Ann's Copper 7/26 questions - Basset

Ann, welcome to the Forum.  There is a lot you can learn about the disease Copper was born with IVDD.  Knowledge will stand you well in protecting him and caring for him in the many happy years ahead you will enjoy his company.

Let me ask a few questions, as it is not clear if the disc (which takes 8 weeks to heal with strict rest) has really healed because you are reporting pain by his still being on the anti-inflammatory Deramaxx.
   What is the reason he is still taking Deramaxx?  

  What date is it to stop?

Currently as of today, what signs of pain do you observe?

Ann, sounds as though your vet is not confident in his IVDD knowledge. Copper is one lucky dog he did not suffer worse neuro damage than knuckling wobbly back legs with Rxing walks at 2 weeks, chiro.  But you can get up to speed on IVDD to be Copper's protector and advocate.
   
Good self knowledge to have in protecting Copper now and in the years ahead
  1)  Why Chiropractic is not recommended for an IVDD dog: dodgerslist.com/2020/04/22/chiropractic
        Dr. James P. Cellini, DVM, ACVIM (Neurology): I never recommend chiropractic for any reason in dogs. It’s nothing but risk and no reward. I explain why in this video.
   3) Nerves may or may not heal in the short time of 8 weeks the disc heals in. There are no meds to heal nerves.  Nerve repair for wobbly legs ought to be thought of in several months rather than days/weeks.

    4) The meds are used only until proof all painful inflammation is really gone. 
    --- Vet must take a guess as how long a course of steroid or NSAID. Often that would be a 7-day or even a 14-day course. 
    --- When the anti-inflammatory course ends, pain meds would also end. This gives you at home the best chance to quickly and accurately asses for pain.


You are seemingly reporting pain even when on Deramaxx if Copper is reluctant to move. It helps to confirm if pain vs. if fear/vulnerability if you also see another sign of pain.

SIGNS OF PAIN:
⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved
⚙︎ tight tense tummy ⚙︎ arched back, ears pinned back
⚙︎ restless, can't find a comfortable position
⚙︎ slow or reluctant to move such as going for a walk
⚙︎ not their normal perky interested in life selves

IF the reluctance is about walking with other dogs, that may well be a sign that Copper knows he could be attacked and feels vulnerable. Let us know your thoughts re: Copper.
    For dogs the inborn instinct about weakness is for survival protection of the pack as a whole. There are two things that can happen in pack dynamics when a dog has been or is sick.
    1. The healthy one may try to eliminate the weaker in a pack of dogs.
    2. For the sick one, now the weaker in the pack to become more protective and aggressive because they know they are weaker now and may be subject to being attacked. 

Strange dogs at a park or your son's dogs can be a fearful thing now for Copper, be alert to protect Copper. Also make sure that Copper feels protected from his best buds when home alone... the crate will be that source of protection.
    Whenever you leave the house, it is a good idea to crate Copper for his own safety.  
    We have had many instances where a deadly attack among dogs could have been avoided by crating.
    One I recall is of two sisters who had grown up together and never showed any signs of aggression to one another. The two dogs were put in the kitchen while their owners went out to dinner. They came home to find the IVDD dog almost dead from the vicious attacks of the other.

It appears there has been no test to verify for sure of no pain existing. That proof can only come when Deramaxx is stopped.
    For how many days is Rx?
    What date was Deramaxx started on?
It is difficult to comment because the usual treatment for a disc episode was not followed at all. Hard to understand what is going on with Copper today.

Baseline at this point would seem to be finding out when Deramaxx can be stopped AND if pain then surfaces.
    And then, if indeed, there still is pain..... wonder if his disc scar tissue healing had maybe been disrupted due to lack of long enough crate rest time, causing discomfort.  
    Should crate rest be resumed to let disrupted scar tissue resume healing? Deramaxx course + pain meds back on board + Pepcid AC stomach protection?

Hope you can shed a bit more light on Copper with your observations and thoughts.

Ann, I attempted to put your data into a date orderly list to try to understand Copper's treatment and what my comment should be.  
    There is just too much missing information to understand things.
    Currently you have a blindfold  of Deramaxx on board to the reality of existing pain or not. Specific details of recognized pain signs is the best way to communicate vs. "feels better"    

 IF, if,  it should turn out that there is real pain observed on stop of Deramaxx, what now is the reason for that pain some 9 weeks from the original ER visit (diagnosis was?)?
   --- re-damaged same disc with chiro or moving too much before disc scar tissue was well formed? IF that be the case you would NOT want your dog going on walks but on STRICT rest.  
   --- at 4 years old rather young to have arthritis. But maybe? In that case movement would be part of the treatment for arthritis.
   ---  other?
   --- An anti-inflammatory is to reduce inflammation. It does not heal nerve damage of being wobbly! What is the cause of the supposition of inflammation?

