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Post by Emily & Scooby on Apr 24, 2023 7:53:14 GMT -7
[Scooby: 9 y/o dachshund, week 3 of crate rest]
Hi! My 9 year old dachshund Scooby is currently on week 3 of crate rest. We have been trending in a positive direction, until it is time to poop. He is in extreme pain when pooping. We have a vet appointment [4/24] today, but I thought we would join this site for other's experiences.
1 - He is not usually in pain until it is time to poop. He is purposely holding his poop in to avoid the pain. He is pooping about every 3 days, usually with assistance. The last time we tried to stimulate him to poop, (Saturday 4/22) he scream and was in a lot of pain. Since then, he has had limited movement and appetite. He did poop on his own last night (4/23) with no screaming. He is shifting positions in the crate with no more trembling at the moment. His tummy is tense and his back is arched.
2 Scooby is 9 years old and weights 15 lbs
He is taking
gabapentin 100mg every 8 hours
methocarbamol 1/4 tablet every 8 hours
Prednisone every 24 hours (we're starting to taper off)
Tramadol 1/2 every 8 hour
(unsure of exact dosage, I'm at work atm. I will update when I get home)
He is not on Pepcid but I'm asking the vet tonight for it.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 9 y.o.
Carprofen as of ER 3/31: for 6 days for pain, walking, no disc diagnosis.
Sulcrafate on 4/6 with no carprofen washout 3-day Rx, wobby walking and in pain
Prednisone 10mg tab as of reg vet 4/6: 5mg 2x/day for 3 days; 4/9 test taper for: √4/6 pain/ √ neuro
5mg tab as of new vet 4/15 taper dose: 2.5mgs 2x/day for 5 days, √4/13, 4/24 pain/_neuro
dexamethasone shot 4mg/ml 4/13 new vet (4/13 in pain) no stomach protection on board nor provided!
gabapentin as of ER 3/31: 100mg 3x/day
methocarbamol as of reg vet 4/6: 125mgs 3x/day
traMADol as of new vet 4/13: 25mgs3x/day
Scooby needs GI tract protector, Pepcid AC, on board for duration of prednisone! ]
☆ 3 -- He has had a few vomiting episodes, but most of those have stopped after we started a bland diet.
☆ 4 Scooby is a 9 year old dachshund. I am his mom, Emily
☆ 5 - We did not do an MRI (couldn't afford) but the vet said it mostly like IVDD. He appears to have a neck and a lower back disc problem. This is an regular DVM who works at an urgent care clinic. Her own dog has IVDD as well.
☆ 6 Started conservative strict crate rest on 4/6.
Emergency vet missed it on 3/31. Our normal vet was upset they didn't recommend crate rest right away, so crate rest started on 4/6. I had to take him to the urgent care (not emergency) vet on 4/13 bc of scheduling issues with our normal vet. We have been seeing Dr. Ramesh since 4/13 and have done 2 acupuncture sessions with her as well.
☆ 7 He seems to pee on his own and generally stands up to do so. Sometimes I do find wet blankets but they are generally soaked through.
☆ 8 He was able to walk a little (like a drunken sailor) before the poop fiasco on Saturday (4/22) night. He can move his legs and tail, although he has definitely been more lethargic and exhausted since the poop fiasco.
This morning he did eat a peanut butter treat before I left for work. My husband gave him his tramadol at 9:30 est and he did not throw it back up. He is due for gabapentin and his muscle relaxer at 1:30 EST.
He seems to be perking better than he was yesterday, but we have backslid so far after this poop fiasco on 4/22. He has a vet appointment today to talk about his painful poops and getting a tummy protectant.
On the Bristol stool scale, his stool is a type 3 (normal sausage shape with grooves/cracks).
Anything else we want to know??? I'm just so scared for him and overwhelmed. I don't want pooping to be the hill we get stuck on when we had made so much progress and had even seen his personality returning.
(my avatar are my two babies, Ellie and Scooby. Ellie is a dachshund mix (and is the biggest weiner looking dog I've ever seen) and Scooby is a standard dachshund).
