Brittany's Elton 8/20 Conserv-Libby; vet: CF; est GRAD 10/15

Brittany, sorry to hear about Elton.   For tonight, the single most important care is immediately crating to restrict movement of the back.  A good review of tips, ideas and how to ensure STRICT rest:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/

Food/water bowls should be attached inside the suite. Only out of the suite when carried to and from the potty place.

Starting the  anti-inflammatory prednisone can tie the vet's hands on his preferred anti-inflammatory drug (whether it would be more appropriate for the symptoms a steroid or a non-steroid NSAID.)  It takes days for prednisone to leave the body.


Gabapentin stays in the body for about 8 hrs. Time giving gabapentin now so that it will be close to being out of Elton's body when he visits the vet. This way the vet can best observe all the symptoms and give give a diagnosis and his choice of treatment.

Suspect IVDD? Do these things NOW.
A quick review. Look below the Banner of the brown doxie:
dodgerslist.com

POTTY 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!

Just Googled and there are varying opinions mostly it is about strength deterioration. Anyway hope by now you've made contact with your vet. I'm in Columbia Falls and hoping to learn what your vet diagnosed and prescribed for little Elton.

Brittony call your own vet today, right now.

Prednisone/prednisolone anti-inflammatory level dose is 0.3mgs X 9lbs = 2.7mgs pred dose every 12 hours!

Get permission from your own vet to dose Pred at rounded up to 3 mgs TWICE A DAY (every 12 hrs.

Knuckling is due to Elton having NO ADEQUATE level of pred to work on swelling. Taper doses do not work on swelling Anything below Pred 3mgs Twice a day is a taper dose.

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After contact with vet about the emergency in my above post, here are other things to consider.

Brittany, I'm so sorry the ER vet visit/phone were conflicting info. And yet still an anti-inflammatory level dose was NEVER prescribed by ER! Anything below 3mgs twice a day is a taper dose for a 9lbs dog and is not working on spinal cord swelling.

Prednisone and prednisolone are basically same med.

Things I'm concerned about is quickly (hours matter) getting prednisone adjusted upwards to an actual anti-inflammatory dose for a 9lbs dog to be Prednisolone 3 mgs every 12 hrs. Your vet may require a trip in for an exam before being able to Rx. ER is a mess but they have seen him and you can report diminishment of neuro functions to knuckling under paws. ER "should" be able to adjust pred to 3mgs every 12 hours (anti-inflammatory level dose during a disc episode). Fingers crossed you can quickly get pred corrected for Elton before nerve damage progresses to paralyzed legs. Hurry, please!

Pepcid AC (famotidine) needs to be on board for the duration of pred. Pepcid AC 0.44mgs X 9lb dog could be rounded up to 1/2 of a 10 mg tablet. Thus 5mgs every 12 hours. Let your vet know you want Elton to be on an acid suppressor purchased at the grocery store.
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If pain is not fully controlled then gabapentin every 12 hours is not yet right. ADVOCATE for
--- gabapentin Rx for 50mgs promptly every 8 hrs (3x/day)
-- traMADol Rx for promptly every 8 hrs.
-- and possibly adding methocarbamol for muscle contraction pain promptly every 8 hrs.

A figure 8 sling will be very helpful for Elton's male anatomy.

Brittany, it may be that your vet would use 5mgs 2x/day since it could be hard to cut a 5mg pred tablet to get down to 3mgs dose size (how do you do that with any accuracy).

The tapering doses of 1.5 mgs is like not giving any predinsione. So the day pred starts at 3-5mgs 2x/day is the first day of the 7-day course.

Discuss with the vet about now giving the missing morning mg dose and then in the evening the 3-5 mgs 2nd dose of the day. Prednisone does not have be given with certain spacing of hours. The typical is to give the dose twice a day.


We are only familiar with IVDD, so not very familiar with immune suppressive doses. Do know for IVDD vets will often round up or down to fit the size of the whole pill or easily split pills of  1/4 or 1/2 of pill. Again you really need an IVDD knowledgeable vet supervising dosing for prednisone doses. That vet also would know your dog's health history to guide in dosing meds. We may not be aware of all of Elton's health and we are not vets either.

