Ivdd/disc Issues

[NeylasMom]

So we're operating under the assumption that Violet has a cervical disc issue until/if we do an MRI (details/history here if interested: http://forum.greytalk.com/index.php/topic/320612-violets-in-pain-i-think-her-back)

 

My question is for anyone who has experience with this sort of thing - how quickly after a "flare up" do you see improvement and how long until they are back to normal? And what meds do you treat with?

 

She seemed to improve quickly. Sunday night after it happened and Monday morning were bad. But Monday afternoon I could see her turning around and by Monday evening she was doing really well. Then the vet visit really set her back on Tuesday. Yesterday was not great. This morning she was improved, but not back to pre-exam. She got her first acupuncture treatment this morning (wow was she spasming when those needles went in) and then they cold lasered basically her whole back after. I went to work for 6 hrs (which means she just slept) and she's doing much better tonight, but she's still slower than before the vet visit. My hope is that she will be a different dog tomorrow once the acupuncture has time to work and she's rested from today's events, but just want to have some idea of what's reasonable.

 

She's been on 200 mg Gabapentin and 50 mg Tramadol twice daily since Sunday night, in addition to her usual 500 mg Robaxin twice a day. I know we have room to increase both if needed. I also picked up some Galliprant from my vet today, but was planning to just keep that in reserve in case something causes her to get worse again or we get "stuck" and she stops improving, mainly because I worry about kidney issues because of her rhabdo incident so I don't want to give it unless really needed (though we went with the Galliprant for that reason).

 

I am completely restricting her activity - no furniture, no running, no playing - outside of 10 min or so potty walks (and the stairs we have to do to take them ), but it is HARD. The minute she feels a bit better she is bouncing around, lord help me.

 

Anyway any input on what to expect or anything we should be doing is much appreciated!

 

ETA: Her PT will do massage & cold laser (and ultrasound if she thinks its appropriate). The soonest we could schedule her is Tuesday. I plan to continue PT with her and acupuncture with my vet weekly and we can also do additional cold laser with my vet after the acupuncture if it makes sense. Likely will stick to a PT Tuesday, acupuncture Thursday schedule.

Edited April 27, 2017 by NeylasMom

[greysmom]

Remember, per Dr Couto, gabapentin does metabolize faster in greyhounds. So increasing the frequency before increasing the dose may make her feel better if it involes a nerve pain issue.

 

Hope she's feeling better tomorrow. It takes a day or so for Lilly to feel back to normal after a acupuncture session. {{{smooches}}} for Violet!

[NeylasMom]

Thanks. And yeah, if we increase it will be to go to 3x/day. I'm honestly not sure how much the meds are helping her. It seems to be more time/rest related than anything else. Thats the only reason I keep wondering about an NSAID, but I want to give it a bit longer.

 

And as I am typing this, she starts rolling around on the floor on her back and then gets a toy and tries to start playing tug with Skye. This is going to be a rough 2 weeks (how long the vet said to really restrict her)!

Edited April 28, 2017 by NeylasMom

[KF_in_Georgia]

Sam took an NSAID briefly, but he developed stomach problems, so we stopped that. (Remember that Meloxicam and Metacam are basically the same sort of med but the pill form is much harder on the dog's stomach and also is harder to dose properly. (It needs to be divided to hit the right dose.) The liquid is easier on the stomach, but it's more expensive. Sam was taking the pill form, and that might have caused his stomach problems.)

 

Sam also took Robaxin, Gabapentin, and Tramadol--all on people scripts I could get at the nearest Walgreen's. He eventually was taking 600mg of gabapentin, taking meds 4 times a day. He'd take a 100mg capsule most meals, two capsules on other meals if he was having a bad day. (He also was taking soloxine and glucosamine--we stopped fish oil since it can be an anticoagulent--and I just used a rolled slice of turkey lunch meat and glued all his pills inside his "turkey burrito" with a dab of peanut butter. Sam's housemate dog got a pill-less slice of lunch meat with peanut butter.

