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Post by Pam & Dobby on Sept 30, 2013 6:32:03 GMT -7
My name is Pam and my dog's name is Dobby.
He weighs about 13.5 lbs.
He is a smooth coat mini/tweeny dachshund.
We believe episode started 9/25/2013, started Tramadol 9/26, and 9/27 started the conservative medical treatment approach.
He is on
Tramadol 25 mg 3x day
Prednisone 5 mg 2x day with plan to begin taper after 3 days
Famotidine 5mg 2x day.
Sucralfate available.
16.2mg Phenobarbital 2x day.
He does not yelp when picked up or moved and has not done so at all. He first presented with tight hard tummy, some muscle contractions, some shivering, trembling and reluctance to move. For the most part, these have all subsided.
He can wobbly walk. At times there has been some leg crossing, knuckling, falling to side or rear end collapse. This seemed to be better yesterday. Have not done much yet today. He still wags his tail.
I carry him out to yard and have him on leash for potty breaks. Have sling and trying to determine how best to use it for support and avoid the urine stream.
He seems to have control of bladder, have not found wet bedding. We have experimented with Sucralfate and adding fiber to diet to find right balance to prevent constipation or loose stools.
He did not eat for close to 24 hrs., but after beginning Tramadol, has been eating fine. Soft/canned food at vet's recommendation. He drinks when he eats, but has not been drinking a lot otherwise.
Dobby is also epileptic since October 2010. Seizures currently well-controlled on 16.2mg Phenobarbital 2x day.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Sept 30, 2013 7:27:04 GMT -7
Pam, welcome to Dodgerslist. It sounds like Dobby will be a good candidate for conservative treatment. You can be instrumental in making that happen with 100% STRICT crate rest 24/7 for 8 weeks and when out to potty only a very, very few footsteps. Much depends on your full understanding of the enemy (intervertebral disc disease), the meds and the care in order to win this battle an protect Dobby for the rest of the many years Dobby will share with you. Have you located our treasure trove of all things IVDD on the main Dodgerslist website? As time permits do make it a priority to read each of the articles…then you will be up to speed and ready to become a vital part of Dobby's health care team… you will be in position to be the captain of the team! Here's the treasure trove: www.dodgerslist.com/literature.htmPain is the one phase of healing (you can read up on other 3 phases: www.dodgerslist.com/literature/healingpage.htm ) that you can have no patience with…pain should be fully under control dose to dose of the pain med, Tramadol. You initmate that is not the case with "for the most part" Your vet has many options that have not yet been employed…. he needs your feedback to know further adjustments are needed. Understand pain and the typical meds so you can be a knowledgable part of the discussion. Phenobarbital may adversely interact with the typical IVDD meds… so that is something to look up for your own self edification and to discuss the risk vs. pain benefit with your vet. How to look up your dog's meds dodgerslist.boards.net/thread/951/dogs-meds How much does Dobby weigh? Let us know if he is pain free.Is constipation now cleared up? The sling would be used just as back up in case his butt tips over to prevent falling. Male dogs are likely to do better with a figure 8 sling. Are you also using a harness rather than collar to attach leash?   |
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Post by Pam & Dobby on Sept 30, 2013 7:42:44 GMT -7
I have been trying to read and absorb as much as I can. Dobby weighs about 13.5 lbs.
I am using a harness. Thanks for the images and info about figure 8 sling.
Constipation has cleared and now watching to make sure stools don't get too loose.
Vet is fairly certain the L2 disc is the culprit.
[9:14am ]
Dobby just had a pretty loose stool. Good bit of mucus but no signs of blood. Will call vet, but my understanding was that if this happened, I would resume the sucralfate and step down the predisone. Does that sound reasonable?
What is the best way to tell if he is fully pain free from dose to dose?
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StevieLuv
Helpful Member 
Conservative Treatment 3x. It really does work!
