Laura Burdick for Bear
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Post by Laura Burdick for Bear on Oct 18, 2023 7:21:19 GMT -7
[Laura's Bear 10/18 conservative- NECK, GRAD 12/13/23]
Hi Paula, this is Laura Burdick with an update on Bear. He just completed his 8 weeks of strict crate rest on October 7 and has been back to normal until yesterday. We have been very careful about not letting him use stairs or jump up/down the sofa.
Yesterday [Oct 17] I was out of town and in the afternoon my husband let him out in the yard. He was running around normally and then my husband said he laid down and would not come when called, so he had to go out and get him. He did not cry when my husband picked him up. My husband crated him to watch him. In the crate, Bear immediately ate some food that was left in his bowl from breakfast. When I got home, I thought I would have to take him to the ER, but he seemed pretty normal. He got up, shook off, and greeted me (in the crate). No crying or obvious signs of back/neck pain. His head was up. I walked him briefly on the leash last night and he seemed OK, just a bit more sedate then usual. This morning again, he seems a bit sluggish. I am continuing to watch him closely.
I have a vet appt. for his annual check up [10/20] on Friday this week (scheduled several weeks ago). It's a new vet since I don't feel comfortable returning to the vet's office where Bear was injured.
Paula, we feel soooo discouraged and absolutely gutted at the possibility of another neck issue so soon after the first. Our previous dachshund was 13 when he had the neck issue and it never recurred even though he lived another 5 years. How could Bear rupture another disk so soon, and with us being so careful? What other conditions should we be looking for, or asking the vet about? Are there tests like an xray or MRI that we should request? I do plan to have them run blood and stool tests to see if it's something else, but I'm afraid I'm just in denial about another neck issue. Thanks for any insights.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 18, 2023 9:13:48 GMT -7
Laura, I'm so sorry that contact was lost where we could share with you on Oct 7th graduation day the safe and proper way to slowly over a couple of months time to transition Bear from couch potato to back to family life and activity.
I sounds as though Bear may have overdone things and caused muscle soreness????? This is just one of the problems of shortcutting a SLOW and GRADUAL reintroduction back to physical activity. You do not know for sure if it is a re-damaged neck or simply muscle soreness.
I'd keep him under 24/7 STRICT rest inside of recover suite. Act like this is a disc episode until the new vet says otherwise.
You know the routine: Carry him to and from the potty place. East in the recovery suite. NO running, no walking around until the new vet sees him on 10/20 (we LOVE exact dates). Fingers crossed the new vet's exam will show there is no new disc episode going on.
Once cleared by the new vet that this is not a disc episode of same or a different disc, THEN, please update with details of the current state of pain, neuro ability, and any meds he is on.
We have a tremendous amount of good ideas on how to safely move Bear into family life and activity. Will be watching for your next post with great hope that it will be time to share the how to's of graduation day if it turns out to be 10/20 now.
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Post by Laura & Bear on Oct 20, 2023 7:37:15 GMT -7
Hi Paula, just saw your response this morning. I wish we had tried the gradual return to normal activity. We didn't do this with our previous dachshund but he was older and not as active as Bear. Bear has been under crate rest this week.
On Wed.10/18] morning he seemed a bit sluggish so I gave him a leftover ✙Gabapentin and he perked up a lot after that.
Yesterday (Thursday)[10/19] he had a good day and seemed fine. I was hopeful, but this morning [10/20] he started crying a lot after I took him outside. He settled and is resting quietly now. I have the vet appt. in 3.5 hours and am very anxious to see what they say. Thanks again for all your help, Laura Burdick P.S. One thing he is doing that puzzles me is he is shaking off (the big shake dogs do from head to tail) from time to time. It puzzles me because it seems like he would not be able to do this if his neck was hurting.
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Post by Romy & Frankie on Oct 20, 2023 13:04:26 GMT -7
Please keep us up to date on Bear's vet visit.
Generally, a big shake would cause pain in a dog having a neck disc episode. Was it after he had taken gabapentin? This could be masking pain he otherwise would be feeling.
