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Cervical Disc Episode Tips

Neck disc episode

Intervertebral Disc Disease (IVDD) is a disease a dog is born with and can involve any of the 27 intervertebral discs whether in the neck or in the back. Although premature aging of the discs begins while the dog is still technically a puppy (by age one), most dogs will not show symptoms of a disc problem until they are between 3 and 7 years old. 
The treatments for a disc episode are the same no matter whether it is a cervical disc or another disc lower down in the spine which is causing the problem: conservative treatment or surgery. A disc problem in the neck can be more painful and may take longer to resolve because a dog moves its head with almost all actions and when any other part of the body moves. That constant movement means that healing can take longer because the neck doesn't get the rest to allow the disc uninterrupted ability to form scar tissue. Conservative management is successful in 2/3 of dogs with a cervical disc episode, while 1/3 require surgery to physically remove the offending disc material.

With neck episodes, neuro diminishment may include some weakness in the front limbs…the dog might slip while trying to walk.  Idea to turn into a DIY Front leg harness for support while taking the fewest of footsteps at potty time.

Make sure the medications are fully controlling pain from dose to dose with no break through in pain. Continued phone feedback to your vet is vitally important until the pain medications have been properly adjusted for your dog. There is no "one-size-fits-all" pain control.

Classic signs of neck disc pain in addition to yelping and shivering/trembling may include:
◻︎ arching of the back to limit painful movement of the neck
◻︎ head held high or nose to the ground
◻︎ using eyes to look rather than turning head
◻︎ not eating due to painful chewing or in too much overall pain
◻︎ holds front or back leg flamingo style not wanting to bear weight (root signature pain)

These are the typical pain medications used to treat IVDD to address each source of pain:
  • Tramadol as the general pain reliever. It has a short half life of 1.7 hours and may need to be prescribed at a minimum of every 8 hours.
  • Methocarbamol treats painful muscle spasms. Also prescribed every 8 hours.
  • Gabapentin for nerve pain. Veterinarians are finding this medication works synergistically in combination with Tramadol.
  • Amantadine. When the above three meds have been Rx'd at the aggressive dose in mgs and at every 8 hours, but pain is still not fully controlled, then advocate for the addition of amantadine - allows other analgesics to function more effectively. The Mar Vista vets explain the mysteries of amantadine http://marvistavet.com/amantadine.pml 
  • Both classes of anti-inflammatories require stomach protection. The steroid class is the most powerful of the two classes (Prednisone, Dexamethasone, etc.)  The lessor class are the NSAIDs (Rimadyl, Metacam, Deramaxx, etc.)  Anti-inflammatories should be accompanied by a stomach protector such as Pepcid AC (famotidine) to avoid serious gastrointestinal damage. For some dogs Pepcid AC is not enough and needs to be accompanied with yet another protector, Sucralfate, when there are signs of GI problems of diarrhea, vomit, bleeding ulcers, bloody stools.
An anti-inflammatory, steroid or non-steroid NSAID, can take 7-30 days (exluding any steroid taper days) to resolve all pain. During a test-for-pain steroid taper is the time to watch for any returning signs or increased neuro diminishment. NSAIDs do not require a taper. Pain/neuro diminishment indicates another course of the steroid or the NSAID.  After repeated attempts to go off any anti-inflammatory, if pain cannot be totally resolved, surgery becomes a consideration. NOTE: Danger to give a NSAID and steroid together or switch without a 4-7 day washout.
These are additional things you can do at home to help with a cervical disc problem during the 8 weeks of 100% STRICT crate rest 24/7 only out of the recovery suite for a very, very few footsteps at potty time with conservative treatment:
  • Raise food and water bowls to head height to avoid bending down to eat and drink.  [photo how to]
  • If you feed kibble, moisten each meal with equal parts water and kibble. Store in the fridge overnight to soften and rehydrate.  Before serving, warm slightly in microwave, just to take the chill off.  This will eliminate pain from crunching kibble.
  • No chew treats or kongs during recovery. Chewing on those makes the head and neck move a lot and can disrupt the healing process of the disc, causing more pain and more time to heal the disc.
  • Pain meds must be adjusted to give full round the clock 24/7 comfort from pain. Your dog may like a rolled up blanket or bolster where he can choose to rest the head on or lean against. Mary's tip: warm up light-in-weight-100%-synthetic fleece in the dryer to drape over shoulders/neck for coziness.
  • Raise the crate up on a table so there is no need for your dog to to raise the head to look at you or watch the world from his recovery suite.
  • During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back/neck can increase a disc tear and escape of disc material into the spinal cord. Properly adjusted meds are the first line in getting pain in control.  An adjunct of acupuncture and laser light therapy in severe cases may be beneficial an effort to resolve inflammation, pain.
  • For an animal with very mild neuro deficits, the risk of a transport to therapy has to be carefully weighed against what benefit is to be gained.  OPTION: Acupuncture vet who does home visits to avoid back/neck moving during transports. For transport to only the most necessary and valuable of visits, pad out the recovery suite extra space snug around your dog with a rolled up towel/blanket to prevent body shifts during braking or cornering.
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