Posts: 1,335 
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Post by StevieLuv on Sept 30, 2013 9:00:53 GMT -7
Starting the sulcralfate is a good idea - Dobby should get it 1 hour before prednisone. You will have to check with your Vet about decreasing the prednisone - because the pred is what is getting rid of the swelling. Signs of pain are shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy. If you are seeing any of these signs before the next dose of pain meds then they will need to be adjusted. You are doing a great job keeping on top of Dobby's condition! Keeping you in thought and prayer  |
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Sabrina
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My Charley-dog, a Dodger'sList grad enjoying life!
Posts: 471
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Post by Sabrina on Sept 30, 2013 9:17:59 GMT -7
Hi Pam, I'm Sabrina. So sorry to hear of Dobby's disc episode! Well done for being proactive and working on learning all you can about IVDD for Dobby's sake. I was typing a reply and then saw Maureen already answered your questions - so I just wanted to add my reply with some links to pages on the Dodger's List main site in case you haven't seen them yet - and even if you have, I know when my dog was first diagnosed I had to read everything again and again before it started to fall into place! Some dogs are experts at hiding pain. "Signs of pain are holding the head in an unusual position...head held high or nose to the ground, shivering/trembling, not wanting to move much or moving gingerly, yelping, tight/tense stomach muscles, holding leg up flamingo style...not wanting to bear weight on the leg, just not their usual perky-interested-in-life self": www.dodgerslist.com/literature/healingpain.htmIs Dobby showing any of these signs? If so, let your vet know because that means it's too soon to taper the pred. The pred at the anti-inflammatory dose is what's working to resolve the swelling/inflammation that is the cause of the pain: www.dodgerslist.com/literature/healingsweling.htmIf Dobby is still in pain, read up on the pain medicines (from the healingpain page and the link Paula gave you to research the meds) and then talk to your vet to see what other options are available for Dobby, given his epilepsy medication. Good to hear that your vet has already prescribed Sucralfate. The addition of Sucralfate will help to protect his GI tract so that he can hopefully stay on the anti-inflammatory dose of the pred until it controls the swelling/inflammation. If you haven't already read up on how to time this med (it needs to be given on an empty stomach 1hr before the meal & pred), here's a good resource: www.marvistavet.com/html/body_sucralfate.htmlSo let us know if you see any signs of pain, and what the vet says. ))Hugs!(( - Sabrina |
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Post by Pam & Dobby on Sept 30, 2013 9:35:26 GMT -7
Thanks! Vet said that I should start sucralfate & could give it now, as it is about 5 hours since food or meds and about 2 hrs. before next meds or food. Dosing at least 2x day and could go up to 3-4x day.
Because of other health concerns, she would like to try taper pred to 1x day after 3 days at 2x day. Plan would be to stay on that level for at least 5 days. Re-check at vet clinic on Friday, if there is no obvious need to go sooner. I can call vet at any time & she wants update 1x day or whenever anything changes.
I may have been a little off on my first post. On 8/25, he got a dexamethasone injection and a buprenorphine injection. Tramadol to be given every 8 hrs. Sucralfate to protect his stomach & Pepcid. Prednisone started 1 dose on 9/27 and then 2x day for 3 days.
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Post by Pam & Dobby on Oct 1, 2013 10:33:19 GMT -7
Waiting on return call from vet. Dobby seems to be having more pain and is much less steady on his feet than the previous 2 days.  |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 1, 2013 13:47:08 GMT -7
I'll be praying for Dobby, Pam. Please let us know what the vet says.
Blessings to you and Dobby.
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Post by Pam & Dobby on Oct 1, 2013 14:53:22 GMT -7
We are adding Methocarbamol 1/4 of 500 mg tablet every 8 hrs. If that does not seem to be adequate, next step will be to do the Tramadol every 6 hrs.
Thanks for your prayers! |
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 1, 2013 18:03:32 GMT -7
I have just re-read all of your posts, and saw that Dobby is on phenobarbital for epilepsy, so is our Stevie. Please make a mental note that Tramadol can lower the seizure threshold in dogs with epilepsy. It did with Stevie, but her epilepsy has proven very hard to control. I'm not trying to alarm you, just give you a heads up - our Vet didn't know this either, so we all learned something new when the seizures started again.
