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Post by Lisa & Buster on Aug 15, 2021 0:32:33 GMT -7
[Original subject line: Buster’s IVDD journey] My name is Lisa and my dog’s name is Buster. We live in Nashville, TN. Buster is an 18 lb dachshund. He was diagnosed with IVDD on 8/4/21. He was fine on 8/3 and then the morning of 8/4 he was paralyzed. We went to vet same day and he had no deep pain sensation and c annot control his bladder or move hind legs. Vet did lab work- all fine; did x-ray which showed some calcification. Initial vet recommended surgery, which I was unable to do immediately. I started arranging financial assistance but was unable to do so within needed timeframe. Therefore we are on conservative treatment plan. His crate rest began immediately on 8/4 before we even went to first vet. Since 8/4, he has been on prednisone (20 mg- stepped 2/ day for 1 week, then 1/day, then every other day. Gabapentin oral solution 1ml, every 12 hours and was on amantadine 2.5 ml every 12 hours. I’ve been expressing his bladder since 8/4. [MED LIST/HISTORY- Moderator's Note. Please do not edit
18 lbs age?
prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: _pain / _neuro ]
gabapentin formula ?mgs per 1 mL: ?mgs (1mL dose) 2x/day
traMADol 25mgs 2x/day
✙Pepcid AC 10mg 1x/day ]
Went to specialists where he had an in-house neurological consult to seek MRI and surgery consult on 8/9 and was advised not a candidate for surgery and would never be a candidate. They also confirmed no DPS. Was told less tha 5% chance of ever regaining use of back side and that someday he may be able to use wheels. No changes to meds. I followed up with regular vet as advised by specialists that same week, on 8/12. Meds were changed in that amantadine was discontinued and added tramadol, 25 mg 2/day. I have scheduled an appointment with rehab vet/facility for 9/9/21, which was the soonest available. The rehab vet procedure is a 90 minute consult to assess and develop treatment plan. The rehab facility o choose was recommended by local dachshund owners who have had surgery and they offer acupuncture, cold laser, and PT. Crate rest has continued uninterrupted and I have ordered LumaSoothe [infrared light therapy] to treat at home while crate resting and waiting for rehab appointment. I added ✙ Pepcid AC today for stomach protection. He was eating Blue Buffalo life Protection kibble prior to 8/4 and I switched him to wet on 8/4 because he was drinking less water. I joined a Facebook group who immediately sent me here. I have gotten answers to a lot of my questions there and by reading this site and others. I also asked dozens of questions at all 3 vet appointments. I live alone and work full time. Thankfully, I only have in office days twice per week. I’ve been able to work partial in office days this week and next as well. They of course will expect me to return to 2 full days in office sooner than later. My specific question tonight is that I’ve noticed my dog can sense when his bladder is full as he whines a little, i am curious if this is a good sign or irrelevant. When he does whine, I express his bladder. He has bowel movements independently and the regular vet showed me how to clear his bowels in case he gets backed up. |
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Post by Ann Brittain on Aug 15, 2021 7:45:46 GMT -7
Hi Lisa, Welcome to Dodgerslist. I'm glad you found our group through your research and on the advice of others on Facebook.
There are some questions you can answer that would help us evaluate Buster's condition. How old is Buster? Is his pain under control with his current medication?
Signs of pain can be: reluctance to move, shivering, trembling, yelping when picked up or moved, tight tense tummy, can't get comfortable in crate, arched back, head held high or nose to ground, holding front or rear leg flamingo style and not wanting to bear weight. Is his appetite normal?
Is he drinking normally?
In your research, you may have already read about strict crate rest. But I'm attaching a link which goes into detail about how to set up Buster's recover suite and the importance of maintaining crate rest for 8 weeks. You mentioned you have an appointment to discuss rehab on 9/9. Since his down date is August 4, that would be early to start any kind of PT. However, coming up with a plan in advance is a good idea.
My understanding or the benefits of LumaSoothe is limited, but I trust other moderators will have broader knowledge and be able to advise you on its use.
It could be a good sign that Buster may be sensing when his bladder is full. I'm sure your vet has advised you that it's important to empty his bladder to help prevent urinary tract infections (UTI's). Urine with a strong odor or that becomes dark and cloudy can be indications of UTI"s. You'll want to consult your vet if you notice any of these symptoms.
Bowel movements are less problematic as Buster's body will automatically eliminate poop. Medication can cause a dog to become constipated. If you notice a change in Buster's stools, you can add a tablespoon or two of pureed pumpkin (plain, no sugar) to his food. It's a great, natural, way to relieve constipation.
