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Post by Sarah & Ramsay on Sept 21, 2022 8:19:50 GMT -7
My 16-year-old dachshund Ramsay (14.5 lbs) woke up in his crate [9/20] yesterday morning with a huge yelp. i rushed over and found him to be extremely weak.
I took him outside to potty and he was very wobbly and extremely weak on all four limbs. He couldn't walk at all.
This is the THIRD dachshund I've had with IVDD, so I know the drill (thanks to Dodgerslist). Ramsay hasn't had an IVDD episode in 10+ years, when his back legs went out. Strict conservative crate rest healed him that time.
I took him to the vet [9/20] yesterday and she suspects IVDD, with pain primarily around his neck. Bloodwork came back normal. The thing that is different from any other IVDD episode I've seen in my other two dogs is that he is weak in ALL FOUR LIMBS. It's absolutely awful and heartbreaking to watch him go completely limp.
Vet gave him hydromorphone injection and subQ fluids.
Also prescribed:
-Rimadyl (12.5mg 2x day)
-Methocarbamol 150 mg/ml suspension (1.5ml 3xday)
-Gabapentin 50 mg/ml suspension (1.3 2x day)
[MED LIST/HISTORY- Moderator's Note. Please do not edit
14.5 lbs 16 y.o
9/20 happy tail wag lost
Rimadyl as of 9/20: 12.5mg 2x/day for ? days; then test STOP _pain/_neuro
methocarbamol 150mgs/mL: 225mgs (1.5mL dose) 3x/day
gabapentin 50mgs/mL: 65mgs 1.3mL dose 2x/day
Ramsay needs GI tract protector, Pepcid AC, on board for duration of Rimadyl! ]
He doesn't seem to be in pain right now.
Given his age, I am not considering surgery. He is eating (by me hand feeding him wet food into his mouth), but he doesn't want water. He is not able to potty on his own, so I need to learn out how to express his bladder.
Right now it is a "wait and see" situation to see how he does over the next few days.
One of my main questions is - Could this be anything other than IVDD? It is so strange he is immobile on ALL four limbs. His eyes are bright and he has somewhat of an appetite. So it's heartbreaking he can barely move.
All advice welcome. 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 Sept 21, 2022 9:34:31 GMT -7
Sarah, sorry to hear about Ramsay's neck disc episode. Good job on recalling the need for crating and vet help asap! A back disc would affect only the back legs. A neck disc can affect all four legs. Here are the points to consider with this neck episode --- extras you can do at home to help Ramsay: dodgerslist.com/2020/05/05/cervical-care-tips/--- Pepcid AC with one active ingredient, famotidine. Phone vet to verify Ramsay has no health issue to prevent use of Pepcid AC (famotdine) for duration of Rimadyl. Signs of GI tract damage progress: nausea> lip licking> not eating or drinking normally> vomit> loose stool> bleeding Ulcer > red or black blood in diarrhea> perforated stomach lining.
NOTE water intake include water in food + drinking water. Not a good idea to change food when Rimadyl is on board. Because you don't know if GI problem are benign change in food or serious GI tract damage. Best to soak his regular kibble in water or broth. PAIN Report what you observe to the vet for over the phone med adjustments. Neck discs are typically more painful and may require an aggressive every 8 hr pain med dosing. Resolution of spinal cord inflammation/swelling provides the relief from pain. It can take an anti-inflammatory a range of 7 to 30 days before all swelling is gone. Til then the pain meds provide comfort.
Let us know if you observe any of these SIGNS OF PAIN nearing next dose: ⚙︎ 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 Rimadyl. 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. Pain meds are effective for 8 hrs. If Ramsay is not fully out of pain, advocate for: --traMADol-general analgesic 3x/day --methocarbamol- muscle spasm pain. With all 3 pain meds on board it is likely the more usual of 125mgs Methocarbamol could be Rx'd for 3x/day for a 14lbs dog. --gabapentin-nerve pain 3x/day NEURO FUNCTION Can Ramsay sniff at an old pee spot in the grass? And then does he make the decision to release urine there? That is bladder control. Do you find urine leaks in his bedding? Or Does he leak on you when lifted. That indicates loss of bladder control an the need to get a hands on top of your hands type of expressing lesson. dodgerslist.com/2020/05/05/bladder-bowel-care/This is the predictable and orderly step by step loss of neuro functions. Let us know precisely what Ramsey front legs are doing and what his back legs are doing. 1. 9/20 Pain caused by the intial disc tear & inflammation in the spinal cord 2. 9/20 back 9/20 front Wobbly 3. ___ back __ front Nails/toes scuffing floor 4. ___ back __ front Paws knuckle under. Can not or is slow to right the paws 5. ___ back __ front little leg movement ___ back __ front can't move up into a stand 6. ___ back __ front do not work at all (paralysis), can't use to reposition in crate, can't scratch ear 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/ |
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Post by Sarah & Ramsay on Sept 21, 2022 10:02:46 GMT -7
Thank you so much.
