Mark's Tyson 4/12 Conservative Bichon Grad now 6/12

Mark, so very glad to hear Tyson is in good spirits with increase of those happy tail wags. Good spirits is good for healing!

I appreciate your very nice comment about the help you've received here. Thank you.

Not clear what exactly you want to know about column #4 of the ROADMAP. Asking a specific question helps focus our energy on giving a matching comment.

Mark,
    The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.

STRICT rest means:
◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/
◼︎no dragging or meandering at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎At home laser or acupuncture for severe neuro damage is best.
◼︎ POTTY TIME strictness is a must to ensure limited movement of the vertebrae. Walking and even footsteps cause the vertebrae to push on discs including the early healing one. That risk is outweighed by the health benefit to release urine and avoid bladder infection.
        Carry your dog to and from the recovery suite to the potty place and then allow a very, very few limited footsteps.
◼︎  Any time out of the crate is a dangerous time for a dog going through an IVDD disc episode. Transport to a vet is risky as there is a chance of too much movement. Most vets who understand how strict the crate rest must be will understand that it's too much of a risk to bring the dog in to the office for a follow-up exam. You can call her to give status updates on pain and neuro function.
     Vehicle transports for the most urgent of health reasons such getting lesson on bladder expressing, require attention to keeping the dog with limited movement of the vertebrae.  
    With urgent vet visits, secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels on either side of the dog to prevent movement or jarring the spine when braking or turning corners.


 

Owner knowledge is key for ensuring the disc heals!
▶︎ STRICT nursing care aids the body in self healing the disc: dodgerslist.com/healing-the-disc/

STRICT rest means:
◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/
◼︎no dragging or meandering at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎At home laser or acupuncture for severe neuro damage is best. Seek a mobile vet.

Knowledge of the importance of STRICT limited movement of the vertebrae, gives the dog the best chance of healing. Owner knowledge makes it easy to say "no" to well-intentioned but harmful advise.  Not all veterinary professionals and other related services know IVDD.

My thoughts.  It just could be, that by graduation day on June 7 Tyson might be showing a new different neurological situation than where he is today or even on May 11.  What sense does it make to jump the gun for a consult in mid May? It certainly makes no sense to start any active physical PT during the 8 weeks the disc is trying to heal.

PREDNISONE TAPER for SAT 4/23
Since pain was not controlled with traMADol add until 4/19, it's gonna be a common sense, best guess sort of thing if the Pred taper should being as scheduled on Sat. 4/23.  If you are leary that two days would not be enough time for pred to complete it's mission and test for that, then discuss with the vet your concern.  It is always worrisome when a taper begins on a weekend when vet is not open even if your have your Plan B.  Let us know what you and your vet decide about the scheduled pred taper on 4/23.

Mark, would recommend to not go deep into the medical...well unless you are the type who likes to study the detail. Then by all means Google to read, read about things medical, learn the medical term definitions and then you can talk medical speak. Here on the Forum that goes beyond our abilities.

Keep things simple with IVDD.
Inflammation or swollen tissue is caused by pressure to tissue. The bad disc IS pressuring the spinal cord. No one has done advanced imaging such as an MRI or CT to view the cord as to the degree of impactful bruising, contusion or just a bulge of light pressure to the spinal cord. No matter the degree of damage, the cord does not like any pressure at all. The nerves react with sensation of pain. Swollen and inflammed tissue surounding the cord is very painful.

Pressure swelling-inflammation/contusion inflammation(impact bruising or crushing)= Pain

Prednisone is the drug to work on reduction of swelling/inflammation anywhere in the body, including around the spinal cord.

VET HELP
Is there another vet in the same clinic as the lady vet who is on vacation? That vet can then access Tyson's file and via a phone call adjust meds.

Ditto if Tyson was initially seen by an ER vet. Another ER vet on duty could access Tyson's folder. Think you would have a better chance though at the Lady vet's clinic with the vet on duty.

Mark, sorry your vet left without a plan B and details on who would/should take her place in supervising Tyson's meds.

Pain = inflammation
The body's natural response to tissue damage is inflammation. You know the usual for yourself if a hammer has missed the nailhead and landed on your finger:  redness, swelling, pain, maybe loss of tissue function.  With the reduction of prednisone, you may or may not see neuro decline, you may or may not see signs of pain. The taper is "the" test to get answers.

Hopefully the rotating vet you speak with will be one who is comfortable in their knowledge of IVDD including how important limited movement of the vertebrae is. Meaning if meds can be adjusted over the phone it eliminates a risky-to-the healing disc car trip.     

Explain your concerns in simple terms: 
-- TraMADol was added to the pain med cocktail. On 4/19 pain was finally in full control.
-- Prednisone taper is scheduled to begin on Saturday 4/23
-- Your concern: Is it likely 4 days from 4/19 will have given prednisone enough time to fully resolve swelling?  If pain would surface on 4/23 Sat afternoon or 4/24 Sunday when clinic is not open, what options are there to care for Tyson?

Seeing any new vet (including ER) not in the Lady's clinic would require transport for an exam before prescribing. That is the law—exam for new patient/new clinic, then Rx meds.

An experienced vet comfortable with IVDD in the Lady's clinic, would:
-- Ask if pain should surface, do you have enough pills on hand to cover immediately:
       • going back up to anti-inflammatory level Pred dose 5mg 2x/day until the clinic reopened
       • resume giving all pain meds 3x/day (gabapentin, traMADol and methocarbamol)
       • You would be on your own to resupply Pepcid AC 5mgs 2x/day

-- Based on his experience, the vet may have another idea to give you an Rx for another course of Prednisone. Such as a 5-7 day course. Also Rx's for the pain meds.

