Drew's Scamp 5/6 conserv. DoxMix; GRAD 7/1

Drew welcome!  I remember my own similar situation having to quickly decide between two treatments.  I hope this information will give you a review that you can more easily see what the best treatment at this time would be.  

Most surgeons would not want to operate on a dog who can still walk. They like to try the least invasive treatment first.  For Conservative treatment to work it requires:
1)  STRICT  limited movement inside of the recovery suite that the disc may heal.
Conservative vs. Surgical crate rest


     Potty time means YOU carry Scamp to and from the pottyplace. Set him down on an old peed spot so that  he only takes a very few limited footstep to do his business.  
            Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps.
            Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over.
            A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot.
        An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!
    More tips and idea for at home care here:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/

2)  The pain meds MUST be Rx'd and dosed to provide full comfort from pain round the clock, night and day. You report no pain, so the meds seem to be good for Scamp.  
     Just so you know..... Pain Is Inevitable, Suffering Is Optional.
      It may take 7-30 days for prednisone to resolve the root cause of painful swelling. Pain meds alow the dog to heal the disc in comfort during the time prednisone is at work.
    The best pain medications control is using more than one approach to address pain from multiple fronts (traMADol-general analgesic, methocarbamol- muscle spasm pain, gabapentin-nerve pain). All three pain meds need to be prescribed three times a day as they last for about 8 hrs.

What are you ACTUALLY promptly dosing one single pain med on board as well as the sedative?
    -- Gabapentin (nerve pain med) 100mgs ?x/day actually dosed?
    -- Trazadone (sedative) 50 mgs ?x/day actually dosed
    -- ⚠️Prednisone at 5mgs once a day is not up at the anti-inflammatory dose to work on swelling. It is generally a taper dose that is not included in the 7-30 day range to resolve the root cause.  Were blood tests done that indicated a reason for the low dose prednisone?

3) MONITORING NEURO FUNCTIONS
As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example.
     Nerves do heal in the exact opposite order nerve damage occured.
1. 5/6  Pain with initial tear of disc and ensuing swelling
2. _?_Wobbly walking
   _?_ legs cross
3. _?_ Nails/toes scuffing floor
4. __ Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all
5. __ Weak/little leg movement,
   __ can't move up into a stand
6. __ Legs do not work at all (paralysis, dog is down)
7. __ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors.
8. __ Tail wagging with joy is lost
9. __ Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.
    If surgery is not an option (for whatever reason) then the best option is conservative therapy. 

Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance.
    Precious hours can be lost with a general vet who gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.
    🚩A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/
    🚩Dr. Isaacs indepth Interview on surgery and conservative treatment: dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers

Please keep us updated as you and your vet make decisions, details of any changes in meds, and how Scamp continues to do.  DATES would be greatly appreciated instead of "yesterday, last week" notations.  Before we comment, your previous posts are always re-read. A date ensures no erroneous assumptions are made.  Thank you for understanding.

Thank you, Paula!  Noted on using dates moving forward.  I will be sure to call those out for clarity.

Apologies on confusion with "Will be provided".  I meant that is what the prescription states, and the cadence in which we started at of 8AM today (05/07).  They gave him a [name of?] pain IV last night (05/06) in the ER

I'm unsure why the low dose of Presnisolone.  No blood work was taken during the visit.  Did not realize this would be considered a low dose.

Understood on most doctors not wanting to perform surgery if the patient can still walk.  They offered the option for either treatment, and I was unsure if the surgery gave the greatest chance for the 'fix' to actually stick (understanding either scenario could result in relapse).  I just didn't want to lose time if performing surgery while still having motor function would provide a great prognosis post-surgery (as opposed to after losing function).  We had such success the first time up until this point - surgery was instantly where my head went as the solution.

Ultimately, we landed on doing conservative for now, but admittedly it has me nervous with the unknown! 

I appreciate the time you put into this -- and the quick replies!

Hello Paula - I apologize about another question. Do you feel we should contact the ER about a higher dose of Prednisone? If yes, is there a proper dosage amount to request?

Thank you, Paula! I will follow up with Scamps primary doctor about the proper Prednisone amount.

I will also keep you posted on how Scamp is progressing!

I would love to read sometime how you became so invested in this cause! If you have a bio, would love to read.

Sincerely appreciate all the assistance again!

Hello Paula -- thank you for all the help yesterday!  Zero rush on this inquiry, but I was curious if the image below is an acceptable crate, or if you'd recommend a hex-crate (we have one of those as well).  This is what we used during his original surgical recovery, but I've seen photos of more people using a hex-crate and perhaps adding a little more space. 

Scamp can get up and turn around, but doesn't have the space to do a full body stretch or sprawl out.  I didn't know if he should be allowed to have a little more space that at least allows him to take a few steps to his food/water.  Note:  An interior hung water & food bowl is on the way! I work from home so just offer him water every hour, and he chooses to accept or not

I don't know if this has any validity, but I've historically preferred he stand to eat/drink as it seems to settle better.  In the past (pre-episode/meds) whenever he has laid and ate/drank, he always seemed to dry-heave some as if trying to get it to settle.  Not doing that now, but something I've noticed in the past.

Thank you again!

Good Afternoon, Paula,
I wanted to share we heard from our vet today, 05/09. They shared they’d like to stick with the Presnisolone at 5MG; 1/Day. They spoke to my wife and stated ‘it is a powerful medicine and based on his weight we’d like to exercise caution. If we do not see improvement during tapering, we can revisit.

