Eileen's Ozzy 6/28 conservative - Bulldog

Eileen, you did not mention the very important Pepcid AC (famotidine) to suppress stomach acids that would cause black bloody diareah.  Bone up on stomach protectors so you are in position to strongly advocate  for NOW not just ==> Pepcid AC but also a 2nd called ==> sucralfate.   Two GI protectors on board would very likely allow the steroid to continue to stop the neuro diminishment you are reporting of rear leg use.

Get on the phone asap to get an Rx to sucralfate today or most certainly 1st thing in the am. It works to bandaid over the damaged areas of the stomach lining and promotes healling

Get to the grocery store to pick up Pepcid AC (famotidine)
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory steroid prednisolone and thereafter every 12 hours for as long as your dog is on the steroid.
--The dose of famotidine may require reduction in patients with liver or kidney disease.
-- It may be prudent with heart murmurs to choose another class of acid reducer.
          thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg

MEDS
Hand to use a med chart to understand patterns and have facts in hand when communicating with vet or here:    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

1.  Complete the missing med info so we fully understand Ozzy's situation.
  - Prednisolone as of 6/28:  ? mgs dose, ? times/day given for two days
  -  Methocarbamol 500mgs tab:   ? mgs dose, 3x/day  for muscle contraction pain
  -  √ Gabapentin 100mgs 3x/day for nerve pain
  - __ traMADol as the overall analgesic. What is the reason all three sources of pain are not being covered? With pred having been stopped, naturallly there is the expectation the pain would be covered fully just as you report. Ozzy needs pred back on board and quite possibly all 3 pain meds given promply every 8 hrs (3x/day).

STRICT REST
Verify you have since date of 6/28 disc episode, Ozzy has not been allowed to walk at potty time. Only allowed to take a very few minimal footsteps to take care of business. And that you were able to lift and carry him from his recovery suite to the potty place and back.
   More detail and tips on carrying out the essential ==> STRICT REST   

            ▼  Thank you in advance for registering   ▼

IT is not healthy for his spinal cord to be without pred til holidays are over. Time matter with nerve damage to get pred back on board. This is a time to use ER tonight!

Provide the formula for pred . ?mg of pred in one mL of liquid.

Be cautious of any vet wantiing to switch from the pred to a NSAID (non-steroid) It take time to clear one from the body before the start of a different class. Meaning while both are in the body pred and an iffy NSAID, that is double the jeopardy for bleeding ulcers!

Know your meds
Vets choose an anti-inflammatory during a disc episode to get painful swelling down in about 7-30 days. These powerhouse meds do wonders OR they can be dangerous. Vets who practice safe medicine and owners up to speed on medications make all the difference. Did you get all four questions right?
- Answers here: dodgerslist.com/2020/04/18/steroids-vs-nsaids/

Any vet on duty at ER has access to Ozzy's file. That vet CAN indeed Rx, and adjust meds.

Any vet knowledgeable about IVDD would understand the need to get an anti-inflammatory restarted ASAP (hours matter in preventing more damage to the spinal cord.) They major goofed by not Rxing pepcid AC. They need to fix this now tonight.

I see Ozzy has been w/o any pred in his body since 7/1.  Two options then:
   -  A NSAID  could likely now be Rx'd with safety if also with Pepcid AC + Sucralfate
   -  Best would be back on pred 2x/day as it is the most powerful class of anti-inflammatories to get spinal cord swelling down.  Please give the pred formula:  how many mgs pred in one mL liquid.  Forumula on the bottle might be written in this format:  10mg/mL  or  5mg/5mL, etc.

Be polite but strong in advocating for Ozzy with the ER people.  It does Ozzy no good to risk a transport into a vet's office. Movement is the bane to the damaged disc and how it can then damage the spinal cord.  Waiting til Wed is PURE maddness when dealing with spinal cord damage.  

PHONE the ER and ask for an Rx to your local 24 hrs pharmacy in your town.
Also get an Rx for sucralfate
Go to grocery store to buy Pepcid AC. Same as use by people.

Using pred would require NO days of washout to resume. It could be restarted tonight! Hours do matter with diminishment of neuro functions in back legs. Do they understand Ozzy rear leg situation?

Switching to the less powerful class of NSAIDs when there is neuro diminishment is not the norm.

Do they understand it IS the norm when an emergency of neuro diminishement you have reported, days of washout CAN BE dispenced with IF.....

IF two GI tract protectors are on board. 1) Pepcid AC to suppress acid production AND  2) sucralfate's gel coating to bandaid and damaged areas and aid stomach lining healing.

STRONGLY but politely indicate and speak up to what you want— pred with two stomach protectors TONIGHT! You are worried about hours mattering in getting pred restarted to avoid further neuro diminishment. They should be just as concerned as any vet who knows their IVDD would be.

The less powerful NSAID have the same adverse side effect of GI tract damage as does prednisone.

What city/state are you in?

Don't be fooled by "non-steroid".  Whether steroid or a non-steroid the stomach MUST be protected.  And now since the black blood, must be double protected with not just Pepcid AC but also with Sucralfate.

