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Post by Cara & Mitzi on Dec 5, 2021 13:27:44 GMT -7
[Original subject line:Introduction to Mitzi! ] Hi all, grateful for this space to learn more and figure out how to best support my fur baby. Tuesday night she started suddenly running around the house frantically screaming in pain. A visit to the [11/30] ER led to the IVDD diagnosis. We saw a spine specialist Friday who confirmed a lateral disk rupture at L2-3 [LUMBAR]. We are grateful it is lateral, removing the immediate concern of impending paralysis. She has an ER appointment tonight for bloody stool.☆ 1 It appears her pain is somewhat managed but she is now bleeding rectally (red jam like consistency). She is mostly restless and it's hard for her to get comfortable. Once she does, she rests well. ☆ 2 23 pounds and seven years old. A.. Gabapentin 100mg started Friday every 8 hours and after two days, every 12 hours. - Meloxicam .07ml by mouth every 24 hours.
- Methocarbamol 1/4 500mg tablet every four hours, as needed.
- Trazadone 1/4 100mg tablet as needed to relax (only given 1/8 tablet last night to support rest)
[MED LIST/HISTORY- Moderator's Note. Please do not edit 23 lbs 7 y.o. Meloxicam as of 11/30 ER?: 0.07mL 1x/day gabapentin 100mgs 3x/day for two days, 12/6 100mgs ▼2x/day methocarbamol 125mgs every 4 hrs. trazodone 12.5mgs nites needs GI tract protector, Pepcid AC, on board w/MELOXICAM! ]
B.. 🔘 No steroids and it appears we will need pepcid after stabilizing her from this GI upset. ☆ 3 -- Bloody diarrhea started last night but was normal and firm stool until then. She is still eating and drinking water normally. ☆ 4 Mitzi is a westie mix who my mom, Carol, and me, Cara adopted last March. ☆ 5 Yes, diagnosis was given by a veterinary neurosurgeon. ☆ 6 What was the date you saw the vet for CONSERVATIVE treatment? 12/3/21 ☆ 7 bladder control? Yes☆ 8 She is fully mobile, gratefully, and isn't wobbly but has a little weakness in back right leg.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Dec 5, 2021 17:00:22 GMT -7
Cara, welcome to the Dodgerslist IVDD Care and Support Forum! Many vets know IVDD and some are new to it. You really can play an instrumental role in working with the vet you have hired when you bring the best command of this disease to the table. Get up to speed on IVDD at the Dodgerslist website www.dodgerslist.com in the next week or so. Meanwhile expedite your learning with links we point you to for the "now." So very glad you've attended to the RED FLAG signs of GI tract damage with the bloody diarrhea. So you will be up to speed on the use of Pepcid AC and other stomach protectors, please take time to look at this information: 3 stresses +Pepcid AC! dodgerslist.com/2020/05/06/stomach-protectionWould you fill us in on a few details. As you will learn we depend on your painting a full picture of Mitzi so we can make our most accurate comments. -- What date did Meloxicam start? For how many days is she to take? -- Why is gabapentin for nerve pain being lowered after 2 days to 2x/day? = It may take meloxicam 7-30 days to finally resolve all the painfully inflammed tissue around the cord. = Normally it will take 3 different pain meds each addressing a different source of pain. Pain meds last for about 8 hrs and the reason they are normally Rx'd for promptly (never as needed) 3x/day (every 8 hrs): 1. traMADol as the over all general analgesic 2. gabapentin for nerve pain 3. methocarbamol for muscle contraction pain Have absolutely no patience with pain. Phone what ever vet you can get hold of to get her meds adjusted tonight! Pain would be Fully managed night and day, dose to dose when the frequency and the mgs dose is correct for Mitzie's needs. Let us know what the ER or the Surgeon hospital did to adjust pain meds. Mitzi has a file in both places so any vet there can Rx/adjust pain meds. Discuss with the vet you speak with about getting a 2nd stomach protector on board in addition to Pepcid AC (famotidine). Pepcid suppresses acid production. Sucralfate coats the GI tract where damage has eroded tissue and aids in repair. Quickly read up on these two meds so you know why you are advocating for GI tract protection for the red flag signs of diarrhea and blood in the stool.
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Post by Cara & Mitzi on Dec 6, 2021 12:09:29 GMT -7
Wow, thank you so much for the quick and helpful reply!
The vet didn't go well last night. It's like they forgot she had IVDD and after the exam for her bloody stool brought her out on a leash jumping up all over. She then was back in pain that had been managed, which led to a very rough night.
They instructed us to stop the Meloxicam until the bleeding stops. Her last bloody stool was 11pm last night and no stool since. They then gave her ✙metronidazole - 250mg/half tab every 12 hours and Proviable forte probiotic with 2ml of the paste orally every 12 hours and one tablet sprinkled on food daily. Back to ▲gabapentin every 8 hours since she no longer is taking meloxicam.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 23 lbs 7 y.o. Meloxicam as of 12/1 ER?: 0.07mL 1x/day for 4 days stopped 12/5 due to bloody diarrhea! gabapentin 100mgs 3x/day methocarbamol 125mgs every 4 hrs. ✙metronidazole - 125mg 2x/day trazodone 12.5mgs nites needs GI tract protector, Pepcid AC, on board w/MELOXICAM! ]
Meloxicam was started on 12/1. She had daily doses for four days before the bowel issue and today is the second day without the meloxicam.
