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Post by Magen & Murphy on Jul 11, 2024 8:04:47 GMT -7
This post is being marked for important info. If there is new or different information, please do so in a new post. Thanks!
[Original subject line: Murphy, 12 yo Setter Spaniel]
Hi Paula! Desperate dog mama here- Magen. I have a 12 yo setter spaniel who means SO much to me. He is a therapy dog and is the sweetest boy ever that has spread so much joy over many years. I am COMMITTED to helping him get well and need all the tips possible.
My vet has not been helpful and is not very familiar with IVDD. She has indicated to me several times that he may not recover. I have been sleeping on the ground with him petting him for about a week and we are both exhausted. He has been injured for 2 weeks. Started mild (some difficulty getting up but normal walking) and was on meloxicam. After one week and moving around too much (I suspect) he had more difficulty getting up so we switched to a steroid (after 4 day washout which was MISERABLE) on July 7. Currently on day 4 of steroids. His pain is better managed but he whines to pee but doesn't want to get up so he is currently wetting his bed. Detailed info below about our current treatment plan.
★1 How much does your dog weigh? 51 pounds
Please list the exact names of meds currently given, their doses in mg’s and times per day given?
100 MG Tramadole- 6:30 AM (been on this since July 3), 2:30 PM, 10:30 PM
500 MG Methocarbamole- 6:30 AM (just started this July 10- was on gabapentin before since July 3), 2:30 PM, 10:30 PM
10 MG Prednisone- 7:00 AM [true STRICT rest started 7/10] (been on this since July 7), 7:00 PM
10 MG Omeprazole- 7:00 AM (been on this since starting wash out July 5), 7:00 PM
[MED LIST/HISTORY- Moderator's Note. Please do not edit
51 lbs (21.13kg) 12 y.o
7/10 true conservative crate rest started with neuro damage: knuckling
Prednisone as 7/10 w/true STRICT REST: 10mg 1x/day for 2 days; 7/12TEST TAPER for _ pain and _neuro
traMADol 100mgs 3x/day
methocarbamol 500 3x/day
omeprazole 10mgs 1x/day since 7/5]
★2 What breed? How old? What is your dog’s name? Your name, too? Murphy is a rescue- setter spaniel mix (we guess). He is 12 years old (a very healthy 12- walks 2 miles every day, no signs of arthritis, great annual blood work, healthy teeth, was able to jump in bed and in Tahoe prior to injury). My name is Magen.
★3 Did you specifically get a diagnosis of IVDD, aka: a disc problem, a disc herniation, a bulging disc, slipped disc? No official diagnosis. Did Xrays but he wasn't sedated so she said the quality of the image isn't very reliable.
Did show narrowing in lumbar region. He is sore to the touch in that same region. Xrays did rule out tumor, fracture, infection, etc. A month ago (5/27) he actually wouldnt jump on the bed so I had been lifting him but he was still able to walk, run, etc. Watched him closely and gave him meloxicam. He walked up 2 flights of stairs to get on our back deck and after that was more painful and struggled to get up (6/22). Continued meloxicam and went to vet and vet did not advise any crate rest. Continued to let him walk around and I believe now he has reinjured it even more. While on the prednisone, he was going out more often to pee and in the last 24 hours has struggled more with knuckling. Doing 100% crate rest now.
Vet is general DVM.
★4 Saw vet on 6/20 for reluctance to jump before he went up the flights of stairs and hurt it worse (6/22). He had zero neurological deficits at this visit so started meloxicam daily. She didn't advise rest. I am kicking myself now and wish I knew more because we could have prevented the second relapse. Saw vet again on 7/3 and that is when we started tramadol (100 mg 3x day), gabapentin (300 mg 2x day), and recommended steriods but had to do 4 day wash out (started omeprazole then as well). Gabapentin seemed to make him anxious and unsettled so stopped it when we got the methocarbomal on board 7/10. Seems to be resting better.
★5 No current pain in last 24 hours.
Has back legs tucked under him. Was flamingo style but not any more. Resting more frequently and more soundly.
