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Post by Krista & Sully on Aug 16, 2021 13:41:46 GMT -7
[Original subject line: Introduction: Sully (Stage 2... possibly 2/3) ] Hi everyone, I'm new here. Not sure if I'm doing this totally right, but the information for my dog Sully is below. I appreciate any and all help so much. This has been emotionally and physically draining for me and, of course, my baby Sully. Answers are below. Thank you. ☆ 1 Pretty calm this second but overall, he is definitely in pain. ☑r eluctant to move much in crate such as shift positions or slow, ginger movements ☑ shivering, trembling (occasionally throughout day/night) ☑ yelping when picked up or moved (occasionally, not always)☑ tight tense tummy
☑ can’t find a comfortable position, appears restless (goes through periods of complete restlessness)☑ Arched back
☑ Holding front? or back? leg flamingo style not wanting to bear weight (occasionally)☑ Not their normal perky selves? ☆ 2 25 lbs A.. Prednisone 5mg 2x day / Started about 2 weeks ago and was tapering off before we knew bed rest was needed and met with specialist (neuro) yesterday [8/15] who said if we decide to stay conservative, she wanted to restart from the beginning with the prednisone to see if he improves with crate rest traMADol 1/2 tablet 50mg 2-3x day Gabapentin 100mg every 12 hrs[MED LIST/HISTORY- Moderator's Note. Please do not edit25 lbs age? crate rest started 8/13, never told how important!prednisone as of 8/15: 5mgs 2x/day for 7 days, then 8/22 test taper for: _pain / _neuro traMADol 25 mgs. exactly how often actually giving? gabapentin 100 mgs 2x/day needs GI tract protector, Pepcid AC, on board w/PREDNISONE! ] C.. PEPCID AC: He was not recommended to take this by any vet and don't know if he needs it? --> 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 ) ☆ 3 -- Eating and drinking. normal, no blood no diarrhea.
☆ 4 Mixed chihuaha/min pin/schitzhu (from DNA test, don't know how accurate) My dog is Sully, I am Krista☆ 5 Likely bulging or split disc and has had calcifications between verterbrae that we knew of since around 2018 or 2019. He has not had an MRI but this was determined a while back through XRAY. Neurologist said it is likely exactly IVDD but she can't be sure without MRI and only will do MRI if we decide to go with surgery (what she recommended if he does not improve soon. She recommended to schedule even now but I am hesitant.)Have been to primary, ER vet and Neuro Specialist. All agreed on diagnosis.
☆ 6 She is recommending surgery but said conservative is still an option. She is scared he will lose more ability to walk if we wait for surgery becaues he did not improve from initial prednisone treatment. That being said, when he first started prednisone, we had no idea the precautions we were supposed to be taking until he was at the point of tapering off. We had only been limiting jumping on/off tihngs at first, were not limiting walking, etc.... only been on crate rest now since 8/13 (3 days) 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 This is my main concern and reason for being here. My dog can squat and pee but does not want to. The neurologist said if he can walk to the extent he is he can almost 99% pee. And she was right. But, due to the pain of squatting, he is holding it causing more pain for himself and I don't know what to do. Is there a video of someone instructing how to use the sling during poddy time for dogs that CAN pee? I am distraught on this part because I know he can pee!!!☆ 8 Can walk but wobbly. Can wag tail. Gets excited and will wag tail at happy talk.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,589
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Post by PaulaM on Aug 16, 2021 15:26:41 GMT -7
Krista, your Sully has been given a 2nd chance to heal with the help of your wonderful specialist. Now it is your turn to step up to calm your mind, make sure Sully is provided the very STRICT REST required for the disc to heal and to know when to call the specialist to advocate for Sully. For now you will have links to important information you need to read now, ASAP. In the coming days do go back to the Dodgerslist website to explore and delve more into all things IVDD and use that orange search bar, too, to find topics of interest. It takes working with your vet (specialist) to let them know when meds need adjusting. You are their eyes and ears! Call now today to report your observations of pain and advocate for pain meds adjustments. Often it does take an Rx for promptly giving every 8 hrs on the pain meds. That is how long they last in the body. Also covering each source of pain is necessary for full pain relief. Discuss and look for an Rx: • traMADol as the over all analgesic at the max analgesic dose in the neighborhood of a full 50 mgs tablet promptly every 8 hrs. How often had you been actually giving traMADol every 12 or every 8 hrs? • gabapentin for nerve pain discuss about promptly every 8 hrs. • methocarbamol for muscle contraction pain every 8 hrs. • Ask if Sully has any health reasons he may not take an acid suppressor such as Pepcid AC (famotidine) Here's a link worth reading right now so you are up to speed on why Pepcid AC: dodgerslist.com/2020/05/06/stomach-protection/
Which legs FRONT or the BACK are not wanting to bear weight? For how many days is Sully to stay on prednisone 5mgs 2x/day. before tapering begins?
Good news! Sully has a very good chance to not only self heal his disc but also self heal with time the nerve damage of wobbly walking. Knowing it is YOU who can make this happen, should give you the calmness and the energy to do right by Sully.
Nerves heal typically in the reverse order of the damage to the spinal cord:
1. Deep Pain Sensation: the first neuro function to return. DPS is the critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about this very tricky to correctly idenfiy neuro function. 2. SULLY !!! Tail wagging with joy at seeing you or getting a treat or meal. 3. SULLY !!! Bladder and bowel control verified with the "sniff and pee" test. 4. SULLY !!! Leg Movement, and then ability to move up into a standing position, and then wobbly walking. 5. ___ Being able to walk with more steadiness and properly place the paw. 6. ___ Ability to walk unassisted and perhaps even run. LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/
Does Sully knuckle under his back paws? IF he does, can he eventually correct ot the right position on the floor?
Knuckling: thumb.ibb.co/k3dqRS/Knuckling.jpgPOTTY TIME 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!
Hold the sling slightly in readiness in case Sully's butt is going to tip over you can prevent a fall. Most male dogs prefer a fiture 8 sling over a belly sling that goes too close to their penis.
dodgerslist.com/wp-content/uploads/2020/05/Figure8.jpg ** HOPE THIS HELPS -- Use the QUICK REPLY at bottom of page by being in "DeskTOP mode" when on a cell phone. Enables you to scroll up to see my PINK questions to respond to. -- No need to quote things in your reply. We want to only concentrate on your words about Sully. --Email Alerts because you registered! Thank you! Timely communications are needed when helping your dog. How-to 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
Anxiously waiting for an update to know Sully is in comfort with pain med adjustments. And of course all the details of mgs, how often and names of meds, too.
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Post by Krista & Sully on Aug 16, 2021 16:06:31 GMT -7
Deleting quoted material. Krista we only want to read your own words when you reply. We use our own colors to mark your post. We have to not only delete all the quoted words but we have to remove all your colored text. Thanks for understanding.
