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Post by Sysphike & Bella on Sept 15, 2021 13:09:15 GMT -7
Hello,
Mid-August, Bell's hind legs suddenly caved in and slipped after we took her swimming. We took her to our primary vet the next day. She was given a physical exam, no xrays, etc. She was prescribed rimadyl 100mg/day for 14 days, restricted exercise and see a neuro for MRI if things don't improve. Things may have improved minimally, it is hard to tell. However, she was still wobbly. We took her to the emergency neuro as appointments were unavailable for weeks out. [8/30] MRI showed multilevel IVDD with severe compression at L1-L2, L2-L3 and significant other compressions.
She was prescribed prednisone 10 mg: 1 tablet by mouth every 12 hours (twice a day) for 5 days then 1 tablet one time per day for 5 days then 1 tablet every other day for 5 treatments. Gabapentin 300mg up to 3x/day as needed. Currently we give her before bedtime. We are tapering down prednisone and will be done with this regimen in 8 days.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
53 lbs 6 y.o.
Rimadyl as of mid Aug: 100mg/day for 14 days; Last dose 8/30; 3-day washout,
Prednisone neuro Rx as of 9/2 10 mgs 2x/day for 5 days then 9/7 test taper _pain/_neuro; final taper dose on 9/23
crated 9/11
gabapentin 300mgs 1x/day
Pepcid AC as of 9/14? ?mg ?x/day ]
Unfortunately, we didn't know about the strict crate rest until we came across Dodgers' List. We started crating her 9/11, almost a month after her first wobbly incident.
Bella doesn't seem to be in pain, but it is hard to tell with pits. Before the crating her, we took her for regular walks. Her gait was ok, bouncy at the beginning. She would become more wobbly after about 15-30mins. She had 2 flamingo leg episodes, once F L and the other time one of her hind legs (can't remember which). Both episodes were short (front about 10mins, hind about 2mins).
She poops/pees on her own. With tapering down prednisone (10mg ea 2 days and we have 3 more tablets left), Bella has significantly more frequent bathroom breaks (around every 3-4yrs vs 3x/day normal). Her H20 intake was increased at the start of prednisone, but now started to normalize.
We are just worried sick that we didn't catch in in time and her back will not heal since she has numerous affected discs and strict crate rest was so delayed. If it were just one or two, but she has like 6. The neuro said that he is surprised how well she is doing.
Anyone experience with multi level IVDD? Our next neuro appointment is not until Oct. I don't even know if I should refill prednisone, stop, continue with rimadyl after washout. Gabapentin yes, no... Aside from the crate rest, i am honestly lost what do do next or what do look for (she doens't seem to display the normal pain signs, such as whining, tight tummy, etc).
Any an all advice is so appreciated.
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Post by Romy & Frankie on Sept 15, 2021 15:35:43 GMT -7
Welcome to Dodgerslist. We are glad you’ve joined us all. We’ve got valuable information we’ve learned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you! Learn more about us and how we team up with veterinarians:
It is not uncommon for dogs to have multiple areas of compression. The fact that Bella can walk, even if wobbly, makes her a good candidate for conservative treatment. The hallmark of conservative treatment is Strict crate rest for 8 weeks. We have information about crate rest including tips for setting up the recovery suite here:
I know what you mean about pitties not showing pain. They are a stoic bred. My dog Frankie must have been in excruciating pain, but the only sign of pain he showed was panting. Flamingo legs can be a sign of pain. Is she still doing this? You know Bella best and may be able to spot subtle signs of pains that may be missed by those who do not know her well. If you think she is in pain let the vet know right away so meds can be adjusted.
A vet usually prescribes a course of pred for a period of time and then starts a taper. When the taper starts, pain meds are usually stopped or cut back also. If, at this time, pain is seen, or neuro functions diminish, more time on the full (not taper) dose of pred and all pain meds is needed. If not the pred has done its job by diminishing the inflammation and no more meds are needed. Only the rest of the 8 weeks of crate rest are needed. No meds can heal nerves already damaged. Only time can do this and nerves heal slowly. So at the end of the 8 weeks may dogs will still be showing signs of neuro diminishment, like difficulty walking. This does not mean that additional time on meds is needed.
All anti-inflammatories like pred cause excess stomach acid which can result in stomach damage. To prevent this damage a stomach protector like Pepcid AC should be used. Ask the vet if Bella has 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).
The usual dose during a disc episode is Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as the dog is on an anti-inflammatory.
What is your name? Is it Sisphike? I am Romy.
How much does Bella weigh?
