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Post by Susan & Stella on Nov 17, 2023 20:35:54 GMT -7
PaulaM, I did call vet after that last vet 11.14 visit and the responses I got here BTW. She did not want to taper again until she saw Stella again 11.30, which is a long time between tries I now realize. I will pursue that again when they reopen.
I too have been concerned about Stella taking steroids so long, we did taper a few times and got to every other day, but on 10.19 I felt her back was curved more and called/alerted the vet of that. Vet ended up putting the dosage back up as we felt that curve might have been pain. Unfortunately that was a different vet in same practice who had never seen Stella during all this. I think that was a real problem and also I had just prob. over-reacted too.
11.14 visit, regular vet. I thought she would start taper again but no. I think it was the paw issue. Stella does NOT actually knuckle her paws while walking or any time on her own... never did, just the vet testing them to see her correction response...
and the response has been improving since the 1st vet visit, but seems to be about the same each visit now... a little slow but good, but not perfect for quite a while now.
So question??? are you saying you don't think the 'not correcting her paws' when the vet flips them over should equal no taper??? I thought that was what Romy and Frankie were saying, and the only reason I think the vet had to not taper IDK.
After reading that steroid link again, vet did taper gab at the same time... as noted in meds list I provided on 11.15 (which I forgot to add previously) to a complete stop of gab before stop of Pred.
I do feel this vet is good, and she has been my vet for 15yrs. with a lot of happy clients and keeps very busy. I did ask towards the beginning of all this had she treated IVDD before and she said yes and w/conservative treatments and with good results. We do talk about alternative stuff, less shots, etc. but that is more my thinking than hers. BUT as you are now, I do question the length of time between that one taper try and now why so long? the paw thing is my best guess. I will question her more directly next talk, asap.
I do absolutely follow the tapering meds exactly... it's a scary thing to me!
Once you corrected it, Stella's crate rest is fairly strict. Though admittedly I have been a little lenient as far as her constantly being in it more recently, maybe a few hours out of crate but strictly watched during quiet time (which our home usually is).
Never allowed stairs or jumping up, she never tries to since this all started. Always crated nights when I am sleeping. Leashed to potty and back inside. It has lasted quite a while at this point and I hope the swelling and disc has healed.
I thought you had said a11.14 acupuncture would not do her any good at this point? That is why I cancelled it.
Going to post this reply now and maybe you will be able to respond to my questions. I hope to get back to vet tomorrow 11.18... though honesty doubt anyone. Would love to get this next taper going asap. I hate having to wait after reading your response... don't really have a choice. Will try and call in morning but they are limiting Saturday, and may not even be open, not sure.
Well, I spent 2 hours writing a reply to the above post last evening 11.17 and now I see nothing... will try again and send again asap. Susan
OK, now I see it... geesh. Page 2...
[MED LIST/HISTORY- no changed, FYI for Page 2 posts
18 lbs 10 y.o
had not been providing strict crate rest 8/8 to 9/11
STRICT rest as of 9/12, should have graduated Nov 7.
prednisone as of 8/8: 10mgs 1x/day for 14 days, 8/22 test taper for: pain / √8/22 new knuckling neuro
as of 8/22: 10mgs am; 5mg pm for 28 days ; 9/28 test taper for _pain _neuro
as of 10/19: anti flam dose: 10 mgs 1x/day ⚠️for 30+? days, then taper TBA
gabapentin 100mgs 2x/day as of 10/26
Pepcid AC (famotidine) 10mgs 2x/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 Nov 18, 2023 9:23:41 GMT -7
Susan, regarding acupuncture.... it is all about the timing. Timing during use of anti-inflammatory pred and gabapentin is an issue. Acupuncture now when there are no signs of pain: NO Acupuncture now when there is a very slight delay to right paw: NO WHY? 1) Pain (if there is actually any. No one can know until the taper begins) is being masked properly by pain med gabapentin 2) Neuro for the very mild and improving paw delay is NOT worth the danger to a healing disc to be transported into the vet.Timing during and after a taper. "If, iF, if on the taper there would be NEW pain or an INCREASE in neuro diminishment of paw correcting itself or other neuro issue, then there must be considerations:"
Please go back to Page 1 and scroll down to the last post. I have singled the paragraph to reread in a purple color to easily find. There you will see if, maybe, might acupuncture could then fit in to the picture at that TIME.