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Post by Laura & Bear on Oct 20, 2023 17:23:50 GMT -7
Hi there, yes he did a big shake this morning later on after the crying. I mentioned this to the urgent care vet. I just don't understand how he could do that with a sore neck, particularly a ruptured disk. Also, I told the vet today that his recovery after starting the pain meds for the last episode in August was nothing short of miraculous. That same night of the vet visit, I got up around 2am to give him his pain meds and I took him outside on the leash for a pee. His behavior was back to normal: head and tail up, alert, and wanting to chase after something he saw in the backyard. I would think if he had a ruptured disk he would still be having some stiffness and discomfort at that point. He had a perfect recovery after that, with no signs of pain in the 8 weeks that followed. And no pain for the first 10 days after his crate rest ended.
Yesterday [10/19] he seemed fine (on crate rest).
This morning [10/20] was horrible. He yelped once when I was holding him to take him outside, then cried/yelped a lot after I brought him back inside. I left him with his head hanging out of crate, afraid to touch him again, and went into another room.
A few minutes later, he stood up, did the full body shake and slowly[pain] came into the room I was in. I closed the door and kept him lying in his bed until it was time for his appointment. He cried a lot when I tried to get him out of the crate at the vet's office and again inside while I was holding him.
The urgent care vet [10/20] today thinks it's his neck again, although it's not quite as bad as it was before. She wants us to repeat the same regimen as before:
exact same meds [?] with the crate rest.
[names mgs, x/day?:
Dex injection
Prednisone as of date? for ? days, then taper
methocarbamol
gabapentin
amantandine
Sucralfate to bandaid damaged lining areas]
Pepcid AC to suppress acids
But she wants us to follow up with her in 2 weeks for another assessment. She said we could also follow up with a
neurologist, but the earliest appt. I could get is Nov. 30 (I took it while I look for something sooner). He is resting quietly this evening.
Thanks so much for any insights. I am absolutely gutted and depressed by this relapse so soon after his recovery.  P.S. Sorry, forgot to clarify: The big shake was NOT after the gabapentin. He did it without any pain meds. Reply |
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 21, 2023 9:41:38 GMT -7
Laura, there can be causes for neck disc pain. There has been no advanced imaging such as a $2000+ MRI to verify the status of the disc, the nerves and the spinal cord.
-- Xrays can't show these kinds of soft tissue. Xray show only hard tissue like bones, etc.
-- Xray is used to rule out other disease which can mimic signs of a disc episode. When a vet has a very high suspicion of a another disease, an Xray might be called for. This is but only one example: such as the dog was hit by a car, fell off a bed. Maybe then the hard tissue of bone (vertebrae) may have been broken and impacting the disc and nerves.
Mostly a disc episode is diagnosed by the vet's hands on exam, the way the dog acts, the breeds (doxies) prone to being born with IVDD and the dog's medical history (bear did heal under conservative treatment, but re-damaged damaged a new neck disc with physical activity introduced too fast. So likely the urgent vet's diagnosis was based on those factors.
Without advanced imaging, one can only have knowledge there are different degrees of disc damage.
-- However, not specifically which degree of damage Bear has.
-- Some discs bulge and painfully compress the nerves, spinal cord.
-- Some discs can tear where disc material escapes and could shift/move around being more painful in a certain position.
-- Without advanced imaging there is no proof of another disease and no proof of a disc episode.
So your choice is to go with what appears to be a prudent diagnosis by the urgent care vet until you see meds are not working to control pain while disc healing is taking place.
--- Stick to STRICT rest for 8 weeks to allow the disc to form needed scar tissue, and pain meds to provide comfort until pred can get the swelling gone in 7-30 days (excluding any taper days).
--- Well before Nov 30 you will have weeks of information/observations to know if you want to even keep the neuro appt to confirm a disc problem or if Bear has another disease that mimics a disc episode. Likely expect the need of an MRI to help the neuro make the diagnosis.
Accuracy for the OCT current med list aids our best understanding of Bear's treatment. Without a current accurate med list, we are at a loss to comment.
Fill us in, please, on the complete med list for October. Below is his old AUG reported med list you can use as a reference
Aug 2023 MED LIST/HISTORY-
15 lbs 7 y.o.
Dex injection as of 8/12
Prednisone as of date?: 2.5mgs 2x/day (taper dose ) for 7 days, then 8/19 test taper for: _pain?/ _neuro?
methocarbamol 750mg tab: 375mgs 3x/day
gabapentin 100m 3x/day
amantandine 25mgs 1x/day
Sucralfate 500mg 2x/day not yet given
Glandex supplement (pre/pro biotic FIBER blend)
Pepcid AC started Aug 13: 5mg 2x/day
As always, you can help us. Thanks bunches:
• Use exact name of all meds.
