Lisa's Lulu 10/10conserv- B.Terrier- NECK; GRAD 12/5

Lisa, you have indicated with an X that currently Lulu is experiencing many signs of pain.  Lulu should be able to heal in comfort.  Have no patience with pain as it can hinder the healing process. 

There should be NO pain dose to dose of pain meds, night and day.  You have a pain emergency to call 10/13 now and get the meds adjusted over the phone.  The vet on duty where you saw the neuro can access Lulu's file and make adjustments over the phone. This avoids a dangerous car transport with the potential of too much movement for the healing disc. 
Let us know what adjustments the vet made: name of med, ?mg    ?x/day.

Gabapentin should be given every 8 hrs because that is how long it is effective.   Confirm if you had been giving every 12 hrs and that you now are giving every 8 hrs.

Confirm Pepcid AC (famotidine), an acid suppressor is now on board.  ?mg    ?x/day   Good reading to understand why you have asked if there are any health issues and if none, that you have it on board:
🚩 3 Reasons why Pepcid AC: dodgerslist.com/stomach-protection/
🚩  Pepcid AC (famotidine) drug information: marvistavet.com/famotidine.pml

Did the Neuro say that she has a neck disc?  With front legs affected, that is a sign of a neck disc.  
    Are the back legs also wobbly or just front legs wobbly?
    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/

When things are in order for Lulu, please do register. Thank you in advance.

Lisa, any pain is TOO much pain. You are the eyes and ears for the vet to know if he needs to adjust pain. Accurately reporting using dates, observations, dose times and amts, etc. is the best way to communicate.  

MEDICATION CHART-
     A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. Useful tool for quality communications with your vet.
D/l a sample and the blank form to use with Lulu's meds
       🚩 dodgerslist.com/wp-content/uploads/2023/12/med-chart-printable.pdf

Update us on signs of pain you see re: the adjustment to gabapentin you made Sun 10/14(?).  In your post only list the pain signs you observe with this current gabapentin at 100mgs 3x/day

Lisa thank you for the neuro exam report. That clears up quite a bit.

Keep updating your vet about any signs of pain still not fully under control. You are still reporting signs of pain. When the meds are correct, pain is under control in 1 hrs and stay that way right up to next doses of meds.
     There are other meds that could be added to bring about full night and day control of pain. Your vet depends on your observations to know if there still needs more adjusting of pain meds while Prednisone is at work to resolve the painful swelling.

Make sure you are PROMPTLY dosing each med on time whether that be 2x/day for some or 3x/day for other meds. You would want to wake her up for her meds so that the level of pain meds stay at optimum level in her body.

What is the formula for Amantidine liquid? Look at the bottle for # of mgs/ amt mL.   

The top Differential Diagnosis is for IVDD.   Until there is a higher suspicion that she has another disease, Lulu is being treated for IVDD.

Let us know what the Neuro says and any changes if you are still seeing pain Tues 10/15.

I am happy to hear that Lulu is standing to eat. Is she showing any signs of pain currently?

What did the vet add/change yesterday 10/15 to get that pain under control?

It does not seem probably to think that pred might  have gotten all painful swelling resolved with the scheduled pred taper to go into effect on Sunday 10/20.  Discuss with vet extended days on the original anti-inflammatory pred dose 5mg every 12 hours.

The pred taper is the time to see if pred had done its job. All vets must guess on the number-day pred course.  The pred 7-day course is a common guess.  However, in many cases, it may take several courses adding up to a range of 7 to 30 days to fully resolve the root cause of the pain.... painfully inflammed tissue around the spinal cord.

Lisa,  great to hear you are on top of any sign of pain or neuro on the pred taper.  Good job in getting help quickly.

Would you provide the details to help us understand?

The doctor you spoke with 10/18 is the Neuro, Dr. Christina Isack, DVM, DACVIM?

Amantadine changed to pill.
  --  A whole pill is ?mgs  ___
  --  What is the dose in mgs ___
  --  how many times a day dosed?  __


What did you observe that indicated she did not have a good night on 10/17. Please describe what you saw re: pain and/or neuro diminishment.

