Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32 
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Post by Ryan & Woody on Sept 7, 2023 7:53:17 GMT -7
[Original subject line: Woody's taken a bad turn.. ]
I posted in this forum [9/4] not long ago and already since then things have taken a bad turn, and I just can't believe it..
History:
Woody had surgery for L2/3 disc last year (when he was 12 at the time, now almost 14). The disc was so calcified it was "like a rock" as the surgeon said, and was adhered to the spinal cord, so he just carved away bone at the top of the vertebrae to give it more room instead of removing the disc. He recovered ok, but had infrequent mild pain episodes from a pinched nerve root in that area (that same disc just rubbing on the nerve root now), that never affected his walking.
In April of this year, he did something that resulted in him rolling/knuckling his back legs when he would finish pushing off a stride (so he wasn't placing them upside down, they were just rolling over as he pushed off with them). He kinda bounced back from this in a week and within a month wasn't doing it much at all.
Then in June, after just kinda skipping around the yard a bit, he suddenly started doing it again. This time it was a bit more. And I also noticed he didn't have his usual strength/spring in his back legs (normally whenever I'd pick him up he would sort of jump up into my arms). But now there was barely any push. But if we went on a 'walk' where he would get up to a stride with momentum, he walked perfect. However, this time he didn't bounce back in terms of the rolling paws and strength.
We thought all of this was related to the pinched nerve root getting more irritated/inflamed. Finally on Aug 16th we tried a [name of ?]steroid epidural to try to bring down the inflammation. We did an MRI at this time, where the surgeon also noticed the new since his surgery last year L1/L2 disc was mildly protruding and tickling the spinal cord. He figured this could be part of the issue, but he did say it was mild.
After the epidural, we did take things slower for a couple weeks, worked on PT. He wasn't doing "better" than before but was ok at two weeks. At 3 weeks, I was beginning to think we were on an improvement trend, maybe rolling his feet less. We increased his walks by a couple minutes, but no change in routine aside from that.
The past Sat/Sun [9/2 - 9/3] I thought he didn't look quite as sharp, but still ok (figured maybe the extreme heat/humidity was just slowing him a tad).
But Mon 9/4 day morning he woke up and it's the worst I've seen him walk since surgery. He's rolling both feet a ton now, weak in both back legs, mild incoordination.
I'm crushed and heartbroken. With a steroid epidural he should be as best as he should be at this point.. not going backwards. I hate to think maybe I made wrong choice with the epidural.. maybe it weakened the healing at the disc to become worse.
After speaking with the neurologist, I do believe it's this new L1/L2 that's been the main cause with the past few episodes and is now worsened. They recommended strict crate rest and to re-evaluate him in a week, saying "he should look better in a week, but not to stop crate rest for 6+ weeks".
I dunno, I know it's only 2 days in, but I'm feeling so hopeless and skeptical that in a week he should be looking better... Especially with how chronic, calcified and slow-moving this disc has been, is there really any chance it's going to "heal down" or reabsorb to relieve pressure to have some neurologic improvement?.. I feel I'm just losing him little by little..
Thanks
- he weighs 12lbs
- he's on ▲gabapentin 150mg/3x day
- just started carprophen
- probably still has some [Name of steroid? on 8/25] steroid in his system from the epidural
[MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 14 y.o.
8/16 MRI: new L1/L2 disc bulge, the thoracolumbar discs are all diffusely markedly desiccated (dehydrated).
9/4 back legs: weak, incorordination
8/25 methylprednisone injection
CARTrophen (Pentosan-polysufate-sodium) as of 9/7?: ?mg ?x/day for facet joint arthritis
gabapentin ▲150mg 3x/day ]
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 7, 2023 10:15:12 GMT -7
Ryan, so sorry to hear of the advancement into a disc episode. With first indication of a disc episode, crating at once prevents worsening pain and neuro damage. Woody has relatively mild symptoms and he CAN self heal the neuro damage. STRICT rest is the key to ensuring Woody heals his disc on graduation day. Nerve healing is the slowest part of the body to heal, so it may or may not heal as soon as the disc can. Crate rest for a disc episode is much more strict than for post-op rest. Lots of tips and ideas to make the next 8 weeks of disc healing rest go safely for a healing disc: dodgerslist.com/2020/05/14/strict-rest-recovery-process/STRICT REST 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. ◼︎ Carry dog to and from recovery suite out to potty place 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 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!◼︎Eats in the suite. Attach food/water bowls inside suite ◼︎No PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture, if wanted, is best for early healing disc. ◼︎ 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 such as with Woody. Vets who know their IVDD often will take care of med adjustments, updates over the phone rather than to call a dog in for a risky to the disc car transport in. ◼︎ Avoid dangerous detours. Follow the "Roadmap." Tape it to your fridge. D/L and print out: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf MEDS Could you fill in some missing info: -- Steroid Epidural: What was the name of the steroid given 8/25? -- Carprofen: What date did it start?
