Marge's Pip 7/20 conservative - Canada

Marge, welcome. Is his name Murphy?

When there is a suspicion of a disc episode and there is only pain, it can be hard to diagnose. As other issues such as arthritis, sprained muscle, etc. can have same symptoms of pain.

Therefore, the proper thing to do is to crate at once (in case it may be a disc episode).How to carry out STRICT REST: dodgerslist.com/2020/05/14/strict-rest-recovery-process/
     Observe for a few days to see if muscle sprain pain goes away or if continued pain, then may be disc episode needing anti-inflammatory, pain meds and stomach protector.

MONITOR pain due to a disc episode.
Resolution of spinal cord inflammation/swelling with an anti-inflammatory provides the relief from pain. HOWEVER, it can take an anti-inflammatory (steroid or a non-steriodal NSAID) a range of 7 to 30 days before all swelling is gone.

The best pain medications control is using more than one approach to address pain from multiple fronts (traMADol-general analgesic, methocarbamol- muscle spasm pain, gabapentin-nerve pain). All three pain meds need to be prescribed three times a day.

Advocate for the three pain meds plus a stomach protector such as Pepcid AC (Famotidine) to protect against the side effects of the anti-inflammatory. Verify your dog has no health issues (heart, liver, kidneys). Purchase at any grocery store.


SIGNS OF PAIN with a disc episode:
⚙︎ 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

    -- Understand anti-inflammatory drugs with a disc episode. An informed owner is a dog's best defense when taking an anti-inflammatory. What your job is, how to arrange for a Plan B with your vet.
dodgerslist.com/2020/04/18/steroids-vs-nsaids/
    -- Be informed on each med your dog takes: www.marvistavet.com/pharmacy-center.pml

MONITOR NEURO DECLINE due to a disc episode
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, slow to or can't right the paw on the floor.
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  with conservative treatment or after surgery or.
    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:
dodgerslist.com/2020/02/10/surgery-vs-conservative/
 

Marge with no pain meds on board, no anti-inflammatory on board and he IS moving w/o pain to roll on his back...that is a good sign this may well NOT be a disc episode.

If you are wanting a second opinion, then make sure there is not undo movement to the back during the transport.

THE USUAL: Transport to a vet involves risk of too much movement of the spine with potential to then damage the early healing disc during an actual disc episode.
      The benefits of the treatment always needs to be weighed against the risk of too much movement.  Many things can be handled via a phone call vs. a transport in.

Marge....Oh, boy, there MUST be some missing information, cause what you report is strange.  What is gabapentin dose in mgs and how many times a day given?

Some background points: 
-- A disc episode cannot be proved with an X-ray. Only a $1000+ MRI can prove disc damage.

-- Xray is typically used to rule out other suspicioned diseases (broken vertebrae, tumor, bone disease, etc.) that may have the same symptoms. Overdoing muscles can also cause pain, but does not cause loss of neuro function.

-- Vets and owners first learn if the dog happens to have been born with IVDD typically around 4-7 years old signs of pain and or neuro diminishment happens.

-- A virtual consult is not a hands on exam.

-- Most disc episodes are diagnosed with
    -- a hands on exam
    -- knowing the breeds prone to being born with IVDD: Dachshunds and many other short legged, small breeds;
    -- the way the dog presents at the exam

If there is any suspicion Pip has something disc related, then there is only true conservative treatment, not some half-way confinement treatment. 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 rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.

IT'S COMPLETELY YOUR DECISION how to care for your dog.
Owner IVDD knowledge is the 🔑KEY to fighting the IVDD enemy!
    "It's not the will to win that matters—everyone has that. It's the will to prepare to win that matters. ~~ great coach "Bear" Bryant
    🔑 The Forum's goal is to immediately expedite getting things right specifically for your dog's needs to ensure a good outcome on graduation day. In other words, those things that make conservative treatment work for many disc episodes.
In the longer term, helping you to get up to speed on disc disease for living many happy years ahead with your dog.
    🔑 "Vet" the information you'd rely on for at home care:
        -- Dodgerslist list teams up with veterinarians to teach about IVDD: dodgerslist.com/2020/04/20/education-team-ivdd

OK, with all that's written above, what is actually going on with Pip muscle soreness or actually damage to the disc pain?
--- what signs of pain or neuro diminishment has changed since you last wrote that demands an analgesic for nerve pain (gabapentin)? To give a pain med where the dog feels better, and then not do true conservative treatment could spell disaster.

Dr Larry Carpenter DVM MS (Ortho surgeon) ACVS explains and cautions veterinarians about conservative treatment during a disc episode.

See how things just don't line up and cause us concern?  We look forward to getting filled in with all the details of the virtual vet consult to make sense of things. 

FYI only anti-inflammatory drugs cause extra acid production and the need for and acid suppressor such as Pepcid AC (famotidine) 

There are dogs that get agitated in the crate and Pip may be one of these. But there are ways to help with this. Try covering the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he jumps up, he won't be able to see anything. That may discourage him from jumping up. Other tips on calming in the crate can be found here:
I hope that your regular vet will be able to give a diagnosis, and you will have a better idea of what treatment is needed.

Paula I want you to know how much I appreciate your very detailed and informative posts. Right now Pip is confined to a small area upstairs with no access to furniture and stairs blocked etc. We're carrying him outside for short potty breaks. He's not being allowed access to his toys. Things I've observed are: he will do a full body shake or stretch occasionally which I don't think would happen if he was in pain. Rolled onto his back last night too. Tail wagging.

I haven't started gabapentin yet and won't unless I can confirm ongoing pain is present. The dose prescribed was 25 mg every 8 hours. He is sensitive to meds so the vet didn't want to give a higher dose.

I'm planning on setting up an ex pen in our den when we get home. It's troubling that I find myself dealing with two different opinions -- the first vet probably has over 40 years of experience --the second specializes in emergency medicine and works with neurologists. Her own dog has ivdd. But I'll err on the side of caution. and treat this as potential ivdd.