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Post by Todd & Oreo on May 14, 2022 7:06:05 GMT -7
[Please do not edit this post as it is being marked for info. Any corrections or additional info? Then make a new post. Thanks!]
[Original subject line: OreosDad Oreo's conservative 5/13 ] Oreo is a 15lb 8 year old male Shih Tzu.. he's been very active, rambunctious, and healthy until 5/11 when in the evening he jumped off a recliner and apparently injured his lower to mid back. Exactly how the injury occurred isn't 100% positive. During the night he slept very little and began exhibiting signs of pain and nausea. The next day 5/12 he was rushed to the vet when they opened for business. Blood work and X-rays were done. X-ray did shows signs of narrowing and calcification as per the vet's examination and blood work was very good. Vet was hopeful he would make a rapid recovery and was sent home. Diagnoses was "slipped disc". Upon getting him home his mobility seemed to have worsened from when he was taken to the vet that morning. The next morning 5/13 he was 80% paralyzed in the rear legs and was rushed back to the vet. Pain tests were positive. The vet urged us to rush him to University of Tennessee Vet Hospital for surgery where we met with a neurologist and a resident student. The neurologist recommended conservative treatment and stated that Oreo was still somewhat mobile under her exam. Recommend recheck in 4 weeks after strict crate rest. Today 5/14 he's 100% paralyzed and and has l ost all bladder control. No signs of pain, just very unhappy with being confined. He's eating and drink as normal. The neurologist stated that when she examined him he was still "walking". To me this doesn't seem at all accurate but apparently him being able to drag himself with his front legs only must meet their/her definition for "walking"? We were urged to bring him back if he became worse. He seemed to be worse from the time we took him in to the time we left. It's almost like they are not looking at the same dog as we are. She did state that 2 other neurologist concurred with her assessment and wouldn't recommend surgery at this time without giving Oreo a chance to heal on is own. Just very confusing. Meds: Deramaxx once 1/2 pill once per day; Deramaxx is 7.5mg 1x day for 7 days I believe Gabapentin 100mg every 12 hours Trazadone every 8-12 hours Valium every 8-12 hours; Valium is 5mg every 8 hours. [MED LIST/HISTORY- Moderator's Note. Please do not edit
5/13 somewhat mobile during Neuro's exam
5/14 hind end paralyzed; lost bladder control.
Deramaxx as of 5/13: 7.5mgs 1x/day for 7 days, 5/18 test STOP for: _pain / _neuro
gabapentin 100gs 2x/day
valium 5mgs 3x/day
trazodone ?mg ?x/day
Oreo needs GI tract protector, Pepcid AC, on board w/Deramaxx! Strict crate rest was started 5/13 with small cage/gate that he's unable to walk around in and also a medium crate as needed. Both cage and crate are similar in size and completely limit his mobility.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 14, 2022 7:40:35 GMT -7
Todd, welcome. First things first is to verify you know how to express the bladder. This is a health issue that simply can't wait on. Watch the expressing video so you will get more out of the hands on top of your hands lesson you local vet or one at U of Tennessee will give today.https://dodgerslist.com/2020/05/05/bladder-bowel-care/ Discuss with vet about use of prednisone vs. Deramaxx with loss of hind leg function. Hours matter in preserving nerve function lossVets choose an anti-inflammatory during a disc episode to get painful swelling down in about 7-30 days. Did you get all four questions right? - Answers here: dodgerslist.com/2020/04/18/steroids-vs-nsaids/** i.postimg.cc/9MqP4ndF/healingsweling.jpg
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 intial disc tear & 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. √yes 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 (DPS), 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. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. A quick overview of conservative treatment vs. a surgery:
A disc episode compresses the spinal cord and causes a lot of bruising, swelling, and inflammation. -- Surgery immediately relieves the pressure with severe paralysis by removing offending disc material. -- Conservative treatment relieves pressure with an anti-inflammatory drug and takes 7-30 days.
Just as with any traumatic injury, the body can self heal nerves and the disc. -- The disc heals under Conservative treatment with very STRICT limited movement and time of 8 weeks. -- Damaged nerves in the spinal cord heal with time after a surgery or conservative treament. Best to think in terms of months rather than days/weeks for this slowest part of the body to heal. Please keep us posted. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 14, 2022 7:41:35 GMT -7
Todd is your name? Continuing post for info after your expressing emergency and alerting the vet about loss of hind end leg function. I can well imagine your dismay as I recall how I felt the first time I experienced learning my dog was born with disc disease. Things happened so fast and I was clueless about IVDD. So glad you have joined us all. You will be able to very quickly get up to speed in IVDD, meaning your mind can focus on what is true and have as much calmness as possible about nerve healing. You can be assured you will have the skills to advocate for Oreo, bring things up for discussion, in other words play an instrumental roll in helping Oreo's disc heal. Our comments are based on specific details about your dog. You've provided lots of good info, thanks. A few more details will help complete the picture. QUESTIONSDeramaxx: For how many days is this anti-inflammatory drug prescribed for? How many mgs is each dose you give 1x/day? Valium. how many mgs each dose? Which do you actually give it? Every 8hrs or every 12 hrs? Pepcid AC (famotidine) Oreo needs GI tract protector, Pepcid AC, on board w/Deramaxx! Dogs don't speak up at first signs of trouble like a person would. Red flag signs can progress from nausea> vomit> loose stool>.... Bleeding ulcers (red or black blood in diarrhea) can turn to a life-threatening perforated stomach lining. LEARN MORE: dodgerslist.com/2020/05/06/stomach-protection/
FIRST do ask your vet in this very, very particular way... --Is there a medical/health reason my dog may not take Pepcid AC (famotidine)? --Doesn’t need it, we wait til there is problem…are NOT answers to your question! --The dose of famotidine may require reduction in patients with liver or kidney disease. -- It may be prudent with heart patients to choose another class of acid reducer.
