbamol 125mgs 2x/day
gabapentin 1mL dose 2x/day
[?] pepcid .5 2x/day  [   1/2 of a 10 mgs tab or 0.5mgs dose ?]In 2 weeks 9.8, her recommendation is to discontinue the methocarbamol and she how she does.
The next week after that (laura's 6th week of crate rest) she said she could roam around the house [after 6 weeks] but no jumping. I brought up crate rest for 8 weeks and she said we could that but does think she needs more mobility at this point. (I would like to continue the crate rest for the whole duration of the 8 weeks)

week 7-if doing well can decrease Rymidyl to once daily and see how she does. Again, recommended more roam time.

week 8 [9/26 thru Oct 2: GRAD DAY 10/3]-Discontinue Rymadyl and continue Gabapentin long term and expects by then Laura will be walking well.

She also recommended that Laura lose 2 pounds. Today, 8.25 She weighed ▼ 14.5 pounds so she wants her at 12.5 as to take pressure off the back even more.

I don't want Laura to be on meds she doesn't need to be and we discussed this during the visit. Again, she expressed this is what she recommends based on the tenseness/tightness that she felt on her back

Hopefully this all makes sense. Thoughts?

Thank you for all the help.

Jessica, to recommend more days on Rimadyl for tightness and tense in the back is appropriate. 

Good points Romy makes in her above post about diets, etc.

RIMADYL (Carprofen)
It normally takes 7-30 days on Rimadyl to get the pain resolved. Those number of days is by using short courses of Rimadyl, stopping Rimadyl and the pain meds to get a quick and accurate read on pain.  If pain, then another short course and another STOP test.

Rimadyl Rx you report is for finally stopping Rimadyl after 51 days of it during 8th week (9/26-10/2) . Grad date is 10/3 

Since no one should want a dog on meds any point past the benefit of all pain gone, vets very, very typically Rx a 7-day or maybe a 14-day course and then full stop Rimadyl and pain meds to prove what's going on. To prove if another course is even needed.

Many, many disc dogs have greatly benefited from Rimadyl (carprofen). The concern is using any NSAID long term rather than using a short course, a STOP test to see if the benefit has been received.

This is not to scare, but just to have you fully aware as even the FDA advises about any NSAID. 
     Side effects can be stomach damage due to more stomach acids produced and the reason for acid suppressing Pepcid AC protection.  GI tract damage is progressive starting  with red flag signs of: nausea, not wanting to eat, vomit, loose stool, bleeding ulcers, black or red blood in diarrhea, deadly perforated stomach lining.
     Something else could look like GI tract problems but is not. It is not very common but can happen:  Rimadyl toxicity in the liver can start as an off and on sort of pattern-some lethargy that comes and goes, diarrhea that comes and goes, vomiting or lack of appetite that comes and goes.  

Seems you have two choices.
--- Tell your vet what you want for the use of Rimadyl and gabapentin because that is what is in your comfort zone for safety of your dog.
--- Hire a different vet.

Why does a young 4 year old dog need long term use of a pain med without proof the dog actually needs it long term?

Jessica, for sure the first thing thought is always could this be a disc episode.

If you are suspicious, then the first act is to immediately crate your dog.

Crating to limit movement of the back would be to prevent nerve function damage.  It is the movement of the back that pushes on a prematurely aged disc. That bad disc in turn can push upwards to invade into the spinal cord canal.

Giving an anti-inflammatory drug ties the hands of the vet on his diagnosis of being kinda blindfolded in exam and also what meds he prefers.  So if you determine it is pain, a pain meds lasts for 8 hrs and will be out of her system for tomorrow vet appt and exam, diagnosis, treatment.  Anti-inflammatory take 4-7 days to leave the body! Makes harder work for vet to observe Laura for himself with the blindfold of an anti-inflammatory still in her system.

DETECTIVE WORK
Determine if the shivering is due to anxiety, being chilled? If you hug her and cuddle does the shivering go away?  IF she's cold, does a nice warm blanket warmed in the dryer stop the chilly shivers?

Are you observing pain? Often if there are two or even more signs of pain, then you have a pretty good idea it IS pain.