Uecker's Geoff 9/23 conserv -Chi/JRT/Dox; GRAD: Jan 2024

Welcome, Uecker! We are glad you have joined us all.

Pain is an important symptom to make sure it's being correctly identified.  Better pain is not good enough.
--- Pain during the course of pred prior to 9/27 test taper day, means the vet needs to be alerted. Expect another course of pred, adjustment in pain meds and is it not time to taper.  A 3-day pred course is a short one. Often vets will try a 7-day or even a 14-day course.  So let us know for sure  if you are seeing any signs of pain when having to move, at potty time, nearing the next dose of the single pain med gabapentin.
   IF pain, indeed, then...  Expect:
    --  Gabapentin for nerve pain to be 3x/day as pain meds last for 8 hrs.
    --  adding in methocarbamol for muscle contraction pain 3x/day
    -- traMADol as the general analgesic  3x/day

Let us know specifically if you ARE seeing pain and what the vet does to adjust meds.

STOMACH PROTECTION
 Pepcid AC (famotidine) lasts for 12 hrs.  Geoff's 16 lbs should be on 5mgs TWICE a day (every 12 hrs)

How is his stool now after being on lactulose regarding constipation? Now back to a normal Play Doh type texture?

Which type of recovery suite do you have? Water/food  bowl attached inside the suite? Wire crate, ex-pen, child's Pack N Play.
   This link explains the detail necessary to provide strict limited movement of the back in order for the disc to heal. Also tips in setting up the suite, it size, and other things to make the next 8 weeks of STRICT rest go smoother. dodgerslist.com/2020/05/14/strict-rest-recovery-process/

Uecker, yikes this is not good at all that a vet did not have the knowledge on correct way to pick up an IVDD dog!   I hope the picking up like a baby has not impacted this disc trying to heal and form strong scar tissue.

Your dog is in pain because of having to move too much to poop. Disc episode are very painful.  A normal dog even with constipation would not be in pain but just have to exert more to get the poop out.  Sounds like clearly a 3-day pred course is not likely to be long enough to even consider a taper on 9/27.

That constipation needs to get corrected soon! Vertebrae movement to poop could be damaging the early healing disc. Too much pressure could cause the disc to rupture than now which is a suspect of a buldge.

The usual is a 7-day or a 14-day pred course, then begins the kinda of a test tapering to find out if pred had done its job.  Pain meds are also naturally stopped that same day because they block YOUR ability at home to accurately and promptly assess for pain.

Let us know you and your vet's  Plan B for the taper:
   With any TAPER, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free!

Food and water bowls should be attached at head height inside of the suite

Gingerlead is a fine belly sling to use with your own harness.  A long winter scarf, a belt or ACE bandage can work also in conjunction with your own harness for potty times.

The single most important care is the at home in the suite STRICT rest of limited movement and limited footsteps.  If you must have laser or acupuncture, hire a mobile vet who comes to your home.  The focus right now is getting the disc to heal. Nerves may or may not heal in the short 8 weeks a disc does. The body will self repair nerve damage. Think more in terms of months rather than days weeks. for this slowest part of the body to heal....nerves.

Can you be more specific on what you observe about his wobbly walk.
--- do his back paws knuckle under?  Can  he correct them slowly or not at all?
--- do his  back paws graze the ground.
--- or do his back legs sometimes cross.

Uecker, good job on advocating for extension on pred. Kudos to you!

Excellent to hear that getting pred on board has so quickly turned neuro diminishment. That is the power of pred if it can be in use quickly. So to confirm:
   9/25 not as wobbly
     "    the rear paw (left or right?) no longer knuckles under 
     "    a less painful hunched back 

PREDNISONE and GABAPENTIN
Is this now the prednisone anti-inflammatory level dose prior to the Oct 1 taper starting?  On Oct 1, will gabapentin be stopped?
Since you've been reporting pain what is the reason they did not increase  Gabapentin  to every 8 hrs (3x/day)?  Gabapentin is effective for 8 hrs.

