|
|
Post by Jamie-bam on Aug 15, 2024 5:23:48 GMT -7
[Original subject line: Bam bam - conservative - considering options]   (?) 5.9 year old, 10.5 lb YorkieAlways had less strength in his hind legs than his sister littermate, but never indicated pain. 8/3 noticed on our normal walk that he wasn't keeping the pace 8/4 had to take walk breaks to allow him to catch up 8/5 took him to the vet because he laid down during morning walk and was having some trembling in rear right leg. Vet suggested treating for tick born disease which is common in our area. Doxycycline 50 mg once a day 8/6-8 some pain signals. Give warm showers to loosen tight muscles 8/11 ok doing short walks 8/12 tried a normal walk, but he got tired. two yelping episodes in close sequence while being held. Major pain signals ( heavy panting, shivering)
8/13 right rear leg weakness, crossed hind legs when standing. Wobbly walking. Unable to bend head [NECK?] to eat/ drink. Vet suggests IVDD. Gabipentin 50 mg twice a day Carprofen 12.5 mg twice a day Methocarbamol 125 mg twice a day, reducing over time [MED LIST/HISTORY- Moderator's Note. Please do not edit
10.5 lbs 6 y.o.
8/13 vet appt for neuro damage (right rear paw drag, left hind leg weakness), pain
carprofen as of 8/13: 12.5mgs 2x/day for how many days? Then a TEST STOP for _ pain; _neuro
gabapentin 50 mgs 2x/day
methocarbamol 125mgs 2x/day
Doxycycline 50 mg 1x/day
Bam needs GI tract protector, Pepcid AC, on board for duration of Carpforfen! ]
Heat therapy Borrowed a pet stroller to use for outdoor time. Limit movement. Bought dasuquin chewables. start seeing right rear paw drag and not place correctly
8/14 visible lean when standing. left hind leg showing weakness. Called neuro vet to schedule consult 8/15 woke with pain and urgent need to pee at 5 am (an hour earlier than normal) QUESTIONS ☆ 1 currently pain? At 5 am, Yes.Groaning when picked up/ moved Panting 3 hours later the carprofen has stopped the pain response★2 10.5 lbs Age? 6A.. Please list the exact names of meds currently given, their doses in mg’s and times per day given. Carprofen 12.5 mg 2x Gabipentin 50 mg 2x Methocarbamol 125 mg 2x Doxycycline 50 mg 1x Nutramax dasuquin B.. no steroids C.. PEPCID AC: is this a question for my vet? I think it is being suggested to prevent future gastro issues if a steroid is started? ☆ 3 -- no gastro issues present ☆ 4 What breed? Yorkie Bam bam. Your name? Jamie ☆ 5 🔘 Was the diagnosis IVDD not conclusive 🔘 -- Is the vet a general DVM? Yes, seen general vet twice. 🔘 -- or a specialist surgeon: ACVIM neurology or ACVS ortho? Appointment scheduled with neuro August 27th ☆ 6 🔘 What was the date you saw the vet for CONSERVATIVE treatment? August 5th for initial symptoms, August 13th for worsening symptoms 🔘 SURGERY? None planned☆ 7 🔘 Can your dog specifically sniff and squat and then release urine which is bladder control? Yes, able to control and relieve himself. ☆ 8 Currently can your dog wobbly walk? Yes, but one paw has started to occasionally fold under.
|
|
PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,863
|
Post by PaulaM on Aug 15, 2024 8:23:18 GMT -7
Moderator Paula is reading your post and preparing a reply. It can take 20-40 minutes or longer dependent on the complexity. Thank you for your patience. 👀 Please refresh your browser to see new replies.
Welcome! We are glad you've posted as our temporary guest! When your mind calms and allows, please register and log into write posts. Many benefits for us and for you and your pup to register.