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 24, 2023 9:58:03 GMT -7
Emily, welcome to the Forum. We are glad you are here. Look forward to your filling in the missing info on the med list when you get home. Til then it appears the reason for Scooby's pain is that he is in the pred taper. This taper is a kind of a window to find out if pred had fully completed its job to rid the body of painful inflammation. Normally all pain meds would have been stopped at the begin of the taper to help you get a QUICK and accurate assessment. Rule of thumb on prednisone taper
pain = swelling = back to original anti-inflammatory pred dose, +pain meds and Pepcid AC
no pain = go to conclusion of pred taper. No pain meds, just Pepcid AC for duration of prednisone finish out the 8 weeks of crate rest for the disc to heal The full details on how Pred, an anti-inflammatory, works with a disc episode. Good reading to be able to ask the right questions and discuss treatment: ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/Rather than a trip in to the vet where a vehicle transport could cause too much movement to the early healing disc, call now and update the vet via phone. Vets who understand IVDD often take care of things like med adjustments over the phone. --- Describe with dates when the pain appears --- Describe the pain signs you observe:
traMADol can cause constipation. 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. 🏵To calm your mind, I bet you'd like a realistic idea of how long it takes to heal. This is one of the most frequent questions asked. Here is the answer along with two tools to help you during your dog's recovery time: ==> dodgerslist.com/most-asked-disc-disease-ivdd-questionsPlease keep us posted on med detail changes. How Scooby reacts to any med changes (pain, neuro). A medication chart is useful to see those 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 |
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Post by Emily & Scooby on Apr 24, 2023 13:39:43 GMT -7
We started gabapentin and carprofen at the Emergency vet 3/31.
Our regular vet switched us from carprofen to prednisone, along with sulcralfate (3 days worth). This is also when we started the methocarbamol 4/6
The new vet had us continue prednisone, gabapentin, and methocarbamol. She added the tramadol to our regimen. This was also his first acupuncture session. 4/13
2nd acupuncture session/check up 4/20
I'll add more as I get home. Thank you for all of the resources.
Actually, I have the itemized receipt from the vet in my purse.
Prednisone 5mg tablets. 1/2 tablet 2 times a day for 5 days, 1 time a day after that (not sure the rest of the directions are on bottle)
Methocarbamol: 500mg tablets. 1/4 table every 8 hours.
Gabapentin 100mg every 8 hours
Tramadol 50mg tablets. 1/2 tablet every 8 hours.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 24, 2023 15:45:41 GMT -7
Emily, both carprofen and prednisone play a key role in our understanding Scooby's treatment. Coming in late, it seems there may be some missing information that would explain the "why" for us.
-- What is your understanding of why the switch from carprofen to pred on 4/6 with reg vet?
a) with no crate rest Rx, was there a new or worsening of back leg neuro function on 4/6?
b) with no crate rest Rx, was pain not in control round the clock?
c) other reason?
d) What was the start prednisone dose in mgs and times per day. For how many days, then a taper?
-- What are the details of the 4/13 new vet "continuing on" with prednisone?
a) What pred dose in mgs and times per day were given 4/13 onwards? For how many days at that dose?
Here is how prednisone works with a disc episode.
1. Pred is used at the anti-inflammatory level dose during a disc episode. All vets must guess for how many days. Often the pred course will be a 7-day or even a 14-day course.
2. For a 15 pound dog the dose would be in the neighborhood of 5mgs 2x/day. Often a vet will round up to the size of the pred pill. A Blood test helps a vet to know if Scooby's organs can use prednisone. If he has a health problem that may be the reason Scooby was not prescribed the "anti-inflammatory level" dose? When is the last time he had a blood panel?
3. It may take pred 7 to 30 days (excluding any taper days) to finally rid the body of painful inflammation around the cord.
4. It normally takes addressing each source of pain every 8 hrs to provide full comfort from pain while prednisone works to resolve swelling/inflammation. Scooby now has the full complement of pain meds on board!
traMADol as the general analgesic
methocarbamol for muscle contraction pain
gabapentin for nerve pain.
5. It is not clear for us, but if Scooby is still on a pred taper dose (less than Pred 5mgs 2x/day), then discuss trying Scooby on the anti-inflammatory level (5mgs 2x/day) for a 5-7 day course.
