Jodi & Tank
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MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Jul 10, 2023 16:12:29 GMT -7
Thank you. I will add that Tank has been more restricted than ever since 6/25.
When you say: "be sure to relate organized and accurate info including dates. The detail matters! Make a list before you go, to have the facts handy" do you mean similar to how you are outlining the details in these posts periodically?
[MED LIST/HISTORY- Moderator's Note. Please do not edit
NOTE:
If the ▲7/9 date of increased diminishment of front leg buckling is accurate, then graduation date would now be 9/3.
13.8 lbs 7 y.o.
Started crate rest 6/25
as of 6/25 back legs wobbly, frnt leg buckles
Dex as of 6/26: 0.75mgs 2x/day for 4 days; 6/30 a test taper for: √7/1 pain / √6/30 frnt leg buckles neuro
as of 7/3: 0.75mgs 2x/day til neuro appt; then test taper for: _Pain / ▲7/9 frnt leg buckles Neuro
Gabapentin 50 mg 3x/day resumed upon pain 7/1
Methocarbamol 125 mg 3x/day resumed upon pain 7/1
traMADol 16.6 mg 3x/dayresumed upon pain 7/1
Pepcid AC (famotdine) 5mgs 2x/day for duration of Dex]
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Jul 11, 2023 6:33:36 GMT -7
Unfortunately, since it's believed that there was too much movement allowed and as a result front leg buckling started on 7/9, the 8 weeks of strict crate rest should start over from that point. If the 7/9 date is accurate, then graduation date would now be 9/3. I'm glad to hear that crate rest has been more strict. I'd still like to share my Jeremy's story as it might help your husband to keep Tank's movements to the very minimum. When Jeremy was 3 years old, He showed signs of pain and I took him to the ER where he was diagnosed with IVDD. At that point, he had no neuro deficits at all. The ER vet told me that I shouldn't take him for walks and no stairs but that he could walk around a couple of rooms in my home so that's what I did. By the following afternoon, Jeremy's hind legs were completely paralyzed with no deep pain sensation and he required emergency surgery. It took him a year to walk again, though he never walked completely normal. He never regained bladder/bowel control the rest of his life. Your Tank is in even a more precarious situation since his is a neck disc and that affects all four legs as you've seen. Ask your husband to think of the crate as a cast for the spine. The less movement, the better. Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to a minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! dodgerslist.com/wp-content/uploads/2020/04/Potty-leash-harness400-19kb.jpgHealing prayers for Tank. |
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Jul 20, 2023 11:00:06 GMT -7
Thank you
7.20.2023. Today is the visit with the Neurologist.
She is questioning if this is really IVDD but to his muscle loss in face, shoulders and hips plus the gate that she has noticed. Muscles, loss in face, shoulders and hips plus the gait that she has noticed. We are getting bloodwork and chest x-rays done today. Will know more later.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 20, 2023 11:34:47 GMT -7
So glad you have this appt, today 7/20, with neuro. There are other diseases which can mimic the symptoms of IVDD. So getting the correct diagnosis means the proper treatment will be used.
Will be watching for your update on what the neuro's diagnosis is.
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Jul 20, 2023 17:51:33 GMT -7
Today is the visit with the neurologist who is suspecting something other than IVDD. Bloodwork and chest X-rays ordered. Will report back soon
7.20.2023 - First visit with Neurologist. Pain meds were withheld for today (last dose was 10 pm day before) per Neurologist request. Most notable notes:
General Appearance: Abnormal QAR
Musculosketal: Abnormal: Generalized muscle wasting. Most prominent over head and Thoracic Limbs (TL)
Neurologic Exam:
Mentation: QAR
Gait/posture: Ambulatory tetraparetic with SS gait in all four limbs. Patient will knuckle in TLs when walking for longer distances
Postural reactions: Normal in all four limbs but will fatigue and will knuckle over
Spinal Reflexes TL: Absent withdrawals
Spinal Reflexes PLs: Absent withdrawals, Absent CT
Muscle Mass/Tone: Decreased tone in all four limbs
Cranial Nerves: Normal
Spinal Palpation: No pain elicited
Neurolocalization: Diffuse neuromuscular
Pain Assessment: 0/5
Body Condition Score: 5/9
Vet notes: Dysfunction with neuromuscular system. Indication of problem with peripheral nerves as they communicate with the muscle, or with the muscle itself. Many disorders of the neuromuscular system to not usually cause signs of pain, which does not fit with Tank’s case. However a few underlying causes, such as polymyositis can cause discomfort. There is a possibility that our neurolocalization is incorrect given Tank’s improvement on steroids, and his current examination not being fully representative of his disease process. However, since Tank’s exam today is consistent with neuromuscular disfunction, further work up for disorders of the region is recommended.
