Sara's Stuart 12/18 Conservative; GRAD 2/12/24

An update: I spoke with the vet this evening who is recommending to switch to a [name of?] steroid since he has deteriorated since the vet examined him. He recommends to start [12/21] tomorrow morning. He also prescribed ✙amantadine along with continuing the gabapentin. Yes, he is eating and drinking fine. He’s not showing any signs of pain that you mentioned. Thank you for the tips on potty and others.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
17.3 lbs 5 y.o.
12/17 pain, 12/18 wobbly backlegs
carprofen as of 12/17: 37.5mg 1x/day for ? days, then test STOP for: _pain? √12/18 wobbly neuro?
gabapentin 100mgs 3x/day
amantidine as of 12/21  ?mg    ?x/day 
Stuart needs GI tract protector, Pepcid AC, on board for duration of Carporfen!
  ⚠️ if switching to a steroid w/o 5-7 days NSAID washout, then needs both Pepcid AC + Sucralfate]

Stuart was given 25 mg carprofen on December 17 (from Cody’s previous prescription) and then started the 1/2 tablet of 75 mg carprofen once per day on the 18th and his last dose was [12/20] yesterday.

He is also getting Pepcid AC.

He started 5 mg ✙prednisolone [12/21] this morning which is prescribed every 12 hours for 4 days, then once a day for 4 days, and then one every other day for 4 days.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
17.3 lbs 5 y.o.
12/17 pain, 12/18 wobbly backlegs
carprofen as of 12/17: 75mg 1x/day for 3 days, STOPPED 12/20 √12/18 wobbly neuro
✙prednisone as of 12/21: 5mgs 2x/day for 4 days, 12/25 test TAPER for: _pain/ _neuro
gabapentin 100mgs 3x/day
amantidine as of 12/21 ?mg 2x/day
✙Pepcid AC 10mg ?x/day
⚠️ if switching to a steroid w/o 5-7 days NSAID washout, then needs both Pepcid AC + Sucralfate]

He’s still wobbly on his feet today but better than yesterday. I carry him to and from his potty spot. He’s very bored so I have provided him some toys in his crate. He was prescribed 25-50 mg amantadine every 12 hours. I have not yet filled that prescription. He has a recheck appointment with the vet on January 3rd.

I did ask about both Pepcid and sucrafalt and the vet said that the literature does not support it being any more effective than without. I am still giving him the Pepcid anyway. He does specialize in pain management. I suppose I could call and ask for the sucrafalt to be prescribed anyway. He is eating and drinking normally and seems comfortable so far.

Thank you for the advice. I called and left a message for the vet to prescribe sucrafalt. I’m giving him 10 mg of ✙Pepcid with his steroid.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
17.3 lbs 5 y.o.
12/17 pain, 12/18 wobbly backlegs
carprofen as of 12/17: 37.5mg 1x/day for 3 days, STOPPED 12/20 √12/18 wobbly neuro?
✙prednisone as of  12/21:  5mgs 2x/day for 4 days,  12/25 test TAPER for: _pain/ _neuro
gabapentin 100mgs 3x/day
amantidine as of 12/21 ?mg  2x/day
✙Pepcid AC  10mg    ?x/day 
⚠️ if switching to a steroid w/o 5-7 days NSAID washout, then needs both Pepcid AC + Sucralfate]

To add he’s getting the 10 mg Pepcid 30 mins before steroid ever 12 hours. It is late here but will hopefully hear back from vet tomorrow about the sucralfate. Question about sling. He’s intact so I’m concerned about where to put along with testicles getting in the way. I haven’t tried it yet but I assume the sling would work behind them and not hurt them. Weird question.

The prednisolone works on reducing swelling of the spinal cord. It is this that causes the pain of IVDD and any neuro deficits. But once a nerve has been damaged, the prednisolone cannot help. The only thing that helps damaged nerves is time. A steroid taper can start before Stuart has his full balance, as it may take time for this to happen.
A steroid taper is a good time to determine if pain is still present. If pain is still present, so is inflammation, and the dog should start back on the full dose and a taper tried again in a few days. It is quite common for dogs to try to taper more than once. Most vets stop or cut back on pain meds during the taper. The reason for this is that pain meds may mask the emergence of pain during the taper. If this happens, it will take longer to know if all the pain, and therefore inflammation, is gone or if the dog needs more time on the full dose of pred.

