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Post by Tammi & Stoney on Sept 10, 2021 17:02:06 GMT -7
Stoney is 10 lbs, dachshund, 11 yrs old, no preexisting conditions. He was 100% this morn, [9/10] 8am I left him and upon my return at 1130am he was falling over, no coordination but has pain sensations. Took him to urgent care vet, who is very familiar with ivdd. She did xrays and bloodwork. Bloodwork fine, xrays show calcification of some discs none herniated, showed narrowing of c2/c3( I believe), so she is treating as cervical. 5mg of prednisone every 12 hrs, 1/4 of 5mg diazepam every 8 hours and 50mg gabapentin every 8 hours. I am adding pepcid myself.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10lbs 11 y.o.
Prednisone injection 9/10
prednisone tabs as of 9/11: anti-inflammatory 5mgs 2x/day for 3 days,
as of 9/14: anti-inflammatory 5mgs 1x/day for 7 days, then
as of 9/21 test taper for: _pain / _neuro
diazepam 1.25mgs 3x/day
gabapentin 50 mgs 3x/xday
Pepcid AC ?mg ?x/day ] Strict crate rest. He is resting, refusing food and water, n o interest in getting up or moving. Is there any advice on getting meds in him, I put first dose of diazepam in a small piece of Turkey and had to gently put it in his mouth to get him to take it. Very worried about getting meds in him with him refusing the bites of food. I am making him drink using a syringe. Any advice welcome. I had a graduate of ivdd, but she never refused food. Thank you. Tammi
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 10, 2021 17:25:30 GMT -7
Tami, I'm sorry to hear about Stoney. With neck disc, because they are painful, it normally will take covering each of the different sources of pain with the appropriate pain med. When the med combo has been adjusted for Stoney needs, pain would in in control within in an hour. -- Diazepam 3x/day may or may not work as expected to cover muscle contraction pain for some dogs. -- Methocarbamol is the more typical one used for muscle spasm pain. You could discuss this option if pain is not being covered. -- Gabapentin 3x/day should be good for the nerve pain. -- traMADol acts as the overall general analgesic also 3x/day. Have you reported back to urgent care so they know the pain meds Rx are not yet corrected adjusted to provide round the clock dose to dose pain relief. Can you call now? What about prednisone. For how many days are you to give 5mgs Pred 2x/day?What is the neuro condition of the front legs? - can he push up on front legs? - use them at all? The back legs? - Can he push up with back legs? - can he use them at all? -- do the back paws knuckle under? OR can he correct the knuckled under paw eventually? Stoney is in pain, so do not force food or liquids til the pain meds are doing the job. Provide water in his suite so he can lap if he chooses. Extra things you can do to help with a neck disc: dodgerslist.com/2020/05/05/cervical-care-tips/ |
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Post by Tammi & Stoney on Sept 10, 2021 17:51:48 GMT -7
Hi, I just gave diazapram 1.5 hours ago, and gabapentin 10minutes ago. He seems to be responding to pain meds, they gave him injection of pain meds and prednisone before I left hospital 3.5 hours ago. I do have tramadol if needed. She said prednisone 3 days then start taper. He is not trying to get up, but when I took him in he was not knuckling that I noticed but stumbled, fell over, no coordination. Vet said he has pain sensation, he can move tail and legs when I pet him but no interest in standing or moving. As far as meds go, any advice in getting pills in him? He has no interest in anything I put them in. I put last dose in small very small meatball of his wet food and put it in back of mouth gently as possible, had to get it in him.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 10, 2021 20:34:39 GMT -7
Tami, fingers crossed to hear the pain meds will be fully controlling pain tonight. A 3-day course of prednisone is rather short. So be very vigilant when the taper starts on Monday 9/13 that there is no worsening of neuro functions NOR any increase of pain. If you are still seeing pain, then of course it would not be time to taper, but continue with the original pred dose. Stoney got a prednisone injection on 9/10 AND he started prednisone tabs 5mgs 2x/day also on 9/10?
STEROID: A taper of the Prednnisone gives an opportunity to test for pain/swelling. With pain meds on board, it's very difficult for you to be able to determine if there would still be actual pain/swelling and still a need for the original dosage of Prednisone for a bit longer. Normally pain meds are stopped or back off for the taper day to get an accurate and quick read on pain/increased neuro. Let us know how your vet wants to handle pain meds on 9/13. Rule of thumb: pain = swelling= another course of steroid + all pain meds, Pepcid AC back on board.
