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Post by Mary-Anne & Spike on Sept 7, 2022 13:51:58 GMT -7
QUESTIONS
☆ 1 Is there still currently pain? yes
☐ reluctant to move much in crate such as shift positions or slow, ginger movements. YES
☐ shivering, trembling
☐yelping when picked up or moved YES
☐ tight tense tummy
☐can’t find a comfortable position, appears restless. Sometimes less than 20% of time
☐ Arched back
☐head held high or nose to the ground NO never has done this
☐ NO never has done this [flamingo] although he is tiny so wobbles a bit when he is in the crate all day and goes for a pee or poo.
☐Not their normal perky selves? YES. He is VERY VERY hyper small dog.
2 How much does your dog weigh? 4.5lbs (mini Maltese)4.5yrs old
[MED LIST/HISTORY- Moderator's Note. Please do not edit
4.5 lbs 4.5 y.o
9/5 wobbly legs
9/6 escaped suite, pain returned
ONSIOR 5mg Tablet as of 8/29; 2.5mgw 1x/day for 14 days; 9/12 test for pain (empty stomach? but can give pill in treat).
Methocarbamol 100mg 50mgs 3x/day
Gabapentin 50mg tab: 25mgs 3x/day ( for 14 days)
Codeine Tera 15mg - 3.75mgs as needed at bedtime if in pain
Spike needs an acid suppressor on board for duration of Onsior ]
he has small liver issue that prevents strong medication etc***
☆ 6 saw the vet for CONSERVATIVE treatment September 2nd 2022 afternoon . Recommended 8 weeks conservative.
All medication above started on August 29th 2022 evening
Methocarbamol 100mg 1/2 tablet Every 8 hours
Gabapentin 50mg 1/2 a tablet Every 8-12hrs (14 days)
ONSIOR 5mg Tablet 1/2 tablet every 24hrs (empty stomach but can give pill in treat)
Codeine Tera 15mg - 1/4 tablet as needed at bedtime if in pain
C. PEPCID AC: Not that we have been told
☆ 3 -- List any red flag signs of stomach damage. - NONE
☆ 4 Your name?
Mini Maltese. 4.5yrs old. 4.5lbs. Spike is his name.
☆ 5 IVDD is what they diagnosed. They said they couldn’t get specific as no MRI. Saw 3 vets who all poked at him including a full neurological exam I(which was supposed to be aggressive in pressure). He displayed only a small amount of pain in the lower back. Did not have any issues in the Neuro exam which is why they ruled that out. Doctor recommended “no mri” at this point.
-- Is the vet a general DVM? 2 of 3 exams were general and 1 was a Neurologist
He originally had minor yelping we don’t know from what so when we took him into vet they poked and prodded and said it was nothing and we just went on and walked him etc. He had very little issues. Then it got worse so we took him back in 3 days later cause he started having major fits overnight.
They said again not much and gave us the above meds [8/29].
We reached out to the only [9/2] Neurologist in our city and got in and they said it’s likely IVDD not nerves as he passed all nerve tests. They told us about your site and we felt horrible because we think we make it worse not knowing he was supposed to be in a crate and not walking. We are terrified and worried and don’t have much help here.
He stopped the major yelping but then yesterday
[9/6 relapse] ran around the yard by accident getting through the gates. Last night and today he’s been back to frequent yelping.
He eats, drinks, and poops well. He has moments where he seems exhausted and out of it in the crate and others where he is simply resting. Today he wagged his tail a bit for the first time since this started. Often though his little yelps happen when he isn’t moving. He will be sound asleep or just laying down and will just give out a short little yelp.
I feel yesterday him running might have made it worse but again, we don’t know and are trying so hard. Every day we are crying because we don’t know what to do and what is happening. He is a really happy and energetic dog and he is a rescue so we’ve only had him for 2 years. He had all his teeth removed earlier this year (again rescue dog) and that is when they said his liver results require us to not give him too much medication (pending a more clinical answer to provide for this to you).