How many mgs dose?
How many times per day given?
For how many days are you to give?
-- Any use of a steroid or a non-steroid (NSAID) should be accompanied by an acid suppressor. Gain an understanding of the why, how to ask your vet, signs of GI damage to watch for, etc.: dodgerslist.com/2020/05/06/stomach-protection/ Let us know when Pepcid AC (famotidine) is on board for Woody.PAIN With gabapentin (nerve pain) increased to 150mgs 3x/day is all pain in control fully day and night? If not have no patience with pain. Alert your vet and expect: other sources of typical pain to be addressed: traMADol as the general analgesic 3x/day methocarbamol (muscle contraction pain) 3x/day MONITORING NEURO FUNCTIONS As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example. 1. 9/4 Pain with initial tear of disc and ensuing swelling
2. 9/4 Wobbly walking
legs cross
3. 9/4 Nails/toes scuffing floor
4. 9/4 Rear paws knuckle under. Dog is slow to correct
or can't right the paw(s) at all
5. __ Weak/little leg movement,
__ can't move up into a stand
6. __ Legs do not work at all (paralysis, dog is down)
7. __ Bladder control is lost. Bladder overflows leaking on you when lifted.
Can no longer sniff and then pee on an old urine spot outdoors.
8. __ Tail wagging with joy is lost when specfically doing some happy talk to the dog.
9. __ Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy.
Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance.
Precious hours can be lost with a general vet who gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.
A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/
Please keep us updated. It helps us see a date and with exact names of meds or mention of events. |
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 7, 2023 13:51:36 GMT -7
Thanks Paula..
But for neurologic improvement to happen, the disc must heal down or dissipate, no? I just fear that with knowing his discs are "hard as rock" as the surgeon told us last year during his surgery, there isn't much hope for them to "heal"..
Do you also not worry about significant muscle loss after 2 months of strict crate rest? Especially in a 14 year old dog, that is not so easy to get back.. Of course I want him to walk better, but.. I also know significant muscle loss will mean he has less muscle supporting the back and spine and thus likely to re-injure it easily..
- the steroid injection was methylprednisone.
- It's also not actually carprophen he's taking, but "cartrophen", which is an injection under the skin that our vet suggested we could try (not approved yet in USA, but we are in Canada). It's a drug mainly for arthritis and OE, but there's some studies (in humans) that show it can have beneficial effects on disc healing.
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Post by Romy & Frankie on Sept 7, 2023 15:07:26 GMT -7
The goal of conservative treatment is to have the body absorb the extruded isc material so it is no longer pressing on the spinal cord. This can still happen for Woody.
During the weeks of crate rest, some muscle will be lost. This muscle tone will be regained when the dog returns to regular activity. For an older dog like Woody this may take longer but it will still happen.
Below there is an illustration of this:
Is Woody not on an NSAID or steroid type of medication at this time? Cartrophen is more likely to be effective for arthritis than IVDD. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 7, 2023 20:04:25 GMT -7
Ryan, the 8/16 MRI revealed a mild L1-L2 disc protrusion. Not a herniated disc where disc material had escaped into the spinal cord canal that needs surgical removal or with conservative treatment would with time shrink back enough to no longer aggravate the spinal cord.  A disc is like a jelly doughnut. It is the interior jelly part with an aged disc that becomes mineralized/calcified/hardened. When vertebrae move the disc is supposed to act as a cushion. Degenerated discs no longer cushion and return to a normal shape. Degeneration includes tiny little cracks on the outside of the doughnut are painfull when then happen. And the disc can bulge more than it should...bulge into the canal. No MRI has been taken on 9/4 to know the state of the disc. So one must act like this disc CAN HEAL! And with time the body will self repair the neuro damage, too. The tiny cracks will heal when there is little movement of vertebrae. STRICT CRATE REST is the key to allowing the disc form good secure scar tissue. With graduation on Nov 2, it will be safe to slowly begin physical activity and tone his muscles. Due to his neuro damage CRATE REST is very important. HOWEVER, note you will be carrying him to and from the potty place outdoors every 4-6 hrs to potty. The few minimal footsteps allowed will help to keeps his muscle firing. In his recovery suite, he will likely reposition his body using his legs. He may stand up on all four legs to look around. So he is not entirely immobile in a cast. Right now the important thing is to protect the spinal cord with least amt of movement and to let the disc exterior form good secure scar tissue so it does not fully rupture causing worse neuro damage. Find out why the vet is is not using any anti-inflammatory to get the painful inflammation down. He gave a pain med, then why no anti-inflammatory? Methylprednisone lasts in the body for 19-20 hours, so there is no longer any steroid anti-inflammatory to work on inflammation. Typically an Rx for a pill form of a steroid or a NSAID is for at home use. Know your anti-inflammatory drugs (two Classes) in order to understand the vet and for you to ask pertinent questions. Vets choose an anti-inflammatory during a disc episode to get painful swelling down in about 7-30 days. These powerhouse meds do wonders OR they can be dangerous. Vets who practice safe medicine and owners up to speed on medications make all the difference. Did you get all four questions right? - Answers here:  Thanks for the heads up on CARTrophen (Pentosan-polysufate-sodium). |
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 8, 2023 16:36:22 GMT -7
Hi Paula, Thanks for this. I'm pretty familiar with the anatomy and mechanics of it all.. unfortunately. He is taking a short course of ✙Metacam [dates?], yes. But we're cautious about this because as I said he had a steroid epidural 3 weeks ago, which will last for 4-6 weeks. So that is still present in him. [MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 14 y.o.