Biggest issue now is that when he needs to go pee, he whines and whines because he doesn't want to have an accident in the house. Will start panting.Doesn't want to get up though when asked to. This all started within the last 24 hours. He was getting up 3-4X day to go potty but had such a LONG walk (kicking myself on this too now that I know more). On 7/10 I believe he reinjured hiimself with all the walking because now he doesn't want to get up (he is capable) and is wetting his bed. He also had some knuckling with one leg when walking back into the house 7/10 which freaked me out because he did not have that before. I so regret letting him walk so far to go out so often because I fear it has made him worse even with the steroids on board. Do I know just let him pee himself rather than get up? He is too heavy to pick up and freaks when we try to lift the crate.
★6 Eating and drinking great. Poops normal.
★7 Murphy has maintained all ability to get up and walk the entire time. Would knuckle some when kneeling to pee but would ⚠️recover foot placement after several seconds or get up from stance to begin walking. Back would shake some when he got back inside to lay down but then would settle down after 15 minutes or so. Yesterday he started [7/10] ▼knuckling while walking on 1 side. Could this be because he has been walking around too much? Please tell me this is a small setback that we can recover from with more rest and strict protocol.
★8
Murphy can sniff and squat but not hold stance very long. Squats multiple times to fully empty bladder.
Just recently and when prednisone started has been wetting his bed. Drinking lots of water. I do feel he senses he needs to pee because he whines and then eventually goes and then falls asleep. Haven't gotten him up yet since the knuckling incident so not sure of the damage/ his current ability. How can I clean him well with his feet tucked under him? I am nervous to move his back legs too much and hurt him. How long can he sit on a thick blanket with pee on it? He has long hair (not sure if that helps absorption).
THANK YOU for your help! I have been crying every day this past week and want to know I am doing all that I can to help the best boy and most fiercely loyal dog there ever was. I will take all the advice and insight you can give because I don't have a good resource in my vet. Appreciate you!!!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 11, 2024 10:48:40 GMT -7
Magen, we are so happy you have joined us!!! Wonderful to hear you are on board with STRICT rest now and that pain is fully under control only twice a day dosing of the 2 pain meds. Xray can't prove a soft tissue spinal cord or soft tissue disc episode. Xrays can rule out other disease. So having ruled out other disease, it is prudent to be highly suspicious that Murphy does then have a disc problem likely suspicioned to be located in his lumbar region. Thus your vet did officially diagnose IVDD and provided meds similarly used for IVDD. With IVDD knowledge, your mind will be able to override negative emotions ad replace with positive actions that will help Murphy. With good IVDD care Murphy can heal. With gained knowledge you can become the captain of his health care team which Murphy needs. If need be even hire a vet more comfortable with IVDD. Hopefully, though, when you see that you can speak up for Murphy and bring ideas to the table, your vet will be able to consider them. OK, let's get to what you can do right away. -- STRICT limited movement is a must do if Murphy is to heal the disc and prevent the disc from doing worse neuro damage than knuckling.
As damage to the spinal cord increases, there can be a predictable stepwise order of deterioration of functions if excessive back/neck movement for example.
Nerves do heal in the exact opposite order nerve damage occured.
Go to the Large Breed tips page. Learn about a Help 'em harness for helping Murphy get to a stand position. Learn about potty options other than taking him outdoors that required too many footsteps to get there. 🚩 LARGE BREED page: dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/PREDNISONE It is important that you have an understanding of this hormone anti-inflammatory drug and how it is used with a disc episode to understand your vet's use of this drug, be able to participate in asking good questions (speaking up for Murphy). Good reading here: 🚩 dodgerslist.com/steroids-vs-nsaids/The prior use of prednisone is negated due to setback of disc redamage resulting in nerve knuckling nerve damage happening on 7/10. The 8 weeks of STRICT rest began on 7/10 and basically predisone's work has to restart on 7/10 too. It can take about 7-30 days for pred at the anti-inflammatory level to resolve all painful swelling. Lower doses (taper doses) don't do a good job of getting the swelling down and are not counted in the 7-30 range. Murphy has not been on an anti-inflammatory dose with the RX of 10mgs once day. That may be something to bring up to the vet if Murphy now under STRICT rest had not resolved pain when pred begins its taper. You say Murphy's blood work was excellent, but maybe there is another medical reason the vet is not using the upper range of the anti-inflammatory level dose twice a day? While on pred, Murphy may need to be allowed out to pee every 2-3 hours or maybe even every 3-4 hrs depending on how much water he is drinking. SKIN HYGIENE to prevent staff infections
Correct mattress set up is a must to keep urine away from skin: This page has loads of tips for water/food bowls, mattress system, urine barrier creams, keeping your dog's skin clean, etc. Look for the button to " JUMP TO THE TIPS" 🚩https://dodgerslist.com/strict-rest-recovery-process/
During care, if need be clip his fur away at strategic areas so that you can adequately clean his skin. The worry of urine against the skin is same as a baby in wet diaper can get a rash. IF the rash is bad and skin in broken, bacteria can cause infection.
