Marissa's Hank 9/17 Surgery (was 8/27 conservative)

Welcome to Dodgerslist Marissa!

Sorry to hear about Hank's IVDD episode.. We are here to help. In order to help you I need to ask some questions.  What breed is Hank and how much does he weigh?  What date did he first see the Vet and begin crate rest?  Tell us a little more about the beginnings of this disc episode.. 

I am concerned about 25 mg Pepcid.  Normally we give 5 mg for our small dogs.. If he is larger then that may explain the 25mg.

Tramadol is a pain reliever and I see he is no longer taking it, I hope that means he is no longer in pain..

The Vet wants Hank to ween off the Dexamethasone to check to see if the swelling and inflammation has been resolved.  If there are no signs of pain such as shivering, tight hard tummy, yelping, reluctance to move, not his happy perky self,during the taper of the Dex, then the taper can go to completion and afterward no medications will be necessary.  If there are signs of pain, call the Vet immediately and let him know so he can prescribe another course of Dex and pain medications.. If that happens don't worry, it is common. It just means it is not yet time to taper.. The taper can always begin again a bit later. 

For constipation add the pumpkin and water to his kibble..

Sounds like you have been reading up on IVDD and that is wonderful. Here is a links to continue your reading..
www.dodgerslist.com/healingindex.htm   www.dodgerslist.com/literature.htm
 
We are here for you, if you have any questions ask away.. 

Hi Marissa, I just want to chime in here and give you a clearer picture of the medications you mentioned. First of all, Tramadol is an opiate-like pain reliever - it does NOT control inflammation or swelling like a steroid does. It is usually given IN ADDITION to a steroid. The steroid controls the inflammation and swelling on the spinal cord while the Tramadol controls the pain. Dexamethasone and prednisone are steroids. They are given until the swelling is gone from the spinal cord. When you taper a dog off a steroid, if pain returns, that means the steroid is NOT done getting rid of all the swelling, and a longer course of steroid would be indicated. Glad you're giving the Pepcid to protect the stomach. The usual dose for a dog up to 15 pounds is 5 mg given 30 minutes before each dose of steroid.

Here is a link on how conservative (non-surgical) treatment works. It consists of 8 weeks of strict crate rest plus meds. It is the crate rest (minimized movement of the spine at all costs) that heals the disc while the meds mask the symptoms. Please read through it and you will better understand what Hank needs: www.dodgerslist.com/literature/conservative.htm

Strollers are great. Just don't leave him in it unattended and only take him on smooth surfaces in quiet areas. Here's a link on strollers: dodgerslist.com/literature/strollers.htm

We look forward to hearing how Hank does! Best wishes, ~Lisa

Marissa, you'd have to ask your vet about dropping down the dose. If you are giving the steroid twice a day, then you would give the Pepcid twice a day. Perhaps he has you giving 10 mg once instead of 5 mg twice. Not sure. In any event, I'd check with your vet.

Best of luck with figuring out surgery. Remember though, even if you can't get the surgery, he may still recover with conservative treatment. We've seen it happen thousands of times. ~Lisa

Marissa, I hope the vet visit today will get pain meds on board pronto. Pain meds can be tramadol and methocarbamol together. If there is to be surgery shortly then they may want to reduce Dex. But the important thing today is to get pain under control.

If you will be continuing with conservative treatment, we need some further clarification to best help you:

A steroid would need to be continued back at the original anti-inflammatory level of dose. Please clarify for us the mg's of each of his meds that are prescribed. Currently we understand only a part of what he is taking.

======
13.5 lbs.
Pepcid AC 10mg 1x a day    [it is usually to give 5mg of Pepcid AC 2x a day. Give it 30 mins before the steroid and give the steroid with a meal for best protection of the stomach]
Prednisone 8/27- 9/6
▲Dex started 9/6, currently half tablet of once a day [how many mg's of Dex is given?]
Pumpkin [Pumpkin can cause constipation OR it can help to loosen stools.  The KEY is water.
 To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. To firm up the stool add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato.]
No pain meds on board 
Anti-biotic  [what is the exact name, dose in mg's and frequency given?]
======

What Dr. Nancy Kay, DVM, ACVIM  writes so aptly fits the disease that Hank was born with…disc disease:
"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  You want to protect Hank during this disc episode and know how to live with this disease in future years. Being a reader is what it takes to become the captain of Hank's health care team..to know which vet to hire, to question and ask so you have a full understanding of the WHYs behind your vets treatments. Forturnately Dodgerslist in conjunction with veterinary professionals has been documenting this disease to help owners quickly get up to speed on IVDD. This treasure trove of information is at www.dodgerslist.com/healingindex.htm

