Kelly's Owen 5/25 conserv. NECK - Chi; NC. GRAD: July 20

Kelly, welcome to the Forum. There are a couple of things for you to know about and take care of until we have full clarity about Owen, meds, etc.

PAIN you described on the taper of Prednisone would indicate the need for another round of pred up at the original anti-inflammatory level dose.  It was not clear if all those pain signs are going on or just some, so will ask about later in this post.
    The first Rx on 4/27 was a 6-day prednisone course and then began 5/2 tapering to test for pain. Often it takes in the range of 7-30 days at the anti-inflammatory level to resolve all swelling.  Taper days do not work on reducing swelling, they sere another purpose.
    Read the full info on how prednisone is used during a disc episode to do the best job of working with your vet helping Owen:  dodgerslist.com/2020/04/18/steroids-vs-nsaids/
    PHONE the vet to get another course of prednisone asap, first thing Monday morning to report pain which would indicate very likely another  course of Pred, getting meds back up at higher doses.

Recommended reading to get up to speed quickest as possible:
1) Shortcut Thru IVDD: dodgerslist.com/2020/06/26/time-and-ivdd/

2)ROADMAP. Avoid dangerous detours with the Conservative Roadmap for your fridge. VIEW, DOWNLOAD and print: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf

Please list only the pain signs you currently see.  Not clear which signs you were reporting

Kelly, thanks completing with so much information! The way the date is written (DATE, MONTH, YEAR) is European and made me wonder if you were in another country. To avoid confusing us, either write the date:
    - MONTH-date (JUNE 7) or
    - date-MONTH (7 JUNE).
    - OMIT the year: 22.

Do you have have Owen's thread bookmarked in your browser? Then you can always quickly return directly back here, no need to do any navigating.
Here is Owen's thread for your browser: dodgerslist.boards.net/thread/8642

The way conservative treatment works:
1)  STRICT rest to heal the disc
2) Prednisone is given until there is proof all swelling is gone.
    Prednisone (anti-inflammatory) is used at the anti-inflammatory level dose/frequency. May take several courses adding up to 7 to 30 days. Taper days are not counted. Each taper dose is a test of sorts to prove if pain still exists.
3) Pain meds are used promptly on time to fully control pain. Pain meds are effective for only about 8 hrs. That is why usually Rx'd every 8 hrs (3x/day). Never used as needed. The time for lowering/stopping pain meds is the day the prednisone taper starts.

YOUR REPORT:
1) Strict rest has been in effect since May 25. Graduation day will be July 20.
2) The current Prednisone 2.5 mgs ONCE a day is not at an anti-inflammatory level dose. This is a taper dose that is not effective to work on painful inflammation. Prednisone is NEVER given as needed! Pred always follows a very specific way to dose and reduce to signal the body to make its own steroid hormone again.
3) You report pain. Pain meds are not at an effective time schedule to provide round the clock, daily pain relief since you are observing pain.

PLEASE LIST for us and your vet only what you observe. You listed ALL the signs and confuses us as to which you are actually observing

IMPORTANT! WHICH SIGNS OF PAIN do you actually observe?

⚙︎ shivering-trembling   ⚙︎ yelping when picked up or moved

⚙︎ tight tense tummy     ⚙︎ arched back, ears pinned bac

⚙︎ restless, can't find a comfortable position 

⚙︎ slow or reluctant to move in suite such as shift positions

⚙︎ not their normal perky interested in life selves 

     ➕if a neck disc:

◻︎ head held high/ nose to the ground

◻︎ looks up with just eyes and does not move head and neck easily. 

◻︎ not eating due to painful chewing or in too much overall pain

◻︎ holds front or back leg up flamingo style not wanting to bear weight 

WHAT YOU CAN DO
1) Continue strict rest to allow the disc to heal by July 20
2)  Advocate for a course of prednisone up at the usual higher end of the  anti-inflammatory level. Some vets will try a 5 or 7-day course, then there is a taper (reduction in mgs and/or frequency). The taper helps you monitor if pain still exists. NOTE: Does Owen have a health issue he may not use the upper end of the  anti-inflammatory level??
3)  Report to Dr. B on the phone the specific pain signs you observe from the list above. You are his eyes and ears at home to know if meds need adjusting. Communicate with him and advocate for adjusting pain meds.
    Typical are three pain med. Each address a different kind of typical pain.
     traMADol as the over all general analgesic   3x/day
     methocarbamol for  muscle contraction pain  3x/day
     gabapentin   for nerve pain  3x/day
4) Pepcid AC lasts for 12 hours.  Dose at 5mgs 2x/day

Please update us on wha the vet prescribes or changes (date, mg, x/day)

