Kelsey's Chocco's Aug 12 conservative Australia; GRAD Oct 7

[Melbourne time: Sat Aug 13, 4:30 p.m.]

Hi Paula, I’ve just taken him to the vet [Sat, Aug 13th ?]. She said it’s the same injury (same spot). She’s not sure if it’s just weak so he has done it for a second time or if it was just masked this whole time and actually needs surgery (he was fine and acting fully normal for 8 months)

She wants him to get a CT scan… is this necessary/urgent?

She put him on 100mg gabapentin 2 times daily for 5 days and meloxicam 0.46ml once per day (no timeline given)

[MED LIST/HISTORY- Moderator's Note. Please do not edit
6kg / 13.23 lbs       2.5 y.o.
Meloxicam as of 8/13:  0.46mL 1x/day for how many days?, then test:_pain/_neuro
Gabapentin 100mgs 2x/day (5-day supply ends 8/18 
needs GI tract protector, Pepcid AC, for the duration of MELOXICAM ]

He can still walk but is very reluctant [Pain!] at the moment. Wobbly when he tries to walk. She said on one side of his back legs [knuckles)] he didn’t realise that his paw was faced downward.

I observed this 2 days ago [date?  Thurs Aug 11? ]. Not sure yet about bladder control, he had a bowel movement today but when I take him out to the toilet he hasn’t urinated, not sure if he has urinated in his bed.

Kelsey, because of the time differences  Australia/USA, would you use specific dates rather than "yesterday, 2 days ago, last week, etc.)

You have an emergency to phone the vet ASAP about pain. If not open Sun 8/14 a.m. then you may need ER to help with uncontrolled pain. Alert vet that pain is not yet in control (reluctant to move).  

When pain meds are properly adjusted for Chocco's needs pain would be in control in ONE hour and stays that way night and day, right up to the next dose of pain meds.  Let us know what ER or your own vet prescribes (date, name, mgs, and frequency)
    Pain meds last for about 8 hrs that is why for a disc episode they are normally prescribed for promptly every 8 hrs (3x/day).  There are 3 sources of pain for a disc episode. All three sources are addressed by vets who are comfortable with their knowledge about IVDD.  Advocate for:
    1) Gabapentin for nerve pain to be every 8 hrs.
    2) methocarbamol for muscle contraction pain every 8 hrs
    3) traMADol as the general analgesic every 8 hrs.
    4) Pepcid AC (famotidine).  FIRST do ask your vet in this very, very particular way...     Know your stomach protectors why's to best discuss on behalf of Chocco:   dodgerslist.com/2020/05/06/stomach-protection/
       
Chocco needs GI tract protector, Pepcid AC, on board w/Meloxicam!      
Dogs don't speak up at first signs of trouble like a person would. Red flag signs can progress from nausea> vomit>  loose stool>....  Bleeding ulcers (red or black blood in diarrhea) can turn to a life-threatening perforated stomach lining.  

MELOXICAM

All vets must guess on numbest of days to use meloxicam.  It is the STOP of meloxicam that proves the vet's guess correct or not.  Many vets try a 5-7 day course or maybe a 14-day course, then at the STOP they also stop the pain meds so YOU at home can correctly, accurately & quickly observe if there is any hint of re-surfacing of pain.  If gabapentin is for 5 days, it may be that meloxicam is also for 5 days???  
   A treatment plan that has no timeline is a treatment that yields no data of success or need of adjustment, continuation.  All meds have side effects. No one wants a dog on meds past the benefit of all painful swelling gone.  Find out how many days of Meloxicam, then a stop.    
1) What date did you give first dose of Meloxicam....we track this valuable information about Meloxicam to help you understand Chocco's treatment.
2) You took him to the vet on Sat, Aug 13?

A disc episode diagnosis is generally by the way the animal acts, the hands on exam, the dog's history and the breed.  
    X-ray can't proof a disc episode. So they are not used UNLESS there is a high degree of suspicion of another disease that would show on the image.  Discs and spinal cord are soft tissue and don't show on the image.  A broken vertebra bone is hard tissue and it would show.
    $1200+ MRI or CT types of advanced imaging can show both soft and tissue.

3) What date did you see his back leg (left or right?) knuckling under?

As long as Chocco can walk, then by definition he must also have bladder control.  My inclination is he is in pain and does not want to move to pee. He needs his pain medications adjusted.

Most surgeons would not operate on a dog who can still walk.  No one can know if this is the same disc as no MRI (gold standard imaging) or CT has been taken. It matters not which disc (a new disc or same disc) with conservative treatment. All disc get the same 100% STRICT rest which allows the bad disc to heal.

4) Let us know if a surgery would be an option for your family, if at some point it could be a consideration.

MONITOR NEURO FUCNTIONS, understand surgery vs. conservative
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. Thurs Aug 11? Pain caused by the intial disc tear & inflammation in the spinal cord
2. Thurs Aug 11? Wobbly walking, legs cross
3. _______Nails/toes scuffing floor
4. Thurs Aug 11? Paws knuckle under. Does not attempt to correct.
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 or after a surgery. 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. 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/

MONITOR FOR PAIN
Resolution of spinal cord inflammation/swelling provides the relief from pain. It can take an anti-inflammatory (steroid or a non-steriodal NSAID, Meloxicam) a range of 7 to 30 days before all swelling is gone.  Typically there can be several courses each with a stop to assess, before all swelling is gone.  Some dogs can get the swelling resolve with one course of the anti-inflammatory.

Adjusting meds by phone avoids a risky-to-the disc car transport. Describe the pain that you're seeing.  Vets who know their IVDD, understand the important of strict rest and will adjust meds over the phone.


SIGNS OF PAIN:
⚙︎ 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

    -- Learn about Meloxicam. 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 on the stop of Meloxicam and pain meds.
dodgerslist.com/2020/04/18/steroids-vs-nsaids/
    -- Be informed on each med your dog takes: www.marvistavet.com/pharmacy-center.pml

5) What is the Plan B for when Meloxicam stops as a kind of test to know if all swelling is gone or not gone?

Kelsey, if he WAS knuckling at the 8/13 exam and NOW is  NOT knuckling that shows healing of that back paw neuro function!!

 Conservative treatment of meds & rest is showing that very likely this IS a disc episode and not some other disease and not showing a need for a disc surgery.

IF the treatment was not able to get pain in control with an aggressive pain meds approach AND with 100% STRICT rest nerve function continued to decline, it could be time to consult with a specialist.  But today, things sound like they are going in a typical orderly fashion of healing.

We read your words literally.  "Seems to be in less pain" is not good enough. There should be NO pain right up to the next dose of pain meds.   Instead of you interpreting what you see, could you tell us what you observe that makes you interpret there is still pain, but less.

Here are the typical signs of pain. What do you observe?

Kelsey, if you are observing another sign of pain in addition to not wanting to run off that c ould help you determine if actually in pain.

If you are seeing any one sign of pain as Gabapentin typically wears off at the 8 hr mark, that is likely true pain. In case of true pain, alert your vet to Rx gabapentin for every 8 hrs. (3x/day).

Have you gotten the timeline for a stop of Meloxicam? This is important information to know if your dog has been prescribed a 7-day course, a 14-day course of this inflammatory.

What about Pepcid aC (famotidine) is is on board now for the duration of Meloxicam. IF not, what is the health reason he may not take it?