Thank you so much for the very very helpful information. This is great. Answers are below to your questions. My most overwhelming question here is whether or not I should get him surgery. It's extremely expensive and this will likely happen again as he has had more minor back episodes (which I realized is this now) in the past. The surgery is so expensive with MRI and I am just scared and confused whether to do it or stay conservative.
• I will ask this [pepcid AC]. He doesn't have any health issues other than this that we know of.
Back legs. He can pee but does not want to because he is uncomfortable with his back was the neurologists assumption.
He will be on [pred ] 2x a day for 7 days, then 1x day for 7 then every other day for 7 days.
My concern here is that he did squat to pee the last time he peed but it has been a while. When he squatted to pee, he did not want to revert back to standing position bc he seemed in pain. If he squatted, does that mean this [BLADDER CONTROL] is verified? This is very confusing for me.
Knuckling: He does occasionally knuckle but can correct typically. Eventually he can regardless.
Thank you so so much.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,589
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Post by PaulaM on Aug 16, 2021 16:32:03 GMT -7
In the list about monitoring neuro function in my last post the neuro functions are numbered. -- A dog must have #1 deep pain sensation before they can do a #2 happy tail wag. -- A dog must have the #3 bladder control before they can #4 wobbly walk. So, naturally ("YES !!!), of course as the specialist said, Sully most definitely has bladder control!!!!! Sully is an EXCELLENT candidate to recover with the no risk, less invasive conservative treatment-- he CAN wobbly walk! Conservative is what the surgeon wants to work. Surgeon suggests if Sully deteriorates due to not following the strict Conservative Treatment rules of limited movement, Sully may need a surgery. Get a feel for the two treatments. Education is key. T his is information to keep in the back of your mind: dodgerslist.com/2020/02/10/surgery-vs-conservative/I expect you will be very conscientious in carrying out Conservative treatment. I expect that Sully will not need an expensive multi-thousand dollar invasive surgery procedure. Swap out those emotionally draining concerns for the positives along with us. Sully will detect any negative energy and may think something is wrong and maybe think it his fault. So whenever you are around him put on a happy smile, talk to Sully telling him "you are on it and all WILL definitely be well." Soon you, too, will begin to believe it yourself! Sully has a 2nd chance. With that 2nd chance as the surgeon said, you are starting from square one on 8 weeks count of STRICT rest and of the use of prednisone/pain meds to get all painful swelling gone. Do you have the ROADMAP to conservative treatment taped on your fridge? This way you will know how long (how soon) you would expect improvement for each of the four phases of healing. The ROADMAP will keep your mind on the goal and not get confused to think maybe a detour looks like a good idea. ROADMAP Avoid dangerous detours with the Conservative Roadmap for your fridge. VIEW, DOWNLOAD and print: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdfHere's an idea of what the RoadMap will look like taped to your fridge Deleted all quoted material from your reply above.
Krista we only want to read your own words when you reply.
We use our own colors to mark your post.
We have to not only delete all the quoted words but we have to remove all your colored text.
Thanks for understanding and only using QUICK REPLY at the bottom of page to reply in.
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Post by Krista & Sully on Aug 17, 2021 13:24:27 GMT -7
So sorry - still getting used to this forum. Thank you SO MUCH for this help. Wow. You have really improved my spirits... I feel like there is a lot of hope. I appreciate it so much.
I'm really having trouble with my dog's bladder. This is my biggest challenge right now. He will poop but he won't pee - but he does have bladder control. I know this because he holds it almost 24 hours and then will be in a lot of pain because he has to pee and finally will. It's been exhausting mentally and emotionally.
The doctor said to express his bladder if over 24 hours but Sully won't let me. He freaks out and I've tried so many ways. I just don't know what to do. The neuro thinks he is not peeing because of the back pain but I don't know - it makes sense because he can pee... she said not to worry about infection as she saw him Saturday and I called her today regarding it.
I just don't know what else to do. I take him out multiple times a day and nothing. Until he wakes up panting and in extreme pain because of both his bladder and back. It's killing me knowing he can pee but won't until it's really painful. (His pee stream is normal and a lot comes out when he finally does pee).
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Post by Romy & Frankie on Aug 17, 2021 14:06:05 GMT -7
A dog has bladder control if he can hold the urine for a reasonable amount of time until he is in a place suitable for urinating. He then deliberately releases it. If Sully can do this, bladder control is not the problem. If Sully simply refuses to pee until he simply cannot hold it anymore, it sounds as if peeing causes him pain.
There are two things I can think of that could cause this. The first is a UTI. I know your doctor said not to worry about that, but I think Sully should have a urinalysis. Simply holding urine in for that long can cause a UTI.
Another likely cause is that overall his pain is not well controlled and simply moving to go out to pee hurts him. If you see any of the signs mentioned in the first post, especially more than one sign, Sully is in pain. Pain will only slow the healing process. A dog should not be in pain. Vets have many ways to control pain. If the neuro thinks he is not peeing because of the back pain than clearly a change to pain meds is needed.
Let your vet know about the signs of pain you are seeing right away. Tramadol and gabapentin leave the body quickly, so will often have to be taken 3x a day to provide full relief. Also speak to the vet about possibly adjusting the dosage of the tramadol. Methocarbamol is a medicine used for painful muscle contractions that are often seen with IVDD. Adding that to his meds could help.
If Sully does have bladder control, he will resist being expressed. When Sully's pain is fully controlled, he may have no problems urinating regularly
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Post by Krista & Sully on Aug 17, 2021 14:59:29 GMT -7
Thank you so much. He does not seem in pain overall as of right now, especially compared to before when he was on the meds from his primary and the ER docs. I'm wondering if it's a UTI, as well. I am taking him into my primary vet just to see if they can rule [uti] that out or not. I really am reluctant to take him into the vet because of the crate rest. He's been to vets 5 times in past week and a half alone and is a really anxious dog to begin with. Just another stressor on his plate / he doesn't sit still well in those situations but I don't want to risk adding fuel to the fire if it can be avoided. Hopefully we can rule something out. I will keep you posted when I get back. On a better note, it does seem that overall he is having less spasms and much less extreme spasms, less pain once they switched him to the Tramadol with restarting Pred and staying on Gabapentin. He is still very tired but seems to be slowly getting *some* hints of his personality and perk back. The neuro removed the muscle relaxer from the mix. I do not know why and I called her [8/17] this morning to be sure that was accurate and she said yes he should be taking Gaba + Pred + Tramadol and we added ✙ Pepcid today. [MED LIST/HISTORY- Moderator's Note. Please do not edit 25 lbs 6.5 y.o. crate rest started 8/13, never told how important! prednisone as of 8/15: 5mgs 2x/day for 7 days, then 8/22 test taper for: _pain / _neuro traMADol 25mgs 3x/day gabapentin 100 mgs 2x/day ✙Pepcid AC 10 mg tab: 5mgs 2x/day ] Thank you so much for your advice.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,589
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Post by PaulaM on Aug 17, 2021 15:45:35 GMT -7
Describe specifically what you observe that causes you to use the word "spasms." Do the spasms happen nearing the next dose of pain meds or some other event?