7.20.23 Today’s bloodwork was CBC, chemistry panel, CK, and thoracic radiographs. The chemistry panel showed markedly elevated liver values which is consistent with Tank’s chronic steroid use. The remaining values and thoracic radiographs were unremarkable.
My notes: After discussing, we decided to perform further testing (blood drawn) for neuromuscular disease. TVMDL Toxoplasma and Neospora Serology and Acetylcholine antibody titers to test for myasthenia gravis.
These tests take approximately 1-3 weeks to return. While waiting for the results, they want Tank to switch to Prednisone and stay on the methocarbamol. Can stop the gabapentin and tramadol.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
NOTE:
If the ▲7/9 date of increased diminishment of front leg buckling is accurate, then graduation date would now be 9/3. 7/20/23 Neuro suspicions not a disc episode
13.8 lbs 7 y.o.
Started crate rest 6/25
as of 6/25 back legs wobbly, frnt leg buckles
Dex as of 6/26: 0.75mgs 2x/day for 4 days; 6/30 a test taper for: √7/1 pain / √6/30 frnt leg buckles neuro
as of 7/3: 0.75mgs 2x/day til neuro appt; then test taper for: _Pain / ▲7/9 frnt leg buckles Neuro
Methocarbamol 125 mg 3x/day
Pepcid AC (famotdine) 5mgs 2x/day for duration of Dex]
Waiting for these tests to determine next steps, one will likely be to taper off Pred.
The vet pointed out to me the hollows in Tanks face which is due to muscle loss. I had begun to notice this but didn’t know what to make of it.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 20, 2023 18:41:39 GMT -7
Jodi, I'm guessing having to wait 1-3 weeks for some of the test to come back is a worry. Hopefully soon the neuro will have the results back to be able to prescribe the appropriate treatment.
Please keep us posted on how Tank is doing while on just the prednisone and the methocarbamol.
What did the neuro say about rest for Tank? Should it remain strict until she can give the diagnosis based on test results?
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Jul 21, 2023 8:08:08 GMT -7
The good news is that steroids is the treatment for neuromuscular disease (at least that is what I remember her saying in the appointment).
Tank is not showing any signs of pain as of now. He is very sluggish.
The specialist said crate rest could be stopped. I'm guessing she is quite confident this is not IVDD. ??
So the meds are now 7.21.2023
✙Prednisone 2.5 mg 2x/day
Methacarbamol 125 mg 3x/day
Famotidine 5mg 2x/day
[MED LIST/HISTORY- Moderator's Note. Please do not edit
NOTE: 7/20/23 Neuro suspicions not a disc episode
13.8 lbs 7 y.o.
Started crate rest 6/25
as of 6/25 back legs wobbly, frnt leg buckles
7/21 Neuro suspicions & testing for neuromuscular disease, myasthenia gravis. Crate rest is stopped
Dex as of 6/26: 0.75mgs 2x/day for 4 days; 6/30 a test taper for: √7/1 pain / √6/30 frnt leg buckles neuro
as of 7/3: 0.75mgs 2x/day til neuro appt; then test taper for: _Pain / ▲7/9 frnt leg buckles Neuro
✙Prednisone doses as of 7/21 for suspicion of myasthenia gravis: 2.5mg 2x/day
Methocarbamol 125mg 3x/day
Pepcid AC (famotdine) 5mgs 2x/day for duration of pred]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 21, 2023 9:30:03 GMT -7
Jodi, thanks for the update. I did a little research reading yesterday to find that pred is the treatment for neuromuscular, and gabapentin was not recommended. So it appears Tank is on the road to getting the right treatment if test results concur with Neuro's high suspicion. Hope to hear from you Tank will soon be feeling more himself.
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Jul 25, 2023 17:57:09 GMT -7
Thank you, Paula and Romy and Marjorie. You guys are lifesavers. Such a valuable thing you are doing here. I will be forever grateful. You helped me and Tank so much!
