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Post by elizabethhogeland on Oct 11, 2013 11:33:36 GMT -7
Hello, I am so blessed and glad to have been referred to this forum! My 3 year old doxie is having her first bout of IVDD. I have had dachshunds my whole life and never experienced this with any of them. Princess is in her second day of strict crate time and pain med cocktail with steroids. She seems to be doing a little better maybe but is just sleeping all day (which is fine with me!). We have never crated our dogs so she is not enjoying it but she doesnt fight it. Lets face it, our doxies are smart breeds and know when they need down time! Our sub-vet told us if she didnt improve or became incontinent that she would need put down. After much support and comments with advice and success stories, I no longer feel like that should be an option and I believe we will be able to continue to give her a good full long happy life! Thanks for having me and my little Princess here!
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Oct 11, 2013 11:51:46 GMT -7
Welcome to Dodgerslist, Elizabeth. I'm sorry to hear of Princess' difficulties. I do commend you for not listening to the vet who told you if Princess does not improve and becomes incontinent, she would have to be put down. Absolutely not true!! Dogs can lead very happy lives, even if they never walk again. And owners learn to deal with incontinence and it becomes just a routine part of daily life. www.dodgerslist.com/index/SDUNCANquality.htmKudos on starting the crate rest. 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks is the SINGLE most important thing you can do to help your dog-- it is the hallmark component of conservative treatment. Carried in and out to potty. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM). In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc. Can you give us a bit more in essential information about your dog: -- Is there still currently 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, arched back, holding leg up flamingo style, not wanting to bear weight on the leg, just not their usual perky-interested-in-life self. There should be no signs of pain between doses of medication. If you see pain starting close to the next dose, then the dose needs to be adjusted by the vet. -- What are the exact names, dose in mg's and frequency of all meds? -- Pepcid AC should be given to protect your dog from the excess acid produced by the anti-inflammatory. The FDA and manufacturer pkg insert indicate gastrointestinal problems are side effects of using anti-inflammatories. The natural defenses of the stomach to shield against stomach acid is hindered when taking anti-inflammatoriess. Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms. Please get your vet's permission to give 5 mg of Pepcid AC (generic is famotidine) 30 minutes before each dose of the anti-inflammatory (not to exceed every 12 hours). Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If your vet says your dog has no health issues such as liver, heart, etc to keep her from taking Pepcid AC, then do get it on board. -- Currently can your dog wobbly walk? move the legs at all? or wag the tail when you do some happy talk? Once your dog is off all medication and has no pain, the very, very lightest least aggressive range of motion and leg massage is necessary for paralyzed or weak legs during conservative treatment. The information highlighted in PINK pertains to a dog who can't walk. Check with your vet before starting. www.dodgerslist.com/literature/massagepassiveexercises.htm-- Can your dog sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up? -- Eating and drinking OK? -- Poops OK - normal color, firmness, no dark or bright red blood? The best way for you to help your dog is by learning about his disease. Here are some links to get you started. Please click on all of them to get a good background of understanding. www.dodgerslist.com/healingindex.htmwww.dodgerslist.com/literature.htmDodgerslist has an excellent DVD available for only $3 including shipping. It's great to have on hand to show to family/friends/petsitters so they will know what they can and cannot do with your dog and how they can help: www.dodgerslist.com/store/DVDorder.htm Once we have the additional information, we'll be better able to help you and Princess. We're here for you each step of the way. All the best to you both. |
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Post by elizabethhogeland on Oct 12, 2013 9:18:02 GMT -7
Thanks for responding! Princess only seems like she is in pain when being carried out to go potty. She just tenses up and seems like it hurts to be moved. She is currently on 3 different medications.
500mg methocarbamol,
50mg tramadol
5mg prednisone
all are taken every 12 hours.