8/16 MRI: new L1/L2 disc bulge
9/4 back legs: weak, incorordination
8/25 methylprednisone injection, effective for 4-6 weeks
✙Metacam as of date?: ?mgs ?x/day for ? days, then a test STOP for: _pain / _neuro
CARTrophen (Pentosan-polysufate-sodium) as of 9/7?: ?mg ?x/day for facet joint arthritis and possible repair of disc cartilage
gabapentin 150mg 3x/day
Woody needs GI tract protector, Pepcid AC, on board for duration of Metacam+methylprednisone! ]I guess I'm just really worried that given how calcified his discs are, they aren't going to shrink down or be absorbed away.. Woody hasn't been in pain through any of this. Probably because he's been on pain meds the whole time, but also as our neurologist explained, when a disc is chronic and slow moving enough, often it may not even cause (noticeable) pain. And yes cartrophen is typically used for arthritis, but some human studies show it may be beneficial for disc repair: pubmed.ncbi.nlm.nih.gov/35102748/Our vet said it's something that "couldn't hurt to try, but of course we don't know if it will truly help". Our neurologist also said that "within a week [of crate rest] they should be looking better, and in 6 weeks or so hope to see neurological improvement, with the max neurologic improvement happening around 2 months." Does that sound right..? When do people typically start seeing neurologic improvement on crate rest..? Thanks Ryan |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 8, 2023 19:52:56 GMT -7
Ryan, I am so concerned to now learn that Metacam has been on board AND nothing on board to protect the GI Tract! Can you address this soonest possible? Woody doesn't need another problem of bleeding ulcers to deal with on top of this disc episode with both a NSAID and steroid, methylpred, still in the system for so long.  What date did metacam begin?
For how many days is he to take?
?mg how many times a day?Let us know when Pepcid AC (famotidine) is on board for Woody.You know the degree of calcification on the past surgical disc. You don't know the degree of calcification on this current disc.
Different vets have their own personal experiences to base citing number of months for nerve healing.
After being on this Forum since 2007, and getting now over 20-30+K of owner reports, I'd say each dog heals on their own time schedule and each part of the body heals at different speeds.
Every disc episode is different. Owners who cheat on the 8 weeks of rest often see the dog's disc relapsing and having to start from square one.
As for nerve healing it is all over the place. Dodgerslist says, have patience with nerve healing to see what the body can do. Meanwhile with graduation, dogs just get on with the business of enjoying life if after crate rest they need the assist of a cart while waiting on more nerve healing.
The good news for Woody is not only does he have the essential deep pain sensation (DPS) which is critical for nerve healing to continue, but he is WAY,way advanced past DPS on the neuro scale. With Woody's neuro diminishment of back paws knuckling and wobbliness, his body can heal the nerves. Even his cord may be able learn to adjust to the bad disc and not be aggrevated by it. Time will tell. Right now the focus is all about getting the disc to heal. Nerve repair may or may not come back in the short time it takes the disc to heal. Nerve repair is the slowest department of the body.
