Sigrid's Gretta 11/27 Conservative; GRAD TBA 2/6??

Sigrid, sorry to hear Gretta is experiencing a disc episode.

It is imperative to get pred back up at the anti-inflammatory level (2.5mgs 2x/day) asap by the vet's directive.  Hours matter. When pred is back on board at anti-inflammatory level, neuro diminishment can often be turned around.  If too many hours pass before getting back up on orig pred dose, it may take some time for the body to self repair that wobbly nerve damage.  Gretta, can still be a good candidate for conservative treatment if her pain can be fully managed.

The taper of prednisone is to determine if it has  completed its job to resolve all swelling.  When there is pain/neuro diminishment on the taper, it tells you and the vet another course of prednisone is needed.

It may take 7-30 days of prednisone up at the  anti-inflammatory level.  All vets must guess how many days it might take to resolve swelling.  So far Gretta has received 10 days (two 5-day courses) at the anti-inflammatory level dose. Clearly it is not time to stay in the taper, but for the vet to be alerted and expect another 5-7 day pred course  

Typically it takes 3 pain meds each addressing a different source of pain RX'd for every 8 hrs (3x/day) to provide full comfort. Alert your vet asap in the morning to discuss another course of pred and perhaps a more aggressive pain med approach.
    traMADol-general analgesic
    methocarbamol- muscle spasm pain
    gabapentin-nerve pain

Sigrid, let us know about addition of methocarbamol 250mgs plus back to pred 2.5mgs twice a day and effect on back leg wobbliness and pain  this morning.

DISCLOSURE for reported change in meds (mgs, frequency)
Pepcid AC whole tablet is 20mgs?
1/4 tablet dose is 5mgs?
You are giving the dose TWICE a day for the duration of prednisone? 
Pepcid AC is affective for 12 hrs.

What is the methocarbamol 250mgs prescription frequency?  2x/day, 3x/day?
A 250 mgs dose of methocarbamol is pretty high.  More typical on the Forum are vets dosing 125mgs dose 3x/day for a 12lbs dog.  Discuss with your vet if you are seeing 250mg provide too much muscle relaxation.

If she is sitting on her butt and rocking from one leg to the other front leg, that is not so bad.  But if she is actually airborne a bit by hoping leg to other front leg, that is too much movement.
--- try draping a blanket over the suite that comes down to her sitting eye level. Should she hop up, she'll be in the dark of the blanket cover.  Soon that hopping behavior should extinguish.  As you approach try commanding "sit" and each time she stops hopping, praise "good sit" maybe that will help too.

You may want to review the difference in the two treatments (conservative vs surgery) in helping you to understand, ask good questions with your vet and decide "if" or "when" a surgery at some point.
dodgerslist.com/2020/02/10/surgery-vs-conservative/

With the pred back up to 2x daily, Greta should become more comfortable. As Paula mentioned, it can take up to 30 days on the full dose of pred before the swelling in the spinal cord, which causes the pain, is gone. If you see additional neuro diminishment on the 2x a day dose, please let the vet know immediately.
As you mentioned, Methocarbamol can sometimes cause clumsiness and muscle weakness. 250 mg is a higher dose than we usually see prescribed for a 12 lb dog.

Sigrid, it seems you are reporting that Gretta is no longer in pain with going back to orig Pred mg/frequency, and the addition of Methocarbamol.  Important to hear she CAN still take the few permitted footsteps at potty time even if wobbly.  Anti-inflammatory drugs (prednisone) might take around 30 days to rid the area around the spinal cord of inflamed tissue. She's had two 5-day courses + your 12/14  ?-day of dosing til you can connect with the vet.

Kudos to you managing all that you have to do within bounds you set. There are many reasons (health issue, financial, situation too complicated for a safe surgery, etc.) a surgery may not be optional. When that is the case, conservative treatment is the best treatment. Make it perfectly clear to vets why your position is conservative treatment. There is no guilt in maintaining a home budget that does not over extend the resources—— that is the prudent thing to do to protect the family.

It would be helpful to give us a med report with dates, mgs, frequency so we can follow along to  know how to comment.

MED LIST
Please provide the new updated info that is missing (colored in pink).
prednisone as of 11/27: 2.5 mgs 2x/day for 5 days, 12/2 test taper for: _pain / √12/7 neuro
                        as of 12/8: 2.5mgs 2x/day for 5 days,  12/13 test taper for: √12/14 pain/ _neuro
                        as of 12/14: 2.5mgs 2x?/day by owner til vet contact
methocarbamol 250mgs ?x/day
gabapentin 75mgs 2x/day
Pepcid AC (famotidine) ?mgs   ?x/day for duration of prednisone

     1) Prednisone: how many times a day are you dosing 2.5 mgs?
     2) Methocarbamol: How many times a day are you dosing 250 mgs? Did the Rx give a range of frequencies?