• Give the dose in mgs.
• Give the frequency of dosing 1x/day, 2x/day, etc.
• Use the date rather than Tuesday, last week, etc.
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Post by Laura & Frankie on Nov 2, 2023 10:46:16 GMT -7
Hi Paula, this is Laura with an update on Bear. We were able to get a quick appointment with a different neurologist [11/2] today. Here is the current medication:
[Moderator's note: please do not modify
15 lbs 7 y.o
10/7 completed 8 wks rest
10/17 running in yard, random neck discomfort, can shake head with no discomfort
11/2 Neuro appt: suspicions that some disc material not yet absorbed causing pain
Dex injection 10/20
prednisolone as of 10/21:5mg 2x/day for 7 days, 10/28 taper test for:_ pain/ _ neuro
gabapentin - 10mg 2x/day
methocarabamol 375mg 2x/day
amantadine 50mg 1x/day
Glandex supplement (pre/pro biotic FIBER blend)
Pepcid AC 5mg 2x/day ]Started on 10/20 (day of urgent care visit) TX: in house : dexamethasone-SP (3 mg/mL) 0.1 mg/kg IM methadone (10 mg/mL) 0.15 mg/kg IM ketamine (100 mg/mL) 0.5 mg/kg IM • RX: dispensed: prednisolone 5 mg 0.5 mg/kg Q12 hr X 7 days, then tapergabapentin 10-20 mg/kg Q8012 hours X 7d limit methocarbamol 55mg/kg PO Q12 hr X 14 days amantadine 4 mg/kg PO Q24 hr X 30 day supply -strict cage rest FOLLOW-UP: in 2 wks at EmmaVet or Neuro if able to be seen sooner Glandex supplement (pre/pro biotic FIBER blend) Fish oil supplement (Zesty Paws) Pepcid AC started Oct. 21: 5mg 2x/day The [11/2] neurologist found that Bear is still having neck pain (when he pressed) and said his range of movement of his head is a little bit reduced. I told him that Bear is doing a full body shake and also rolling on his back in the grass and he said sometimes the neck pain just happens in a certain position, like it gets tweaked. He said it's likely IVDD but recommended MRI and possible spinal tap. And he was going to do extensive bloodwork to look for infection or other causes. The estimate for all of this was $5,000 and my husband did not want to do it. He wants to continue with the meds since Bear seems to be doing well again on the meds. (Currently we are tapering off the prednisone at 1/day but the vet said to give him 1/day for another 7 days then continue to taper down.) The vet said to follow up in a week via email to see how he's doing. We could opt for the MRI at that point (my preference). He also discussed disk surgery, which we would like to avoid. I want the MRI so we can get a more definitive diagnosis and treatment plan with medication or other non-surgical options. I asked him about the relapse and why that could happen. He said it's most likely the same disk and not a different one. He said if there was an initial disk rupture that sometimes the jelly material does not dissipate and remains there like a lump, still causing pain. So it could be eliminated with the surgery. In our area, we could probably expect to pay $15-20,000 for the surgery (my guess, since they didn't give me a surgery estimate yet). I still have the Nov. 30 appt. with a different neurologist and I just called there to see how much they would charge for the MRI. They gave me a range of $3-5,000 that would include the exam and bloodwork and possibly other stuff that could be needed. We could still schedule the MRI with today's neurologist if we decide to do that (I'm hoping to convince my husband once the sticker shock wears off). But that's where we are right now. Still feeling incredibly frustrated. Also, Bear's nails are much too overgrown and I can't do anything about it. I was hoping they could cut them while he was asleep for the today's MRI. And I was hoping the MRI would show a healed disk so we could stop the crate rest. Lastly, Bear seems fine now that we are home. He was doing great at the neurologist until they pinched his toe and pressed on his neck. But now he seems OK. P.S. Also, regarding the high cost, I told my husband we should ask the vet's office where was injured to pay! I'm still so furious with them. Thank you, Laura |
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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 2, 2023 12:06:07 GMT -7
HELP!! what are the current meds he is on? Please simplify and give the current dose in mgs and number of times a day given.
