StevieLuv
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Post by StevieLuv on Oct 8, 2013 6:57:58 GMT -7
Don't give up!!! (((hugs))) The taper sometimes has to be tried more than once. She just isn't ready yet - try not to despair, pain = swelling = more time on prednisone. Don't lose hope, and try not to worry about negative side effects - those usually are seen with long term steroid use (months) She will have to pee and poop more because she will have an increased appetite - those are the biggest immediate side effects. On a side note - I had to take prednisone for 6 weeks once before beginning a taper after tangling with a full grown pig.
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Post by Jean & Mimi on Oct 8, 2013 7:11:18 GMT -7
Update - hubs took her to the vet today. Vet confirmed she still has deep pain sensation in left leg which is a good thing. She said she is being really stoic about the pain she is in. She immediately put her back on the ▲dexamethosone for two more weeks at 3x per day - which will give her a month on the dex at full dose. The vet told my husband that I was right!!!!! That she could be on the dex for that long and it would be ok. So yay for no taper yet to really give that disc time to heal. She can also continue on the Tramadol and Gabapentin. So to confirm continuation of medication....
▲Dexamethosone: .125mg 3x per day for two more weeks Tramadol: 25mg 3x per day Gabapentin: .8ml 2x per day Pepcid: 5mg 2x per day
Continuation of solid crate rest. I feel somewhat victorious that I was able to get my point across to the vet thanks to all of the information I have found here and learned from you. We have now seen all three vets that are in the practice. I am not ready to let my dog go. I want her to heal and be able to wobble around on her own. I don't need perfect, but I want her to be able to go in our very flat back yard and bark at the squirrels.
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Post by Samantha & Shorty on Oct 8, 2013 7:30:53 GMT -7
Praying for Mimi's recovery... I only wish for the same with my boy
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Marjorie
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Post by Marjorie on Oct 8, 2013 16:41:18 GMT -7
Great job on advocating on Mimi's behalf, Jean! You have every reason to be feeling victorious. We all have to remember that we hire these vets and they work for us and while they're the ones with the medical education, we have every right to be involved in the decisions being made. As Paula always says, we're the Captain of the Team!
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Post by Jean & Mimi on Oct 9, 2013 6:43:16 GMT -7
Update for today...
Mimi had a little bit of better night last night, back at the three doses yesterday. But is still doing a bit of grunting. Last night when we took her out for last potty she did manage to take a few steps (progress from the night before) and did the same during the middle of the night breaks. Instead of just sitting there with her head up like the night before, she was able to get comfortable and rest. She is still doing full body shakes (not with any encouragement from us mind you).
After continuing to read everything here (both literature and other posts), I called the vet today to double check her dosage. He said this is the dose they prescribe based on the consultation with the 2 neurosurgeons that they work with who treat IVDD dogs from a surgical perspective. I told him that she seems perkier, is still interested in food (and will consume it with no issues), and pees/poops on her own but is still doing the occassional grunting. He advised that when we are home on Saturday and Sunday to do a test with [Dexamethosone] .25 mg in the am and then the .125 in the afternoon and at night. He said if she seems like she is in less pain, and has no gastrointestinal side effects then we can continue but he would also prescribe the sulcrafate(sp) to protect the GI tract. I was very clear with him that surgery isn't an option financially. He still thinks she has time to heal.
I swear this vet probably thinks I am crazy but I just have to be sure we are doing everything we can. I think the five day taper was a mistake and now it is taking her a bit to be pain free again. But on the more positive side again, last night I didn't sleep tossing and turning and worrying. She was in the bedroom with us in her crate and I got up to go downstairs on the computer (to read some more on this site). Hubs called out to me that she was in her crate whining for me. When I came upstairs she was wagging her tail and quickly rolled to give me her belly. So sometimes she shows signs of pain (only in the past three days) and others she doesn't at all (when she was in the deepest pain she would not roll over, would not wag her tail but would just lay quietly with her head up). Now she is curling herself into balls under the crate blankets or stretching out. I also heard her several times rearranging the blankets last night and not whimpering or grunting. Please note the only sign we have of any pain is this low breathing grunt on occassion when she is picked up. She doesn't grunt in her crate or when she moves, she is not in her crate shivering. I am giving it a few more days to get the dex up to a the dose she had it before. I hope to see progress and will definitely do the test on Saturday and Sunday.