Hoping all goes well and pain is well controlled.
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Post by Pam & Dobby on Oct 1, 2013 20:08:35 GMT -7
I am aware that Tramadol can lower the seizure threshold. So far, no seizures that I have observed or seen evidence of. Did you switch to something else for Stevie that worked for pain but did not increase seizures? I'm thinking about asking about Gabapentin because I know it is also used by some as an AED. Do you or did you have a neurologist on board?
Dobby's seizures have been well-controlled for about 1.5 years now, but all of these extra meds make me a bit nervous. Most of them can be taxing on the liver and some can impact the kidneys as well.
I will need to make a new schedule tomorrow with the addition of the new med. He did get one dose today and it may have helped some but I'm not sure I'll get another one in before tomorrow morning.
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Post by Pam & Dobby on Oct 2, 2013 5:56:59 GMT -7
Quiet night, but Dobby woke up this morning with very messy stinky diarrhea. As far as I am aware, this was not seizure-related (always a concern for him). After that episode & clean-up, I took him out and he was able to hold himself up to urinate, give me a few tail wags, but very unstable for walking. He has eaten, had Pepcid, Tramadol, and Phenobarbital. Trying to think through when to give Methocarbamol, Prednisone, Sucralfate. I think Sucralfate should be given 2 hrs. after eating and 1 hr. before Pred.
I'm calling the vet again, but just thought I'd post here to see if anyone had any suggestions.
So far, everything that my vet has said & done seems in line with recommendations on dodgerlist and other reading. True, she may not have the expertise of a neuro in interpreting everything. She has been willing to give me a referral from the start. She has debated about doing an x-ray in-house, but says that they are often inconclusive in this type of situation. May help rule out some things, show some things, but MRI,CT, etc, would be much more accurate.
I have raised Dobby's dish and I use a harness with him. I am just trying to process all of the information and suggestions and figure out what to do next.
If surgery is not an option, what are pros and cons with seeing a neuro for consult without diagnostic testing?
Thanks for any help.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Oct 2, 2013 9:00:43 GMT -7
I'm sorry to hear about the diarrhea happening. The Mar Vista vet page is something I keep bookmarked for my dog's meds. Briefly they give these pointers, but you will want to read the article for yourself here: www.marvistavet.com/html/sucralfate.html-- staggering sucralfate administration with the administration of these other medications by at least 2 hours. -- If possible, it should be given 30 minutes prior to the administration of an antacid. -- at least one hour before feeding or two hours after -- One dose of Sucralfate lasts approximately 6 hours after it is taken orally. With all the complicatedmeds Dobby is on, a chart sure is a must have. You may like to use this one as a guide as you redo: www.dodgerslist.com/literature/crateRRP/medchart.pdfA reason for an MRI is if conservative is not working and there is suspicion that another disease may be the culprit. Your vet really has such a good feel for IVDD! An Xray is to rule out other problems, such as tumor, fracture. It can help to suspicion a disc problem but not prove one as xrays show hard tissue not the soft tissue of discs and spinal cord. Another reason for a neuro consult, without MRI is if you feel your DVM has run out of options for medications to control pain during conservative treatment. When you get things under control with the diareah, would you consider sharing a vet recommendation with other members trying to locate an ivdd knowledgeable vet? Here is our directory: dodgerslist.boards.net/board/10/guidelines-posting |
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Post by Pam & Dobby on Oct 2, 2013 19:51:07 GMT -7
Dobby was very subdued all day. More icky poo at 9pm, but better consistency than what he had first thing this morning. He was able to hold his bottom up enough not to fall or sit in the poop, but then did not step away from it.