It is very scary when our dogs are diagnosed with IVDD. It is less so when we learn all we can about the disease. We have lots more information at our main website:
Use the search bar at the top of the page can be used to search for additional topics.
Healing thoughts for Bella.
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Post by Sysphike & Bella on Sept 15, 2021 21:24:07 GMT -7
Thanks for the advice. This is so much useful info. Makes me a bit more hopeful. Bella is 6yo, 53lbs, and has so much personality. A charmer and everyone loves her 
We have 3 preds left for the next 6 days (1 tab/2 days). So, if we start noticing an increase in pain and/or more wobbliness, etc then increase pred dosage again. Right? Would that be full dose as in the beginning (2 tab/day) or just 1 tab/day?
My neuro said if I don't see an improvement w/i 5 days, then pred is not working and I should probably think about physical therapy.
Another question - For the past 2 days, Bell suddenly started having diarrhea and requires more potty breaks to pee and poo. I started giving her pepcid around the same time. Could that be the cause? I expected more pee more towards the beginning with higher pred doses.
Take good care. S
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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 16, 2021 11:16:17 GMT -7
S, diarrhea is VERY likely due to the use of prednisone causing xtra acid production plus Bella's stress with change in routine, also causing more stomach acid production. Loose stool, diarrhea with red or black blood are typical RED FLAG signs of GI tract damage. When Pepcid AC alone is not enough to protect, then an Rx of SUCRALFATE is added to Pepcid AC. Read to know what you are advocating for if diarrhea is not at this time showing any signs of clearing up. Dates are always of great importance to help us understand and be able to comment. We will be better able to comment when we have a full picture of the med list. What date did prednisone start at 10 mgs 2x/day?
What dose of pepcid AC are you giving in mgs and are you giving it 2x/day?
What date did you begin Pepcid AC/
Gabapentin blocks the brain from knowing about existence of nerve pain. When on the taper of prednisone, the idea is to quickly have the ability to know if any pain is in existence or not. What date will gabapentin be again lowered or stopped to give you a clear picture about pain?If the taper of pred reveals pain, then alert your vet and advocate for another course of pred at the original dose. No one can know how long it would take prednisone to fully resolve inflamed and painful tissue around the cord. This is why a short pred course is Rx'd and then a taper to give proof one way or the other about improvement about inflammation pain and/or worsening neuro function.
MONITORING 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/There are 4 phases of "improvement" or healing. So the use of the term "improvement" is mystifying as to what exactly is meant.
Prednisone's only job is to reduce/get rid of painfully inflamed tissue. The body self heals the disc. The body self heals damaged neuro function. Tape this ROADMAP flyer to your fridge to help you understand each phase of healing, what method is used to heal that phase and how long it will take to heal. dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf A diagnosis is derived at by narrowing down the most likely diseases to just a few. Then picking the top most ideas Bella is dealing with. Physical therapy for conservative treatment of strict rest waits til the disc has healed in 8 weeks, not 5 days of prednisone. Did you get a written report from the Neuro exam/visit/MRI that explains some things better, can upload and share? Which type of disc was more highly suspected in L1-2 and L2-3? 1) — Hansen Type 1 occurs mostly in small breeds (Dachshunds, Beagles, Poodles, Spaniels, Shih Tzus, Pekingese, Chihuahuas, bulldogs, etc) but it could occur in any dog. Discs prematurely age starting at age one. Normally it is not until that dog is 3-7 years old that typically the vet and the owner first learn he was born with the disease. The first signs of pain and possibly neuro diminishment are the clues as the disc protrudes into the spinal cord. 2) — Hansen Type 2 is more common in older 8-10 y.o. large breed dogs such as the German Shepard and Labs. The disc is a slow gradual chronic degenerative process where the disc bulges up into the spinal cord but does not tear.
3) Top diseases Bella could have. |
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Post by Sysphike & Bella on Sept 25, 2021 12:14:47 GMT -7
Your advice was so useful. You really helped us understand IVDD so much better and gave us hope. Bella is doing much better. We take our out for short potty breaks, otherwise crate rest seemed to help her the most. She is still a bit wobbly, but it is noticeably less than in the beginning. And we didn't start crating her until 9/11 (we didn't know), even though her 1st IVDD episode started mid-August when her hind legs suddenly started caving. We will continue keeping her on strict rest to give her the best chance for healing (whatever that means...). You were probably right. Bella's diarrhea, which occurred during the end of the taper-down period, was most likely pred related. For 3-4 days 9t became so bad that we had to take our out 5x/night on some days and only drops would come out. Upon the vets recommendation, she was given the antibiotic ✙ metrodizanole 250mg 2x/day for 5days in addition to the 12.5mg pepcid AC 2x/day. Her poo is now normal again. Metro and pepcid AC were discontinued at the same time (we discontinued pepcid b/c she is no longer on pred). She started her on a probiotic supplement to bring her gut microbiome back in swing after the pred and the metro. Attached are Bella’s reports from the ER and neuro/MRI. These are excerpts io to avoid mentioning vet's names (I wasn't sure if this is appropriate and frankly I wasn't too goose pimpled with them). I find the reports difficult to read, and it was explained to me that she has multilevel IVDD and not much further. She has a follow up exam tomorrow, and I am not even sure if I should/need to take her io to avoid unnecessary movement of her spine. My understanding is that IVDD will always stay with her, almost like OA. This episode may heal (whatever that means) and another episode can always happen again. Bella has a pre-existing mild to moderate OA in her front R elbow (she gets galiprant for that here and there).