 

Sam was a senior dog (I think he was 10 when he started having trouble). He hadn't been playful for years. Occasionally, he'd have a terrifying Bambi-like split he didn't know how to get out of, and the prospect of that happening when I wasn't home horrified me. But mostly he just needed to be able to stand up and lie down comfortably, and the meds did that for him until one day--they just didn't. He was 13 years old, maxed out on all the meds, and he spent a whole sleepless night panting. We made our last trip to the vet's the next morning. (The vet smelled Sam's breath and suspected that Sam's kidneys were giving out.) We had tried chiropractors. His first visit gave him some relief for a couple of weeks. His second visit was a horror: he screamed in pain, he nearly went for the chiropractor, and he was in pain again in less than 48 hours. We just upped the meds and I never made him go back to the chiropractor.

[tbhounds]

Really feel you need to start an nsaid-you need to reduce the inflammation.

[Roo]

I don't have any input on the IVDD, but Terrier Daisy is on daily Meloxicam for arthritis and does well. No side effects, but I do make sure to give it with breakfast every day (I hate taking NSAIDs on an empty stomach, so I don't make her do it ).

[XTRAWLD]

I fortunately haven't had to do a NSAID but was very close. I've been doing gaba and metho, (but Ry's gaba dose is higher than Violets) no tramadol and knock on wood it's been working well for us. If she's really showing pain, I agree with tbhounds and get the inflammation down, give her some relief and then go back to what you were doing before (or try upping the gaba a bit - she might surprise you).

Edited April 28, 2017 by XTRAWLD

[NeylasMom]

I fortunately haven't had to do a NSAID but was very close. I've been doing gaba and metho, (but Ry's gaba dose is higher than Violets) no tramadol and knock on wood it's been working well for us. If she's really showing pain, I agree with tbhounds and get the inflammation down, give her some relief and then go back to what you were doing before (or try upping the gaba a bit - she might surprise you).

Thanks. She's much better again today. I just wonder if she still needs the NSAID to address underlying inflammation (I don't really fully understand how these disc things work). Painwise she's improving at a pace that I'm comfortable with provided we continue this upward trend from here.

 

Here's a crazy question for all of you as well. The neuro of course wants no chiro for the time being. I was always a tad nervous about that because I had a terrible experience with one, but she seemed to benefit from the treatments she was getting. When the chiro first came, Violet was still having a lot of the muscle spasming issues behind her shoulder blades and was worse off than right before this happened. The chiro had to do a lot of adjustments, but the main thing she found was in Violet's neck. We saw immediate improvement from that first visit. Since then, she's done less adjustments focused in other areas and we had been spacing the visits out, but according to her that neck adjustment had "held". Part of me is wondering whether this couldn't just be fixed with the chiro doing an adjustment. But I feel like that's playing with fire. I really just don't understand this stuff well enough to know what an adjustment does exactly and whether it's possible there's no degenerative issue, but just something got out of whack again?

 

Does anyone have any thoughts on this?

 

It seems to me the smart thing to do would be get the MRI so I know exactly what we're dealing wtih before I risk the chiro, but then we have that whole anesthesia risk thing. I think I will give the chiro a call just to see what she thinks as well.

Edited April 28, 2017 by NeylasMom

[greysmom]

If it *is* a disc issue chiro may not be the right way to go (I'll be interested to hear what your chiro says). The purpose of chiropractic adjustment is to realign the structure of the body (the skeltal structure - the spine and what's attached to it) to help it function properly. If the underlying soft tissue is the issue then chiro can have only a minimal impact. And adjustment could aggravate the problem if it moves or jostles the disc that's protruding. Xrays of the affected area could tell you and your chiro more about the risks involved.

 

It could be that her initial injury was structural - a movement in the spinal structure when she was playing caused the disc to swell and press on the spinal column nerves - that the first adjustment fixed. If that's the case you just need to give it time and medication for the swelling to go down, which an nsaid would help with. But Violet has issues with nsaids, so you're left with steroids. IMO, not a much better choice because of all the side effects, but getting the swelling down is your goal, so it may be your only choice.

 

On nsaids - it could be that she just had a issues with that one rx. My Toni can't take rimadyl but has been taking meloxicam for a couple years now without any tummy troubles. The liquid form of meloxicam is also gentler on the stomach, and I think you'd have to use that form because of Violet's size. Piroxicam could be a possibility for you to try - it used to be used along with oral chemo (for some observed anti tumor characteristics) and seemed to be less upsetting on the stomach.

