Dee's Winnie 2/2023 conserv neck Pug; GRAD 4/12

Welcome Dee! What's your pug's name?

Coming in cold without any detail facts of meds, dates, etc. your vet and the neuro have at hand makes it difficult to comment. So in general:
    Say if it were Feb 15th of the disc episode diagnosis in the neck, then it takes 8 weeks of STRICT rest to let the disc heal.  1) Had you done the very STRICT rest of limited movement of the spine so the disc could heal?
            Tips and ideas on how to do STRICT rest:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/
---- If you had not provide true STRICT rest, then possibly, you could try conservative treatment.
---- If you had done the strict rest for 8 weeks AND repeated attempts to taper off of prednisone reveal the inflammation was still not resolved that would be the reason to consider a surgery.

2) What was the particular NECK disc diagnosis?  
  a)  Is there a root signature pain issue where your dog holds her paw up (front or rear limb) not wanting to bear weight ? A neurological disorder caused by compression of the nerve roots which branch off the spinal cord going down to the legs.
   b) Or a neck disc actually pressing on cord in the neck area?

3) What is the date of the scheduled surgery?
4) Your dog's weight? Age?
5) Prednisone dose in mgs times per day.
    Read the 3 reasons to use acid suppressor Pepcid AC (famotidine) for the duration of prednisone:   dodgerslist.com/2020/05/06/stomach-protection/
6) gabapentin ?mg ?x/day 
7) methocarbamol  ?mg ?x/day
8) What is the name of the Chinese herb?
   Chinese Herbs are composed of many herbs in one bottle/pill, meaning you would need to Google each one to familiarize yourself on what your dog is taking. Very experienced holistic vets will be hesitant to prescribe Chinese herbs when conventional medication are already in use. The reason is there is no asurity there would not be any interactions with the other medications that could make your dog sick or worse.

Will be watching for your reply to learn more about your gal.

Dee, what's your girl's name?

It really at this point matters not which type she has.  You've tried 3 unknown courses of prednisone. Each time the taper revealed pain. When pred is not able to get the swelling down, then a surgery is often a consideration. 
   Missing pred detail:  Had each pred course begun with the usual TWICE a day dose of 5 or more mgs  (for a 21 lbs dog) and then a tapering?

There are two types of IVDD:
Hansen type II IVDD, also referred to as chronic disk.  It is more similar to disc disease in humans. Instead of an extrusion in the center of the disc, there is a bulging and protrusion of the disc exterior.

Hansen Type I
This type of disk displacement has acute onset and occurs most commonly in breeds with dwarf legs (eg, dachshund, Pekingese, beagle, basset hound, Welsh corgi, pugs and other dwarf legged breeds).  These dogs where born with the disease called IVDD. MORE:  dodgerslist.com/2020/06/26/what-is-disc-disease/
    In dogs with Hansen type I IVDD, a portion of the nucleus pulposus herniates, or extrudes, through the fibrocartilage of the annulus fibrosus into the spinal canal. Disk material in the spinal canal can then cause compression of the spinal cord.

Looked up the ingredients and recommend you speak with the surgeon:
Jing Tang's Cervical Formula
   Prednisone increases risk of bleeding ulcers. Hence, a good idea to protect the stomach from extra acids with PEPCID AC (famotidine). Your girl does not need an other problem on top of what she is dealing with!
   Cervical Forumla contains Chuan Xiong (Ligusticum) aka Lovage. This herb inhibits blood clotting.  Cervical Formula is something to discuss stopping with the surgeon  in light of upcoming surgery and with the current use of prednisone til surgery.

Jing Tang's Body Sore
   Chuan Xiong (Ligusticum) aka Lovage.This herb inhibits blood clotting. Body Sore is something to discuss stopping with the surgeon in light of upcoming surgery and with the current use of prednisone til surgery.
Hong Hua (Carthamus) (Flos Carthami) aka safflower.  This is another anticoagulant, inhibits blood clotting.

I'm glad to her pain is full controlled until the time of surgery.   Speak with the surgeon if adjustment to conventional pain meds now are a more prudent idea in lieu of continuing with  Chinese herbs.

We support both conservative treatment and surgery and have lots of information about home care to share with you.  

Do keep us posted when the surgery is imminent and as you get post-op updates from the neuro.  Your posts are alway welcome here.