Our biggest concern is how do we know if he is getting better? Are set backs normal? When do we know this isn’t working? We haven’t slept in a week. We have a baby cam in his crate all day. Yesterday he barked at a dog walking by and we feel like sometimes there is hope and then don’t really know if we are trying to see it or not. We also really feel that our current vet let us down by not telling us about crate rest and the neurologist seems very busy so we can’t really get much from her.
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Post by Romy & Frankie on Sept 7, 2022 15:15:58 GMT -7
Welcome to Dodgerslist. 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/
Where do you live?
What is your name? I am Romy.
IVDD or Intervertebral disc disease is a disease your dog was born with. It causes premature aging and hardening of the disc. IVDD, in dogs is often called a ruptured, pinched, or herniated disc . The disc cushions the space between the vertebrae in the spinal column. With IVDD, the disc material begins to bulge out of position and puts pressure on the nerves of the spinal cord. This is what causes the pain and neuro deficits, like problems walking.
Conservative treatment can work to get the disc to heal, allow the body to shrink back disc material to no longer aggravate the cord
Strict crate rest is essential for dogs being treated conservatively during an IVDD episode. STRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times Spike should be carried to his potty area and then allowed only the fewest amount of steps while pottying.
The frequent yelping indicates that Spike is in pain. Please let the vet know that Spike is in pain and advocate for the pain meds being adjusted. Pain will only slow the healing process.
Gabapentin does not last long in the body and often must be given 3x a day to help provide relief. Are you giving it every 8 hours?
We have information about the meds commonly used in a disc episode here: dodgerslist.com/meds-used-during-disc-episode
All dogs with IVDD, particularly those on an anti-inflammatory, are at risk of excess stomach acid. This can lead to serious stomach damage. To protect the stomach from this damage, a stomach protector like Pepcid AC is used. Ask the vet if Spike 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.) Famotidine is an over the counter medicine in the US. Since Spike has liver issues, discuss the dosage with your vet.
Is Spike having any difficulty walking or showing other signs of neuro problems? It is very stressful when our dogs are diagnosed with IVDD. It becomes less so when we learn all we can about the disease. Spike is a good candidate for Conservative treatment, but he must be on Strict crate rest for 8 weeks to allow the disc to heal. Any time out of the crate is dangerous. Read more about the crate rest process here: dodgerslist.com/2020/05/14/strict-rest-recovery-process/Learn more about IVDD at our main web page:
Use the search bar at the top of the page to search for particular topics.
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Post by Mary-Anne & Spike on Sept 7, 2022 15:39:49 GMT -7
Thank you for responding.
I’m in Canada.
Gabapentin is being given every 8 hours yes.
We have left a message to see if we can use Pepcid AC with Spike. I think we have that in Canada too.
Spike seems weak when getting out of his cage to pee and poo. Doesn’t fall over and can pee lifting a leg but weak for sure. Only 1 other odd sign is he seems to lick his groin prior [neuropathy] to an [yelping??] episode.
We called the Neuro vet [9/7] tonight about his pain and she recommended
- upping the ▲Codeine to 2 times a day
- adding ✙Trazadone (dont know dose yet)
[MED LIST/HISTORY- Moderator's Note. Please do not edit
4.5 lbs 4.5 y.o
9/5 Wobbles a bit
9/6 escaped suite, yelping returned
Onsior 5mg tab as of 8/29; 2.5mg 1x/day for 14 days; 9/12 test for pain (empty stomach? but can give pill in treat)..