Pred to continue in a taper dosing: 11/2 neuro notes some neck pain if possible in a certain position
?methocarbamol ?mg ?x/day
?gabapentin ?mg ?x/day
?amantandine ?mg ?x/day
?Glandex supplement (pre/pro biotic FIBER blend)
?Pepcid AC 5mg 2x/day
Pain meds on board during a pred taper would not allow a clear assessment about pain.
As neuro says in a certain position a bit of disc material/bulge could cause discomfort til it hopefully will shrink back enough to no longer irriate the nerves.
When will the pain meds be full stopped so YOU can have an accurate picture if pain still exists? Pain meds are a blind fold to the true need of anti-inflammatory prednisone or no predisone because swelling is gone.
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Post by Laura & Frankie on Nov 2, 2023 13:25:21 GMT -7
Here are the current pain meds: prednisolone 5 mg once a day gabapentin 10 mg every 12 hours methocarbamol 1/2 of 750 mg. tablet every 12 hours amantadine 50 mg once per day The neurologist assessed him [11/2] today and determined he is still having neck pain. He said to continue the prednisone at the current dose (5 mg. once a day) for another 7 days, then continue tapering. He didn't say anything about stopping pain meds. We talked about long term pain meds to avoid another relapse, in lieu of surgery. Bear does not appear to be in any pain until his neck is pressed, then he is in pain. Otherwise, he is behaving normally. He is able to shake off and was trying to roll in the grass on his back this afternoon. The vet said it could be the same disk and the material did not dissipate so it's still there and could be causing the relapsed pain, just when he moves his neck in a certain position like a tweak.On his first episode in August, we stopped the pain meds when we began tapering the prednisone and Bear showed no signs of pain. Then he had no pain meds for the remaining weeks of crate rest.
Hope this helps to clarify. Thanks, Laura |
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Post by Laura & Frankie on Nov 2, 2023 13:45:38 GMT -7
P.S. Also sharing this info. from the report the neurologist just sent me:
NECK PAIN
Based on the history and clinical signs, a neurological problem was localized in the cervical region (neck). Differential
diagnoses at this point include intervertebral disc disease (IVDD), neoplasia, trauma or inflammatory- infectious
disease. Given our findings, we are most suspicious for intervertebral disc disease. This is the most common cause of
neck pain. We discussed pursuing an MRI of the neck and spinal tap-given his recent improvement, you are electing to
try medical management a while longer before committing to an MRI.
Disc material normally functions to provide cushioning between the bones in the spine. In predisposed dogs, the
intervertebral discs become dehydrated and hardened. This predisposes them to acutely rupture, which can cause
compression of the spinal cord. This compression results in clinical signs such as pain, weakness and incoordination. In
severe cases, if your pet becomes unable to move all his limbs, he can also experience trouble breathing. This can be a
life threatening condition and your dog should be examined by a veterinarian immediately.
Another common cause of severe neck pain in dogs is meningitis, which is an inflammatory disease affecting the
meninges, the membranes surrounding the brain and spinal cord. Common symptoms of canine meningitis include:
fever, stiff and painful neck, weakness in the legs, loss of balance.
A correct diagnosis of the underlying cause of neck pain requires acquiring a complete medical history and conducting
a physical examination. Bloodwork and urine tests are performed to detect signs of an infection and to determine
organ function. Advanced imaging, such as X-rays and MRI are often required to obtain a definitive diagnosis. A spinal
tap is often performed along with the above mentioned diagnostics if meningitis is suspected.
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Post by Romy & Frankie on Nov 2, 2023 14:29:43 GMT -7
When, during Bear's earlier episode, you stopped the pain meds when the taper began, pain, which indicates continued spinal cord swelling, could be quickly noted. This may not be the case with his current episode if pain meds are continued.
According to the report, the neuro believes it is most likely IVDD. An MRI and spinal tap would help if the neuro suspected it was not IVDD.
Long term pain meds will not keep Bear from relapsing. But there are some few dogs that do stay on meds long term in order to keep comfortable. It seems too early to know if Bear will be one of those, as he is still in the acute phase of the episode, still on crate rest and meds.
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Post by Laura & Frankie on Nov 2, 2023 14:45:08 GMT -7
Thank you. Are there questions you recommend I should ask the neurologist in a follow up? I just don't understand how IVDD happens again 10 days after the first episode. And he said he thinks it's more likely the same disk continuing to cause issues. But Bear had 8 weeks to heal that disk. I wish I had been better prepared with more questions to ask the dr. However, I expected to have the MRI done today to answer all my questions, and my husband nixed that when he saw the cost. He was not expecting it to be that high. We are now researching options to have the MRI done elsewhere.