▼ Thank you in advance for registering ▼ |
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,863
|
Post by PaulaM on Aug 15, 2024 8:56:04 GMT -7
Jamie, welcome to the Forum. Phone your vet asap to get the pain med adjusted for Bam's needs if all pain is not be fully controlled dose to dose of the two pain meds (gabapentin, methocarbamol)  Resolution of spinal cord inflammation/swelling provides the relief from pain. It can take an anti-inflammatory (steroid or a non-steriodal NSAID Carprogen) a range of 7 to 30 days before all swelling is gone. The best pain medications control is using more than one approach to address pain from multiple fronts. Pain meds last for 8 hrs. That is the reason they are Rx'd for promptly every 8 hrs (3x/day) -- traMADol-general analgesic -- methocarbamol- muscle spasm pain -- gabapentin-nerve pain). All three pain meds need to be prescribed three times a day for best pain control Until you find out Bam has another nameable disease, act like this IS a disc episode. ---- The single most important of care for the disc is STRICT limlted moved to prevent worseing pain, and worsening nerve damage beyond what has happened. Potty time will be the time to make sure there are no extra footsteps. Exactly how to handle potty time, DIY slings, mattress set up and more are outlined in this article. 🚩 dodgerslist.com/strict-rest-recovery-process/ STRICT rest means: ◼︎ eats and drinks inside the recovery suite ◼︎ no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy WHYs: dodgerslist.com/chiropractic/ ◼︎no dragging legs or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎Hire mobile vet for laser or acupuncture to avoid dangerous trips into vet office. ◼︎ Avoid dangerous detours in caring for your dog. Follow the "Roadmap." Tape it to your fridge. D/L and print out: 🚩 dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf
Did the vet say the disc was in the neck? There are extra things you can do at home to help the neck heal, such as softening hard kibble, raising food/water dishes, etc. More info here: 🚩 dodgerslist.com/cervical-care-tips/ ➕if 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 MONITORING NEURO FUNCTIONS and alert vet.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. 8/5 Pain with initial tear of disc and ensuing swelling2. 8/13 Wobbly walking, legs cross3. Nails/toes scuffing floor4. 8/13 Right rear Paw knuckles under. Dog is slow to correct or can't right the paw(s) at all5. Weak/little leg movement, can't move up into a stand6. 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 lost9. 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/surgery-vs-conservative/Fill us in a bit more... 1) Did your vet say the disc was in the neck?2) For how many days is Bam to take carprofen 12.5mgs 2x/day? Often vets will Rx a 7-day course or even a 14-day course. 3) What date did STRICT rest begin for Bam? |
|
|
|
Post by Jamie Bam on Aug 16, 2024 4:07:47 GMT -7
No, the vet did not communicate a guess to the part of the spinal column
2) For how many days is Bam to take carprofen 12.5mgs 2x/day?
Often vets will Rx a 7-day course or even a 14-day course.
Given [refers to how many days?]
3) We'd kept him quiet since 8/5, but didn't know about strict until 8/15 when I found your info. Until yesterday, quiet included riding in the car with us to work, lap cuddles, baths, sleeping in our bed. At the office he was good about laying down and not moving about. With strict rest, he keeps standing in his kennel.
He tried to adjust the padding in his kennel yesterday afternoon [8/15] which ended with a big slip and seems to have injured himself more because he struggled to turn himself around and with squatting at potty time last night and this morning.
I did try to talk to his vet yesterday [8/15] about adjusting the meds, but haven't gotten a call back. She was concerned about over medicating.
While he took treats (including a non-rawhide stick) and water well yesterday, he refused his normal kibble. I'll try soaking it today.
|
|
|
|
Post by Jamie-bam on Aug 16, 2024 7:59:53 GMT -7
Soaking his kibble got him to eat half his normal morning meal. Win! (Especially because he's getting extra treats and was slightly overweight to start).
The vetprofen was supplied for 14 days at current dose.
Still trying to get the vet about meds. I'll ask about the Prevacid.
He's able to turn his head to both sides and look up. He CAN move his head down, but giving him food and water in raised position has him eating it better.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,863
|
Post by PaulaM on Aug 16, 2024 8:39:16 GMT -7
Jamie, the good news is that you have committed to STRICT rest as of 8/15...this is BIG as it going forward will provide Bam with every chance to to heal his disc and all the nerve damage that has happened (wobbly walk, right rear paw knuckles under). I just see you have answered several questions...thanks very much! Do you have his bedding set up as recommended with a 2-4" foam mattress? This system provides comfort, skin and back safety and easy maintenance for you for the next 8 weeks. If all goes well with strict rest, mark your calendar for Oct 10 graduation day from STRICT REST! We've got ours marked, and we'll have lots of good tips for gradually and safely transitioning Bam back to family life.
MATTRESS SETUP
At suite freshening time, dispose of used pee pad, put the bottom sheet in the washer. Having extra fleece bottom sheets means you have them near by and can quickly remake bedding. Fleece is no sew, no worries about raveling just cut one of those cheap about $10 (100% synthetic throws found at target, a large grocery store down to sizes you need. Fleece (no cotton, 100% polyester) is available at almost every fabric store like JoAnns. Fleece washes and dries very quickly. On a warm summer day I even dry mine outside in the sunshine so it smells wonderfully outdoorish for my dog.ORDER OF MATTRESS SYSTEM Top layer: Fleece "bottom sheet" tucked in all around tightly and a bit under the mattress keeps pee pad from shifting. MIddle layer: Pee pad on top of mattress Bottom layer: Mattress enclosed in trash bag to protect and avoid having to clean
Ex-pen option: It is ok for Bam to stand up on all four legs. To sit on his butt and of course to lie down. The suite should be only large enough in area that he can easily turn around and when lying down can fully stretch out his legs. What he should not do is be rambutious. Such as jumping against the side of his recovery suite. QUICK REPLY posting No need to quote our words/questions. We want to read only your words in your posts to eliminate confusion. QUICK REPLY at the bottom of each page allows you to scroll up to a previous post and then back down to reply.