Methocarbamol 100mg tab: 50mgs 3x/day
Gabapentin 50mg tab: 25mgs 3x/day for 14 days)
Codeine Tera 15mg tab: 3.75mgs ▲2x/day
✙Trazadone ?mg ?x/day
Spike needs an acid suppressor on board for duration of Onsior ]
Is there a general quick link to find out what typical signs look like for recovery and when to know it’s not working? We just don’t know what to expect to expect in this crate rest period.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 7, 2022 18:09:39 GMT -7
Moderator, Paula, is reading and preparing a reply to your post. Refresh your browser to see when reply is posted. THANK YOU for REGISTERING!!! Now you can get an email alert when a reply is posted. 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.....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! EMAIL ALERTS 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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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 7, 2022 19:04:49 GMT -7
Welcome! My name is Paula, what is yours? You are in the right place to learn about IVDD and how to do at-home care with lots of tips and tricks to make things go smoother. Put on a happy face and voice when around Spike. Tell him all is gonna be good because you are on it. Soon you, too, will understand and know in your heart things will be back to a good place in time. BTW, with rather mild symptoms of wobbly legs there is great potential with good care, Spike can heal the neuro diminishment!!! STAY strong, stay positive and do not give up hope. Every dog heals in a different amount of time, every disc episode is different so you really can't compare to other dogs.  The single most important care is the 100% STRICT rest inside of a recovery suite to allow the disc to heal in the course of 8 weeks. That escape, very well has interrupted the forming of scar tissue and more pain. This page will give you lots of ideas in making sure crate rest time goes safely and smoothly...check out all the tried and true tips members have shared: dodgerslist.com/2020/05/14/strict-rest-recovery-process/Any time out of the recovery suite is a dangerous time. A harness, a leash and a sling (if he is wobbly in the least bit) must be on him in order to always be one steps ahead of these guys! Leash and harness to avoid any escapes, controls Spike's speed and limits his footsteps to the very minimal few. The sling is to prevent his wobbly back legs from causing him to fall and twist his spine.  Which recovery suite are you using? Wire crate, 8-panel ex-pen, Baby Pack N Play? A gated area is not safe enough and likely too large an area. The recovery suite should only be large enough to turn around easily. When lying down to fully stretch-out the legs. Pad out any extra area with a rolled up blanket. Setting up the Recovery Suite
Ex-pen flexibity may be an option with your tiny Spike as you can size down the panels to wrap snuggly around his mattress. I case you find you need a 2nd suite for the bedroom at night, it is good to have one of each type of suite.  Who is your wonderful neurologist who knows of Dodgerslist?
Most DVMs in a general practice see many different species- hampsters, cats, all breeds of dogs, reptiles, birds, maybe even farm animals. They practice many specialties in the course of a day: pediatrics, dentistry, surgery, internal medicine. Is it surprising, that keeping current and indepth knowledge of each and every disease for every species is probably not likely? However, YOU can easily become a mini-expert on one very-important-to-you disease.
Be able to monitor for predictable step by step neuro declines. This is to know when to alert your vet/neuro. As nerves begin to self heal, that happens in the reverse order. We are counting on your stepped up at-home care to avoid any more neuro setbacks due to escapes (too much back movement). As you can see by the list, Spike has a small degree of nerve damage that CAN heal with good home care. 1. 8/29 Pain caused by the intial disc tear & inflammation in the spinal cord 1a. 9/6 Pain causing a relapse to the early healing disc with escape 2. 9/5 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. 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/TOOLS to get up to speed on IVDD. IVDD Knowledge allows one to turn of those upsetting/scary movies which can run over and over in the mind: 1) Shortcut thru IVDD: dodgerslist.com/2020/06/26/time-and-ivdd/ **  Have no patience at all with pain. Pain hinders healing. With med adjustment expect all pain to be gone in the hour and to stay away round the clock and dose to dose of his three pain meds (gabapentin, methocarbamol and codeine). Let us know if all pain is now under control
For how many days is he to take Onsior?
What date did you first observe he was a bit wobbly? |
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Post by Mary-Anne & Spike on Sept 8, 2022 5:42:00 GMT -7
Good Morning! Thank you for your reply we really appreciate it.
The Onsior she said minimum 14 days
Wobbly started about 3 days into the crate specifically that would be September 5th.
We’re getting the Trazadone today to start and the Codeine we upped yesterday
He seemed way more “out of it” drugged up basically. Which allowed him to not have any episodes last night.
He seems to have small episodes at about hour 7 of pain meds. Just shy always of the 8 hours.