Many dogs have recovered even after being given diagnosis's similar to Buster's. But doggie wheel chairs are a great tool for paralyzed dogs, but they are not an option until completion of strict crate rest. Remember nerve healing is not an exact science and each dog heals differently. We'll keep positive thoughts for your Buster.
Please keep us up dated on Buster's progress.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Aug 15, 2021 8:48:09 GMT -7
Lisa, we'll be looking forward to confirming questions Ann has asked about pain. The single most important care you can give is the full 8 weeks of limited movement a recovery suite provides. There is opportunity for DEPS to come back if the disc is not allowed to make nerve damage permanent! Graduation day is Sep 29 to ensure the disc has healed. Nerve repair may or may not come back in that short 8 weeks it takes the disc to heal. When prednisone goes to the taper (on 8/11) that would be the time to stop pain meds and asses if there is still painful swelling. So we a confused why a pain reliever traMADol was added on 8/12. Clearly if there was pain, it would not be time to continue on with the prednisone taper! It may take 7-30 days (excluding any taper days) to resolve all spinal cord swelling. A short 7-day pred course Buster had was not long enough if the vet saw pain on 8/12 and Rx'd traMADol . If you ARE seeing signs of pain, advocate for: --- Another course of pred. Maybe a 7-day maybe a 14 day course. The taper days are not high enough to be working on spinal cord swelling. --- All three sources of pain are normally covered by three different pain meds and Rx'd for promplty every 8 hrs because that's how long pain meds last in the body. traMADol as the general analgesic gabapentin for nerve pain methocarbamol for muscle contraction pain. SNIFF and PEE TEST The only way for humans to know if there is bladder control is with the “sniff and pee test.” Winter can feel the push and discomfort of a full bladder. IF the nerves going to the bladder area damaged, then his brain can't message the bladder neck to open and release urine. NOTE: the baldder can open due to reflexes such as a the reflex to pull you hand away from a hot stove. Reflexes however can't allow all urine to escape from the bladder. IF winter leaks on you when lifted or you are finding urine leaks in bedding that is a sign of lost bladder control and the need to continue to express his bladder. NOTE you can also express for poop to avoid Buster the anxiety of finding poop where he sleeps HOW to express for poop and a review of bladder expressing here: dodgerslist.com/2020/05/05/bladder-bowel-care/PLEASE LET US KNOW what the results of the SNIFF and PEE test are: Carry outdoors, set them on an old pee spot to sniff. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. See if they will release urine on the old urine area. If urine comes out after sniffing, bladder control is returning. You should continue to do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe. Stay strong, stay positive. Nerves can take months rather than days/weeks to self repair. Pain can be fixed in one hour when the pain meds are right while prednisone can take weeks to resolve painful inflammation. A dog can recover and heal with time if given the gift of 100% very STRICT rest 24/7. Only out of the recovery suite at potty times for 8 weeks is how the disc heals. |
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Post by Lisa & Buster on Aug 17, 2021 20:52:51 GMT -7
Buster is 6.
Regarding the meds- the regular vet (seen on 8/12) said he didn’t want to continue the amantadine as he did not feel it was helpful for ivdd. Buster’s pain was not controlled at that time and I advocated for adding tramadol, which he also said he did not feel was helpful for ivdd. I have seen on several groups that tramadol was used frequently, so that is why I asked for it. With gabapentin and tramadol, I think his pain is managed for the most part.
His appetite is normal but he is not drinking as much. The vet said I could add low sodium broth to water to help him drink more.
As of yesterday, 8/16 he has crystals in urine. I called vets office and they had me bring urine sample in- waiting on results.
Also, the prednisone was 2/day for first 7 days, then dropped to 1 per day. Tomorrow, 8/18, he is supposed to drop to 1/ every other day.
He does not urinate on his own with the sniff/pee test. I had been taking him outside to express, but now do this inside so I can monitor the amount and the color.
The Pepcid, I added myself after reading the need for this. My vet said it’s fine to add. He is 18 lbs so I give 10mg 30 mins prior to prednisone and pain meds. I’ve only been doing it for the prednisone dosage in the morning.
The vet also said it was ok for Buster to army crawl with front paws. I AM NOT letting him do that and told him I thought he could do more damage doing that. He said the damage was already done. I will NOT do it as it is not in line with full crate rest.
