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Post by Stephanie B on Jul 2, 2022 10:23:19 GMT -7
 i.postimg.cc/BnqHfBN0/Conser-Rest.png1.Yes, Bruno is currently in pain.2. Bruno weighs 9 lbs 8 oz and is roughly 2-3 years old. I rescued him 16 months ago and the vet estimated he was around 1 year old when I brought him home. A. Bruno was given 100mg of Gabapentin to take every 8-12 hours and 2.5mg of Prednisone to take 2 tablets per day for 5 days, 1 tablet per day for 5 days, then 1 tablet every other day for 5 doses. Both medications were prescribed today, 7/2/22. [MED LIST/HISTORY- Moderator's Note. Please do not edit
9 1/2 lbs 2-3 y.o.
7/2 am wobbly; 2 hrs later (time??) vet appt.
Methadone (opiod) shot on 10am 7/2; Duration of effect is 4 to 6 hours
prednisone 2.5mgs tabs as of 7/2: 5mgs 2x/day for 5 days, 7/7 test taper for: _pain / _neuro
gabapentin (nerve pain) 100mgs 3x/day
⚠️Bruno needs GI tract protector, Pepcid AC, on board w/prednisone! ] B. Yes, Prednisone, mentioned above. C. Pepcid AC was never mentioned when talking to a veterinarian. 3. Bruno is not eating, but that could be because he is in pain. 4. Bruno is a Chiweenie - Chihuahua and Dachshund mix. My name is Stephanie. 5. Yes, Bruno was diagnosed with IVDD. The veterinarian is a general DVM. 6. We saw the vet for conservative treatment on 7/2/22 [10am].
7. Since we left the vet, Bruno has not gone outside to go potty. He was given a Methadone shot to relieve pain, and is a bit out of it at the moment. In an hour or so, I will carry him outside to use the bathroom. This morning, two hours before we went to the vet, he [8 am 7/2] went outside and used the bathroom with no issues.8. This morning, Bruno was able to walk outside and use the bathroom. We went back to sleep after that. Two hours later, I opened his crate to get him ready to go to the vet, and he [10am] couldn't walk without leaning against the wall for support. At this point, I have not let him try to walk. He has trouble sitting and is wobbly. I understand that I am posting to this thread really early on in Bruno's diagnosis, and I know I need to continue to monitor him closely, but I appreciate any and all help I can get here. Thank you so much. Stephanie |
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Post by Romy & Frankie on Jul 2, 2022 13:47:17 GMT -7
Welcome to Dodgerslist, Stephanie. We are glad you’ve joined us all. We’ve got valuable information we’ve learned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you! Learn more about us and how we team up with veterinarians: dodgerslist.com/about-team-dodgerslist/
You mention that Bruno is in pain. The signs of pain we look for are: - 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 - 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 If you are seeing any of these signs, let the vet know what you are seeing right away, so the pain meds can be adjusted. Bruno should not be in pain. Pain will slow the healing process.
Did the vet say for how long the methadone shot would be effective?
Gabapentin is effective against nerve pain, particularly when given every 8 hours, but sometimes more than gabapentin is needed. What we have seen work most effectively against IVD pain is a three medicine approach, each addressing pain differently.
Methocarbamol for painful muscle contractions. 3x/day Tramadol Rx'd 3x/day as the general pain reliever Gabapentin for nerve pain also Rx'd 3x/day.
All anti-inflammatories, like pred cause excess stomach acid which can sometimes lead to serious stomach damage. Because of this a stomach protector, like Pepcid AC is used. Ask the vet as soon as you can if Bruno has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
This is particularly important as Bruno is not eating. This may be because of pain, but it may also be because of nausea caused by excess acid. If this is the case, Pepcid AC should help.
The usual dose during a disc episode is Pepcid AC (famotidine) 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours.
The hallmark component of conservative treatment is the very STRICT crate rest part. It is the immobility enforced by crate rest that allows the disc to heal. Strict means: - no laps - no couches - no baths - no sleeping with you - no chiro - no dragging or meandering at potty times Carry Bruno to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over.
