Kate's Milo 8/20 Conservative - NECK - GRAD: 10/15

I'm sorry to hear that Milo is having another disc episode, Kate.  Cervical episodes can be more painful.  You're one step ahead in that you already know how to do correct strict crate rest for a full 8 weeks.  Take it one day at a time.  Milo is in good hands!

As for Milo being "pretty sedated and out of it", he could have been given a very high dosage of hydromorphine and cerenia at the ER and that may not have been out of his system when the at-home meds were started.  If you have concerns, you should reach out to the ER and let them know.  

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/

Is there still currently pain?  With the injections at the ER this morning, Milo may not be showing signs of pain.  However, do keep this question in mind and let us know if the at-home meds are keeping pain completely under control, with no sign of pain from one dose of meds to the next.  Cervical episodes can be more painful than back episodes and Milo is only on one pain med - Gabapentin.  Should pain arise, contact the ER and advise so pain meds can be adjusted.  Most vets will prescribe three pain meds to get the severe pain of cervical discs completely under control:  Tramadol as a general pain med, Gabapentin for nerve pain and Methocarbamol for the pain of muscle spasms which often accompany cervical episodes. 

Signs of 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.

Please list the exact doses in mgs and times per day given for each med prescribed.

How many days has the Carprophen been prescribed for?  Were instructions given to also stop or taper off of Gabapentin when Carprophen is stopped?

[MED LIST/HISTORY- Moderator's Note. Please do not edit
11.5 lbs/ 12 y.o.
Hydromorphine at ER on 8/20
Cerenia at ER on 8/20
Cerprophen 12.5 mg 2x/day for ?? days, then stop?
gabapentin 50mgs ??x/day
Famotidine ??mg ??x/day]

It's been awhile since Milo has been on conservative care so here's a bit of a refresher:

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

Healing prayers for Milo

Kate, very good to hear gabapentin alone currently is blocking pain and providing full relief from pain round the clock, night and day.  FYI, often neck discs require each of the 3 sources of pain to be covered by three different meds:
   √ Gabapentin for nerve pain 3x/day
   __methocarbamol for muscle contraction  pain 3x/day
   __traMADol as the general analgesic 3x/day

While you got an Rx for Gabapentin 50mg either 2x(every 12 hrs) or 3x (every 8 hrs) a day, we need to know which have you been actually giving?
    Are you keeping a med chart to note patterns with doses, etc.?
D/l a a sample and a blank form to use with your dog's meds from this link:   www.dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf
Involuntary subtle front and rear limb twitches 
This symptom is not one we've heard related to a neck disc. It does not seem like you are observing as pain for Milo. Discuss if methocarbamol to relax muscles might be something to consider for Milo.  Let us know what the vet thinks is the cause of the twitching (pain or ???)

CDB oil supplement during conventional meds
  This is Dodgerslist stance on the use of CDB supplement while conventional meds are on board for a disc episode:  ==> www.dodgerslist.com/2020/02/24/devices-supplements

Carprofen
With the 7 whole 25mg tablets split in half and given 12.5mgs 2x/day, that means Milo got a 7-day course of this anti-inflammatory drug.  This is important information for you to understand during conservative treatment.  
  Highly recommended you read for full NSAID understanding:     ==> www.dodgerslist.com/2020/04/18/steroids-vs-nsaids/
    Summary points:
     -- Usual for a 7 or 14-day course to be Rx'd.
     -- It can take in the range of 7-30 days for carprofen to resolve all swelling. 
     -- The stop date on Sunday 8/27 is a sort of test to actually know if all painful swelling is gone. If pain not gone, asap another carprofen course + pain meds + famotidine back on board also.
     -- Pain meds block your eyes from observing for pain. Pain meds usually stopped at same time the carprofen course ends.
     -- Find out from your vet if gabapentin stops or starts to back down on Sun 8/27 when 7-day carprofen course has finished.  
    -- Let us know you and your vet's Plan B should pain resurface on the stop of carprofen Sun 8/27 or any day after. It can take carprofen 4-7 days to totally leave the body dependent on how fast a dog's metabolism is.  

Your vet would take into consideration weight, any health issues and prescribe the correct dose. Look for the Rx to include 3x/day dosing for pain medications. Pain meds last for 8 hrs. I don't think people's doctor is qualified nor licensed to prescribe meds for an animal. 

