Laura's Bear 8/12 conservative- NECK, GRAD 10/7/23

Laura, sorry to hear Bear is experiencing a neck disc episode.  When you can fill us in on some details about his med list.
    Make sure the pain meds are being given promptly every 8 hrs  (3x/day). The two pain meds (methocarbamol, gabapentin) are effective for 8 hrs.  Read up about amantadine which is not a pain med per se  but can be very helpful:==> www.marvistavet.com/amantadine.pml    
    See below why Pepcid AC is important to suppress stomach acids. Sucralfate protect in a different way. And how to time dose both meds for best results.

Bear's MEDICATIONS 
-- What is the name of the 8/12 steroid injection?
-- Which are you actually giving methocarbamol every 8 hrs?
-- Which are you giving gabapentin 1 or 2 capsules?  Every 8 hrs?
-- Sucralfate reacts with stomach acids to form a protective gel at the site of any stomach damage/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

Printable med chart includes how to use and a blank to personalize to your dog's meds: dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf

As an example, one dosing schedule for first dose of the day might be:
    5am sucralfate
    5:30m pepcid AC
    6 am prednisone, methocarbamol and gabapentin, amantidine with breakfast

EXTRAs for a Neck disc
There are extra things you can do at home to help the neck heal, such as softening hard kibble, raising food/water dishes, etc. More info here:
==> www.dodgerslist.com/2020/05/05/cervical-care-tips/
    Never hurts to browse the tips to make crate rest go smoother over the next EIGHT (8) weeks and expecially safety at potty times ==> www.dodgerslist.com/2020/05/14/strict-rest-recovery-process/

    Bear's been seen at ER, so his file could be accessed by the vet on duty in order to adjust meds over the phone if pain surfaces. Car trips can be a potential for too much movement and further damaging the neck disc.
     Unfortunately, your local vet has not seen Bear and will most likely not be able to Rx or adjust meds until he has examined Bear.   Do what you can to maintain the single most import of care...the very STRICT REST.  If a transport is an absolute emergency, pad out the crate with rolled up snug around his body and neck. This will help to prevent any extra movement when breaking or taking a corner.

Laura, very good to hear pain meds (gabapentin/methocarbamol 3x/day) Rx'd are sufficient to keep pain fully at bay night and day.  If pain should surface, THEN you advocate over the phone to get meds adjusted.  Do not give traMADol to Bear unless it has been Rx'd specifically for him.

Thank you for clarifying the vet only Rx'd sucralfate because you asked and you have not been giving.  So Bear has no protection against stress, prednisone caused stomach acids!  Let us know when you have 5mg PepcidAC (famotidine) 2x/day on board.

Pepcid AC (famotidine) should be on board as it is the drug that suppresses the stomach acids Prednisone and stress all cause.  For most dogs Pepcid AC alone does the job.  If not, then sucralfate would be added. Sucralfate works in a different way to bandaid areas of stomach damage. 

What date did you first give the prednisone pill? The pred taper date is KEY information in determining if the 8-day course (1 day Dex, 7 days pred) was enough or not.
        This page is KEY for you to to understand how pred is used during a disc episode, what your job on the taper is, and if the two pain meds will be stopped OR back down on pred taper day.  What is you and your vet's plan for pain meds on taper start day?  ==> www.dodgerslist.com/2020/04/18/steroids-vs-nsaids/

-- Why have you changed Bears diet to rice and meat only?
-- What does he normally eat?  
With a neck disc you can soak his kibble (if that is his normal) to soften and make it easier to eat with his neck disc.

When on pred it is not a good idea to change his food. Change in food can give the same GI tract issues of soft stool as Pred could. Then you won't know what the culprit is (change in food or Prednisone) His normal food is well balanced for all the repair jobs his body must do.  Turkey/rice is not balanced. Rice can cause gas because dogs don't digest rice.  Keep us updated when you have gradually over a day or to returned Bear to his normal diet.

You have a good sense of crate rest needs. Enough to now know this vet is not comfortable in their knowledge of IVDD. It takes 8 weeks to heal the disc.  It  could take 7-30 days (excluding any taper days) for prednisone to resolve all painful swollen tissue around the cord. Thus referring to a specialist in two weeks in general doesn't make sense.  
            You want the specifics handy of what to expect with Conservative treatment.  Gather these 2 tools to avoid dangerous detours:
  1) D/L and print out for your fridge for easy reference "Conservative ROADMAP": www.dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf
  2) Handy wallet sized Med reference card. D/l to print a copy at this link:
 ==> www.dodgerslist.com/wp-content/uploads/2020/04/Med-card-to-print.pdf

Laura, thank you for your report with lots of details. Just one detail is missing on Pepcid AC ?mg ?x/day (we do not want to assume anything).