We have some more info on crate rest here: dodgerslist.com/2020/05/14/strict-rest-recovery-process/
➤ Medications used during a disc episode: www.dodgerslist.com/meds-used-during-disc-episode/ ➤ What to expect for each phase of healing: www.dodgerslist.com/in-the-right-place
Here are some emergency signs and the appropriate action to take. You can print this flyer and put it on your fridge for easy reference: dodgerslist.com/wp-content/uploads/2020/05/emergency-fridge-flyer.pdf
We encourage you to register and set up email alerts as timely interaction/communications is needed when helping your dog. How to register and how to do the email alerts here: www.dodgerslist.boards.net/thread/7353/register-bookmark-dogs-post-thread
It is very scary when our dogs have IVDD. It becomes less so when we learn all we can about the disease. We have a lot more information on our main website: www.dodgerslist.com
You can use the search bar at the top of the page to search for specific topics. |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 2, 2022 14:41:57 GMT -7
Stephanie with your reporting current pain, that means the pain meds are not yet right for Bruno.
Have no patience with pain. When the meds are correct pain is in control in one hour. And full comfort is provided dose to dose, round the clock. With the weekend upon us, you may need to contact ER to get help for the current uncontrolled pain and get those meds adjusted.
Methadone (opioid) shot lasts for 4-6 hours. You provided no specific time at vet appt so, it may well have worn off by now and the reason for pain surfacing!
As Romy explained, typically with a disc episode there are 3 sources of pain that need covering. Pain meds last for about 8 hrs. Are you giving gabapentin PROMPTLY every 8 hrs.? If not move up to every 8 hrs (3x/day) Advocate for all three sources of pain to be covered every 8 hrs:
Gabapentin for nerve pain
traMADol pill (synthetic opioid) as the over all analgesic at home
methocarbamol for muscle contraction pains
When possible always provide exact date, time, and frequency given, mgs dose so we can best understand things.
Hope to hear back, Bruno, has the right combo of meds on board and is in full comfort from pain.
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Post by Stephanie B on Jul 2, 2022 15:45:54 GMT -7
Thank you both so much for replying so quickly. Today has been an absolute nightmare and I'm trying my best to handle this the right way.
I just sent my boyfriend to the store to get ✙Pepcid AC and we will start that right away. His Methadone shot was around 10am [7/2] today, so it definitely wore off by this point. We gave him the first doses of
Gabapentin [every 8 hrs] and Prednisone at 3pm today, 7/2.
His next dose of Gabapentin will be at 11pm today, 7/2.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
9 1/2 lbs 2-3 y.o.
7/2 am wobbly; 2 hrs later (time??) vet appt.
Methadone (opiod) shot on 7/2 10am ; Duration of effect is 4 to 6 hours
prednisone 2.5mgs tabs as of 7/2: 5mgs 2x/day for 5 days, 7/7 test taper for: _pain / _neuro
gabapentin (nerve pain) 100mgs 3x/day
✙Pepcid AC 5mgs 2x/day ]
He is currently sleeping, which is amazing - he has been up for so long at this point. I am happy to see him resting and in a comfortable position. I will bring up the other two medications to our vet tomorrow morning when we see her. I will update this thread tomorrow once we get home from the appointment. Thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 2, 2022 15:51:23 GMT -7
➡️ EMAIL ALERTS PLease register. This opens the feature to be able to receive email alerts when someone has posted. Timely interaction/communications is needed when helping your dog. The guest board is a temporary thing to give you quick access and answers when harried and hurried. It would help us help your dog so much better if you would register and log in tp post. Registered members can set up email alerts when anyone has posted on their dog's thread.....very handy! Illustrated guide on what to expect during registration:dodgerslist.com/2021/06/30/forum-registration Appreciate your registering when you are able. Thank you! |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 2, 2022 16:29:00 GMT -7
Stephanie, so glad you have access to your vet on Sunday 7/3 to make sure all meds will be providing full round the clock comfort. We were anxious to not have any way to contact you. Hope you will find it doable to register have the handy email alert feature. Let us know that you are dosing Pepcid AC (famotidine) 5mgs every 12 hrs for a 9 1/2 lbs dog. Dogs don't speak up at first signs of trouble like a person would. Red flag signs can progress from: nausea> not eating> 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/Let us know your vet tells you Bruno has no health issues to prevent use of Pepcid AC. 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 Prednisone.  With true STRICT rest of conservative treatment employed AND free from pain around the clock, Bruno should be able to self-heal his nerve diminishment and his self-heal the disc with time. KNOW PREDNISONE Pred is one med that is unlike others. It is a hormone that must be tapered off in a particular way your vet instructed. On the taper that starts THURS 7/7, you have an important job to observe for any surfacing pain. To do that job, your vet should tell you whether to full stop all pain meds or back them off with frequency and less mgs. You can not assess pain, with pain meds are on board.