Owen seems to be in pain. You are reporting shivering and trembling, hunched back, nose down, reluctant to look up. These are all signs of pain. Gabapentin and methocarbamol are effective medicine for IVDD pain, but they do not last long in the body. They are most effective when given every 8 hours.
Michael Richards, DVM explains it well in his article on Pain and Pain Control:
"Another way of thinking about pain, is like a seesaw. You can put a rock on the high end of seesaw and it might not cause it to go down. If you add a second rock that might not move it, either. But eventually you will reach the point where the weight on the upper end suddenly causes the high end of the seesaw to fall, this is how pain threshold works. You really don't feel pain even though something has the potential to cause it until there is enough "weight" to tip over the pain threshold -- then you feel it suddenly."
If you think that Owen is bloated because of constipation, consider adding pumpkin to his food. To firm up the stool add 1 teaspoon of pumpkin for every 10 pounds of body weight, 1x a day to kibble. I did this when my dog was constipated. It worked well for him and to my surprise, he loved it.
Dogs sometimes don't eat because the meds make them nauseous. Pepcid should help with this. Other times dogs don't want to eat because of pain. If this is the case with Owen, a regular schedule of pain meds may help. If Owen starts to refuse food more often, let your vet know.

Kelly, please confirm you are giving gabapentin 25 mgs 3x/day.

Let me add to the excellent points Romy makes above.  

CLEARLY Owen's pain has not been recognized as a very serious issue due to wrong diagnosis. He deserves better now. Owen needs you to speak up just as you would not put up with all the stuff he's been going through pain wise. You would be on the phone to your doctor to get help.  Be Owen's voice and speak for him with Dr. B to get the pain meds corrrectly adjusted. When the pain meds are correct, there will be no pain in one hour. After that no pain at all dose to dose, round the clock, every day!

You have reported serious pain that surfaces before the next dose is given, when he has to move!
    You are reporting ALOT of different areas of pain that has not been treated seriously until Prednisone can get all the painful swelling on in 7-30 days (excluding any taper days.)

So far with the start of crate rest, Dr. B's  Pred 3.6mgs 2x/day for a 7-day course is the FIRST time pred has been up at the anti-inflammatory dose.  

Let us know how you dose 3.6mgs of prednisone.
    - How do you split a 2.5mg pill?  
    - Is prednisone a liquid?
        -- What is the formula (how many mgs pred in 1 mL of liquid?)
Understand the roll you play with the pred tapers on 6/14.  GOOD READING: dodgerslist.com/2020/04/18/steroids-vs-nsaids/

No one knows how long pred will be needed. Each dog is different, each disc episode is different. No one wants a dog on pred any bit longer than necessary. Therefore a vet calls for a 5-7 day course of pred AND then as the taper starts, it is possible to see if any hint of pain starts to surface as pred leaves the body and when pain meds are stopped and no longer blocking observation of pain.
    With any test for pain prednisone TAPER, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free!

All pred prior to not being crated was for naught. The disc could not heal due to movement no matter what pred was on board.

PAIN MEDs never as needed
Having to suffer with pain until next dose of meds kicks in around an hour later is not doing right by Owen. A disc episode is quite painful. Therefore owners/vets ought to act like it is indeed painful.
So this is where we stand on this Forum about pain...
    - Dogs tend to hide pain as a protective mechanism.
    - A lack of outward evidence does not necessarily indicate dogs are not experiencing the negative consequences of pain.

We side with the World Small Animal Veterinary Association (WSAVA) guidelines:
1. We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt. Treat predictable pain.
2. Where a dog is judged to be in pain, treatment should be given immediately to provide relief. Positive response to an appropriate treatment is the gold standard to measure the presence and degree of pain.
3. When pain is moderate or severe, the veterinarian should consider combining drugs that act at different sites in the pain pathway to provide optimal analgesia; Combining different classes of analgesic drugs allows the veterinarian to optimize the management of pain.wsava.org/wp-content/uploads/2020/01/Recognition-Assessment-and-Treatment-of-Pain-Guidelines.pdf
    
Neck discs just are MORE painful. The head mostly needs to move whenever another part of the body move. NECK disc pain is serious and needs serious attention to each of the 3 typical sources of pain. You are reporting pain surfacing nearing the next dose. This means gabapentin is not being dosed often enough at 2x/day.  Let us know you have moved to gabapentin 25mgs 3x/day.

Methocarbamol at 1x/day is also insufficient. It is effective in relieving pain for only about 8 hrs!

 Advocate for methocarbamol promptly every 8 hrs for the VERY typical to neck discs muscle spasm.

Kelly, a whole prednisone tablet contains 2.5mgs of pred?  
    The bottle contains pre-split half tablets of 1.25mgs dose?
       3 x 1.25mgs = 3.75mgs prednisone you will give 2x/day?

3.75mgs pred is pretty close and would not seem to warrant further splitting those tiny tablets. 