[XTRAWLD]

My vet told me also absolutely no chiro. My chiro said absolutely do chiro. Go figure. Here is a snippet of the email from my chiro...

 

It's disappointing to hear the vet was so opposed to chiropractic. I think vets opposition to chiropractic comes largely from a lack of understanding about the benefits of chiropractic in general and for disc issues.
As I mentioned in my previous email, I've treated many animals and people with disc issues who have experienced much relief and many benefits from care (i.e. less pain, better mobility and function).
However that being said, I understand if you want to hold off until Ryder's recheck in April.

 

At least us humans are able to communicate to the chiro that we are experiencing pain and where, and dogs can't. I mean certainly, they show it with muscle twitches, crying out, growling, curling lips, but you know what I mean, it's harder to pinpoint and resolve.

 

I completely believe in my chiro's ability, and Ryder has benefited greatly from chiro before we got a diagnosis. So if I was trying to be blind, I guess I could go ahead and treat him with chiro against the vet's wishes. That consideration is coming up soon as he'll be going for a recheck with the vet soon.

 

I personally have a doctor that perfers medical treatments with pills and is opposed to supplements and natural treatment, and I think you will find the same with most vets. There are vets out there that are just not open to the idea of alternative therapy. That said, to be fair, adjusting the neck even slightly the wrong way when there is a known issue could cause irreparable harm. Have to weigh the risks.

 

I really believe that until you know the severity of the issue you can't say yay or nay and honestly that means getting that MRI. I don't think you will have anything definitive without it. I know it's a tough decision.

 

Edited to add: We also discussed soft tissue injury prior his diagnosis because I was desperately trying to resolve his limp, and my chiro had this to say:

 

In terms of soft tissues injuries, it's always important to make sure the joint moves well as proper joint movement has a healing effect on the surrounding soft tissues and within the joint itself (i.e.improves cartilage health). Also soft tissue injuries will ultimately effect joint movement and function, so chiropractic can certainly be beneficial for these types of injuries. As I deal with a lot of sports injuries in people, I commonly treat these types of issues in my human practice.

Edited April 28, 2017 by XTRAWLD

[NeylasMom]

Thanks, I really appreciate all of this feedback.

 

Chris, sorry, I think I was misleading on the NSAIDs. The only one she's taken in the past that I can recall is Rimadyl and she did NOT have side effects. My only concern is that I think its likely her kidneys are already compromised from her rhabdo incident, though not to the 75% level where kidney disease would be evident. So my concern if we introduce an NSAID is further stress on her kidneys. However, that's probably less of a concern if we are only talking about a shirt course to reduce inflammation, not leaving her on it for pain management. Does that make sense?

 

My vet did give me Galliprant btw. Only enough for 10 days because it's all they had. But there is supposedly less risk for organ issues with it. Though part of me says go with the known - at keast I know Rimadyl didn't give her stomach issues or other weird side effects, but I don't think we have any. We have a ton of Deramaxx and those 10 Galliprant.

[a_daerr]

Did you say in the last post that she's been on a steroid? If so, there's a washout period before you can start the NSAIDs, so be aware of that. My vet is really big on alternative medicine (there's a vet chiropractor in the practice). However, he told us absolutely, 100% no chiro with suspected disc issues. The wrong adjustment can lead to nerve damage and/or paralysis. We currently have Truman on Gabapentin, Prednisone (tapering down), and Tramadol as needed, when he's particularly yelp-y or uncomfortable. We've already done the MRI and pinpointed the specific disc. Tuesday, we'll do a re-eval with the neurologist and probably schedule him for ventral slot surgery. It's my understanding that acupuncture and cold laser can help stimulate growth in the nerve when done regularly over time. Surgery is the only immediate, curative option (although there are plenty of risks and drawbacks there too).

 

Interested to know how you guys move forward. Seems like we're in the exact same boat.