It does appear to provide her relieve from pain that prednisone could not do, a surgery to physically remove disc material where it should not be is the way to go.

What is the title of the person saying ok on the Chinese herbs?  Your local DVM vet or the surgeon?


Dr. Isaacs answered alot of questions we've 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/


Unfortunately when my dog had a back surgery, a most unusual situation developed that a vertebrae did not hold and pressed on the spinal cord. My dog enjoyed many happy years ahead with a wheelchair. Your being prepared mentally ahead of time, will be of comfort should something rare happen.

Dee, just so you know, surgery is not an option for everyone.  

When there is a matter of a health issue or not a financial option for the family, then the dog still needs help.  Just like for humans, often dogs can live a good life with the aid of modern medicines.

With conservative treatment the hope is the prednisone will get the swelling around the cord resolved AND with time the offending disc material where it is not supposed to be will be reabsorbed/shrink back enough to no longer aggravate the nerves, no longer cause pain.   

Winnie's disc has healed by this point.  So like for those dogs where surgery is not an option for whatever reason, they need the long term aid of modern medicine to enjoy a good life, pain free.

There are trade offs with any medication—  risks vs. benefits. All anti-inflammatories (steroids like prednisone OR non-steroids, NSAIDS) have side effects.  

So the vet chooses a combination from what is available:
-- may use the lowest dose of an anti-inflammatory drug possible that still provides pain relief
-- may use a combo of pain med(s)
-- may call for laser therapy at the clinic or prescribe a home device to use for pain
-- may use acupuncture at the clinic.
-- If you are not comfortable with a surgery at this point, then seriously discuss using modern medicine as a long term option.  Find a vet who will address your concerns and support your wanting to try a long term non-surgery option.

The MRI/Neuro consult report may have information we are not aware of. So above can only be a general guideline.  If you have the means to u/l the neuro report, details might change the picture.

Hope this helps you out.

Dee, I'm sorry to hear pain surfaced in the wee hours of this morning.

Until the surgery, the pain needs to be brought back in control.

Typically it will take three different pain meds each working on a different source of pain dose every 8 hrs.
 Often used by vets:    
√ Gabapentin for nerve pain 100mg 3x/day
√ Methocarbamal for muscle spasm pain 250 mg 3x/day
__ traMADol (a synthetic opiate) as the over all analgesic  www.marvistavet.com/tramadol.pml
__ for tough pain, amantidine. www.marvistavet.com/amantadine.pml

Let us know the pain med adjustment details and which kind of vet adjusted them.

COMPARING IVDD DOGS
It is really not possible to compare one IVDD dog with another in their healing. It is also not really possible to compare one surgery to another. There are many variables that could make the outcome after a surgery different dog to dog.

The surgery itself can cause temporary swelling around the cord. That could/might show as some temporary neuro diminishment.  It usually takes about 14 days for all the surgery caused swelling to subside. Do discuss all of your concerns with the person who will be doing Winnie's surgery to make sure you are in your comfort zone with his knowledge and skill.
  --- how many ventral slots has he done.  What was the outcome for those dogs.
 --- how long does it take to get post-op pain fully in control at the hospital and at home?
 --- if there were to be some post-op related neuro diminishment, how long might that take to reverse?  Describe what neuro diminishments post-op might be observed?

Acupuncture can jump start nerve healing and may help with pain. Many of our members have found it beneficial. However, there is no treatment that will work for all IVDD dogs.

FYI, based on your reports, and not having read the actual Neuro/MRI report information.

Dee, Winnie's proposed neck surgery is not due to the more usual reason of having front or back leg nerve damage. But rather Winnie's is likely because several courses of prednisone could not get the painful swelling around the spinal cord resolved. There are likely pieces of disc material where they should not be (they escaped the interior of the disc) and aggravate the spinal cord in the neck area.

VENTRAL SLOT neck disc surgery

One of my dogs could walk but use of even the most aggressive of pain med combo 3x/day would not allow us to continue on with conservative treatment, the pain was so bad in her neck. She had a successful ventral slot surgery to relieve the pain by removing disc material where it should not have been. It is important to speak with the person doing the surgery so you feel confident in his skill and you are prepared about possible surgery risks in order with a clear mind to choose the surgery.