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 8, 2023 20:23:25 GMT -7
Thanks Paula.. Will look into pepcid. But he’s only taking the metacam for a week and has always tolerated it well previously.. But I’ll check. I mean, the MRI report literally said “the thoracolumbar discs are all diffusely markedly desiccated”. So.. all very calcified  |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 9, 2023 9:03:39 GMT -7
Ryan, thank you for the additional info on the MRI report re: the back discs being severely dehydrated (desiccated). No mention of all discs being mineralized/calcified. This is the aging process of the jelly-like disc interior becoming less hydrated. Less able to act like a normal disc to bounce back into normal shape as the spine moves. These degenerated disc exteriors degrade with tiny cracks (often painful as the cracks develop). The aged disc could bulge into the spinal canal to affect neuro function. You can read more about calcified discs and what they mean here: www.dodgerslist.com/2020/06/05/calcified-discs-meaning/Could you give us the detail about Metacam. It helps us to understand the treatment. What date did metacam begin?
For how many days is he to take?
?mg how many times a day?
Hope to hear that Woody can be on an acid suppressor such as Pepcid AC for the duration of Metacam and while methylpred is slowly leaving the body.
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 10, 2023 16:38:53 GMT -7
Thanks. He’s already off metacam.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 14 y.o.
8/16 MRI: new L1/L2 disc bulge
9/4 back legs: weak, incorordination
8/25 methylprednisone injection, effective for 4-6 weeks( til 9/22+?)
Metacam ±8/31: ?mgs ?x/day for 7 days, ±9/6 test STOP test for: _pain / _neuro
CARTrophen (Pentosan-polysufate-sodium) as of 9/7?: ?mg ?x/day for facet joint arthritis and possible repair of disc cartilage
gabapentin 150mg 3x/day
Woody needs GI tract protector, Pepcid AC, on board for duration of Metacam+methylprednisone! ]
We rather not mess with mixing this with the steroid even though the systemic absorption of a steroid epidural should be pretty minimal.. I kind of wish we could give an nsaid, but I suppose there must still be some good anti-inflammatory action still happening with the steroid in the spine..
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 11, 2023 19:46:01 GMT -7
Sigh.. so Woody had an episode [9/11] today. I can’t even understand why. Last two days especially he’s been super quiet in his crate resting. After a nice 4 hour nap I picked him up from crate and he yelped in pain (this is the first time he’s ever shown pain!). When I put him down his walking is all exaggerated and all over the place, uncoordinated… Back was hunched and neck low. Almost like a neck issue but never seen a semblance of a neck issue previously.. ugh..
Anyway, gave him more gabapentin [?mg ?x/day ] and started metacam [?mg ?x/day] again. An hour later he did thankfully seem to bounce back, walking is as it was again, and no more pain, and very fluid/normal in neck movement. (I don’t think it was ever his neck, he was just stiff and rigid all over). So at least there’s that..
But I’m even more disheartened and discouraged.. The neurologist said we should be hoping to see at least the start of a trend to improvement within a week.. and literally a week since we started now, he had this episode today..
Even on strict crate rest this happens? I just don’t get it..
It’s hard not to be tempted by surgery to just “fix this”.. I don’t know at what point we say this isn’t working and let’s do surgery before it’s too late to see any improvement..
I’d really rather see conservative treatment work for him but really doesn’t seem we’re on the right trajectory even with crate rest..
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 11, 2023 20:09:47 GMT -7
Ryan, sorry to hear the 7-day course of Metacam was not long enough to get all the swellilng down. Not unusual. Do not loose hope. The anti-inflammatory is "the" KEY to understanding the treatment. The STOP of the NSAID is a kinda of a test to see if the inflammation was fully resolved. Usually the pain med is also stopped to give the fastest and most accurate of assessment about existence of pain.
It can take a NSAID in the range of 7-30 days to resolve swelling. It is prudent of a vet to give a course and then stop. No one wants a dog on a NSAID any longer than necessary due to side effects.
We'd like to be able to follow along to give you our best comments regarding being prepared and what to expect with a course. Could you fill us in on the last course and also what you are giving this time as of 9/11
Metacam ±8/31: ?mgs ?x/day for 7 days, ±9/6 test STOP test for: √9/11 pain √9/11 neuro
as of 9/11 ?mgs ?x/day for ? days, then test STOP test for: _pain / __ neuro
Gabapentin ?mg ?x/day promptly given?
Do let us know what your neuro wants for length of NSAID Metacam course. There is an issue to switch to steroid prednisone about either 5-7 days of Metacam washout OR double stomach protection of Pepcid AC (famotidine) + Sucralfate.
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 16, 2023 13:08:53 GMT -7
Just an update..
So we did have Woody seen by the neurologist after the last episode on Mon Sept 11, who confirmed he does ALSO have a disc in his neck bothering him.. How we keep having such bad luck, I just don't understand..
But with extra meds and muscle relaxer on board now (✙methocarbamol), he seems pretty comfortable in the neck at least.. Not hesitant to shake, turns his head around freely, etc. So, I'm not too concerned with the neck as it seems quite mild, knock on wood though..
