Susan's Teddy 8/8 surgery?wks - NECK; GRAD ?

Welcome to Dodgerslist, Susan. I'm sorry to hear that you were given incorrect instructions as to strict crate rest at the beginning of conservative care and Teddy's condition worsened. The current instructions - strict crate rest, no couch, no walking, carry outside to potty - is correct.  Since today is the beginning of correct strict crate rest, graduation day (8 weeks) would be 9/29.

The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.

Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/2020/05/14/strict-rest-recovery-process/

STRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: dodgerslist.com/2020/04/22/chiropractic/ ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment.

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.jpg


Most vets who understand the importance of strict crate rest will agree to phone updates instead of office visits.  As you have seen, too much movement and the damaged disc can tear more, causing more pain and/or nerve damage, even paralysis.  Unless there is a worsening of neuro function, which would necessitate an emergency visit, updates concerning pain, med adjustments, tapering of meds, can be done by phone.  Please speak to the vet about giving phone updates instead of the transport to an office visit on 8/9.

Is there still currently pain? ☐shivering, trembling ☐yelping when picked up or moved ☐reluctant to move much in crate such as shift positions or slow to move ☐tight tense tummy ☐can’t find a comfortable position ☐Arched back ☐ Holding front or back leg flamingo style not wanting to bear weight ☐head held high or nose to the ground ☐Not their normal perky selves? Full pain relief is expected in 1 hour and stays that way dose to dose. If not in control your vet needs to know asap to adjust meds.

PEPCID AC: Anytime a dog is taking an anti-inflammatory, stomach protection must be added. Ask if your dog has 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). i.ibb.co/DCN9611/91x-Aj-s00z-L-SY355.jpg
Doxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours. NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.html

GI Tract problems? —Eating and drinking OK? No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?

With a cervical issue, there are a few other things that should be done, such as raising the food and water dishes so your dog doesn't have to bend neck, moistening hard kibble to soften, etc. dodgerslist.com/2020/05/05/cervical-care-tips/

Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD soonest possible. Owner understanding ensures proper conservative treatment principals:
▶︎ 4 phases of healing, what it takes to heal each phase:
dodgerslist.com/in-the-right-place
▶︎ Roadmap for your fridge so the whole family is on board. Stay the course, avoid dangerous detours for the healing disc:
www.dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf

Healing prayers for Teddy.

I agree that we should not be stingy with pain meds during an IVDD episode. Pain only slows the healing process. It is much harder to get a dog's pain under control than it is to keep the dog pain free with the right meds given on schedule.

Since Teddy is taking pred he will need to urinate more frequently. I found with my dog I had to take him out every 2-3 hours while on pred.

 Pepcid AC (famotidine) takes 30 mins to be at peak efficiency in stomach protection and lasts for 12 hours. So initially dose Pepcid AC 30 mins BEFORE prednisone. Thereafter dose Pepcid AC every 12 hours (2x/day).

It is good to dose prednisone and then give breakfast right after. 



A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. 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

Susan, it appears the pred taper will be on 8/9. Typically all pain meds are also stopped in order you will be able to quickly and accurately observe if another course or pred would be needed. The current 6-day course may do the job. The typical range of courses (excluding any taper days) is 7-30 days to resolve all the painful swelling.

Let us know the plan you and your vet work out for the pain meds being full stopped or backing down on them on Aug 9.

Susan since Teddy's disc relapse of 8/3, can you confirm you have been doing the necessary VERY strict crate rest:
  STRICT rest means:
     Carried to and from the potty place
     Allow no more than a very few minimal footsteps to take care of business.  The 6 foot leash is attached to harness.  You stand in one spot allowing Teddy only the 6 foot leash length to take some footsteps.  
        Or better yet is to use an ex-pen in the grass as a potty place. The ex-pen lets Teddy know there will be no sniffing around with the visual and the physical of the fence. Scroll up to see Marjorie's post to see the picture of leash/harness or ex-pen options.

Potentials for pain
 1🚩When pain meds are correctly Rx'd for Teddy's body, then pain would be in control 1 hr after dosing and from there on full night and day pain control right up to the next doses of pain meds (gabapentin, methocarbamol, and traMADol ).  
   Call your ER vet today 8/5 to advocate for a higher dose. Your job is only to report observations, Vet's job is to prescribe. Vets who know IVDD understand the need to do what can be done over the phone vs. a more risky to the healing disc transport in.  Any vet on duty would have access to Teddy's file and be able to adjust meds.
  The usual in controlling pain is to Rx at the higher end of the traMADol mg range AND promptly every 8 hours.

traMADol reading references for 18lbs/8.6kg Teddy.  Look for an increase in mg from the current 50mgs and still dosing every 8 hrs.
2🚩Lack of STRICT rest since 8/3 relapse due to walks, and now seeing new or increased signs of pain since Rx's on 8/4, may mean there has been still too much movement of the back/neck.
    Confirm: is the pain observed 8/5 the same as on 8/3 (meaning the pain meds were not yet properly Rx'd for Teddy's need?         OR is it worse? meaning some new damage to the disc happened and another restart of 8 weeks rest?

3🚩 Discuss if Gabapentin mg dose can be increased also 3x/day. Discuss if there should be a move to the more powerful and newer LYRICA® (pregabalin)

4🚩 Are you doing these extra things for a neck disc?: such as softening hard kibble, raising food/water dishes, etc. More info here:
==> www.dodgerslist.com/2020/05/05/cervical-care-tips/
5🚩 Are you documenting pain events, etc with date/time on the med chart? Quality and accurate information helps to explain things.

6🚩 If max pain meds are Rx'd, yet the pain can't be brought under control in 1 hrs and thereafter round the clock, then there may be a reason to pursue surgery.  Bone up on this topic in order to ask good questions.


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:
    www.dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/

More excellent info to help with conservative vs. surgery decisions:

I am happy to hear that Teddy is currently showing no signs of pain.

The size of the crate should be just enough for the dog to stand up, turn around and fully stretch out when lying down. If the pen is now that size, it will be just right.

The articles I've read about electro-acupunture say it's a relatively new procedure. It uses two needles instead of one with an electrical charge. The thought is that it may have a more stimulating effect on damaged nerves. There are no studies, that I've found, confirming it's more effective than traditional acupuncture. As with all treatments, be sure to determine if the person offering electro-acupuncture is qualified and knowledgeable.

Teddy had a couple more episodes of pain /yelping during the middle of the 8/5 night. Er vet doesn’t make med adjustments without seeing the dog in person.

This morning Teddy ate his food, was carried outside and walked a small amount in order to take care of business and [8/6] has settled quietly in his crate. It’s strange since his pain seems controlled during the day but not late night.

We do have trazodone on hand and am wondering if we should go ahead and give him a 25 mg dose before bed?  When I say we have trazodone on hand I mean that it's our adult prescription, [traZODone] not one that was prescribed for Teddy.

If surgery is recommended by his neurologist we are able to move forward with that.

In the meantime I agree with optimizing his pain meds. After his relapse Aug 3 the neurologist adjusted his pain meds after watching a video we sent Aug 4. She also asked to see him at her next earliest appt which is Aug 9. In the meantime we are doing our best to avoid a trip to the ER.

Yes, I’m keeping track of his pain episodes. I realize trazodone is not a pain med but thought the sedation may be helpful at night. I’ll talk to vet about both tomorrow.

Susan, glad to hear the surgery went well! And that Teddy is in comfort at the hospital post-op.  Please keep us updated as you receive new info about Teddy.