Short RULE OF THUMB on the pred taper
pain = swelling =
back up at anti-inflammatory dose (5mgs 2x/day),
pain meds & Pepcid AC
It may take 7- 30 days on pred (excluding any taper days) to resolve painful swelling. Vets use the safe approach by Rxing one pred course. Bruno got a 5-day course. Then taper to see if pred had done its job. If pain arises then try another pred course.
Please read the FULL story of how prednisone is used with a disc episode. You'll want this background to ask the right questions, better understand what the vet is saying. Be prepared...here is the link: dodgerslist.com/2020/04/18/steroids-vs-nsaids/
Let us know what you and your vet have come up for a Plan B and if there will be a full stop of all pain meds or backing them off on July 7th. Of course if you observe pain is not being controlled, then it would not be time to start a pred taper on 7/7. Instead you vet would likely call for a 2nd course of pred (maybe another 5-7day or a 14-day course of pred. |
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Post by Stephanie & Bruno on Jul 3, 2022 12:30:10 GMT -7
Post is being marked. If you have additional or corrective info re: actually dose times, etc, just make a new post for that info. Thanks!]
Hi Paula. We just got back from the vet a little bit ago. I can confirm that the vet told us Bruno has no health issues to prevent use of Pepcid AC. We are going to begin dosing Pepcid AC 5mgs every 12 hours for 9.5lb dog.
We are taking the strict rest of conservative treatment very seriously and are praying for self-healing. We return back to the vet next week for another checkup to see where he's at.
His Prednisone should last until July 21st (2x a day for 5 days,
[tapering doses]: 1x a day for 5 days, then 1x every other day for 5 doses).
The Gabapentin should last a bit too - I was given 50 capsules and Bruno can take it up to 3 times per day (every 8 hours minimum).
We also started ✙Tramadol today 7/3, 25mg every 8-12 hours. [WHICH actually??]
[MED LIST/HISTORY- Moderator's Note. Please do not edit
9 1/2 lbs 2-3 y.o.
7/2 am wobbly; 2 hrs later (time??) vet appt.
prednisone 2.5mgs tabs as of 7/2: 5mgs 2x/day for 5 days, 7/7 test taper for: _pain / _neuro
gabapentin (nerve pain) 100mgs 3x/day
✙traMADol (general opiod analgesic) 25mgs ? times per day actually?
Pepcid AC 5mgs 2x/day ]
When we go back next week, I will discuss plan B with the doctor and figure out what is best for Bruno. This is an extremely difficult time for us, and I am doing my absolute best to stay strong for him. I appreciate all of the help and advice you have to offer.
We currently only have a wire crate for him, but am wondering if switching to a wire pen would be more beneficial for him.
I am also going to either take time off work next week or try to work from home so that I can closely monitor him.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 3, 2022 12:58:31 GMT -7
Stephanie, thank you for taking the time to register!! Good job in getting the meds adjusted! Now we wait to see if in one hour all pain is fully in control. If not further med adjustment is needed. Let us know if pain is now being controlled right up to next doses and when needing to move such as reposition in the crate or the very few footsteps allowed at potty time. We appreciate your sharing med options. To understand things and catch patterns, we need to hear the actual mgs and actual times per day you give any med. Hopefully you ARE doing 3x/day for pain meds: gabapentin 100 mgs ?x/day
traMADol 25mgs ?x/day
Prednisone, the important part is the anti-inflammatory level (5mgs 2x/day) for 5-day course⚠️The 5-day pred course taper BEGINS on THIS Thurs 7/7.
Now is the time to get your plan B in order. Know if you are to full stop both pain med OR begin backing down in mgs and frequency this Thursday. Quickly get up to speed on how prednisone is used during a disc episode: dodgerslist.com/2020/04/18/steroids-vs-nsaids/All transports to a vet are a potential for too much movement of the spine and worsening neuro function if the disc is would be further damaged. Vets who know IVDD take care of things that can be done over the phone (med adjustments, updates from you on observations, pain or neuro loss). Advocate on behalf of Bruno to take care of those things that are appropriate for handling via phone call. How to monitor for neuro loss.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. 7/2 Pain caused by the intial disc tear & inflammation in the spinal cord
2. 7/2 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. 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, 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.