Would you update the med list so we have accurate information to base comments on. MED LIST/HISTORY 25 lbs What is Sully's age? crate rest started 8/13, never told how important! prednisone as of 8/15: 5mgs 2x/day for 7 days, then 8/22 test taper to assess for: _pain / _neuro traMADol 25 mgs. exactly how often actually giving promptly every 8 hrs or promptly every 12 hrs? gabapentin 100 mgs 2x/day Pepcid AC How many mgs each dose? Are you giving 2x/day?
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Post by Krista & Sully on Aug 17, 2021 19:23:25 GMT -7
Spasm / muscle twitching happening closer to end of doses 6.5 [y.o.]Med list updated after [ ER, primary or specialist?] vet appt [8/17] today: Gabapentin 100 mg 2x every 12 hr tramadol 50mg 2-3x a day (every 7 or 8 hours) as needed. — have been giving every 8 hours. Prednisone 5mg started Sunday 8/15 2x day for 7 days then 1 every 7 and then 1 every other for 7 days. ✙ Methocarbomale restarted as needed 2x day. Prednisone [is this Pepcid AC?] 10 mg - 5mg half hour before each prednisone dose or 1x day with full 10mg before prednisone. [MED LIST/HISTORY- Moderator's Note. Please do not edit 25 lbs 6.5 y.o. crate rest started 8/13, never told how important! prednisone as of 8/15: 5mgs 2x/day for 7 days, then SUNDAY 8/22 test taper for: _pain / _neuro traMADol 25mgs 3x/day gabapentin 100 mgs 2x/day ✙methocarbamol ?mgs 2x/ay Pepcid AC 10 mg tab: 5mgs 2x/day ]Primary said no UTI or infection - no broken bones / etc, looks good other than IVDD stuff. Finally peed and poop, of course on the way to the vet but he started light therapy today while at vet. Thank you!
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 17, 2021 20:46:47 GMT -7
Krista, our comments are based on the facts provided by you. Not sure if we have a full understanding of things. LIGHT THERAPY -- Do you mean laser light therapy given by a male [Primary family?] vet 8/17. Let us know there is no "light/easy" physical therapy being done by any vet.
-- Specialist vet removed methocarbamol. Which vet restarted methocarbamol ?mgs 2x/day ? -- How did primary family vet know there was no bladder infection? • Did the vet do a urinalysis. Not all bladder infections show observable signs. The urinalysis is the only way to tell. • What date did the vet say there was no infection? When the bladder is not being properly voided, an infection can develop in a matter of days. -------------- MED LIST Let us know if this is now the correct:prednisone as of 8/15: 5mgs 2x/day for 7 days, then SUNDAY 8/22 test taper for: _pain / _neuro NOTE: the taper will be starting on a Sunday when your vet is not open. You will need to have a Plan B of what do to if the test for pain taper reveals there is still painful spinal cord swelling. Now is the time to make sure you understand the tapering of prednisone on Sunday 8/22. This page is for you: dodgerslist.com/2020/04/18/steroids-vs-nsaids/traMADol ▲50mgs 3x/day Confirm if Sully now is getting a full 50mg tablet dose of traMADol promptly every 8 hrs.gabapentin 100 mgs 2x/day ✙ methocarbamol ?mgs 2x/day Confirm how many mgs in each dose of methocarbamol Pepcid AC 10 mg tab: 5mgs 2x/day The dose for a 25lbs dog would be 10mgs every 12 hrs (2x/day) Let us know with methocarbamol having been just restarted today (DATE: 8/17) there are no pain spasms or any other signs of pain nearing the next dose. Pain would mean you need to report to your primary family vet all your observations of pain. The vet would then understand pain meds are wearing off before the next dose. Pain meds only last about 8 hours in the body. So if Rx'd for every 12 hours, the meds are wearing off too soon. Advocate that all three pain meds (gabapentin, traMADol and methocarbamol be doses the same: promptly every 8 hours. Are you using a med chart? 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.pdf
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Post by Krista & Sully on Aug 17, 2021 22:12:20 GMT -7
Sure. Apologies if I am being unclear, have been exhausted from all of this on top of work. Luckily I work from home most days with flexibility when I have to go in. Here are my answers:
Yes, laser light therapy was started today 8/17. Not physical therapy - he is on strict crate rest 100 percent of the time at home with exception to be carried out to supervised poddy. My primary vet restarted the methocarbomal today 500mg[!!!!] every 12 hours. I second that decision from what I’ve observed and will be communicating on that with him.
He did not do a urinalysis that I am aware of but I need to double check the instructions and review sent home with me - not sure if this was done while he was with them for X-rays [calcifications proove nothing] and laser light therapy - Sully peed on the way to the vet appointment (a whole lot). So he had held it a little over 12 hours. The vet did a physical examination and said to continue to watch this but given the X-rays and location of calcification suspects (matched with original X-rays), he suspects he is not necessarily reluctant because of pain but may be some nerve communication there - something like that. They checked his pee from my car and the booster bed he wet and did not find it concerning (smell, etc.). Is not straining to pee. I will be there tomorrow and will be reporting back on how he does today and tomorrow morning. Will be back in afternoon tomorrow 8/18.
I am worried about transport of sully to laser light treatments as he is an anxious dog in the car to begin with. The visits should be fairly quick but I am apprehensive as I don’t want to cause any stressors physically and emotionally there, but I am not letting him walk through the appt.
Will review tapering info.
Sully is getting 1/2 of [ TRAMADOL?] 50mg 2-3 times a day as needed, per 8 hours if 3x and 12 hours If 2x depending on what I have been observing for his pain from morning dose til next either 8hour dose or 12 hours.
The vet said there is no infection and was not concerned in that regard today. The above paragraph all from today.
I will talk to primary tomorrow and discuss administering the pain meds gaba / methocarb / tramadol in the recommended dose at 8hours.
I am not using med chart yet but will, thank you. I have been tracking with pill cases and noting observance in phone notes for visits. This may be a better route with chart.
Tonight, he is very tired from the commotion of the vet visit being he got X-rays and the laser therapy, and also back on the methocarbomale. So this is good as he is not showing restlessness yet compared to prior nights when winding down. Hopefully he is able to rest for longer tonight.