Prednisone 
   For how many days course is the 5mg 2x/day to be given?

With the change in meds, let us know if Lulu has pain fully under control dose to dose.

I am sorry that Lulu is again experiencing pain. Please let us know about the meds as soon as you are able.

Lisa,  what does "better" mean?  Please describe your specific observations that support her pain level change since pain meds were adjusted by the Neuro on 10/18.  "Better" is not good enough!
     Pain needs to be fully in control round the clock, when she has to move, nearing the next dose of pain meds, whether during the day or thru the night.

PREDNISONE
The very important part of prednisone are the number of days of use prior to the taper reduction in mgs and/or times per day dosing.

Can you upload a jpg of the bottles to help provide this important information? 

1) For how many days was the original 10/10 pred Rx of 5mgs 2x/day to be given?
2) With the neuro's 10/18 refill, for how many days of pred 5mgs 2x/day are to be given?

Be wary of trying to compare your dog's disc episode with another dog's.  Only your vet knows your dog's health history to prescribe the dose of pain meds.

The time to phone your neuro for an update is when you see that what has been prescribed is not fully controlling pain.  With a new Rx, expect pain to be in control within the hour IF, the meds were correctly adjusted.

Do not have any patience with pain not fully in control. Call your vet to get pain meds adjusted.  Be able to communicate with details of what you see that make you believe she is in pain.  "Worse" "better" are not details.

PUMPKIN
Why was pumpkin puree added?
Was it for loose stool, if so Pepcid AC (famotidine) is what suppresses acids caused by prednisone and the GI upset caused.

GI UPSET
This is nothing to fool around with.  GI upset can lead to bleeding ulcers.  As long as the vet would say Lulu has no health issue to prevent use of Pepcid AC, then go to the grocery store and buy it.  Lulu does not need bleeding ulcers on top of all that she is dealing with.  Know you stomach protection during the use of any  anti-inflammatory including the steroid prednisone:   dodgerslist.com/stomach-protection/

Lisa, it could be that Lulu is not moving around much and now her new normal is one poop a day. Is the poop well formed or constipated? If you have concerns, do discuss with the vet.

Monitor for that yelp.  Could be she expected there to be pain and anticipated it with a yelp?  If there are other signs of pain and more yelps, then notify the neuro to see about further adjusting the pain medications while pred is in the process to fully resolve the painful inflammation.  

Lisa could you tell us how many whole 10 mgs tablets are in the Refill bottle the Neuro gave you?

Thank you, your pictures are good.  However, there is not enough information on the bottle to determine when the next taper date will be tried.

[green bottle: prednisone RX'd on 10/10/24. 5mgs 2x/day for 7 days. Taper to start  Sun 10/20]

[Brown bottle:
  • Prednsone  RX date not listed.
  • Number of days to give not listed.
  • Quantity of 10mgs tablets not listed.
    Not able to determine the new taper date. ]

Lisa, thank you for all the details of especially using dates and counting the pred pills, etc.

I'm so very happy to hear pooping is back to normal!!   And that the adjusted meds have brought full control of pain night and day.  Just as it should be... Lulu can heal in comfort from pain while prednisone works on the root cause.

All vets must make a prudent guess as to how long it might take pred to complete its job.  All meds have side adverse side effects.  Be up to speed on pred side effects:  🚩  vcahospitals.com/know-your-pet/steroid-treatment-long-term-effects-in-dogs
  

A 30-day course on top of a 7-days course of pred does not align. Waiting to find out in 30 more days what pred has done is unusual with what 1000+'s of reports on how vet's prescribe prednisone.   
   
Often the prudent guesses for how long a pred course to give are:
   --  7-day course
   --  14-day course
 
You are ultimately in charge of Lulu. Dr. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated so we can team up to work with our vets.
Being the team captain and playing a very instrumental component of at home care for Lulu, means your understanding of the treatment is essential.   
            When something seems off, that is the time to ask questions on behalf of Lulu to understand the thinking behind prescriptions.  You now are aware that something is off.