(NOTE pred taper days are not counted in the 7-30 days it may take for the body to be rid of painfully inflamed tissue around the cord.) MONITORING FOR NEURO FUNCTION As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. √ 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't move up into a stand 6. _ Legs do not work at all (paralysis, dog is down) 7. _ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. _ Tail wagging with joy is lost 9. Deep pain sensation, 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. A quick overview of conservative treatment vs. a surgery: dodgerslist.com/2020/02/10/surgery-vs-conservative/Clarify if the wobbly, stumbling leg issue is with the back legs or the front ones? Or are both the front and the back legs affected? Can he use his back legs to reposition in the recovery suite?
Can he specifically give you a happy wag IF you do some happy talk?Are you giving Pepcid AC 5mgs 2x/day?SIGNS OF PAIN Let us know with meds now in his body for over an hour what you observe: ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned bac ⚙︎ 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 a neck disc, typical signs: ◻︎ head held high/ nose to the ground ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg up flamingo style not wanting to bear weight
PILLING
Once he is fully out of pain, will be much easier to care for him. Hope these ideas will help with pilling.
1) This vet gives best demo on pilling a dog I've seen:
2) Three Treat Method
Wash your hands of any pill dust to avoid transferring to outside of treat. Gabapentin is very bitter as is traMADol
Put the pill into the well of a small mashed banana ball, a cream cheese ball, liverwurst ball, Gerber Lil' meat sticks, or inside of a sticky small marshmallow and sealed completely so no taste is on the exterior.
Use the three treat method. Prepare 2 treats with no meds inside PLUS the med ball. Give plain treat while holding med ball in front of eyes. The idea is your dog will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so she will hurry to swallow the med ball to get to treat #3. |
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Post by Tammi & Stoney on Sept 11, 2021 4:11:34 GMT -7
Hi, prednisone injection given 9/10, I start prednisone 5mg 2x a day with Pepcid at each dose today 9/11 to clarify, only injection of prednisone was given yesterday, I gave Pepcid also on return home yesterday. Taper would start tuesday 9/14. She did not say to reduce pain meds. He has not moved from the position I placed him in, laying on his side. He does not wag but when I move his tail or back legs he does move them back to comfortable position. He can and does move his head, lifts it some to look at me and moves it to try to reject the meds I have disguised. I am successfully getting meds in him. I am going to get him out of resting crate to check bladder soon. I really hate moving him. At that time is there anything I need to check. I am going to lay him on wee wee pad to express bladder if needed. He shows no interest in moving or eating or drinking.
I do give him syringes of water when I do meds. He did sleep some last night. I gave pain meds at 3am (diazaprim) and 4 am (gabapentin). Next dose of pain meds 11am and 12am.
***also, should/can I call vet to add methocarbanol (sp) along with these meds? Can it be added with diazepam and gabapentin ??
****at 930am,updated, I went to express bladder and he already peed while laying in same position. I checked, he has movement and feeling in back legs but can’t use front [legs]. I cleaned him, no poop as yet. I noticed gabapentin was spit out so redosed, making sure he swallowed it. All meds are in including 5mg of prednisone (given at 645am with Pepcid). I adjusted new dosing time of gabapentin accordingly. Calling vet at 1 pm when they open to see if I can up pain meds(diazepam ) and possibly add methocarbonal.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 11, 2021 8:47:02 GMT -7
Tammi, both diazepam and Methocarbamol are for muscle spasm pain. The vet would choose only one. Since Stoney may be in a lot of pain (has not moved since since being placed, not interested in life of moving, eating or drinking). Important reading reference about methocarbamol: What date did the not able to move front legs at all start on? If now, a new/increase of neuro diminishment, the vet needs to know today! SYRINGE TECHNIQUE to avoid Stoney aspirating liquids. Place the tip of the syringe in the mouth, just behind one of the canine teeth. Angle the syringe slightly to the side and deposit the liquid onto the tongue. vcahospitals.com/-/media/vca/images/lifelearn-images-foldered/423/dog_administering_liquid_meds_2020.jpgHard to believe with a 4-day course of pred (1 pred injection + 3 days of pred pills) all painfully inflamed tissue will have been resolved on Tues 9/14 when the taper is scheduled. So if the test for pain taper is to stay scheduled for 9/14, be very observant of declining neuro function and/or increased pain that signals not time continue the 9/14 taper.