As such, seems that is what both places would like to try first, but he is resting pain free thus far! (Although could be from the gabapentin).

I’ll let you know if anything changes. Thanks!!
Drew


---------
I called Scamps primary vet today (05/08) to ask about the right dosage. They shared they still hadn’t received treatment records from Cornell but were following up with them.

The vet tech (I assume?) who answered said she believes they prescribed 5MG/daily because of his weight (19 lbs), and that is what they’d probably suggest. I shared for IVDD I’m seeing many dox at lower weight starting their regiment at 10MG/day to help with inflammation, and then tapering off.

She stated she is going to call Cornell to get records and have our vet look into it and call back. I’ll keep you posted when I hear!

As for the pain IV provided at Cornell, I’m sadly not entirely sure. It is not listed on the invoice (just ED visit & discharge RX), nor was it included on the summary paperwork. My wife said she believes it was a pain medicine starting with an M? He certain had something hooked up bc he had a wrap on his foot when returned.

As for Scamp now, he is not displaying any pain or discomfort ❤️. If anything, he is bummed he is being cooped up. His back is no longer arched while walking, and he is going to the bathroom successfully outside (never lost control, but monitoring for any changes). I’m optimistic, but know it’s a long 8-weeks, and we will get a better sense of the status during taper.

Out of curiosity, I’m seeing some groups suggesting acupuncture therapy? Is that something to consider during this phase, or after 8 weeks? Or, if he is showing positive signs, not something to introduce?

Thank you again — we owe this forum big time!!

I should clarify. “Walking” without an arch refers to his potty breaks only. Not the long walks we previously went on every night (and I know he’d love!) haha.

Thank you! Drew

Hello Paula & Team,
I wanted to provide a brief update on Scamp (and apologies in advance because bathroom details below .

The past two nights Scamp has been extremely restless, not getting much sleep at all.  We were concerned it meant he wasn't comfortable / slightly in pain, so we kept an eye on him essentially all night long.

He has been going to the bathroom (pee & normal size / consistency poop) consistencly, including earlier in the day yesterday (05/12).  However, when he was restless again in the middle night (05/12), we took him back outside.  He pee'd, but didn't seem to have an interest in pooping (although not necessarily new, we often have to ask him to poop, but we didn't press the matter last night).

He remained restless - and later that night ended up going to the bathroom a substantial amount all in the crate.  After cleaning everything up and carefully cleaning him, he calmed down and was able to get rest.

After going pee this AM (leg lift and all) but no poop (didn't think he could possibly have anything left), Scamp rested easy until he woke up around 1:30PM, slightly shivering.  I immediately took him outside and yet another substantial large poop.  While it is not all runny, it is not solid -- but normal in color.  He was brought inside and now resting easy once again.

I suppose my question is, do any of the meds we are currently on have 'constipation' or diarrhea as a common side-effect?

As a reminder, below are the meds Scamp was prescribed, and the cadence we have been giving him since 05/07.
- Trazodone 50MG; 1X day [3PM, to keep him calm during evening]
- Gabapentin 100MG; 3X/Day [7AM; 3PM; 11PM]
- Presnisolone 5MG; 1/Day [4:30PM]

I do not believe (or at least hopeful) the poop situation is not neurological.  I'm attributing it to the medicine but would love your feedback/insight if this is common.

Thanks as always!
Drew

Thank you, Paula.  Scamp actually woke up and was shivering again moments ago.  Took him out and this time all runny and liquid.  I immediately gave him the antacid (Famotidine - 10 MG).  Hopefully that will settle his GI tract.  Any idea for how long something like that may take to 'kick-in' / time to be concerned?

I'm going to encourage water in-take to ensure he stays hydrated.

Thank you!
Drew

Drew, here are some things to attend to:

Famotidine is 10 mgs twice a day. Wasn't sure if you were doing 10mgs 2x/day or not.

For most dogs Famotdine alone will do a very good job of protection.  However, when famotidine had not been started at the get go and now you see GI issues, you may need to advocate for getting an Rx for an additional GI protector.  Please read up on it so you know how sucralfate works with food, with famotidine.  SUCRALFATE

⚠️RICE
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.
    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 one teaspoon of plain canned pureed pumpkin 1x a day.
-- To firm up the stool add 2 teaspoona  plain canned pureed pumpkin 1x a day to kibble.

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

Bananas with bright yellow skins, a very few brown speckles contain electrolytes and other nutrients. Diarrhea tends to deplete these nutrients. By eating bananas, some of those nutrients are restored. Green bananas are hard to digest.

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.

Boiled chicken breast with fat disc removed from  chilled broth is an excellent source of protein.

A risk to the disc transport in for a vet appt is not likely necessary for a GI tract issue which could be handled over the phone.  Describe the poop, the color, diarrhea, etc.  An Rx for Sucralfate can be done over the phone.  Your feedback and phone updates will be able to confirm if that was the right diagnosis....acid caused  GI problems.

Check for dehydration during diarrhea:
Skin on the neck when you pull it up it should fall back reasonably quickly and not remain "tented"

Check to see if his nose, lips and gums are wet or dehydrated and have become tacky.

Pull up the lip and press gently on the gum which is normally pink. When you press down it will turn white and when you release the pressure it should turn pink again right away.

Please keep us posted, Drew.