I'm worried and discouraged. Is there anything that will help the inflammation that does not affect the GI system? I will be reading about meds again and talking to vet again tomorrow.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 2, 2013 20:12:21 GMT -7
Hi, I apologize for taking so long to get back to you - working out of town, but home now. Stevie was put on Buprenorphine for pain, and it hammered her flat, seriously she was absolutely gonzo for about 17 hours. We now know that because of the phenobarb she should have had about 1/2 to 1/3 the regular dose. She is on potassium bromide and phenobarb for seizures, and the addition of the potassium bromide 3 months ago has made an enormous difference - she went 7 weeks plus a day without a seizure - YAY!! I remember what a pain it was to figure out a medication schedule with Stevie too, and I ended up with a small whiteboard in the kitchen to plot it all out and keep track. Penobarb twice a day, then an hour later the sulcralfate, then an hour after that the prednisone and pain meds (we didn't have Pepcid the first time around) The medications for IVDD are short term, so I wouldn't worry too much about any long term effects on the liver or kidneys. The big thing we learned to watch for was that the sedating effects of pain killers can be magnified because of the phenobarb, so can hind end weakness and ataxia. Stevie did have a CT scan when she went down the first time - we had adopted her only 5 weeks earlier and had no history other that that had been having seizures in her foster home. The Vet wanted to rule out brain tumors that could be causing the seizures and then the paralysis that happened after a big seizure on Jan 25. - CT scan showed no brain tumors and 8 bad discs, 2 that were causing the problem- hello IVDD That was our only consult with a Neuro. I don't know that any of this will help you to decide about a neuro consult - it never hurts to talk to the expert though. Just wanted to let you know that you aren't alone - we got through it and you can too. Your Vet sounds great and Dobby is so lucky to have a family that will fight for him!! |
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Post by Pam & Dobby on Oct 2, 2013 20:46:55 GMT -7
So phenobarb, then sucralfate, then prednisone+pain meds is a good sequence?
Also, if watching for sedation, hind end weakness, and ataxia (magnified by phenobarb), is there anything I should do?
I think I should try to get some sleep.
Thank you for sharing your experience.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 2, 2013 20:57:08 GMT -7
That sequence of meds worked for us - though I was told later that I could have given the phenobarb along with the pred and other meds. I was concerned about the sulcralfate interferring with the phenobarb absorbtion (I worry - I get an "A" in being a fussbudget about my pets) but giving it all in one lot would be alot more time efficient - double check with your Vet before you settle on a schedule. That white board saved us alot of grief, we didn't have to rely on memory because everything was written on it - even every time she peed or pooped. If you think that the drugs are interacting and causing him to be too sedated your best bet is to call the Vet so that they can adjust the dosages. Because he is on crate rest you don't have to worry about him falling down the stairs or something equally horrid, and extra sleep is always good for healing |
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Post by Pam & Dobby on Oct 3, 2013 13:42:23 GMT -7
Dobby threw up during the night. Was not good this morning. Would not eat. Very disinterested in surroundings. Seemed in pain. Took him to vet & he got some fluids and barium to coat his stomach. He had more explosive stinky poop while there. Vet checked him out pretty well. Thinks this is all a reaction to prednisone. So we are taking him off of that. We will try to manage pain and let his GI system repair for a couple of days. He has since thrown up again and had a very small amount of very icky poo. He managed to throw up in one crate and before I could finish cleaning that up he had the icky poo in the other crate In spite of all this, he seems brighter than he was all morning. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,565
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Post by PaulaM on Oct 4, 2013 13:58:36 GMT -7
Barium should do a good job of stomach protection…your vet is smart to use it.
Were any changes made to the pain meds. Is Dobby pain free? Hope to hear the poop and vomit stop very soon.
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Post by Pam & Dobby on Oct 5, 2013 12:39:41 GMT -7
No more vomiting and the poop is headed in the right direction.
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Post by Pam & Dobby on Oct 6, 2013 6:36:24 GMT -7
Quiet night. I think we both slept a little better and a little more. No getting up for vomit, poop, pee, or clean-up. Dobby only pee'd 2x yesterday. He has not had any Prednisone for 4 days, is not eating or drinking as much, and of course, is not active.
