Karianne's Oscar 7/13 Conservative NECK; GRAD 9/8

Karianne, welcome!

The taper of pred 7/18, is to reveal if all painful inflammation is gone. Pain meds are often stopped or back down so you at home can QUICKLY and accurately assess for pain.  For the full story please read up on anti-inflammatory such as prednisone are used with a disc  episode:      ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/

If pain another course of pred is used. A 4-day course that was prescibed was a very short one. Often courses are 7-day or even 14-day.  So if pain reveals itself, would not be  unusual. As it can take 7-30 days excluding any taper days to fully resolve the pain.    

These are the things you can do at home to help with the neck disc: 
==> dodgerslist.com/2020/05/05/cervical-care-tips/

It appears you are reporting all those signs of pain as occuring today 7/18.  Then for sure there is no need of being in a pred taper. Alert the vet asap to get another course of pred.  Neck discs just are more difficult.
    
---  Discuss  using a pred dose more up at the anti-inflammatory level for a 15lbs dog:   prednisone 5mgs 2x/day.
    
--- Discuss TODAY adding sucralfate (a stomach coater) to the Pepcid AC (an acid suppressor) for full protection from emerging signs of a potential for a bleeding ulcer:  not eating> vomit> diarhea> red or black blood in stool > bleeding  ulcers.  How many mgs of Pepcid AC (famotidine) do you give? What is the mgs for one whole tab?  
        More info to aid in your understanding of why stomach protection: ==> dodgerslist.com/2020/05/06/stomach-protection/
    
-- Discuss targeting each source of pain with its own pain blocker.

Karianne, best to always mention new meds fully (name of med with the mgs dose + how often you will/are giving.

Don't see need to drop any current med
Meds do need adjusting if you Currently see pain.  
   Diazepam can be related to relaxing muscles for urinating along with thge Prazosin.

Mostly see reports of med list with methocarbamol for muscle contraction pain as it seems to work best, especially with neck discs. Do discuss replacing diazepam or adding methocarbamol.  Let us know your vet's opinion.

50 mgs gabapenin now 3x/day should work for nerve pain.

traMADol 50 mgs 3x/day should work for over all analgic.  Bring up for discussion if your Rx is not the same.

Please continue to keep us up to date on med details (?mg    ?x/day) and how that relates to pain.

Paula -

Let me know if you are seeing me under members now. I'm logged in.

I called the vet and sent over a note with all the detailed med requests. Do you have any recommendations of what to do when the dog is whining all night?  I had him at my head height in his crate and my hand through the crate slates - I guess I will see how the additional meds do tonight. I just need him to sleep through the night (instead/in addition to him sleeping all day like he did today_

Karianne

Thank you for registering.

Pain means that there is still swelling in the spinal cord. Only the full dose of pred works to reduce swelling, so when a dog is showing signs of pain, it is the wrong time to taper.

The healing process will be slowed by pain. If tramadol is what is needed to keep Oscar pain free, and the vet is okay with prescribing it, then it should be fine to give it to him. The signs of stomach damage Oscar was showing were likely caused by the anti-inflammatory. Some dogs simply need more than Pepcid AC. The addition of the sucralfate, along with the Pepcid AC will give his stomach double protection, and he should help him feel better.

Realized i mistyped - I AM using the Tramadol at the dosage in the previous post (25mg 3x/day). I am NOT using the Trazadone.