- The correct diagnosis is what provides the correct matching treatment.
- Owner knowledge is what provides the protection and ability to advocate (speak up on Copper's behalf)

Order of events with missing info in pink

50lbs 4 y.o.
7/26 never given 100% Strict rest for 8 weeks to heal disc.
9/11-18 Administered Chiro
Purpose of ER visit: pain degree? neuro? diagnosis?
Carprofen as of 7/?/23; ER: 100mg 1x/day; stopped 7/28
prednisone as of 7/26 : ?mgs ?x/day for ? days, ≠8/13 final taper dose: 8/13 none pain / _neuro
carprofen as of 9/1:  for 20 days STOPPED ≠9/20
Deramaxx as of 9/23: 37.5mgs 1x/day for ? days, then TEST STOP for √9/23 pain / __ neuro
Copper needs GI tract protector, Pepcid AC, on board for duration of Deramaxx!

The  above list of events is more than mystifying.
    Below is how a disc episode diagnosis is treated by those who know IVDD. I would say the very best thing you can do for your dog is self education. Copper could have another disc episode one day or maybe never again. You want to be able to "vet" any vet about their IVDD knowledge, safe use of meds in order to protect Copper.  He has been one very lucky dog!
   --anti-inflammatory (NSAID or a steroid) for a 7- day or even a 14 day course. then observe for pain and neuro on the stop if another course is needed.
   -- three pain meds every 8 hrs to provide comfort while anti-inflammatory does its job in 7 to 30 days (pred taper days do not count!)
   -- Pepcid AC to prevent a very potential of stomach damage from acids caused by stress and the anti-inflammatory.

Recommended:  getting up to speed on IVDD readings 
  1) anti-inflammatory drugs, how used with a disc episode:   
  ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/
  2) anti-inflammatory drug safety read your NSAID's pkg inserts: animaldrugsatfda.fda.gov/adafda/views/#/nsaidLabels
    "Rimadyl® (carprofen)  "Carprofen is an NSAID, and as with others in that class, adverse reactions may occur with its use. The most frequently reported effects have been gastrointestinal signs.  Concomitant use of Carprofen with other anti-inflammatory drugs, such as other NSAIDs or corticosteroids, should be avoided because of the potential increase of adverse reactions, including gastrointestinal ulcerations and/or perforations."

Derramaxx® (deracoxib) "Since NSAIDs possess the potential to produce gastrointestinal ulceration and/or perforation, concomitant use of Deracoxib with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. As a class, NSAIDs may be associated with gastrointestinal, renal and hepatic toxicity."

=========
"   Consider a minimum of a 7-day washout period between NSAIDs and either glucocorticoids [steroids] or other NSAIDs." SMALL ANIMAL PAIN MANAGEMENT CLINICAL PHARMACOLOGY. 2009 Katrina R. Viviano, PhD, DVM
===========

WASHOUTs
No dog need be in extreme pain if a switch from one class to another is an emergency to switch!   Usually a switch between a NSAID to NSAID or to a steroid requires a 4-7 day washout period. HOWEVER, should the vet deem that a switch is medically necessary, it can be done with the addition of a second stomach protector, Sucralfate in addition to what should already have been on board Pepcid AC® (famotidine).

You get to be the captain of Copper's IVDD health care team. Your ability to self educate allows you to confidently step into that inportant roll. Go over to the main Dodgerslist website and up your knowledge to more than what we can point you to here on the Forum:   www.dodgerslist.com   If your vet is open to things you bring up (drug safety, strict rest to heal a disc, etc.) then he will be a good vet to work with. If not, then you may need to interview and hire a vet who is comfortable in their knowledge of IVDD: dodgerslist.com/2020/05/10/find-ivdd-vet/

The goal of our Forum is to support you, to teach you how to learn to look up things, question everything and read so you become the most important part of your dog's health care team.

By doing your own reading, making your own notes, your own list of questions, you OWN future conversations with your vet. Your vet will understand why you are hiring them, what your financial situation is re: treatments, surgery, etc. You become the captain of the health care team. So naturally you will want to be an integral part of making decisions and work closely with the vet you have hired.
    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!" www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdf

Oh gosh, Ann, there is no shame in not knowing something new to you.  That's easily fixed by learning.  I wanted to be able to give you and easy "what to do next." Not being able to do that, I wanted you to understand why. I'm so very sorry it came across differently.

Most DVMs in a general practice see many different species- hampsters, cats, all breeds of dogs, reptiles, birds, maybe even farm animals. When you think about it, general vets are awesome people. They practice many specialties in the course of a day: pediatrics, dentistry, surgery, internal medicine.  As you report your  vet has been very good over the years with other issues. IVDD just is not his strong point.