He has not had a completely normal poop, but it is definitely improving. He is only using his back legs to prop himself up, not walking at all. We had to stop the Prednisone due to the extreme nature of his GI reaction in spite of using Pepcid and Sucralfate. Ulceration, bleeding, etc., can apparently develop very rapidly with dire consequences. The sad part is that his back and hind end/leg issues were responding very well but reversed as fast as they had improved when we had to stop the prednisone. Is there still reason to hope that he will regain use of his legs?
Will see vet tomorrow to assess where he is and decide next steps. I found out that a vet who used to work at our clinic is certified in acupuncture and has a mobile service. I'll be checking into that tomorrow.
Clarification: I think he is eating OK, just not as much as before all of this. His system has been through a pretty rough time. Had another poop. Soft & a lot of mucous, but not explosive & no obvious blood.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
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Post by StevieLuv on Oct 6, 2013 9:12:10 GMT -7
There is definitely still reason to believe that Dobby will recover the use of his legs - especially since he was responding to the prednisone. Many dogs cannot take the prednisone, because of digestive issues like Dobby's, or because of other medical conditions. He will just have to use the natural steriods that his own body is producing right now - maybe slower, but still can get the job done. It is good to hear that his intestinal tract is settling down. His appetite should improve as that gets healed up. Accupuncture is a great treatment for IVDD if it's available to Dobby. Helps with pain,and stimulates nerve healing (and Stevie's vet does some points for epilepsy at the same time). Let us know how his appointment tomorrow works out |
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Post by Pam & Dobby on Oct 7, 2013 17:20:23 GMT -7
Saw the vet this morning. Although the use of his legs (lack of ability to use them) was worse than when the vet saw him last week, most of the checks she did for reactions or reflexes were good. He wagged his tail for her. His poop this morning was not 100% normal, but still improving. We will continue with
Tramadol 25mg every 6-8 hrs
Methocarbamol 1/4 of 500 mg tablet every 8 hrs
Famotidine 5mg 2x day
Phenobarbital 16.2mg 2x day.
Vet mentioned the possibility of adding Previcox once we are sure his poop & any GI issues are completely resolved. She was also going to talk with the vet who does acupuncture. She wants me to monitor his ability to pee & poop on his own and on a reasonable schedule. He does not seem to be urinating as often as maybe he should.
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Post by Pauliana on Oct 7, 2013 20:35:22 GMT -7
Hi Pam, It would be a good idea to have your Vet or Vet tech teach you how to express Dobby with their hands on top of your hands.. especially since you feel he isn't urinating enough. Here is a link that will help you get more out of the lesson. Helpful videos with tips on expressing both urine and poop: www.dodgerslist.com/literature/Expressing.htmWagging his tail for the Vet is a great sign and glad his GI problem is beginning to resolve.. Sending healing thoughts Dobby's way.. |
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Post by Jean & Mimi on Oct 8, 2013 5:31:18 GMT -7
Prayers for an easy recovery for Dobby and that his GI tract is feeling much better.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 8, 2013 6:45:28 GMT -7
Feel better Dobby!
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Post by Pam & Dobby on Oct 8, 2013 16:29:03 GMT -7
I think Dobby had the best day he has had in a week. Poop this morning was pretty close to normal and he has pee'd 3x today, the last time kind of squatting but holding himself up. Seemed to be resting comfortably or brightly paying attention to surroundings most of the day.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Oct 9, 2013 6:23:22 GMT -7
Great news! |
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Post by Pam & Dobby on Oct 9, 2013 18:31:48 GMT -7
What do I need to think about regarding the vet who does acupuncture, cold laser, Chinese herbs, etc.? Anything I need to ask?