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PaulaM
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Post by PaulaM on Oct 9, 2013 10:42:47 GMT -7
Mimi, so glad to hear having Dex back on board working on swelling and the pain meds are giving relief until all the swelling can be addressed by Dex. Since Dex is notorious for the damage to the GI tract it could possibly do, very glad to hear you will be getting a 2nd stomach protector on board…. sucralfate. Do you now have sucralfate? It has a special timing in regard to eating and Pepcid AC …check out the details on this vet's website: www.marvistavet.com/html/sucralfate.htmlYou did an excellent job in working with your vet to advocate for the meds Mimi needs. Kudos to you gal! I agree with your vet Mimi can heal her disc, heal her nerves with time. The important thing is to have pain control while that is happening. The hope with conservative treatment is the disc pressing on the spinal cord and causing all the inflammation will over time shrink back enough to not irritate the nerves and allow neuro functions to come back. The taper at 5 days was a test to find out those details, so it was not a mistake. It is a prudent thing to not be on these meds any longer than needed, you only know if you do the taper test. The important thing on a taper is to quickly ID if pain returns and immediately let the vet know so the steroid can go back up to the original level. I'm not sure what the grunting is, do continue to observe if trembling, tight tense tummy go along with it to confirm pain. Otherwise all you report confirms Mimi is not in pain to be able to curl up, stretch out, roll on her back and rearrange her blankets.
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Post by Jean & Mimi on Oct 9, 2013 10:53:40 GMT -7
Paula,
Thank you so much for your reply. The grunting seems to be primarily when she is picked up for potty time and it seems more like heavy sporadic breaths (not panting, just a noise). She moves around her crate ok other than the back legs not doing much. I didn't observe her moving her blanket around last night, but I heard her moving around and it sounded like that (plus this morning her blanket was all over the place and she was underneath).
I do not have the sucralfate yet. I have been doing the pepcid 2x per day and have seen no issues at all (including her desire to eat etc). If we see more response on Saturday with the .25 of dex and it goes well, the vet will do the sucralfate. If the .25 does nothing then we won't continue.
Thank you for the encouragement. She just seems so so sad. I miss her being herself.
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Post by Jean & Mimi on Oct 10, 2013 7:26:18 GMT -7
Morning update...
I saw what I see as small improvement last night. She did not seem in pain at all, was laying down, curled up or stretched out on her side. She was doing her barking "give me some of your food" last night while wagging her tail at us.
I have been trying to isolate the grunting thing. To me, it seems she grunts when she is a little anxious or unsure of something or she just was unsure of something. FOr example, she grunts when she is being picked up for potty or crate transfer but once she realizes she is firmly supported in your arms, she stops. She grunts when she tries to do something that takes more effort for her (sometimes rolling onto her back, I cannot stop her from doing this I have tried). During these times her belly is not tight, she is not shivering or showing any other signs of pain. Please note that back when this injury first happened, she was shaking a ton with the pain. Also, she is pooping again so it's not constipation.
I have caught her doing the following which I believe are signs that there is no pain:
- curling into a ball to lick her privates - Full body shake - both standing sometimes as well as while she is sitting in her crate (her balance is not great so sitting is easier for her) - sleeping either stretched on her side, curled into a ball, moving herself under covers etc.
The only think I haven't seen her do is the typical stretch she used to do (down on front paws, then up and stretching out each leg separately). I don't know if she can do that as she has limited balance in back. So I think we are on top of her on the pain front.