Nerve Damage There are no medications which can heal nerve damage. That includes prednisone. It is only the dog's body that does the job of self healing plus time enough for YOU to see how much nerve healing could happen. With a very slow to right paw nerve damage it is likely to heal on it's own with time. HOW MUCH TIME? No one can tell you! STRICT crate rest for 8 weeks is all about focusing on disc healing. Nerve healing might or might not come back in that short of time of 8 weeks. Expect for this slowest part of the body to heal (nerves) to take several months to even a year out. |
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Post by Susan & Stella on Nov 18, 2023 13:46:38 GMT -7
OK, thanks so much... sorry I can be so confused when reading responses.
I will call vet Monday AM... and push for starting another taper program for Stella. Will have to try to figure out just how to ask firmly, but nicely I guess... any suggestions. Previously I like how you worded such things... maybe start w/why the long wait since last time?
Also, I will get back to you once I get a response and directions on taper. I did look into all that again have an idea what she might say, but all also say vet should already have that in mind. I will read up through all this again.
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Post by Romy & Frankie on Nov 18, 2023 14:13:34 GMT -7
I understand that it can be difficult to ask the vet detailed questions about why they are recommending a particular treatment plan and ask about other options. I sometimes have trouble with this myself. But we are the only voice our dogs have and must speak for them.
You have read and learned a lot about IVDD and are in a position to ask informed questions and become the most important part of your dog's health care team... its captain! Dr. Nancy Kay, DVM, ACVIM highly recommends this kind of relationship with your vet: "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" |
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Post by Susan & Stella on Nov 19, 2023 9:55:44 GMT -7
Hi Romy & Frankie, Great link!
I am not particularly quiet about my feelings or thinking, and will ask questions when I know what to ask, sometimes that is the question that is hard for me to figure out. With this IVDD there are so many things to learn, and it's not set in stone... each dog is so different and there are lots of unknowns. Almost every vet visit brings up more questions. My vet will converse and discuss whatever I ask about, but to know what to ask often comes after the visit (or just after leaving), not during.
I am making a list and will try to narrow it down to most important, what's next.
Thanks for the help as always! Susan n Stella
Woke this AM [11/18] feeling strong/clear headed about asking to get Stella off the prednisone, after reading all through our convos last eve. Seems that is what is needed from what I am seeing n reading here. Checking her paw and its response to a ‘manual test’ of folding it back is just some way to gauge a neuro function. You're saying pred does not improve that anyway, but time might eventually. I don’t really see it as a problem in of itself.
So, taper her off the pred and gab, then deal with what might happen next.
Plan B: Maybe she needs the gab to be pain free short term, or even long term.
Will call the vet's office 11.20 early AM and put that out there to the vet via the front desk.
Unless there is some purpose to do otherwise (what possible reason is there), then that should start as soon as she gets back to me with the taper steps.
Thanks, as always... Susan
[11/19] Romy n Frankie.
BTW... on that last link you sent me, I found a great suggestion to take someone w/you to DR visits... that has been my DH for my cancer visits... now pretty much good, TY! Anyway, on that site it suggests to do that as 'emotional static' interferes with understanding... HA... true!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 19, 2023 11:09:14 GMT -7
Susan,
Yes, keep communications simple. Get pred taper + gabapentin same date stop (or reduce down from 100mgs 2x/day)!!
Do not complicate vet communications by also bringing up what "IFs" short or long term when requesting a pred taper and off of gabapentin for the NOW, Monday 11/20.
Please do let us know what the changes to pred and gabapentin will be on Monday 11/20. Fingers crossed you will be able to successfully advocate for Stella.
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Post by Susan & Stella on Nov 19, 2023 16:36:00 GMT -7
Paula,
Thanks for the suggestion to keep it simple. I'll just say I want to start the taper again.
Last taper vet stopped the Gab before the Pred. Stella has only been on 2x daily Gab after the leakage episode anyway, vet felt 3X was too much for her and causing the leakage while asleep a couple times. It did stop the next day.
I am finally confident this is the correct thing to do.
