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Post by Meg & Olive on Jul 19, 2023 17:26:44 GMT -7
☆ 1 Appears well controlled with current Meds Some, stays pretty still/calm and doesn't shift position much on her own Yes ☐ tight tense tummy ☆ 2 Olive (spayed female) is 9.5 years and weights 16.5 lbs- Gabapentin, 75 mg, 2x/day for 3 wks then as needed - Prednisone, 5mg, 2x/day for 5 days, then reduced to 5mg 1x/day for another 2 wks - Methocarbamol, 250 mg, 2x/day f or 3 wksThen given Clavacillian (7/18/23), 125 mg, 2x/day for 7 days to treat bladder infection, plus given a antimicrobial spray and Desitin to treat pressure sore on left hip and sore on vulva.[MED LIST/HISTORY- Moderator's Note. Please do not edit
16.5 lbs 9.5 y.o.
prednisone as of 7/11: 5mgs 2x/day for 5 days, 7/16 test taper for: _pain / _neuro
gabapentin 75mgs 3x/day til 8/1
methocarbamol 250mgs 2x/day til 8/1
Clavacilian as of 7/18 UTI" 125mgs 2x/day for 7 days
antimicrobial spray
Desitin
Olive needs GI tract protector, Pepcid AC, on board for duration of prednisone! ]
B.. the start date & dose? Date of steroid taper? Yes, - Prednisone, 5mg, 2x/day for 5 days, then reduced to 5mg 1x/day for another 2 wks C.. PEPCID AC: Phrase a simple question that you expect a simple "yes "or "no" to it. Does my dog have any health issues to prevent use of Pepcid AC (famotidine)? (doesn't need it, we wait til there is problem…are NOT answers to your question!) If you get a "no health" issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
(NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. www.1800petmeds.com/Famotidine-prod11171.html ) ------
thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpgCurrently, not giving Pecid, but will start. Have always been giving meds with food and they presently seem well tolerated. ☆ 3 -- Eating and drinking well, regular unassisted bowl movement. No current red flags. ☆ 4 Miniature Dachshund, Her name is Olive. my name is Megan ☆ 5 diagnosis IVDD Yes, initially at ER vet then confirmed by Reg Vet. Initial diagnosis on 7/11/23 after acute injury while playing with our other dachshund. Type 1, level 4 IVDD. Back leg paralysis, no reflexes, but does have deep pain response. Xray indicated several discs thin in her thoracic region-- Is the vet a general DVM? I believe so -- specialist surgeon: ACVIM neurology or ACVS ortho? Don't believe so. ER vet was however ☆ 6 What was the date you saw the vet for CONSERVATIVE treatment? 7/11/23 ER vet, Reg Vet on 7/13/23 and 7/18/23 ☆ 7 specifically sniff and squat. No Yes, wet pee pads, often large amounts, even after expressing bladder, she appears to not what to allow us to completely express her bladder or we're not always successful in expressing urine when we try. Vet said the same thing, that she appears to have some limited control and often stops stream while attempting to express. ☆ 8 Can not walk at all, back leg paralysis, no reflexes, but does have deep pain response, will occasionaly wag tailHi. New to the group. Looking for some advice and support. My 9yrs old dauschund Olive was diagnosed with type 1, level 4 IVDD a week ago after an acute injury while playing with her brother. She has back leg paralysis and no reflexes, but she does have deep pain response and overall things are not going well. They recommended surgery but quoted us 12-15K and we just couldn't afford that. Overall her pain appears well controlled with pain meds, anti-inflammatory and steroids and she doing OK in containment as well as long as we keep her close to us. We've been using a normal small, soft dog bed that's sitting on top a memory form pillow, placed inside a plastic clothes hamper, for easy transport around house. We also sometimes put her chariot, as we call it, inside a play pen when we can't watch her as closely and to ensure our other dauschund Moby doesn't bother or jump on her. But she's already developing a suite of other issues, she has a bad UTI/bladder infection and was put on antibiotics yesterday. She's also developed a large, oozing pressure sore on her left hip/butt. The vet shaved a large section of her fur to get the gunk off and to help with drainage. We were given an antimicrobial spray and told to put Desitin on sore as well. Then today [7/19] I noticed she now as a sore on her vulva. It appears to have split, it looks r aw and red and is clearly painful. This I'd assume is a result of her constantly sitting in her pee, she has very little bladder contol. We had been using dog diapers, which worked great and kept her pretty dry but vet said to go back to pee pads until pressure sore heals. We try to express her bladder several times a day, every 3 hours or so with mixed success, but still tons of leakage. Everyday it seems to be something new. I'm a mess and don't know what to do. Any thoughts or advice to get her on the road to recovery and reduce these side issues would be appreciated. Thanks. |