Hope you will be able to make contact the Neuro today to confirm meds.  If not assume you have enough meds on hand to continue what seems to be the right direction (no pain now and no new/increased neuro diminishment) til you connect with him after the weekend.

Sigrid, true that methocarbamol is definitely used for neck discs.  However, you can observe how many vets and even neuros do Rx methocarbamol for back discs. It is not unusual for Methocarbamol to help provide comfort as you are observing. 

Here at the Forum we have accumulated a lot of learning and knowledge over the years by watching what vets prescribe.  Would you share the neuro resident's Tramadol Rx  (mgs, x/day) even if you've not yet needed to use?

Conservative treatment is all about limited movement of the spine so the disc can heal. Too much movement could potentially place the dog back at square one of 8 week count to heal the disc. It might potentially be so much movement that there is neuro diminshsment.
    Any time out of the suite is a danger of too much movement as you are well aware.  In addition vehicle trips in for a vet visits are also times that could potentially have the back moving too much. Vets who understand the need for strict rest, often will be open owner updates via a phone call or to adjust meds.  See if the neuro resident will also be open to:
    -- your describing via phone: no neuro set backs,
    -- describing if wobbly is a bit less or still the same,
    -- that you observe no signs of pain nearing pain meds doses or when Gretta has to move.

When there is a very serious urgent health reason making the risk of a transport override the benefit of strict rest:
    -- Secure the crate in your vehicle.
    -- Pad outcrate with rolled up towels on either side of the dog to prevent movement or jarring the spine when braking or turning corners.



MONITOR & report PAIN
◻︎ shivering-trembling ◻︎ yelping when picked up or moved
◻︎ slow to move          ◻︎ tight tense tummy
◻︎ arched back, ears pinned back 
◻︎ restless, can't find a comfortable position
◻︎ slow or reluctant to move much in crate such as shift positions

MONITOR and report NEURO FUNCTION diminishment
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 tearing disc & inflammation in the spinal cord
2. 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 on their own
6. Legs do not work at all (paralysis, dog is down)
7. Bladder control is lost
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.

It is important for the owner to know how many days course of pred has been prescribed, then the taper.

You re-started the anti-inflammatory dose of pred on 12/14.  For how many days is the 2.5 mgs 2x/day to continue?  Then begins the lower prednisone taper doses.

Sigrid, thank you for sharing the mistake in too low a prednisone dose. It may well explain the discomfort you saw being on a low dose is the same as tapering to find out if there is pain. And there was the addition of movement with a car transport and exam.

Good news is diarrhea is over and she has better neuro control when taking a few footsteps at potty time and standing to drink water!!

Glad to hear should any pain surface as you continue with the pred taper, you already have permission from the neuro to go back to a full 2.5mgs of prednisone 2x/day.

Since the taper is the time to observe for pain, have the three pain meds (methocarbamol, amantinine and gabapentin) been stopped so you are not blindfolded about pain?  There is no proof all painful swelling has been resolved by prednisone until pain meds are stopped.

Give us the details of mg dose, times per day if pain meds are still on board.  If still on board when will they stop?

Sigrid, you have a number of confusing things going on at the same time. Makes it difficult to know which of those things is the culprit.

1. Changing food while on pred is not a good idea. Food change can cause diarrhea making it difficulty to know if you have a serious GI problem or just a temporary food change issue. 

2. Prednisone, stress, nerve damage (wobbly walking) can all contribute to extra acids in the tummy.

3. Plain pureed pumpkin can loosen stool when extra water is added. 
--To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day.
-- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble.
       FYI NOTE: Rice is complex carbohydrate that tends to ferment in the dog's colon, causing unfortable gas. In addition rice often passes right through the dog's GI tract exiting totally undigested. Whereas pumpkin or sweet potato is nutrient rich plus high in fiber. Dogs can absorb/digest its nutrients from the fiber.

How long to wait til one finds out if prednisone has completed its job? Discuss with your vet!
        Most vets stop the pain meds to find out quickly on the taper if pain would surface or if neuro diminishment would increase to call for another course of anti-inflammatory level dose 2x/day of prednisone.        It can take 7-30 days for pred to fully resolve swelling. Taper days are not working on swelling.
        No one wants a dog on prednisone if there is no more work for pred to do.  The taper part, however, is a "must" for health reasons to signal the body resume making its own steroid hormone again.
     It just happens the taper is the perfect window with no pain meds on board to get proof all swelling/inflammation is really gone.