Thank you. Let me know if there is anything I need to clarify as I’m utilizing the desktop on mobile right now and it’s a bit trickier..
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,589
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Post by PaulaM on Aug 17, 2021 22:29:15 GMT -7
Pain meds are NEVER as NEEDED all over the place, up and down. IF your dog as pain then should be PROMPTLY every 8 hrs day after day, after day UNTIL the prednisone taper to test for pain begins on Aug 22.
Check your methocarbamol bottle. 500mgs is a whole tablet--- WAY too much for a 25 lbs dog.
Laser light therapy if wanted should be by a mobile vet who comes to your home. Transports are for really urgent health issues. At home STRICT rest is the single most important care. With mild symptoms of wobblness, that will self heal. Pain should be addressed by adjusting at home pain meds. So why Laser Light therapy, then?
How about when you are fresh tomorrow you update the MED LIST for what you actually will be giving promptly from now on. No more as needed up and down mg doses — that is not how pain meds are used during a disc episode.
We really can not give good advice unless we know the correct details about his meds.
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Post by Krista & Sully on Aug 18, 2021 4:07:56 GMT -7
This should help:
SULLY MED SCHEDULE [25 lb Sully] 6:30am: Pepcid - 1/2 Pill [whole tablet is 10mgs?] 7am: Prednisone 5mg - 1 pill [whole tablet is 5mgs?] Tramadol 50mg - 1/2 pill [whole tablet is 50mgs?] Gabapentin 100mg - 1 pill [whole capsule or tablet is 100mgs?] Methocarbomale 500mg - 1/2 pill [whole tablet is 500 mgs?] 3pm: Tramadol - 1/2 pill 6:30pm: Pepcid - 1/2 pill 7pm: Prednisone - 1 pill Gabapentin - 1 pill Methocarbomale - 1/2 pill 11pm: Tramadol 1/2 pill
[MED LIST/HISTORY- Moderator's Note. Please do not edit 25 lbs / 11.34 kg 6.5 y.o. crate rest started 8/13, never told how important! prednisone 5mg tab as of 8/15: 5mgs 2x/day for 7 days, then SUNDAY 8/22 test taper for: _pain / _neuro traMADol 50 mgs tab: 25mgs 3x/day gabapentin 100 mg tab: 100 mgs 2x/day methocarbamol 500 mg tab: 250mgs 2x/day Pepcid AC 10 mg tab: 5mgs 2x/day ]
The laser light therapy was recommended by my primary vet in addition to acupuncture, which he won’t be starting for 2+ weeks. I believe his first session has helped him. He peed when I took him out this morning [PAIN RELIEF. Pain meds RX are not yet adequate], which peeing has been an issue since starting this. I understand transports are not recommended but he is not walking around, I am carrying him safely and the vet is up the street from me. Still welcome your advice there and will consult with my vet today on the 8hr increments for gaba and methocarbomale and see what he says.
I understand, I do really appreciate your advice. Not trying to give bad info it’s just hard to put this all together with med names and numbers and time frames on somewhat of a frazzled brain. Hopefully what I’ve provided above is a little clearer. I feel relieved and Sully does too, it seems things could be getting a little better. He slept through the night from 12am - 6am for the first time in what seems like ages (8/12 being last time). Thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,589
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Post by PaulaM on Aug 18, 2021 9:46:45 GMT -7
Kristi, both laser and acupuncture can help with pain as you saw Sully able to pee this am w/o pain. The crux of the matter is that going in/transporting Sully is a potential situation for more damage to the spinal cord. Getting the pain med Rx corrected requires no risky transport. In my book, reducing risk to the early healing disc is very important. Dogs always have the potential to do the unexpected when outside of their recovery suite. Therefore only the most important of health things are they allowed to leave the suite: to potty, for the utmost of health issues requiring a vet to see the dog. Med adjustments can be handled over the phone with you being the eyes and ears to report your observations and advocate. With Sully having relatively mild symptoms of pain and wobbly walk plus ability to right his paw, he is in an excellent position to heal with conservative treatment. Conservative treatment requires the SINGLE MOST IMPORTANCE of care of limited movement of the spine/vertebrae. If a risky to the disc transport and office visit were to cause Sully to twist his back, attempt to escape, dart off or any other thing that would cause too much movement, his early forming scar tissue on the outside of the disc could well relapse (crack more, tear more). Sully would then very likely see increased/ diminished nerve damage. As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When self healing of nerves begin, often it follows the reverse order of the damage. 1. SULLY now: Pain caused by the tearing disc & painful inflammation in the spinal cord still exists2. SULLY now: Wobbly walking, can correct Paws knuckling3. ____ Weak/little leg movement, can't move up into a stand 4. ____ Legs do not work at all (paralysis, dog is down) 5. ____ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 6. ____ Tail wagging with joy is lost 7. ____ 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/
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Post by Krista & Sully on Aug 18, 2021 11:40:45 GMT -7
Hi Paula - thanks for the advice. Here is an update on meds list / med schedule after calling my vet, thanks to your suggestion for med re-evaluation: 6:30am: Pepcid 5mg [2x/day] 7am: -Prednisone - 5mg [2x/day]-▲ Tramadol - 3/4 of 50mg pill (whole pill is 50mg. So 37.5mg of that pill - upping dose from the 25 mg to see how he does) -▲Gabapentin - 100 mg (1 capsule is 100 mg) [3x/day] -▲Methocarbomale - 250mg (half of 500 mg tab) [3x/day] 8 hours later - 3pm: -Tramadol - 3/4 of 50mg pill (whole pill is 50mg. So 37.5mg of that pill - upping dose from the 25 mg to see how he does) -Gabapentin - 100 mg (1 capsule is 100 mg) -Methocarbomale - 250mg (half of 500 mg tab) 6:30pm (half hour before eating and taking pred) -Pepcid 5mg 12 hours later from morning doses - 7pm: -Prednisone - 5mg 8 hours from 2nd dose of day - 11pm -Tramadol - 3/4 of 50mg pill (whole pill is 50mg. So 37.5mg of that pill - upping dose from the 25 mg to see how he does) -Gabapentin - 100 mg (1 capsule is 100 mg)
-Methocarbomale - 250mg (half of 500 mg tab)
[MED LIST/HISTORY- Moderator's Note. Please do not edit 25 lbs / 11.34 kg 6.5 y.o. crate rest started 8/13, never told how important! prednisone 5mg tab as of 8/15: 5mgs 2x/day for 7 days, then SUNDAY 8/22 test taper for: _pain / _neuro traMADol 50 mgs tab: ▲37.5mgs 3x/day gabapentin 50mg tab: 100 mgs ▲3x/day methocarbamol 500 mg tab: 250mgs ▲ 3x/day Pepcid AC 10 mg tab: 5mgs 2x/day ]\
I spoke with vet again about my concerns about transport to laser light therapy. They recommended he still come in today for treatment and are allowing me to carry him in and be in the room with him during treatment. Did not recommend pushing off treatment. He has otherwise been on total crate rest with very little movement. The car ride there is about 5-10 minutes and he does not try to jostle around. I understand there are unknowns that can always present themself, but I am comfortable with transporting him there if I am allowed to carry him in and out. I don't have any other option in regard to getting him additional treatment if I do not take him in. The only mobile vet in the area has 819 people on their waitlist. I will have to take him in for a treatment at some point during crate rest to try to get him better. Otherwise, how else do other people manage getting accupuncture / laser light therapy? I agree with your concerns completely, but I do not know if the benefits of pushing off treatment outweigh the risks. The whole thing has taken a toll on me like many other owners and I want to do best by Sully but I feel comfortable following what my vet is recommending. Thank you again, Krista
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Post by Romy & Frankie on Aug 18, 2021 13:45:52 GMT -7
Thank you for updating the med list. Sometimes it is hard to pull all the information together. With the new meds, does Sully now seem to be pain free?