Starting tomorrow, they want her ▼prednisone cutdown to 2.5mg every 12 hours. She is eating and drinking just fine. She seems to know she needs to use the bathroom but does not let us know she needs to go until its about too late. We are taking her out every three hours but she will not urinate and poop outside. I am not sure if its her body positioning but she clearly knows when she needs to go. She cannot walk at all and is even unsteady when she sits. She can kick her feet and wag her tail fine but is not bearing any weight on her back legs (making crate rest a little easier). She is for the most part her happy self although it is clear she doesn't feel good and misses her playmate (our other doxie).
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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 12, 2013 9:36:56 GMT -7
Hi Elizabeth, my name is Maureen. I am so glad that you found us, and realize that your sub-Vet is so very wrong! Euthanasia is not an IVDD option, and our Stevie was paralysed too - she walks now, kind of wobbly, but she walks. Are you using a sling to support her hind end when she is out to potty? Sling walk dodgergallery.ourdogs.net/recovery/slingwalk Here is a video about how lift and carry an IVDD dog Please watch carefully for signs of pain when you start you prednisone taper tomorrow, many dogs need to be on a full anti-inflammatory dose of prednisone for a longer period of time.. pain = swelling = prednisone still needed. Marjorie has given so many good links, and there is so much to learn about IVDD. You will become her best advocate with your new knowledge. Keep us posted - we are in this together and will do anything we can to help  |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 12, 2013 11:03:15 GMT -7
Elizabeth, you have reported some good neuro functions making Princess a good candidate to recover with conservative treatment and the smart 100% STRICT crate rest you've been doing! Kudos to you on the prompt crate rest! if there is still pain today, then I do not believe that all the swelling in the spinal cord has been resovled and very likely will not have been resolved by Sunday. Please get with the vet today while they are open and know what all your options are…plan B in other words, if there is any hint of pain Sunday morining. How a taper works: Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. When the vet guesses swelling might be gone there will be a taper. The dose is lowered to less than the anti-flammatory dose.. your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too.
Rule of thumb is:
pain = swelling = more time on Pred needed.
If there is no pain on the taper then it goes to completion. Then no meds at all are needed. Disc healing will continue for the remainder of the 8 weeks. Nerves can continue to self heal…think in terms of months.Tensing when being moved IS a sign of pain. Tramadol given every 12 hours is not likely to fully control pain during the weeks that pred is needed to resolved all the inflamamtion. Tramadol has a very short half life of 1.7 hours and often needs to be given every 8 hours to fully control pain. Something to discuss today as part of plan B. Check out this page to get a good overview on the typical pain meds used with IVDD and what to expect with this first phase of healing: www.dodgerslist.com/literature/healingpain.htm Cortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. This directory is in alpha order and where I look up each of my dog's meds to understand drugs and protect my dog: www.marvistavet.com/html/pharmacy_center.html While on pred you may need to take her out every 3-4 hours IF she does indeed have bladder control. Can you verify she can pass the sniff and pee test so we know for sure about control? The only way for us humans to know if there is bladder control is with the sniff and pee test. Carry outdoors, set on an old pee spot to sniff it. See if urine is then released. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. If urine comes out after sniffing, she has control. Leaks in bedding or leaking on you when lifted are signs of bladder control loss and the need for a vet lesson on expressing. How to: www.dodgerslist.com/literature/Expressing.htm Let us know your specific observation at potty time. You may wish to bookmark Princess' thread to get an email when there has been a reply:  We look forward to your next update on Pred, Pepcid AC and if you are observing bladder control. Hang in there, Princess and you will get over this bump in the road to enjoy many happy years ahead. |
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Post by elizabethhogeland on Oct 12, 2013 21:22:55 GMT -7
Back to the vet first thing in the am... I think she has blood in her urine, pretty sure that is not normal or ok  Found more info on the K-9 backpack, maybe a UTI? Still going to check her out in the morning |
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Post by Linda Stowe on Oct 13, 2013 7:45:18 GMT -7
Elizabeth, Indeed blood in the urine can indicate a UTI. You should get her to the vet asap and be sure to take a sterile urine sample. It also might indicate she needs expressing.