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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 19, 2023 21:43:55 GMT -7
Welcome Meg. You are in the right place to get things in order for Olive. #1 Alert the vet about pain during the pred taper'The pred taper is for you to deterime at home if all painful inflammation is gone. Usually the pain meds which block pain would be stopped on the taper day of 7/16. Currently you report pain of reluctance to move. The 5-day prednisone course is a short one. Most vets will take a guess with a 7-day or even a 14 day course. With signs of pain, clearly it is not time to stay in the pred taper. But instead get back up on the prednisone anti-inflammatory levelof 5mgs 2x/day. Report your observations to the vet so another course of pred can be started asap. Learn more about how pred is used during a disc episode. Knowlege is how you help Olive, have the ability to understand the vet and ask good questions: ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/#2 Try to avoid any products with toxic-to-dogs ZINC (Desitin). If Olive is licking the barrier cream that is not good. Instead barrier cream products without zinc: • Aquaphor Baby, Aquaphor regular Healing Ointment OR Bayer's A+D® Original Ointment  OR  #3 Let us know when Pepcid AC (famotidine) is on board for the duration of prednisone. Three reasons WHY to use a stomach protector: dodgerslist.com/2020/05/06/stomach-protection/#4 STOP the dangerous use of a plastic close hamper. Instead provide a safe healing environement for her disc and for her skin issues. • kid's Pack N Play, wire crate, ex-pen, pet stroller ==> features • Set up a mattress system to wick away urine from fur & skin and help keep the skin healthy. Full details on the layering of mattress/synthetic fleece linens and other tips to make the 8 weeks of STRICT rest go smoother ==> dodgerslist.com/2020/05/14/strict-rest-recovery-process/ • In addition to [name of?] antimicrobial spray you might give Marjorie's tip a try: Brew up a pot of decaf green tea. Let it cool. Then use a tea dampened washcloth to gently wipe belly and legs. Tea is mild with acidifying, antibacterial properties. It neutralizes urine on skin and fur to avoid urine scald rashes. Store tea in fridge and slightly warm before use. Non-scented baby wipes also useful in keeping skin and fur free of urine.
#5 Confirm if she has the ability to pee on her own. If she can specifically do a happy tail wag if you do some happy talk, her bladder control can be coming back. So after giving her a chance to pee outside, then express her bladder to verify bladder is pretty empty. See if that helps with so much urine in bedding. If you need another expressing lesson, don't be shy to take her so you can get a hands-on-top-of your hands type of lesson: Tips for expressing urine and poop ==> dodgerslist.com/2020/05/05/bladder-bowel-care/ SNIFF and PEE test The "sniff and pee test" is the only way for humans to determine whether bladder control exists. Carry the dog outdoors, set him down on an old pee spot for a sniff. Make sure that neither the sling nor your hands are on the stomach region as this could put pressure on the bladder. If urine comes out after sniffing, bladder control is returning. Until you are certain that full voiding is always occurring, continue to do a quick express check after dog pees. Tell us what you observe. |
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Post by Meg & Olive on Jul 23, 2023 22:28:02 GMT -7
Hi. Thanks so much for the helpful tips and advice. As suggested we started Olive on pepcid (5 mg 2x/day) on the evening of 7/19 and will continue as long as she's on the prednisone.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
16.5 lbs 9.5 y.o.
