PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 30, 2022 8:22:15 GMT -7
Mark, please clarify, methocarbamol (muscle contraction pain) had not been stopped nor backed off along with gabapentin? Anything else that needs correction for his meds?
Did you observe a 2nd sign as a means to confirm Tyson is in actual pain (swelling is not yet resolved)?
MED LIST/HISTORY- 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 final taper dose on 5/21. Methocarbamol 200mgs/1 mL: never stopped nor tapered!, still on 120mg (0.6mL dose) 3x/day Pepcid AC 5mgs 2x/day
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Post by Mark & Tyson on May 1, 2022 5:18:22 GMT -7
Hi Paula, No -- you were initially correct in that I did stop the Methocarbamol along with the Gabapentin and Tramadol. Ty was off ALL his pain meds and taking ONLY his tapered Prednisone @ 5mg 1x/day. I was questioning whether the Methocarbamol was necessary to eliminate since its function is muscle relaxing rather than pain killer, and I was seeing signs of spasm (trembling). In any case, I started seeing other pain signals and decided late Friday night to implement my "Plan B" option. I simply felt he was not ready to taper off the prednisone yet. I contacted the vet the next day, and as of Saturday Ty's ▲Prednisone has been rescheduled to 5mg 2x / day - through 7 May; then tapering to 5mg 1x / day through 12 May; then tapering to 5 mg 1x / 48 hrs through 31 May.
She has left the pain management up to me to determine based on Ty's level of comfort. I have started back on Gabapentin 50mg 3x/day and Methocarbamol 200 mg/ml 0.6 mls 2x / day (no Tramadol, though she wrote a new script in case I need it) and he seems comfortable again. She initially wanted to increase pain meds only with no increase to prednisone and warns she likely won't extend prednisone again after this.
[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 4/18: 5mgs 2x/day for 5 days, SAT4/23 test taper for: √4/29pain / _neuro as of 4/30:5 mgs 2x/day for 8 days, FRI 5/8 test taper for: _pain/_neuro last dose 5/31 Methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day gabapentin as of 4/29 50mgs tab: 50mg 3x/day Pepcid AC 5mgs 2x/day ]
Not only has Ty "bounced back" since Friday night, he has even taken a few tentative and very shaky steps.
I am thinking that a few laser therapy sessions at a nearby clinic might be worth the risk this week to try to get that inflammation under full control. Thoughts? Recommendations?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 1, 2022 8:14:27 GMT -7
Transports are only for the high beneficial things worth the risk of potentially too much movement of the healing disc. IF, if a Re-tear of the disc, that will mean pain for Tyson, starting back at square one in the 8 weeks of rest, more vet bills, your anguish of subjecting Tyson to a transport.
Inflammation: When meds can be administered at home to deal with inflammation, that is the safety for the disc. At home vet visit for laser, if you must have, is an alternative safety measure for the healing disc. Car transports to get any service means a risk for his healing disc.
Tyson is on such a clear path of healing! Be mindful to keep disc safety at the front of your thoughts for Tyson: "any time out of the recovery suite is a danger to the healing disc."
Taking a few shaky footsteps means the nerves have healed even more to allow those footsteps. Do nothing to set Tyson back.
Being in full comfort means the inflammation will be worked on by prednisone in the safety of his at home recovery suite.
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Post by Mark & Tyson on May 1, 2022 11:00:21 GMT -7
Thanks for those reminders, Paula, which I will now make my mantra: disc healing paramount!