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound. --Give 30 mins before the anti-inflammatory. --Dose thereafter every 12 hours for as long as your dog is on the anti-inflammatory. thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg **
★1 Do you observe any of these signs? Let us know which you observe. There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Tell your vet about any of these observations asap to get meds adjusted. ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned back ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions
★2 If your dog moves around too much, the disc cannot heal. With pain medications (gabapentin for nerve pain and valium for muscle contraction pain) to mask pain, dogs will not be in pain and want to be more active. So it is up to you to restrict your dog’s activity for them. STRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging when out of the recovery suite for expressing the bladder.
★3 List any red flag signs of stomach damage: Not eating, vomit, loose stool, bleeding ulcers, red or black blood in diarrhea? ★4 Currently, can your dog.... --- Wag the tail when you specifically do some happy talk?
★5 Peeing or overflowing. Can your Oreo: -- Specifically sniff an old pee spot then release urine (bladder control). Pee? -- Do you find wet bedding or leaks on you when lifted? Indicator signs of an overflowing bladder (loss of control). Manual bladder expressing is necessary for health reasons to avoid a bladder infection. How to: dodgerslist.com/2020/05/05/bladder-bowel-care/Will be anxiously awaiting to hear back on how the vet gets things right Oreo current situation today.
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Post by Todd & Oreo on May 14, 2022 9:28:32 GMT -7
We just spoke with our vet at the referring office and she was shocked that Oreo wasn't getting surgery. She asked us to bring him back in for weekend observation but didn't sound overly optimistic and suggested that we may need to have some difficult conversations in the coming days. He's being take there now.  Valium is 5mg every 8 hours. Deramaxx is 7.5mg 1x day for 7 days I believe. [MED LIST/HISTORY- Moderator's Note. Please do not edit
5/13 somewhat mobile during Neuro's exam
5/14 hind end paralyzed; lost bladder control.
5/15-16 weekend vet observation stay
Deramaxx as of 5/13: 7.5mgs 1x/day for 7 days, 5/18 test STOP for: _pain / _neuro
gabapentin 100gs 2x/day
valium 5mgs 3x/day
trazodone ?mg ?x/day
Oreo needs GI tract protector, Pepcid AC, on board w/Deramaxx! Spoke with the vet again after she reexamined Oreo and she sounded more positive. She felt that bringing him back for a few days to stay at the vet was the right call. Also felt like the the Deramaxx hasn't been given enough time to work. He's still able to start peeing( learned how to express his bladder) and still feel pain. So he's with for them for the next few days. |
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Post by Romy & Frankie on May 14, 2022 13:29:36 GMT -7
I am happy to hear that your vet is feeling more positive about Oreo. Anti-inflammatories, like Dex take some time to work. One day is not enough time. It can take as much as 30 days for the anti-inflammatory to eliminate the spinal cord swelling.
When you say your vet thinks you may need to have "difficult conversations", I am not sure what she means. If she means euthanasia, know that this is never an appropriate treatment for IVDD. It is much too early to have a sense of how much healing will take place. Nerves are very slow to heal, but heal they can. Even if Oreo never regains his ability to walk, he can still have a very high quality of life. Take a look at the information we have about quality of life here: dodgerslist.com/2020/04/18/hope-quality-life/Oreo is staying at your regular vet for a few days. At the vet's it is important that his movement be very limited. It is this limited movement that allows the disc to heal. The vet is probably aware of this, but all staff should be aware also.
I hope you have had a chance to look at the information about surgery vs conservative treatment that Paula mentioned. The neuro did not recommend surgery when Oreo had some leg movement, but since Oreo is now down (paralyzed), the recommendation may change. If surgery is not an option for you, know that many dogs have recovered with conservative treatment. |
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Post by Todd & Oreo on May 19, 2022 4:40:23 GMT -7
Oreo came home form the Vet after a 4 day stay. He was very happy to come home and wagged his tail the whole ride home. We were advised by the vet to continue strict crate rest and to only take him out to potty. The vet had us buy athletic stretch bands that allow us to walk behind him and use the bands to help him not fall over and keep moving. The bands are very strong and stretchy. His rear mobility has increased since we last saw him. He is able to move his legs a little and does move them while walking with the aid of the bands.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 19, 2022 7:33:18 GMT -7
Todd, so very happy to hear Oreo's back legs are now moving again! That is so wonderful. POTTY TIME FOOTSTEPS Be watchful at potty time to allow Oreo only a very, very few minimal footsteps to take care of business. Walking around not a good idea as each time the vertebrae move, they press on the disc trying to heal. Limited movement of the spine is the key component of STRICT rest. Carry Oreo from the recovery suite to the potty place and then allow a very few limited footsteps. The sling will save your back and prevent Oreo's butt from falling or twisting which could damage the early healing disc. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. Or an ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! Like the tip you shared about the use of Athletic exercise resistance bands as a sling. As long as Oreo is good with the band type of sling, that's perfect. Some dogs do not like anything near their penis at potty time. These DIY figure-8 sling ideas would solve that issue: Todd would you update us on a few things. We need to be able to follow with Oreo's treatment to be able to properly comment. -- Was the non-steroid anti-inflammatory DERamaxx continued at the clinic? Or was a steroid used (prednisone, DEXamethasone, etc.) That info should be on your bill.-- Deramaxx was to have stopped on 5/18. Did that happen?-- Normally pain meds are also stopped to be able to quickly and accurately monitor for any hint of pain surfacing. Did gabapentin and valium stop?Please list the current dose in mgs and how many times a day for each med Oreo is still taking. |
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