Denny's Osito 5/16 Surgery4wks NECK Boston/Dox; GRAD 6/14

We have more information about steroids vs NSAID here:
More info on crate rest is here:
STRICT means:
- no laps              - no couches
- no baths           - no sleeping with you
- no chiro therapy - no dragging or meandering at potty times
All anti-inflammatories, like Rimadyl, cause excess stomach acid. This sometimes results in serious stomach damage. To lessen the chance of damage, a stomach protector like Pepcid-AC is used. Ask your vet if Osito has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
More information on stomach protection is at the link below:
It is very upsetting and scary when our dogs have IVDD. It becomes less so when we learn all we can about the disease. More information can be found at our main website:
www.dodgerslist.com

You can try some of the suggestions found at the link below.
dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite

The section titled "Tips and hints to extinguish unwanted behavior" in particular.

How often are you actually dosing Gabapentin 100mg?   every 8 hrs or every 12?

How old is Osto?

Denny, good to hear gabapentin at only 2x/day is doing the job to keep Osito free of pain.

As a refresher for you since the last disc episode was a surgery.
Rest must be necessarily more strict than it was for surgery. The 8 weeks of rest is for disc healing and avoiding a relapse, starting from square one to heal the disc.


ANTI-INFLAMMATORY during conservative treatment
The anti inflammatory, Rimadyl, could possibly take 7 to 30 days to resolve all painful swelling around the spinal cord. Vets simply must guess how many days to use Rimady.. Often the approach is to RX a 14-day course of Rimadyl.  At the Rimadyl stop on 5/28, the vet will learn from your observations if another course is needed or not.  For many dogs, Rimadyl can do the job on a 14-day course.  Fingers crossed that will do it for Osito.

You job with the projected 14-day course of Rimadyl TEST STOP on Tues 5/28 is to monitor for surfacing pain.
1) Let us know what you and your vet have for a PLAN B should pain arise when he's not open?
2) Let us know on 5/28 if the single pain med, gabapentin, will also be stopped to give you a quick and accurate assessment about pain?

No Pain= no meds at all needed...
finish out the 8 weeks of crate rest for the disc to heal. 

This page is a good review of how Rimadyl is used during conservative treatment. This kind of knowlege allows you to understand your vet's treatment and ask good questions.    

Also more about:
1) Protection against stomach acids Rimadyl causes. Dogs don’t speak up at first signs of trouble like a person would.  By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life-threatening perforated stomach.
Pepcid AC ==> dodgerslist.com/2020/05/06/stomach-protection/

2) Your options for a Plan B   ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/

*

Denny as you learn more post-op, let us know how the surgery went and how Osito is doing.

Denny, I know what a quilty feeling that is. How about a med chart to keep the doses from being missed and gives a place to make notes.

A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds
dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf
(After 5/20:  dodgerslist.com/wp-content/uploads/2023/12/med-chart-printable.pdf)

⚠️There will be a switch in classes of anti-inflammatory ( NSAID, Rimadyl to STEROID prednisone in 3 days starting 5/19.  


There normally needs to be a 5-7 day washout period when switching from a NSAID, Rimadyl to a STEROID, prednisone.
    However, should the surgeon deem it medically necessary (extreme pain, neuro diminishment) to switch w/o a washout, a switch can be made without a washout period by adding TWO stomach protectors:
---Sucralfate marvistavet.com/sucralfate.pml
---Pepcid AC marvistavet.com/famotidine.pml

Please advocate for both Pepcid AC and Sucralfate. And learn their timing with food, with each other.  The sample med chart referenced above will also give you an idea of timing meds.

A bit worried about the upcoming switch. Please keep us updated. And monitor for GI damage signs :  nausea (lip licking), not wanting to eat/drink, loose stool, vomit, bleeding ulcer, RED or BLACK blood in diarrhea.

When things settle down, let us know:
---What is the gabapentin formula noted on the bottle:  
      1. How many mgs gabapentin in on mL of liquid?   
      2. How often are you actually dosing gabapentin. It is nice to know there is a range. But we like to know what you actually give.
--- Prednisone as of 5/19:  ?mg    ?x/day 
    

Denny, thanks for including all the background information about the meds.