I know when worried about our pets, it is hard to not be distressed.  If you find you must cry do it outside where Milo doesn't see or hear. He will think something is not right and might even think he's the cause!

You report GOOD news...Milo is definately better than yesterday. If he can roll on his back that definately means the pain meds are controlling pain.  It is only the carprofen test stop that reveals if all painful swelling is really gone.  Heck it might be gone today for all anyone knows.  You WILL have an answer starting Sun 8/27. And if another carprofen course is needed, that would  not be unusual.

Observing two or more signs of continued pain, would help you to confirm that pain is not being controlled by the current single pain med, gabapentin.


If you heard him yelp, due to too much movement, then you will want to PHONE the ER vet and see about methocarbamol.  IF it was only one time yelp and he is calm and relaxed now, WHEN you can, discuss methocarbamol for being proactive in addressing any potential pain.
        Transports can be too much of a risk for early healing disc. Vets who know IVDD understand, and typcially adjust meds over the phone.
   If your vet has not yet seen Milo for this disc episode, then I believe he would need to examine him before presribing any meds or adjusting them.  Your best bet is to work with ER to get the vet on duty to look at Milo's file and be able to adjust meds for full control of pain and potential pain.

Do know Milo's body IS INDEED healing the disc. It's gonna take 8 weeks of limited movement to get the job done.

FAMOTIDINE for a 12lbs doxie should be:
    5mgs 2x/day.
Famotidine is an antihistamine (contains no mineral salts of aluminum, calcium or magnesium). Famotidine suppresses production of stomach acids. Once started, keep with the every 12 hour dosing.  Famotidine lasts for 12 hours.  

We consulted with the Neuro surgeon who supports Dodgerslist. This is what he told us:

Milo received Hydromorphone and cerenia while ER on 8/20.
He was started on Caprophen 25 mg 1/2 pill q12h on 8/20 and has had 3 doses so far given religiously q12h.
He started Gabapentin 5mg q8-10h on 8/20 and given religiosity q8h.
Famotidine 10 mg 30 min prior to Caprophen started on 8/20. I was instructed ▼famotidine should be administered as 5mg bid. The does will be adjusted tonight when the next dose is due.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
11.5 lbs 12 y.o.
carprofen as of 8/20 12.5mgs 2x/day for 7 days, Sun 8/27 test STOP: _pain? _neuro?
gabapentin 50 mgs 3x/day (Rx is for 2 or 3x/day)
famotidine ▼5mg 2x/day ]

I am going to request that vet prescribes methocarbamol and tramadol as recommended but it's still pending due to three vet hasn't called me back yet.
Hopefully i can start Milo ok these tomorrow. 
Thank you very much!

Thank you so very much for helping us save our doggos.
I am waiting for the vet to call me back. When I spoke with the assistant, she said it should be no problem since he was taking these meds when he had his last episode. He's not presenting any new pain manifestations. He's looks relaxed and taking a nap after his last dose of gabapentin and caprophen. He still twitches [ask the cause]. He doesn't look like he's in pain when he does but I can't know for sure. I will definitely address it with the vet.

Is it OK I'm hoping he may actually get better with conservative Tx? I just want my baby better. I wish I could bare his pain for him
He drinks water ans eats. This is good, right? Yesterday 8/20 he didn't want to eat od drink for a whole day

I was extremely worried. Please tell me he's doing well consider his injury. I'll do whatever it takes to save my lil buddy ❤️😭
Thank you.
Please continue educating me. Thank you for clarifying famotidine-gabapentin interactions.
Dogerlist is a blessing. I know I wouldn't have lost my previous doxy had I been properly educated but the vet and known about Dogerlist. I applied you more than you'll ever know.

Thank you Paula. I'm very sorry for sending a duplicate medical message. I have this pop window asking for medications and I thought I had to reply to it. My apologies for taking away your time.
    I spoke with the vet and he said Milo definitely needs more caprophen tx and will get more medications and then we'll re evaluate. I addressed the twitching and the dr said methocarbamol will help with that. He will also prescrib tramadol in case Milo needs it. I have been monitoring Milo for pain and I certainly don't want to over medicate him I'd his pain is controlled with gabapentin. 
I will send a medication update as soon I get medication and instructions.
Milo is stable and resting. Thank you for sending ivdd materials. 
I have a question, Milo wants to give me kisses and lick my face. Can I let him or it'd hurt him. Thank you 

Good morning, Milo has been prescribed additional medications
:methocarbamol 500mg,, quantity=15, give 1/4 pill q8h will start today on 8/22
Tramadol 50mg, quantity=21, give 1/4 pill q8h, prescribed on 8/20 and not stared as of yet due to Milo's pain seems to be controlled with gabapentin. 