Other than the paid meds and the comment that using front legs to move around was ok, he did seem in line with everything I’ve researched.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Aug 17, 2021 22:16:24 GMT -7
Lisa, sounds like your vet is not at all comfortable in his knowledge of IVDD. He maybe/might be a vet to work with ONLY IF, if he is interested in learning more about IVDD. It is you who will have to be on your toes all the time, keeping your self educated about IVDD to recognize harmful advise and politely say no thanks and to have the ability to speak up for what Buster needs. Or maybe you'd end up hiring a more IVDD knowledgeable vet if another vet is in your town or nearby. What is the gabapentin formula? How many mgs are in 1 mL of liquid? Info should be printed on the bottle or the Vet's receptionist can find out for you. Amantadine is not a pain med per se. Neuros who know their meds are finding when an aggressive pain med approach (three pain meds of gabapentin, traMADol and methocarbamol 3x/day) are not fully covering pain, THEN amantadine is added. You can read more about this med here: marvistavet.com/amantadine.pmlThe prednisone taper going on since 8/11 is a test to find out if there is any remaining pain! On the 8/12 appt Buster was in pain and his pain meds were adjusted. CLEARLY it was not time on 8/12 to continue the pred taper. It was time, instead to RX another 7-day or 14-day course of the real anti-inflammatory level for 18lbs dog ( 5mgs 2x/day) followed by a test for pain taper. It can take the anti-inflammatory steroid prednisone a range of 7 to 30 days before all swelling is gone. Any taper days are not counted as they are no longer working on swelling. In the meantime a multi modal pain medication treatment provides the required comfort (tramadol-general analgesic, methocarbamol- muscle spasm pain, gabapentin-nerve pain). Today 8/17 you report PAIN. while in the final taper days! Pain managed for the most part is not good enough. If are not able to sucessfully advocate for another course or pred, you may need to hire a different vet. Please understand just how prednisone is used during a disc episode. You are going to have to take the reins and stand up for Buster. dodgerslist.com/2020/04/18/steroids-vs-nsaids/Please always be specific with details for us and the vet what you observe that makes you say pain is only managed for the most part:
SIGNS OF PAIN when moving, nearing the next pain meds dose: ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned back ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions ⚙︎ not their normal perky interested in life selves
If pain, then advocate for:
-- another course of prednisone at the usual anti-inflammatory level of 5mgs every 12 hours for a 18lbs dog.
Depending on the dosage, steroids can be used at low levels as replacement steroid hormone in dog not able to make sufficient hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive effects for other diseases at much higher doses.
-- Advocate for a three way cocktail of pain meds. Each pain meds works on a different source of pain. All pain meds last in the body for about 8 hours. Thus the reason to advocate for prompt every 8 hrs doseing schedule.
methocarbamol for muscle contraction pain eery 8 hours
gabapentin for nerve pain every 8 hrs
traMADol as the general analgesic at minimum of 50 mgs full tablet every 8 hrs for an 18lbs/ 8.16 kg dog
The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours.
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Post by Lisa & Buster on Aug 17, 2021 23:23:58 GMT -7
I will call the vet and ask he change the meds, to increase prednisone again and add methtocarbamal. He allowed me to influence his choices before, hopefully he will again without another office visit as my budget is very strained from meds, 3 appointments and now a $97 urinalysis it’s been an expensive 2 weeks.
His current tramadone dosage is 25 mg every 8 hrs. Following the above quoted guidelines would have him at 40-80mg every 8 hours, correct?
Sounds like the gabapentin dosage is closer to what it should be, since he is on 50mg every 8-12 hours. The gabapentin he is on now is not liquid, I asked for tablets as Buster takes those better.
What drug, if any, is likely causing the crystals in his urine? It concerns me as I don’t want a UTI to progress to stones or renal failure. If it’s not related to any of the medications, I will try to increase his water intake, but I’ve already been trying that and getting good results.