I would give gabapentin PROMPTLY evert 8 hrs.  Gabapentin lasts for 8 hours in the body.

MAKE SURE Osito's PAIN IS fully in control day and night. Pain free right up to the next dose of gabapentin:
1) James S. Gaynor, DVM, MS, DACVAA, DAAPM
Veterinary Anesthesiologist, Peak Performance Veterinary Group, Colorado Springs, Colorado:
Good pain control has a number of significant physiologic benefits. Pain elicits a stress response that’s important for survival, but it’s detrimental when severe or prolonged.... breaks in analgesia lead not only to an uncomfortable patient but also to maladaptive pain that serves no purpose, which makes it more and more difficult to keep the dog comfortable.

2) The veterinarians at Best Friends Veterinary Center give a good explanation about complicated topic on pain:

· It is easier to prevent pain than to get it under control once it is there. It also takes higher dosages to bring pain back down once it is present. The best pain management preempts the pain, cutting it off before it has a chance to start. This is why we usually have you start your pet’s pain medication prior to surgery, and why we use high doses of medication immediately following a painful injury or procedure and then taper down gradually.
·         Pet owners get worried when their pet is groggy and “drugged up” but that’s normal when a dog or cat is on strong pain medication, just as it is for a human on morphine. Animals can’t push the button on the morphine pump so we have to guess at how much medication they need. It is always better to have a groggy pet who is comfortable than one who is painful.
          Pain reinforces itself. The more pain transmitters are used up the harder the body works to replace them and the more become available to trigger yet more pain. With severe pain, even gentle touches can trigger pain because the whole nervous system has been over-sensitized. This is called “ramp up.”

STOMACH PROTECTION
When on ANY anti-inflammatory drug (Rimadyl or prednisone) the GI tract should be protected for the duration of its use.

Let us know if you are dosing Pepcid AC 5mgs twice a day (every 12 hours.  Pepcid AC lasts for an effective 12 hrs.

Confirm: Pepcid AC (famotidine) 5mgs ?x/day (should be 2x/day--every 12 hrs)

Call and explain his behavior. Ask for a traZODone or other drug to help him be able to relax in his suite.

Denny, while the surgeon may not be on duty over the weekend, there are vets there who can access Osito's file and adjust meds.

Confirm: Pepcid AC (famotidine) 5mgs ?x/day (should be 2x/day--every 12 hrs)

Assume a BIG surgery will be a painful thing. Don't think about scrimping on pain meds.  The pain due to the operation itself usually finally goes away in about 12 days.  Make sure Osito is not deprived in mgs nor x/day doses.... Pain meds last for 8 hrs. 

We are a group who LOVE the detail.  So your saying "pumped up" means you give:    Gabapentin 1.2mL dose promptly every 8 hrs (3x/day) ?

Denny, your report warms my heart and makes my day. I am so happy for Osito. Good job pet parents... you got things under control for Osito.

Denny, it takes all of the surgery caused swelling about 14 days to resolve. It is VERY typical to give 2-3 pain meds promptly every 8 hrs to make sure the dog suffers with no pain for about 2 weeks.

Osito, you are telling us is pain free with only one pain med (gabapentin) given promptly every 8 hrs. That is wonderful!

Denny, most surgeons want either 4 or 6 weeks worth of post-op rest to heal all the surgical areas. This post-op rest includes the surgeon's directed at home PT.

Once the directed post-op rest has been complete, then a dog can safely start a gradual reintroduction back to family life and PT.

We wait to hear from you the number of weeks the surgeon has directed for post-op rest.

Once we know Osito's graduation date, then we will ask for updates on his current neuro situation.
   -- the current neuro issues:  wobbly legs, knuckling under paw?, can't move up into a stand by himself,  etc.

Your answers is our base to reply on specific things you can do for that safe, gradual transition back to his home life and ideas for getting PT, if needed, at a clinic or things you can do at home.

Let us know how many weeks Osito has been directed for post-op rest so we, too, can mark our calendar for Osito's graduation day.