The expected 7-day course of Dex+ pred both dosed on 8/12 will taper on Sat 8/19.  Since the Rx for the two pain meds allow a 2x/day dose, that could reveal something about pain when pred reduces. It is not until both pain meds are stopped that you get the real honest truth if pain remains and if there would be a need for another  course of pred to finish resolving the inflammed tissue around the spinal cord. The sooner you find out the truth, the better for the spinal cord. It is the vet's descretion about stopping because there may be a disease Bear might have (one is epilespy) where definately backingdown is necessary. So it is the vet's decision which:  backing down pain meds or full stop on Sat  8/19.  The Plan B is what if pain would surface over the weekend when vets are not open, would you be prepared to handle?  Neck discs are often more difficult because the head will move when any other part of the body moves.  So a 7-day steroid course might or  might not be long enough. The pred taper and stop of pain meds tells the truth.

It is best to not be doing all those food switches while on pred (no canned food, no solely chicken, no rice)
--- Move today 8/14 back to his normal food. Gradually over a day or two get back to Beneful (soaked).
--- Bear does not necessarily need to eat an entire meal before dosing pred. Mix in a teaspoon or two of chicken meat on the soaked kibble. Soak the kibble in the chicken broth.  A teaspoon or two of chicken will not unbalance the Beneful formula.
--- After he eats as much as he will of soaked Beneful, dose the medication.
--- a med schedule could look like this:
      7:00 am dose Pepcid AC and feed a meal or whatever amount he will eat.
      7:30 am dose the scheduled pred and any other meds due at that time

The Glandex you've let us know that Bear is taking is a combo of FIBER and pre/probiotics. It's intent is to firm up the stool a bit so the poop will push on anal glands as it exits. Hope is the glands will kinda get expressed a bit with each poop.

Take Bear outside every 4-6 hours while on pred. Pred makes then drink more.  Is Bear currently while on pred drinking more water?  IF not, in light of Glandex, you might offer him a small drink of no-salt, no fat homemade chicken broth to lap up. Or freeze into ice cube for him to lick on.

Starting exercises only 2 weeks after a disc episode would quite likely cause damage to the early healing disc AND the progressive neuro diminishment signs the "Client communication" listed.  
    A neuro consult is not just for reasons of a surgery. A consult could be because local DVM(s) are not confident in their knowledge of IVDD in prescribing adequate pain meds and for the length of time needed to get all the swelling down. It is good prepare yourself with an understanding of both surgery and conservative that you may not have had explained in a short vet visit:  
    More excellent info to help with conservative vs. surgery decisions:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

Just clarifying...has Bear been seen by his local DVM vet re: this disc episode?  OR only seen by the ER vet?

Laura, I see your dilemma.

Has Bear had any signs of epilepsy now or in the past?

Best is the superior nutritious quality of homemade NO salt/NO onion meat broth you make. So easy to make!
    Cover hamburger patty(ies) or a chicken part(s) in water. Simmer till meat is tender/cooked falling off bone.
    When cool, discard disc of fat at the top. If chicken, also discard the skin and bones.

Serve this no-salt, no-onion, no-fat meat broth as an ice cube several times a day and to soak his Beneful Kibble in. Maybe you can offer a 1/4c slightly warmed broth to increase its delicious fragrance to get her to lap some up time to time during the day?     Save the meat to combine into soaked kibble at no more a couple of teaspoons of meat in order to not unbalance the minerals to protein ratio kibble formula.

No vet is licensed to Rx meds or adjust them without first having examined the dog. The very best senario is you are somehow able to get what you need one of the vets who has seen Bear.  See if you can drive the boat a bit, yet do it a polite way.
    You want confirmation Bear does not have epilepsy or other issue where backing off of 2 pain meds would be warranted.
    You want on the pred taper, to know if she may full stop pain meds on Sat 8/19.
    You want to have a few pred and pain meds pill on hand should pain surface to go back up on doses.  It would not be fair to Bear to suffer pain until the vet reopens to update by phone. And likely expect another course of pred + pain meds 

pain = swelling = another course of pred back at the original anti-inflammatory dose +pain meds and Pepcid AC

no pain = go to conclusion of pred taper.
No pain meds, just Pepcid AC for duration of prednisone
finish out the 8 weeks of crate rest for the disc to heal

Laura, caution on using high fiber since you report at this time Bear consumes little liquid.  Metamucil (fiber supplement) could cause further constipation unless Bear increases his hydration!  

Here is an actual food that contains nutrition/minerals the body needs AND which is also a high fiber food.  
    See the two examples below for an understanding about the importance of hydration with high fiber foods or supplements.  
    Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation.
     NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe
     1) --To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day.
     2) -- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to dry kibble.

FYI NOTE : Rice is complex carbohydrate that tends to ferment in the dog's colon, causing uncomfortable gas. In addition rice often passes right through the dog's GI tract exiting totally undigested. Whereas pumpkin or sweet potato is nutrient rich plus high in fiber. Dogs can absorb/digest its nutrients from the fiber.