PAIN A disc episode is known to be quite a painful thing. Pain meds are effective for about 8 hrs. Confirm and keep us updated if you are seeing any hint of pain surfacing before the next 12 hr dose. Pain signs when having to move, turn around in his recovery suite. Pain hinders the healing process. This is where we stand on this Forum about pain...we side with Dr. Downing. Robin Downing, DVM, CVA, DAAPM is one of only four veterinarians in the world to hold the Diplomate credential in the American Academy of Pain Management - the largest interdisciplinary pain management organization in human medicine: "It is always better to use a multi-modal approach to pain management." --Dogs tend to hide pain as a protective mechanism. -- A lack of outward evidence does not necessarily indicate that these patients are not experiencing the negative consequences of pain. And we side with the World Small Animal Veterinary Association (WSAVA) guidelines as well: 1. We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt. Treat predictable pain. 2. Where a dog is judged to be in pain, treatment should be given immediately to provide relief. Positive response to an appropriate treatment is the gold standard to measure the presence and degree of pain. 3. When pain is moderate or severe, the veterinarian should consider combining drugs that act at different sites in the pain pathway to provide optimal analgesia; Combining different classes of analgesic drugs allows the veterinarian to optimize the management of pain. wsava.org/wp-content/uploads/2020/01/Recognition-Assessment-and-Treatment-of-Pain-Guidelines.pdf
- Do you now have Pepcid AC on board with the sign of not wanting to eat his kibble! Why to protect the stomach when on NSAID, Carprofen: dodgerslist.com/stomach-protection/ thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpgJamie, avoid Bam gaining too much weight. If you must give a treat, then subtract it from his daily kibble. Better yet, choose a local treat (carrot, apple). Then make the treat VERY tiny. Say about 1/2 of pinkie size fingernail. To dogs it is not the size of the treat, but that they got a treat even if very tiny.With a 14-day course of vetprofen (carprofen), the stop day will be Aug 27. Find out of the pain meds will also be stopped to enable you the fastest and most accurate way to observe if all painful swelling is really gone or not.Rule of thumb on STOP date is:PAIN = swelling = more time on non-steroid anti-inflammatory (NSAID), pain meds and Pepcid AC needed.NO PAIN = no meds at all needed, finish out the balance of 8 weeks for disc healing.Always have a plan in place with the vet during a test for pain stop on what you should do should pain surface. Have enough meds on hand should that happen over a weekend or evening when the Vet is closed, to save an expensive ER visit.--- The full details on how non-steroidal anti-inflammatories work with a disc episode. Good reading to be able to ask the right questions and discuss treatment:dodgerslist.com/steroids-vs-nsaids/ |
|
|
|
Post by Jamie-bam on Aug 16, 2024 14:40:34 GMT -7
Thank you so much for all the info and sharing your knowledge - I feel much more in control. Knowing that he isn't doing more damage to himself by sitting or standing in his crate is releiving.
The vet got back to me (they were calling an old number :-(). I now have ✙Pepcid AC [?mg ?x/day] and a✙sedative [?mg ?x/day] for better night sleep. The new pain med schedule seems to be working at controlling his pain and helping him be more comfortable.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10.5 lbs 6 y.o.
8/13 vet appt for neuro damage (right rear paw drag, left hind leg weakness), pain
Vetprofen (carprofen) as of 8/13: 12.5mgs 2x/day for 14 days; 8/27 TEST STOP for _ pain; _neuro
gabapentin 50 mgs 2x/day
methocarbamol 125mgs 2x/day
Doxycycline 50 mg 1x/day
✙name of sedative; ?mg ?x/day
✙Pepcid AC ?mg ?x/day ]
We do have 2-3 inch supportive foam mattress in all his rest locations (we have a few stations in the house depending on time of day and where the family is). They are "pee proof". We thought about putting a fleece ontop, but he tends to scratch at those to rearrange them and the foam mattresses already have a snug cover. Hopefully he doesn't lose bladder control, but if he did we would move him to a different rest location and launder the soiled foam mattress cover.
As a tiny dog, all his treats are tiny - and we're very careful about how much he gets.
Again, thank you so much!
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,863
|
Post by PaulaM on Aug 16, 2024 18:07:51 GMT -7
Jamie, very good to hear that pain is fully under control night and day!
Wish we could read your med bottles. But we can't! Please update the new meds on board for us.
Pepcid AC ?mg ?x/day
name of Sedative ?mg ?x/day (actually dosed if given a range)
What is the plan you and your vet have worked out for Aug 27 stop of 14-day course of Vetprofen?
-- Will pain meds be stopped also on Aug 27 to allow you to quickly and accurately recognize any hint if pain would surface?
-- What is the Plan B you and your vet decided on should pain/neuro decline happen with the stop of Vetprofen (carprofen) when your vet is closed?
1) you get a few extra pain & Vetrophen pills from the vet to have on hand to dose until your vet reopens. With neuro decline hours matter in getting the anti-inflammatory back on board.
2) you will get a paper Rx which you can refil at your local 24hr pharmacy?
3) A plan B is free, an ER visit is expensive.
|
|