If Sully's pain is now controlled, he may be less reluctant to pee. If he is still hesitant to pee, please ask again for a urinalysis. A UTI does not always result in dark-colored or strong smelling urine, and UTI's sometimes makes it painful to pee.
If you have decided that the benefits of laser therapy outweigh the risk, then continue to make sure his back is kept straight when lifting. Also consider padding out the crate with rolled up towels or blanket so that Sully will not shift in the crate as you turn a corner or brake.
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Post by Krista & Sully on Aug 18, 2021 15:15:59 GMT -7
Ok great, thank you for the advice. I have a booster seat for him that is flat laying and have my fiance assisting me to travel.
I do think his pain is managed, yes. Especially since we have altered the doses, although before those doses, I do think the pain was still much less than previously. Thank you so much! I will report back with any questions or updates.
Please keep me posted if there is anything in here I should add. Have a good one.
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Post by Krista & Sully on Aug 19, 2021 20:01:01 GMT -7
Update since altered doses / general update:
Cut ▼methocarbamol dose in half to 125 mg 3x day (updated above). Sully was basically sedate since the pain/muscle meds were upped yesterday into this morning. Passed out / dead weight from drugs. Obviously more comfortable but motor function was all skewed (in addition to side effects from IVDD, of course). Toward end of each 8 hours, motor functions would improve leading me to communicate this with the vet. He recommended I cut methocarbamol in half and remain at 3x a day with the gaba and tramadol.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 25 lbs / 11.34 kg 6.5 y.o. crate rest started 8/13, never told how important! prednisone 5mg tab as of 8/15: 5mgs 2x/day for 7 days, then SUNDAY 8/22 test taper for: _pain / _neuro traMADol 50 mgs tab: 37.5mgs 3x/day gabapentin 50mg tab: 100 mgs 3x/day methocarbamol 500 mg tab: ▼125mgs 3x/day Pepcid AC 10 mg tab: 5mgs 2x/day ]
Pain still seems overall managed but keeping an eye on him in that regard. Going to vet tomorrow with fiance for 3rd laser light therapy. Not many problems there with transporting since I live down the street and I have communicate with vet I am only comfortable if I can bring him in and out and sit with him through the therapy. They have been so accommodating. It definitely does seem to help but hoping to see more results with further sessions.
Side rant - any thoughts on the assisi loop? I have one and have been using it on him 3-4 times a day in suspected primary pain area and he seems to relax immediately. I suspect it does bring him a decent amount of comfort at the very least and doesn't seem to be a placebo.
Apologies for the long reply and not sure if this is the appropriate place to expand on this, but my mental health is really suffering if I am being completely honest. This is really emotional and mind boggling to me. I am trying to stay positive and keep my worries minimized with the Road Map on my fridge, etc. I suffer from clinical anxiety and daily life in general has been hard to manage prior to Sully's bump in the road. Sully's my best friend (like everyone else's pups here) and the constant unknowns with his health and progress the past couple weeks has my brain all out of sorts. Trying to stay as strong as possible and positive for Sully especially when he I am present with him, but it's really difficult. If you have any suggestions for support in that regard, I am open to them.
In the end, this is about Sully and his recovery. We will make it through regardless but I am wondeirng more if it would benefit both of us to get the surgery. That's my biggest hurdle. It's not really about the financial commitment, while significant... I've weighed the pros and cons based from the advice of the neuro/vets, this fabulous resource and my own personal research daily. Something in my gut has kept me from pulling the trigger and I don't know why or if I should be trusting that. I truly think he would make it through without surgery but I don't know how I would forgive myself if he doesn't recover without it.
Thanks for all your help and for listening overall.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,589
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Post by PaulaM on Aug 19, 2021 21:25:53 GMT -7
Krista, excellent detective work on the over-relaxation that the muscle relaxer methocarbamol was causing! Kudos to you and for reporting to get methocarbamol adjusted. Could you be specific in what the "more results" are you're expecting with further sessons of laser light /acupuncture therapy? What exactly have the previous two sessions helped with?IF you have the prescription Assisi Loop for dogs (targeted pulsed electromagnetic field) and you find it offers relaxation/comfort maybe it can be in place of visits into the vet. What does your vet say?I can relate with daily life anxiety so this idea may be of help with the addition of the clinical kind. A simple breathing technique can help YOU help your dog.It is called belly breathing. Helps to relax, slow you down, quiet your mind. Do it anytime during the day, whether you are sitting at your desk, driving in your car, or walking down the street! It works for me to take stress away.As for surgery, with Sully fairly mild symptoms most surgeons would not want to operate on a dog who can walk even if it is wobbly walking. I believe you gut is telling you made the right decision for conservative treatment. In case your gut needs a bit more support:There are situations a surgery on a wobbly dog would be a consideration: from dodgerslist.com/2020/02/10/surgery-vs-conservative-- If with STRICT crate rest, neurological functions worsen and are lost (leg movement and bladder control).-- STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, pain returns.-- If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and are a mix of pain relievers), but the pain can’t be brought under control. Dr. Andrew Isaacs, DVM, ACVIM (Neurology) answers about conservative medical management vs. surgery: Unfortunately, there is no guarantee with any surgery. Therefore, I will recommend surgery only if the risk associated with surgery is less than the risk of continuing with medical management. There is always a small risk the dog may not make it through anesthesia/surgery, is permanently worse, or never improves. Because of this, an owner should never be told they have to do surgery. It is important to not be rushed into making the decision and have the opportunity to ask as many questions as needed. 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. The decision to pursue surgery depends on multiple variables. Any dog can be managed medically. However, typically the decision to treat medically versus surgically is dependent upon the risk:benefit ratio. If the same outcome can be obtained medically versus surgically then it is wise to treat medically. dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/The first attempt to go off of Prednisone will be on Sunday 8/22. This is a test to find out if all the pain is actuall been eliminated. Or if a 2nd course of prednisone is needed. Which does your vet want on this Sunday's prednisone taper test for pain: 1) full stop of all pain meds to you are not wearing a blindfold about existence of pain OR.... backing off of pain meds? Let us know what your vet wants. My impression with pain meds still being adjusted is that all the painful swelling may not be gone by Sunday. It may be prudent to not do the pred taper on Sunday but extend the 7-day pred course. Something to get your vet's feeling on so you know what do this coming Sunday. Remember it can take 7-30 days (excluding any taper days) before pred completes the job of riding the body of inflamed tissue. 2) There is still some adjustments to pain meds that could be made to achieve maximum analgesic/comfort, so one can't claim at this point all med adjustment have been taken if Sully happens to show pain prior the scheduled Sunday test for pain taper. If he shows pain, then clearly not time to do the Sunday taper. Again my imprression is it may not be time to start a taper on Sunday. What do YOU think and what does your vet think?