Will keep you here informed. S
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Post by Susan & Stella on Nov 20, 2023 14:52:36 GMT -7
Hello,
I ended up in a phone convo with vet, which really was good to know more of the why. When asked about why she wanted to wait I did get some reasonable answers that hadn't been expressed to me directly, previously.
Nearing the end of the 1st taper when down to 5mg every other day, 10.19, I went to see her about my concerns w/Stella "tracing the walls" n "hunching" her back.
I did not know these next things... Vet felt the nerve pinching inflammation in her spinal canal wasn’t down all the way and wanted that to be stable. At that point she felt Stella needed more time on Pred. Also, she found "no muscle weakness" as she has seen w/long term pred use and feels 5mg is a low dose.
Next visit 10.26 no significant improvement, L foot slight worse turnover. She wanted to time the next visit and acupuncture, but didn’t realize that pushed the next appt to 11.30; and that if she had realized that right off it would have changed trying to taper her again sooner. (Also, [she?] didn’t know I had cancelled acupuncture for now.)
She did say she had a dog that kept reinjuring itself and took a year to reduce the swelling and finally got him tapered and all was well. So, she is a bit concerned with that happening,
She did acquiesce to do a taper and sent an email with the taper instructions. BUT, now I have mixed feelings again, though she agrees that we just don’t know for sure... Thoughts?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 20, 2023 19:56:25 GMT -7
Susan you mention things that all are history, in the past.
We are talking about today Nov 20, 2023! Of course no one knows if all painful swelling is gone. That kind of knowledge only takes place when pred is tapered.
No one should be OK having a dog on pred when pred has finished it work of eliminating painful swelling. Pred does not work on healing nerve functions such as a knuckling under paw (whether mild of just slow to right the paw or severe to can't right the paw at all).
What is the taper schedule with mgs, times per day for pred and what about gabapentin stopping? What date will you be starting the pred taper with gabapentin stopping or at minimum reducing in dose + times per day?
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Post by Susan & Stella on Nov 21, 2023 5:49:47 GMT -7
Paula,
The [pred] taper schedule...
11.20 5mg 1X daily AM for 8 days started
11.28 5mg 1 every other day for 2 weeks, then off altogether 12.12
[MED LIST/HISTORY- no changed, FYI for Page 2 posts
18 lbs 10 y.o
had not been providing strict crate rest 8/8 to 9/11
STRICT rest as of 9/12, should have graduated Nov 7.
prednisone as of 8/8: 10mgs 1x/day for 14 days, 8/22 test taper for: __pain / √8/22 new knuckling neuro
as of 8/22: 10mgs am; 5mg pm for 28 days ; 9/28 test taper for _pain _neuro
as of 10/19: anti flam dose: 10 mgs 1x/day for 30 days, 11/20 taper for __pain? __neuro?
gabapentin 100mgs 2x/day (⚠️not stopped on 11/20 pred taper!)
Pepcid AC (famotidine) 10mgs 2x/day]
As far as the gab she is on 2x daily now. She ended convo with leaving the gab on, until after the pred was finished and then getting her off that too thinking she may need some pain relief during the process. Although, she was not taking anything for her other issues anymore that was a concern for vet. I do have a natural Vets Best for 'as needed' pain relief, leftover from then.
She also brought up acupuncture. Not sure about best timing, but I would be open to that since it might help as you mentioned.
So that's where we are right now. SnS
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 21, 2023 10:44:37 GMT -7
Susan, oh dear.... faulty thinking is going on about the prednisone taper.
Your job at home is to find out ASAP, quickest way possbile if all swelling is gone or not.
How long do you intend to further not know anything——for 22 more days until final pred taper December 5?
The End date of final pred dose appears to actually be:
as of 10/20 8 days (5mg 1x/day)
+ 14 days (5mg EOD)
22 days on end date Dec 11
--- on the start date of the pred taper, gabapentin should help quickest answer about pain by full stopping gaba on same date. Since that was not done, do it today 11/21!
--- OR at bare minimum, because yields a slower answer about pain is to drop gabapentin down by the dose in mg and frequency dose from the current 100mgs 2x/day, today 11/21!
Stop having acupuncture pushed on you! Don't jump the gun. Do not muddy the waters of finding out if pain exists by having pain meds on board or acupuncuture.