6. Discuss with any pred taper that the 3 pain meds also be stopped or back down. This gives you the best opportunity to quickly and accurately assess for existing pain. Pain meds on board during the pred taper blindfold you. Is pain really gone or hidden and needing another course of pred
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Post by Emily & Scooby on Apr 24, 2023 19:20:15 GMT -7
[quoted text removed. Preference is to only read your words]
When we took him to the emergency vet on 3/31, it was for ragged breathing and apparent pain. They kept him overnight (we arrived at 3am), did xrays, bloodwork, etc., and sent him home with gabapentin and carprofen. They said he was just bruised up from some kind of trauma (a fall, playing hard with his dog sister, we don't know for sure). They just said to make sure he wasn't allowed to go run in the yard, play with his sister, or anything strenuous. Nothing about crate rest. Lo and behold, he worsens over time.
From 3/31 at the emergency vet to 4/6 with his regular vet, there was a severe worsening of symptoms. He had been walking when he came home from the emergency vet. Regular vet decided he needed the prednisone for swelling more than he needed the carprofen. She also added the muscle relaxer as he started to have spasms (which I think the spasms may have worsened his injury). She also said absolutely STRICT crate rest until he could be reevaluated. She was so upset the ER had not recommended it to us.
[reg vet on 4/6] Original pred. 1/2 table (10mg) by mouth once daily for 3 days with sulfacrate. He got worse after stopping the pred and couldn't get him back in, and she gave me more pred on 4/12 [dose in mgs/frequency?]but by that time I couldn't get pills in him, hence moving to the new urgent care vet.
Pred from the new vet was only 5mg per tab. She said he still needed it because of the swelling and pressure on his injured area. We started on 4/15 as he was given a pain injection shot on 4/13 and didn't want them overlap too much. (I'm not sure which one it was, he received Acepromazine 0.02mg/kg, buprenorphine .012mg/kh, and [steroid injection shot on 4/13 ] dezamethasone 4mg/ml).
We started on Sat 4/15, [prednisone] 1/2 pill 2x a day for 5 days, but I messed up and he got only 1/2 pill in the evening of 4/15 and 4/16, then twice a day from 4/17 to 4/22.
Yesterday, 4/23, [continued pred taper reduction with dog in pain!] was his first day of only 1 dose of a 1/2 pill. We are on a 1/2 pill once a day for 5 days, then half pill every other day until we're done with the bottle.
He had a blood panel done on 3/31 at the emergency vet and on 4/13 at the new vet. His blood work came back pretty much immaculate both times. Nothing abnormal to note.
update after vet appointment 4/24
He received another Butorphanol shot to help with immediate pain. He also got his first cold laser therapy.
We have upped the ▲tramadol to a whole pill (50mg) 3x a day. We also have ✙lactulose for his constipation (start off with 1ml every 8-12 hours as needed, can up to 1.5 mil if no results) and✙ omeprazole tables (20 mg) 1/4 tablet (5mg) every 24 hours.
I asked them about Pepcid and they said it works the same way as the omeprazole.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 9 y.o.
Carprofen as of ER 3/31: for 6 days for pain, walking, no disc diagnosis, no crate rest Rx.
Sulcrafate on 4/6 with no carprofen washout 3-day Rx, wobby walking and in pain
Prednisone 10mg tab as of reg vet 4/6: 5mg 2x/day for 3 days; 4/9 test taper for: √4/6 pain/ √4/6 neuro
5mg tab as of new vet 4/15 taper dose: 2.5mgs 2x/day for 5 days, √4/13, 4/24 pain/_neuro
dexamethasone steroid shot 4/13 new vet (4/13 in pain) no stomach protection on board nor provided!
gabapentin as of ER 3/31: 100mg 3x/day
methocarbamol as of reg vet 4/6: 125mgs 3x/day
traMADol as of new vet 4/13: ▲ 50mgs 3x/day
✙ Pumpkin 1 tsp 1x/day
✙ lactulose 1ml every 8-12 hours as needed
✙ omeprazole 20mg tab: 5mgs 1x/day, takes 3-5 days to reach peak effectiveness ]
They said I could give him his gabapentin, omeprazole, and muscle relaxer when we got home, but he's pretty high from his injection still and hasn't taken his meds yet. They said the injection should wear off in 3-5 hours, depending on how his body metabolizes it. It is currently 10:11 PM est.
Also said to continue pumpkin since he really seems to like it and to continue to bland diet for his belly upset.