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Post by Krista & Sully on Aug 20, 2021 13:06:33 GMT -7
Thanks for the props!! I am feeling a little better today for a few reasons. I would like to add that I am very thankful for sharing your feelings and what has helped you cope. I will have to try those breathing exercises! I appreciate it.
Reasons I am feeling good today:
1. I was fearful that Sully was getting a lot worse. His legs have been much wobblier than usual and started going to bathroom less frequently again. My major suspicion was that the medicine dosage increase was to blame... and now seeing a pattern that I think it is what is causing him more ataxia and imbalance. His pain seems pretty low toward the end of the 8 hours before his next dose. I know the answer is to talk to my vet, but I have been calling daily to adjust meds/with questions and he is going there for the laser light therapy. The laser light therapy definitely seems to be improving. The only thing I'm concerned about is that his meds are too high.
I spoke with the vet yesterday and today and he said he would recommend he stay on the meds through tapering prednisone, but it is pretty obvious to me that he is functioning much better in terms of walking without them. Obviously he does need the medication for pain control, but maybe I should discuss lowering the dosage again with him? His pain seems a lot less overall and movement seems a lot better even toward the end of dosages of the gaba/methacarb/tramadol.
The results I am seeing from laser light therapy: less spasms (toward end of pain dosages), seems to be in less pain overall as dosages wear off right before next dose... also, when we are doing the actual sessions, he is twitching/spasming less each time in the area he suspects he has the most pain. So it seems like this is helping quite a bit but who's to say for sure.
In terms of the assissi loop - it is not the prescription one. It is the 2.0 version that I have been using. Seems to comfort him a lot when we are utilizing it but who knows how effective it is really. Other people swear by it from what I've found but I have no clue.
I think you are right in terms of trusting my gut with this healing process. It still isn't totally out of the question should the taper go wrong and he get much worse... but that is how I have been feeling about it overall. If the taper proves that his condition is worsened quite a bit, I will likely consider the surgery as the next step as I don't know how he will do on another round of the prednisone. Quite honestly, I know it is helping him, but I don't think his body likes it at all.
In terms of tapering, I discussed with my vet and he said to still taper (as stated above) and continue the pain meds, which we will adjust Monday seeing how it goes. If it's obvious he's not at least the same or better, then we'll need to discuss another round of prednisone and/or surgery.
This feeling is fleeting where I see a hole at the end of the tunnel with conservative treatment... and I know it is still very early... but right now at this time of day, I feel very good about how it's going with the exception that I'm not sure if his meds are a little too strong right now. Last question - if we decide the reduce the dosages right before the taper and then again when he tapers, is this common / any concerns or issues I should bring up here?
Thanks again and hope you have a great start to your weekend.
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Post by Romy & Frankie on Aug 20, 2021 15:17:44 GMT -7
Pain meds, particularly Gabapentin, do sometimes have the side effect of loss of balance or wobbliness. So if you are seeing him walk better when his dose of pain meds are wearing of, this could be the reason. While less wobbliness is important, pain control is also very, very important. Pain will slow the healing process. You could try lowering the pain meds and see if his pain is still under control. But if it a choice between temporary wobbliness or pain relief, I would choose pain relief.
Some of our members have seen positive results from an assisi loop. if Sully finds it comforting it may be working for him.
Usually pain meds are tapered or stopped at the same time the pred starts tapering. The reason for this is that if during a pred taper pain is seen, we know that there is still swelling in the spinal cord and more time on the pred is needed. If pain meds are still being used at this time, they may mask the pain which shows that there is still spinal cord inflammation. That makes it will be more difficult to tell if additional time on the pred is needed. It is common for dogs to have to taper more than once before all the swelling is gone. Since Sully is still walking, even if wobbly, he is a good candidate to recover with conservative treatment.
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Post by Krista & Sully on Aug 23, 2021 6:14:10 GMT -7
Good morning!
I hope you had a good weekend. Sully began tapering yesterday (sunday, 8/22) and is down to 1 pred every 24 hours. I took him for acupuncture on Saturday (8/21) and the vet recommended stopping muscle relaxer (as well as my neuro) as he doesn’t seem to be having many spasms at this point / does not seem to be in pain. They said that he likely needs as much use of his muscles (abs and front legs) to compensate for the weakness in his legs... and that if the pain were more centralized in his neck they would recommend staying on the relaxers but do not recommend it at this point since the focus point is more in his mid to lower back area.
We stopped the methocarbamol on Saturday afternoon 8/21 and here is updated meds list:
- 5mg Prednisone: 1x day (morning) - 5mg Pepcid 2x day before pred (morning & night) - Taking down 100 mg ▼Gabapentin 3x day to 2x a day to see where pain is at / if walking improves at all as neuro prescribed - ▼Tramadol is down to 25mg 3x a day, if he still does not seem in pain today with 3x a day will take down to 25 mg 2x day every 12 hours with gabapentin (as prescribed originally by neurologist - things to look out for? agree/disagree with following this process?)
[MED LIST/HISTORY- Moderator's Note. Please do not edit 25 lbs / 11.34 kg 6.5 y.o. crate rest started 8/13, never told how important! prednisone 5mg tab as of 8/15: 5mgs 2x/day for 7 days, then SUNDAY 8/22 test taper for: _pain / _neuro traMADol 50 mgs tab: 37.5mgs▼2x/day gabapentin 50mg tab: 100 mgs ▼2x/day methocarbamol 500 mg tab: 125mgs 3x/day STOPPED 8/21 Pepcid AC 10 mg tab: 5mgs 2x/day ]
Definitely want to taper the pain meds so we can see how the pred taper is doing. Sully hasn't had diarrhea or vomitted at all since the beginning, but I have a feeling these medications don't make him feel well overall. He just seems sad and tired. He doesn't seem to be in pain anymore - rarely pants, if ever... don't see spasms at this point, not breathing heavy like he was before.