prednisone as of 7/11: 5mgs 2x/day for 5 days, 7/16 test taper for: √7/19 pain / _neuro
gabapentin 75mgs 3x/day til 8/1
methocarbamol 250mgs 2x/day til 8/1
Vetericyn plus (Hypochlorous Acid ) antimicrobial spray
Desitin w/zinc
Pepcid AC (famotidine) as of 7/19: 5mgs 2x/day for duration of prednisone ]
We also moved her out of hamper into her new 'suite', baby play pen with a memory foam dog bed which covers entire base, then her dog bed at one end and some blankets on the other side so everything is level. She seems happy and likes the extra space to stretch out.
Overall she's doing better. Antibiotics seems to have improved her bladder infection and her pressure sore and sore on vulva are healing quickly with continued use of antimicrobial spray and Desitin. She hasn't attempted to lick wound, she can't really get at it plus, we’re back to using dog diapers over pee pads so it's generally covered, but does still get air. So we've continued using the Desitin for now.
She is starting to want to be more active, jumping up and down on front legs when excited about something and has attempted to crawl (drag herself) out of her dog bed in pen or when out in yard. But I'm hesitant to let her move to much since it's only been 2 wks.
She's still eating and drinking ok. Pooping a little less frequently but larger, softer poops than before. We're still having some trouble expressing her bladder regularly, although we certainly continue to try. Vet was a bit concerned so did an ultrasound. Bladder had urine in it but wasn't extremely full so she's likely peeing enough in diapers. And when we have been successful, diaper stays dryer or occasionally completely dry bw pee breaks (~ every 3 hrs).
We started trying the sniff and pee test 7/20. No luck the first few days, but today 7/23 she peed outside on two separate occasions, unassisted. So hopefully that will continue.
We also got her bloodwork back. Everything looks fine (for now), no red flags or abnormal results except for her thyroid which was quite low (0.4), so they are running a more intensive panel to check T4 and TSH?? to see if just a result of everything her body is going through at the moment or if she has hypothyroidism, which doc thinks is possible due to some other symptoms (a bit overweight, generally low energy even before IVDD, skin issues). Should know more in a few days.
Hoping for a good week with continued improvement.
Oh and the antimicrobial spray is Vetericyn plus.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Jul 24, 2023 8:33:17 GMT -7
Meg, did you speak to the vet as Paula recommended concerning the signs of pain that you were seeing (doesn't shift positions much and tight tense tummy)? As Paula mentioned, pain indicates that there is still swelling pressing on the nerves of the spine and still a need for the original anti-inflammatory dosage of Prednisone for a bit longer. The taper dosages are not enough to get the swelling down. Getting the swelling down is a very important part of conservative care. It's that pressure on the spine that causes pain and nerve damage. Please let us know what the vet said about doing another round of Prednisone.
Be sure to fill in extra space in the play pen with rolled up blankets/towels. The recovery area should only be large enough for Olive to stand up, turn around and lie comfortably with her legs extended. The less movement, the better. Too much movement and the damaged disc could rupture or tear more, with more pain and possibly more neuro damage, and the 8 weeks of strict crate rest would have to start over.
Please do discourage her from trying to drag herself and from jumping up and down on her front legs. You can try covering the top of the play pen with a blanket, bringing the blanket down to her eye level when standing on her front legs. That way, when she jumps up, she won't be able to see anything so that might discourage her. Or take cardboard and attach it to the inside of the play pen to make a ceiling so she can't jump up.
Good to hear that Pepcid AC has been started. Keep an eye on that soft poop and if it becomes diarrhea, speak to the vet about adding a second stomach protector, Sucralfate. Sucralfate works a bit differently than Pepcid, helping to heal any damaged areas and needs timing with other meds. Hopefully, with the addition of Pepcid AC, a second stomach protector will not be needed.