The reason to be on a steroid is to get swelling down and over 1-2 weeks or longer to get all the pain resolved. So the Holistic vet was incorrect to continue to taper Dex because there was no noticeable improvement. Getting swelling resolved just takes time. Improvement of leg function may or may not happen during the 8 weeks of crate rest as nerves are very slow to self repair.  This page will help you to understand each of the phases of healing and which you must have patience for and which you can't have any patience with.  The word "improvement" is just too general of a term, we owners need to be precise in our understanding to best communicate with vets. Here's the link: www.dodgerslist.com/literature/healingpage.htm

Here is how a taper of a steroid works and why it is done:
Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. When the vet guesses swelling might be gone there will be a taper. The dose is lowered to less than the anti-flammatory dose, your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain and immediately reporting back to the vet.  

Rule of thumb is:
pain = swelling = more time on Pred needed.

If there is no pain on the taper then it goes to completion. Then no meds at all are needed. Disc healing will continue for the remainder of the 8 weeks.  Nerves can continue to self heal…think in terms of months.

Thanks for the reply, Paula!

To clarify his meds:
Steroid: Dexamethasone- 5 mg pills - he is down to ▼2.5 (half a pill) once a day now
Anti-biotic: Clavamox - 125mg pill twice a day
Pain: Tramadol - 50 mg pill twice a day

I did ask the vet about the steroids and he said to leave as is until we get more info on the consult tomorrow morning. As of right now, Hank is on .5 tablet of Dex once a day.

I was also instructed not to feed or give Hank any of his meds tomorrow morning before the consult.

*UPDATE*

Hank was able to get surgery yesterday! However, unfortunately we had to rush him to another hospital because the Animal Trustees did not have the instruments to take a good picture of his back. We were really concerned because he did not have feeling in his right rear leg.

He officially has a herniated disc between his L11 and L12. The surgery went well and today he is doing well today - he has feeling back! He will stay in the hospital one more night. They are taking him off the morhphine this afternoon so I will be able to visit later!

Question: Is it normal for dogs to need help going to the bathroom after surgery? If not, is it a bad sign if I have he can't and I have to express his glands myself?

Thank you dodgerlist for your support so far! My adoption agency, Central Texas Dachshund Rescue, family and friends have been extremely instrumental the last few days. I know it is still a long road of recovery - but I feel grateful that at least his the build up on the disc was cleaned out.

StevieLuv - many thanks for your advice, especially your thoughts and prayers for Hank!

I will be sure to look over all those sites before they discharge him tomorrow.

He is not home yet, but I am picking him up in 1.5 hrs! They said he has all his feeling back and was even wagging his tail!! I am going to have to express his glands for now as he is still unable to go potty on his own. I am excited to have him back with us!! I will post an update late tonight with his status.

Thanks for asking, StevieLuv!

Thanks for the tip, Paula! He actually went on his own last night when we got home! He did not go as much this morning though so I will keep monitoring- - I think he did not go because of the wet grass. He never went potty in wet grass before this happened either.

Does anybody have any tips on how to use the harness properly? I just want to make sure I am doing this right. I started using an old belt (vet recommended) and I sling it right in front of the hind legs to lift his rear so he is not dragging his legs. Is this ok?

I also want to share the official diagnosis and recovery instructions from the vet:
Diagnosis: intervertebral disc herniation at T-11 - T-12.
Surgery: A right sided hemilaminectomy was performed at the T-11 - T-12 and T-10 - T-11 disc spaces. A large amount of chronic extruded disc material was removed. Fenestrations were performed at T-12-T-13 and T-13-L-1.

Crate rest: Hank must be confined to crate for the next 6 weeks.
Urination: please take out 3-4 times a day to urinate and defecate.

Rehab:
Passive range of motion: Please place both hind limbs through a full range of motion three times a day as shown at discharge. Perform 20 repetitions for each limb.
Weight shifting exercises: Stand Hank on a non slip surface and support his hind limbs by holding him at the hips. Then sway his wips from side to side. Perform 20 repetitions three times a day.

Medications: .5 tablet of Tramadol (50mg tablets) by mouth every 8 hours for the next 7 days. They advised me I could cut down to two by Monday if he looks better.

We have a follow up with the surgeon in a week.

Hank sounds like he is well on his way to recovery! Love hearing progress reports like this one. We used an old scarf to support Stevie's hind end when taking her out to potty - it was longer and I didn't have to stoop so much

Hank is making wonderful progress!