Let us know what the vet says.
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Post by elizabethhogeland on Oct 13, 2013 17:13:14 GMT -7
We went in and saw our normal vet today. He ok'd pepcid and ruled out any bladder infection. He said her urine was so dark because she was holding it too long. We will go back to see him once a week for the next 4 weeks then see where she is at and if the treatment is working or to try something else. He seemed surprised we were suggested to put her down and reassured me that this is no death sentence and that as long as we are willing to fight, he would help us. He did warn us it is going to be spendy but we will somehow manage!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 13, 2013 18:58:52 GMT -7
Is the taper of pred to continue?
Is she showing signs of pain, were the pain meds adjusted? NOt wanting to pee could be another sign of pain, has she been pooping?
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Post by elizabethhogeland on Oct 13, 2013 22:33:31 GMT -7
He said to go ahead and ▼ taper the pred. because he doesn't want her on steroids longer than she needs to be. The ▲medications for pain were increased a little bit but not in dosage, just frequency. She is pooping (and letting us know before hand so we can get her out!) just fine. He thinks she may have control over her bladder, he said if she didn't, she would not be going at all or very little but she did urinate 4-5 times yesterday. He thinks the reason she goes in her bed is because she can't move at all to get out. He strongly encouraged us to take her out to potty more frequently so that will hopefully improve.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 14, 2013 5:56:02 GMT -7
Hi, Elizabeth Am I correct that Princess was still showing signs of pain when she was seen by the vet and that is why he increased the pain meds? If that is the case, the Prednisone should not be tapered at this time. As Paula explained, the taper is a test to see if there is still pain. If there is still pain, that means there is still swelling around the spine. By increasing the pain meds, those meds will mask any pain that Princess may still have so it will be difficult to tell if Princess still has swelling around the spine. Usually the pain meds are tapered or stopped during a steroid taper, not increased, so observations can be made as to signs of pain. Please confirm the doses and frequency of each medication. I believe from what you said that this is now the current dose: 500mg methocarbamol 3xday 50mg tramadol 3xday 2.5 mg prednisone 2xday 30 mg Pepcid AC 2xday Is that correct? The purpose of the Prednisone is to get the swelling around the spine down. That swelling is pressing on the spine, causing pain and has the potential to cause nerve damage. So it's very important to get the swelling down. I agree with your vet that Princess shouldn't be on a steroid for longer than she has to. But she does need to be on a anti-inflammatory long enough to get the swelling down. Sometimes it takes 1-2 weeks to get the swelling down and sometimes a full month. That is not uncommon. As for bladder control, your vet also said that if she didn't have control, she wouldn't be going at all or going very little. That isn't true, Elizabeth. The bladder fills up and will overflow and that's not a good thing. When urine stays in the bladder too long, a urinary tract infection can start. Also, the bladder can stretch out of shape and may not go back to normal shape once control comes back. The fact that she's not going outside and is going in her crate or when you pick her up indicates that she does not have bladder control. Did the vet say what was causing the blood in the urine if she doesn't have a bladder infection? Even if she has some control (seems to know when she has to go), she may not be emptying her bladder completely and may need some help. Please try to express her (every 3-4 hours while she's on the Prednisone). Here is information on expressing but your vet should give you a hands on your hands demonstration: www.dodgerslist.com/literature/Expressing.htm The only way to be sure Princess has bladder control is the sniff and pee test. Take her to a place where she's gone before, let her sniff and see if she can release urine on her own. You can hold up her hips but don't use a sling when you're trying this test so nothing is pressing on her bladder. If she can release urine, then you know the brain is connecting with the nerves. Please confirm with us that the reason the vet increased the pain meds was that Princess was still showing signs of pain during the visit. If that is the case, please immediately contact the vet and demand that Princess continue on the original anti-inflammatory dose of the Prednisone for a few more days. |