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Post by Romy & Frankie on Nov 2, 2023 15:06:16 GMT -7
Unfortunately, it does sometimes happen that a dog will have another episode shortly after the first, either another disc or the original disc not completely absorbed. Consider asking the new neuro if the pain meds should be stopped or at least cut back during the taper. This will make it very clear if swelling is still present. I know your husband did not want to pay for 5,000 worth of blood work. Very expensive! Was any blood work done recently? We have a list of other possible questions to ask at the link below: dodgerslist.com/2020/05/10/find-ivdd-vet |
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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 3, 2023 18:39:11 GMT -7
Laura your med list helped alot! Just a few things more.....
-- What was the date you got the Prednisone Rx and gave the first dose of (how many mgs?) 2x/day? for 7 days. Then pred began tapering to once a day doses and still is a taper dose.
-- gabapentin at 10mgs dose 2x/day is like not giving any. Can you double check the size of the pill and if you are cutting it in half or ???
OR is gabapentin a liquid?
1) Then what is the formula: how many mg gabapentin in 1mL of liquid?
2) What mL dose of the liquid do you give?
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Post by Laura & Bear on Nov 4, 2023 18:22:34 GMT -7
Hi Paula, the ▲gabapentin is 100 mg. capsule and he's now getting it 3x day, per the neurologist's instructions.
Plus methocarbomal 3x day and the
amantadine 1x day.
[Moderator's note: please do not modify
15 lbs 7 y.o
10/7 completed 8 wks rest
10/17 running in yard, random neck discomfort, can shake head with no discomfort
11/2 Neuro appt: suspicions that some disc material not yet absorbed causing pain
Dex injection 10/20
prednisolone as of 10/21:5mg 2x/day for 7 days, 10/28 taper test for: w/neck pressure only Pain / __ neuro
gabapentin - 100mg ▲3x/day
methocarabamol 375mg ▲3x//day
amantadine 50mg 1x/day
Glandex supplement (pre/pro biotic FIBER blend)
Pepcid AC 5mg 2x/day ]
For several days prior to that, when Bear started tapering down the prednisone, I tapered the gabapentin and methocarbomal from 3x to 2x per day and he seemed fine. At this point in the first episode, I had stopped all pain meds and Bear showed no signs of pain.
But this time, I'm going to continue them until the follow-up with the neuro on 11/9.
Bear had 7 days of prednisone at 2x day from 10/21 to 10/27. Then per instructions I began tapering to 1x day on 10/28. We did that for 6 days. When I saw neuro on 11/2, I asked about the prednisone dose and he said to continue 1x day for another 7 days before proceeding with more tapering. I sent neuro a follow-up email asking if Bear should be getting the prednisone 2x/day since he still had neck pain when pressed. (NOTE: He had no signs of pain until pressed. I detest those painful neuro exams.) I never got a response.
Romy: Bear had blood work done on his first urgent care visit because I was concerned about a tick bit/Lyme. It came back negative. No further blood work yet. The $5,000 was for the exam, blood panel, MRI, and a spinal tap. We have decided to wait on the MRI for now, and not pursue that unless we are prepared to go to surgery.
And right now [11/5], Bear seems to be responding well to the meds and crate rest (same as last time). I wasn't super pleased with the neuro, who was very young and seemed to be focused on MRI/surgery. He didn't discuss medical management at all. I plan to seek a second opinion with another neuro.
Thank you both!
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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 5, 2023 9:41:47 GMT -7
Laura, with all the pieces of the puzzle revealed, here is my assumed comment.
The young neuro's report stated it is "most suspicious" for IVDD. It is a neck disc episode unless an MRI/spinal tap proves another disease that mimics a disc episode. The neuro mentioned to you likely some disc material has not yet been reabsorbed enough to no longer irritate the nerves. When Bear moves in a certain position or there is pressure on that spot, there is discomfort.
Bear has been on the anti-inflammatory level of steroids for 8 days (Dex inj 1 day + prednisone 7 days 5mg 2x/day).
For many dogs 7 days is enough to get the painful swelling down.