For prednisone - currently giving 2.5 mg 2x/day (vet said i could increase to 5mg 2x/day but didn't recommend)- continue until total of 7 days and then we will decide whether to continue or taper

Tramadol - 25mg 3x/day - vet didn't want to add but said I could decide. 
I'm not using the tramadone 

Pepcid 5mg 2x/day 1/2 before pred.
✙Sucralfate- 1m  [gram tab?] tab -> 1/2 tab 2x/day dissolved in water. -
Diazepam 2.5mg 2x/day a
Prazosin 1mg 3x/day
gabapentin 250mg/5L: 50mg (1.0 mL dose ] 3x/day

[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 15.5 y.o.
prednisone as of 7/13: 2.5mgs 2x/day for 4 days, 7/18 a test taper for: √7/18 pain / _neuro
                   as of 7/19 2.5mgs 2x/day for 3 days, 7/22 retest taper: _pain/ _neuro
Diazepam 2.5mg 2x/day as of 7/17
Prazosin 1mg 3x/day
gabapentin 250mg/5L: 50mg (1.0 mL dose) 3x/day
✙traMADol 25mgs 3x/day as of 7/19
✙sucralfate 500mg 2x/day as of 7/19
Pepcid AC 5mg 2x/day as of 7/15]

He did sleep through the night and he is very thirsty but keeps vomiting. He does not want to eat and can't keep anything down.

I've tried feeding small 10ML/time of water.

He is very weak and has started urinating in his bed. I think it's going to be very tough on him to survive this episode and his quality of life seems terrible. During his last episode that Dodgerslist helped us wiht in 2019, his recovery was tough but not this tough and at 15, is it worth making him suffer? He's had hind leg weakness for the past 6 months and I've had to hold him when he defecates because his hind legs are so weak.

I want to fight for him, but I feel like I'm making him suffer.

Karianne, the approach to take is to get things right so Oscar can heal in comfort.

-- Alert your vet (local or  otherwise) of the not keeping liquids down and may be getting dehyrated.  It may well be worth getting hydrated at the vet with IV liquids.  His body was not protected until 3 day on pred.  Then with continued vomiting no sucralfate on board til yesterday or today  (exact start date of sucralfate, please!).  Oscar deserves getting things right that he did not get in a timely manner. Give the pepcid AC and the sucralfate time to work and stay down to do the job.

Do continue til you get possible IV liquids at the vet asap today??  Continue to give small amt of water, a drop or two. Wait see if he holds it down, then another small amount.  

Place the tip of the syringe in the mouth, just behind one of the canine teeth. Angle the syringe slightly to the side and deposit the medications onto the tongue.  Lightly stroke neck to encourage swallowing.
Dosing liquid meds. This way of given liquids can prevent accidently aspiration of liquid into lungs.
SUCRALFATE
Sucralfate reacts with stomach acids to form a protective paste at the site of any ulcerations.
    ~Ideally give Sucralfate on an empty tummy at least 1 hour before feeding or 2 hours after feeding
    ~If possible, it should be given 30+ minutes prior to the administration of Pepcid AC.
    ~Give Pepcid AC 30minutes before Prednisone
    ~Give prednisone with a meal. Pred could be given along with pain meds IF also due at that time.
resource: www.marvistavet.com/sucralfate.pml


One dosing schedule for first dose of the day could be:

5am     sucralfate
5:30m  pepcid AC
6 am    pred, diazepam, prazosin, gabapentin with breakfast

I am glad to hear that he is able to keep small amounts of water down.

Please keep us up to date when you speak to the vet.

Sorry the [sucralfate] tablet is 1 gram. They had it written as gm and in my multi tasking with work, kids and the dog - I read it wrong.

Karianne, my heart is sad to hear things did not turn out differently. Maybe something else was going on disease wise. For others reading they need to have clarification that a disc episode itself, is not a death sentence.

My sympathies to you and your family for your loss. The pain of losing a loved one is great and deserves your attention and time to process.  Maybe what Carmen, one of our members, has written about the grieving process will help you, too.   May all the years of memories soon become sweet ones for you. dodgerslist.com/2020/07/28/tears-heal-grief/

Thank you all. And to be clear for those going through IVDD episodes - Oscar did have an episode in 2019 where he lost everything but bladder and bowel function and dodgerslist helped us with conservative treatment - meds and crate rest and after 8 weeks he was back up and running with only a slight limp that no one noticed but me. This time was different and we aren’t sure what happened and his paralysis progressed and he may have had other issues going on.