Julia's Melo 12/15 conserv. NECK- chi/MinPin; GRAD 2/7

Welcome Julia, we are glad you have joined. Thank you for Registering, also!  Now you can set up to receive automated email alerts whenever a post is waiting for you to read.  

Julia, there are things that need to be addressed when a dog has a disc episode. It is the owners job to have an understanding of what role each med plays (side effects, intended outcome) as it helps one ask good questions, better understand the vet's prescriptions. Knowledge is needed to be a good advocate (speak up) for our pets.
My favorite place to do my homework on meds prescribed is at the Mar Vista Vet website: marvistavet.com/libraries.pml Just type in the name of the med to get the veterinary information to get yourself up to speed.

-- Prednisone is the anti-inflammatory that gets the swelling down in 7-30 days. (taper days are not counted)
-- 3 typical sources of pain. Each needs it own med.
gabapentin for nerve pain
traMADol as the over all general analgesc
methocarbamol for muscle contraction pain
-- Pepcid AC to suppress acids that prednisone, stress and nerve damage can cause.

When Prednisone decreases to 2.5mgs 2x/day on 12/22, you will want to be alert for any signs of pain surfacing BEFORE the next dose of meds. Or pain when having to move.

Alert the vet ASAP about pain, where the dose would likely go back up to Prednisone 2.5mgs 3x/day.

Please keep us posted on how things are going.

This is tough that med reductions will happen during the holidays when clinics might be closed. Do you have a PLAN B worked out if pain would surface or is a vet on duty at the neuro's clinic you can call at night or holiday? Best to find that out today what the Plan B is.    Read about Plan B's here:  dodgerslist.com/2020/04/18/steroids-vs-nsaids/

P.S.  I love his nickname!!      I'll be watching for your post made in the QUICK REPLY area at the bottom of the page.  Then there is no need for redundant quoting us. You'll see you can scroll up to read questions in pink and back down to compose your reply.  Use a 1-2 word reference if needed to clarify meaning of a sentence.

Julia, I'm so sorry we did not hear from you when the traMADol was prescribed on 12/23.
  When the brain does not have information needed, it fills in the missing stuff and comes up with bad movies to replay over and over again in your head.

REASONS for pain to go over with your vet ASAP to get pain in control while the disc is healing.
1) 12/22 prednisone stepped down to 2.5mg 2x/day. This can be the reason for pain. That is a reason to alert your vet and the likelihood Prednisone 2.5mgs THREE times a day is needed a bit longer the 7 days prescribed.

2)  Tramadol lasts at effective pain control for about 8 hrs. You are giving traMADol every 12 hours.  When pain surfaces nearing the next dose of pain meds, that tells the pain meds are not yet right.
           In addition, traMADol dose of 25mgs for a 12 lbs/5.44kg dog is likely too low according to resources below.
    The usual in controlling pain is for the vet to Rx traMADol at the higher end of the tramadol mg range AND promptly every 8 hours UNLESS there is a health reason Milo has.  
    Look for the vet to prescribe about 50mgs every 8 hrs  


Once pain surfaces it can take longer to get back in control. Prompt mediation before pain surfaces is the trick to keeping pain full in control round the clock.

COST OF SURGERY varies widely across the country.  Check your area:   dodgerslist.boards.net/board/13/member-reported-surgery-costs-recommendations

NUMBER OF DISCS IN THE SPINE
The neck C1-7, Chest T1-13, the low back L1-7
i.postimg.cc/Vs4dF7PW/DCAanatomy400.jpg

While the most common site of a disc rupture is between T12-13 (the last Thoracic vertebrae.) all discs could be subject to the prematurely aging that is IVDD.  This is an unpredictable disease. Some dogs have only one disc episode their entire live. Other dogs have multiple disc episode whether after a surgery or after conservative treatment.  LEARN MORE about your dog's disease: dodgerslist.com/2020/06/26/time-and-ivdd/

QUALITY OF LIFE
Ask most human patients about their quality of life when they are in a hospital being treated for a condition.  Melo, on the other, hand will very likely have a different view in his at home hospital with you as his nurse. Dogs live in the moment. They treasure a hot meal, have excitement when you bring a treat pill, love a warm, comfy spot to sleep in.  People who have limb issues will worry how will I drive to work, to get groceries? Melo, has you to do all of that.  Until Melo begins to heal his nerve damage he won't care how he gets from point A to B--- just that he can.
Melo will likely have a very good chance of living many happy years ahead with you when his disc heals at the end of 8 weeks on Feb 7th or if a surgery.   Bone up on surgery vs. conservative so you are in position to ask good questions with the Neuro and make the best choice in treatment with the information you have:

Dr. Isaacs answered alot of questions our IVDD community has had about surgery: "Surgery needs to be a decision an owner enters into recognizing the risk, but also recognizes the benefit. This way if something unforeseen occurs an owner can be comforted and at peace with the fact that surgery was the right decision and they did all they could for their dog." You will find it worthwhile to read the rest of his answers about surgery:
dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/

More excellent info to help with conservative vs. surgery decisions:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Another vet where the Neuro works could access Melo's file and would then be able to prescribe adjustments to meds if the Neuro is not on with you call tonight.  PREDNISONE back up to 2.5 mgs 3x/day and increase traMADol in mgs and times per day.

Please keep us posted on what the vet says, the details of med adjustments and that Melo has fully controlled pain he deserved when healing. Pain deters healing!

Julia, timely updates from you help to keep us informed and able to spot things for you.

Phone to avoid a risk of  too much movement to the early healing disc. Report increased knuckling on the taper asap now today, soonest.

What date did the knuckling (right paw?) increase?

The pred taper is the time to watch for ANY surfacing neuro diminishment or pain and report at once to the vet.

Likely the vet will Rx another anti-inflammatory prednisone course 2.5mgs 2x/day for 7 days.

You may have been able to more quickly recognize pred had not finished its work, if pain meds had been full stopped on the 12/28 taper date. Or more quickly backed off would  maybe have sooner shown you pain surfacing before the increased neuro diminishment followed of knuckling more.

See if you can phone in the report and get the prednisone adjusted QUICKLY rather than a risk of too much movement during a car transport and waiting another 24hrs of nerve damage. Hours matter in getting quick treatment with nerve function diminishment. Vets who understand IVDD handle those things over the phone.
   With and urgent health where a transport is necessary, pad out the crate with a rolled up blanket snug around Melo's body. This prevents his back/neck from movement when braking or coming to a stop.

I am glad to hear that Melo has had decreased knuckling last night. The fact that the pred is now back to 2.5mg 2x/day should help. Increased neuro deficits during a taper means that there is still inflammation in the spinal cord and more work for the pred to do before another taper is tried.

I know that this morning, Melo had a solid poop, but if the diarrhea becomes frequent again, let the vet know. He may want to add another stomach protector to the Pepcid AC

Julia, check out the benefit of pumpkin vs. rice

Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation.
NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe

--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 for 12lbs Melo. The pumpkin fiber will work to absorb moisture in the digestive tube firming up loose stool by time it exits the body.

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.

Please let us know what you observe at potty time if there is some firming up of stool.

Julia, the prudent suspicion would be it is the prednisone that is causing extra acids on top of change in routine acids and possible neuro diminishment caused acids. Full story here: dodgerslist.com/2020/05/06/stomach-protection/


In order for prednisone to continue on with its important work of getting swelling around the delicate spinal cord area, vets who know IVDD often start a 2nd protector call sucralfate in addition to the over the counter Pepcid AC (famotidine)

Sucralfate is an Rx item.  See what you can do to discuss and advocate for getting sucralfate on board to bandaid any damaged areas of the stomach lining and to provide the needed environment for ulcer healing. Do you homework to know why you are advocating. Plus to know the  timing food, Pepcid AC with sucralfate  SUCRALFATE

Was the blood black or red?

Julia, the diagnosis drives what the treatment should be.

What was your vet's diagnosis for either black blood (digested in the stomach) or red blood (blood from intestines) in his 1/9 loose stool?   

Was Melo's blood black or red in his stool?

Pepcid AC (famotidine) suppresses stomach acids.            Prednisone causes extra stomach acids that could lead to bleeding ulcers.  Prednisone is scheduled to be on board from the 1/20 taper date and until the final taper dose.

Flagle (metronidazole) an antibiotic.  Do you have the Mar Vista Vet Drug directory bookmarked to know about each of Melo's meds?
   -- Are you giving Flagle with food?
   -- Where in the body did the vet diagnose a bacterial infection?
  -- What effect on poop texture have you seen after dosing Flagle