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Post by Mark & Tyson on May 3, 2022 5:52:46 GMT -7
After picking up the new script for Prednisone, I noticed a discrepancy between the instructions on the label and the total number of pills. Once I notified the vet of my concern, they supplied me with the missing pills, but now I want to double check that their taper plan seems correct to you: the current dosing is at 5mg @ 2x/day, which lasts for another 9 days; then tapers to 5mg @ 1x/day for another 10 days; then tapers again to 5mg @ 1x/48 hours for another 20 days. Does this tapering seem sufficient?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 3, 2022 8:14:33 GMT -7
Prednisone is an unusual drug. It is actually a hormone! The body normally makes its own cortisol hormone to run certain body functions. When pred pills are in use, the body no longer makes its own steroid hormone. A typical prednisone taper schedule regimen can vary from days to weeks depending on the mg dose a dog had been on and for how many days. This is why prednisone must always be used under the supervision of a vet. The vet has the veterinary training and his experience to best design the taper schedule for a patient. If you look at other prednisone patients on the Forum, you will see a variety of tapering schedules. Prednisone always ends in an every other day dose for the purpose of signaling the body to restart production of its own steroid (cortisol). Hey, if you have a photo of Tyson, we'd love to see him! : -- Mark & Tyson > Edit Profile > Use only the Uploaded/Linked jpg > Save Avatar Changes
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Post by Mark & Tyson on May 4, 2022 5:49:26 GMT -7
Within the last 24 hours or so, I have seen [5/3] what looks like a setback. Ty is suddenly much more "low key" than he has been for the past several days (pain?) and yesterday afternoon when I returned from an errand, I noticed that he is suddenly not readily displaying the same degree of neuro function in his front legs as he was prior. He is not as willing to "stand" on his front legs as he had been up until yesterday, and he is now preferring to curl his front legs under him again. Is it possible that he has reinjured or strained himself (maybe by being too frisky) in his crate, torn some scar tissue, or that there has been further disc extrusion? Or are ups and downs like this typical during the healing phase? He seemed to be making such reliably incremental progress. Now, I don't know what to think.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 4, 2022 7:16:00 GMT -7
Mark, neuro function does not diminish unless there is a reason of something pressing on the cord. Pain, if you are reading "low key" correctly + at least one other sign of confirming pain happens when something is pressing on the cord. Being too frisky, rambunctious in the recovery suite has the potential to disrupt early healing disc scar tissue.
Add in traMADol (general analgesic) to the existing gabapentin (nerve pain) and methocarbamol (muscle contraction pain). Let us know what you observe when adding traMADol.
What is the Rx for traMADol? ?mgs ?x/day
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Post by Mark & Tyson on May 4, 2022 8:27:25 GMT -7
It finally occurred to me that on my return from the gym yesterday, a neighbour stopped to talk to me just outside where Ty's crate area is for 5-10 minutes. I think Ty must have heard us, become excited, and likely strained and hurt himself by the time I came inside and recognized his changed behaviour.
I have now ✙Tramadol as you suggested, [5/4] administered the first dose, and will report its affect. Does this mean we are back to square one in terms of disc healing time? So disappointed.
[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 4/18: 5mgs 2x/day for 5 days, 4/23 test taper: √4/29pain / _neuro as of 4/30:5 mgs 2x/day for 8 days, FRI 5/8 test taper: _pain/_neuro last dose 5/31 Methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day gabapentin as of 4/29 50mgs tab: 50mg 3x/day ✙traMADol 25 mg 3x/day Pepcid AC 5mgs 2x/day ]
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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 4, 2022 9:05:56 GMT -7
Mark, let's see what traMADol does for suspected pain.
Also let's see if there is a change in not willing to stand -- due to frisky overdoing/straining muscles yesterday caused soreness OR -- if he still can not move up in to a stand because of too much movement causing a neuro diminishment via a disruption of the disc scar tissue.
What is the Rx for the traMADol? How many mgs is each dose? How many times a day do you give?