1) This FDA type of warning
 ==> animaldrugsatfda.fda.gov/adafda/views/#/nsaidLabels  comes with each pkg of the various brands of NSAIDS, carprofen, previcox, etc.:
"What are the possible side effects that may occur in my dog during Carprofen Chewable Tablets therapy?
Carprofen Chewable Tablets, like other drugs, may cause some side effects. Serious but rare side effects have been reported in dogs taking NSAIDs, including Carprofen Chewable Tablets. Serious side effects can occur with or without warning and in rare situations result in death.
The most common NSAID-related side effects generally involve the stomach (such as bleeding ulcers), and liver or kidney problems.

2) Veterinary Pharmacist explains to veterinarians:
“As the classic NSAID toxicity, GI ulceration is the most common and important adverse class effect associated with NSAIDs.

When switching a patient from one NSAID to another (when no side effects have been seen), a washout period of 5 to 7 days minimizes chances for adverse drug interactions. Informing clients of the potential adverse effects of NSAID therapy and signs of NSAID toxicity greatly increases the likelihood of safe use of this class of drugs.

In cases in which an animal is switched from one NSAID to another OR has been treated with corticosteroids, there should be a washout period before initiating therapy with a different NSAID to avoid adverse drug interactions. 

Based on current opinion leaders’ recommendations, a minimum washout period of 5 to 7 days would be appropriate for an animal that has been treated with a non-aspirin NSAID or a shorter-duration corticosteroid (e.g., oral prednisone, dexamethasone). 

Because all NSAIDs have toxic potential, veterinarians and pet owners should never consider any NSAID to be completely safe. ”
Lascelles BD, McFarland JM, Swann H. "Guidelines for safe and effective use of NSAIDs in dogs" Veterinary therapeutics: research in applied veterinary medicine 6(3):237-51 · February 2005. p248. www.researchgate.net/profile/B_Duncan_X_Lascelles/publication/7468324_Guidelines_for_safe_and_effective_use_of_NSAIDs_in_dogs/links/02e7e5166e788375a7000000.pdf

   As you can see in Monitoring Ozzy's neuro functions, he is still a good candidate to heal his disc under conservative treatment.
    Calm your mind. Gain 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 tools to help you during your dog's recovery time:
==> dodgerslist.com/most-asked-disc-disease-ivdd-questions
        🚩Stick to the tips for good conservative crate rest principals and many tip to make things go smoother here: dodgerslist.com/2020/05/14/strict-rest-recovery-process/
        🚩Avoid dangerous detours with the Conservative Roadmap for your fridge.
VIEW, DOWNLOAD and print: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf
        🚩 Arm yourself with IVDD information. A shortcut thru IVDD: dodgerslist.com/2020/06/26/time-and-ivdd/

MONITORING NEURO FUNCTIONS
  Let us know exactly where Ozzy is with his rear leg weakness
As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example.
1. 6/28 Pain with initial tear of disc and ensuing swelling
2. Wobbly walking
    legs cross
3. Nails/toes scuffing floor
4. Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all
5. Weak/little leg movement,
can't move up into a stand
6. Legs do not work at all (paralysis, dog is down)
7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors.
8. Tail wagging with joy is lost
9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy.
    Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance.
    Precious hours can be lost with a general vet who gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.
A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Please keep us posted in the morning on pain and neuro for Ozzy.

Hello. I have a happy update on Ozzy. Yesterday [7/4] he started regaining strength in his legs and was able to walk around a little bit. Today we had our follow up appointment and he was a champ! He has been able to walk around a little more with no trembling in his legs. His vet said he looks like he’s making great progress. Because of the reaction to the anti-inflammatory, the fact that he’s making progress with the meds he’s on, and the fact that he’s not in pain with the current meds we’ve decided to stay the course. I think putting him in total and complete crate rest has done wonders for him. We are hopeful he will continue to improve in the next few days and can avoid surgery. Thank you so very much for all your kind words and helpful advice. This has been truly one of the scariest things for a pet parent to go through and it’s nice to have this support. 

No other anti-inflammatory is being given. He was given a probiotic when he was initially given the steroid and still had issues with it. I was not willing to chance him getting sick again from the steroid. Because he’s progressing well with the current regiment that’s what we’re sticking with. 

[MED LIST/HISTORY- Moderator's Note. Please do not edit
29lbs 9 y.o.
prednisolone as of 6/28 ?mg/mL formula?: ?mgs (2.2mL dose) 2x/day for 2 days, then a test taper for:√7/2 pain / _neuro stopped due to signs GI tract damage due lack of an Acid Suppressor.
methocarbomol 500 mg tab: 500mg 3x/day
Gabapentin 100mg cap: 100mgs 3x/day]

He will have one more week of meds and then we will taper him off and see how he responds. The amount of steroids he was taking was 2.2ml. Sadly he’s simply one of those dogs that can’t take the synthetic anti-inflammatory medications. That said he’s now also getting a dose of ✙Omega 3 and a little ✙cbd oil to help. It seems to be working for him.