Still mostly concerned about his back and the walking. If I could ask some questions to you Paula or others who have observed a lot of cases from this forum..
- If there's going to be neurologic improvement, how soon into crate rest would you be hoping to see some positive signs by..?
- I have a hard time judging/assessing how well he is walking.. For one because we are letting him walk so little, there's not much opportunity. But also with him being off his legs so long and muscle relaxers and perhaps some muscle loss already, it's hard to tell the difference between him getting "weaker" from crate rest or weaker from neurologic decline.. So question is, do people often find their dog looks weaker over the course of crate rest?
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Post by Romy & Frankie on Sept 16, 2023 13:42:32 GMT -7
I am glad to hear that Woody is comfortable now. He should not be in pain. Pain will only slow the healing process.
There is no timeframe for nerve healing. Woody's neuro function may improve during crate rest, but it may not. Nerve healing continues to take place after the crate rest period. I know how hard this is, but with IVDD we may have to think in terms of months not weeks to see improvement.
The anti-inflammatory works on nerve inflammation, but cannot heal nerve damage. Time alone does that.
Since Woody's symptoms are knuckling and wobbly walking, an increase in these symptoms, in addition to weakness, would be what to look for.
His muscles will quite quickly become stronger when he returns to regular activity |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 16, 2023 15:56:33 GMT -7
Ryan, it seems you are not able to read our posts. This is frustrating for us. As we really would like to provide helpful comments that are general ones but rather specific to Woody. Without having details asked about Woody, we are at a loss.
No one knows how many courses of Metacam are needed before all swelling is gone. Most vets use a 7- or 14-day course and then test to see. It can take in total 7-30 days for the anti-inflammatory metacam to finally resolve painful swelling.
Crate rest heals the disc, but not neuro functions. Time is what heals neuro damage.
WOULD YOU HELP US?
9/11 Dx NECK disc in addition to L1/L2 disc on 8/16
1. What's the exact date metacam started somewhere around 8/31?
2. What was the metacam dose in mgs and times per day? for 7 days?
Did the neuro give another course of Metacam around 9/11?
1) exact date 2nd course of Metacam started?
2) how many mg dose?
3) ?x/day
4) for how many days?
?Pepcid AC 5mg 2x/day for duration of any anti-inflammatory (steroid or NSAID)
Gabapentin ?mg ?x/day promptly given?
methocarbamol ?mg ?x/day
names of other extra meds? ?mg ?x/day
ATROPHY
Can be typical to have some mild to moderate atrophy due to disuse of muscle that takes weeks to months. Once safe to resume physical activity at graduation, muscles will bulk up again.
Muscle atrophy of nerve damage can be severe only taking days to weeks to become observable.
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 17, 2023 6:29:10 GMT -7
- We did just a few days of metacam when this first happened around Sept 4. Metacam restarted Sept 12. 5kg dose 1x/day.
- Methocarbamol started Sept 12. 100mg 2x/day.
- No pepcid for now as vet feels not really needed. Maybe I'll give if we go longer than 7 days..
[MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 14 y.o.
8/16 MRI: new L1/L2 disc bulge
9/4 back legs: weak, incorordination
9/11 Neck disc Dx
8/25 methylprednisone shot, effective for 4-6 weeks( til 9/22+?)
Metacam as of 9/4: 5kg 1x/day for 7 days, 9/10 test STOP for: √9/11 pain! / _neuro
as of 9/12: 5kg 1x/day for ? days, then test STOP for _pain?/_neuro?
CARTrophen as of 9/7?: ?mg ?x/day for facet joint arthritis & possible repair of disc cartilage
gabapentin 150mg 3x/day
methocarbamol 100mg 2x/day as of 9/12
Woody needs GI tract protector, Pepcid AC, on board for duration of Metacam+methylprednisone! ]
Do dogs usually take methocarbamol for duration of crate rest?.. As he has a mild heart murmur, I'm a bit reticent to give this one for so long..
Also wondering if anyone here has ever tried less invasive surgical approaches, novel medications, or supplements that you've seen? Such as possibly..
- laser disc ablation?
- the new enzyme trial to dissolve discs at Texas A&M?
- 4-aminopyridine?