Neurosurgeon office called this morning for an update and said the doctor would reach out with next steps.
I guess we are in a holding pattern, keeping her calm in my room until the GI tract heals and we can start on anti-inflammatories again.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Dec 6, 2021 14:30:42 GMT -7
Cara, it is angering to hear on two accounts whatever vet you saw and his tech were not in the know about IVDD. Danged lucky it did not progress beyond unacceptable worse pain to actually having nerve damage occur! 1. Report of diarrhea and prescribing of meloxicam w/o Pepcid AC, could have been handled over the phone without subjecting Mitzi to a vehicle transport. Vets who know IVDD adjust meds over the phone frequently. 2. Whoever walked Mitzi out was ignorant of proper handling of an dog with a disc episode. That could have been avoided by Mitzi's GI tract damage being handled on the phone by OKing Pepcid AC. In addition Meloxicam could well have continued if a knowledgeable vet had Rx'd the 2nd protector called Sucralfate. That is what vets who know IVDD do. Many of us have learned at points in time, it is us who need to step up to the plate and express concerns and advocate for our dogs. Always be polite, but firm about your concerns. Maybe this time you had no choice but to bring her in? Why were you not allowed to go into the exam room with Mitzi to speak up and protect her? Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated on IVDD. Education gives one confidence to speak up. Education allows you to participate, to team up with the vet hired. When things settle, do make it a point to survey as many of the readings on our Main Webpage www.dodgerslist.com and be the prepared IVDD savvy owner Cara needs. 1) This is a good spot to start : dodgerslist.com/in-the-right-place/ 2) Then click on the other topics in the "KNOWLEDGE" pull down menu. Still on methocarbamol 125mgs every 4 hrs.? Have no patience at all with pain. It takes ONE HOUR to get pain in control when the mgs, the frequency (3x/day) and covering each source of pain are in place: methocarbamol for muscle contraction pain gabapentin for nerve pain traMADol as the over all analgesic. Please keep us posted on the pain level today.
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Post by Cara & Mitzi on Dec 7, 2021 12:28:02 GMT -7
Agreed! I was furious with them and myself for not preventing it from happening. SO many differing opinions and views are dizzying my head. But my last dog had IBD and Epilepsy so I'm no stranger to being an advocate for my dog. Just need to learn up on IVDD as quickly as I can while caring for my mom and working.
Her pain has not been properly managed since the GI incident. Spoke to the surgeon who thinks it's more likely a stress colitis than reaction to NSAIDs (which seems likely as Mitzi is an anxious dog) SO we are waiting to make sure GI tract is calm before proceeding with NSAIDs. He doesn't believe pepcid will help at this time, if it's colitis. If pain can't be managed this week, he said he's leaning toward suggesting surgery sooner than later to repair the ruptured disc.
In the meantime, we added ✙trazadone back in to keep her from pacing, itching, licking, and shaking. She had her first dose today - 1/4 of 100mg tablet and it finally calmed her down. Surgeon suggested gabapentin as often as every six hours, if needed, and we will check back in tomorrow.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 23 lbs 7 y.o. Meloxicam as of 12/1 ER?: 0.07mL 1x/day for 4 days stopped 12/5 due to bloody diarrhea - stress colitis?! gabapentin 100mgs 3x/day up to every 6 hrs methocarbamol 125mgs every 4 hrs. metronidazole - 125mg 2x/day ✙trazodone 12.5mgs nites will need GI tract protector, Pepcid AC, on board w/MELOXICAM! ]
Correction to my original message - methocarbamol is every 8 hours and, yes, still giving her that.
No poop since the last bloody one on Sunday night so I'm hoping a normal one is forthcoming.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Dec 7, 2021 15:46:12 GMT -7
Cara, you have a lot on your plate.
When you can do tell us what you are actually currently giving in mgs and frequency for each med. It is nice to know the surgeon gave you a range that you could increase to. For now we can't properly comment unless we know what you actually give.
With the subtraction (stop) of the non-steroid anti-inflammatory drug (NSAID) it would be expected the pain meds would need to necessarily be more (mgs and/or frequency) to compensate that there is now nothing working on the the painfully inflammed swollen tissue around the spinal cord.
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Post by Daniel & Winston on Dec 11, 2021 0:31:49 GMT -7
Hi Cara - I am also a new member with a 7 year old Maltipoo with a lumbar IVDD. This forum as been a miracle. 12 hours ago I was clueless and distraught- Paula had been a lifesaver! I hope Mitzi is doing well!