I will post an update when I know more. XOXO
What is a good post I could read and learn about after strict crate rest "graduation"? Tank is doing well, is showing no signs of pain as we wait for results of blood testing. My fear is that he might have IVDD too, and is just better because of the crate rest and steroids he has had to date. I would like to read up more on what "would have been" protocol for after graduation.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 25, 2023 18:55:27 GMT -7
Jodi, the information we share with you upon graduation is tailored specifically to Tank. It it common that each dog will have a different need upon graduation day. So on Aug 20, you can tell us what you observe re pain and neuro functions, that he's off all meds in order to be graduated from a disc episode, what his confirmed actual diagnosis is, etc. Then at that time we take all your observations and comments and give you ideas for handling graduation day that fit what Tank needs on Aug 20.
Can you give us an update on today with new med (pred) regarding pain such as not moving much/sluggish or other signs of pain? What about neuro functions any new diminishment or perhaps some nerve function is better? He is now off of crate rest, correct?
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Jul 29, 2023 13:22:58 GMT -7
UPDATE: 7.29.2023 Saturday
The blood tests came back negative for infectious disease and negative for myasthenia gravis. The neurologist said that with the knowing the negative tests results and with the good response to prednisone, it's possible that his signs are all due to an immune-mediated polymyositis (inflammation of multiple muscles by the immune system) or that she is misinterpreting his improved exam, and his signs are not associated with his muscles but with his spinal cord. The options she gave me are: continue on with his current meds or taper him off prednisone so that she can re-evaluate him and make further recommendations if his exam changes on the taper protocol.
That email came Friday 7.28.2023, and I have not responded to it yet.
Tank remains pain free and is still on:
Prednisone 2.5 mg 2x/day
Methacarbamol 125 mg 3x/day
Famotidine 5mg 2x/day
He is off crate rest and I have seen much improvement in the 10 days since he switched to prednisone. He is getting stronger. Is not buckling or falling at all anymore. Since he is off crate rest, I allow him to walk and sniff when out for potty (no leash) and let him move about as he pleases indoors. When we need to leave him home alone, we do crate him. If left alone for more than an hour, he will wet the crate but does not wet the crate during his overnight sleep. During the day, he no longer lets me know when he needs to potty and has peed inside about 4 times in 2 weeks. He is not as thirsty since switching from Dex to Pred but still potties a lot.
Mild muscle spasms sometimes occur before 8 hour window is up. Neurologists does not think it is pain related but "possible" muscle weakness.
My other dog had a vet appointment this morning and Tank tagged along. Primary vet concurred that muscle loss in shoulder area is indicative of something else going on with him. Wasn't as concerned with muscle loss in face and called it Pred Head.
Tank seems to be feeling good and actually barked today while he was outside. It was the first time that I have heard him bark in a very long time, as if he was engaging in life again. Still has a weak voice, still moving slow but not as sluggish. He's a little more perky but tires easily.
Any insights or thoughts are welcome.
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Post by Romy & Frankie on Jul 29, 2023 13:51:44 GMT -7
It is good to hear that Tank is feeling better and is stronger and more engaged.
If Tank has IVDD, crate rest is what will allow the disc to heal. If it is another disease, one of the muscles, crate rest may not be an appropriate treatment. Without a definite diagnosis, it is difficult to know. In both scenarios, pred is a common treatment for the disease.
In any case, the vet thinks a pred taper will help with the diagnosis. You may want to consider this so that Tank can get the most appropriate treatment |
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Aug 2, 2023 5:20:26 GMT -7
Thank you, we are going to start tapering the Prednisone [8/2] today, cutting his dose in half by only giving one half of a 5 mg tab every day for 10 days. After 10 days will give one-half of a 5 mg tab every other day [final dose ±8/18?]. The neuro will exam Tank at the end, when he is completely off Prednisone.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
NOTE: 7/20/23 Neuro suspicions not a disc episode
13.8 lbs 7 y.o.
Started crate rest 6/25
as of 6/25 back legs wobbly, frnt leg buckles
7/21Crate rest is stopped Neuro suspicions & testing for neuromuscular disease, myasthenia gravis.
Dex as of 6/26: 0.75mgs 2x/day for 4 days; 6/30 a test taper for: √7/1 pain / √6/30 frnt leg buckles neuro
as of 7/3: 0.75mgs 2x/day til neuro appt; then test taper for: _Pain / ▲7/9 frnt leg buckles Neuro
Prednisone doses as of 7/21 for suspicion of myasthenia gravis: 2.5mg 2x/day for 12 days, 8/2 taper; final dose 8/18.
