Alice’s Murray 2/17 conservative NECK; Grad 4/14

Alice, so sorry to hear Murray is having another disc episode.

Please understand that the STRICT rest during conservative is much more strict than after a surgery. 
---With a surgery the offending disc material has been removed making it less of a chance for more disc material to escape from the bad disc.
--- Conservative treatment depends on little movement to neck/back. Until the disc can form secure scar on the exterior of the disc, too much movement could cause more disc material to escape. That would not only cause more pain but possible damage to neuro functions (legs, bladder control, etc.). Disc healing takes 8 weeks of strict rest.


Please confirm that you're on the same page as to conservative care.
    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

STRICT rest means:
◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/
◼︎no dragging or meandering at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎At home laser or acupuncture for severe neuro damage is best. Car transports are a danger to the early healing disc. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.

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 if at all wobbly, to prevent back/butt from tipping over.
    The harness and leash are to control speed and limit footsteps. An option is to use a wire ex-pen in the grass to provide both a visible and an physical barrier to let Murray know there will be no darting off  no meandering around.  ONLY a very, very few footsteps to take care of business.



Since it sounds as if Murray saw a neuro on 2/17 why is another risky to the disc car transport scheduled for 2/21?  When at all possible vets try to avoid a transport by adjusting meds and taking updates via a phone call. 

With urgent vet visits, secure the crate in your vehicle. Transport VERY carefully using a crate padded out with rolled up towels on either side of the dog to prevent movement or jarring the spine when braking or turning corners.

Please fill in the missing info. The med list plays an invaluable tool our understanding of the treatment to form useful comments for Murray

-- does Murray still weigh 15 pounds?
-- Carprofen ?mg ?x/day  for how many days? 
-- gabapentin ?mg ?x/day
-- methocarbamol ?mg ?x/day
-- amantadine ?mg ?x/day
-- trazadone ?mg ?x/day
-- Murray needs GI tract protector, Pepcid AC, on board for duration of carprofen!  He does not need another health problem of bleeding ulcers in addition to his disc episode.  Understand the 3 reasons for stomach protection:   dodgerslist.com/2020/05/06/stomach-protection/  Pepcid AC® can be purchased at the grocery store. Let us know when Pepcid AC +?mg 2x/day is on board.

These are the extra things you can do to help with a NECK disc:    dodgerslist.com/2020/05/05/cervical-care-tips/

Alice, there seems to be some missing information that makes a mystery of why a neuro appt when you've decided on conservative treatment.....
   -- If you are still seeing pain, then call ER and have the doc on duty refer to Murray's file and adjust the meds over the phone tonight.

What is the purpose of Murray's appt with a neuro 2/21?
 -- Did the ER vet have a very high suspicion Murray has a different disease than his diagnosis of a disc episode.?
  -- Will the neuro take over the duties of monitoring Murray instead of your local vet?
  -- If the Local vet will be monitoring Murray, he will also need a hands on exam before being able to prescribe or adjust meds. Meaning a 3rd risk to the disc car transport.
  -- Another reason for the consult appt with a neuro tomorrow:  ________?

Sometimes when a local vet is not comfortable in using meds,  a Neuro consult would be for other than a surgery. It would be to get meds adjusted by a neuro who uses pain meds every day for their patients.
     If Murray is showing pain, it very likely is due to the pain meds being prescribed for every 12 hrs (2x/day).  Pain meds (gabapeintin, methocarbamol) last for 8 hrs.    Read up on Amantadine here  to understand the roll this med plays in assisting pain meds.

Could you list only the signs of pain you and and the ER vet observed Feb 16 and 17?

Are you still seeing those signs pain still today/tonight?

Alice, nice job on getting Pepcid AC on board. Do double check with your vet if for a 15lbs dog 10mgs Pepcid AC 2x/day is a good dose for Murray.
The usual formula is:
0.44mgs famotidine X 15lbs = 6.6mgs Pepcid AC twice a day.

Also very good to hear pain meds dosed every 12 hours are providing full relieve from pain night and day, dose to dose. Those neck discs can be a more painful thing due to the head often having to move when any other part of the body moves. Thus often, the neck discs are more painful.

Let us know what the neuro said at today's 2/21 appt.

Very good news that Murray has improved with the meds.