PUFFY- DIARRHEA  
Details are important because we can't see Goeff. Is the puffy in the stomach. That could be from too much poop still remaiing in the digestive tube?  So glad to hear texture of poop is greatly improved.  As vet says key an eye onb poop to stop lactulose in time before you get diarrhea.

ENZYME - Milk Thistle
Thank you for sharing full info on what he takes. Is Milk Thisthle on board?

Not sure the digestive enzyme would help with constipation, but can't harm either.
While on pred he should be drinking more, a benefit to to help with constipation (better hydration).
    Had there been a raw food change to account for constipation. What does he eat, brand? 

EATING
No problem if he wants to lie down to eat.  But that sounds like a sign of pain: reluctant to raise up to stand.

We can see Geoff, so can you paint a picture for us: Is he lying down on his side? Or does he lie on his belly?

Many male dogs just do not like anything touching their belly. Especially at potty times. So he may not do well with a GingerLead.  Try the DIY figure 8 sling for Goeff's rear wobbly legs.


Keep up the good work in monitoring Geoff and you dedication to ensuring a good healing environment.

Uecker, warms my heart to hear how diligent you are in checking out meds such as Milk Thistle before giving with pred on board.

Providing us with all details helps us to see the full picture about Geoff treatment. So thank you for naming the food he eats, which paw knuckled but now does not, going poop more often and standing to eat, etc.

Hopefully the Pepcid AC alone will be doing an excellent job of stomach protection.  The Hill’s Prescription Diet Gastrointestinal Biome is a highly processed high-fiber food. Not a raw diet in any way.  You giving it on top of an actual raw diet?  Your vet is selling it to you?     Ingredients listing Note: #5 and #6 ingredients are RICE!!!!! Read on below about relationship to your reported "puffy" and what rice does to dogs.
   This Hill's very high fiber wet food...their quote: "is shown to help FIRM loose stool in 24 hrs"  Jeesh, no wonder poor Geoff is suffering with constipation!  And then has to be on a strong laxative to reverse what the Biome did, what the heck?*!  

HIGH FIBER
Just for your own information on high fiber foods and how they work and what Dodgerslist recommends for these situations:
   Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. Pumpkin (unlike commercial preparations  i.e. Lactulose) is an actual food with minerals, vitamins, etc.
    NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe 
    --To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add 1 to 1.5 teaspoons of plain canned pureed pumpkin 1x a day. Another way to hydrate are some frozen broth ice cubes to lick on during the day since you feed a wet food.
    -- To firm up the stool add 1 to 1.5 teaspoon plain canned pureed pumpkin 1x a day to kibble. No extra water.

Give a teaspoon of pumpkin for every 10 pounds of body weight,

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

Figure 8 Sling
Hopefully Geoff will accept the figure 8 sling at potty time. Otherwise the other way is a bit of a back killer for you. You would bend down to support his wobbly back legs by supporting his thighs with your hands. 

GABAPENTIN
$2 per 100mg capsule(?) is really an outrageous price. Prices vary pharmacy to pharmacy and day to day prices can change, so you gotta call and shop around. Also there is a break point where the price/pill(or capsule) drops lower. So ask pharmacist where price point drops.  Then explain to your vet why you want... say a 30-day 3x/day Rx to gabapentin to a particular pharmacy. Then you have plenty on hand if Rx'd 3x/day. Not fair for Goeff to be denied full relief from pain because the meds are not being adjusted. Gabapentin lasts for 8 hrs.
    Also note by law you do not have to be a member of Costco or other Big box stores (if you have one nearby) to use their pharmacy. So include Coscto, Walmart and other local pharmacies in your price checking.

What is your city/state?

SLEEP
As the care giver it is  important you  are getting a good night's sleep. Try moving back or up his pills by an hour ea day till you achieve giving last dose of the night at a reasonable 10pm or 11 pm schedule???
    A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf

Uecker, like hearing he's not struggling so much to poop. Means less pressure on his early healing disc... THAT IS A GOOD THING!

Glad to hear Geoff is feeling a little better. Still a "little better" is not good enough. What specifically do you observe about pain:
  --- nearing next 12 hrs dose of gabapentin
  --- when  he has to move such as at potty time
 ---  other?