MONITORING NEURO FUNCTION
Please tell us what you observe, that is the best kind of help to aid a vet and us as well to understand intact neuro functions vs. reflex. NOTE: a neck disc could affect the back legs as well as the front legs.
Using the phrase "has no interest" in moving, doesn't clarify about neuro function. Not interested in life around him or not interested/avoiding a food offering can well be a sign of being in pain.
-- Do you observe any attempt of the back legs being used to try to reposition his body in the suite? That would be comfirmation of an existing leg neuro function.
-- When dreaming (head level), do you see any action of the back legs? That could be confirmation of existing back leg neuro function.
-- Any leg movement at potty time or your pulling/touching a paw/limb can cause a reflex movement. Most vets do not have the practiced eye/training to correctly identify about pinching toes. Likely you also do not have that ability.
For us humans to be able to distinguish between reflex and brain directed, we have to see some sort of head level involvement with the tail, with a limb or with release of urine so we know the movement was done with purposeful thinking.
--- Sniff (head level nose) on an old pee spot, then release of urine would be a brain directed neuro function. A sniff & pee would give you confirmation that Stoney's release of urine in his bed this morning was not due to increased neuro diminishment re: loss of bladder control and now an overflowing bladder situation that needs manual expressing of the bladder. Let us know what you think: still has bladder control OR now needs to be expressed every 2-3 hours to keep him dry.
--- Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail movement during potty time can often be a reflex
--- Itchy sensation at neck and then attempts to scratch would be purposeful back leg movement. Tickling paws, etc can cause reflex leg movements of pushing in or out.
Please keep us updated when you reach the vet on what adjustments are made for pain relief, and the 4-day pred course. |
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Post by Tammi & Stoney on Sept 11, 2021 15:28:59 GMT -7
Update on Stoney…talked to urgent care vet, she wanted to increase Valium to 2.5 mg every 8 hours. I called my primary vet and she agreed with methocarbamol being a better choice.
We also discussed prednisone plan…5 mg twice a day for 3 days the 5 mg once a day ( which she said is still antiflammatory) for 7 days, start taper then. So, pain meds are
50mg gabapentin every 8 hours,
125mg ✙methocarbamol every 8 hours,
25mg ✙tramadol every 8 hours as needed.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10lbs 11 y.o.
Prednisone injection 9/10
prednisone tabs as of 9/11: anti-inflammatory 5mgs 2x/day for 3 days,
as of 9/14: anti-inflammatory 5mgs 1x/day for 7 days,
then 9/21 test taper for: _pain / _neuro
diazepam 1.25mgs 3x/day SToPPED
gabapentin 50 mgs 3x/xday
✙methocarbamol 125mgs 3x/day
✙traMADol 25mgs 3x/day (NOT GIVING as of 9/11)
Pepcid AC 10 mg 2x/day ]
5 mg prednisone twice a day for 3 days then once a day for 7 days then taper, of course Pepcid with prednisone. It could be prednisone kicking in or the switch of Valium to methocarbamol but he is perkier, more interested in what’s going on, lifts his head more, lifts back leg for belly rub, ate half a McDonald’s hamburger, licked off syringe of water instead of refusing. These little things are so important to me. Not a lot but to me it’s major. When he looks at me his eyes are peaceful. I haven’t gave tramadol yet, may wait until tonight. Could the methocarbamol have given him more relief in 2hours? I am not questioning, I will take no pain for him….feeling hopeful and grateful
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 11, 2021 15:57:36 GMT -7
Tammi, nice job you and your vet have done in working together to get things right for Stoney!!! Kudos to your good vet and you for advocating. Thanks for providing the full prednisone Rx which includes a step down in the anti-inflammatory level to 5mgs 1x/day Then after 11 days of anti-inflammatory level prednisone, the taper to test for pain is to begin on 9/21. Methocarbamol would begin to relieve muscle spasm pain in an hour or so. Because Stoney's pain was so intense, it may have taken longer to get the pain under control. Adding traMADol to the mix could also helpful as an over all analgesic that nerve pain gabapentin and muscle spasm methocarbamol would not address. Prednisone will take seven to thirty days before all the painfully inflamed tissue around the cord is resolved. So in my book prednisone is not a pain reliever. It is the pain meds that provided comfort you observing til Prednisone completes the job of riding the body of all swelling around the cord. The test to find out if all swelling is actually gone will come on the 9/21 pred test taper for pain. How many mgs of Pepcid AC do you give every 12 hours? Pepcid lasts for 12 hrs and the reason it is dosed 2x/day (every 12 hours) to suppress stomach acid production for the duration of prednisone. Do you have a med chart in use? 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** i.postimg.cc/6QLMK2Jp/Med-Chart-PREVIEW.jpgSo, very relieved to read your observations of the back leg moving and all the signs that pain relief is in effect for Stoney. What are his front legs doing? Any purposeful movement? |
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Post by Tammi & Stoney on Sept 11, 2021 16:08:47 GMT -7
Thank you for being there for Stoney and I as well. This is my 3rd dog you, Dodgerslist , has helped me with…. The support, the knowledge and the push are appreciated beyond words. I am giving 10mg of Pepcid 2x a day with prednisone. I have been noting all meds, dosage and times given. I will print chart you provided. Again thank you. I will update tomorrow.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 11, 2021 16:12:10 GMT -7
Tammi, it is such a pleasure to work with you and your ability to take action and get things right for Stoney. LOVE IT!!