I still have him scheduled for acupuncture on 4/27 (Thursday). Do you think that is a good idea??? They said we could also do round 2 of cold laser therapy if my wallet is up for it. Good thing for Care Credit!
I have printed out and are using the medicine charts you linked to. They will be so helpful - this is a lot of medicine for one little dude! I'm praying we can get him on the right track and we can overcome this.
Anything else you can think of need to know??? It's been a long, hard few weeks. I have been keeping a log as of 4/13, as recommended by the new vet. Log of medicines, improvements, poops and pees, backslides, 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 Apr 25, 2023 8:47:26 GMT -7
Emily, unfortunate there had to be so many cooks in the kitchen with Scooby's disc episode treatment. Then on top of that was your unexpected and overwhelming need to be educated about IVDD and its meds. You simply were not in position to recognize and speak up for Scooby. This is the case for many of us when we were 1st timers. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated so we can team up to work with the vet we hire. dodgerslist.com/2020/04/20/education-team-ivddThe " MED LIST/HISTORY" we assemble for each dog tells the story on their treatment and provides the basis for our comments. You can see the entire History in your last post with hopefully now the correct dates, accurate doses, etc. If not please in your next post correct any misinformation.1. CALL and discuss TODAY 4/25! The oral bioavailability of omeprazole is initially low (approximately 35-40%) but increases to about 65% in the first 3-5 days of administration. www.medscape.com/viewarticle/508018 Pepcid AC works in 30 mins. Scooby currently has had and still has an upset stomach likely from the prednisone and espeically the very strong Dex. Omeprazole: Occasionally, some animals develop nausea, vomiting, flatulence, diarrhea or loose stools. www.petplace.com/article/drug-library/library/prescription/omeprazole-prilosec Famotidine: a very limited potential for side effects, hence their recent release to over-the-counter status. marvistavet.com/famotidine.pml Pepcid AC (famotidine) from the grocery store seems a better quick acting choice during a disc episode. Scooby's GI tract has not been adequately protected since 3/31 to even now 4/26. Read: dodgerslist.com/2020/05/06/stomach-protection/2. One of the typical signs of increased damage to the GI tract leading to bleeding ulcers can be a loose stool (decreased appetite, vomiting, diarrhea, or red or black blood in the feces). Having TWO products that cause loose stool on board PUMPKIN & Lactulose can be confusing if stool turns too loose. Pick just one of these to give Scooby.3. PREDNISONE & DEX. It appears Scooby has only had FOUR (4) days of anti-inflammatory levels of steroid (4/6 Rx prednisone 5mgs 2x/day for 3 days + 1 Dex shot on 4/13). All other doses have been taper doses less than an anti-inflammatory level dose. This could well be the reason Scooby is having trouble getting the inflammation resolved. Discuss today 4/25 using an anti-inflammatory level pred dose for a 5-7 day course and then a taper to see if inflammation is resolved. Pain meds on board with a taper keep you from properly assessing for existing painful tissue around the spinal cord. 4. What are the "bland diet" ingredients?5. The SINGLE most important care you can give is the at your house in the recovery suite care. This is how the disc is protected from too much movement. The disc is in the early stages of trying to form secure scar tissue. Vehicle transports to a vet simply involve a potential for too much movement. Proper meds provide full pain relief. Mild neuro wobbly walking you have reported can be self-repaired by Scooby's body, even dogs with paralyzed legs can self repair neuro function. If you are of a mind laser is a must do thing, then hire a mobile vet to come to your home. Protection of the healing disc is #1. Vets who understand IVDD, handle things over the phone whenever possible. They only call for a visit with the most urgent of health issues.... such as learning to express a dog who's lost bladder control, etc. Please give us an update since the change in meds 4/24. Was appt with Reg vet?--- Any pain surfacing before next dose of 3 pain meds (traMADol, methocarbamol and gabapentin), when having to move? --- Is the wobbly back legs the same as when first reported 4/6ish? Worse or better 4/25? --- Do the back paws knuckle under 4/25? Can he correct their placement on the ground? Or is he slow to do so or can't at all? Best way to reply is using the QUICK REPLY at bottom of page. We only want to read your own words in your posts. Thank you very much for helping us out.
➡️ QUICK REPLY: Easy, fast and recommended! Go to the "Quick reply" typing area at bottom of your dog's thread to write a reply. |
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