[NeylasMom]

Did you say in the last post that she's been on a steroid? If so, there's a washout period before you can start the NSAIDs, so be aware of that. My vet is really big on alternative medicine (there's a vet chiropractor in the practice). However, he told us absolutely, 100% no chiro with suspected disc issues. The wrong adjustment can lead to nerve damage and/or paralysis. We currently have Truman on Gabapentin, Prednisone (tapering down), and Tramadol as needed, when he's particularly yelp-y or uncomfortable. We've already done the MRI and pinpointed the specific disc. Tuesday, we'll do a re-eval with the neurologist and probably schedule him for ventral slot surgery. It's my understanding that acupuncture and cold laser can help stimulate growth in the nerve when done regularly over time. Surgery is the only immediate, curative option (although there are plenty of risks and drawbacks there too).

 

Interested to know how you guys move forward. Seems like we're in the exact same boat.

Thanks. Good luck with Truman's surgery if you move forward with it! Between yours and other feedback, clearly the chiro is out for now. We'll see how she recovers from this incident. I'm thinking we won't pursue the MRI now if we can get her back to a pretty good place, but if she has another "flare up" we will likely move forward with it so we know what we're dealing with. I'm not sure if I would consider surgery, but it's not completely off the table since she's only 8. One day at a time.

 

And no, Violet is not on steroids, never has been. I think I may have mentioned at some point that I started her on Gabapentin and Tramadol myself until the neuro could see us, but intentionally did NOT give an NSAID in case they wanted to use a different one or steriods instead. I didn't want to give anything that might require a washout period if they wanted her on something different. So she's only been on the Gabapentin & Tramadol since Sunday night, plus the Robaxin that she's been on for months. And she takes Curcumin, which is supposed to be a natural anti-inflammatory.

Edited April 28, 2017 by NeylasMom

[XTRAWLD]

I'm not sure if I would consider surgery, but it's not completely off the table since she's only 8. One day at a time.

 

Again, you might be surprised and she might not need it. I've been very lucky with Ryder that it isn't worse and that surgery isn't necessary. Will it be in the future? Maybe, but not right now.

 

Like you said, one day at a time, but I'm like you....prepare for the worst, hope for the best and hey might turn out better than you expected.

[NeylasMom]

Well for anyone who's interested, the chiro of course said she's comfortable working on Violet even if there's a disc issue and said she's worked with clients in the past with disc issues and has helped them. She was really nice about it, said she understood if I wanted to follow the vet's advice so no pressure, but said she thinks much of the fear from the neurologists is based on the older type of stuff that was much harsher. Anyway, she offered to do more soft tissue stuff and stay away from her neck if I wanted to still do an appt and would feel more comfortable. We weren't going to have one for 6 weeks anyway so we'll just see how things go for now.

[greysmom]

A lot of traditional medicine doctors/veterinarians have have trouble with chiropractic! It's still considered to be an alternative treatment in most places and by most medical professionals. Just a long-standing prejudice, I'm afraid.

 

Does your chiro do manipulation or use an ultrasound or lazer device?? The non-manipulative chiro could actually be useful for her. Even with a generally positive attitude towards the practice, I would personally steer clear of manipulating until I knew what exactly was going on in there. I would definintely do acupuncture, and then see where she stands (literally!).

 

nsaids =

[NeylasMom]

A lot of traditional medicine doctors/veterinarians have have trouble with chiropractic! It's still considered to be an alternative treatment in most places and by most medical professionals. Just a long-standing prejudice, I'm afraid.

 

Does your chiro do manipulation or use an ultrasound or lazer device?? The non-manipulative chiro could actually be useful for her. Even with a generally positive attitude towards the practice, I would personally steer clear of manipulating until I knew what exactly was going on in there. I would definintely do acupuncture, and then see where she stands (literally!).

 

nsaids =

Yeah, thats what I'm going to do for now. No sense in having her come to do the manual stuff since we have a physical therapist who does massage, laser and ultrasound who we LOVE (she's who recommended this particular chiro). We weren't supposed to have the chirp come for 6 weeks so for now we'll stick with acupuncture once a week and PT once a week.

 

I'm holding off on the NSAID until tomorrow. She is MUCH better today, but I'm afraid we may have just overdone it a tiny bit on the length of our walk so we'll see. If she still seems uncomfortable tomorrow, we'll add it in with dinner.

 

Thanks again for the feedback.