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Post by Mark & Tyson on May 4, 2022 11:57:48 GMT -7
Quick follow-up to report that: he briefly stood on all fours (unprompted) while eating his dinner tonight. Such a relief, and yet another lesson learned. He must have really strained himself, but hopefully is just experiencing sore muscles rather than neuro loss. As before, the Tramadol seems to have done the trick in terms of pain management. I feel like I must owe you some pretty steep counselling fees by now, Paula! -------
The tramadol is 25 mg tablets, 1 tablet / 8hrs. He pretty much went to sleep half an hour after I gave him his first dose. He does still seem to be able to stand on his front legs but is not so willing as previously, which makes me suspect that it is now painful for him. I noticed this change yesterday after coming inside from the gym. No more chats in the driveway for me, I guess. I really hope the issue is muscular rather than disc related tearing / spinal cord pressure! The good news is that we still have another week on the full dose of prednisone.
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Post by Romy & Frankie on May 4, 2022 13:45:27 GMT -7
Glad to hear that the tramadol is taking care of any pain.
Tyson may just have strained himself and not damaged the healing disc. He is able to stand, and you are not reporting any neuro diminishment.
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Post by Mark & Tyson on May 4, 2022 14:02:37 GMT -7
I am wondering whether the crate I have him in might be too tall? Perhaps I should be crating him in a shorter cage so that when someone knocks at the door or he hears someone / another dog outside, or he anticipates food, he can't freak out and hurt himself by jumping up and clawing at the bars? I just assumed he'd be safe in his crate, but I guess not.
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Post by Romy & Frankie on May 4, 2022 14:21:37 GMT -7
To keep Tyson from jumping up in the crate, consider draping a blanket over the top of the crate, letting it hang down a bit over the sides. Tyson will be unlikely to jump up, if he can't see when he does.
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Post by Mark & Tyson on May 4, 2022 15:41:58 GMT -7
Definitely showing less strength / inclination in his front legs. Any way to know for sure whether this is neuro function or strain? I'll try the blanket, but it is not usually something he sees that triggers his excitement. It is what he CANNOT see that drives him nuts.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 4, 2022 20:04:35 GMT -7
Mark. as you may have experienced with your own muscle soreness, often it will subside with a good nights rest. Draping a blanket over the suite as Romy mentioned is to dissuade Tyson's from rising up too high or bouncing with his front legs, if that is what he had done. So drape the blanket down to his eye level when sitting on his butt and front legs extended to support his upper body. This way if he tries to rise up or bounce, put his paws against the side of the suite, all he will see is darkness. Soon he will learn he sees more of what's going when in a sit. Hopefully the draped blanket will give him a sense of calmness in a more den like situation and not go nuts, if that is what he did. Does he eat his meals in his suite? I'll be watching for your update in the morning. Hope you, too, can get a good nite's sleep.
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Post by Mark & Tyson on May 5, 2022 4:18:06 GMT -7
Thanks again, Paula. After another good night's sleep (and the Tramadol on board) Ty seems to be back to himself this morning. He showed more agility during potty time and stood to eat breakfast. His paws are still not strong and his proprioception is still weak, but otherwise he seems okay. I will definitely try the blanket -- I have one over the bedroom crate, so it won't seem strange to him for me to drape one over his kitchen crate. Maybe he will actually get the message that I want him to REST!
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Post by Mark & Tyson on May 6, 2022 6:30:36 GMT -7
Just wondering whether you can supply me with some further information regarding cervical IVDD causing front limb paresis / loss of proprioception. I can find material on cervical IVDD, but most of it focuses on neck pain, and I can find information on IVDD, most of which focuses on rear limb paresis / paralysis, but I can find very little written about Ty's precise issue. It has been a few weeks since I have seen any dramatic progress in the front limbs (along with a bit of a setback on Tuesday), and I am wondering whether it's normal to hit a plateau or a bad sign? We are in week 3 now, and some literature suggests that if a recovering dog doesn't start walking by the end of week 4, the chances of the dog ever walking dramatically diminish. I also have read that the chances of full recovery with cervical IVDD paralysis are lower than with thoracic or lumbar variants, but I don't know whether to believe everything I've read. Can you offer any experiential advise? I don't want to lose hope but I also want to be realistic aboout how far rest can take him on this journey.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 6, 2022 8:14:16 GMT -7
Mark, the body is working on nerve repair. At the point there is more nerve connection, then you see from the outside a new observation of neuro improvement. Until then it may seem from the outside that nothing is happening. Nerves are the slowest part of the body to self repair. Generally speaking we ought to think more in terms of months rather than days/weeks for nerve repair. There is no timeline for nerve repair that any one can give you. Every dog is different, every disc episode is different.