Sara, do monitor Stuart.  The amt of gabapentin for nerve pain and amantidine to enhance should not be enough to sedate him.  So why is he not wanting to move much and is not interested in life around him?  Is he in some degree of pain (muscle pain needing methocarbamol) or a general analgesic such as traMADol?)  Is his tummy bothering him since there is no sucrafate on board with the Pepcid AC?

What does his stool look like?   GI tract damage causes: not wanting to eat, vomit, loose stool, bleeding ulcer, red or black blood in diarrhea. 

I'm glad to hear that Stuart feels calmer in the larger crate.  Do keep in mind though that the recovery suite should only be large enough for Stuart to stand up, turn around and lie comfortably on his side with his feet extended.  Any extra space must be filled in with rolled up blankets/towels.  The less movement in the crate, the better.  Think of the crate as a cast for the spine.

Please take a look at these ideas to help keep Stuart calm and relaxed in his recovery suite.  

Try to keep a happy voice and face around your dog. Dogs are very sensitive and pick up on our feelings very easily. Tell him everything's OK and that he's getting better every day. And you believe it, too!

To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him/her. It also creates a den like feeling that dogs love.

Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price.

Place a DAP pheromone diffuser at floor level where the recovery suite is.

Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones

Use a diffuser with one oral calmer from below:

1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed

2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.

3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba)

Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc.

Consider some of these ideas:
-- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising and only inside during conservative care. More details on strollers: www.dodgerslist.com/literature/strollers.htm
--Caster wheels can be added to a wire crate so the crate can be wheeled from one room to the next so your dog can stay with you.
-- Put a garment you have been wearing and have not washed in the crate.
-- Nan Arthur, CDBC, CPDT, KPACTP writes:
"According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day.

Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.]

-- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on 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 on high.

-- Play classical music or one of the wildlife TV shows.

-- Fill a Kong with soft dog food and freeze. Put part of the dog's total daily dinner kibble in the Kong to lengthen time to consume dinner. Good low cal snacks are carrots, apples, or frozen green beans, licking a frozen low sodium broth ice cube. Good thick low salt/no fat chicken broth is full of cartilage-building proteins and amino acids. Freeze it up into cubes for easy access as you need it. Fun and keeps the body hydrated: place cubes in a bowl for licking.

If a dog is jumping up at the sides of the crate, you can lower the ceiling of the crate. Cut a piece of cardboard the size of the top of the crate, punch holes in the corners and tie the cardboard down into the crate to the level of the top of the dog's head when standing. Or cover the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he/she jumps up, he won't be able to see anything. That may discourage him/her from jumping up.

        dodgerslist.com/2020/05/14/strict-rest-recovery-process/

        dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite/

Sara, what a wonderful report on how comfortable he feels!  And what a lucky dog to have not had any stomach damage with the switch w/o double protection.

When will gabapentin 100mgs 3x/day  AND  amantidine 50mg 2x/day be stopped? Until pain meds are gone, no one knows for sure if all painful swelling exists. No one knows if there is still work for prednisone to do.  Pain meds do a good job of blocking pain from your eyes.

It is fine to roll Cody onto the deck with you for some fresh air. Do wait til graduation day before strolling him around on the street or anything bumpy. The stroller will also be nice to use in the house to keep him by your side as you go room to room.  Always supervised while in the stroller for safety reasons.

It takes 8 weeks of strict crate rest for secure scar tissue to form on the exterior of the disc. Graduation day is likely to be 2/12, 56 days since crate rest began.

I am sure it is difficult for Stuart to watch Cody go out for walks when he cannot. I am not sure about the layout of your house, but if you could move him into another room when leaving with Cody, it might help. Stuart will probably still know, but at least he will not have to watch it.

Does his rear end trembling seem like pain to you ? This can be a sign of pain, but to be sure, we look for another sign to confirm. These are the signs of pain we look for:
- shivering or 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 in suite such as shift positions
- not their normal perky interested in life selves

An update on Stuart: he had his vet appointment today. The vet noted [1/3/24] that he is slow of both back paw flips but is responding. He noted no signs of pain during the exam. He prescribed laser therapy 3 times per week for 2 weeks then a folllow up to see his progress and next steps, including if surgery would be needed. We could afford surgery but I’m just not sure if that is the best course of action if conservative crate rest could also be effective though I’ve seen the stars for reoccurrence for conservative vs surgery and surgery seems to be better. But guess we will wait and see.