I got more caprophen, additional 30 pills and gabapentin another 30 pills.
The vet said Milo has to finish caprophen and will be reevaluated. 

Can I give methocarbamol at the same time as caprophen and gabapentin?

Milo has been stable and happy ❤️ 

I have a cold laser/red light wand.is it oknto use it on his spine?
Thank you 

Thank you so very much. I started to relax a bit. It's so healing to see my puppy (he's an old puppy) smiling and looking more like his normal self. I've been extremely careful with him. 
I have a question about feeding Milo. We've been pretty active. We used to brisk walk for and hour and a half daily. I don't want him to gain wait. Should I give him smaller portions since we have zero activity now? Also his poop is a little loose. Is it a side effect of medications? I don't think he has a tummy ache. He's doesn't throw up.
Thank you!

Thank you very much Paula. I will call the vet [8/24] tomorrow and see if he can prescribe it. My Poor little guy, I hate having him go through all this 😭
I've been concerned with Milo scratching and digging in his bedding/blankets. I try to district him when he does it because it looks like it's something that can definitely hurt his neck. He also rolls on his back and wiggles around. He normally does these things and these aren't new behaviors. Should I discourage it while he'shealing? 
I'm also very curious of what the repairing provecess looks like in his spine, what is happening now? Do you have any information for someone with no MD or DVM training? Thank you

Thank you so much Paula, this is extremely helpful. I will definitely print the Roadmap!
It's so sad so many doxies have this disease 😟 It's so unfair. Is there any research in place? Is anyone working on finding a cure or reliable prevention? My doxi has never walked up or down the stairs,  I have ramps and rugs on floors. Never played tug of war, never has been picked up wrong. He's been on glucosamine his entire life. I just don't understand how he's gotten his 3 episode already. And i understand he may get more and not make it 😭 It very heartbreaking 😣

Would you please address his gigging in his blankets and wiggling around? Should I be stopping it? I have been but it doesn't take much for another injury. Thank you 

Thank you so much Romy. I've been undereducated and I appreciated this postal and all the materials so much. I was under the impression it's only dachshunds and beagles, and these other longer pups with huge wobbly ears. This is so sad. I feel like I live on the edge since his episode when he was 5. I'm sure I'm not the only dog's mom on here. 

I can't thank you enough for your support and empathy.

I was unable to get the additional medication for the stomach that Paula suggested because my vet is closed on Wed but I'm happy to say Milo's poop was so much better [8/23]this morning!! I just want him to be comfortable 😞

When is a good time to consider spreading gabapentin more? Milo is still on 50mg g8h.
I'm not trying to rush things, I'm just wondering what the recommendations are.

I was laying next to him last night and he still twitches but I want to say every 10 -15 minutes now while before he did every few seconds which was heart breaking. Is is a good sign?

Thank you so much!

Hello! Milo is doing really well ❤️ It seems like his appetite is back to normal. He no loner twitches.He's still on the same medications. I was wondering when it would be a good time to start weaning him him off of Gabapentin and Methocarbamol. He gets both every 8 hours. Should I try spread them out more? Every 10 or 12 hours? Please provide guidance. I don't want ot over/umdermedicaid him. He still takes caprophen and famotidine as prescribed. 
Thank you very much.

Thank you very much! I will definitely address it with the vet.
I'm nervous about stopping caprophen 😣 I hope he's having a good recovery. Time will tell.
Than you!

Does Milo know I love him? 😣

Hello. I'd like to get a puppy stroller to take Milo out for walks in it.
Is it ok to do that? I'd never want to compromise his discretion healing. 
Please provide guidance. Thank you so much.

Thank you very much Paula. I understand the reasoning behind the stroller.

The [9/1] vet said I can start gabapentin and Methocarbamol every 12 hours.
    Caprophen and famotidine still the same, every 12 hours and total of 3-4 weeks.

I will check with thr vet prior to 9/11 if I should stop all meds all together or continue with Caprophen + famotidine for another week from 9/11.

I'll start 9/4 gabapentin and methol q12 hours starting  tomorrow. Thank you. I'm very nervous. I hope he's healing and that he's pain won't start manifesting with lower frequencies 😑
Thank you