BTW, for a 10 lbs dog, Pepcid AC would be 5mgs every 12 hours.
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Post by Tammi & Stoney on Sept 12, 2021 4:44:23 GMT -7
Hi, question… Stoney has not pooped since Friday,9/10. He cannot stand [with front or back legs?] . I tried massaging belly and anus. I can feel that there’s a need. He ate some yesterday and a small breakfast this morning. Is there anything I need to do? He cannot squat to poop.
He is peeing [peeing or is it overflowing via reflex?] with and without my help in a laying position
but it’s pooping I am concerned with. Any advice??
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2021 8:15:24 GMT -7
Tammi, pooping is not a health issue that bladder control is. All poop will exit the body whether the dog has the neuro function to push it out when in an appropriate spot or just plops out with reflexes as poop nears the exit. IF Stoney has not really eaten much he may not yet have enough poop to need to go. You can read about expressing poop and a how- to video on this page: dodgerslist.com/2020/05/05/bladder-bowel-care/IF by Monday he has not gone on his own and your feeling is that he is constipated: High fiber canned plain pureed pumpkin can be useful to soften stool. --To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin (or other high fiber food) 1x a day. What is of more concern to us is reading he releases urine in a lying down position without your help (that is you are not expressing him). We can't tell if Stoney has just recently now lost bladder control and now needs to you express his bladder every 2-3 hours while taking prednisone. Please help us by using dates and telling us his current neuro function situation. "He is peeing with and without my help in a laying position"
-- What date did you start manually expressing his bladder? How many times a day to you express? Every 2-3 hrs to keep him dry? -- IF "with my help" does not mean you are expressing, then are you using a front end sling and maybe also a rear end sling (if wobbly) to get him into a stand position to go potty on a pee pad?
-- Does he leak urine on you when lifted?
-- As you can see we are kind lost without you painting a picture of how things are done at potty time we can't tell if now Stoney has no bladder control and must be expressed.
-- What date could he no longer use his front legs?
-- Today what is your assessment about back legs neuro function:
1) can wobbly walk with back legs?
2) very weak to little leg movement such as can raise back leg for tummy rub and .....?
Are you now giving for your 10lbs Stoney Pepcid AC 5mg 2x/day?
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Post by Tammi & Stoney on Sept 12, 2021 11:35:43 GMT -7
Ok on the pooping, he has not gone yet but he has not eaten a lot, I always soaked food…kinda like a stew. I will try pumpkin if he doesn’t go today.
As far as bladder, I do get him out or place a wee wee pad under him and try to express in laying on side position, he cannot stand. He doesn’t leak when lifted. I do not use a sling. I have gone to get him out to express several times but he already has gone.
I am not sure if he has bladder control, I am doubting. I am keeping him dry. I am trying to express every 2to 3 hours, most of the time he has already peed.
I am having a struggle finding bladder, maybe because it’s already empty. I started trying to express on friday9/10 when I brought him home. I feel he hasn’t had control since then. I did adjust the ▼Pepcid to 5mg.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10lbs 11 y.o.