For how many days did the vet say to take pred 10mgs one time a day? Keep us updated on his rear leg neuro functions for any dimishment or improvement. Neuro worsening requires alerting vet ASAP and speaking up (advocating) for using the anti-inflammatory level of prednisone.
Let us know which potty option you will be using.
How often are you taking him to potty? Every 2-3 hours or ....?
Let us know which kind of sling or harness you use for MurphyLet us know if there is anything we missed or other area of concerns you have. |
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Post by Magen & Murphy on Jul 11, 2024 11:17:35 GMT -7
Such great info and so good to know to restart the minimum 5 day prednisone dosage since re-injury. If you go back up to the meds portion, I listed the times I am giving so I am actually giving prednisone 2x day and the tramadol and methocarbamol 3x day. Does that help clarify?
If the clock started yesterday 7/10: is it your recommendation to do 7 days from then at 20 mg per day before tapering? My vet is not going to be a good resource to ask. She prescribed the wrong dose in the first place at 40mg per day! She also didn't give good instructions for tapering. I assume I would do 5 mg in the AM and 5 in the PM after day 7....?
My other big question is do I continue to let him wet his bed even if I can coax him to get up and get outside? I don't mind cleaning it up and it keeps him super still. Don't know if the benefits of complete rest/ stillness outweigh the risks of him sitting in the urine more often.
Just ordered a fleece sling to try to help him get up and walk out to the potty place. We did move the location to be much closer to the door and built a makeshift ramp to get over the door threshold to the mulch area. I would say it is 10 steps total. Planning on trying that later tonight to see if he will pee and poo. Will definitely let you know how that goes.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 11, 2024 12:18:08 GMT -7
Magen, Prednisone is currently for 2 days since 7/10 knuckling setback. That is a 2-day course. Likely all swelling would not be gone when it tapers and pain meds are stopoped, you would observe pain surfacing. Usually a course is 5-7 days, maybe even a 14-day course. It is NOT YOU, but the vet who MUST Rx this hormone drug. It is YOU who presents information and advocates strongly but nicely for Murphy.
It is NOT YOU who designs the taper schedule. The taper MUST be done in a precise way designed and supervised by the VET! Make sure the taper schedule is in writing from the vet on the bottle . That is her job. If you get an Rx script to take to the pharmacy, it would also be on that Rx paper. If you can't work with your vet, then you need to hire another. That means unfortunately, Murphy would have to be transported in for an exam before any vet can Rx. Best is if you can work to get meds right with this vet. When the pred taper starts tomorrow 7/12, that is the time to also stop pain meds. Maybe all the swelling would be gone?? Don't be upset if it is not, as likely all pain would not be gone in 2 days. With weekend coming, that leaves you in a bad place with likely the remaining 2-day pred course not gonna work. An ER visit is very expensive, a "Plan B" is free! RULE OF THUMB Pain= another course of PRED + all pain meds, GI protectors back on board. No Pain= go to TAPER conclusion...finish out the 8 weeks of crate rest for the disc to heal. You need a PLAN B if 2-day course does not rid all the swelling pain. PLAN B would be to get today OVER THE PHONE to avoid danger in transporting Murphy into office. Adovcate for a 5-7-day pred course up at the anti-inflammatory level. Advocate for enough pain meds to match the 5-7 day pred course. At end of course, then another taper to find out if all pain is gone (means also stopping pain meds). On the Rx paper or the Pred Rx bottle SHOULD BE the diretions for tapering off of pred. The final taper always ends in and every other day dose. What does your current bottle of pred have for the taper directions?