As for the additional dex this weekend, I am going to do it, but I will make sure to have the sucralfate on deck before I do it.
Hope everyone is having a good day.
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Marjorie
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Post by Marjorie on Oct 10, 2013 7:46:05 GMT -7
You know your dog best, Jean, and it does sound like you've done some good observations as to the grunting. All of the other things she's doing that you've outlined do indicate that she doesn't have pain. As for the stretching standing up, that is difficult for a dog to do when their back legs aren't strong and steady. You're doing a great job with Mimi. Keep up the good work! And thanks for encouraging other members in their IVDD journeys.
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lupi
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Post by lupi on Oct 11, 2013 6:34:30 GMT -7
Glad to hear Mimi seems to be feeling better. Barking and tail-wagging are such beautiful things!
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Post by Samantha & Shorty on Oct 11, 2013 7:07:08 GMT -7
Happy to hear about the great progress!!
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Post by Jean & Mimi on Oct 11, 2013 11:14:38 GMT -7
Hi Everyone, no news to report, still same ole same ole... no better walking, still doing the grunt when picked up but otherwise exhibiting no signs of pain (and doing stuff contrary to pain). I am going to to the test with the increased dose of ▲ dex in the am tomorrow. I am also getting the sucralfate today so I will have that on board. So now I have a few questions: 1. Do I still give the pepcid? If so when? I know you have to give the sucralfate an hour before eating and pepcid 1/2 hour. Can I give the pepcid during the hour before eating? Also, I give Mimi her meds with a bit of cheese. Can I give the sucralfate with cheese? 2. Can I give a dose of sucralfate tonight too, before she starts on the increased dex? Any issues with that? 3. I know sucralfate has to be given at least 3x a day. The morning dose and evening dose are no issue. However the mid-afternoon dose is a problem. Hubs is home by 3:30 which is usually when Mimi gets her afternoon dex and tramadol. So if we give those right away (with a bit of cheese) can she have her sucralfate with a bit of cheese at that time too? We don't feed her then, but I am wondering if the other meds will cause an issue. If so, is it harmful for her to wait so long between sucralfate doses? There is no way to have anyone come and dose her earlier, this is the best we can do. I am not worried about the eating time because she usually has her "dinner" with us at about 6:30 or so. Any thoughts or guidance would be helpful. By the way if this works her meds will be as follows: Sucralfate 3x per day (not sure of dosage yet) Dexamethosone: .25mg in the am, .125mg afternoon and night Tramadol: .25 mg 3x per day Gabapentin: 40 mg 2x per day Pepcid (waiting to hear what I should do with this) Just realized that 2.5 weeks in to this whole episode she is still on a LOT of meds. It's somewhat heartbreaking when I see other dogs reducing and doing fine. I wonder if she will ever recover.
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PaulaM
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Post by PaulaM on Oct 11, 2013 17:55:06 GMT -7
Jean, with the use of Dex, and it's notoriety of causing GI tract problems, it is very prudent to use TWO stomach protectors and be proactive to protect the stomach lining. In addition to give Dex with a meal for further buffering of the tummy. Please read up on sucralfate so you understand this med needs an empty stomach to form the gel like coating. I don't think the small amount of pilling cheese would effect sucralfate's effectiveness. This vet's web site goes over all the details of using it with Pepcid AC, eating, and other meds. Work out a schedule that works best for your family. We'll then be glad to comment. With so many meds, I found a chart kept the dosing on time and none missed especially if two people are giving meds. The two links are below: www.marvistavet.com/html/sucralfate.htmlwww.dodgerslist.com/literature/crateRRP/medchart.pdfActually many dogs have taken over two weeks to get all the swelling down…with a disc episode the healing is a very individual thing and you really cannot compare with another dog's disc problem. Do remember, the body is working of scar tissue formation on the disc's surface, that you can't see but it is happening.