All the best, S
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Post by Romy & Frankie on Sept 25, 2021 13:34:01 GMT -7
I am happy to hear that Bella is doing much better.
Besides the probiotic, is she taking any other meds now?
One thing that the report mentioned was that although she has multi-level IVDD, the MRI showed that most of these were minimal to moderate. Only L2-L3 had moderate to severe compression. The lumbar spine has discs usually labeled 1-7. L2-L3 is closer to the chest area.
It is impossible to tell if Bella will have any IVDD episodes in the future. Some dogs do some don't. My dog Frankie had an IVDD episode when he was six but never had another. Once Bella graduates from crate rest we can discuss dos and don'ts to lower her chances of another episode.
It may not be necessary to bring her in for a follow-up. You may just be able to discuss how she is doing on the phone with the vet especially if you are just reporting good news. As you know, we try to minimize transports of our dogs during a disc episode. |
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Post by Sysphike & Bella on Sept 3, 2022 18:25:04 GMT -7
Dear Group! It has been a while since we posted here. Bella has had her 1st episode in Jul 2021 and another flare up in May 2022. Both times it happened after her jumping in the water and swimming. So, no more of that. We treated her both times conservative since our neuro determined that surgery wouldn't be the best route due to her multi level IVDD. We didn't get an MRI the 2nd time and just followed the same treatment regimen as the 1st time around.
All in all considered, the vet says Bell is doing very well. We go on our slow walks, sometimes she has busts of energy which I try to control. I still carry her down the stairs and keep her back straight as much as I can. She is happy, her gait is fine, just slower than before and little wobble remains if you pay close attention. She is not on any medication for iVDD anymore.
I have heard that laser disc ablation is minimally invasive and lit shows promising results to prevent IVDD recurrence (https://pubmed.ncbi.nlm.nih.gov/27901458/). I have called a few specialty vets here in Los Angeles and none seems to know or interested about it. Hence, I thought this almighty group might know. I would like to see if this may be an option for Bella.
Thank you in advance. E
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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 3, 2022 21:08:45 GMT -7
Sysphike, sorry to hear another disc episode in May 2022. Dr. Bartels at Oklahoma State University pioneered this procedure (since retired). Try contacting the the College of Veterinary Medicine to see if they have any contacts in California or a nearby state. This one is not close to you, but may be able to advise you on a surgeon closer to California. --Dallas Veterinary Surgical Center dvsc.com/contact/ |
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Post by Sysphike & Bella on Sept 4, 2022 9:20:33 GMT -7
Thank you, Paula. That is a good advice. Have you heard of IVDD dogs that had this procedure done and how it worked for them? If sci lit publishes as promising and it has been around for a long time, I wonder why it wouldn't be offered widely. I will definitely follow your leads. Anything for my Bell  |
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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 4, 2022 12:41:33 GMT -7
I don't know why there are a limited number of clinics who do the LDA. As with any surgery there is a risk so best to talk everything over with your vet and have them call OSU or the Dallas Surgical Center who do a lot of this procedure to discuss if they believe this is right for Bella. Choose a clinic that has a history/experience of doing this procedure. Every single disc in the spine has the potential to be effected by the ongoing disease process of IVDD. For the LDA procedure only 7 discs are selected to zap (those that seem to herniate most are often located mid back). When LDA was rather new, Dodgerslist contacted Dr. Dugat at Oklahoma State University to learn more about LDA.A follow up is Dugat's 19 July 2021 Evaluation of the intervertebral disk, vertebral body, and spinal cord for changes secondary to percutaneous laser disk ablation. onlinelibrary.wiley.com/doi/abs/10.1111/vsu.13684Hope this helps you in your research. Keep us posted if you do the procedure, where, etc. so others can have your personal experience. |
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