#1 is to find out if there is still any existing pain being masked by both gabapentin and prednisone.
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Post by Susan & Stella on Nov 21, 2023 16:33:57 GMT -7
Paula,
I hear your frustration... I have it too with this!
All this time we have been keeping Stella from pain. I will stop the ▼Gab tonight 11.21, as you are now telling me, she had 100mg this AM, last one. Then, with Gab done completely and Pred tapering that will let us know if the swelling is gone or not... knowledge, the goal! If swelling is not gone, she will be in pain was my worry.
[MED LIST/HISTORY- no changed, FYI for Page 2 posts
18 lbs 10 y.o
had not been providing strict crate rest 8/8 to 9/11
STRICT rest as of 9/12, should have graduated Nov 7.
prednisone as of 8/8: 10mgs 1x/day for 14 days, 8/22 test taper for: __pain / √8/22 new knuckling neuro
as of 8/22: 10mgs am; 5mg pm for 28 days; 9/28 test taper for _pain _neuro
as of 10/19: anti flam dose: 10 mgs 1x/day for 30 days, 11/20 taper for: __pain? __neuro?
gabapentin 100mgs ▼1x/day on 11/20; 11/22 to be stopped
Pepcid AC (famotidine) 10mgs 2x/day]
You did mention ‘off Gab’ too, I guess I dropped the ball (again) too easily w/my vet on that one. That was a question about acupuncture, I will not set appt. I can see that will confuse things. Tell me what if she does have pain during taper? Sounds like you are saying to wait until taper ends (or even a week later, to grad) ... to do some of the 'purple' highlighted choices. I was just going down that list and trying to be prepared with a Plan B... that need is loud n clear, but the answer isn't for me at this point.
Date is correct at Dec 12, Pred will be done... plus the week to grad. Is it possible to do this taper any faster? Let me know how, safely, because I really do NOT know myself, aren't we supposed to go by what the vet says to?
I am glad you are speaking up and helping, truly I am. S&S
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 21, 2023 19:15:09 GMT -7
Susan your question "what if she does have pain during taper?" The quick answer is vet and pet owner act in a humane way by dosing meds to provide full comfort from pain asap! The taper is a means to find out if pain really exists or not. That's the point of the taper. Don't you agree...no way would anyone in their right mind continue on with a taper with a dog in pain and give no meds to provide comfort?
You can read my full reply in purple back on page 1 dated Nov 17, 2023 at 3:46pm
"If on the taper there would be NEW pain or an INCREASE in neuro diminishment of paw not correcting itself slow or not at all itself or other neuro issue, then there must be considerations:...."
The plan B would have been agreed upon with your vet in advance. IF pain would surface on a day vet is not open (holiday, late at night, weekend) you would have what you need for meds in your hands at home to immediately give doses until vet reopens. When she opens you two can talk about those considerations on page 1 dated 11/17/2023 3:46p.m.
My fingers are crossed that no pain nor neuro diminishment will surface on this taper which is a kind of test for pain. Pain means not the time to continue on with a taper. Instead back up on comfort giving level of meds while you discuss all the considerations/options for Stella. Please keep us posted thru the holiday even....we'll be here.
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Post by Susan & Stella on Nov 21, 2023 20:42:04 GMT -7
Well, sounds like around and around we go w/Pred (can't seem to avoid that w/o taper) and etc... I will call vet tomorrow and hopefully we can discuss the options. Nobody in their right mind is right! hence my worries!
Everything crossed we don't need any of it!
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Post by Susan & Stella on Dec 12, 2023 9:26:48 GMT -7
So Stella had her last taper Prednisone [12/12] this AM... YAY! She seems to be just fine! So happy that part is done with, hope she never has to be back on them! Now to see what is next...