Dr. Mike Richards, DVM explains why your vet may not know IVDD in depth: "Many people know the symptoms of one disease very well...Veterinarians are almost all general practitioners. Most work on several species of animals and treat disorders of all body organs and systems medically and surgically. Inevitably, they are not going to know the medical problems of every single dog breed or cat breed well. They are not going to have "cutting edge" knowledge about every organ system in their head. It is very easy for a non veterinarian to learn the medical problems of one or two breeds in more depth than their veterinarian. It is a little more difficult, but not close to impossible, for a lay person to learn more about a particular organ system than the average veterinarian. Especially if it affects a beloved pet of theirs...My knowledge of veterinary medicine surpasses almost every lay person's knowledge, in general. That gives me the ability to research many topics more quickly than a lay person can. It doesn't take me as long to get "up to speed" as it took a particular client to acquire an in-depth understanding of a particular disease affecting their pet."

 A vet adds to their knowledge base with every new case. If they don't see enough IVDD cases in their practice, then IVDD may not be their strong point.

The good news is that each of us owners CAN be very knowledgeable about the one single disease that is very important to us! Treating a disc episode is not rocket science when there is an understanding about how the disc heals, how meds are used with a disc episode. We owners can get up to speed if we are willing to read on behalf of our loved one. The folks coming to this Forum  are pretty much in the same boat I was in 2007 with my dog being paralyzed. I didn't know squat about IVDD nor its care. Dodgerslist helped me to learn and eventually join the Forum to help others. You can read which vets we work with and and what people say about Dodgerlist's help: 
   Owners say:  dodgerslist.com/2022/08/22/what-owners-say-about-dodgerslist/
    Vets say and help with our IVDD education goal: dodgerslist.com/2020/04/20/education-team-ivdd

YOUR OBSERVATIONS:
Anyway with your stopping of Deramaxx, I think you have learned there is likley no new in increased damage to that disc at this point in time 9 weeks later. No need of crate rest.

I think you shared some interesting things that may help you to speak with the vet about and confirm.  
   -- A currtent disc episode's disc pain/spinal cord tissue damage pain does not ease up with movement. 
   -- Arthritis pain often will ease up with movement. So exercise is important with arthritis.
   -- The wobbly likely is the nerve damage from the July ish disc episode. There are no meds which can heal nerves, including the non-steroid anti-inflammatory drug Deramaxx.
    Nerve healing just takes time to see how much the dog can self heal and to what degree.  Anyway slightly wobbly and getting steadier and steadier is a good thing to show you nerve healing is still going on!!

If your vet concludes that the discomfort is from some type of arthritis for your 4 year old. Maybe in the back where there are facet joints between the vertebrae were affected by the July disc episode. A disc collapse can put stress on the nearby facet joints. Then there is a specific NSAID that targets arthritis unlike general NSAIDs (Deramaxx). Discuss the NSAID Galliprant:  www.galliprantfordogs.com  
    Also a couple of accupuncture treatments could help make Copper comfortable and maybe no med would be needed or less of it needed?  It is all testing different things to see what works best for him.

The good news, Ann, is you have picked up on ideas, should another disc episode happen in the future, to be able to protect and advocate on Copper's behalf.  There are no "safe" medicines. There are only vets who use drugs in a safe manner and educated owners who can speak up for their dog.
-- Limited movement for 8 weeks ensures the disc scar tissue is not re-broken. Chiro, walking around vs only minimal footsteps, and shortcutting 8 weeks are dangerous to the exterior (annulus) of the disc healing.
-- Stomach protection with Pepcid AC (famotidine) is to protect again extra stomach acids caused by the dog's change in routine to STRICT rest, damage to spinal cord and the use of an anti-inflammatory (steroid or NSAID.
-- Don't switch anti-inflammatory drugs without 5-7 days washout:
    NSAID to another brand of NSAID (such as carprofen to Deramaxx)
    NSAID to steroid (such as carprofen to prednisone)
    Expect with a washout, an increase in pain meds to account for very likely increased pain!
-- If an emergency switch and no washout can be used, then use TWO kinds of stomach protection: Pepcid AC plus Sucralfate.  Double stomach protection for the double jeopardy.

DOGS vs HUMANS
A lot of us know about back pain for sure with personal experience. The thing is we, then, might believe for a dog it is similar. A disc episode for a canine is a much more serious situation.
Why the difference? Because dog's vertebrae go all the way into the hip area. While for people the vertebrae stop mid back. This means for people with a disc problem there is not likely to be paralysis, loss of bladder control but only just a lot of pain.  
    However, with a dog neuro damage is quite likely when the disc is in the back where the nerves get trapped and pressured in the boney vertebrae canal. Even with a neck disc there is the potential for bladder and back legs nerves to be damaged.

Dr. Thomas, Neurology (ACVIM) addresses veterinarians explaining why crating is the single most important care for a disc episode. The annulus is the exterior of the disc:  

Keep in touch, Ann. And let us know what your vet thinks about arthritis and other meds/acupuncture for it?

I just had to jump on here again to report that we just took Copper for his favorite walk again and what a huge difference there was from a few days ago. Tail up, trotting along, telling off other dogs, totally his old self. We kept it to just ten minutes. I think he has really turned a corner in the last few days. Thank you.