Prednisone injection 9/10
prednisone tabs as of 9/11: anti-inflammatory 5mgs 2x/day for 3 days,
as of 9/14: anti-inflammatory 5mgs 1x/day for 7 days,
then 9/21 test taper for: _pain / _neuro
gabapentin 50 mgs 3x/xday
methocarbamol 125mgs 3x/day
traMADol 25mgs 3x/day (NOT GIVING as of 9/11)
Pepcid AC ▼5mg 2x/day ]
He cannot use front legs to stand, leans .
He is still lift leg for belly rub, back legs. He does use front legs to get from side laying position to front on belly laying position, doesn’t stay on belly laying position long, and uses front legs to scoot and flip on other side …moving his body to other side of crAte.
He cannot untuck his front legs/feet if they are under him I notice so I do it for him. I don’t see a decline but I don’t see improvement. He has good appetite, no wagging tail but loves belly rubs, lifts his head and rolls forward to eat.
***update…just tried to express bladder, it was empty. I had him on his side on wee wee pad. He rolled to laying belly down on floor and got to a semi standing position and was trying to walk.
I put him back to side laying position. I did notice back legs were correct, a slight knuckling over but he did correct one.
Front legs were very weak, not straight but he was mostly up. He was leaning, I am not sure it all happened fast but I think he was leaning more to left. I rubbed belly on right side and he raised right rear leg for me, I turned him on other side he raised left rear leg for me. Tail seems like he is hold it tight to his body. When I move tail straight out he brings it back and keeps it hugging him. He whines for me to be in room with him. He is quiet and calm when I am loving on him. No trembling, not tense, rolls from side to belly haunches laying position for treats or snack. I am not feeling or seeing signs of pain at all. The trying to get up to standing position was the first time since friday9/10.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2021 15:59:25 GMT -7
Tammi, you have witnessed some very good things happening!! Being able to correct a knuckled paw is wonderful. Getting himself up in to a stand without help and the attempting to take some footsteps is fabulous too!
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Post by Tammi & Stoney on Sept 13, 2021 11:42:53 GMT -7
Update… about the same today, which is good because nothing declining. He did poop last night in crate, normal stool.
Either I am not finding bladder or he is not drinking a lot ( I am syringing water to make sure he stays hydrated). There is a little pee every now and then where he is laying. When I express, I have had doc show me and wAtched videos, I don’t feel a lime shape. I am doing it while he is laying on side, my hands praying style, middle of penis towards spine. I have moved around and don’t feel much. Nothing comes out. Should I syringe more water then I am, about 20cc [1⅓ tablespoons] several times a day plus his 2 meals have about a quarter cup of water in them.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 13, 2021 13:25:06 GMT -7
Tammi, check for dehydration: Skin on the neck when you pull it up it should fall back reasonably quickly and not remain "tented" Check to see if the nose, lips and gums are wet or dehydrated and have become tacky. Pull up his lip and press gently on the gum which is normally pink. When you press down it will turn white and when you release the pressure it should turn pink again right away. There isn't a firm rule on what the daily water intake should be according to Wayne E. Wingfield, DVM, Diplomate, ACVS, ACVECC Colorado State University: There is a paucity of data regarding water needs for the dog and cat and many authors recommend dramatically different fluid and energy requirements. Dr. Jon @ PetPlace.com writes: In general, animals should take in two and a half times more water than food. A useful guideline for dogs weighing 20 pounds or less is that they need about 1 cup (8 ounces) of water for every 5 pounds of body weight. What does your vet say about water intake? Your vet knows Stoney best as well as his disease. BLADDER EXPRESSING. With a full bladder, with slight hand pressure urine will easily come out. Even the act of lifting your dog can cause them to leak on you. For me with my male doxie it took more hand pressure than praying hands can cause when the bladder has emptied some. One hand kinda in a flat fist gave me more pressure ability against one stationary but slightly cupped praying hand.