The continued use of prednisone taper doses possibly could be trying to find the lowest dose possible that gives comfort while giving the body time to see how much disc material could be "dissipated" or reabsorbed by the body for Bear's case??
The increase in pain meds (gabapentinn to 100mgs 3x/day, methocarbamol 375mgs 3x/day) would be to provide comfort while pred continues with taper doses and the disc continues to form scar tissue.
It is always best to ask questions to fully understand a treatment. Ask the thinking behind the pred treatment rather than having to assume.
At the point pred has finished its final every other day doses and all pain meds have been stopped, then you will have valid information to know if pain still exists. Right now there are blind folds on re: pain due to gabapentin and methocarbamol on board.
If pain still exists at the end of pred and pain meds, then you need a professional to help you determine why the pain and what the options for treatment would be.
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Post by Laura & Bear on Nov 5, 2023 15:24:36 GMT -7
Thanks, this is helpful. I will just add that I had already started to taper the pain meds from 8 to 12 hours and Bear showed no signs of pain.
He [11/2] only had pain when the vet pressed on the disc. Wouldn't that make sense, if it takes 8 weeks for a disc to heal? Let's say you break your arm and it hurts for a few days because of the inflammation. Then the inflammation goes down and and it stops hurting as it is healing. However, if you press directly on the broken bone before the healing period is over, it will still hurt a lot! I would think a disc would be the same. It's strange to me that pressing directly on a disc that takes 8 weeks to heal is supposed to be pain free before the 8 weeks is over. Anyway, just my two cents. The problem with the neuro is that he left the room after discussing the MRI with me and did not return. The assistant was running in and out, relaying my additional questions to him after we decided against the MRI. I hope he will answer my follow up questions at the one week mark.
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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 6, 2023 10:56:49 GMT -7
Laura, disc healing is a separate issue from pain of swelling.
The disc is made of cartilage. Cartilage can continue to form scar tissue same as if you stay off of a sprained ankle it can heal. In Bear's case, stay off of "back/neck movement" to avoid disrupting the disc cartilage healing process. If the disc healing process is interrupted, there could be new pain with a chance of nerve damage.
Pain"Inflammatory proteins that leak from the disc's core trigger inflammation and pain. The proteins in the disc interior cause inflammation if they come into contact with nearby muscles, joints, and nerve roots. Inflammation can cause pain, increased muscle tension, muscle spasms, and tenderness around the affected disc, as well as sharp, shooting pains in the leg or in the arm if a nerve root is affected [as shown in the graphic below] " Zinovy Meyler, DO, Physiatrist. How a Disc Becomes Painful. 2/11/2021.
Your neuro suspicions perhaps a piece of escaped disc material might cause pain if Bear moves in a certain position or one applies pressure on the protein disc material in a certain way. The hope is with time the escaped disc material would dissipate or shrink back enough to no longer aggravate the nerves to avoid having to consider a surgery. Or perhaps use of other options to use least amt of meds to allow a good quality of life just as humans might use meds to enjoy a pain free life. You have not reported Bear wanting to avoid placing weight on front legs by holding it up like a flamingo bird and neuro did not report nerve root pain. So it appears the escaped disc material is not pressing on a nerve root like in graphic below. But instead for Bear the escaped disc material is lodged in the spinal canal that houses the bundle of nerves (spinal cord). On your next appointment with a clearer knowledge of dog anatomy, you will be able to ask good questions, understand the "why" behind Rx's and treatments, etc. Vet visits seem to go by very fast!!! Good idea to start a list of questions as something comes to mind so nothing goes unanswered in helping you to understand exactly what is Bear's situation. 
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Post by Laura & Bear on Nov 14, 2023 13:25:08 GMT -7
Thank you, this is helpful!
Hi Paula, could you recommend any safe activities to keep Bear occupied as we are on week 4 (or 12) of crate rest? I know with the neck you have to be careful. He has started chewing on his blanket. Is a licky mat OK, or a snuffle mat? Thank you!
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Post by Romy & Frankie on Nov 14, 2023 14:18:56 GMT -7
You are right that activities that would be fine for a dog with a back disc issue can be dangerous for a dog during a neck disc episode. The goal is to keep the movement of the neck to a minimum.
Chew treats or kongs are likely to result in too much neck movement, which could hinder healing. A lick mat may be okay depending on how Bear approaches it. If he is very enthusiastic and approaches it with vigor, it would not be safe. Calmly licking with minimal movement of the head/neck should be fine. You would have to see what he does.
