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Post by paulkib on Aug 29, 2013 21:15:39 GMT -7
Hello,
Last night my 5-year-old dachsie, Schnitzel, went down with an IVDD injury. He was completely paralyzed at first, but by the time we got to the ER vet in an hour he was able to walk a bit, though unsteadily. We opted not to do surgery and are trying crating and meds (steroids and tramadol). He has been able to urinate, though with difficulty because he doesn't know how to pee without hiking his leg. I'm confident he's managing to eliminate enough urine. However, it's been over 24 hours and he still hasn't had a a bowel movement. He had one at the time of the injury when he lost control of his bowels. He has since eaten two meals (one he threw up), but hasn't had a BM yet. Is this something I should be concerned about or is this pretty normal?
Thanks!
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PaulaM
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Post by PaulaM on Aug 30, 2013 7:54:11 GMT -7
Paul welcome to Dodgerslist we are glad you found us. First thing is the red flag warning of not eating and vomit with the use of steroids. Please get Pepcid AC on board asap this am. Then call and ask for an Rx of Sucralfate. Cortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not to take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. Pepcid AC is a generally safe over-the-counter suppressor of stomach acid production for healthy dogs. Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach. We ask that all members read about each med their dog is on or may take as a safety measure. This directory is in alpha order: www.marvistavet.com/html/pharmacy_center.htmlLet us know you are doing the single most important part of conservative treatment….that is the 100% STRICT crate rest 24/7 only out to express the bladder or if control out to potty in the grass. 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks …. 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). In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc. We'd like to better support you, can you fill us in on some important details: -- Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy? -- What are the exact names of meds currently given, their doses in mgs and frequencies? -- Do you find wet bedding or leaks on you when lifted up? -- Poops OK - normal color no dark or bright red blood? |
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Post by paulkib on Aug 30, 2013 11:55:35 GMT -7
Thanks for your response, Paula. Hurray! He finally had a BM this morning, which made me very happy!It looks normal.
In answer to your questions:
He is on total crate restriction in a padded crate. He can stand up and turn around and that's it. We take him out to potty on the leash and then it's right back in. Fortunately, the tramadol has him sedated enough that he is not complaining much and not stressed out (he is not used to being crated, so he will be a basket case once he is off of the tramadol). He's still in some pain, though not yelping or whining. His back is arched when he stands up and he is stiff when I pick him up. When he sits up he sits with his nose pointing up, so obviously he's still very uncomfortable. When he is lying down he is relaxed and doesn't seem to be in any distress.
He is in predinisone (5 mg) twice a for 3 days, once a day for 3 days and then every other day for 3 doses. He is also on tramadol (50 mg)every 8-12 hours (I'm giving them every 8 right now per the vet's recommendation). (He is a big boy, BTW, 26.9 lbs. -- not overweight.)
No wet bedding, thank goodness, he still has his bladder control.
I have a call in to the vet to ask about the Pepcid or something else for his tummy.
I appreciate your help!
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Sabrina
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Post by Sabrina on Aug 30, 2013 12:12:59 GMT -7
Hi Paul, I'm Sabrina. I'm so sorry you and Schnitzel have to go through this. Yay for the normal BM! Since Schnitzel is still in pain, give your vet a call. IVDD is so painful, and if the pain isn't fully controlled dose to dose this interferes with healing. Often with IVDD a second or even third pain med is needed along with the tramadol: www.dodgerslist.com/literature/healingpain.htmAlso, as there's still pain it's too soon to plan on tapering the pred: "Often it takes being at the anti-inflammatory dose for 1-2 weeks or even for some dogs more like a month before all the swelling is gone." So here's another thing to discuss with your vet! Rule of thumb is: pain = swelling = more time on the anti-inflammatory needed. When Schnitzel's pain is fully controlled and he's more like himself, here's a page with strategies to help him "rest" during crate rest! www.dodgerslist.com/literature/EmergencyCrate%20Training.htm#EmergencyconfinementEdit to add: It's best to carry him out to potty:  Do let us know what the vet says about getting Schnitzel's pain under control. ))Hugs!(( - Sabrina |
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Post by paulkib on Aug 30, 2013 12:59:34 GMT -7
Thanks for your advice and encouragement, Sabrina. I just spoke with the vet's office. They said to stop all meds for a couple of days and start him on Pepcid (5mg 2X/day) ASAP. I said I was concerned about taking him off the tramadol, thinking that he will become agitated in the crate in addition to having to deal with the pain. They said I could try just taking him off the prednisone to see if his appetite improves. Now, after reading your post, I'm concerned about taking him off the prednisone, too. What are your thoughts?
Update: I remembered that I had some canned Alpo in the cupboard and gave him about 1/2 cup of that. He started slowly at first, but then licked the bowl clean. Hopefully he will keep it down. Not the healthiest thing in the world, but I'm glad to have something on his tummy!