My goal is to let the rehab vet we see on 9/9 be the lead as she does many more IVDD cases than the general vet. When I scheduled, I was told she would do a 90 min consultation and then develop treatment plan to include acupuncture and cold laser treatments. I will not allow for chiropractic care and do not think her clinic even offers that. They do have PT at her clinic but I’m aware that will be after the crate rest. Hopefully, she will also refer me to a better prepared vet to address IVDD or continue to treat him herself. She has been recommended by others in my area for IVDD, I really wish we could have gotten in sooner.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Aug 18, 2021 8:08:04 GMT -7
There are two kinds of stones for dogs Calicum Oxalate Stones or Struvite Stones. You can read up to have an understanding of what causes each and what the treatment is here: corrected link: marvistavet.com/bladder-stones.pmlIf you desire therapies: -- Does the rehab vet have mobile service that he can travel to your home for laser light and acupuncture? -- Can rehab vet prescribe a laser light device for you to lease buy to use at home where it is used under the direction of your vet? Assisi Loop comes to mind but there are prescription devices. If money is tight, then laser light and acupuncture treatments may not be the priority. Money may be best set aside for necessary meds. The single most important care you can give is the at-home STRICT rest the recovery suite affords. Trips into a vet appt are a potential for unexpected extra movement that might be damaging on a permanent basis. Right now it can't be determined if enough nerve repair could take place to bring back the all important ability to perceive deep pain sensation (DPS). IF you see that Buster can do a happy tail wag because you did some happy talk, then DPS has returned. Let us know if/when you observe.Nerves can self heal on their own if the nerve damage is not permanent. Only time will tell. Because nerves are so slow to self heal, we ought to think in terms of months rather than days/weeks for nerve healing. If your regular vet will help you with appropriate meds by your advocating over the phone, maybe he can work. You are in control of at home STRICT rest so that's no problem. For an 18 lbs dog, expect traMADol RX adjustment to be at minimum of a full 50 mg tablet every 8 hrs. Gabapentin is a 50 mg tablet not a 100mgs capsule? |
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Post by Lisa & Buster on Aug 18, 2021 10:26:26 GMT -7
The gabapentin is a 50mg tablet.
Called the bet and he suggested keeping prednisone at 1 (5mg) per day instead of decreasing [taper] to 1 every other day and was fine with increasing ▲tramadol to 50 mg 3/day. He suggested to see if the pain is managed with tramadol and gabapentin before adding methocarbanol.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
18 lbs age?
prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: _pain / _neuro
as of 8/18 vet wants taper dose of: 5mgs 1x/day for ? days, then final every other day taper ]
gabapentin 50 mgs tab: ?mgs 2x/day
traMADol ▲50mgs ▲3x/day
✙Pepcid AC 10mg 1x/day
When off all meds and no pain, then LIGHT ROM can begin for paralyzed legs]
The rehab vet does not provide mobile services. I will ask about the laser treatment device for home use. While finances are tight, the in office laser and acupuncture do fit in my budget at a certain level. She charges $100 for acupuncture and laser is included. I will not be able to afford multiple times per week, but can afford weekly treatments at that rate, along with meds.
To provide better specifics in regard to my statement that pain is managed for the most part, he will occasionally hold his head very high and pants a couple of times per day.
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Post by Romy & Frankie on Aug 18, 2021 14:39:54 GMT -7
Since Buster's pain is still not completely under control, now is not a good time to continue tapering the pred to once every other day. In fact, because of the pain, speak to the vet about having Buster go back to the full 2x a day dose.
Please let us know if the increase in tramadol is now keeping Buster pain free.
I am not sure exactly what link for sturvite stones Paula was referring to. I am sure she will let you know soon.
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Post by Lisa & Buster on Aug 18, 2021 15:08:35 GMT -7
Meant to also add that Buster’s tail has not wagged since he went down on 8/4. I’m told by all 3 vets he’s unable to do this.
Can you please repost the link for sturvite stones? It is not functioning as a hyperlink. Thanks for everything you are doing
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Aug 18, 2021 17:07:34 GMT -7
Ophs, so sorry about the bad stone link: marvistavet.com/bladder-stones.pmlLisa, is it so painful for me to still be writing and asking why your vet is not wanting to use the anti-inflammatory level of prednisone. I feel for Buster having to unnecessarily suffer with this pain. Pred 5mgs once a day IS A TAPER DOSE! So there is nothing working on swelling.
Why does this vet want no anti-inflammatory on board? I ask again how old your dog is. Tryng to figure out why your vet is hesitant to use prednisone 5mgs 2x/day for another 7 days course and then maybe all the painful swelling will be gone. But instead appears to be willfully drawing out letting Buster suffer with pain when it is known that it so very, very often takes all three pain meds each working on a different kind of pain. Why wait/delay on methocarbamol? Why delay using an anti-inflammatory drug prednosne at the actual anti-inflammatory level dose (5mgs 2x/day). When YOU asked "Why" what reason did he give?This is where we stand on this Forum about pain...we side with Dr. Robin Downing, DVM, CVA, DAAPM one of only four veterinarians in the world to hold the Diplomate credential in the American Academy of Pain Management - the largest interdisciplinary pain management organization in human medicine: "It is always better to use a multi-modal approach to pain management."