Dr. Ruben reflects the vet Rx's seen on this Forum who know IVDD are prescribing for prednisone specifically for a disc episode of using the upper range twice a day

Definately 10 mgs 2x/day is in the immune suppressive range for a 9 lbs dog.

How many days left of 3mgs 2x/day pred pills do you have left?

I can point you to specifically a very knowledgeable IVDD vet at Glacier Animal Clinic, Columbia Falls, Dr Mark Lawson.   
    Here is Dr. Lawson's take on treating a disc episode. Stuff owners don't often get to hear or if it was said, in the emotion of it all some things are forgotten once home.

Any vet who has not examined Elton would very likely want/need to see Elton before Rxing meds. So if your vet has not yet see Elton for this disc episode, Elton would likely need to be transported in for a vet exam.

If a vet transport is a must to get more pred pills when you are running out, then that is an urgent vet visit exam.  Secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels/blankets snug around your dog to prevent movement or jarring the spine when braking or turning corners.

3:12 pm here. Checking on some information for you and will get back to you.
Do you have the ability if an appt is avail to go today?


how old is Elton?

Gave 2.5 mg of prednisone and 50 mg of gabapentin at 7:30 pm. Going to continue with 2.5 mg. If it doesn’t work out will seek the advice of the vet in Columbia Falls.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
9 lbs 3 y.o
FYI: 2020 traMADol caused barking day/night; had to stop
crated 8/20 with leg weakness
After 8/21 ER vet appt , fell over while pooping
no pain with gabapentin 8/23
8/23 back paws knuckle under with pred taper doses
8/24 can no longer right knuckled paw or move up to stand, pain in control
8/31 slipped out of sling and fell over
prednisone 10mgs tab: as of Fri 8/20: 5mg dose for 1 day til 8/21 vet appt
Prednisolone formula: 3mgs/1 mL as of Sat 8/21: ER  Rx : 3mgs (1mL) 1x/day for 7 days, 
          as of 8/21 owner giving 1.5mg 1x/day followed phn instruction by  mistake
          as of 8/22 owner giving 1.5 mgs 2x/day
          as of 8/23: 'solone 3 mgs am;  'sone 2.5 mgs pm
          as of 8/24: 5mgs 1x/day am for 2 days 
         as of 8/26: 5mgs 2x/day for 5-7 days
         as of 8/31: 5mgs 1x/day for 5-7 days
         as of 9/1:  2.5mgs 1x/day for 7 days
         as of  9/1:  2.5 mgs EOD for 7 days
gabapentin 50 mgs 2x/day
Pepcid AC 5mgs 2x/day ]

The Prednisolone I have is liquid, the prednisone is tablets.

Prednisolone  formula.   3mg/ML 

 Nothing was marked by vet. But 3mg dose is 1ML.
Dosage says
   1ML per day for 7 days.
   0.5ML per day for 7 days.
   0.5ML every other day for 7 days. 

 "3mg" dose? 1ML 

Yes [Libby]. a 1.5 hour trip with an infant is often 2 hrs. 

[Surgery?] Unfortunately, no. Last year yes. This year, no. Kills me to say that. 

I wonder if Elton's vet would consult with the vet in C Falls for dosage, or if she would find that incredibly offensive. 

I called Glacier Animal Clinic to see if they do any med consults with other vets since he is knowledgeable with IVDD. Not even a remote possibility. Even if I could get him in, he’s booked out. It’s very frustrating that vets don’t do consults with each other in IVDD cases. They certainly do in congestive heart failure - specialists and cardiologists consult with general practitioners for meds. I get having to see the dog, but with records, grading of IVDD plus video consult. It’s wild to me that no one offers this. In many other illnesses for dogs they do. Especially on how dangerous it is to transport an IVDD dog.

Anyway, just venting. Hopefully, he makes progress soon.

Brittany, just so we know, did Elton begin  5mgs 1x/day today, 8/31?

COMMERCIAL REAR SLINGS/harnesses
Both of these rear sling/harness products would be used with your own front end harness so that you control speed.  If you are using an ex-pen in the grass then it is the ex-pen that lets the dog know there isn't going to be any sniff festing or darting off at something with the physical of the fence.