Thanks,
Ryan
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 17, 2023 10:52:26 GMT -7
Ryan, very appreciative for revealing his med list and of Woody's heart murmur. Pepcid AC may not be for Woody, then. Ask and discuss with your neuro if a Proton pump inhibitor (PPIs) such as omeprazole. The details are what makes it possible for us to understand treatments. Each member of the Forum in exchange for our comments provides med details, observations. This kind of information has helped us to hone our knowledge since 2002 about treatments and what to expect. We share that knowledge in our comments to members that an owner can better ask questions, understand more clearly what the vet explains in order to translate that into home care. At the end of a Metacam course is the time to be watchful for pain surfacing or any neuro diminishment. The end of the course is a kind of a test for pain/neuro. When you learn the end date of the 2nd 9/12 course of Metacam, please do share that with us. It may take Metacam in the range of 7 to 30 days before all swelling/inflammation is gone. Only the test stop at end of ea course reveals the answer. Sometimes it just takes more than one course to fully resolve inflammation. Methocarbamol (for muscle contraction pain) is very typical with a neck disc. All pain meds are only used until all inflammation is proved to be gone. That normally is with the stop of the current course of Metacam + full stop of methocarbamol and other pain meds or at minimum backing them down (vet's call). This lets you at home get a quick and accurate read if another Metacam course + all pain meds is needed. Of the 3, these are two I can comment on: Laser Disc Ablation- Dodgerslist has asked a few of the neuros we work with, they really don't seem to have an opinion about this preventative procedure. Ask your neuro. You can learn what the restrictions are an more about the procedure: has requirements before it can be done. VRC Hospital, Malvern, PA www.vrcmalvern.com/wp-content/uploads/2020/08/PLDA_neuro_trifold_8-6_AB_RUN.pdf There are a limited number of clinics that do LDA. Here are two more --Garden State www.gsvs.org/neurology-neurosurgery/ --OSU news.okstate.edu/articles/veterinary-medicine/2016/disk-surgery-dogs-does-it-work.html --Dallas Surgical Center dvsc.com/2020/01/laser-disc-ablation-preventing-intervertebral-disc-disease/ Texas A&M new enzyme trial also has requirements. Dodgerslist has been in contact with the researcher, Dr. Jeffery, who related as the trial started Fall 2022 "the results are looking really interesting." You can read more about this procedure of injecting chondroitinaise into the disc: dodgerslist.boards.net/thread/9109/time-sensative-episode-trial-enrolling |
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 17, 2023 12:17:41 GMT -7
Thanks Paula..
Sigh, I dunno. I know there's only so much you can know/tell me.. I'm just really doubtful he's going to improve on crate rest and part of me wants to do surgery just to "fix it" once and for all.. But I also just can't justify it currently since he is still able to walk and not in pain..
He's had this pinched nerve root for a long time.. So our neurologist suspects chronic inflammation there, which I know is probably not going to go away with just a couple weeks of metacam (it didn't even respond to a steroid epidural!)..
And, how am I even supposed to know when the inflammation is gone if he is does not have any pain associated with the back? Unless he suddenly starts walking better but I'm very doubtful of that..
I could definitely see crate rest working for an acute injury that has opportunity to bounce back.. But I fear Woody's has been too chronic and too slow progressing to suddenly reverse course..
Anyway, sorry, I'm sorta just feeling a bit hopeless/venting..
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Post by Ann Brittain on Sept 17, 2023 15:10:21 GMT -7
Hi Ryan, I'm sorry to hear you're feeling discouraged. It is an emotion most of us who love an IVDD dog have experienced. It's a one day at a time process and it may sound cliche, but time can work wonders.
Our Buster had surgery after losing use of his hind legs. He, eventually, walked again, but it never returned to a totally normal gait.The important thing is Buster didn't let his disability stop him from enjoying the rest of his life.
I've often wondered if he would have recovered better if he hadn't had surgery, but, at the time, we made the most informed choice we could make to help him recover. Personally I don't think I'd get in a hurry to get Woody surgery unless your doctors feel it's his best option.
Crate rest can be a tedious process, but it will not hurt your dog and could help him recover.
Sending you and Woody positive thoughts. I know you'll do what's best for your boy.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Sept 18, 2023 11:09:41 GMT -7
Just wanted to add a few tips to help Woody's neck heal, such as raising the food and water dishes so he doesn't have to bend his neck, moistening hard kibble to soften, etc. More tips here: dodgerslist.com/2020/05/05/cervical-care-tips/Try to take it one day at a time and not expect too much too soon. Woody is not in pain and is safe and sound in his recovery suite. You're doing all that you can to help him and have done a great job in becoming knowledgeable about the disease. We all do understand the fear and impatience that come with having a dog with IVDD. Nerve healing can be so very, very slow but nerve damage can heal, but it can take weeks, months. Hang in there and know that we're there for you and Woody. Healing prayers for Woody. |
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 18, 2023 17:56:12 GMT -7
Thanks Ann & Marjorie.. I don't have other options anyway so must put my hope into this.. Appreciate the support a lot..