And we side with the World Small Animal Veterinary Association (WSAVA) guidelines as well: 1. We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt. Treat predictable pain. 2. Where a dog is judged to be in pain, treatment should be given immediately to provide relief. Positive response to an appropriate treatment is the gold standard to measure the presence and degree of pain. 3. When pain is moderate or severe, the veterinarian should consider combining drugs that act at different sites in the pain pathway to provide optimal analgesia; Combining different classes of analgesic drugs allows the veterinarian to optimize the management of pain. wsava.org/wp-content/uploads/2020/01/Recognition-Assessment-and-Treatment-of-Pain-Guidelines.pdfI'm frustrated and feel the same as this pain specialist does about what Buster must be thinking: MED LIST could you update the missing information where the PINK text is?
18 lbs Buster's age?prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: _pain / _neuro as of 8/18 vet wants taper dose of: 5mgs 1x/day for ? days, then the final every other day taper]gabapentin 50 mgs tab: ?mgs 2x/daytraMADol 50mgs 3x/dayPepcid AC 10mg 1x/day |
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Post by Lisa & Buster on Aug 19, 2021 22:35:02 GMT -7
Buster is 6. Talked to vet again, he’s given a 14 day 5mg/twice daily ▲prednisone.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
18 lbs 6 y.o.
prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: _pain / _neuro
as of 8/18 vet wants taper dose of: ▲5mgs ▲1x/day , then final every other day taper
as of 8/20: 5mgs ▲2x/day for 14 days, then 9/3 test taper for: _pain/_neuro
gabapentin 50 mgs tab: ?mgs 2x/day
traMADol 50 mg tab: 50mgs 3x/day
Pepcid AC 10 mg tab: 10mg 1x/day
When off all meds and no pain, then LIGHT ROM can begin for paralyzed legs]
I’m not sure what’s missing from gabapentin… it’s 50 mg tabs (not oral solution). Pain is fully controlled at this time. Thank you for the support.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Aug 20, 2021 7:58:36 GMT -7
Lisa, I am so happy you successfully advocated for another course of prednisone. Kudos to you! Love hearing pain is control with current pain meds. As you are well aware, the vet has room to move with pain meds. So if any pain would surface nearing the next pain med doses or when Buster has to move, immediately phone to describe what exactly you observe that indicates pain to you + time when it happens and advocate for: -- gabapentin to be promptly every 8 hrs (3x/day) -- add methocarbamol (for muscle contraction pain) to the pain cocktail which is often dosed at 125mgs promptly every 8 hrs (3x/day) Re: gabapentin we do understand from you Buster is now on the pill form. What we do not have clarity on is what portion of that tablet do you give. A whole gabapentin tablet is 50 mgs. Do you give the whole 50 mgs tab 2x/day or 1/2, 1/4 or what? Now that Buster is back up on the anti-inflammatory level of prednisone for an 18lbs dog (5mgs 2x/day) Pepcid AC needs to be able to work on suppressing the stomach acids that cause stomach damage. 18lbs Buster X 0.44mgs famotidine = 7.92 mgs Pepcid AC dose
Most vets would round up to a full 10 mgs 2x/day
Let us know you are now giving Pepcid AC 10mgs 2x/day Fingers crossed that Buster can now heal in comfort with pain fully managed right up to the next dose of pain meds, round the clock, day after day. Please do keep us updated about any neuro function changes and pain. |
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Post by Lisa & Buster on Aug 20, 2021 11:46:47 GMT -7
Sorry, I must have missed providing an update, as the gabapentin is every 8 hours (3/day). I do give the full 50mg tablet. I have increased the ▲Pepcid AC to twice a day and give 10mg 30 minutes before each prednisone dosage.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
18 lbs 6 y.o.
prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: √ pain / _neuro
as of 8/20: 5mgs 2x/day for 14 days, then 9/3 test taper for: _pain/_neuro
gabapentin 50 mgs tab: mgs 3x/day
traMADol 50 mg tab: 50mgs 3x/day
Pepcid AC 10 mg tab: 10mg ▲2x/day
When off all meds and no pain, then LIGHT ROM can begin for paralyzed legs]
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Post by Lisa & Buster on Sept 2, 2021 6:47:59 GMT -7
Update: today we begin week 5.