He peed and had a poo this morning. Was less wobbly this morning but again a little bit more drowsy than normal.
Dr. Villani is our Neuro Doctor who recommended you. I am in Canada but she is from the USA and is here now. My name is Mary-Anne .
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 8, 2022 7:04:03 GMT -7
Mary-Anne, would you describe what you observe that happens nearing next dose of pain meds that the word "episode" does not. thanks
⚙︎ 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 Any sign of pain happening prior to the next dose of pain meds, means the pain meds are not yet right for Spike. You are the eyes and ears for the vet to know what is happening at home. So give them a call and describe what you observe. Expect when the pain meds are correct all pain is in control. And pain control stays in gear round the clock, right up to the next dose. Normally when the vet guesses swelling might be gone there will be a stop of anti-inflammatory Onsior and all pain meds. Usually the first course of Onsior will be 5 or 7 days or even a 14-day course and then a test stop. Your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain (shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy, holding leg flamingo style not wanting to bear weight). To have a clear picture on a stop, pain meds are also stopped or backed off on Sep 12 by starting to reduce mgs/frequency given. Let us know which your vet wants.
Rule of thumb on Onsior stop pain = swelling = more time on NSAID Onsior, pain meds and Pepcid AC needed. no pain = finish out the balance of the 8 weeks strict rest to allow the disc to heal Always have a plan in place with the vet during a test for pain stop on what you should do should pain surface. Have enough meds on hand should that happen over a weekend or evening when the Vet is closed, to save an expensive ER visit. --- The full details on how non-steroidal anti-inflammatories work with a disc episode. Good reading to be able to ask the right questions and discuss treatment: dodgerslist.com/2020/04/18/steroids-vs-nsaids/ |
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Post by Mary-Anne & Spike on Sept 8, 2022 10:38:49 GMT -7
Hi There! His former episode was very loud yelping. Doesn’t really move around when doing that. The last 48hrs he has not had a big episode. It’s
[last 48hrs] just small yelps (PAIN!) when moving around or just laying around trying to sleep. So he yelps, stands up , and readjusts himself. No shaking. Sometimes panting though.
We took your advice and asked for a more aggressive medication route and this is
what they have given us as they keep suggesting to do an mri which is $4000.00 and he has a weak liver so putting him to sleep [anesthesia] is a very bad idea unless needed.
This is what they have increased us to [on 9/8?]…
Increase ▲gabapentin to a full tablet every 8 hours instead of 1/2 of a tablet.
Keep Onsior and methocarbamol the same.
Increase codeine to every 8 hours.
Add trazodone 12.5 mg every 8 hours.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
4.5 lbs 4.5 y.o
9/5 Wobbles a bit
9/6 escaped suite, yelping returned, disc relapse
Onsior 5mg Tablet as of 8/29; 2.5mgw 1x/day for 14 days; 9/12 test STOP for _pain/neuro; (empty stomach? but can give pill in treat)
Methocarbamol 100mg tab: 50mgs 3x/day
Gabapentin 50mg tab: ▲50mgs 3x/day for 14 days)
Codeine Tera 15mg tab: 3.75mgs ▲3x/day
Trazadone 12.5mg 3x/day for anxiety
Spike needs an acid suppressor on board for duration of Onsior ]
In addition. He was 3hrs into his meds (with Codeine)……and WIDE awake and alert. So that is what I emailed the vet and pointed out very curtly that it seems very odd he is WIDE awake 3hrs into a medication cycle like that. Mary-Anne
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 8, 2022 14:05:36 GMT -7
Mary-Anne, hope the increase of gabapentin (processed in the kidneys) for nerve pain will get the painful yelping gone.
Which vet adjusted the meds... your local DVM or the neuro?
Which vet indicated anesthesia for an MRI was a concern with Spikes liver issue?
As you may have noticed we LOVE the detail and always ask. The kind of vet lets us know their expertise in this case. Dates give us an indication of patterns. Accurate information for us to consider on this side of the computer helps a lot in how we comment.