Watching for nerve repair is like watching a kettle of water to come to a boil! Frustratingly sloooow. Ortho surgeon Andy Torrington BVMS CertSAO MRCVS with years of experience explains why the need for patience with nerve healing which apply to the front legs as well as back leg function whether after a surgery or with conservative treatment:
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Post by Mark & Tyson on May 8, 2022 7:15:42 GMT -7
Wow -- those words really resonate, Paula. Thanks for that encouragement. Some days can feel particularly discouraging, for whatever reason, so I really appreciate the sage counsel.
Happy to report that yesterday, I witnessed [5/7] two full steps on all fours in the suite (along with a gleeful bunny hop that briefly altered my heartbeat!) and lots of standing on all fours. Proprioception also seems to be improving, and I am now seeing some deliberate front paw placement. This is all very exciting, but it raises a question in my mind regarding how restrictive I need to be about all this tentative walking in the suite? I am still sling walking (front and back supports) at every potty time, though I am seeing increasing demonstrations of desire for independence. I learned a valuable lesson about the price of overdoing it, so I want to check and see whether or not I should be permitting free movement within the suite. How much is too much at this stage?
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Post by Ann Brittain on May 8, 2022 8:27:14 GMT -7
Hi, as Paula commented in a previous post, you really want to restrict movement until the end of crate rest. I know it's difficult when your dog wants to be active. A few steps at potty time are okay, but be sure Tyson does not have opportunity to move around too much or run.
It's great to hear this positive news. Just hang it there and soon your pup will be back to his old self.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on May 8, 2022 10:39:17 GMT -7
Mark, here are my thoughts with Ann's important comment at potty time. With Tyson feeling more fisky, you might want to consider a 6 foot diameter fenced in potty place. The physical of seeing the fence boundary will let him know there is simply not going to be any attempts to dart off. Check your local hardware store or big box store for some garden edging wire poke in the ground fence. Or you can also use an ex-pen as a potty place in the grass. In his recovery suite, it is ok for him to stand and take a few footsteps to turn around. What is not permitted because it is too much movement for the back is putting his front paws on the side of the suite, bouncing up and down or anything else that is rambunctious activity.
Your report of new ability to take a few footsteps AND place the paws correctly on the floor is, indeed, exciting. As many times as there are reports of dog's nerves healing, it continues to be an awesome thing to hear about. Tyson is on a roll!!! Keep up your good work in ensuring the disc heals for his upcoming graduation day of June 7th.
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Post by Mark & Tyson on May 9, 2022 5:54:37 GMT -7
Thanks for those reminders, Paula and Ann. I have to keep reminding myself that less is more, and while I want to see progress, I also need to remember that the disc is only half way healed. Using the sling for support, I allow little to no actual steps at potty time -- his legs look like those of a cartoon dog running in place! It is in the crate I'm having the hardest time keeping him from literally climbing the walls and hopping around when he's excited.
[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 4/18: 5mgs 2x/day for 5 days, 4/23 test taper: √4/29pain / _neuro as of 4/30:5 mgs 2x/day for 9 days, Thurs 5/12 test taper: _pain/_neuro last dose 5/31 Methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day runs out before 5/12 gabapentin 50mgs tab: 50mg 3x/day traMADol 25 mg 3x/day Pepcid AC 5mgs 2x/day ]
In any case, I feel a lot better about heading into the taper on [5/12] Thursday given his current status. I plan to halve his pain meds along with his prednisone, so that he will be getting 12.5g @ 3x/day Tramadol and 25 mg Gabapentin @ 3x / day for those 10 days. After that, I will go down to @ 2x/day for both.