Meds are changed to
200 mg ▲gabapentin every 8 hours
75 mg tramadol every 8 hours
10mg Pepcid 30 min before all medications. Vet pulled prednisone after 7 days due to concern for side effects with longer term usage.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
18 lbs 6 y.o.
prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: √ pain / _neuro
as of 8/20: 5mgs 2x/day for 14 days, then 9/3 test taper for: _pain/_neuro
gabapentin 50 mgs tab: as of 9/2▲200mgs 3x/day
traMADol 50 mg tab: as of 9/2▲75mgs 3x/day
Pepcid AC 10 mg tab: 10mg 2x/day
When off all meds and no pain, then LIGHT ROM can begin for paralyzed legs]
I also use LumaSoothe [Low Level Light Therapy] 1-2 times a day. Complete crate rest continues, only comes out to express. We take stroller trips for some spirit lifting and also visit backyard for some sunshine.
Next Appt: 9/9- rehab dr. To assess and make a treatment plan. Services offered include acupuncture (with or without electrical stimulation), cold laser therapy, water therapy. This rehab center has treated many IVDD dogs. I have confidence they will not start therapies too soon and I feel confident to advocate.
My question is this: previously, as recently as 2 days ago (8/30) the meds seemed perfect and allowed him to rest comfortably. However, now the meds seem too much. He seems over medicated and reacts differently. His eyes are distant, he’s not reacting to reassurances, he seems completely out of it. At peak medication (1-2 hours) he becomes very anxious and is looking around like scared.
Is this a sign he’s ready to decrease meds a little? What’s the average time to adjust for improvements? I do not want to reach out to vet before I get your advice honestly as my experience has been that you have more experience with the trajectory of disease and healing process and I want to know what I’m asking for before I call. I can also just wait till rehab appt, but don’t want to delay too long.
Neurology signs- he reacts when I scratch just above his tail, he licks his legs after being expressed (very gently), he reacts when I lightly massage his legs, no bladder control, no reaction to touching his back feet. He will signal when bladder is ready to be emptied if I haven’t already done so recently. No tail wags for happy talk.
He also will do this thing when his neck will “jerk” up. I’ve felt around to see where this movement originates and it seems to be a muscle under his front leg. It is rhythmic.
Thank you for your help and sorry for the long post, but I wanted to present everything that’s happening.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
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Post by PaulaM on Sept 2, 2021 9:12:44 GMT -7
Lisa, honestly I am at a loss about Buster's disc episode treatment (the medications part of it). What were the exact observations of pain you saw (on what date?) that made the vet call for increase of pain meds? Did Bruno go in for a vet exam or was this adjustment made on the phone? Gabapentin from 50mgs to 200 mgs 3xday? Tramadol from 50 mgs to 75mgs? On the date you observed pain signs, what had changed to cause new/increased pain? --- too much movement of the back/neck causing a re-tear of early healing disc scar tissue formation? --- Pet stroller going outdoors other than just the deck, jarring and rolling over bumpy ground? Pain meds do not work on the swelling around the spinal cord. Only an anti-inflammatory can do that. There are two classes of anti-inflammatory drugs— Steroids AND Non-Steroids. i1.wp.com/dodgerslist.com/wp-content/uploads/2020/02/steroid-vs-NSAID.jpg **It appears our med list is very wrong, then. The Aug 19 vet approval for a 14 day Pred course to begin tapering 9/3 never happened! JEESH all this time and there has been nothing working on swelling? ! Then why did the vet not go to the other class of anti-inflammatory drugs, a NSAID?
MED LIST
18 lbs 6 y.o.
prednisone as of 8/4: 20mgs ?x/day for 7 days, then 8/11 a test taper assessment for: √ pain
as of 8/20: 5mgs 2x/day for 14 days, then 9/3 test taper for: _pain/_neuro
gabapentin 50 mgs tab: as of 9/2 ▲200mgs 3x/day
traMADol 50 mg tab: as of 9/2 ▲75mgs 3x/day
Pepcid AC 10 mg tab: 10mg 2x/day
When off all meds & no pain, then LIGHT ROM can begin for paralyzed legs
Do advise your vet of signs that pain meds may be too high.
-- But then there is no anti-inflammatory on board working on swelling.
-- So then the pain meds may well have to compensate for the extra discomfort of nothing on board to work on inflammation.
-- Is there a different vet you can hire in Nashville who has a high comfort level about IVDD?
-- A specialist is not just for the purpose of a surgery, but because they use meds daily, can be a consult to get the right meds on board for this disc episode.
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