So the diet has never been 100% raw food? Then before this disc episode what was the main food brand name (wet or dry?) that you enhanced with raw veggies and what specifc kinds of "fresh" foods, meat, etc.?

Uecker, what a good report on bowels getting back to normal and making Geoff feel like himself again (out of pain). Thank you for the detail so we can visualize what you observe!

Now would not be the time to change up his food to a different canned food. If there were to be loose stool you wont know if due to merely temporary thing caused by change in food vs. a serious thing of stomach damage. Same deal with the lactulose and why to stop it before there would be loose stools. Keep an eye on things in mind for stopping lactulose.

Uecker, did not see Thyro-tabs usual dosing time, hopefully below will still be of some help in your new schedule.

9/28
7:30a Pepcid AC (2x/day)
8a prednisone (1x/day)
    gabapentin (2x/day)
    + breakfast
11:30a Thro-Tab (2x/day) (4 hr separation from Pepcid)
Nusentia's Enzyme Miracle "FEEDING GUIDE: Add 1 scoop (approx 1/2 tsp)  for every cup of pet food at each meal"


PREDNISONE dosing by pill (Exogenous)
The maximal activity of the adrenal cortex is between 2 am and 8 am, and it is minimal between 4 pm and midnight. Exogenous corticosteroids suppress adrenocortical activity the least, when given at the time of maximal activity (am). Therefore, it is recommended that Prednisone be administered in the morning prior to 9 am. www.drugs.com/pro/prednisone.html

According to the Nusentia's Enzyme Miracle "FEEDING GUIDE: Add 1 scoop (approx 1/2 tsp) for every cup of pet food at each meal"

See if this schedule works or can be modified to suite your situation.

9/28
7:30a    Pepcid AC (2x/day) 30 mins before pred

8a         prednisone (1x/day)
            gabapentin (2x/day)
            + breakfast w/Enzyme Miracle® (giving a meal with pred could help with stomach protection.)

11:30a  Thro-Tab (2x/day) (4 hr separation from Pepcid)

Before all the constipation, what was Geoff's normal number of times/day to poop? My dog pooped 1x/day. Other dogs have different schedules.  Maybe Geoff's body is getting back to his normal schedule? ?  Let us know what you observe today whenever he poops re: if approaching a normal texture.

Uecker, normally med times can be changed. But it is done gradually by moving time forward or backwards incrementally by an hour as mentione in an earlier post. Best you run your proposed schedule by the vet to make sure of the things you don't know such as lactulose with Thyro Tab, etc.

Uecker, sorry to keep asking things. Since we are not there we depend on your ability to paint us a picture (using dates, all details about a med (mgs, x/day, etc.) and the "answer" if you had asked  "why, what is the thinking behind that?"

1) What were the pain or neuro observations that explain what "not so well" means?

2) What are all the details of pred change?
   as of 930  pred dose in mgs?  2x/day  for 5 days; 10/14 test taper for _ pain _ neuro

It is not unusual to see owners reporting vets Rxing lactulose but not calling for a stop of Pepcid AC. So this was quite a surprise to me. But then Geoff is on a Thyroid med that is not in are area of knowledge.
     You have reported while on lactulose AND taking Pepcid AC (famotidine), the stool was progressing to a better texture.  Hmm that appears to show may there has not been an interaction for Geoff????
   Web MD:  "Lactulose is a colonic acidifier"   Drug interaction with famotidine:  listed as "0"
   
You can do a search your self on "Lactulose and famotidine drug interaction?" to further learn more.

The concern always with use of any anti-inflammatory is the protection of the GI tract from potential of deadly bleeding ulcers caused by too much acid from lactulose, prednisone, change in routine stress and spinal cord damage.  Of course, don't want a dog to be constipated either.  Surely there is a happy medium approach?