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Sabrina
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Post by Sabrina on Aug 30, 2013 15:32:26 GMT -7
So glad Schnitzel could eat something! I do hope he can keep it down. Great news on getting the Pepcid on board, too. Do you know who you spoke to at the vet's office? (Receptionist, tech, vet, etc). My main problem with my own vet's is that I get different answers based on who I speak with (I'm in a semi-rural area so I don't have many options!). It is hard enough dealing with IVDD without having advice given to you by folks who might or might not be qualified to give it. Whoever told you to stop the pain meds is not knowledgable about treating IVDD. Since Schnitzel is showing signs of pain he needs more pain control, not no pain control! My concern with stopping the prednisode for "a couple of days" is that Schnitzel would have nothing working to combat the swelling/inflammation that is causing his pain: Inflammation, swelling in the spinal cord - www.dodgerslist.com/literature/healingsweling.htmLike Paula said, I would be asking the vet about adding a drug called "Sucralfate" to further protect Schnitzel's upper GI tract. Sucralfate acts as a sort of "bandaid": Sucralfate needs specific timing: www.marvistavet.com/html/sucralfate.htmlOn Dodger'sList I've seen Sucralfate used this way: Sucralfate given on an empty stomach one hour before the meal and prednisone, then Pepcid AC 30 mins after the Sucralfate/30 mins before the meal and pred. (Of course like it says on the healingsweling page: "There are no safe medications. There are two safety factors with drugs. One is a vet who practices safe medicine... The other is an owner who is educated on what the side effects are and monitors their dog.") Depending on what time it is where you are, you may have to speak to an on-call vet. I know it can be frustrating trying to speak to a vet personally, but when dealing with IVDD uninformed (as evidenced by telling you to stop the pain med) vet clinic workers just won't cut it. Make yourself a list of questions to ask the vet so that once you are speaking directly to him/her you don't forget anything(!). Hang in there! ))Hugs!(( - Sabrina |
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Post by paulkib on Aug 30, 2013 17:30:15 GMT -7
I spoke to the vet tech who took a message and talked to the vet. The vet tech called me back. This is my local vet, not the one we saw at the ER. Unfortunately, he is gone for the weekend. The "on call" vet is the ER hospital and they won't answer questions over the phone, you have to bring the dog in to get any information (it's one of those high tech places with cardiology, neurology, oncology departments, etc....not very personal).
He has tolerated the food really well, so I am thinking that the one-time he vomited might not be a huge deal. It was his first time taking food after the injury and he hasn't vomited since. Now that I know he is keeping food down and have in on the Pepcid, I think I will keep him on his meds through the weekend and then ask the vet about the sucralfate on Monday. Does that sound OK?
BTW, I stretched out the time between tramadol doses from 8 to 10 hours to see how he would do and he was acting all Schnitzel-y -- barking at stuff and complaining about being in the crate, non-stop! I'm glad to have the tramadol to knock him down. Otherwise I'm afraid he would hurt himself more trying to get out of the crate. I think this will be a serious problem as he recovers. I can't keep him sedated for 8 weeks. I'd be interested to hear your suggestions on how to deal with this as we move forward. You know how our dachsies can be when they're not happy! Right before this happened (literally, this week) I began the process of training him to tolerate being crated. Too little, too late!
Thanks!
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Post by Pauliana on Aug 30, 2013 20:04:13 GMT -7
Hi Paul, welcome to Dodgerslist from me too! Very glad to hear that Schnitzel's stomach has settled but I would be prepared to act to get Sucralfate on board at the first sign of stomach upset or diarrhea.. Once it gets to that point it can get serious very quickly. Does your vet have an answering service? Most do.. I would still call to request Sucralfate and if he is still showing signs of pain other additional meds would be Methocarbamol for muscle spasms or Gabapentin for nerve pain both work very well with Tramadol and they are the standard 3 pain meds commonly presribed for IVDD. You would need to put on your detective hat and determine by Schnitzel's behavior how pain is presenting. Sabrina was so right..He needs pain relief and it can be balanced with the right stomach protection.. Never be patient with pain because pain is detrimental to healing. www.dodgerslist.com/literature/healingpain.htm www.dodgerslist.com/literature/healingsweling.htmAs far as his upset with being in the crate.. You might try these natural calmers first: Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives. Of course always keep your vet in the loop on all things you give your dog. Farnum's Comfort Zone with D.A.P. www.petcomfortzone.com/dogs.html [pheromone diffuser] with one oral calmer from below: Oral calmers: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.php [Composure] 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com Plain Benadryl (Diphenhydramine) with no additional medications added. Buy at your grocery store or pharmacy. Get the dosage from your vet. The wrong dose can have dangerous side effects, so your vet needs to prescribe the proper amount for your dog. |
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Sabrina
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Post by Sabrina on Aug 31, 2013 6:30:59 GMT -7
Like Pauliana said, I do hope there is some way to get in touch with your vet. As concerned guardians of our dogs, we have to educate ourselves so that we can advocate to our vets for the best treatment possible. However, our vets are the ones who've had the intensive veterinary schooling. Without talking directly to Schnitzel's vet, you don't know the reason why the vet relayed the instructions to stop the pred "for a few days" - was the vet reviewing Schnitzel's chart/history and had some reason Schnitzel should not be on Sucralfate? Was the vet distracted and not clearly focusing on the reason Schnitzel is on the prednisone? Etc, etc. GI problems that steroids can cause can be life-threatening, and while I'm very glad Schnitzel seems to be on the mend, the safest thing any of us can do for our dogs is to educate ourselves and work with our vets every step of the way when dealing with these medications. www.dodgerslist.com/literature/IVDDcourse/medications_used.htmlwww.dodgerslist.com/literature/drugs.htm#prednisoneThere must be some Murphy's Law relating the need to speak with our vets to the likelihood of the day being part of a long weekend! ))Hugs!(( - Sabrina |
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Post by paulkib on Sept 4, 2013 19:52:48 GMT -7
Hi Everyone,
Thanks again for your help. I wanted to check back and give you an update.