Again it would be best if you speak directly with the person who will be doing the surgery to ask your questions.
    

The 2nd opinion recommendation is a good one for the very same reasons Neurosurgeon, Dr. Isaacs mentioned: 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 are in a much better position to ask the 2nd opinion surgeon good questions now that you've been learning more.  Write those questions down so you are able to clearly communicate your issues.  
        So if surgery were not to be an option for whatever reason, what would be the 2nd opinion surgeon's recommended way to help Winnie manage pain to lead a good life?  You are paying for an expert consult, make sure you get your monies worth in information to help your mind come to a decision.
    Be able to ask which class of anti-inflammatory he would recommend if trying a long term med option. 

I think you missed seeing the question asked, please provide details. What adjustments to Winnie's med list have been made in light of you reporting 2:30 am 5/16 pain (shivering, head low)?  What do you observe today re: pain when having to move or nearing next dose of 2 pain meds?

Med list/history as reported by owner
21 lbs   8 y.o.
prednisone 1st course date?: 7.5mgs 1x/day for ? days, then tapered: √ pain/ _neuro
                       2nd course date?:  ?mg   ?x/day  for ? days then taper:   √ pain/ _neuro
                       3rd course taper dose: 5mgs 1x/day   √5/16 pain/ _neuro;  pending 5/23 surgery
Gabapentin 100mg 3x/day
Methocarbamal 250 mg 3x/day
Jing Tang body sore- Lovage inhibits blood clots; safflower. also anticoagulant
Jing Tang cervical-Lovage anticoagulant 

Was Tylenol 4 Rx'd by a vet? Which kind of vet?  The acetaminophen can be toxic to dogs and should only be used under the Rx of a vet.

What was the 5/16 dose of Tylenol 4 in mgs you gave?  

"still on on pain meds"  does that mean you have now added a daily dose of Tylenol 4 to her usual pain meds Gabapentin 100mg 3x/day  and Methocarbamal 250 mg 3x/day?  
    How many times a day are you giving the Tylenol 4?

There are two classes of anti-inflammatory drugs. Did you explore the info pointed out to you?  This is for you to be able to ask if prednisone can't be long term, what about the other class the NSAID (non-steroid anti-inflammatory drugs)?

    We simply are not in position to do other than speak in generalities. It is frustratrating to have to ask about unshared med details (mgs,  x/day), observations,  missing neuro/mri report, leaves us without the necessary details to come close to understanding Winnie's situation.  It is not because we don't want to help, but basically we are not able to diagnose anything nor give you a treatment plan... we are not vets. That is the vet's job.  He has the training/expertise, the dog's complete history, has the ability to do a hands on exam.  Bring all meds, reports, dates, details to the 2nd opinion surgeon so he has all the facts.

Once there is a prescribed treatment whether that may be a long term med plan to see if that will work to bring full comfort from pain  OR a surgery to remove the offending piece(s) of disc material, we have lots of information to make the "rest" period go smoother.

We have only the best wishes for Winnie to get a good solution. Earn yourself that confidence to make the choice of which solution because you are reading, discussing pros and cons with a surgeon you have confidence in.  A 4-hour drive may be hard for a 2nd opinion, but wondering will not give you answers. Take action, have a conversation with a 2nd opinion vet and then make your decision. 

Take action to seek out a surgeon or a local vet to support your choice of a surgery or long term meds.

Please do keep up updated on your possible 2nd opinion vet, observance of any surfacing pain, details of changes to meds.

Tylenol is not used that often with dogs. It can be toxic in the wrong dosage. Was it the surgeon who recommended this, or your regular DVM?

Thanks for letting us know.

Is Winnie's pain still under control? I know you mentioned she was not showing signs of pain earlier in the day.

I am happy to hear that she is showing no signs of pain today.

Will you be able to get her the second opinion? Winnie definitely needs a plan going forward. A second opinion should also help you decide if she should be treated with surgery. There are a very few dogs that must remain on low doses of anti-inflammatories long term. A second opinion should also be able to tell you if this is an option for Winnie.

Today is day 3 of winnie being weaned off of pred...usually this is when the pain will come back. Slowly awaiting to see. But then I wonder even if the pain doesn't return..it will eventually so surgery would be best in that case.