[MED LIST/HISTORY- no changed, FYI for Page 2 posts
18 lbs 10 y.o
had not been providing strict crate rest 8/8 to 9/11
STRICT rest as of 9/12, should have graduated Nov 7.
prednisone as of 8/8: 10mgs 1x/day for 14 days, 8/22 test taper for: __pain / √8/22 new knuckling neuro
as of 8/22: 10mgs am; 5mg pm for 28 days; 9/28 test taper for _pain _neuro
as of 10/19: anti flam dose: 10 mgs 1x/day for 30 days, 11/20 taper w/final dose 12/12: __pain? __neuro?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Dec 12, 2023 19:10:29 GMT -7
So happy to hear she has taken her last taper dose today. Now you observe for hopefully no signs of pain surfacing. Normally graduation day is not until a dog has been off of all meds for a week. So mark your calendar for December 19. Let us know her current neuro ability and anything specific you want to know about.
With your information, we can provide you a safe way to take her from couch potato of currrent strict rest til 12/19 to slowly joining in on family activity and physical exercise.
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Post by Susan & Stella on Dec 21, 2023 18:28:00 GMT -7
Hello,
Stella has not had any signs of pain, or setbacks... even her foot turn over was good last vet visit 12.14. I was, of course, nervous thru all the taper until the last few days... but I had felt (almost) positive she would be fine. She is happier off the meds too. Her mood has lightened and seems to feel great! Still limiting stairs, and jump ups w/no couch or furniture. She walks quietly outside beside either Jim or me a lot now, which is a new reality of her being careful. Though she does trot around some now n then too, but we try to keep her activity to a minimum at this point. She uses a ramp for porch to ground access, which is a big help not having to carry her so much... just the main stairs morning n night for now, not sure that will ever change.
I am curious about anything that could be done to keep her stable, improve whatever, or to help her muscle strength or just general stuff that would be OK that she might enjoy/be good for her.
Thanks Susan & Stella
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Dec 21, 2023 20:30:23 GMT -7
Susan, thank you for telling us the taper completed with no pain/ no neuro issues. Now we can share with you on graduation day how to safely and slowly introduce her back to family life. GRADUATION, A SLOW RE-INTRODUCTION
No stairs ever, anymore! Determine how you are going to ease back into more normal activity at graduation from rest. The idea is to gradually give more freedom under controlled conditions. Not free rein of the house and yard immediately! LOL Your dog's muscles are soft and out of shape after the rest period. Take a look at our information. Gradually building your dogs muscles over a month's time will have your dog safely running and having fun again!SAMPLE SCHEDULEHere is a sample schedule to safely and slowly introduce your dog back to family life and physical activity: www.dodgerslist.com/2020/06/15/back-friendly/?highlight=sample%20scheduleDIY back PROTECTION around the house i2.wp.com/dodgerslist.com/wp-content/uploads/2020/07/home-back-protect-banner_700-45kb.jpg 1) Good ideas in making your home back friendly: dodgerslist.com/2020/07/09/home-protect-ivdd-backs/
2) Teach your dog to be safe and not jumping up or down, but to use a ramp whether over steps leading outdoors or to furniture in the house. Dogs are best at visual learning rather than verbal commands. Dog trainer Anna Jane Grossman says “Dogs learn in pictures. Inside your dog’s brain is a very simple algorithm – pleasant images in one place and unpleasant images in another."
2) At the top of the GRADUATES board are several discussions you may be interested in including furniture blockers, scooting protection, DIY ramps and more: dodgerslist.boards.net/board/8/graduatesHAPPY DAYS AHEAD You and your dog have survived a disc herniation! Learn what you can do from this point forward. Lots more ideas and tips in living with an IVDD dog such as dentals, nail trims, safe ways to have fun together, and more: www.dodgerslist.com/living-with-ivdd-tips-2 PT THERAPY AT CLINIC or HOME Safety first. You should always consult with a veterinarian before starting any exercise program with your dog. For example, although senior dogs need to stay limber, severe arthritis might make certain movements inappropriate. -- Strengthening core muscles. This applies not just for humans, but REALLY applies to the IVDD dog: "...improve the strength and coordination of the muscles that surround the spine so they can act like the world's greatest back and neck brace." www.spineuniverse.com/conditions/spondylosis Core exercises don't require specialized equipment. Here are 5 exercises you can do at home: totofit.com/five-basic-exercises-essential-to-building-core-strength/Please keep us post as you gradually return Stella to physical activity. If she is sore from doing too much you may be confused if a re-damaged disc that needs immediately cratiing and getting to a vet. So go slow, as the sample schedule indicates. Trotting is for later on. |
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