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 21, 2023 17:02:46 GMT -7
Another update..
So.. we have aways found acupuncture and laser to help in the past so I’ve been continuing with those during crate rest. He travels very calmly (just rests in his bed), and is good at the vet, so I’ve figured it’s been worth the movement of going.. (maybe I’m wrong but dunno).
Last Saturday [9/16] we did laser and tried electrical muscle stimulation along his back (like TENS), which he has done once before (and was tired after for day or two but was then ok). Our vet thought it could help, and everything I read also seems suggests it SHOULD helps.. but ugh, seems like since then he’s been very uncomfortable and not able to settle. I’ve had to raise his ▲gabapentin to 250mg 3x/day now.. and also seems even a little less “sharp” with his left leg/paw.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
12 lbs 14 y.o.
8/16 MRI: new L1/L2 disc bulge
9/4 back legs: weak, incorordination
9/11 Neck disc Dx
9/16 travel for laser + TENs; pain + increased left rear leg neuro diminishment
8/25 methylprednisone shot, effective for 4-6 weeks( til 9/22+?)
Metacam as of 9/4: 5kg 1x/day for 7 days, 9/10 test STOP for: √9/11 pain! / _neuro
as of 9/12: 5kg 1x/day for 6 days, 9/18 test STOP for: √9/16 pain/ √9/16 neuro
CARTrophen as of 9/7?: ?mg ?x/day for facet joint arthritis & possible repair of disc cartilage
gabapentin ▲250mg 3x/day
methocarbamol 100mg 2x/day as of 9/12
Woody needs GI tract protector on board for duration of Metacam+methylprednisone! ]
I know correlation doesn’t equal causation so may not have been that.. but I feel it could be possible it overstimulated the nerve root.. dunno
So.. Ugh.. I feel I’ve wasted 2 weeks from his recovery and maybe even set him back. I hope I haven’t screwed things up..
Not sure I have a question. Do most people have pretty linear recoveries on crate rest? It seems nothing is going right (after first week, out of nowhere he had a neck issue, then another week later, now this)…
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 Sept 21, 2023 17:51:17 GMT -7
Ryan, oh gosh, I am so sorry to hear that Woody took a step back in pain and reduced left rear leg neuro function.
Nerve healing goes in a forward motion as long as nothing is disrupts the process. The nerves can grow at a rate one millimeter per day. So a twelve inch nerve span damage requires year or so to grow. However nerve fibers that are bruised or compressed may recover faster. Nerves severely damaged may not recover at all. The nerve healing may appear to us at time to reach a plateau and nothing is happening. Then all of a sudden it "appears" the function returns. When the nerve has been re-damaged it then will take step backwards.
Disc healing also goes in a forward motion as long as it is not disrupted by too much vertebrae movement. Damage to the disc could require starting the count from square one of 8 weeks of rest.
1. Is the increase to gabapentin 250mgs 3x/day now fully providing comfort from pain?
2. What about Metacam? For how many more days is he to take the 5kg 1x/day dose now with this pain and neuo setback?
3. The stop of both Metacam and gabapentin will be the test for you to verify if inflammation is actually gone.
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 21, 2023 18:09:27 GMT -7
He did 6 days of metacam and stopped [9/18], so he stopped that on.. Monday. Our neurologist and regular vet both don't really want him to take it more than a week.. And I can't say we notice a difference with him being on it or not.
He seems comfortable now on more gabapentin.
Should I just not do laser or acupuncture at all? I don't feel he's been necessarily moving too much.. I mean, he is not down, he can still walk. So even in a crate or his stroller around the house, he's going to move around a bit.. I can only control so much.
And just taking him out to potty is more movement than going to the vet for laser/acu.