My only real concern right now is his walking. It hasn't improved. I thought it was improving but it doesn't seem so... one second he will seem to be walking better, next he is falling over or having trouble getting up. I know the gabapentin can cause ataxia, but at what point should I be concerned? What would you consider "getting worse?" If he is not in pain, is this something I should not be focused on?
As mentioned, pain seems to be improving or "nonexistent." It's all just very confusing still. At what point do you seriously consider surgery when they are kind of in this purgatory?
The vet who did his acupuncture was great. He said he would definitely be able to heal conservatively but he did warn me that after the 1st or 2nd session he will likely have moments he seems much worse or much better and teter back and forth until we get him stablized on somewhat of a "high" with the sessions. He said many times he will see improvement after the first 2 sessions and from there it often continues upward.
It has gotten a little easier emotionally overall (or maybe just at this minute it feels ok haha). But it hasn't gotten any less confusing for me. He goes to the neurologist on Sunday 8/29. Really, really hope we see more improvement by then. At what point would I be calling the neuro to see if he should be back on the full dose of pred (if the taper seems too soon)?
Thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 23, 2021 7:53:20 GMT -7
Krista, glad to hear the prednisone test TAPER is proceeding as planned for 8/22. Your vets have chosen to handle pain meds by backing them off. So all looks in order for the test taper. So lets look at what is being tested in more detail.PAINUntil the gabapentin and the traMADol have backed off and then comes to a stop, you do not really know for sure about pain. What you report of no observable signs of pain certainly at this point is a good sign that all pain just might be gone. The proof will come when off all meds and you still do not see any pain.NERVE FUNCTIONGetting worse for Sully would be loosing neuro function so that knuckling under the paws returns, can no longer move up in to a stand position. Your vets may have alluded to muscle atrophy, which to you could appear to you related to neuro function diminishment but has to do with not using muscles. Weak muscles from disuse is k inda like when you've been sick in bed with the flu for quite some time, when you get up to go to the bathroom you feel kinda wobbly/weak in your legs, it is not nerve damage but due to not using your legs while laying in bed. Muscle atrophy will turn around when the disc has healed on Oct 8 graduation from STRICT rest. Then it will be safe to slowly introduce physical activity. click to enlarge picture: Right now you carry Sully to and from the potty place and the limited footsteps you allow in a 6 foot diameter potty area is enough to keep his joints flexible and keep up circulation in his muscles. The priority is always the protecting the scar tissue the disc is forming. Think about scar tissue this way. If you scrape your knuckle, your body forms scar tissue as long as the knuckle is not moved too much. Move your finger too much then the scar tissue tears and bleeds! Similar deal with a damaged disc. EXCEPT with a disc there is no bath of blood bathing surrounding the disc to aid and expedite healing. This is the reason why it takes much longer for a disc to heal than a scraped knuckle, a broken arm. IF the scar tissue breaks, then there is not only pain, but a good chance disc material could escape and severely damage the spinal cord where neuro functions are lost: bladder control, leg paralysis and having to start at square one all over again.
THE GOAL with conservative treatment Always protect the disc from too much movement to avoid the early healing disc from getting damaged. Always weigh what is the benefit to be out of the recovery suite vs what the potential disc risk could be. --Things like going potty are a health concern. You make it quick and ensure limited footsteps are taken. -- Things like medication changes can be made by phone eliminating the need for a risky to the disc transport in a car and then moving him into the building, maybe be excited and move too much in the vet's clinic, etc. -- What is the benefit you expect from a neuro appt on Aug 29 that makes the risk of a transport so worthwhile? At this point you are reporting things are going in a good direction with no pain, and no neuro loss. -- Same question about transporting to acupuncture for a dog who CAN WALK and is NOT SHOWING PAIN. You are willing to expose Sully to disrupting the early healing scar tissue for what benefit? -- Vets who know IVDD, understand the single most important care is the STRICT rest at home inside of a recovery suite. Readings of interest to you:
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Post by Krista & Sully on Aug 23, 2021 10:07:09 GMT -7
Thank you for the info. I'm sure atrohphy has played a role, but in terms of nerve function, he is definitely knuckling over more today. That is what is concerning me. He can still correct it very slowly and can take steps on his own / stand up (terribly), but he is having more trouble standing up [moving up into a stand or JUST remain in a stand position?] it seems.
Should I contact my vet and see if he should be put back on prednisone? I don't know what an emergency situation is anymore. Wouldn't having him on another round of prednisone cause other potential health issues? I'm sorry if it seems I am asking the same or similar questions repetively. I just can't tell where this is going.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 23, 2021 11:40:53 GMT -7
Choice of description is important in communication in the role of being the eyes and ears for your vet.
Terms that are too general to even know what they mean. Avoid: -worsening -improved or not improved: Use dates when communicating something happened
The VERY best way to report nerve damage is to use a specific description such as those from the MONITORING list below
NEURO MONITORING 1. √8/13: Pain caused by the tearing disc √as of 8/23 Pred taper 8/22 showing no painful inflammation 2. ▲ 8/18: Can wobbly walk ▲ 8/18 Can correct Paws knuckling ▼ 8/23 Paws increased knuckling under more often and slower to correct paw 3. ▼ 8/23 Weak legs, fell over ____ little leg movement, ▼ 8/23 less able to move up into a stand 4. ____ Legs do not work at all (paralysis, dog is down) 5. ____ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 6. ____ Tail wagging with joy is lost 7. ____ Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.
Krista if the above neuro monitor list accurately reflects what you are seeing today (8/23), here is how I would phone in and give a report:
PHONE REPORT: Today Sully is on a prednisone taper that began on 8/22. Currently 25lbs Sully takes Prednisone 5mgs 1x/day.
8/21 pain meds were reduced. I have not observed any signs of pain todate (8/23): traMADol 50 mgs 2x/day gabapentin 50 mgs 2x/day methocarbamol stopped 8/21
This is what I observe today (8/23) about nerve function: -- he is less able to move up in to a stand position with back legs -- he fell over on his butt -- knuckling back paws is now more often, and slower to correct paw
From your report the vet can ask more questions to fine tune things in his mind. The above report would very likely indicate to any vet who knows their IVDD, that on a pred taper if neuro functions decline, it would clearly not be time to continue on with a taper. Instead it indicates to go back up to the anti-inflammatory level of prednisone at 5mgs every 12 hours. Next a vet then has a decision as to whether a 7- day course or a 14 days course and then another taper test. It may take several test tapers (several pred courses at the anti-inflammatory level) to finally rid the body of swelling that is impacting the spinal cord. To be honest, there is no clarity if all these vet visits have possibly contributed too much movement and damage to the disc's early forming scar tissue, hence a decline of neuro function you report!
