John's Thalia 5/25 conserv. NECK, Doberman; GRAD 7/20

Welcome!   Please let me know if you are John and your girl is Thalia.  We do want to get your names correctly.  I'm Paula, and very glad you have joined us all here.

I will be watching for your introduction of your girl with answers to our questions. 

Until then I can offer the same general information that you likely can find elsewhere on the internet.  Hoping this information goes towards you being able to come to a surgery or non-surgery treatment, have a good question and answer talk with your surgeon in deciding which treatment.

#1 is of course doing the 100% STRICT rest to prevent the neck disc from further damaging the spinal cord  beyond dragging the right front leg. With a large breed dog, it may be unsafe for your own back to lift and carry her.  And it may be unsafe as in you can safely keep her back supported under both ends of her body and keep the back parallel to the ground.  Check out these large breed care tips to use at potty time and more:
🚩 dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/  
NOTE.  It is still important that the amount of movement to the potty place be minimized to a few minimal footsteps to take care of business.
--One of several tips explained:  try a pee pad right outside and adjacent to the crate.

Full scope of how to do non-surgery conservative treatment until or if you decide on a surgery:  🚩  dodgerslist.com/strict-rest-recovery-process/

EXTRAs you can do at home for a Neck disc
🚩  dodgerslist.com/cervical-care-tips/

HOW TO DECIDE on which treatment:
🚩 dodgerslist.com/surgery-vs-conservative/


TOOLS to monitor and understand the full picture of non-surgical treatment


1) Help all of your family recognize emergency signs and action to take.
  🚩 dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf
 
2) 🚩 dodgerslist.com/ivdd-healing-the-torn-disc/  the 4 phases of disc healing.

3) Avoid dangerous detours during non-surgical conservative treatment.  D/L and tape to your fridge for handy reference.  
🚩  dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf

I'm having difficulty in noting the date of med use. This is important information to understand what is going on. Data from you is what we base our comments on.

Please add a date of start or when  stopped to these meds:
-name of Nsaid were stopped 5/23

-Prednisone 10 MG as of Monday 5/27: then 1 Tab every 12 hours for 5 days after that then 1 tab very 24 hours 7 days then 1 Tab every 48 hours 7 doses (Actually only one dose was given and then pred was stopped on date?)

- Omerprazole 20 mg  2x/day  Date started  Date if stopped?
- Famatodine twice a day    ?mg   2x/day. Date started?  date if stopped?
- Gabapentin 300 MG every 8-12 hours (which actually dose promptly on time?)
- Trazadone 100 MG 8-12 hours (which actually dose promptly on time?)
- cerenia   ?mg    ?x/day    Date Started?  Date if stopped
- Metronidazole 1 1/2 250 mdtabs every 12 hours
- Carafate 3 times daily   ?mg    3x/day   (how many grams in one whole tab?)  Start date?   Date if stopped?
- Endosorb   ?mg    ?x/day     Start date? Date if stopped?    

Thank you, let me organize my thoughts with this current information and then reply

John, let us know if you stopped the meds personally or if the vet is the one who has Thalia on these current meds?

We always like to know the credentials of the person changing meds, given a treatment etc.

Any any event..these meds seem appropriate as long as Thalia is not showing any signs of pain from a disc episode nor new/increased neuro diminshment from the suspect neck disc.  Typically a neck disc is a very painful thing requiring usually 3 different  pain meds to get pain in control.  Thalia is no longer on any pain med.

Thalia's current med list, please review for correctness:
cerenia inj 5/29 by general vet
cerenia tabs as of 5/30: 24mgs for 4 days, ends 6/4
Carafate 1gm tab: 1000 mg 3x/day
Metronidazole antibotic 250mg tab as of 5/29: 375mgs (1½ tabs) 2x/day
Endosorb 1.5 gram tab: 3g (2.5 tabs) ?x/day
Trazadone 100 MG used once 5/25 

Generally, the GI protectors are used for the duration of any anti-inflammatory drugs because they cause extra acid production.

There are other factors that also cause extra stomach acid:  STRESS!  Thalia's whole world has changed.  She requires strict rest inside of a recovery suite that limits her movement.  Her GI gut  is very stressed as evidenced by blood in her  red stool. The lower digestive tube lining has been breached with red blood another stress on the body.

Discuss with a vet you trust, if adding back in Famotdine (it works in 30 mins) to reduce stomach acids.

Make sure you are effectively using the Carafate (sucralfate):
Sucralfate.  Sucralfate not only “bandages” the ulcer but accumulates healing tissue factors in its bandage; it not only protects the ulcer but actively assists in the healing procss. In order to be most effective, this med should be given:
1.  30 minutes prior to Pepcid AC, if your vet concurs it should be brought back in use.
2.  Give Carafate on an empty stomach at least one hour before feeding. 
Read up on all meds your dog is on.  Here is the link to carafate (sucralfate) marvistavet.com/sucralfate.pml

I recommend a med chart if you are not yet using  one:
        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/2023/12/med-chart-printable.pdf
        So below is a possible dosing schedule for first dose of the day. Again you can "inch" up or back an hour a day til you achieve a schedule that works for you.
    5:00am sucralfate
    6:30am Pepcid AC  (how many mgs had been Rx'd for Thalia)?
    7:00am 
    7:00am breakfast

** i.postimg.cc/6QLMK2Jp/Med-Chart-PREVIEW.jpg

John, during conservative treatment there are 4 phases of healing. Each take different things and have a different length of time to heal. More on how to monitor and be aware of each phase later on. 

