Cynthia's Piper 9/16 conservative; Terr-chi-dox; GRAD 1/1/24

[Original subject line:6.5 year old newly diagnosed with IVDD-- med mishap? ]  

Our terrier/chihuahua/dachshund mix presented with pain (shaking, not eating, yelping from some movements, not taking the stairs, refusing to jump on the bed) on Nov 4th-6th. No other health issues. 6.5 years. 9 pounds. 

We took her to the ER vet on the 6th and they diagnosed her with IVDD based on tenderness/pain associated with the lower spine, right by the tail. The prescribed 3 weeks crate rest, Gabapentin (.8mL every 8-12 hours) and Metacam (1.5 mg/mL; .25ml once per day).

[MED LIST/HISTORY- Moderator's Note. Please do not edit
 9 pounds  6.5yo
Nov 4 pain only symptoms
metacam 1.5 mg/mL as of 11/6: 0.25mL 1x/day ?x/day for 20+ tba days, then a STOP test for: _pain / _neuro 
gabapentin formula ?mg/mL:  ?mg (0.8mL dose) 2x./day  
Your girl needs GI tract protection: Pepcid AC + ASAP Sucralfate, on board for duration of Metacam!   ] 

She seems to improve day by day—no yelps of pain, no shaking and adjusted to her crating and limited movements well. Ate and drank normally. She can pee and poop well and never lost the ability to walk and doesn’t appear to have any neurological damage.

Went to our regular (but new to us) vet on the [Nov] 16th who recommended tapering the meds down and adding more exercise (including stairs!) to prevent muscle loss, but we want to stick to the crate rest. We figure she should never do stairs again, nor jump on furniture—correct? 

On the [nov]18th and 19th, she seemed bothered—in pain? Eventually wouldn’t eat and appeared to have a stomachache.

Today, the 20th, she vomited A LOT of blood. Slightly mucousy, but no food/chunks and solid red. We took her to the ER again and they recommended stopping the Metacam. They have instead given her some liquid to sooth her tummy for 5 days (Sucralfate ¼ gram every 9 hours), want us to continue the Gabapentin (we already reduced to 2X/day last week), and offered Codeine (7.5 mg/12 hours).

She seemed like she was on the mend, and not in pain, and we were going to reduce her meds, but now we have this new wrinkle. After this experience, and reading this site, I am SO MAD that they didn’t suggest something for her stomach. And I am even more hesitant to use medicine.

What would you recommend? Does healing the tummy with Sucralfate sound reasonable? Any supplements or other strategies that are gentler on the system?

Is it still okay to taper her meds? I am wondering if we can NOT start the codeine. Are we at a loss without the anti-inflammatory? Is the idea to stick with crate rest for the next two weeks, and gradually reduce pain meds, only using them as she presents with pain (which is a bit hard to precisely know)?

I just saw this in another post. So with the absence of the anti-inflammatory, we might expect to see an increase in pain. And the codeine sounds like a no go (why, oh why, did the prescribe it then?!); so then should we already now return the Gabapentin to 3x a day, or just wait and see how things are going?

"Codeine is not a recommended analgesic for dogs or cats. It is generally only available in combination with acetaminophen (Tylenol) which makes it completely unsuited to feline use. Its use in dogs is discouraged as most dogs lack the CYP2D6 enzyme primarily responsible for the conversion of codeine to morphine, its most active metabolite. That being said, there may be some analgesic value to codeine in dogs via the C6G metabolite."