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Post by Mary-Anne & Spike on Sept 8, 2022 16:13:47 GMT -7
Hi Paula!
Both our DVM and Neuro are chatting with each other.
The liver isn’t a huge concern it’s more a matter they said of making sure we monitor and control.
The Neuro Adjusted the meds upon our request for something more aggressive in treatment of pain.
Our DVM who did Spike’s tooth surgery (had all teeth removed 8 months ago) is the one who recommended we need to be cautious with putting him on Anesthesia.
When we asked if it’s an actual liver condition they simply stated it’s not , it was just the levels on the blood test which prevents them from giving too much anesthesia.
Although he yelped a lot today, he appeared to walk more steady when going for a pee.
We administered the new doses for meds approximately [2:30pm MST] 3hours ago and so far he is resting nicely with no yelping. He stood up looked at me and wagged his tail and went back to sleep.
We are going to give him the Pepcid AC as per your suggestion as well. We asked our Neuro and DVM if it’s an issue and neither seemed concerned.
Mary-Anne
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 8, 2022 20:36:25 GMT -7
Mary-Anne, that is wonderful to hear your local vet is communicating with the neuro...good work among colleagues!
Also good report that no yelping since dosing increased gabapentin, hope that no pain shows nearing the next dose of all of his pain meds (methocarbamol, codeine and gabapentin)!
Let us know when Pepcid AC is on board AND the dose in mgs and that you give it 2x/day.
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Post by Mary-Anne & Spike on Sept 9, 2022 4:55:58 GMT -7
We had the worst night ever with him. It’s totally puzzling. He was up every hour yelping in a lot of pain. Even when he laying down he does small whimpers. His stomach is hard for the first time.
WHen we took him out for a pee he didn’t yelp. He went. Poo and pee and went back in. Took his meds but looks very weak (obviously up all night).
We have no idea what else we can do. We’ve reached out to the Neuro and I think we have no choice but to go MRI route asap.
We’ve been 100% crating,resting, and medication on time. We’re pretty devastated.
Mary-Anne
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Post by Mary-Anne & Spike on Sept 9, 2022 8:33:13 GMT -7
We just dropped him off so they are going to run an MRI.
They said his nose isn’t responding now to smell and one of his paws is not responding the way it did a week ago in the nerve tests. Because the pain medication is not working they are leaning to testing for Meningitis. And will do a brain scan as well and spinal tap.
Fingers crossed that we get answers today.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 9, 2022 8:42:03 GMT -7
Mary-Anne, for conservative treatment to continue, pain must be in control. There are other pain med adjustments you could discuss: A fentanyl patch for at home. In hospital stay for IV pain med approach to get pain back in control.
Very curious timing sequence of pain. He had pain at night. Yet at some particular hour of the night when moving to go potty he did not show any reluctance to move, no yelping with a potty break.
Please let us know what you and your vet have decided about the MRI. We are here to support you with any choice in treatment (continued conservative or a surgery)
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 9, 2022 8:44:02 GMT -7
I see our posts crossed and you have taken Spike in for MRI, etc. We will be watching for your next post as you learn more.
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Post by Mary-Anne & Spike on Sept 9, 2022 13:25:03 GMT -7
We just heard back that they are awaiting final lab confirmation on spinal tap but are fairly certain it is Granulomatous meningoencephalomyelitis
They indicated his discs were hydrated
We are awaiting confirmation on him receiving an 8 - 12 hr drip
They also are going to start today coating his stomach with an ant acid. Rather than the 5 day period of removal we are going with 3.5 as per the Neuro’s recommendation.
Mary-Anne
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 9, 2022 13:58:15 GMT -7
Mary-Anne, hoping that what sounds like a switch from NSAID Onsior to a steroid (steroid) with the coating of the stomach will help turn the path. Here on the Forum we only know one disease enough to comment on (IVDD).
Do let us know how Spike does with the drip as you get updated. Sending positive thoughts for Spike.
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