|
|
Post by northwoodsdoglover on Mar 17, 2013 7:48:26 GMT -7
Hey everyone!
Thank you so much for Dodgerslist. I can't tell you how much it has helped me and my wirehair dachshund Max. He is 6 years old and weighs 19 lb.
Max first started showing signs of a neck problem around 3/2, walking a little slow and holding up a front paw on occasion. Because I didn't know that could be a sign of a disc issue, we assumed he had just hurt his foot and would get better after a couple of days. Of course that was not the case... and he began to show increasing signs of pain (hunched back, not wanting to walk, trembling when being carried, etc.).
But - after reading this site I realize how lucky we are, because that was as bad as it got for him. No paralysis, no loss of bowel or bladder control, and he still has full sensation. The vet prescribed strict crate rest (and thanks to Dodgerslist I now know what that actually means!) and gave him Prednisone, Methocarbamol, and Tramadol. He's also on Cephalexin for a skin problem that we had been treating before this all started.
I do have a couple of questions: first is, how long does a Prednisone treatment typically last? The first time we saw the vet on 3/7 she prescribed 5mg of prednisone 2x/day for 2 days, then 1x per day for 5 days, then 1x every other day for about 10 more days. It seemed that as soon as we dropped to the 1x/day dose he started regressing. So I took him back to the vet this Friday 3/15, and she basically said start over with the same routine. She also upped his tramadol to 25mg every 8 hours, and it seems like he is much more comfortable. Today would be the first day I would skip the evening pill, and I'm a little nervous about it. It just seems that since we know this takes 6-8 weeks of crate rest to really get better, 2 days on the higher dose of prednisone isn't very long.
I should add that this is a new vet to me, and we live in Wisconsin's northwoods far from any major cities. It's not that I don't trust her, but I don't know how much experience she has with IVDD and similar injuries. I've had trouble finding good vets in this area in the past.
My other question is if long-term antibiotics can contribute to IVDD at all. Max has been on Cephalexin and then Clavamox and back to Cephalexin for skin lesions that don't want to clear up. (On a side note - one good thing to come of all this is that the prednisone has cleared his skin right up! So now we know it is probably an allergy issue, and once his back is better we can work on that.) Would that have any effect on IVDD? I mean, I know that if a dog has IVDD then he has it, and at 6 years old Max is right on target to show his first signs, but I'm just curious.
Anyway, thanks again for this fantastic website. I feel like I understand this disease much better, and feel so much more hopeful after reading everything here. You are doing a wonderful thing here!!
Teresa
|
|
PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Mar 17, 2013 8:43:49 GMT -7
Teresa, welcome to Dodgerslist. We are just thrilled to know you have been reading and it is helpful. You are doing the things an IVDD owner must do, read to know the enemy and be able to WIN!!!! Do give us the dose in mg and frequency for all his meds. Anti-inflammatories (steroids and NSAIDS) are associated with increased stomach acids which can cause: not eating, vomiting, and loose stools, bleeding ulcers to life threatening stomach perforation. Phrase the question to your vet this particular way:" Is there a medical/health reason for my dog not take Pepcid?" If there is no reason, we follow vets who are proactive in stomach protection by giving doxies 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory. Most of us have started the habit to learn the meds given our dogs before they go in the mouth by asking the vet, Googling, etc. Being informed makes you a good monitor of meds and knowledgeable to ask pertinent questions. This is a wonderful veterinary website to bookmark: www.marvistavet.com/html/pharmacy_center.htmlAn anti-inflammatory (Pred) is used until all the swelling is gone. Usually it takes 1-2 weeks, but can be more like a month on the anti-inflammatory dose. Tapering is less than the anti-inflammatory dose. If on the taper there is any hint of pain then it is known there is still swelling that pred needs to resolve and to go back on the orig dose for a bit longer. Most vets start with a 5-7 day course before doing a taper. It may be because Max has very mild symptoms you vet is thinking a short 2 day course would do it...obviously it did not. Getting swelling resolved is trial and error to see what works. So meds serve the purpose stated above. Crate rest serves another purpose to let the disc heal...there are no meds to heal a disc. Good over view to understand what does what: www.dodgerslist.com/literature/healingpage.htmAnti-biotics have no connection with a disc episode. Disc disease is a disease that the body can no longer rejuvinate discs, they become prematurely aged. Let us know that Max is completely comfortable (no shivering, trembling, yelping, tight tense tummy, doesn't move much doesn't hold his head in an unusual position). If he is still showing signs of pain your vet have more options to increase the dose of Tramadol, add gabapentin to get it just right for Max. All it takes is feedback to the vet via a phone call to let them know what you observe. Let us know that you are doing 100% STRICT crate rest 24/7 only out to potty …. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM) |