Hope to hear back from you, you had a conversation with a vet who knows their IVDD and now have a satisfactory solution to a prednisone taper scheduled for over the weekend.

P.S.  FYI, with registration comes a handy feature for you. Get an email alert when a reply has been posted.

Happy to hear that Tyson can move up to a sitting position.

Generally the pain meds are stopped or cut back during the taper so that it will be immediately known if inflammation still exists. Some vets stop completely, some vets cut back gradually. It would be up to your vet as to which he prefers.

It would be best to get your vet's guidance on how to cut back the pain meds.

Yes -- tomorrow is the day.
So -- NO meds tomorrow (besides the Pepcid followed by Prednisone in the morning)?
How soon should I know whether still in pain? In time for the Prednisone dose that night?
Vet is away for 2 weeks and I have had calls in at the clinic for days but no reply so far.
I am moving forward on the vet's initial approval of Plan B. If I see signs of pain, I'll put him back on all meds and inform the clinic afterward. She verbally agreed to that plan already last week.
p.s. the little monkey has started "climbing" the bars of his crate with his FRONT paws. Yikes! How to stop him from exerting himself? I must admit, it's a good problem to be having!!!

Good to know, thanks!
Spoke to another vet from the same clinic last night [4/22], who reassured me that for Tyson's weight (15 lbs), the 5 mgs / day of Prednisone would still have anti-inflammatory properties. He does not expect to see any neuro decline but said it would be fine to drop all pain meds except ▼Gabapentin 50mgs tab: 50mg 3x/day to monitor pain.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs  11 y.o.
prednisone as of 4/12: 5mgs 2x/day for 6 days
                   as of date 4/18: 5mgs 2x/day for 5 days, SAT4/23 test taper for: _pain / _neuro
gabapentin 50mgs tab: ▼50mg 3x/day 
Pepcid AC 5mgs 2x/day ]

Mark, scroll back up for the list of pain signs. Observing two or more pain signs can be helpful in confirming pain when you are uncertain because pain med is still on board, whether he over exerted and is just a bit tired, etc.

Had there been any further reduction of gabapentin in mgs or times per day?

Keep us posted as the evening goes on

Mark, good to hear Tyson is in comfort.

Until all pain meds are stopped there is no real proof about pain. The question is how long do you and your vet want keep blindfolds on about pain?

Mark, truth is no one not even the vet can know if there will be pain on the prednisone taper.  
    The taper is a kind of test to give proof if all painful swelling is gone. And to get that proof as soon as possible.
    Delaying finding out if there is still painful swelling, means a delay in getting back UP on the anti-inflammatory level that works on swelling.

There is a range of prednisone. The most typical is to expeditiously use the HIGHER end of the "anti-inflammatory" prednisone range with a disc episode at twice a day doses to get the swelling taken care soonest.
     For a 15 lbs dog that is prednisone at the anti-inflammatory level:

Depending on the dosage, steroids can be used at low doses as replacement steroid hormone in dogs not able to make sufficient hormone, can function as anti-inflammatory drug during a disc episode or even higher doses provide immunosuppressive effects for other diseases.

READING REF:
Not all vets are comfortable in using prednisone.
Not all vets are comfortable with their knowledge of IVDD. 

Not all dogs are in good health. Using powerful IVDD meds with heart, kidney or liver disease dogs, may mean the full strength of pred or other meds need to be downsized for the special needs of that dog. 

If there is a question, the blood panel test shows the health of organs to determine use of meds 

We are not vets, we may not be privy to the complete history of a dog.
 
It is the vet's call on which way to go with pain meds on a prednisone taper.
--- IF a dog as been long term on pain meds, it is the vet's call whether to back off of pain meds WHEN the prednisone taper starts.  Depending on the dog's history, some pain meds may need to be backed off by mgs and frequency
--- OR... the vet may decide a full stop of all pain meds WHEN the prednisone taper starts.

Your vet seemingly called for a backing off of pain meds. Did you get the directions, in how many days is the next reduction in mgs/frequency, and so forth til it stopped.  Pain meds last in the body for about 8 hrs. At some point dosing may be almost like not giving any pain med, then it is full stopped.

I'm so sorry you've been left by your vet and then having to kinda start a new with a vet you are not used to.  Talk you your vet about your concerns.  Let us know what he says.

Fingers crossed that Tyson will have a successful taper.

The taper gives the proof. When the taper ends you finally have proof positive if you have not seen any pain arise all swelling is actually gone! Fingers crossed you will NOT be seeing any signs of pain at any point during the tapering process.

IF you would see signs of pain along any point of the tapering process, you got your plan B in mind and what you need to do: Call the vet asap, give the signs of pain, advocate for all pain meds back on board, Pepcid AC and advocate for going up to the typical aggressive level of Prednisone 5mgs 2x/day.

What is the last date of the prednisone taper pill? We are waiting on that information to give you a safe way to maintain his leg health until such time he can move legs himself in a walking motion.

Still waiting to hear back about the Methocarbamol -- is it necessary to withhold the muscle relaxant while on the Prednisone taper, or not? I have noticed some mild trembling during potty time, etc. and don't want to deprive Ty of something to control muscle spasms unless it is necessary. Could you please advise? Is Methocarbomol technically a pain killer?

[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 11 y.o.
prednisone as of 4/12: 5mgs 2x/day for 6 days
                as of date 4/18: 5mgs 2x/day for 5 days, SAT4/23 test taper for: √4/29pain / _neuro
final taper dose on 5/21.
gabapentin
✙Methocarbamol 200mgs/1 mL:  as of 4/29-- 120mg (0.6mL dose) 3x/day  
✙gabapentin as of 4/29-- 50mgs tab: ▼50mg 3x/day
Pepcid AC 5mgs 2x/day ]