Are you saying he is on too much Methocarbamol? (Vet prescribed 150 mg/ml - 1.5ml 3x day)
I am finding urine leaks in his bedding and he won't potty outside. What do you recommend I use to clean him up?
Here are the other details:
1. 9/20 Pain caused by the initial disc tear & inflammation in the spinal cord
2. 9/20 back 9/20 front Wobbly
3. ___ back __ front Nails/toes scuffing floor
4. 9/20 back 9/20 front Paws knuckle under. Can not or is slow to right the paws
5. 9/20 back 9/20 front little leg movement
9/20 back 9/20 front can't move up into a stand
6. 9/20 back 9/20 front do not work at all (paralysis), can't use to reposition in crate, can't scratch ear
7. 9/20 Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors.
8. 9/20 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.
Thank you so much.
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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 21, 2022 10:35:15 GMT -7
Sarah, we are not vets and we do not prescribe anything. You can discuss with your vet if methocarbamol at a 1.5mL dose can cause too much muscle relaxation. Often for a 15 lbs dog the dose will be 125mgs of methocarbamol every 8 hrs.
Is the leaking in bedding because he is not being taken out often enough, over muscle relaxation or truly has lost bladder control?
DOES he leak on you when lifted?
Also discuss if moving to the more powerful class of anti-inflammatory drugs the STEROIDS like prednisone would be useful to combat neuro loss cause by the swelling around the cord.
Review the video technique of expressing and get a lesson from the vet tech or the vet now, today if there is loss of bladder control. Bladder infection (UTI) can happen quickly in a matter of days. A urinalysis will prove if an antibiotic is needed.
While you learn to perfect expressing technique over the course of a week's worth of expressing, often dogs will get a UTI.
Let us know what your vet thinks about bladder control or not. IF prednisone is an option for Ramsay. Is Pepcid AC on board and is all pain fully in control?
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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 21, 2022 10:37:25 GMT -7
This tip and many other good ones comes including how to set up the mattress system from our supply list at the Main Dodgerslist web site. dodgerslist.com/2020/05/14/strict-rest-recovery-process/Use unscented baby wipes for quick clean up on your doxie. Marjorie's tip: Brew up a pot of decafinated green tea. Let it cool, dampen a sponge or cloth with the tea and then gently wipe belly and legs. Tea is mild with acidifying, antibacterial properties to neutralize urine on skin and fur to avoid rashes from urine scald. The tea leaves a clean earthy fragrance. The remaining tea can then be stored in the refrigerator and warmed before use. White vinegar in a spray bottle to disinfect and remove the urine ammonia smell from floors, etc. |
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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 21, 2022 10:39:16 GMT -7
Confirm loss of tail wag.
Did you specifically do some happy talk, or show a yummy treat? And still no tail wag?
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Post by Sarah & Ramsay on Sept 21, 2022 10:55:10 GMT -7
Thank you. I don't know about the loss of bladder function. He is not leaking urine when I pick him up, but I did note two accidents in the crate. I suspect he's lost bladder function?
Re tail wag - he is too depressed and out-of-sorts for tail wags right now.
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Post by Romy & Frankie on Sept 21, 2022 13:19:50 GMT -7
We always ask about a happy tail wag because it is the way that pet parents can tell that their dog has Deep Pain Sensation (DPS). When a dog has DPS, it means that the brain is able to communicate with the rest of the body through the spinal cord. This is an indicator, but only an indicator, of the return of other neuro functions. Do keep an eye out for the happy tail wag. It seems that your Ramsay has lost bladder control. We use the "sniff and pee" test to know if a dog has bladder control. Carry Ramsay out to an old potty spot. Support him with a sling or your hands. If he sniffs and then pees, he has bladder control. If not, he will need to be expressed.