I hope you can get a more detailed schedule for Otis' return to activity. It always should be slow and steady to help build up muscle strength, but too much activity to early can prolong healing of the surgical site.

Denny, if you are saying your surgeon directed 14 days of strict post-op rest, then Thursday 5/30 would be the graduation date.

This is the comment we would start to make knowing that Osito has currently only a small degree of weakness in his right rear leg.  Let us know if we should hold off to a different graduation date or continue on....

GRADUATION, A SLOW RE-INTRODUCTION
     Determine how you are going to ease back into more normal activity at graduation from rest. The idea is to gradually give more freedom under controlled conditions. Not free rein of the house nor yard immediately! LOL
      Osito's muscles are soft and out of shape after the rest period. Take a look at our information. Gradually building your dogs muscles over a month's time will have your dog safely running and having fun again!

SAMPLE SCHEDULE
Here is a sample schedule to safely and slowly introduce your dog back to family life and physical activity: dodgerslist.com/back-friendly/

DIY back PROTECTION around the house
 
  
1) Good ideas in making your home back friendly:   dodgerslist.com/home-protect-ivdd-backs/

2) In case Osito would find he doesn't have good leg control on slick floors.... here are ideas and products to provide improved traction: dodgerslist.com/traction-solution-improvements/

3) Teach him to be safe and not jumping up or down, but to use a ramp whether over steps leading outdoors or to furniture in the house.
Dogs are best at visual learning rather than verbal commands. Dog trainer Anna Jane Grossman says “Dogs learn in pictures. Inside your dog’s brain is a very simple algorithm – pleasant images in one place and unpleasant images in another."

If your Osito is one to take shortcut off a ramp.... here's how to train for that:

and more ideas we can offer........ when you know the graduation date.

Denny, it would not hurt to reconfirm if our slow and gradual things are in line with your surgeon's for Osito.

IF so, and 2 weeks of rest is what he directs, this is my caution to ensure no rowdy, energetic movements for Osito and is always supervised. Always in your control via a leash attached to the harness.  From now on collars are just to hold his tags.


Also, even though prednisone is now on the taper, it IS still in his system.  It may make him feel good as new.  And thus make him eager to overdo things.

So be very cautious of not allowing Osito to jump up or down, dart of running maddly after something.  That is too much movement for the surgical areas.  Look for activity that is slow and gently.

So with all of that in mind, pat yourself on the back for the wonderful care you have been giving Osito!

HAPPY DAYS AHEAD
1) You and your dog have survived a disc herniation! Learn what you can do from this point forward in a quick illustrated summary. Especially good to use with youngsters who may be around Osito to help them understand Osito's disease: dodgerslist.com/wp-content/uploads/2024/04/ivdd-6-Life-with-IVDD-Dodgerslist.pdf
2) Now for the nitty gritty of living with an IVDD dog. How to handle dentals, nail trims, safe ways to have fun together, and more on this page.
dodgerslist.com/after-graduation-living-with-ivdd/

PT THERAPY AT CLINIC or HOME
     The way you describe Osito's pretty good leg ability with some slight weakness stability, doubt he needs anything from a clinic.  
     However, if you believe he could use extra help or means of safe exercise... it would be getting underwater treadmill for him.  
    dodgerslist.com/surgery-dog-water-therapy/
NOTE: You can also use those same water treadmill principles of water height at home in a $15 child's inflatable pool as described in the underwater treadmill video here:  

The movement of the hip joints and muscles and the changes in pressure on the paws from the underwater treadmill triggers spinal cord communication with the brain. Water buoyancy makes it easier than leg movements against gravity. Muscle re-education and strength to perfect the art of walking a normal gait.
-- Strengthening core muscles at home.
This applies not just for humans, but REALLY applies to the IVDD dog:

Core exercises don't require specialized equipment. These are 4 exercises you can do at home: 1) Sit to Stand, 2) Down to Stand, 3) Three Leg Stand, 4) Backing UP.
The last exercise presented in the video, ⚠️HIP extension, is NOT for dogs with IVDD back disease!