The bladder changes shape and location as it empties. --- Full bladder can not really be felt as such. The bladder seems to fill the entire tummy area. You can easily apply enough pressure to get urine to come out. --- As the bladder empties, it becomes a matter of physics. Can you apply enough pressure to the bladder to counteract the neck of the bladder wanting to stay closed? --- Slightly cupping the one praying hand allows you to trap the bladder while the flat fisted other hand is able to apply a bit more pressure. --- The size of the bladder will change as it empties from the size of a large plum down to the last stages of a rather flat grape size. --- As the bladder reduces in size it will slither out of your hands! Use your pinky finger to search around find it more in the hip/thigh pelvic area. Capture it again in one slightly cupped hand and the other flat fisted hand. Expressing is a practice thing to learn how to feel the bladder shape and where it can hide. Many us have gone back to express right there in the vet clinic. The the vet tech or the vet can check your work and give you extra tips. It takes about 1-1/2 hours for liquids to process and reach the bladder. So give Stoney a drink ahead of time, so there will be something for you to express when at the vet. |
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Post by Tammi & Stoney on Sept 17, 2021 10:21:41 GMT -7
Update… day 2 of doing 1 (5)mg prednisone every 24hours instead of every 12 hours, vet wants me to do this for 7 days.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10lbs 11 y.o.
Prednisone injection 9/10
prednisone as of 9/11: anti-inflam. 5mgs 2x/day for 3 days,
as of 9/14: anti-inflam. 5mgs 1x/day for 7 days,
then 9/21 test taper for: _pain / _neuro
gabapentin 50 mgs 3x/xday
methocarbamol 125mgs 3x/day
Pepcid AC 5mg 2x/day ]
He has more mobility in fronts legs, scoots around crate, can halfway sit up, right front is weaker then left front. Not walking or standing, tips to side when he tries to get up.
Back legs are fine, he pees on his own in crate, kinda moves to side of crate, bladder is always empty when I check or at least feels that way.
Pooping in crate, tries to bury it. Not sure if it’s the cutting back on prednisone but today [9/17] he seems less active, more mellow, should I be concerned? He seems depressed, could it be too soon to taper to 1 prednisone a day?
My vet goes by my knowledge, I go by yours, on ivdd basically. Not many vets I have had have much experience with are very helpful. Just basically write prescriptions. Frustrating.
When I take him out of crate to check bladder, should I be doing anything else? Do I let him try to get up and watch, I don’t. I kinda hold him, I know he’s going to tip over but he doesn’t. When he is on belly, like in position to stand, he is wobbly. But he has no problem now rolling on back when in crate for belly rubs. Today though, I am noticing less interest in being engaged in belly rubs. Should I be worried?
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Post by Romy & Frankie on Sept 17, 2021 13:33:30 GMT -7
More mobility in the front legs is good news as is trying to stand. It is common for one leg to be weaker during recovery, so no need to be concerned about that.
Learning to express is tricky. Many of us have struggled with it. I had to get several lessons from the vet or vet tech before I was able to get any urine at all out. I continued to practice and I learned. You will too. One thing that helped me was trying different positions. If having him on his side does not work, try other positions. Once you become proficient, caring for Stoney will be much easier.
If Stoney begins to show signs of pain or decreased neuro functions, you will know it is too early to taper. Look for the signs of pain mentioned in the earlier post. If you see any of these, particularly more than one, let the vet know right away. More time on the full (not taper) dose of pred may be needed.
What are you seeing that makes him seem depressed?
Today you are reporting increases in neuro functions and no signs of pain. I don't think you have any reasons to worry at this point. |
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Post by Tammi & Stoney on Sept 22, 2021 11:23:47 GMT -7
Hi, starting taper tomorrow, every other day 5mg prednisone. What is procol for tapering pain meds?
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Post by Romy & Frankie on Sept 22, 2021 13:25:23 GMT -7
When the taper starts, the pain meds are usually stopped or cut back. The reason for this is that pain during a taper is an indication that inflammation is still present and more time on the full (not taper)dose of pred is needed. If pain meds are still on board, they can mask the appearance of pain. That will make it difficult to tell if all the inflammation is gone or if more time on the original dose of all meds is needed. You can ask your vet if he prefers the pain meds be stopped completely or cut back slowly.
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Post by Tammi & Stoney on Sept 23, 2021 4:52:44 GMT -7
Vet did not advise on pain meds during taper. Do most stop completely or cut back? He is trying to stand in crate but is wobbly and tips over, can use front legs to try to stand but still knuckling on his right front paw. Could he be falling over because of weakness due to being down and in crate for so long? I don’t know if this is a good sign or bad, it breaks my heart seeing him fall to his side. He is very vocal, wants out of crate or me in there.