 You cannot speak up if you don't have all the facts. There may be a simple answer about why what appears to be a 30-day pred course, but may was not supposed to be a 30-day course.   You are like a nurse at a hospital. Your job is to monitor meds.  If you see a concern, the doctor needs to be informed so things can be worked out for the patient's benefit.

Let us know what you find out about the #-day pred course.  The receptionist/vet tech may be able to access the Neuro's notes to provide explanation until you can discuss with your Neuro.

Prednisone as of 10/10: 5mg 2x/day for 7 days; Sun 10/20 TEST TAPER for: √10/17 pain and _ neuro
                        as of 10/23-   30 (10mg refill tabs): 5mgs 2x/day for 30 days,  11/22 TEST TAPER for: _ pain _ neuro

Lisa, thank your for sharing your neuro's thinking behind the pred refill.  

Prednisone, is a hormone, which is useful at different dose levels depending on the disease.

Hoping to learn with the 10/23  7-day pred course + the 10/10  7-day course, a 10/29 pred taper will prove a disc episode vs a tumor if no pain surfaces.  Please keep us updated.

Lisa, so happy to read the Neuro's report of no neck pain and no front leg neuro weakness at all!!     Lulu has come along way in healing 3 of the 4 areas of healing during a disc episode.  dodgerslist.com/ivdd-healing-the-torn-disc/

Dr.'s differential diagnosis appears with IVDD being ordered for the #1 disease   plus for Lulu there are early signs that the upped 14-day course of  prednisone is in action to resolve the root cause of pain.  
    Of course the final proof only comes with your observation during the days of tapering prednisone.  Hope, of course, is the taper will not reveal surfacing of neuro diminishment, nor any pain/swelling.

Regarding leash walking:  
   • What are the risks to an early healing disc with 3 weeks of STRICT REST vs. what are the benefits for leash walking prior to full opportunity for disc healing by Dec 5 graduation date?


   • What are the studies showing the length of time it takes for discs to form secure scar tissue that would support leash walking?

   • What is the risk to continue with STRICT rest for 8 weeks? Conservative Strict rest includes minimal footsteps at potty time every 4-6 hours providing a degree of daily leg/joint exercise.


Lisa, I can tell you that there have been some very few dogs whose owners did not complete the full 8 weeks of STRICT rest to allow the disc to heal. The dog miraculously did not re-injure the early healing disc.  
     On the other hand, there are stories of shortcutting strict rest which did unfortunately cause dogs' disc to relapse and the need to start back at square one of 8 weeks strict rest to again heal the disc.  
    If crate rest IS what your Lulu needs and you don't do it, lack of rest could end ip costing you money of maybe a surgery, Lulu a life-time of pain or perhaps even paralyzed front or back legs.

So ultimately crate rest is your choice to make.
No vet can make it for you and neither can we.

From my years since 2017 here at Dodgers, it is clear that good crate rest principals for conservative dogs typically ensures a good outcome for the healing disc. Lulu depends on you to ask questions to help you make the hard decisions on her behalf right now. 

So with information in hand and if you believe that Lulu can be one of those few dogs to be able to short cut disc healing time, be very careful of the leash walking.
  --- do it when there are no other dogs, squirrels, etc. to cause her to want to dart off unexpectedly, pull on the harness, over exerting stress on the spine. Avoid stepping off/up a curb.
  ---  begin slowly and gradually to lengthen the time/distance. After each session, observe for any signs of pain. 
  ---  With too much exercise all at once, it may be hard to tell the difference between sore muscles from too much exercise or a relapse of the early healing disc. If you see any signs of the IVDD worsening, crate and contact the vet right away.
 ---  As Romy says, also be VERY observant once prednisone begins to drop below the anti-inflammatory level on Nov 5:  the taper doses.  The pred taper (along with no pain meds on board) is the true test if all inflammation pain is actually gone.

When talking about crate rest we often use the example of a broken arm. A broken arm is put in a cast to immobilize the arm and allow the bone to heal. In the case of conservative treatment for IVDD the crate is the substitute for the cast. The goal is to minimize movement, allowing the disc to heal. Too much movement too soon will jeopardize this healing. This is the reason why we at Dodgerslist support a cautious 8 weeks of crate rest.