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Post by Cara & Mitzi on Dec 11, 2021 18:16:59 GMT -7
Thank you. Current situation:
▼Gabapentin 100mg every 10-12 hours (weaned down from every 6-8 hours) ▼Methocarbomal 125mg as needed, down to once/day from every 8 hours Metrodinadazole 125mg every 12 hours (three doses left) Probiotics capsule daily
[MED LIST/HISTORY- Moderator's Note. Please do not edit 23 lbs 7 y.o. Meloxicam as of 12/1 ER?: 0.07mL 1x/day for 4 days stopped 12/5 due to bloody diarrhea - stress colitis?! gabapentin 100mgs ▼2x/day methocarbamol 125mgs ▼1x/day. metronidazole - 125mg 2x/day ends 12/15 Probiotics 1x/day ]
Her pain is managed and she is doing much better. I just wish she didn't get so excited when my mom walks in after being in her room all night. We can't have guests because she just gets far too excited to see family.
The neurosurgeon suggested not trying NSAIDs again as it's not worth potential GI episode again. He said to keep her on rest for another week. He didn't instruct to crate her but to keep her minimally active and not jumping higher than twice her height. She's been in my room with me for 11 days, only going out back with me to potty.
1. Is using her PetSafe Easy Walk Dog Harness appropriate and safe for a lateral lumbar rupture? 2. Do you think NOT taking NSAIDs can slow down her recovery? 3. Do you think that the doctor is only suggesting another week of full rest because it's a lateral rupture?
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Post by Cara & Mitzi on Dec 11, 2021 18:19:21 GMT -7
Hi Daniel and Winston, thanks for the note. Sorry you and your baby are dealing with this too. It's a lot to wrap one's head around and it feels like there's so much to "get right". Hope your baby is stable and well.
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PaulaM
Moderator. ![*](//storage.proboards.com/forum/images/stars/star_magenta.png) ![*](//storage.proboards.com/forum/images/stars/star_magenta.png)
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Dec 11, 2021 22:30:25 GMT -7
Cara, very glad to hear pain is in control as pain meds are being lowered and no NSAID is on board. A NSAID would speed up riding the body of inflammation. But sounds like inflammation maybe/might be close to an end. So then why risk a NSAID with past stress coliti if not really needed? HOWEVER, you won't know til pain meds are fully stopped whether any spinal cord inflammation still exists. If pain does exist on the stop of gabapentin and methocarbamol, then likely they would be continued a bit longer to let the body deal with inflammation. Or you could revisit the idea of a NSAID with TWO stomach protectors on board (Pepcid AC + Sucralfate). What date are the two pain meds due to be full stopped?I would be very, very careful if were my own dog, that the disc is still healing even after another week of rest til 12/18. Add to that, if pain meds would still be on board the dog will feel good and want to overdo movement of the back. I've not heard of dogs being hurt with crate rest, but read too many unfortunate setbacks many owners report on the Forum when they've cut crate rest shorter than the 8 weeks. Conservative treatment goal is to avoid leg paralysis, loss of bladder control and avoid an expensive surgery with STRICT rest as you are doing. It's your dog and your call.Mitzie is reported with a Lumbar L2-3 I would choose a standard harness during the time of 8 weeks of STRICT rest because it gives you more control over keeping the body straight and aligned. Mitzie has learned by now, I hope, that potty time is where you remain standing in one spot and Mitzie can only take a few very minimal footsteps that the 6 foot leash with harness permits to take care of business.
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Post by Cara & Mitzi on Dec 16, 2021 15:07:26 GMT -7
Thank you. I've become pretty frustrated with the neurosurgeon who promises to check in and never does. I laid out my questions and concerns in an email two days ago and offered that if he's not the right doctor to support conservative treatment, let me know. No reply. Also no reply from my primary.
Mitzi is off all pain meds.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 23 lbs 7 y.o. Meloxicam as of 12/1 ER?: 0.07mL 1x/day for 4 days stopped 12/5 due to bloody diarrhea - stress colitis?! ]
She seems to not be in pain but is not interested in food which could be a sign of pain? We are staying the course with rest, in the meantime, and on the waitlist for a vet who supported me with my last dog who had chronic health issues. I had an assisi loop for my last dog and wonder if that may support Mitzi.
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Post by Romy & Frankie on Dec 16, 2021 15:58:51 GMT -7
I can imagine how frustrating it must be to not get a response from the neuro. You are not seeing signs of pain in Mitzi. Very good news! Not being interested in food can be a sign of pain, but it can also be something else. Usually when we are not sure if something is indicative of pain we look for a second sign of pain to confirm. The signs of pain we look for are: ☐shivering, trembling ☐yelping when picked up or moved ☐reluctant to move much in crate such as shift positions or slow to move ☐tight tense tummy
☐can’t find a comfortable position
☐Arched back
More common with neck disc episodes;
☐ Holding front or back leg flamingo style not wanting to bear weight
☐head held high or nose to the ground
If you are seeing any of these other signs, you can be quite confident Mitzi is in pain. In that case, notify the vet as soon as you can about restarting pain meds.
An Assisi Loop can be used as a supplemental treatment during conservative care. Some of our members have used it, and they think it helped.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Jun 16, 2024 21:28:10 GMT -7
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