Pain meds were last given at 11pm on sept 22, last night. They are due to be given now, no signs of pain that I see. How long would it be about til I would expect to see signs of pain? And if I need to start prednisone (along with pain meds) again do I go back to once a day (5 mg once a day) or the twice a day like in the beginning (5 mg twice a day)for 3-5 days? He was on 5mg prednisone twice a day for 5 days, then 5 mg prednisone once a day for 7 days.
***2.5 mg of prednisone with 5 mg of Pepcid is the taper I started him on today, no pain meds given. 9/23/2021
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 23, 2021 8:35:04 GMT -7
Tammi, very good report on attempt to move up into a stand with front legs. He is going in a good direction of healing. With time and more nerve healing the right front paw knuckling can improve too. Stoney has had nerve damage caused by the disc episode. This means it can take time to learn again like a stroke victim needs time to learn the art of coordinating brain directives with muscles movements. There could also be some muscle atrophy due to inactivity but that happens with weeks to month of rest and it is mild to moderate. Stoney has been resting for about 2 weeks now. Lack of nerve input to muscles (caused by damage to the spinal cord) also will cause severe muscle atrophy over days to weeks. That muscle atrophy can take some time to get those muscles strong and back in shape. That is why Stoney could be weak in using his muscles to push up and wobbly with still more nerve healing to give good brain/muscle communications. Reference information: Dani Powers, DVM and Kristin Kirkby Shaw, DVM, MS, PhD, DACVS, DACVSMR. Distinguishing Musculoskeletal from Neurologic Disease. Clinician's Brief March 2015. pp 99-103.
PREDNISONE This synthetic hormone which plays an important role in body function, must always be used under the supervision of a vet. -- The vet will Rx the exact dose and frequency to give at each stage: -- A course of anti-inflammatory level of 5mgs 1x/day. -- At the end of the anti-inflammatory course, the exact way to taper prednisone to signal the body to resume making its own steroid hormone. -- The taper days do not work on reducing swelling (too low a dose). Taper days, however, provide an excellent opportunity for YOU to assess for pain as prednisone begins the process of leaving the body. PAIN MEDS -- Pain meds block the body from knowing about pain. So at this point in the taper you have no proof about pain with pain meds still on board. -- Having pain meds on board makes it difficult for you at home to get an accurate read about pain during the prednisone taper. -- There are things a vet has to take into consideration on whether to full stop pain meds or to back them down. -- It, necessarily, is the vet's call on which to do. Phone and find out which he wants and get the specific directions if backing off pain meds: reduce the frequency how?, reduce the mgs to what?, do both? -- Before calling the vet, it is always good to refresh your mind on how pain meds and the anti-inflammatory are used during a disc episode. You want to be informed to ask the right questions and have a plan B worked out between you and the vet if you should observe pain on the taper. An emergency room visit, should pain be revealed, can be expensive. A plan B is a wiser and financially sound option. dodgerslist.com/2020/04/18/steroids-vs-nsaids/Will be checking in later to see what your vet wants about pain meds. |
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Post by Tammi & Stoney on Oct 3, 2021 17:47:14 GMT -7
Update on Stoney….Stoney is on the end of second taper, looking great!! He is not happy at all about crate rest…barking a lot. But….no, absolutely no knuckling, he can sit straight up on front legs while rear end is seated, he can WALK!!!!!!! I use a towel around mid section at potty time to stop him from falling, my insurance. He is a little wobbly but the walking just started three days ago, September 30. He wants to walk….I do a quick potty and back in crate. He has complete bladder control. He is not happy about the crate at all. But it’s working!!!!! He is like a different dog. From laying on side, paralyzed in front legs to standing and walking….unbelievable.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10lbs 11 y.o.
Prednisone injection 9/10
prednisone as of 9/11: anti-inflam. 5mgs 2x/day for 3 days,
as of 9/14: anti-inflam. 5mgs 1x/day for 7 days,
then 9/21 test taper for: _pain / _neuro
gabapentin 50 mgs ▼2x/xday
methocarbamol 125mgs ▼2x/day
Pepcid AC 5mg 2x/day
9/30 able to walk with front legs]
He is getting pain meds every 12 hours, 50 mg gabapentin and 125 mg methocarbamol, no tramadol.
When taper is done, he will get 50 mg ▼gabapentin and 125 mg ▼methocarbamol once a day or as needed. He is doing reamarkably well. We are blessed.