51 lbs dog x 0.3mg pred = 15 mgs pred twice a day for an anti-inflammatory level dose (total 30mgs a day). Preferable to give hormone twice a day dosing. But some vets do Rx the total amt for once a day. Your goal is that Murphy stays dry in between potty times. Move up potty to every 1-2 hours if need be. He simply can't and should not be made to have to release urine in his bed. That is very upsetting to a dog to be forced pee where they sleep. Consider a pee pad adjacent to the crate as Romy explained, to then make the fewest of cumulative footsteps daily possible. When he can hold his pee to stay dry for every 3-4 or even every 4-6hrs then your new setup sounds like a good reduction in footsteps.. |
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Post by Magen & Murphy on Jul 11, 2024 17:55:14 GMT -7
Hey Paula, Coming to you desperate for help. Tonight is ripping my heart out. Murphy went from being able to walk a short distance yesterday with hardly any knuckling to this evening he seems completely paralyzed in the back legs.
We bought the harness to help him in the front and back and when we attempted to help him when he got up, he screamed out in pain terribly. He immediately tried to crouch back down. I don't know how much of it actually really hurt him or how much the sensation of being gently picked up freaked him out. We do have one that goes around the legs while we are waiting on receiving the Help em up harness. After trying one time, we let him settle back down and tried again (we set up a pee area beside his bed) and he freaked out again terribly. Def like it was hurting his legs to be lifted. He went over to his bed rather than the pee place and is now laying on his bed and resting comfortably. I do feel like he has pain sensation because if I move his back legs or help rotate him, I can tell he definitely feels it. He tenses up. His back legs are also very tight when I try to move them. I don't know how much of his new inability to get up and walk is him being stiff from laying for so long at a time? what is my best option now that he is unwilling to do the harness? He turned his head back quickly at me and started wiggling too which worried me for re-injury. We tried him just trying to walk but he also cries out and I think is so scared because his body isnt working. He is a very sensitive dog by nature. Do we get doggie diapers and change them consistently for a day and then try getting him up again? I am at a total loss and in a puddle of tears. He is comfortable and seemingly "normal" personality wise while he is laying still. He still smiles with his eyes. Only getting up is when I see him get scared, tense, and scream. Please help me. And Murph. So grateful for you and your support. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 11, 2024 21:04:38 GMT -7
Magen it appears from what you describe he is in pain. His pain meds are not correctly Rx'd for full round the clock relief. --- cries out when walking --- screamed out when attempting to get up --- reluctant to move because it hurts
UNtil the pain can fully get in control, you might try human diapers
if they will fit so he doesn't have to move in pain for potty. traMADol (as the general analgesic) is one that is most often under dosed from what I read. Advocate (report pain and speak up) to try the the usual in controlling pain with this med. That means to Rx at the higher end of the mg range AND promptly every 8 hours. Expect the vet to do this math for maximum analgesic effect unless Murphy has some health issue that he may not take that dose: 33.13kg 23.13kg Murphy X 10mgs traMADol = 231mgs traMADol 3x/day (promptly eery 8 hours.) Methocarbamol (for muscle pain) 3x/day is likley already at a good dose. Gabapentin 3x/day (for nerve pain) is not on board. It generally is a part of the pain med cocktail. Advocate for Gabapentin Deep pain sensation. Most general DVM vets do not know how to correctly identify deep pain sensation. You won't likley ID it either. Avoid moving or touching the legs, there is no benefit and only might be upsetting Murphy Deep pain sensationWhat you CAN do in successfully identify if deep pain sensation exists is do some happy talk to him or show him a yummy treat and see if he can still do a happy tail wag. Communicate about REAR LEG function with details.Does he attempt to use the back legs in any manner. Such as push to try and reposition himself in his bed?When he went over to his bed, did he attempt to raise up on the back legs, attempt a walking motion?Did he drag his back legs in trying to get into his bed?
Deciding about a surgery
It is not clear to me about rear leg function yet and waiting on your detailed answers to know if there is still sniff and pee bladder control AND can he do a happy tail wag still. So, you should know this information ahead of time... if and when a surgery.... if an option for your family.
Excellent info to help with conservative vs. surgery decisions:
dodgerslist.com/surgery-vs-conservative/Figure 8 sling for males at potty time
You can make a DIY Figure 8 rear sling to see if that helps to move him til your Help em up gets in.