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Post by Jean & Mimi on Oct 11, 2013 18:27:07 GMT -7
We are back to pain tonight. She is sitting in her crate, head up, large pupils. She has had her gabapentin. Her dex and tramadol are due in 5 minutes. Just when I think I see improvement she falters and is suffering again.
I will see how things go with the increased dex tomorrow.
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Post by Pauliana on Oct 11, 2013 19:31:47 GMT -7
Jean,
So sorry to hear Mimi is in pain again. Was her pain is relieved with the Dex and Tramadol that you gave her 5 minutes after you posted last? Let the Vet know about her pain returning and see what he advises. Also keep him and us posted as you have been doing about how she responds to the increased dosage of Dex tomorrow.
About Pepcid AC, yes you continue to give it but give it 30 minutes after the Sucralfate.. Give Sucralfate on an empty stomach, then Pepcid 30 minutes later (Pepcid is to be given twice a day every 12 hours.. so you don't give the Pepcid 30 minutes after the middle dose of the Sucralfate)
I hope Mimi is feeling better by now..
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Post by Samantha & Shorty on Oct 11, 2013 19:53:59 GMT -7
I am sorry to hear about Mimi's pain and I hope she can rest comfortably after the Tramadol.
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lupi
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Post by lupi on Oct 11, 2013 22:42:19 GMT -7
So sorry Mimi's in pain. It's heartbreaking to see them suffer. I really hope you can get the right type and dosage of medicine for her to feel better.
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Post by Jean & Mimi on Oct 12, 2013 3:52:37 GMT -7
Good morning...
Mimi was able to rest last night and i heard her move herself under the blanket. Still grunting this am but also did a full body shake with a tiny grunt. Seemed to grunt less after potty break. At 6:30 she git her pepcid and at 7 will give gabapentin, tramadol and increase▲ dex. Vet gave a script for sucralfate ao hubs is filling it as soon as the pharmacy opens. I will give her that at around 9 (2 hrs after food). Today and tomorrow we will see.
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StevieLuv
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Post by StevieLuv on Oct 12, 2013 9:50:20 GMT -7
There are so many ups and downs with IVDD. Hang in there - you are doing a great job!! ((hugs))
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Post by Jean & Mimi on Oct 12, 2013 17:04:03 GMT -7
Quick question...can the increased dexamethosone make her pant? She isn't really a panter unless she is very warm. Even when she has been in pain there was never panting before. She cane out from under the blanet she was under and was panting for like 20 seconds. Today was the day with the increased dex. I did see on the IVDD 101 that panting can occur on the steroids but I haven't seen it before. But I know it is also a sign of pain. Thoughts?
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Marjorie
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Post by Marjorie on Oct 12, 2013 19:10:20 GMT -7
Panting can be a temporary side effect of tramadol. Steroids can cause anxiety which can cause panting. Or it can be a sign of pain. Put on your detective hat and see if you place a fan near her crate but not pointed at her, does the panting subside? If you see other signs of pain with the panting such as shivering, trembling, yelping, tensed up tummy, then the panting could be a sign of pain. If she came out from under a blanket, where she may have gotten a bit warm, and was only panting for 20 seconds, I don't think you have anything to be concerned about. If it continues, try the fan. Also a rice sock from the refrigerator can help them cool by laying their tummy along side of it. Fill a sock with 1-2 cups of rice and tie the end of the sock closed. Try a frozen broth ice cube to lick on. Dr. Isaacs discusses this issue: www.dodgerslist.com/neurocorner2/panting.htm
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Post by tugandbucket on Oct 13, 2013 15:27:34 GMT -7
Awww... Hopefully your Mimi is back on the right track now. I know that the slips backward are hard to deal with. I think most of us have seen at least one or two during the 8 weeks. Hang in there, Jean. You are providing excellent care for your little Mimi and she knows it. Rusty and I are prayin for you.
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Post by Jean & Mimi on Oct 14, 2013 6:59:02 GMT -7
Monday Morning Update
So, today begins day 3 on increased dex. Because I don't trust myself to be the judge of what I see happening (because I am afraid that I will see positive things that aren't there), I have been relying on comparing what I am seeing to what my husband sees.