The ideas below should provide some safe entertainment for Bear.
-- During the day try the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from a high.
-- Play classical music or one of the wildlife TV shows. Some relaxing music for dogs is below. You will be able to find others
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Post by Laura & Bear on Nov 19, 2023 9:27:53 GMT -7
Thanks, I will try these ideas.
Good morning, another update on Bear:
On Thursday I had a quick check-in call with the
[11/16] neurologist and told him Bear was still doing great. He's on the prednisone every other day (for just a few more days) and he is finished with the amantadine. I asked if we could try tapering down the gabapentin and methocarbomal from 8 hours to 12 hours. He said yes and he said it was OK to let Bear take slightly longer walks outside.
Bear seemed fine yesterday but this morning [11/19] he seemed just a little bit off. He was 11 hours out from his last pain dose. I took him outside for his potty break and he seemed a little sluggish when I brought him back to his crate. I gave him his pain meds right away (not waiting for the 12 hours) and now he's acting normal again. I am planning to watch him carefully a few more days to see if this happens again. And keep the walks super-short, of course. We are in the middle of week 5 of Bear's relapse episode.
[Moderator's note: please do not modify
15 lbs 7 y.o
10/7 completed 8 wks rest
10/17 running in yard, random neck discomfort, can shake head with no discomfort
11/2 Neuro appt: suspicions that some disc material not yet absorbed causing pain
11/16 Neuro Rx's slighly longer walks
Dex injection 10/20
prednisolone as of 10/21:5mg 2x/day for 7 days, 10/28 taper test w/neck pressure pain for: √11/19 sluggish? Pain / __ neuro?
gabapentin - 100mg ▼2x/day
methocarabamol 375mg 3x//day
amantadine 50mg 1x/day
Glandex supplement (pre/pro biotic FIBER blend)
Pepcid AC 5mg 2x/day ]
I am beyond frustrated. This is uncharted territory for me. Our previous dachshund had a textbook case with his neck disc episode and was totally fine after his recovery with no need for further pain meds after the first 2-3 weeks. Bear was also off all the pain meds after the first 2-3 weeks of his initial neck episode from August.
I'm wondering if Bear is going to need daily pain meds for the long term (or surgery to cure his pain). What is your knowledge and experience with dogs that continue to need ongoing pain meds?
Thanks so much, as always.
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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 13:17:48 GMT -7
Laura the suspicion is a piece of escaped disc material lodged against the cord. It might move and thus sometimes pain and sometimes not.
The key is the word suspicion. No MRI had been taken to verify what is actually going on with the disc and the spinal cord aggravation.
What did the neuro answer when you asked about 8 strict rest weeks to heal a disc would be over on Dec 13 —how does slightly longer walks fit into strict rest to ensure scar tissue formation?
So the EOD taper now includes a drop down in two pain med doses.
AND added is another variable of slightly longer walks.
The waters are muddy. There is no way, now, to pin point whether new sluggish thing (details, what does that mean exactly?) is due to
-- Rx of increased walking or
-- drop in med dose (signaling pain never had fully gone away--- just masked by higher med doses).
When it comes to a point that verifies, the disc has been given time to heal, but yet pain is still not relieved, one can move to the next treatment step. Everything depends on how much residual pain and if it could be managed with least amount of meds or if a surgery is the better path.
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Post by Laura & Bear on Dec 4, 2023 17:35:16 GMT -7
Hi Paula, it's Laura with another update on Bear as we are nearing the end of week 7. He seems to be doing great. The issue I mentioned previously was a false alarm. We are looking ahead to the end of his 8 weeks of crate rest and how to keep him safe after that and transition him back to normal life (minus steps and jumping of course). I need advice on a couple of issues.
Bear's nails are terribly long since they haven't been trimmed since June/July. He is now slipping and sliding if he steps on our hardwood floor, and can't get a grip. I have added a large area rug to our dining room to keep him safe once his crate rest is done, and a runner in the hallway. I'm absolutely terrified to trim his nails since we tried after his last crate rest ended and this may have caused his relapse. He fights, struggles, and cries when anyone tries to cut his nails. How can this be done safely? I would like to ask the vet to sedate him (to sleep) for the nail trim, but I know this is dangerous as well, since they become limp and floppy when sedated. This dilemma is keeping me awake at night.