Expressing is a skill and must be practiced and learned. The best way to start learning is to get a hands-on lesson from your vet. Then practice. Expressing can be tricky in the beginning, but you will learn. While you are learning, you may need to express every few hours. Once you have become proficient, you can express Ramsey about as often as you used to take him out.
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Post by Sarah & Ramsay on Sept 21, 2022 23:27:27 GMT -7
So Ramsay was whimpering/making little yelps to get my attention this afternoon so I took him back to the vet to make sure he wasn’t in pain. They said they think he is actually anxious/in distress instead of in pain. But they gave him another injection of ✙hydromorphone [9/21].
[MED LIST/HISTORY- Moderator's Note. Please do not edit
14.5 lbs 16 y.o
9/20 happy tail wag lost
Rimadyl 12.5mg 2x/day for ? days; then test STOP _pain/_neuro
✙hydromorphone inject 9/21 Duration of effect is 4 to 6 hours
methocarbamol 150mgs/mL: 225mgs (1.5mL dose) 3x/day
gabapentin 50mgs/mL: 65mgs 1.3mL dose 2x/day
Ramsay needs GI tract protector, Pepcid AC, on board for duration of Rimadyl! ]
That helped for a few hours, but he has been back to the whimpering/distress calls for the last 3 hours. I’ve taken him to potty, looked at his bedding, gave him water, but he will not stop.
QUESTION: Can I give him trazadone with his current meds? He has a prior prescription. It’s nearly midnight so I can’t call the vet, but we can’t sleep! Just thought I would try here in case anyone is awake!
Also, any advice on expressing a dog's bladder, when their front legs are paralyzed, too? I tried to find a video on YouTube but haven't had luck.
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Post by Sarah & Ramsay on Sept 22, 2022 11:05:07 GMT -7
Vet said it was okay to add ✙trazadone, so I'm going to see if that will help his anxiety!
[MED LIST/HISTORY- Moderator's Note. Please do not edit
14.5 lbs 16 y.o
9/20 happy tail wag lost
Rimadyl as of 9/20: 12.5mg 2x/day for ? days; then test STOP _pain/_neuro
hydromorphone inject 9/21 Duration of effect is 4 to 6 hours
methocarbamol 150mgs/mL: 225mgs (1.5mL dose) 3x/day
gabapentin 50mgs/mL: 65mgs 1.3mL dose 2x/day
✙traZODone ?mg ?x/day
Ramsay needs GI tract protector, Pepcid AC, on board for duration of Rimadyl! ]
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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 22, 2022 11:18:16 GMT -7
Sarah, the link to the expressing article dodgerslist.com/2020/05/05/bladder-bowel-care for bladder expressing contains a video. There is not only one position to express in. Watch the video to see expressing while lying down and review the tips in the article Trazodone is use for anxiety. It can be given with other meds.
BLADDER control
You have not really confirmed if there is actually loss and the need to express.
-- could be 4 legs paralyzed distresses Ramsay he is not able move away to pee in his recovery suite?? He has no choice but to pee in his bed.
-- Are you taking him outdoors when he signals distress and regularly every 3-4 hours as a dog would usual go out to pee?
Support with TWO slings, place him on an old pee spot to sniff, see if urine is released there. That prooves bladder control
-- dogs who have bladder control would not like you pressing/expressing their bladder.
-- Proof of loss of bladder control is TWO things.
1. find urine leaks in bedding when you have given opportunity to pee outside or on a pee pad scented with old urine.
2. leaks on you when lifted.
-- Did you get a hands on lesson from vet or the vet tech?
What is the stumbling block to getting Pepcid AC on board?
traZODone ?mg ?x/day
What is the stumbling block to getting a 3x/day (every 8 hrs) dose of gabapentin? Assume a painful disease IS painful and treat as such!
For how many days is he to take Rimadyl? |
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Post by Sarah & Ramsay on Sept 24, 2022 16:35:17 GMT -7
Some interesting news: Ramsay seems to be getting some feeling back in his front legs, as he was able to balance on them for a few seconds when I took him out to potty!