I just scrolled back up the posts and see yesterday your post about diarrhea did post. I posted at the same time and did not see your post.  Very glad you got Pepcid AC on board!  It would be good to understand the reason why Pepcid AC during a disc episode with any anti-inflammatory drug on board. Please read:  dodgerslist.com/2020/05/06/stomach-protection/

Did Dr B. say ok to methocarbamol 3x/day?

If you continue seeing diarrhea, especially with blood in it, please let the vet know as soon as possible. Sometimes Pepcid AC is not enough and an additional stomach protector is needed along with the Pepcid. The one we see used most often is Sucralfate. Sucralfate forms a gel-like webbing over ulcerated or eroded tissues and acts like a band aid for any damaged areas in the stomach.

Kelly, with the increase in prednisone up to an anti-inflammatory dose plus increasing pain meds, very pleased to hear Owen is in comfort! Good to hear also Pepcid AC's acid suppressing feature is showing improved looking poop!

Just to clarify use of a vague term "half" tablet.  
-- A whole prednisone tablet is 5mgs?
       -- thus 1/2 pred tablet is 2.5mgs
       -- 1/4 pred tablet is 1.25 mgs.
             You are dosing (1.25 X 3)=  3.75mgs twice a day? 

While it may seem Owen has been on pred for a while, unfortunately until 5/25 when crate rest started, no real healing and nor stop of continued aggravation to the nerves had happened.
  TUESDAY, 6/14, the pred taper will start. This is an opportunity to observe if Prednisone has completed its job to fully resolve painful inflammation. A true and very quick assessment about pain requires no pain meds on board at the start of the pred taper.  What did Dr. B. explain to you on how to handle a full stop of pain meds on 6/14 OR backing them down via times per day/lowered mg dose til fully stopped? 
   

i.postimg.cc/LsxvB4pN/plan-b-SM.png

What is your Plan B?  Ideas covered in dodgerslist.com/2020/04/18/steroids-vs-nsaids ?

Thank you for helping us understand Owen's meds.

"PREP for PAIN TEST day
    Your job at home will be to assess just how well reduction of swelling is going by observing for any hint of pain (▪︎shivering ▪︎trembling ▪︎yelping when picked up or moved ▪︎reluctant/slow to move head or body ▪︎tight hard tummy, ▪︎holding leg flamingo style not wanting to bear weight).
    To avoid being blindfolded by pain meds, the pain meds are also full stopped or backed off on the test date and is your vet’s decision which. Know ahead of time which your vet prefers: full stop of the pain meds or backing them off in mgs/frequency given."  from dodgerslist.com/2020/04/18/steroids-vs-nsaids

Have you asked Dr. B how he wants pain meds handled at the start of the prednisone taper. What did he explain to you? And if not full stopping of pain meds 6/14, how to back off in mgs and times per day?

Hope this helps you out. Please let us know what your vet says about pain meds on the begin of the taper.

Kelly, you last reported Owen gets gabapentin 25 mgs 3x/day, still correct?

Giving 12.5mgs 3x/day would almost be like not giving him any gabapentin.

So  give it a try to hold off an hour or two as you said.  IF pain would show, then VERY clearly it would not be time to taper prednisone. But instead alert the vet to pain signs you saw and likely another course of pred would be issued..   If no pain, then back off to 12.5mgs gabapentin.

Update: Owen is doing GREAT since the prednisone taper started [6/14; ▼gabapentin 12.5mg 3x/day]. No signs of pain, no knuckling of the right front foot. Eating, drinking, doing the bathroom thing well. Would prefer not to be crated, but handling it pretty well.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 11 y.o.
Prior use of pred negated due to not crating, continued pain
crated on 5/25
prednisone as of 5/25 2.5mg tabs: taper dose- 1.25mgs 1x/day √6/2 pain / _neuro
                    as of 6/7 2.5mg tabs: 3.75mgs 2x/day for 7 days, 6/14 TEST taper for: _pain/ _neuro
gabapentin 25mgs 3x/day  SToPPED 
methocarbamol 125mgs 3x/day   STOPPED
▼Pepcid AC 20mg tab: 5mg 1x/day ]

Currently giving the one dose of prednisone (3.75mg) a day with Pepcid AC (5mg) about 30 minutes prior to the prednisone. Only giving the ▼Pepcid once a day. He gets this later in the afternoon so I have a good chance to observe him throughout the day.

Will go back to ▲Pepcid 2 x day, thanks, you guys are so awesome!

[MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 11 y.o.
Prior use of pred negated due to not crating, continued pain
crated on 5/25
prednisone as of 5/25 2.5mg tabs: taper dose- 1.25mgs 1x/day √6/2 pain / _neuro
                as of 6/7 2.5mg tabs: 3.75mgs 2x/day for 7 days, 6/14 TEST taper for: _pain/ _neuro
gabapentin 25mgs 3x/day SToPPED
methocarbamol 125mgs 3x/day STOPPED
Pepcid AC 20mg tab: 5mg ▲2x/day ]