We have been extremely careful all weekend with giving the sulcrafate, then the pepcid, then food, then dex, spaced out according to prescription (or just sulcrafte on empty stomach, food then dex). Here is what we have seen:
- some increased alertness, gradually each day. Saturday was the first time we had seen her seek out affection, like demand affection, in a few days. I also left the back door open so she could look outside and there was quite a bit of barking and getting mad at the squirrels. I have also seen her perk her ears up at sounds outside and bark if there is a closing door. - I have heard less grunting when picking up and going out for potty time. I have also seen more alertness at potty time - including wanting to go see the bushes where the birds and squirrels hide (please don't worry I don't let her). - Pee and poop is fine...no signs of gastrointestinal upset. Still drinking and eating, although she is getting quite spoiled because she likes it when I feed her her kibble. Don't worry, she still eats the kibble from the bowl sometimes too. But she really likes the addition of the low-salt, low fat broth with it. - this morning in particular (even before she got her morning dex, gabapentin and tramadol), lots of moving in crate and needs for attention. Even when she is not perky, to me, her resting seems better. She is doing more of the burrowing under the covers herself, which we didn't see much of all last week.
Hubs is going to speak to the vet today and report this to him (with my comments). I am having him ask about perhaps increasing the dosage of her tramadol for a few days, then taper back to the lower dose. I do not want to make too much of what seems like progress because I have been let down before. But I do believe we should continue with the higher dex in the am until next week when we have to return to the doctor.
On a side note (and I am asking the vet today too) it is time for her heartguard and flea medicine. Is there any issue with her having this while she is on so much other medicine?
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Marjorie
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Post by Marjorie on Oct 14, 2013 7:37:04 GMT -7
You're being a very good advocate on behalf of Mimi, Jean! You and your husband are being very observant and cautious. Please let us know what the vet says after speaking to him.
I would most definitely hold off on the Heartguard and flea medicine until crate rest is completed. Actually, many believe that topical flea medication should never be used on an IVDD dog. This is a chronic illness and it says on the package not to use on sick pets. There are natural flea remedies available. I personally use diatomaceous earth to control Jeremy's fleas but I would even hold off on using something like that until after crate rest.
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Post by Jean & Mimi on Oct 14, 2013 8:01:59 GMT -7
OK, I will check with my vet and find out about waiting. However, I am concerned about the fleas/ticks in my area. I live in NY and the tick situation around here is very scary and lyme disease is a very real possibility. I am extremely hesitant to leave her without this type of protection.
As for the heartguard, how do I continue to prevent her heartworms if I postpone her treatment? I know I can wait a week or so without causing any issues, but I am very concerned because when I was a child, my grandfather inhaled heartworm from being near a dog's feces that had it. So needless to say, personal experience has me terrified of it.
BTW, I am not trying to be difficult at all. I am just really nervous because of what I have seen happen to other dogs in this area without the preventive treatments.
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StevieLuv
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Post by StevieLuv on Oct 14, 2013 9:41:00 GMT -7
Your Vet may be okay with both the flea treatment and the heartguard - benefits outweighing the risks and all that - neither medication has an stimulating effect on her immune system, the way a vaccine would for instance. Technically she is injured and not ill, so it may be okay. You are not being difficult at all - you are caring a cautious and that is GREAT!!
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PaulaM
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Post by PaulaM on Oct 14, 2013 9:57:47 GMT -7
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Post by Jean & Mimi on Oct 14, 2013 13:14:10 GMT -7
Thank you so much for that link! Unfortunately, I am still in the zone to give her the heartworm meds. I live a rural area and have deer constantly in my back yard. THe ticks are a huge concern.
Hubs did speak with the vet and we will give her the heartworm medication as there are no contraindications with the medications she is on. Same as the flea/tick.