**** Vet refilled all meds in case of 3rd round of prednisone is needed. Vet is 100% on board with me. I went there with another one of my dogs for a recheck on an anal fistula. I cornered her and had a long discussion about Stoney and his situation. I felt so much relief leaving there that day. Sometimes it takes face to face to advocate and get results necessary I guess.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 3, 2021 19:01:58 GMT -7
Tammi, thank you for sharing such a wonderful report on now ability to walk with front legs now! Your dedication to making sure of strict rest so the disc can heal has ensured no setbacks for Stoney. Keep up the good work. Stoney is one special guy. You know the focus of STRICT rest is on healing the disc in 8 weeks. Nerve repair may or may not come back in that short of time. But Stoney's body has its own idea of how fast to repair nerve damage. He is on a roll!
Good to hear pain meds should shortly be stopping so you have an accurate read about existence of pain.
-- What date will be the final prednisone taper dose?
-- What date will pain meds be fully stopped?
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Post by Tammi & Stoney on Oct 6, 2021 17:05:32 GMT -7
10/5 last prednisone. That was the end of second round of prednisone.
Pain meds, ▼gabapentin 50 mg and ▼methocarbamol 125 mg are once a day, evening. Tramadol has been eliminated. Vet said use pain meds at my discretion. I don’t see any signs of pain at all and I am very observant.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10lbs 11 y.o.
Prednisone injection 9/10
prednisone as of 9/11: anti-inflam. 5mgs 2x/day for 3 days,
as of 9/14: anti-inflam. 5mgs 1x/day for 7 days,
then 9/21 test taper for: _pain / _neuro; final pred taper dose 10/5
gabapentin 50 mgs ▼1x/xday
methocarbamol 125mgs ▼1x/day
9/30 able to walk with front legs]
He is very unhappy about crate rest. But I do know and agree and I am very diligent with it. I am continuing using the towel/ strap at potty time, which is brief, he does do wee wee pads. He is still very wobbly and doesn’t know it. I do not want him falling or collapsing causing healing set back. We do brief, maybe 3 or 4 minute walk with strap in room with wee wee pads three times a day. He does use a wee wee pad in crate, I have one always leaning on inside of crate and he uses it like a target. So potty time out of crate is basically sniff and walkabout so that’s why I limit it to a very few minutes. He has a crate in three rooms of my home so I can move him where I go, I think he is so much happier with this . Mentally stimulating, he isn’t lonely and I think he feels part of the pack again. I keep his crates up on table and dresser so it’s easier on his neck not having to look up all the time at me. He seems very content when he can see me. Thank you again for the support. I know it’s a ways to go but in the beginning the stress and worry is off the chart. I see so much progress, a long way to go yet but a lot of light at the end of the tunnel!!!!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 6, 2021 20:09:40 GMT -7
Tammi, all sounds good. It is the date when there are no more meds in his body that will give you proof positive that all pain is actually gone. What date will gabapentin and methocarbamol be fully stopped?
IF he doesn't need to walk 3-4 minutes before being able to release urine or poop, then see if you can reduce the time the vertebrae are in motion pushing on all discs including the damaged one.
Nice work on having multiple recovery suites for Stoney to always be near your working area. Nice touch for his neck with elevated suite. Mark your calendar for Nov 5 graduation date. That date is just around the corner and then we'll have suggestions for slowly and safely transitioning him back to family life/physical activity.
Til graduation day do as you are doing, during recovery time, physical activity must be restricted to allow the disc to heal. Stoney can't expend energy in physical activity to become tired. Fortunately for dogs mental stimulation can be just as tiring. You can help in that department if you are able when you take a break from work, to do some mental stimulation with Stoney.
Stoney would be lying down or maybe calmly sitting on his butt.
Use Stoney's daily food ration as the rewards. Treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest. Can also be Lo-cal treats of tiny pieces of apple or carrot.
To dogs the size of the treat matters not. They work just as hard for a big piece as a tiny piece.
This activity takes place inside of the recovery suite while you sit on the floor in front of the suite's open door. Stop if your dog is getting overly excited and displaying rambunctious behavior of too much neck or back movement.
EYE CONTACT
Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall.
To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the very second he looks at you, and then give your dog a food reward.
[NOTE: for crate resting dogs, shift your body a bit to change your angle during the exercise] .... wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later for another session until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward.. As Stoney "get's it" you will confirm with "yes" or clicker but start giving the food reward randomly. Other rewards are you looking at him, coming closer to the suite, petting, talking to him.
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