Not sure if I should ask vet about trying prednisone instead. I feel people generally have better response with that?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 21, 2023 20:09:07 GMT -7
Ryan, thank you for sharing full details about the med list that we did not know about. Let us know for sure if the increase in gabapentin is providing full comfort night and day, round the clock, dose to dose 9/16 travel for laser + TENs; pain + increased left rear leg neuro diminishmentMetacam as of 9/4: 5kg 1x/day for 7 days, 9/10 test STOP for: √9/11 pain! / _neuro
as of 9/12: 5kg 1x/day for 6 days, 9/18 test STOP for: √9/16 pain/ √9/16 neuro
It appears it was not the stop of Metacam on 9/18 that revealed pain. It appears it was the 9/16 visit for therapies that caused pain/neuro Maybe a case of too many cooks in the kitchen problem. Something to keep in mind for the future. Here is what I mean: If the therapies could have waited a week or so to get a true read about Metacam progress with the 9/18 stop test, you might have had actual information if the swelling was really gone and thus no need of any meds and no need of any therapies at all. A true stop test includes not just the stop of Metacam but also the meds that block pain and keep you from correctly assessing existence of pain. Generally vets will full stop Metacam and pain meds on the same date. However, some vets may know a reason about their patient that would make backing off the pain med preferable than a full stop. -- Anyway, it takes metacam about 5-7 days to exit the body. -- Pain meds take 8 hrs to leave the body. -- So on the test stop of Metacam, if there is actual pain existing it may take 5-7 days to get the proper pain assessment. This switching back and forth between the two classes of anti-inflammatory drugs is problematic. It takes NSAID, Metacam, 5-7 days to leave the body before safely giving the most powerful class (prednisone). Having both classes in the body highly ups the potential for bleeding ulcers. Woody has not even been afforded the usual stomach protection with either pred nor metacam alone. Woody's √Stress, √spinal cord damage and any √anti-inflammatory increase stomach acids. Dogs do not speak up at first signs like a person would, so best to be proactive in stomach protection. Woody does not need another problem on top of what he is already dealing with. Read over the various drugs that protect and discuss which would suit Woody best: dodgerslist.com/2020/05/06/stomach-protectionWilliam Thomas, DVM, MS, DACVIM (Neurology) and Luisa De Risio, ECVN (Neurology), RCVS, EBVS European Specialist in Veterinary Neurology explains to veterinarians: Gastrointestinal signs are of particular importance, so ask if the client has noticed decreased appetite, vomiting, diarrhea, or blood in the feces. Patients with spinal cord disease are at increased risk of these signs due to altered autonomic function affecting the gastro-intestinal tract. Additionally, these patients may have been treated with corticosteroids and non-steroidal anti-inflammatory drugs that have gastrointestinal side effects.
Let us know what date if your vet prescribes an anti-inflammatory -- ?mg ?x/day for ? days |
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Ryan & Woody
New Member
MALE - Dachshund . mild hrt murmur
Posts: 32
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Post by Ryan & Woody on Sept 22, 2023 7:16:29 GMT -7
Thanks Paula.
But if we tried pred next week, that would be 5-7 since stopping metacam. I’m not sure if that could be more worthwhile to try?..
I think Woody’s case is a bit tricky/complicated. We think most of his pain is nerve pain, not acute inflammation-related. He’s had a chronic nerve root pinch that would cause small pain episodes every few months since over a year, so he is always on gabapentin and probably will never come off. And his “baseline” gabapentin dose varies so it’s hard to conduct the “stop test” as you say. The only thing we’ll be able to do is gradually reduce it in future and see how he does. But it will never be a “stop” test. And whenever we’ve administered metacam recently or in past for episodes, he’s never shown a difference on it or off. If he does have a degree of chronic inflammation, it’s probably just not responding to a NSAID.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Sept 22, 2023 9:46:29 GMT -7
Ryan, I think your assessment takes a reasonable approach and is an approach members have reported for their dog. It just may mean for Woody that he stays on gabapentin to enjoy living in comfort from pain. At such times as gabapentin does not do the job, then a vet adds in an Rx for a course of an anti-inflammatory.
NSAIDs can be abruptly stopped.
A steroid needs to be tapered off ending in an every other day dose. And can be used at the lowest dose possible long term if need be.
You and your vet will be the best to decide which class (NSAID or steroid) of anti-inflammatory is best for Woody. And if to be long term at some point, figure out the lowest dose possible that still provides needed comfort.
Let us know what your vet says.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Sept 23, 2023 4:58:17 GMT -7
Hi, Ryan. Unfortunately, since there was a worsening of neuro condition resulting from too much movement on 9/16 and the damaged disc tore more as seen by the increased pain and neuro diminishment, the 8 weeks of strict crate rest will need to start over from that point. So the new graduation date will be 11/11.
I see that you had a question concerning too much movement. Yes, there is some movement that we can't control, such as a very few steps taken to do potty and the movement to reposition themselves in the crate. However, the less movement there is, the less chance there will be that the disc will tear more. So we have to take all precaution to limit movement as much as we can. Any time out of the crate is a dangerous time for these dogs. We need to weigh the risk of transport with the benefit obtained from that transport.
At this point, the most important thing you can do for Woody is the 8 weeks of strict crate rest. And that you're already doing. We usually don't recommend acupuncture or laser unless the dog's condition is severe. If you really do want to have acupuncture/laser done, there are acupuncturists who make house calls so possibly there is that option for you.
Healing prayers for Woody.
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