I also spoke about continuing the increased dex until next week when she has her follow up appt and we agreed, especially since we have seen improvement. Most likely we will begin the taper after her appt next week. He didn't want to increase her tramadol right now, but if we felt strongly he could increase the gabapentin. I will call him back and follow up with him. Hubs went to the vet instead of calling and the vet was really busy and didn't have a lot of time to speak. Next time I will be the one to call because when you call, they are really good about calling back and spending time with you.
So for now, to recap meds:
Dexamethosone: .25mg in am, .125 afternoon and pm Tramadol: 25 mg 3x a day Gabapentin: 40mg 2x per day Pepcid: 5mg 2x per day Sucralfate - Sorry don't know the dosage - forgot to check this am.
Fingers crossed for continued improvement.
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PaulaM
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Post by PaulaM on Oct 14, 2013 14:50:11 GMT -7
The ingredient in Heartguard is a neuro toxin to kill heartworm larvae and other worms. Some how avoiding, if possible, giving neuro toxiins to a dog that has a neurological disease, IVDD, seems like a good idea. Mosquitos are the carrier for heartworm larvae. Two things are required for mosquitos to transmit…standing water for mosquitos to grow in AND... the right temperature. During the time the heartworm larvae are developing inside an infected mosquito, which is approximately a two-week period, the temperature must not dip below 57°F at any point in time. If it does, the maturation cycle is halted. Are you now having any days/nights in NY where the temp goes below 57 degrees? Then discuss with your vet and weigh the risk of given your dog a neuro toxin while his immune system is not at its highest with this disc episode. By time graduation day of Nov 19, there may be no need of Heartguard at all til the weather warms again in the spring. Worth a discussion and as Dr. Mercola says: healthypets.mercola.com/sites/healthypets/archive/2010/08/03/why-havent-pet-owners-been-told-these-facts-about-heartworm.aspxFleas and ticks are killed by other means. You can keep potty area grass cut short, spray a ring on the grass area with some natural anti-flea/tick products Perhaps while on crate rest, where she is supervised not in the grass but a few minutes the chance of picking up flea/ticks are minimal. If there should be fleas/ticks, pick them off or try some of these the idea Marjorie was leaning towards until the weather turns cold enough and parasites. Just some ideas to consider.
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Post by Jean & Mimi on Oct 16, 2013 7:28:23 GMT -7
First, I am putting off giving her the flea/tick and heartworm meds for a bit. Yes, unfortunately in our area it hasn't gotten cold enough all the time to stop the heartworm cycle. October has been pretty warm so far. So she still needs it (we also have a lot of bugs/mosquitoes because we live close to a major river). But i am postponing a bit.
But I find myself being paranoid about EVERYTHING now and I don't know how to stop. Last night in the middle of the night I heard her licking. I tried to check but it was really dark and as soon as I approached her crate she stopped. She was either licking her privates or licking/nibbbling a part of her body or something. Please note she does not do this all the time, it's not an every day thing or even frequent. Is it possible she just had an itch? Or was just doing it because? I checked her over this am to make sure there were no injuries or anything I could see and she was totally fine. She has not been doing this ever that I have seen since the incident happened. How do I get over being paranoid about everything? It's starting to get to me with my whole life wrapped up around medicines, watching her for signs of pain or loss of function etc. Please do not misunderstand, I would do and will continue to do whatever I can for her, it is just starting to be a consumption.
On another slightly positive side, I feel like I have seen some progress with the left rear leg. Last week, she would frequently sit with it out like a turkey leg (that's what we call it) laying straight out behind her and would really provide no use to her. This week, I have seen very little of that. It seems she is more conscious of it, tends to either have it out in front of her or tucked under her when she is resting and I have noticed less knuckling during potty breaks. She tries to keep the leg under her and her paw at least flat on the ground. I see this in her crate too when she is barking at us for a piece of our dinner. Again I do not take her out of crate, just she moves in her crate and I can't prevent that.
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