Great news indeed that Olive was able to release urine on her own! Keep taking her out every three hours to see if that continues and once she's gone on her own, do a quick express to be sure she has emptied her bladder. Sometimes when bladder control is returning, they aren't able to completely empty the bladder on their own. Also happy to hear of the improvements of the sores.
Prayers for good news on the thyroid tests. Please continue to keep us updated.
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Post by Meg & Olive on Jul 31, 2023 22:06:13 GMT -7
Hi. I did talk to vet about Olive's meds although it took a few days to connect. She's back on higher does of ▲Prednisone (5mg, 2x/day) as of 7/28/23 for 7 days, through 8/3/2023. She has her next vet appointment [8/2] tomorrow, so we'll discuss taper then as well as status of the rest of her meds.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
16.5 lbs 9.5 y.o.
prednisone as of 7/11: 5mgs 2x/day for 5 days, 7/16 test taper for: √7/19 pain / _neuro
as of 7/28: 5mgs 2x/day for 7 days, 8/4 test taper for : _pain or _neuro
gabapentin 75mgs 3x/day til 8/1
methocarbamol 250mgs 2x/day til 8/1
Vetericyn plus (Hypochlorous Acid ) antimicrobial spray
Desitin w/zinc
Pepcid AC (famotidine) as of 7/19: 5mgs 2x/day for duration of prednisone ]
There wasn't enough blood left in last sample to run additional thyroid labs, so we'll also do another blood draw and hopefully have those results back by end of the week.
Overall she's continuing to do well. More energy, doesn't appear to be in pain, adjusting to crate life. Still eating and drinking well. We still need to use doggie diapers but she's starting to pee and poop more outside on her own and more dry diapers bw potty breaks.
Her bladder infection did get better with meds, but it appears to be back now that she's off the antibiotics. Vet will likely culture urine sample to investigate and more efficiently treat.
Other sore still healing nicely and no new issues.
Beyond occasionally tail wag, no improvement in back leg paralysis.
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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 1, 2023 8:57:20 GMT -7
Meg, hope too hear with the pred taper to begin on 8/4, the pain meds will also be stopped to give you a fast read about pain. Other than UTI returning, all sounds like going in a good path of disc healing. A urine culture gives the vet the name of the bacteria and the correct matching antibiotic.
The focus now is limited movement of the spine to allow the disc to heal in 8 weeks. Nerve function may or may not self heal in that short of time. It is still quite early in the nerve healing department.
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Post by Meg & Olive on Aug 9, 2023 16:12:26 GMT -7
Hello. Thanks for the continued support. We just past the 4-week mark, so about 1/2 way through Olives conservative treatment. Things are still going well, and Olive continues to show small signs of improvement and is in good spirits. She's such the sweetest little pup.
A quick update on meds and other issues. During our last vet appointment on 8/1, they decided to keep Olive on the higher dose (5 mg, 2x/day) of Prednisolone a little longer, through this Friday 8/11, after that we'll go back down to 5mg, 1x/day (# of days yet to be determined). We've also been instructed to continue with her other meds. So, she's still taking▼Gabapentin, 75 mg 2x/day, methocarbamol 250mg, 2x/day, and Pepcid AC 5 mg 2x/day for at least another few days (until at least 8/15). We'll once again revisit meds and hopefully start tapering her off of things after our upcoming vet appointment on 8/15.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
16.5 lbs 9.5 y.o.
prednisone as of 7/11: 5mgs 2x/day for 5 days, 7/16 test taper for: √7/19 pain / _neuro
as of 7/28: 5mgs 2x/day for 15 days, 8/12 test taper for : _pain or _neuro
gabapentin 75mgs ▼2x/day
methocarbamol 250mgs 2x/day
✙Clavacillin (125 mg, 2x/day til 8/7
Vetericyn plus (Hypochlorous Acid ) antimicrobial spray
Desitin w/zinc
Pepcid AC (famotidine) as of 7/19: 5mgs 2x/day for duration of prednisone ]
Her thyroid tests came back, and everything was normal, the very low end of normal, but still normal. The vet suggested we retest her levels in a year or so as hypothyroidism may still be an issue in the future.