Did the vet mention why she was keeping him on carprofen for at least 4 weeks? Possibly another issue along with IVDD? What we see most frequently with IVDD is when the pain meds are stopped, the anti-inflammatory is stopped also. This way, we would know very quickly if the swelling in the spinal cord has resolved. The page below gives more information about anti-inflammatories and IVDD.

dodgerslist.com/2020/04/18/steroids-vs-nsaids

Murray had his last dose of his meds [3/25] Saturday evening. Last night he [3/27]started whimpering when settling. I gave him a gabapentin and trazadone before bed, but then this morning when I was letting him out, he walked out of crate supe slow and hanging his head. I gave him his ✙full regimen of original meds and called the vet when they opened.

[MED LIST/HISTORY- Moderator's Note. Please do not edit ]
15 lbs 7 y.o.
Carprofen 25mg tab as of 2/17: 12.5mg 2x/day for 30 days
                                 as of 3/19: 12.5mgs 1x/day final dose 3/25 test STOP for:√3/27 pain / _neuro
Prednisolone as of 3/31:  ?mgs  ?x/day  for ? days, then a test taper for: _pain / _neuro  
✙gabapentin 100mg tab:  100mg 2x/day?
✙methocarbamol 500mg tab:  125mg 2x/day?
✙amantadine  100mg tab: 25 mg 2x/day?
✙trazadone  50 mg tab: 25mg  2x/day?]

They are suggesting rather than carprofen we use prednisolone. I am so emotionally drained.. this disease is horrible

Hi- he was never on Prednisone

Started Carprofen on 2/17. 2 x day 1/2 pill until 3/18, and did 1/2 pill 1 x day from 3/19-3/25

This morning, gave 1/2 trazadone
1/4 amatadine
1/2 carprofen
1/4 methocarbamol
1 100 mg gabapentin

Per convo wit vet this morning, they want to do methocarbamol, gabapentin, and change the carprofen to prednisolone. (After washout).

[3/31 to start pred] Friday night.

Currently dosing all but carprofen 2 xs day. Also have famotidine to add back in with steroid [prednisolone].

Please let us know with prednisolone on board today 3/31, that all pain is fully managed nite and day. Also is famotidine is back on board 5mgs 2x/day?

On Wed April 5th when the pred taper starts, will the methocarbamol & gabapentin also be stopped for you to be able to make a quick and accurate assessment about pain?

Alice, doing a risk to the disc car transport for a Thursday 4/6 appt?  The taper doesn't even start til Wed 4/5.  Likely no observations will reveal it self whether all swelling is gone or not.   If pain meds are full stopped 4/5 along with pred taper, it might be a day or two or longer if pain would surface if pred had not fully completed its job.

If you have the same concerns, express them and see if a phone consult option would work to report what you observe during the taper.   No sign of pain, means finish out the pred doses + famotidine. Finish the balance of the 8 weeks of rest to heal the disc.
8 weeks of strict limited movement the spine to allow the disc to heal would be on April 14.  If the spine would be caused to move too much, it is possible to have a setback. Meaning for you and for Murray having to start back at square one with counting out 8 weeks of strict rest, back on anti-inflammatory meds, pain meds.

Weigh the risks vs. benefits 
Vets who know IVDD will often take phone updates, adjust meds over the phone to allow the safer option of crating at home for the healing the disc.
    A benefit for a most urgent of vet visit for a health reason such as learning to express, urinalysis, etc., outweighs an exposure risk to an early healing disc of too much spine movement.  Protect the disc! Secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels/blanket on either side of the dog to prevent movement or jarring the spine when braking or turning corners.

With graduation day expected to be April 14, we'd know then, what Murray's neuro status is and be able to offer you insight on how to slowly and safely introduce him back to family life and activity.

Would you be taking Murray on vacation too? What date?

How is Murray doing today? Any signs of discomfort nearing his next dose of pain meds (gabapentin & methocarbamol) or when he has to move his body?

What date will pain meds be stopped or backed off?

I am happy to hear that Murray pain free. The pred taper is scheduled to start tomorrow. During a pred taper watch carefully for any signs of pain that may emerge. That would mean that there is still swelling in the spinal cord and pred still has work to do so the taper should not continue.

Are the pain meds being cut back or stopped when the taper start?. This is usually done so that the use of pain meds does not mask the emergence of any pain during the taper which would indicate that there is still inflammation of the spinal cord.