In any event with decline of neuro functions, prednisone would be back up to the anti-inflammatory level doses twice a day. If your vet has a different thought about medications that you do not understand, it is your job to ask questions until you understand, it is your job to voice any concerns also.
All meds can have side effects. When it comes to preserving the spinal cord that benefit outweighs the risk of some adverse side effect. Using Chemo for cancer patients has side effects but the benefit very much outweighs the risk!
Blood test panels are what tell the vet if Sully's organs are in shape to take meds if there is a question of health.
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Post by Krista & Sully on Aug 23, 2021 16:28:38 GMT -7
Good advice! I'm at a loss of what to do, I called my primary vet earlier and he was in surgery so the nurse spoke with him, relayed the message and my concerns and he said to continue tapering the steroid and gabapentin to 2x a day (rather than 3, which I already mentioned) and to keep them posted / call them tomorrow if I am concerned. They will make change if he seems to be in pain and declining further.
I called the neurologist and she wasn't in the office and isn't back in until tomorrow.
I have the additional prednisone but I have no idea what to do until a professional gets back to me. His pain seems controlled completely most of the day (it's hard to say again with the pain meds, but we have tapered and he seems ok). But again, seems to be declining.
Going to reach back out again tomorrow and call the neuro specialist.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 23, 2021 17:09:19 GMT -7
MONITORING for decline How many seconds tonight does it take Sully to correct his paw? Almost immediately? 1 sec or ????. Then you have something to compare tomorrow morning.
What do you specifically see when Sully has "less ability" to move his body up into a stand position? Compare with the details of what you observe tomorrow morning.
2. ▼ 8/23 Paws increased knuckling under more often and slower to correct paw 8/24 ?
3. ▼ 8/23 Weak legs, fell over ▼ 8/23 less able to move up into a stand 8/24 ? __ little leg movement, 4. __ Legs do not work at all (paralysis, dog is down) 5. __ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on an old urine spot outdoors.
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Post by Krista & Sully on Aug 23, 2021 21:14:44 GMT -7
I’m a mess right now, I don’t know what to do. I have been doing everything talking to vets (via phone) he has been fully crate rested and since the taper he has now stopped using his legs for the most part. He is trying to and he can barely get up into a stand. I don’t understand what could have possibly led to this in the past couple hours but I know that’s not what I need to focus on. He can still reposition himself and stand when I put him in stand position but he’s not really able to do it himself - BARELY. Solidly quick decline and I don’t know if I should just schedule the surgery at this point or what. Or if I should rush him tomorrow. I need guidance, everyone close to me right now is completely unable to help me in terms of weighing a decision. I really want to do this conservatively but I’m losing hope and I don’t even know what to expect through the night or in the morning. He still has deep pain and I have no idea about his bladder. I think he has bladder control because it seems he is holding it in / not peeing it out when I’m carrying him outside or leaking on bed. It seems like he wants to pee when we have gotten out there but then is confused bc he can’t really use his legs to squat since he has just gotten worse and it seems like he panics even when I try to reposition him back up. He will not let me express him at all, this is terrible. I’m just keeping him in his crate and hoping he goes in there. I know he peed last around 8 hours ago. Through this whole thing he hasn’t wanted to pee much until he started to improve Friday into the weekend and now thisz Keeping pain meds the same and I gave him the 2nd 5 mg of prednisone against my vets advice to taper. I don’t know if that’s irresponsible but I don’t know what else to do. Obviously tapering he was not ready. Or something is going on that he has made a turn for the worse. I’m at a loss. Trying not to panic. I know if this goes South quick I need to rush him for emergency surgery but considering he can still stand unassisted once in position and did barely get up on his own for a second a few minutes ago I haven’t rushed him yet. I’m disheartened if I’m now at the point it would be irresponsible to not go with surgery if I financially can afford it. I don’t know why but there’s something in my gut that did not want to do it and I think I was either wrong then or wrong now. To make matters worse, he won’t sit still for more than a minute because I think he has to poop but won’t go outside since a little earlier. I think he pooped last 7-8 hours ago but he has a lot of gas. He won’t stop wiggling around and switching positions in the crate bed and it’s making me even more anxious Thanks
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PaulaM
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Post by PaulaM on Aug 23, 2021 22:09:38 GMT -7
Krista, being able to hold a stand once he's been helped to get to a stand position is just reflex. Being able to stay in a stand is not a neuro function. If Sully is now declined even more to barely now being able to attempt to raise his butt up into a stand position, that is a serious decline in neuro function that needs attention now. If you can afford it, sounds like for your own peace of mind, go and get advise from either a Neuro surgeon (ACVIM) or an Ortho surgeon (ACVS) by going in as an emergency case tonight or very soonest possible. It is hard to tell how fast more decline could take to happen, so the more prudent idea is to seek specialist help now tonight. You need qualified vet help, which does not seem to be locally with your vets. IF indeed there is even more neuro worsening of almost no ability to raise up his butt on his own he either needs attention to get an anti-inflammatory dose of prednisone started soonest possible or to go into surgery. When there is diminishment of neuro function in the legs, a specialist will recognize that as an emergency to deal with without a referral from your local DVM. Specialist clinics are open 24 hrs for emergencies. Find Veterinary surgeons (ACVS) and neurosurgeons (ACVIM) here: find.vetspecialists.comAs damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. You are reporting this night 8/23, Sully is barely able to move up into a stand #5. Remember just standing once someone has helped him has nothing to do with neuro function, a dog can remain standing just by reflexes. 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 barely move up into a stand on own6. 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. 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/Fingers crossed Sully you are able to go tonight to see a specialist as an emergency case.
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Post by Krista & Sully on Aug 24, 2021 6:09:58 GMT -7
Thank you. The neurologist I’m working with is a board certified surgeon at Red Bank Vet Hospital in NJ. They are one of the best for IVDD in the area, so I am extremely confident in the neurologists abilities but the issue is that I couldn’t get in touch with her yesterday around 5pm when he started to decline as she had left the office so they said to bring him in overnight or call in the morning (last night) I knew if I brought him overnight he would be just going into surgery.
So he is going into surgery first thing tomorrow morning. He peed on his own this morning but is still dragging his back legs for most part.
So I will be taking him into surgery [Wed 8/25] tomorrow morning. Treating him like glass until then. He still has dps and bladder control. No longer moving forward with conservative and will keep you posted on how everything goes.
Thanks so much for all of your help through this. I think this will give me peace of mind moving forward.
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