The methocarbamol is nearly done and will likely run out before Thursday.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on May 9, 2022 8:12:01 GMT -7
Mark, is the 1st pain med reduction of 10 days length your vet's directive or something you've decided on?
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Post by Mark & Tyson on May 9, 2022 9:41:59 GMT -7
The vet has left the pain management question up to me based on Ty's comfort. I know she won't renew the prednisone again no matter what, so I thought it might be a good idea to continue with some pain meds during the taper. She suggested that some discomfort might continue even after the swelling has subsided. Is this not a good plan? What do you suggest?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 9, 2022 9:55:26 GMT -7
The point of the pred taper is to find out ASAP if pain remains. Pain med block you ability to quickly and accurately asses for pain.
Vets make the decision to either start backing off pain meds on the day of the taper based on the dog's history. We likely do not know your dog's full history and we are not vets.
Most vets will full stop pain meds on the day the taper starts. Except for those vets who know their patient has had some medical history and use of pain meds that indicates backing off every several days in mgs and frequency til the pain med is gone is better for their client's need.
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Post by Mark & Tyson on May 9, 2022 10:03:20 GMT -7
My vet has indicated that she believes that the single dose of Prednisone 5mgs@ 1x/day will still have anti-inflammatory properties given Ty's weight, and that I should not back off the pain meds at that point. Instead, she thinks I should wait for what she regards as the taper, which would commence on 5/22. If I followed your plan, Paula, and stopped all pain meds on Thursday, what would I do in the event that Ty did show signs of pain during that 10 days?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 9, 2022 12:42:24 GMT -7
Mark, scroll back to the post I made on April 26 at 1pm MST. Tell us what you think about reduction or taper of prednisone and what concerns you have in identify pain.
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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 9, 2022 13:50:27 GMT -7
Medical definition of tapering: A tapering regimen of medication involves gradually reducing the amount of a drug. A reduction from 5mgs 2x/day to 5mgs 1x/day is a taper dose.
Prednisone is one drug that MUST be tapered down from the higher anti-inflammatory level. That taper signals the dog's body to restart making its own very low level of steroid hormone.
The pred taper for a disc episode also provides a perfect window to peek if all swelling is gone or not gone.
Pain surfacing during taper days = not all swelling is gone and another 5-7 day course of pred may just do the trick. Plus all pain meds back on board.
There is a range of prednisone to use at the anti-inflammatory level. The higher range of dose is most often used for treating a disc episode. Getting inflammation down soonest is the optimal for spinal cord protection.
If there would still be inflammation, the higher level of another course of prednisone 5mgs 2x/day could be expeditious in resolving swollen and inflammed tissue around the cord.
Do you have an understanding of why your vet wants to use the lower end (less aggressive) of the anti-inflammatory level of prednisone PLUS continue the use of a pain med?
Does that med combo indicate she believes there is still swelling around the spinal cord?
You don't know the why behind your vet's thinking unless you ask. She doesn't know your concerns unless you express them.
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Post by Mark & Tyson on May 9, 2022 14:10:54 GMT -7
I've had this conversation with the vet, which is how I negotiated for the extended prednisone course and the Plan B -- which we ended up needing. But she also expressed to me that when I used the Plan B, we had gone beyond what she was comfortable prescribing and that she would NOT extend the higher dose of the prednisone again. She does not seem to agree that pain necessarily = swelling on the cord. She told me that she felt I should follow the prednisone taper and give the pain meds as prescribed. She felt there was no need for concern and that the prednisone had already done its job. I don't think I would be able to convince her to increase the prednisone dose again even if I felt Ty was in pain. Do you think it is time to find a new vet? I am not sure I want to try to do that given that it would almost certainly mean a trip in the car, which would risk disc healing. He will have been on the full dose of prednisone for 30 days come Thursday. What are the chances he will still need the 5 mgs 2x / day by then?
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