I am so sorry to hear that Gretta is again having pain. It seems like she has had a relapse, although it could be another disc causing the issue.

Have you continued being Very Strict about the crate rest? Our dogs often want to move around more when they start to feel better.

Can you give us more detail about the decrease in neuro function that you are seeing?

Usually with a relapse, we support starting the crate rest from the beginning. Since you expect to hear from the neuro tomorrow, let's wait for his take on what is causing the issue.

Don't beat yourself up about not being able to afford surgery. Conservative treatment could still work for Gretta.

Sigrid, sorry to hear on the continued taper of prednisone, it was revealed pred still had work to do. So there is no need to restart the count of crate rest weeks. There is a need to get up on the anti-inflammatory level of prednisone (2.5mgs 2x/day) as you did until you could hear from the neuro. 

In light of increasing neuro diminishment (an emergency), discuss with the neuro if use of the upper range of the anti-inflammatory level (5mgs 2x/day) would expedite ridding the body of the swelling around the cord's tissue and help to protect from further neuro decline.  Hours matter in getting proper dose of pred on board.  

It can take upwards to 30 days before pred could fully resolve swelling. So far Gretta has been on pred for 18 days at the lower end of the anti-inflammatory range (2.5mgs 2x/day). Taper days are too low to work on swelling thus they do not count in the 7-30 days it may take prednisone to fulfill its job.

Normally a dog would not graduate UNTIL off of all meds and no pain shows. So while graduation is expected to be Jan 22, it may be a few extra weeks before safe to graduate and get back to physical activity slowly over a couple of months. Let's see what the neuro says.

Your job on the prednisone taper is to observe for pain surfacing AND to observe for new neuro decline. You witnessed 1/16 (please use dates so we don't incorrectly assume a date).

There are ways to help you with your shoulder in caring for Gretta to limit your need to lift her.

We anxiously await hearing what you learn from the neuro this morning 1/18am asap about the emergency of new neuro diminishment (pred adjustment).

My dog was about 60 lbs during his IVDD episode. I could not lift him. I got a Help Em Up Harness. This type of harness has a handle at the top, sort of like on a suitcase. This was a game changer for me. I could lift him by myself. The Help Em Up harness comes in large and small sizes. A harness like this might allow you to lift her up with your good arm. There are other brands of this type of harness available also.

Gretta's neurologist (assistant) called us back after I requested to increase her Prednisone dose to 5mg 2x/day. My regular neurologist was out of the office so they consulted with someone who had not seen Gretta ever.

The new neurologist wants me to keep her at 2.5mg 2x/day due to the fact that at 5mg 2x/day for her weight he said it would act more as an immunosuppressive medication which he felt would be bad for Gretta's recovery.

Since Gretta does have a heart murmur, I may give her the 5mg dose tonight and then go back to 2.5mg 2x/day starting tomorrow 1/19 morning.

I wish I could have consulted with her regular neurologist, and I hope the 2.5mg 2x/day dose will be enough to bring down her inflammation.

She thankfully has not gotten worse today. Still no use of her back legs other than moving her hips when she "squats" to pee as I hold her up with the sling.

Methocarbamol I give either 2x or 3x a day depending on the day and how she is feeling.  Usually it is only 2x day.
Gabapentin is the same.  Usually 2x/day, but sometimes 3x/day if she needs it.

My neurologist is the one who told me to give the gabapentin and methocarbamol either 2 or 3 times a day depending on how Gretta was doing. They said to give every 12 hours and if she was painful they both could be given every 8 hours. I just listed the instructions they gave me.

Thank you, that makes sense. I will make sure I'm giving her the pain meds every 8 hours. I'm in tears and a bit of a wreck watching her not be able to move her back legs. I was able to afford surgery for her and my other dog that passed away last year when they got to this point (when they were younger), so it is really upsetting that I have to do crate rest knowing she may stay paralyzed.

Since my regular neurologist was not in yesterday, I called back today to get a second opinion from her on the prednisone 5mg 2x/day vs 2.5mg 2x/day and I'm waiting for a call back hopefully by the end of the day.

She still has bladder and bowel control, and has deep pain sensation, although less sensation on her left compared to her right. She seems to have some trouble "pushing" her poop out and it usually comes out after she pees and I go to pick her up, but she can hold it in.

My shoulder is tolerable for now, I'm just worried if I end up needing surgery and would be restricted from using my right arm at all for a period of time. I'll deal with that when and if it happens.

My apologies, I'm having a lot of emotions and stress as she is my only dog after losing my beloved boy last year.

Thank you for all your advice and help.

I am glad that you were able to convince the neuro that an in-person visit was not needed.

After the 7 days another taper can be tried. Many dogs need more than one taper.