But first, what's up with that audio captcha when you log in to the site? I watched a stupid 10 minute video and still didn't get a security code. Fast forwarded through it again, still no code. Tried another "puzzle" and got an ad for Ellen -- again, no code. I finally tried the audio version and managed to log in that way. Who has time for this???
Schnitzel is doing so much better! He doesn't seem to be in much pain at all and is walking almost normally when we take him out. He wants to do so much more than we will let him. I have to stop him from trying to drag on the leash, trying to jump, wanting to kick up the dirt when he potties, and hiking his leg. He was "running' in his sleep last night -- his back legs kicking up a storm. All good signs, I think.
We ended up sticking with the originally prescribed meds. He is having no stomach upset and is eating normally. The only real problem at this point is that he's going nuts in his crate. He barks and whines almost non-stop when he's in it (although, thankfully, with the help of the tramadol, he sleeps through the night). My husband and I will let him sit on the couch with us to give him a break from the crate (on the leash so he won't jump off), but even on the couch, he whines.
We've made it through one week and we've still got a long haul ahead of us. Hopefully he will get used to the new routine eventually. I'm trying to keep him busy in his crate with toys and by filling his Kong with peanut butter and other treats -- though I'm worried he's going to weigh 300 lbs. by the end of this!
I'm getting ready to order some of the items Paulina suggested. Do you recommend just using one, or combining them?
Thanks!
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Post by Pauliana on Sept 4, 2013 20:41:07 GMT -7
It's a good idea to to use: Farnum's Comfort Zone with D.A.P. www.petcomfortzone.com/dogs.html [pheromone diffuser] with ONE oral calmer of your choice: Oral calmers: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.php [Composure] 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.comI would suggest either Anxitane or Composure Soft Chews. I am concerned that you are letting him sit on the couch while it's good he is on a leash to prevent jumping, a couch is not supportive enough and can hurt his early healing disc and cause further injury. I know it's hard, been through it with our Tyler but any time out of the crate is a dangerous time. Not sure what's up with the audio captcha when you log in. I have never had that happen since the forum was created and no one else has mentioned it. I'll report it for you and find out why that's happening to you. Very sorry you had a hassle with it. Peanut butter is very high in calories, I would put carrots and other low calorie veggies in the kong if he likes them instead.. Sending healing thoughts over the miles..
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PaulaM
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Post by PaulaM on Sept 5, 2013 8:34:12 GMT -7
Paul can you bring us up to date on his meds. Is there a taper now or are you still on Pred 5mgs 2x a day?
How often are you giving tramadol? You write "doesn't seem to be in much pain at all" …Schnitzel should not be in ANY pain. What signs of pain are you specifically seeing: shivering, yelping, not wanting to move much, not his perky self, tight tense tummy?
Anytime out of his crate is a dangerous time for his early healing disc. The recovery suite is the ONLY safe place for his disc to heal in. Laps, couches, beds can all slope into your body making Schnitzel have to unexpectedly move his body. The recovery suite is always supportive of the spine, always horizontal and not inclining.
Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Anytime Schnitzel is sitting or lying down quietly, give a reward. Soon he will learn which of the behaviors receive a reward.
I agree Kongs filled with p-nut butter are too high in calories and the fat can cause diarrhea….which can be confusing while on IVDD meds. Instead consider feeding a portion of his meals inside the kong. Soak his kibble in water or broth and stuff into the kong for freezing. A frozen kong will take him a while to lick it al out. His daily intake of food/treats should not exceed his normal daily amount of food. Some lo cal treats can be pieces of carrot or apple. Freeze up some lo sodium, no fat broth ice cubes for licking in his bowl.
The captcha should not come up after you have logged and signed in initially. Let us know if it continues to do so… explain the steps you were taking when it happened.
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