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Post by elizabethhogeland on Oct 14, 2013 12:09:55 GMT -7
Ok, so she does have control of her bladder. I have been going back and forth but the pee test worked today. Her pain meds were increased due to the pain, I misunderstood him, he wants the bottle of pred finished oout full tabs. The pain meds do not appear to be worki g at all. Since last night, she is trembling and crying and nothing is helping I don't know how to help her, they said they can't give her any more of the pain medication because she is at the max dosage for it |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 14, 2013 12:22:09 GMT -7
Elizabeth there are still options a vet has for pain control. If your vet is not comfortable, then get to a NEW vet asap today. Ask for Gabapentin to be added to the current mix of Tramadol and methocarbamol. Compounding gabapentin in to liquid takes time that Princess does not have. Most all pharmacies carry a 100mg capsule (the smallest size it comes in)... just call around your local pharmacies for the best price and have your vet call in the Rx. My 13 pound doxie was prescribed 25mg of gabapentin powder. All I needed to do was divide the 100mg capsule powder into four equal parts by dumping into a creased pieced of paper and with a razor blade move the powder into four equal piles. Also just as easy to get 33mg by dividing one 100mg capsule powder into three parts. What the Veterinary Anesthesia & Analgesia Support Group has on gabapentin: vasg.org/g_drugs.htm#GABAP The remainder of the powder piles I stored in one of those 7 day pill boxes with a lid for each day. Can you clarify for us what the vet wants for Prednisone. the dose in mg's and how often you are to give it. |
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Post by elizabethhogeland on Oct 14, 2013 12:35:34 GMT -7
Prednisone is 5mg 2x a day
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 14, 2013 13:55:32 GMT -7
thanks, can you also verify the meds Marjorie asked about too. Is this List now correct?
500mg methocarbamol 3xday
50mg tramadol 3xday
5 mg prednisone 2xday
2.5mg Pepcid AC 2xday
If you misunderstood and gave Pred 2.5 mgs that can explain the pain.
Were you able to get Gabapentin on board?
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Post by elizabethhogeland on Oct 15, 2013 15:55:58 GMT -7
The med list is correct, we see the vet today to talk about the other med
Ok so we went back in today, the vet wants to wait another day or two before giving the other medication to see if her change of dose kicks in and helps at all. She seems better today, less anxious and more perky so I am willing to give her one more day before adding the new medication. She finally pottied outside today and tried to get up and move... Of course we did not let her but she is trying to move a little more. We have hope that this is a turning point. We are going to obviously continue the crate for the next 7 weeks at least but I'm feeling optimistic that she is feeling a little better today.
No, not 30, it is a 10mg [Pepcid AC] tab cut into 4 so 2.5mg
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Post by Pauliana on Oct 16, 2013 19:31:38 GMT -7
Hi Elizabeth, Princess is on an extremely low dose of Pepcid AC.. Normally we give 5mg for dogs of her size.. Being on Prednisone, 2.5 of Pepcid would give her very little stomach protection. As Paula posted earlier: Cortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving Doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. This directory is in alpha order and where I look up each of my dog's meds to understand drugs and protect my dog: www.marvistavet.com/html/pharmacy_center.html Let us know what is decided about Gabapentin since the Vet delayed it to see how the increased dosages would work.. I am glad to hear she is feeling better today. Nothing like a turning point to give you a much needed morale boost. |
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Post by elizabethhogeland on Oct 18, 2013 9:01:02 GMT -7
I have great news! Princess has not appeared to be in pain for a few days now! She has complete bladder and bowel control and is doing great! We are obviously still keeping her crated but she is showing signs of improvement every day, we are so thankful for all of you!
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Post by Jean & Mimi on Oct 18, 2013 9:18:49 GMT -7
YAY!!!! That's great news.
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