Carol, welcome to the Forum we are so glad you are here. These are the thinga to attend to today Oct 1, 2021. Not fair for Sabby to endure pain,
when this can be fixed over the phone to avoid a risky to the disc transport into the ER vet. Hopefully you will get a different ER vet who knows more about IVDD to access Sabby's file and adjust the pain med better for Sabby's comfort. Your local vet will need to first exam before Rxing meds and thus he can't adjust meds over the phone. Do what you need to do, have not patience til Oct 2 with pain!
Sabby is undermedicated for pain and showing signs of GI tract damgage.
1) It typically takes 3 different pain meds to fully cover pain round the clock, night and day.
2) Whenever Prednisone is in use, the GI tract can suffer damage. Pepcid AC (famtotind) is typically used to protect.
PAIN
Resolution of spinal cord inflammation/swelling provides the relief from pain. It can take the anti-inflammatory (prednisone) a range of 7 to 30 days before all swelling is gone.
Sabby was given 7-day prednisone course. The rest of pred is the taper days. Taper days serve a different purpose.
The best pain medications control is using more than one approach to address pain from multiple fronts. Adovcate for the more typical home med approach with the first three pain meds listed. All three pain meds need to be prescribed three times a day because these meds are only effective for 8 hrs.
__ traMADol-general analgesic
__ methocarbamol- muscle spasm pain
__
gabapentin-nerve pain
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Buprenorphine - "The first-pass effect typically removes 85 to 95% of opioids absorbed from the gastrointestinal tract.
This explains why buprenorphine is such ineffective analgesics when swallowed. www.vasg.org/newer_options_for_chronic_pain_management.htm There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, interested in life selves when pain is fully under control round the clock.
STOMACH DAMAGE
Sabby IS showing likley signs of stomach damage with not drinking and eating normally. Take no chances, get the acid reducer on board asap today 10/1 before this develops into bleeding ulcers.
Pepcid AC: Phrase a simple question that you expect a simple "yes "or "no" to it. Does my dog have any health issues to prevent use of Pepcid AC (famotidine)? NO I will get him on this. (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).
The stomach protector such as Pepcid AC (Famotidine) protects against the side effects of the anti-inflammatory.
-- Learn about Prednisone. An informed owner is a dog's best defense when taking an anti-inflammatory. What your job is, how to arrange for a Plan B with your vet.
BLADDER CONTROL
Loss of bladder control means a need to get into a vet, even ER to learn how to express the bladder. The bladder quickly becomes a breeding ground for bacteria when a dog has lost control of their bladder.
This would be a health emergency that would warrant the risk of a car transport in to ER or your own vet today and if bladder control has been lost as you cause us to suspect.
Signs of bladder control loss:
Leaks on you when lifted.
You find urine leaks in bedding "changed his bedding 10 times"
A sling is used under the belly area to keep the butt from tipping over when the back legs are weak or wobbly or just don't work at all. If a dog has lost bladder control, then you'd need go in with him to get a hands on top of your hands type of expressing lesson:
dodgerslist.com/bladder-bowel-care/ Doing a consult with a neuro is not just for purposes of a surgery.
-- If there is a strong suspicion, this is not a disc episode, a neuro can help via advanced imaging, MRI, and other tests to confirm if a different diagnosis.
-- If you find local vets are just not comfortable in using pain meds, then a neuro can get the meds adjusted because they use pain meds every day for their patients. Hopefully, though you will find your local vet is comfortable with his IVDD knowledge to care for Sabby and get things right today, 10/1.
MONITORING NEURO FUNCTIONS at home
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.
9/28 Pain with initial tear of disc and ensuing swelling
2.
9/29 Wobbly walking
9/29 legs cross
3. 9/29 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 reposition body in the crate
? can't move up into a stand
6.
10/2 Legs do not work at all (paralysis, dog is down) Neuro Exam7.
?10/2 Bladder control is lost. Leaks on you when lifted.
Can no longer sniff and then pee on that old urine spot outdoors.
8.
? No happy tail wag when owner happy talks
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.
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/ √
🚩Dr. Isaacs indepth Interview on surgery and conservative treatment:
dodgerslist.com/dr-isaacs-surgery-answersPlease keep us posted on how Sabby is doing, adjustments to meds
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? I am going to consult with some other doctors. I am on a limited, fixed income. I will also discuss with our family vet tomorrow.