|
|
|
Post by northwoodsdoglover on Mar 17, 2013 13:24:57 GMT -7
Thanks for your reply, Paula! To answer your questions: yes, we are on STRICT crate rest, only out to go to the bathroom. Today was the first day that he wanted to walk a little away from me to poop, so I'll try to gently get his harness on him for bathroom trips from now on, or perhaps borrow my daughter's outdoor rabbit pen to keep him confined to a small area. Nothing else at all! Max does seem to be completely comfortable on this new, higher dose of tramadol. No yelping, shivering, panting, etc. He was indeed doing all these things before, but now seems much more relaxed and comfortable. In fact, when I go to his crate for anything (meds, bathroom breaks, just lovin', etc.) he is happy and wagging his whole body so much I'm afraid he'll hurt himself again! I'm doing my best to keep him calm. The only change in his behavior right now is a little more staring into space on occasion... I'm guessing it's because tramadol and muscle relaxants have the same effect on me. Here's his complete med schedule: Prednisone 5mg, 2x per day. We're scheduled to reduce to 1x per day today, but I'll probably call the vet in the am and let her know that 5-7 days is more common (it's only been 2) and see what she says. Tramadol: 25mg, 3x per day. Methocarbamol: 125 mg, 2x per day - I just have enough for 2 more days. When I call tomorrow I will ask your question about Pepcid... I like the way you word it. Not "does he need" but "I know he needs stomach protection, so is there any reason not to give this one?" Again, thanks for all the answers you've given me. I'll take a look at the 2 websites you link to, too!  Teresa and Max |
|
|
|
Post by northwoodsdoglover on Mar 18, 2013 18:53:45 GMT -7
Well, we've had some setbacks with Max today. Later yesterday (after my last post) I noticed that Max was acting a little uncomfortable again, and that with Tramadol every 8 hours it seems that by the end of the dose he was hurting again. Then this morning he whimpered a bit when I went to take him out and he wasn't at all interested in breakfast. I went to take a shower, and when I came out he was yelping in his crate, sitting hunched over, and panting. Poor guy - obviously in a lot of pain.
I called the vet right away and she had me change his meds to the following:
▲Prednisone 5mg 2x/day for today and 2 more days (that means 6 days on this current, higher dose) then 1x/day
Pepcid : 5mg 1x/day
Tramadol: 25mg 4x/day
Methocarbamol: 125mg, 2x per day - but I only have 2 more doses of this and then she wants to stop this one
Cephalexin: a few doses of this left from his skin treatment
and of course, continuing STRICT crate rest.
My questions:
Is it normal to keep having setbacks? It seems like we have a day that he feels better and then suddenly we are back a bunch of steps. This is the third time we've done this now...
Is it common to NOT continue methocarbamol with other pain meds? The Marvistavet website you reference above doesn't list any significant side effects, so I'm wondering why my vet might be concerned about stopping this.
I know that Max's problems are small compared to others on this site, but I just want to keep making sure I know as much as I can to help him.
Thanks again!
Teresa and Max
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Mar 19, 2013 9:02:59 GMT -7
Teresa, I'm glad your vet did up the pain meds for full dose to dose coverage and extended Pred at the anti-inflammatory rate for a longer time as obviously not all the swelling had been resovled. Your observing and reporting signs to the vet, helps them make the right decisions for Max. Your vet is being very conservative in use of Pred with short courses at the anti-inflammatory rate. It is not at all unusual to see a dog on pred at the anti-inflammatory rate for a straight 1-2 weeks or even for some more like a month. Your vet is trying short courses then a taper to peek and see how swelling is going.
Do know she has further options with Tramadol for a 19 pound dog. For example my 17 lbs was on 50mg of Tramadol 3x a day. So if you are not seeing pain in control dose to dose, there is more your vet can do. We do not like to see what appears to be worsening pain, Max may have moved more than he should and cause more tears to the disc? Hard to say. The good news is you are not reporting any neuro diminishment with use of his legs.
Methocarbamol is the med that addresses the pain from muscle spasms so often associated with a disc episode. I personally would want my dog on this med unless you are seeing he is having a problem. Speak frankly with what you have read at Marv Vista and advocate strongly for Max.
Pepcid AC lasts for about 12 hours. The vets we follow use 5mg 2x a day. Give it 30 mins before Pred and give Pred with a meal for best stomach protection. Again, ask your vet if there is any reason not to give it 2x a day for Max for maximum protection from the stresses of change in his daily routines, dealing with the stress of pain and now with acid producer Pred in use.