Did you ask your vet, then about plain pureed canned pumpkin instead of lactulose with Pepcid AC? other options?
--To loosen the stool, mix into a meal of canned wet food  1  1/2  teaspoon of plain canned once a day. Make sure this extra fiber is being accompanied by extra intake of fluids. 
     Freeze low/no sodium meat broth into cubes to lick on during the day.
NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe

It was adjusted over the phone. They mentioned to either keep him on the 2x a day prednisone a little longer, or do the 1x a day prednisone with the methocarbamol added in. I decided to go back to the prednisone 2x a day because he was having a lot of improvement yesterday / no pain sings, and the above notes mention the prednisone should be the 7-14 day course, and the vets did 5 days so far 2x a day. So hopefully this is the correct thing to do, and his pain goes back to zero like it was before and we see improvements again.

Thank you so much for the reply!

Yes yesterday we made such a big improvement. this morning however,he is not feeling well - as in - [9/30]shaking again during potty breaks, and wobbly [increase or same as 9/29?] walking.

Sorry, I talked to the vet tech [9/30]  this morning and she gave me incorrect info.

The prednisone is now 5mg 2x a day for 7 days, 

    [TAPER DOSES BEGIN on 9/6]: 1x a day for 7 days, then every other day.
vs the 5mg 2x a day for 5 days, 1x a day for 5 days and every other day. Since we did the prescription 5 days so far at 2x a day - and he added another 7 - that would give 12 days of 2x a day. confusing!

I did have to search more on the Lactulose. Antacids can interfere with the colon acidification process and make lactulose less effective in trapping ammonia. That could be why its taking so long for him to have the normal softer poop. Its not hard as a rock like it was, and is softer .... but its still not soft soft like playdoh.

I did not do the [9/29 STOPPED] pepcid yesterday and he ended up having 2 poops, and getting more soft than it was previous days.

This is complicated bc of the additional issues w/ constipation along w/ the IVDD. The research mentioned we can't do tums even or anything w/ antacids w/ the lactulose. I will have to ask the pharmacist when the refills come in on Monday and see what he says.

I am not sure if I can add in the Enzyme Miracle bc of any interactions? I know the Milk Thistle had interactions w/ the prednisone so I have to wait on that one. Anything else for an alternative for the pepcid for now? I had my other vet review what this vet is doing for treatment etc and she agrees on everything this vet has been doing so far.

He was doing so well yesterday - no signs of pain, standing up straight, not hunched, etc, I will keep you posted on the next couple days. Hopefully we will turn around again, going back to the prednisone 2x a day.

Thank you. Yes I am confused myself w/ the prednisone.

Sounds like we are doing the prednisone correctly? 12 days total of 5mg 2x a day which falls into the 7-14 days.

We started 9-23 w/ one prednisone at night after the vets appointment.

9-24 started the 2x a day prednisone, 9-24 to 9-28 = 5 days of the 2x a day prednisone.

9-29 [test taper] went down to 1x a day prednisone

9-30 go back to 2x a day prednisone for 7 days, 9-30 to 10-6

10-7 [test taper] go down to 1x a day prednisone for 7 days

10-1; 2:12pm

Thank you Paula. He is doing well today. Back to acting like himself, and no pain shown. yay!! The wobbly is better too, standing up straight again.

He did have a couple pee accidents though, is this common w/ the prednisone? He hasn't had the accidents before. I am worried on that.

He did have 2 poops this morning, yay!! Still mid range majority of it , not hard like a rock, but not soft soft like playdoh either. the last one is normally softer then the rest.

Thank you so much for all your help!!

10-9-23

I just realized my last message did not go thru, we are having some WIFI issues. Yes, vets office contacted back and advised not to do the changes on the weekend so we are doing the [▲Prednisone] changes today 10-9 w/ his medication. We will see how today/tomorrow goes and update. Thank you so much for all your time and help it's greatly appreciated!!

[MED LIST/HISTORY- Moderator's Note. Please do not edit
16lbs 10-11y.o
9/23 wobbly, right rear paw knuckling
Dex inj 9/23
prednisone as of 9/24: 5mgs 2x/day for 5 days, 9/29 test taper for: 9/30 pain / 9/30▲wobbly neuro
                as of 9/30: 5mgs 2x/day for ▲8 days, Mon 10/9 test taper for: _ pain _ neuro
gabapentin 100mgs 2x/day
thyro-tabs 2x/day
lactulose 2x/day ]