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Post by Pauliana on Oct 9, 2013 21:56:17 GMT -7
Hi Pam! First I would let the Holistic vet know about Dobby's epilepsy, just in case, and make sure they don't try to slip in Chiropractic or VOM while treating your Dobby as it is dangerous to a dog with IVDD. I would tend to avoid Chinese herbs considering that Dobbie is being treated with Phenobarbitol for his epilepsy and not sure if there would be drug interactions with the herbs.. Prednisone also has interactions with some of the herbs.. Best to be cautious.. Acupuncture and Laser are wonderful treatments and very helpful for IVDD.. Here is some info on Acupuncture and Chinese herbs as well as supplements. www.dodgerslist.com/literature/healingacupuncture.htmwww.dodgerslist.com/literature/Supplements.htmChinese Herbs www.chinese-herbs.org/===== Chinese Herbs are composed of many herbs in one bottle/pill, meaning you will need to Google each one to familiarize yourself on what your dog is taking. I would be hesitant with Chinese Herbs if your dog has allergies or is taking any conventional prescription drugs. There can be possible negative reactions between prescription meds and Chinese herbs. If your dog is no longer on any prescription drugs Chinese ones may be helpful and worth a try if your pocketbook will accomodate. ========== Radix Glycyrrhizae Licorice may increase the adverse effects associated with corticosteroids such as prednisolone and monoamine oxidase inhibitors such as isocarboxazid (Marplan®), phenelzine (Nardil®), or tranylcypromine (Parnate®). Agents acting on serotonin may also interact with licorice. Radix Paeoniae Alba Historically, dandelion is believed to possess diuretic (increased urination) properties and to lower blood potassium levels. In theory, the effects or side effects of other drugs may be increased, including other diuretics, lithium, digoxin (Lanoxin®), or corticosteroids such as prednisone. However, dandelion also contains potassium and human supportive evidence is lacking. Rhizoma Curcumae Longae Based on laboratory and animal studies, turmeric may inhibit platelets in the blood and increase the risk of bleeding caused by other drugs. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve® ). [IF there were bleeding ulcers to develop with use of a steroid or NSAID, a drug/herb in the system that inhibits bleeding would not be a good choice] www.nlm.nih.gov/medlineplus/druginformation.html========== Bu Yang Huan Wu Wan. It is a combo of herbs and one of them specifically says not to take if on corticosteroids. ========= "COMMONLY SEEN TOXIC CHINESE HERBS AND PRECAUTIONS" Double P II is derived from the classical formula Da Huo Luo Dan. Herbs containing aconitine such as Double P II are toxic to the nervous system. Aconitine excites the vagus nerve and central nervous system first, and then leads to successive inhibition, and finally death because of paralysis ... Herbs containing aconitine include Aconite (Chuan Wu), Aconite (Cao Wu), Aconite (Fu Zi ), and Aconite (Xue Shang Yi Zhi Hao). It has been reported that 0.2 mg aconitine per patient by mouth caused toxic reactions in people, and 2-6 mg per patient orally could kill a human. Signs of toxic reaction are tremors and numbness of lips and limbs, excessive salivation, nausea, vomiting, diarrhea, dizziness, anxiety, disorientation, convulsions, dyspnea, paresis or paralysis, fecal or urinary incontinence, arrhythmia, coma and death. Fu Zi is the most commonly used herb containing aconitine in veterinary practice.21 ...The most commonly used herbal formulas that contribute to GI upset are Ku Shen Si Wu, Stasis Breaker, and Double P II (modified Da Huo Luo Dan). www.tcvm.com/doc/TCVMNews2010SummerR.pdf ========== Devil's claw appears to work in the same way as Cox-2 anti-inflammatory drugs such as Celebrex and also produce changes in leukotrienes, another group of molecules involved in inflammation. Devil's claw should not be used by people with gastric or duodenal ulcers. ============ Happy Traveler: Not recommended to take until dog is no longer taking Prednisone due to the St John's Wort in the product. Here's info: "Do not combine this herb with ANY prescribed or self-administered medication, as this herb has the potential to alter the rate at which many drugs are metabolised." www.herbs-hands-healing.co.uk/contraindications/stjohnswort.html===== White Crane formula: Aconite root is a deadly poison- Herbs containing aconitine are toxic to the nervous system. Aconitine excites the vagus nerve and central nervous system first, and then leads to successive inhibition, and finally death because of paralysis www.tcvm.com/doc/TCVMNews2010SummerR.pdf relieves the pain of neuralgia; Angelica Root- may possess anti-inflammatory properties ========= |
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