 
PrednisoneWith your reporting of pain AND possibly worsening back leg neuro function, Prednisone needs to be at the anti-inflammatory level (which it is not!). Also tomorrow 7/12 should NOT be lowering the pred dose even more. You need vet help to get prednisone and the pain meds adjusted. Hopefully you can do that over the phone or go to ER tonight if this is a real emergency of bad pain and worth the risk of more movement of the back discs. Transport with care, pad his body out with rolled up blanket to keep him from shifting as you brake or corner. When there as for then to bring a stretcher or whatever to carry him safely inside. Please keep us posted on the details of any med changes. I'm so sorry this is happening to Murphy (not having his pain properly in control). This is a big stress for you. If adjusting pain meds can get the pain back in full round the clock, dose to dose control, then Murphy still may be able to heal his disc and with time heal nerve damage with conservative treatment. |
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Post by Magen & Murphy on Jul 12, 2024 1:23:21 GMT -7
Thanks for the quick reply! So he should be getting up even if his back is paralyzed and be in no pain? He should not cry when we use the harness?
On the tramadol dosage I calculated that he is 23 kg and not 33 kg. Is that not correct for 51 lbs?
TOTALLY agree on the prednisone and I will advocate for 15mg continued usage tomorrow when we see the vet. We actually have a new mobile vet coming and she had a senior dog with IVDD so I am so hopeful that she is knowledgeable.
The gabapentin seemed to make him anxious but we can definitely try again and will talk to the vet about this. He may have been anxious about other things so its hard to tease out of course and with all the medications he is currently on.
I cannot get him to do a tail wag but that might be because he is still uncomfortable.
He does attempt to use his back legs in repositioning himself and pushes off to roll from side to side.
He did attempt a walking motion when going to his bed.
He can get upright for a second but then almost collapses back down on his back legs.
We tried the pee pad 2x tonight and he will get up and get over to it (semi dragging) but then plops right down on it. It is almost like he doesnt want to stand with his back legs not working and is tired. He peed a little on the pad laying down and we praised him and then he went back to his bed. He did not cry at all during either of those transfers.
I really think the harness is what freaked him out and made him cry in a big way earlier today. He is rarely leashed if that tells you anything about his normal. We live on a lot of property and he is so well-behaved that even when we go on walks, he stays right by me.
Should I take him to see a neurologist tomorow? I am desperate to know the extent of his injury and prognosis. We would consider surgery if it really improves his odds/chances. I am so nervous about the transport of course. Appreciate the tips about the blankets. What are your thoughts on a light sedative so I can get him there safely and easily?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jul 12, 2024 8:16:49 GMT -7
Magen, 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. From your reporting what your eyes observed, Murphy's legs (or his back) are not paralyzed. If he is in too much pain, even if you do some happy talk to him he may not want to wag his tail but he could if he wanted to. Loss of neuro functions goes in this particular order: 4. 7/10 Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all
5. 7/11 Weak/little leg movement to reposition his body in the recovery suite
___ can't move up into a stand by himself
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 correctly ID only by the surgeon
There is no right or wrong answer in deciding for conservative vs. a surgery. You have the pros and cons for both treatments.... it is you and your surgeon who determine which path to take.
Spinal cord injury caused by the disc episode can involve both compressing of the cord and cord bruising.
 **
You are correct 51lb = 23.13kg. I'm so glad to hear you have a mobile vet coming to visit Murphy. It is always excellent to get a 2nd opinion. And most importantly get Murphy pain free by adjusting medications.
When the pain meds are correct and there is actually an anti-inflammatory level use of prednisone on board, pain would be fully controlled night and day. This allows Murphy to heal in comfort. It allows you to care for him using a harness or rear end sling to get him to the potty place (pee pad or out to grass). Do not allow Murphy to drag, support his rear with a sling or harness. With our small dogs we can support their thighs with our hands also....don't know if you would be able to???
When timing a vet visit that is necessary, one could be such as deciding for a surgery, time med doses to be out of his system by appt time. Pain meds last for 8 hrs. Prednisone would NOT be abruptly stopped for vet visit. This way the surgeon is able to see all symptoms ub making his diagnosis. Best, too, is to confirm with the surgical clinic what they want especially regarding a light sedative for transporting.
Look forward to your finding the mobile vet is one who can help get Murphy back on track of healing in full comfort while an anti-inflammatory level prednisone can do its job. |
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