A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/
A wire crate or an ex-pen make good recovery suites. Many owners like to have two suites (one in the bedroom at night and the other in the family area for the day time). SET UP FOR EMAIL ALERTS Your can receive email alerts when someone has posted. Timely interaction/communications is needed when helping your dog. i.postimg.cc/T1xztZX3/Bookmark.png ** Bookmark your dog's thread to receive an email alert when someone has replied. Go to the CONSERVATIVE Board dodgerslist.boards.net/board/6/conservative 1. Look for your dog's thread and checkmark it. 2. Look for the white ACTIONS button towards top. 3. Select “Notification Options" from the pull down menu — check mark “NEW POST” change from never to INSTANT email — press the SAVE button. Click the “x” to close the window 4. Next choose the “Bookmark” See the tiny book symbol now! i.postimg.cc/GhKYTNg7/Bookmarking.jpg |
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Post by Stephanie & Bruno on Jul 3, 2022 14:21:32 GMT -7
Hi Paula! Good news - Bruno does n't seem to be in any pain. We are so relieved to see him relaxing and sleeping. Sorry for being vague! For gabapentin, we are taking that every 8 hours (3x/day). T ramadol will be taken 3x/day as well, but because we gave him his first dose today at 2:30, we will only get 2 doses in today. Thank you for reminding me about contacting the vet about prescriptions over the phone. I will definitely be utilizing that form of contact this week. As far as neuro loss, Bruno currently has paresis, not paralysis, in his back legs. The PT specialist showed us something we can do this week to keep his front legs strong and exercised while also helping him "find his back feet". We will do this 1-2x per day to keep the strength in his upper body. Our biggest worry right now is that Bruno cannot pee on his own. We have watched YouTube videos and today we watched the nurse express his bladder. It looked so easy! We are having such a tough time. The doctor cleared his bladder with a catheter today around 12pm, so it's been a little over 5 hours since he last went potty. Do you have any tips or tricks for this? We really don't want to have to go back tomorrow for another catheter.  |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 3, 2022 16:20:17 GMT -7
Stephanie, help us out/fill us in. What date did specific neuro loss happen on? Do you mean to say Bruno? -- can no longer wobbly walk? -- He can no longer even weakly move his back legs his back legs to reposition in the recovery suite? -- He can't even attempt to scratch an ear if he would have an itch. -- Can he do a happy tail wag if you specifically do some happy talk to him? IF a dog could use the back legs even if very, very weakly, then he very likely still has bladder control. Loss of nerve function goes in a VERY SPECIFIC, PREDICTABLE order as outlined in my previous post: How to monitor for neuro loss. Once there is total back leg paralysis THEN the next neuro function to be lost is bladder control 1. 7/2 Pain caused by the intial disc tear & inflammation in the spinal cord2. 7/2 Wobbly walking, legs cross3. ? Nails/toes scuffing floor4. 7/3? Paws knuckle under on what date?5. ? Weak/little leg movement, ? can no longer move up into a stand6. ? Legs do not work at all (paralysis, dog is down)7. ? 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 lostAre you saying he has lost bladder control evidenced by leaking on you when lifted? That you are finding urine leaks in bedding?PREDNISONE While on prednisone you willl need to carry him to and from the potty spot every 3-4 hours IF he still has bladder control. Prednisone makes them thirsty, drink more and thus fill their bladder up sooner. LOST BLADDER CONTROL If he has, indeed lost bladder control, you will need to express every 2-3 hrs as you are learning a new skill. After a weeks worth of expressing and he is staying dry, you could like move up to 3-4 hrs, then 4-6 and even 8 hrs overnight. when set down on an old pee spot outdoors. If he can no longer, after sniffing make choice to release urine there, then going in for another hands on top of your hands expressing lesson outweighs the risk of getting a bladder infection tomorrow. NO PT during Conservative TREATMENT. Getting up to speed as quickly as possible allows an IVDD savvy pet parent to recognize and politely "no thanks" to any well-intentioned but harmful advise. The focus for 8 weeks is on preserving nerves and not inviting any undo movement of the entire neck and back to potentially worsen the disc damage which in turn could increase neuro diminishment! Once off of all meds and no pain is proved, a very light least aggressive way to help Bruno's joints and muscle will be presented. The proof of no pain/no new neuro issue depends on the taper of prednisone on starting Thurs. The mild to moderate muscle diminishment will bulk up again when safe to do so at graduation on AUG 27. Nerves can self heal with time (think months rather than days/weeks) as long as they have not been severely/permanently damaged. EXPRESSING LESSON If Bruno has truly lost bladder control, then you need a hands on top of your hands type of lesson. You DO NOT want to only be observing someone else expressing---you learn nothing that way. FIRST view the Dodgerslist Video on Expressing so you get more out of the hands on top of your hands lesson: dodgerslist.com/2020/05/05/bladder-bowel-care/
Transporting Bruno for a real expressing lesson is an urgent and important health benefit that outweighs the risk of a transport.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. |
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