Some history and information seems to be missing for these chain of events. Can you fill us in?

4/29 drags front right paw;
       Previcox Rx'd via local DVM for 25 days
       -- Had Previcox ever been stopped at say a 7-day course or a 14-day to prove if it was even still needed for painful inflammation?
       -- 4/29 was Thalia under STRICT rest in a recovery suite?
5/23: MRI and diagnosis
      --   5/24: What was the reason for Neuro's Rx of Gabapentin?
5/23:  Previcox stopped for 4-day washout to switch to Prednisone
       -- 5/27: What was the reason switch to Prednisone by the Neuro surgeon?
5/27: Non emergency surgery booked for 6/6, but since declined
5/28: Gabapentin stopped
5/29: No report on Forum of any pain with 5/28 stop of gabapentin and 5/27 stop of prednisone.
5/29: Reported on Forum increase of neuro damage of now stumbling with the stop of one dose of pred and no other inflammatory on board.


HOW to MONITOR Neuro decline
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. 4/29 Pain with initial tear of disc and ensuing swelling
2. 4/29 Wobbly walking
           legs cross
3. 4/29 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.


MONITOR FOR NECK PAIN SIGNS
⚙︎ shivering-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
➕these signs specific for a neck disc:
    ◻︎ head held high/ nose to the ground
    ◻︎ looks up with just eyes and does not move head and neck easily.
    ◻︎ not eating due to painful chewing or in too much overall pain
    ◻︎ holds front or back leg up flamingo style not wanting to bear weight

WHAT DOES RECENT NEURO DECLINE MEAN?
The 5/29 stop of Prednisone coincides with your 5/29 report on the Forum of increased neuro diminishment of front right leg weakness now stumbling.  
  
John, no vet knows how long a course to use for any anti-inflammatory drug. It is prudent for them to guess at a 7-day or maybe 14-day course. Then assess for pain/new neuro diminishment.

John, here is a handy tip for you which also helps us out.  When replying use the writing space at the bottom of the page called  "QUICK REPLY"   This area allows you to type there.  Allows you to scroll back up to the post you are replying to and then back down to continue writing.  We try to put all of our questions in PINK to make them easy find/respond to.

No need to quote us in your post.  Just use 1-3 words of reference for each answer.  Before we post, we re-read your old posts to refresh our memory. So we are only looking to read your words, not ours.  

Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with our disease of IVDD. Each of us needs to be self educated so we can team up to work with our vets.

Our hope is in the next few days as your mind calms down and Thalia is in a good place, you will begin to have a chance to delve into the readings on our Main Webpage  www.dodgersLIST.com and be the prepared IVDD savvy owner your Thalia needs as a good team captain with good advocate skills. And to discern who is to be hired for her IVDD health care team.

1) This is a good spot to start. Get the over all picture of what IVDD is and how to live many good years ahead with your IVDD Thalia. Takes about 10 minutes for "Shortcut Thru IVDD"  dodgerslist.com/time-and-ivdd/

2) Then while you are on the www.dodgersLIST.com website, do click on the rest of the "KNOWLEDGE" pull down menu items.

SUMMARY of what happened to Thalia with your updating of events.
4/29 drags r. frnt paw drags.  DVM vet Rx's 25 days of Previcox. No crate rest Rx'd.   Was Pepcid AC, a stomach protector Rx'd 4/29 for the duration of Previcox?
  TAKE AWAY: non-surgical conservative treatment = STRICT limited movement rest to allow the disc to heal.  PLUS anti-inflammatory to get the painful spinal cord resolved over 7-30 days. PLUS  pain meds to provide comfort as the anti-inflammatory does its work.

5/21 On Previcox, w/no crate rest of 8 weeks to heal the disc, neuro diminishment worsens to stumbling.
   TAKE AWAY: lack of STRICT limited movement may have caused a disruption to the healing neck disc scar tissue. Which in turn caused more pressure to the spinal cord. A need to restart crate rest from square one on 5/25.   Most surgeon's would not choose the risk of a surgery for a walking dog. Did the surgeon have the full history, sequence of events/dates to take into account in his decision making with Thalia's recent neuro diminishment of stumbling?

5/23 Neuro appt Previcox is stopped w/ a tentative 6/6 surgery date.   Stomach protection Rx'd: Omperazole + Famotidine.

Can you be specific about what you observed with these general phrases "doing better" "way more control"?
    at potty time what did you observe about her right front leg/paw?
    -- right front paw places properly on the ground?
    --right front paw if knuckled under could right itself or not at all?
    -- right front paw drags?

How is her GI issues coming along now with: metronidzole, carafate, endosorb on board?  Specific details please:
   loose stool, red in stool, black in stool, well formed stool.

Any signs of pain?
   tends to hold her head high or nose to ground;   looks up with just eyes and does not move head and neck easily;   holds right front leg up like a flamingo bird because it hurts to bear weight on;    yelps;  shivers

I am happy to hear that Thalia now has an appetite, no signs of pain and neuro deficits decreasing.

Is surgery still being considered for June 6?

John, just confirming as I did not understand your comment....
so there is no change it your declining of a surgery since you wrote on May 30 "I have a date set for surgery 6/6/24. But I am not going to go through with it. "

That is good Thalia is able to go to your shop and stays super calm!!!

Also less knuckling is a good thing showing there is nerve repair already going on. This is a very good direction of healing. Stick to strict limited movement of the back/neck spine to prevent any setback of the healing disc. Mark your calendar for a July 20 graduation day!