You are doing a good job, staying on top of Max' needs and working with the vet. Reading, studying about IVDD puts you in a strong and knowledgeable position to advocate for Max.
|
|
|
|
Post by northwoodsdoglover on Mar 22, 2013 5:43:03 GMT -7
Well, here's a quick update on Max -
The good news is that he isn't any worse (no paralysis or signs of neurological deficits) but the bad news is that is isn't any better, either. After 2+ weeks he is still having some episodes of pretty significant pain, and the vet isn't happy that we haven't seen any improvements. So we went to a surgeon for a second opinion...
After x-rays we have definite confirmation of a ruptured disc at C2/C3, but the surprise for me is that it is an older injury because it is already showing calcification in the disc space. It's also possible that he has some compression in the next 2 disc spaces as well - hard to tell until we get a myelogram. The surgeon said he is a good candidate for surgery, but didn't want to proceed immediately because he also feels that his injury is relatively "stable" - in that he's unlikely to cause further permanent damage right now, so surgery would be indicated only if we can't get his pain under control.
So, for now he's back on the following meds:
Prednisone 5mg 2x/day
Tramadol 25mg 4x/day
Methocarbamol 166mg 3x/day
Pepcid 5mg 2/day
He's resting somewhat comfortably now, but I have a feeling we'll be bumping our thread over to the surgery section soon... we'll see.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
|
Post by PaulaM on Mar 22, 2013 8:05:31 GMT -7
Teresa, yes, maintaining full pain control has to be done. Do know for a 19lbs dog, your vet has more options if Max is not fully pain free ("somewhat comfortable" does not sound like it to me) Discuss with your vet about going to 50mgs Tramadol 3 or 4 times a day if you are observing any sign of pain. Also many vets are finding good results when pain control is a challenge by adding in Gabapentin to the Tramadol/methocarbamol mix. So your vet still has options to get the pain in control and he'll be depending on your feedback to get it just right for Max.
An indicator for surgery is after several attempts to go off pred, the pain still keeps returning. Often it takes being at the anti-inflamamtory dose of pred (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going. So how many more days have been added to Pred 5mg 3x/day dose that has so far been 6 days? Has there been a date scheduled to try the next taper?
|
|
|
|
Post by northwoodsdoglover on Mar 22, 2013 9:12:53 GMT -7
Hi Paula -
I'm trying to remember without my notes (which are at home - I'm at work) but I believe he was on anti-i doses of prednisone beginning on 3/7, and starting to taper 3 days later. That didn't work. He went back on anti-i dose on 3/15 and has been on that ever since. So it has been 7 days on the current higher course, and will be until his recheck on 3/26. Depending on his condition then, we'll take one of three routes: stay on the higher prednisone longer and wait, start to taper the pred if he's better and evaluate, or proceed with a myelogram and see if we can afford surgery.
When I talk with them today I will ask about more tramadol or adding gabapentin to the mix... he is mostly comfortable, but you are right - he's not completely pain free and he really needs to be if he is going to heal well.
Thanks -
Teresa
|
|
|
|
Post by Linda Stowe on Mar 23, 2013 10:07:42 GMT -7
Teresa, How is Max today. Did you get the vet to add more Tramadol or add the Gabapentin?
|
|
|
|
Post by northwoodsdoglover on Apr 23, 2013 20:31:13 GMT -7
Hi everyone -
It's been a while, but I just wanted to update you on Max - we are nearing 8 weeks, and everything is going well!
We had to try about 5 times before we were successfully able to get Max off prednisone and pain meds, which didn't happen until about 6+ weeks. But we knew about a week ago that things were going well, when he escaped his pen while we were out and was running around the house when we got home. Naughty boy! Back into his wire crate he went, and he was not happy about that! Now it's time to slowly get him back into the swing of things.
Thanks again for all the info and support!
Teresa and Max
|
|
|
|
Post by natureluva on Apr 24, 2013 8:03:30 GMT -7
Hi Teresa, thanks for the update on Max - glad to hear he's doing well! After the 8 weeks of crate rest are complete, you can SLOWLY reintroduce him into activities. Here is a link to help you with that, along with a link to help you safeguard your home for the IVDD dog: www.dodgerslist.com/literature/AfterCrateRest.htm and www.dodgerslist.com/literature/protectback.htm Remember that it took a long time for all of the inflammation on Max's spinal cord to go down (you tried many times to reduce the steroid, but pain returned). Therefore, Max's disc may be only JUST healed. So please do be careful about reintroducing him into activities slowly so that you can hopefully avoid a relapse. We look forward to hearing how he does. Best wishes, ~Lisa |
|
|
|
Post by northwoodsdoglover on Apr 25, 2013 18:35:01 GMT -7
Thanks, Lisa - we'll read up and take it slow!
Teresa
|
|
Teresa and Max