Also, he has been waiting until I take him outside to pee and poop, which makes me think he has control. I have been trying my hand at expressing his bladder but still haven't mastered it.
He is still very anxious and crying, despite adding in trazadone. Here are his current meds:
Rimadyl 12.5mg 2x/day for ? days;
Methocarbamol 150mgs/mL: 225mgs (1.5mL dose) 3x/day
▲ Gabapentin 50mgs/mL:▲ 1.5mL dose 3x/day
✙Tramadol (just added today): 25 mg/3-4x day Which?
✙ Trazadone: 50mg 3x day
[MED LIST/HISTORY- Moderator's Note. Please do not edit
14.5 lbs 16 y.o
9/20 happy tail wag lost
Rimadyl 12.5mg 2x/day for ? days; then test STOP _pain/_neuro
methocarbamol 150mgs/mL: 225mgs (1.5mL dose) 3x/day
gabapentin 50mgs/mL: ▲75mgs 1.5mL dose 2x/day
✙traMADol 25mgs ?x/day actually given?
✙ Trazadone: 50mg 3x day
Ramsay needs GI tract protector, Pepcid AC, on board for duration of Rimadyl! ]
I don't want to get too excited, but I do feel a glimmer of hope.
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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 24, 2022 18:40:24 GMT -7
Sarah, it appears you are not able to read moderator posts to see the questions we ask about. It makes us quite anxious to lack information and not be able to give good comments for your Ramsay. Please help us. QUESTIONS1. What is the stumbling block to getting Pepcid AC on board?
2. For how many days is he to take Rimadyl? The course for Rimadyl is usually a 5 or 7 day course. Sometimes a vet may feel the guess should be a 14-day course. It is important to know what your vet is guessing. All vets must guess.
At the end of the Rimadyl course, the STOP of it is a very important date to know about and begin your monitoring of pain. We track number of days Rimadyl is used during a disc episode.
If there is no surfacing of pain on the stop of Rimadyl, then there is no need of any meds. All meds have side effects. So no one wants a dog on meds that have already done their job.3. Advise your vet about crying/anxious with traZODone 50mgs 3x/day. Another relaxer may work better for Ramsey.
Calmer may also give assist along with the prescription med to help relax Ramsay. Read about calmers + other ideas: dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite/
What date were each of these meds adjusted or added? 4. How many times a day do you ACTUALLY give traMADol? It is good you got a range, but we need to know what is given currently5. Was gabapentin INCREASED to a 1.5mL dose from a 1.3mL dose?In order for humans to monitor neuro self repair, we must look for a head level involvement to confirm how a tail, a leg, the bladder function is operating (via a reflex or via a message from the brain). Here is a sample of what that means:--- Sniff (head level nose) on an old pee spot, then release of urine would be brain directed. Pushing on bladder, or a really full bladder triggered by reflex can cause urine to escape. The fact that he is waiting and holding urine til outdoors does seems to lean to he may have bladder control. A Sniff and then pee would give confirmation it is brain directed.--- Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail movement or leg movements during potty time can often be a reflex--- Itchy sensation at neck and then tries to scratch would be purposeful movement. Tickling paws, etc can cause reflex leg movements of pushing in or out.We look forward to your observations when you observe new neuro progress! |
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Post by Sarah & Ramsay on Oct 5, 2022 9:33:49 GMT -7
I'm devastated to report we decided to put Ramsay down last week. At 16 years old, with complete loss of all four limbs, and in excruciating pain we couldn't control (despite being maxed out on all his pain meds), and with extreme anxiety (that medication didn't help), it seemed like the right thing to do.
We are all heartbroken, but I feel blessed to have been his mama for his long life.
Thank you all for your help.
Best,
Sarah
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 5, 2022 10:17:20 GMT -7
Sarah, I'm so sorry to hear the unexpected loss of sweet Ramsay. My deepest sympathies to you and your family.
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Post by Romy & Frankie on Oct 5, 2022 13:24:48 GMT -7
I am very sorry to hear of your loss of Ramsey. My sincere condolences to you during this sad time.
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Post by Linda Stowe on Oct 5, 2022 14:10:03 GMT -7
My thoughts are with you during your time of mourning, I'm so very sorry for your loss.
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