Methocarbamol 125mg 3x/day
Pepcid AC (famotdine) 5mgs 2x/day for duration of pred]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Aug 2, 2023 8:20:15 GMT -7
When will the pain med, methocarbamol, be stopped or be back down?
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Aug 4, 2023 16:27:04 GMT -7
She said not to change the methacarbamol. We are on day 3 of taper. So far so good. I can't believe how much better he is since starting the prednisone. He is also taking 10 mg of CBD. Not per vet, just because I heard it might help.
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Aug 26, 2023 22:55:42 GMT -7
Hello, just thought I would pop in and let you know that Tank is continuing to improve daily. He has no pain, is walking normally. I would say he is about 90% physically.
He has not needed pain meds since 8/2 and I stopped the methacarbamol too. He is on the last stretch of his prednisone taper and will be fully stopped on 8/31. We see the Neurologist on 9/1.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
NOTE: 7/20/23 Neuro suspicions not a disc episode
13.8 lbs 7 y.o.
Started crate rest 6/25
as of 6/25 back legs wobbly, frnt leg buckles
7/21Crate rest is stopped. Neuro suspicions & testing for neuromuscular disease, myasthenia gravis.
Dex as of 6/26: 0.75mgs 2x/day for 4 days; 6/30 a test taper for: √7/1 pain / √6/30 frnt leg buckles neuro
as of 7/3: 0.75mgs 2x/day til neuro appt; then test taper for: _Pain / ▲7/9 frnt leg buckles Neuro
Prednisone doses as of 7/21 for suspicion of myasthenia gravis: 2.5mg 2x/day for 12 days, 8/2 taper; final dose 8/18.
Pepcid AC (famotdine) 5mgs 2x/day for duration of pred]
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Aug 27, 2023 6:29:44 GMT -7
So very glad to hear how well Tank is doing, Jodi! Great news.
Please do keep us updated as to how the neurologist exam goes with the stopping of Prednisone.
Continued healing prayers for Tank.
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Sept 1, 2023 14:41:57 GMT -7
This is the Doctors Assessment Notes:
Exam: Normal
Pain Assessment: 0/5
Body Condition Score: 5/9
I am ecstatic with how well Tank is doing today! He has a completely normal exam, he seems much brighter than before, and he is very comfortable! Given his response and drastic improvement on prednisone, I am under the assumption that he had an immune-mediated polymyositis. This can relapse and cause recurrence of signs, although it does not relapse in most patients. However, if you notice any recurrence of signs, please let us know immediately. Otherwise, we would like for Tank to continue being off medications
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Post by Romy & Frankie on Sept 1, 2023 14:45:44 GMT -7
This is a very good assessment. I am so pleased to hear this news.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 1, 2023 16:00:33 GMT -7
Jodie, then the vet's assessment is this is NOT a disc episode and not a need, therefore to continue with crate rest?
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Jodi & Tank
New Member
MALE- Dachshund . -2023 inflammatory disease of muscle weakness
Posts: 34
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Post by Jodi & Tank on Sept 2, 2023 9:48:55 GMT -7
Yes, that is correct Paula. The crate rest was stopped near the end of July when we had the first Neuro appointment.
We actually don’t have a firm-without a doubt-diagnosis since no radiology was ever done and the only way to confirm polymyositis is muscle biopsy.
The Neuro’s current assessment of this being a case of immune mediated polymyositis includes the fact that Tank was not improving with crate rest coupled with the dramatic improvement when prednisone was started (He had been on other steroid meds). Not just those things, there was the blood tests that ruled out a couple of her suspicions and the muscle loss too, which I had not reported here because I didn’t recognize it as being too abnormal, since he had been lame and inactive for 3 months (May-June-July).
No matter what, I am so grateful for the excellent advice and support I received here. You taught me how to advocate for pain control and steroids. The importance of crate rest. How to set up a crate/recovery suite. Pumpkin! Advocating for Neurologist! The assurance that surgery is not always necessary! So much more!
More than anything: just having someone to listen and help. Thank you!
I will keep a close eye from now on and especially now as he has only been off prednisone for 4 days now.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 2, 2023 11:06:29 GMT -7
Jodie,
Appreciate your kind words! Glad what we shared was helpful to you and Tank. Polymyositis is not a disease we know. Getting that neuro consult put Tank on the right diagnosis and track to recovery. We are wishing for Tank to continue doing well and enjoying life for many more years ahead!
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