1) Gingerlead: 
   Ginger Lead Combo rear belly sling + leash to connect to your own harness to control speed  $35.95  www.gingerlead.com/dog-slings/dog-support-harness-mini.htm
www.gingerlead.com/dog-slings/media/ss_size1/GL-MINI1.jpg **

2) Walkabout Harness for rear leg support:
     Airlift One Support for males rear sling.   Small $31 Use your own front harness to control speed.
www.walkaboutharnesses.com/products/airlift-one-back-harness?variant=44899490121
i.postimg.cc/wMmq2T5P/Air-Lift-0ne.png **

For peeing the Airlift might be the better of the two. There is more room for the penis. As male dogs may not like anything touching when they pee. I have used their "Original" with less room for the penis. It was something my dog could not slip out of same as would be with the Air Lift One

Both companies have someone you can speak with if you have any questions about fit- which size to order.

Britanny, so sorry to hear the 14 cumulated days at the anti-inflammatory level was not long enough. With the tapering beginning on 9/6, it was not until there was also a decrease in pain masking pain meds (gabapentin) that Elton showed not all painful swelling was actually gone.

Quite typically it can take in the range of 7 up to 30 days at the anti-inflammatory prednisone level. Taper days do not count.  Low dose taper days are for another reason.  For IVDD it happens to be a perfect window to assess for possibly still existing pain.

Make it clear Elton is in pain and you are asking the receptionists to help you.

Rather than asking for an appointment which is not avail til Oct, tell the receptionist you want to get a message to the vet that on the every other day dose PLUS decrease of pain meds, Elton is in pain (hunched back, shaking) again.  
     Give your telephone # and your email address too. A vet has jam packed full days of appointments. You may not get a response til end of the work day. Or ask if, possible can the vet  relay a response via the receptionist.  
    It may be that another course of prednisone would be Rx'd to a specified pharmacy near you and any pain meds needed to accompany.

Have dates handy with when things happened in case the vet needs specifics. We are kinda lost and out of the loop since you last wrote end of Aug and are not able to see the pattern of date/med dose/observation of pain.

Pred taper 2.5 mgs 1x/day started on 9/6.
   Since 9/6 taper what date(s) did you see any sign of pain surfacing other than 9/13 night and 9/14 night?
   
Pain med gabapentin (50 mgs 2x/day).
   What date(s) did you decrease mgs or frequency?  What was the change in mgs or frequency?

NEURO FUNCTION
With the begin of the pred taper on 9/6 (2.5mgs 1x/day) have you observed any decrease or worsening in neuro function from 8/24 of can longer correct knuckled paw nor move up to stand?

Since  8/24 did you observe any improvement of neuro function abilities? 

Anxiously await what med adjustments are to get Elton back in comfort from pain. Hope also to hear it was pain that was not allowing Elton to want to make the effort to pee and is not a UTI.  Which sling did you opt to purchase?

Please let us know what adjustments the vet makes in Elton's medication when you hear from him.  We will be wanting to know.

Hope you will hear something back this evening. IF not right you are to call tomorrow morning.

Brittany, so glad your vet, got back to you after his long day and called for another prednisone course.  And the good thing is already you are seeing pain back in control with no more shaking.

Would you update the complete med list with the prednisone Rx with a bit more information so we know exactly what Elton is currently taking. 
    

i.postimg.cc/mkmykRjQ/Med-List-Elton.png **

Brittany, fingers crossed another course of Prednisone will be able to fully resolve the painful inflamed tissued around the spinal cord.

 The goal with conservative treatment is over time if any escaped disc material lodged in the spinal cord canal it would be reabsorbed by the body enough to allow nerves to again be able to function properly. The nerves might then become accustomed and less aggravated and painful.

The goal right now, besides having full round the clock pain control, is to heal the disc with the 8 weeks of rest. As your vet mentioned down the line to try perhaps the smallest dose of a NSAID for long term to keep pain at bay since surgery is not on option. Same principal as humans use the miracles of modern drugs to carry on with comfort in life for some diseases. 

Top Care Acid Reducer with one single active ingredient of famotidine is perfect and less expensive too!

Any signs of pain since the gabapentin at 40mgs 3x/day and the prednisone increased to 5mgs 1x/day on Wed, Sep 15?