The other issue is his anal glands, which are now bothering him, despite the supplement I've been giving him. Even with the supplement (Glandex) he normally needs to have them emptied at the vet every couple of months, so this hasn't been done since June/July. But he will struggle when this is done, and again, I am scared he will re-injure himself. Do you have any suggestions for this issue?
I would also appreciate any guidance for after his crate rest has ended. I plan to gate off one room of the house for him, and I have fenced off a smaller area of the backyard for when he is off leash. I looked on the Dodger's List website but I couldn't find anything for what to do after the 8 weeks is up.
As always, thanks so much for your help.
Laura
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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 4, 2023 19:48:09 GMT -7
Laura, we tailor transitioning back to family life et al based on each dog's abilities on graduation day (Dec 13). So with much anticipation, we are waiting to get an update on neuro, pain so we can share all the many tips and ideas specifically for Bear.
On graduation day all meds would have been stopped at least a week to confirm all painful swelling is actually gone.
Has the final dose of pred been given? date?
Are all these pain meds still on board or now stopped?: gabapentin, methocarbamol and amanatadine?
Right now the focus is ALL about no disc setbacks, no excessive movement to the back/neck---- healing the disc is the focus.
So no nail trims by anyone.
Anal glands if they simply cannot wait til graduation and is a health issue, then I guess the health benefit to get the glands expressed to avoid (what? infection, or ??) would outweigh the risk of a potential disc setback with transport to a vet. You are the one to weigh risk vs. benefit when making any decisions about vet visits.
Bear should not be walking on any floors, grass. He should be carried to and from the potty place and then back to the recovery suite. At the potty place he only takes a minimal few footsteps to take care of business.
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Post by Laura & Bear on Dec 4, 2023 20:21:06 GMT -7
His last prednisone dose was 11/22 so he's done with that. He also finished the amantadine a few weeks ago. The neurologist gave me gabapentin and methocarbomal, which he is still on every 12 hours although he shows no signs of pain.
I have a vet appt. for him on 12/14 for a wellness check because he's due and more importantly, I need to establish a relationship with a new vet since I have left the practice where he was injured. I understand the focus on rest for now, but I'm looking ahead to when his crate rest is finished (soon) and wondering how he's going to even be able to walk properly on those nails. I read on the Dodger's List site that long nails affect their ability to walk properly and can contribute to back issues. He will be gated in my living room but I don't have wall to wall carpet there so he could walk on the hardwood floor in one area of the room at that time. I looked at his back nails tonight and one is now scratching into his foot pad so that's going to start giving him pain if it goes much longer. I do think the long nails are a big issue that will impede his recovery after his crate rest is finished, so that's why I'm reaching out for guidance on how to address this issue once his crate rest is finished. I do not plan to cut his nails before the crate rest is finished.
Thank you, Laura
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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 5, 2023 11:17:17 GMT -7
Laura, the first step is to verify all pain is really gone. Right now there could be pain blocked by you still dosing gabapentin and methocarbamol.
-- The wellness vet visit with pain meds still on board, will give a false picture of Bear's situation. Kinda of a waste of money for the vet to not have the opportunity to have a clear picture of Bear, don't you think?
° Share with the Wellness appt vet, your concern about Bear's excessive struggle, fighting nail trims. The vet will be able to council you if just taking the edge of with a pill or an injection could be a helpful thing (vs. NOT some sort heavy sedative).
° In preparation for possible vet nail clipping 12/14, begin desensitizing TODAY! That means you only very quickly touch the nail clipper to a nail and then praise him for not getting upset and give a treat. Keep on doing and increasing time nail touches the nail over the days before vet appt. This video will demo the steps to counter conditioning. I'd build up to ONLY the prep for the vet doing the actual first nail trim on 12/14. With such long nails the vet will not be able to trim to a proper length on the first visit. Expect the process will take several trims a week or so apart to eventually get the quick to recede and allow nail trim to the recommended short length. With Bear desensitized, you may be able to start doing some of the trims yourself. Let us know the details your new vet decides on for trims. It may be of help to another Forum member in similar situation.
-- It will be time to get on with re-introducing Bear to physical activity on 12/13 when you have actual proof there is no pain. How long do you think is best to continue to not have any knowledge about pain?
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