Her urine tests came back positive for the presence of bacteria and culture showed it to be E.coli. She was put on another 1-week course of ✙Clavacillin (125 mg, 2x/day) from 8/1 through 8/7. For the moment, her urine appears clearish, and doesn't smell but we'll keep on eye on it and see it we notice any changes over the next couple of days, suggesting a continued issue. Doc will likely retest urine during next 8/15 appointment.
Her other sores continue to heal, and no other issues have arisen. We are still continuing to treat the wound area with Vetericyn plus (Hypochlorous Acid) antimicrobial spray and Desitin w/zinc, at least until the hair fully grows back and no signs of the issue remain.
We're still needing to use doggie diapers but her bladder control continues to improve. She'll pee outside now every time we take her out and is mostly holding her bladder in between potty breaks. We've continued to attempt to express her bladder, but rarely do we get out more than an additional dripple or two after she pees on her own. She also continues to have 1-2 bowel movements a day, and always outside. No signs of blood in her stools, which are softish (hold form) and appear normal in color.
No real improvement in deep pain response (still present but minimal), reflexes (none) or back leg paralysis (still present), but she's ready to be on the move and wants to be scooting around (but we're stopping her when outside and keeping her crated/contained when inside to prevent her from moving around too much).
Which leads me to a few questions...Is it OK to allow her scoot around at all when outside, if we resist it to limited distance and/or time or is that a complete no no until we get through the initial 8 weeks? When can we start using some type of brace with handle or belly band or similar to help lift her up to pee/poop? When is it OK start using a doggie stroller? We'd like to be able to take her with us on walks or to the park and being able to put her in a doggie Stoller would be incredibly helpful. Is that OK? When should we start doing any type of PT, assisted leg movements, stretching, etc....Good to start some of that now? And if yes, what types of exercises are appropriate at this stage.
Thanks for all your advice and continued help.
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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 9, 2023 20:21:33 GMT -7
Meg, glad to hear more healing on several fronts. Leg nerve healing may be a longer process. Stick to the principals of STRICT rest until graduation day on Sep 5. ⌾ Pet stroller only in the house to keep her by your side as you move about the home. Strolls outdoors waits til graduation day. If weather is nice, sit with her on the deck while she enjoys some fresh air in her stroller. ⌾ No scooting anywhere. Way too much movement of the vertebrae in the spine. The early healing disc does not like pressure, it could re-tear. That'd put Olive back at square one of 8 weeks of healing, more pain, maybe loss of the neuro functions she has (bladder control). ⌾ Size of recovery suite should only be enough room to easily turn around in. When she lies down she is ablel to fully stretch out her legs. Water and food bowls are attached to side of suite at head height. If there is too much room, pad out the extra space with rolled up blankets. ⌾ No need to test for deep pain sensation. Of course she has it. Otherwise she would not have bladder control. Deep Pain Sensation: the first neuro function to return which bodes well for more neuro functions to self repair. ⌾ At potty time use a rear sling to support her butt and keep it from tipping over. AND to save your own back. Can be a long winter scarf, an ace bandage, a belt. A harness and 6 foot leash controls her speed and keep footsteps to 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! This harness tip plus more to help make crate rest safe and go more smoothly from: dodgerslist.com/2020/05/14/strict-rest-recovery-process/ * ⌾ We are waiting to hear as soon as possible that there is proof that all swelling is gone. That means she is off all meds and no signs of pain surface. Then we can share with you how to do very, very light least aggressive range of motion (ROM) to help keep the joints flexible and muscle circulation up yet protect the healing disc. |
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