Serena's Luna 10/13 Conservative- Spaniel mix; GRAD 12/8

Serena, sorry to hear Luna is suffering a disc episode. We base our comments on the details you provide.  So a few more questions and their answers would help us out.

First thing, though, is to emphasize that the conservative treatment rest is different than a dog who had a surgery.  Let us know you are on the same page about Conservative 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 crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.

▶︎ Super tried and true tips for setting up the recovery suite, the mattress and more! dodgerslist.com/2020/05/14/strict-rest-recovery-process

Knowledge is key!
Owner understanding ensures proper conservative treatment principals:
▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/healing-the-disc/
▶︎ Roadmap for your fridge. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf

Conservative STRICT rest means:
◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/
◼︎no  meandering at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎ Transports are always a risk to the disc of too much movement that could do more neuro damage.         Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.
        Most vets understand and take updates, requests to adjust meds, etc. over the phone.

POTTY TIME strictness
    Carry your dog to and from the recovery suite to the potty place and then allow a very, 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.

HEAVY DOG CARE TIPS
Check out all of these home care ideas if Luna is too heavy for you to safely carry her out to potty and at other times of caring for her. dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/


QUESTIONS
With your details of event dates, etc., we'd know best how to help. We'd feel awfully bad to mistakenly assume anything ... delaying help for your dog.

QUESTIONS:
★1 Is there still currently pain? List ONLY the signs you observe.
    There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Phone your vet and report any of observations asap to get meds adjusted.
⚙︎ 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
⚙︎ doesn't move much in recovery suite all day
⚙︎ 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

PAIN is controlled by typically using 3 different pain meds. Each deal with a different source of pain.
Luna is only on one pain med.  Pain meds are typically Rx'd for every 8 hrs. Pain med are effective for about 8 hrs.  Please call your vet (ER vet) if there is any sense she is still in pain and get the meds adjusted over the phone to avoid a risky to the healing disc car transport.
    Gabapentin for nerve pain. 
    Methocarbamol is for muscle contraction pain
    traMADol is the overall general analgesic

★2 __How much does Luna weigh? Age?       
     Pepcid AC (famotidine) Be proactive! Avoid red flag signs: Not eating, vomit, loose stool, bleeding ulcers, red or black blood in diarrhea.   Learn Why:  dodgerslist.com/2020/05/06/stomach-protection/
        The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound. www.1800petmeds.com/Famotidine-prod11171.html
        --Give 30 mins before the anti-inflammatory.
        --Dose thereafter every 12 hours for the duration of the anti-inflammatory.
           thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg **

★3 List any red flag signs of stomach damage you are currently observing:
Not eating well, vomit, loose stool, bleeding ulcers, red or black blood in diarrhea?

★8 Describe what you observe currently about neuro functions. Can she....
       -- Do her paws knuckle under?  Can she right them even if slowly?

MONITORING NEURO FUNCTIONS to alert vet
As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example.
1. 10/13 Pain with initial tear of disc and ensuing swelling. Could it be possible you did not recognize signs of pain on 9/9?  Yelping and trembling are not the only signs of pain.  ⚠️Not moving all day in her suite sounds like she IS STILL in current pain.
2. 10/9 Wobbly walking
    ____ legs cross
3. ____ Nails/toes scuffing floor
4. ____ Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all
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 (DPS), 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 general vet who 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/

POSTING HINT
Best to reply to a post by scrolling to bottom of page to "Quick reply" typing area. Avoid clicking on the "Reply" link.

Quick reply allows you to scroll up read a previous post and then scroll down to the "Quick Reply" typing area to continue your own post.

Serena,Luna should NOT be walking anywhere. She should only be taking footsteps, a very few minimal footsteps to take care of business.

If someone else can get on their knees to video Luna taking a few minimal footsteps that would be ok. Actually you know she is currently only wobbly walking. She CAN place her paws correctly on the ground, so you will know if neuro functions decline...and the need to alert the vet.

Hopefully by doing STRICT rest and limited movement of the back, you will not need to see a neuro, but can continue conservative treatment with your local DVM vet for the next 8 weeks. A vet is needed to supervise use of meds. You are the one who does the supervision of limited movement at home.

Serena, hope to hear well before two weeks (but rather on 10/23) that Luna is improving with no pain at all in existence. Nerve healing of wobbly walking may or may not self repair in the short time a disc heals (8 weeks)

So how will you know if all painful swelling around the spinal cord is all gone?
ANSWER: Carprofen the anti-inflammatory may take anywhere from 7 to 30 days to resolve all swelling. All vets must take a guess how long to use. Your ER vet chose a 10-day carprovet course. On Sunday 10/23 carprovet will stop.
--- In order for YOU to have a clear and quick opportunity to assess for pain at home, the gabapentin normally stops on that same date.  Let us know that will be the case.
Short story:

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 Luna's treatment:
dodgerslist.com/2020/04/18/steroids-vs-nsaids/

CALMING IDEAS
-- Many members have found a pet stroller to solve if there is a whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising. More details on strollers: dodgerslist.com/2020/05/17/pet-stroller-conservatve-treatment/

-- Put a garment you have been wearing and have not washed in the recovery suite.

-- Nan Arthur, CDBC, CPDT, KPACTP: According to the book "Stress in Dogs" by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day.

If Luna needs:  Teaching self-calming exercises can also help her to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when she wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second she looks at you, and then give your dog a high-value food reward. [NOTE: for crate resting dogs, shift your body a bit] .... wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give a reward.

[NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest. To dogs the size of the treat matters not. ]
wholedogtraining.com/images/stories/Are_all_dogs_trainable.pdf

-- Provide a lick mat in the recovery suite. Freeze with some soaked and mushed up kibble, a slight slather of canned dog food or other lo-cal smear, as a very tiny treat but one that will take a lot of time to consume. Use as long as your dog is not exceeding the requirement of little neck/back movement during the recovery rest period www.amazon.com/s?k=lick+mat+for+dogs&hvadid=78202818358910&hvbmt=be&hvdev=c&hvqmt=e&tag=mh0b-20&ref=pd_sl_3b30nygjvi_e

Serena, pain med gabapentin could be given at the same time as the NSAID Carprovet.
Gabapentin may be given with food.

It is Carprovet that should be given with food.
 
It is Pepcid AC that should be started and given 30 mins before Carprovet and there after every 12 hrs (2x/day) for the duration of carprovet use.

What is the stumbling block to getting in touch with your vet to confirm Luna has no health issue to keep her from Pepcid AC (famotidine) 5mgs 2x/day? Luna does not need another problem to deal with on top of this disc episode.
This is a handy med chart where you can keep notes and ensure meds are given. All data is in one place to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf

Yes she is always in her recovery x pen except when we carry her out to pee with minimal steps just to potty on leash.


I will call the ER vet and insist on the Pepcid. They said if I give with food the caprovet should be okay, but I will ask again and insist.