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Post by Jennifer & Bandit on Apr 29, 2014 23:59:54 GMT -7
Hi everyone. My name is Jennifer. First of all, I wanted to thank all the contributing members of Dodgerslist. The information on this site, along with the support given on this forum, has made this scary experience a little more manageable. I had never even heard of IVDD and now I have a wealth of information to help me through this. Bandit is a 3 year old, 14.5 pound Japanese Chin who has been showing signs of pain from IVDD since April 12. This is an approximate timeline of his onset: - April 12: Showed decreased energy levels, seemed "depressed" or moody but otherwise no pain.
- April 16: Decreased energy level but enthusiastic during walks. He showed intense trembling when forced to jump on bed, which prompted me to take him to the vet. He was given a physical examination, where the vet found one painful spot along the spine but was unable to find it again. I was sent home with no diagnosis and no meds.
- April 19: By the afternoon, he did not want to walk anymore. He had been hiding in my closet since the initial visit and did not move for food/water. By this time I knew something was wrong, so I had him on baby aspirin (81mg) every two hours. It seemed to help a lot.
- April 21: Taken to the vet again (no aspirin in the morning) and given an Xray, which showed multiple calcified discs of varying degrees along his lower spine. Vet determines IVDD-related issues. Bandit was in a lot of pain, yelped when handled. He was given a shot of Dexamethasone and an immediate order of Tramadol 25mg/12 hours.
- April 23: Started Prednisone 2.5mg/12 hours. Initial Dexamethasone shot helped for the first 24 hours but he was in pain again by day 2.
- April 24: No improvement and increased pain. Upped Prednisone 5mg/12 hours. Added Methocarbamol 250mg/12 hours. Both seem to help significantly.
- April 26: Added Pepcid 2.5mg/12 hours to regimen after discovering this forum
We are now a full week from the initial diagnosis and steroid treatment. Bandit never had any neurological symptoms of IVDD (walks OK, no wobbliness) but does not like to move and shows a great amount of fear/pain when picked up to go potty. Appetite/thirst/bathroom functions still OK, though sometimes I just let him go in his recovery area (gated off 2x3" area covered in potty pads, blankets, etc.) as more than 50% of the time he still screams when picked up to go potty. I know that he has to be under strict crate rest for the next 8 weeks but I'm concerned that we're still not managing his pain properly. He is definitely more alert and in less pain and has started wagging his tail again, but recovery is slow. I really wish that I had known the initial signs of IVDD because we could have started to treat it sooner... I literally saw him deteriorate before my eyes over the course of a week and I'm definitely feeling like a bad fur mom Questions: - How much pain should I be expecting? If he yelps when picked up but is otherwise comfortable in his recovery area, does that mean his pain isn't being managed well?
- When should I taper the steroids? My vet wanted me to start tapering off now, even though he's still in a lot of pain. She also seemed reluctant to prescribe Gabapentin since he's already on so many medications.
- He initially had trouble holding in his bladder/bowels after upping the Prednisone, but the past two nights he has been able to sleep through the night with no accidents. Does that mean the Prednisone is having less of an effect?
Thanks to everyone in advance. I'll keep the group posted during this recovery process in helps others in the future.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Apr 30, 2014 5:10:47 GMT -7
Welcome to Dodgerslist, Jennifer. We're here for you and will help you and Bandit through this episode. The answer to your first question is that you should not expect any pain at all. Pain needs to be completely under control from one dose of medication to the next. Pain hinders healing and have no patience with it. Yes, his yelping when picked up indicates he is still in pain. Dogs are very good at hiding pain so when you see signs of pain, it's a clear cry for help from your dog. Please contact your vet today to strongly advocate for more pain meds. Tramadol has a short half life and is most effective when given consistently every 8 hours. Your vet has room to bring the dosage up, too. Gapabentin works very well along with Tramadol. Your vet needs to be more aggressive with pain meds. 5 mg of Pepcid AC should be given 30 mins before the Prednisone and then every 12 hours thereafter as long as Bandit is on Prednisone, even throughout the tapering. Aspirin is a NSAID - Dexamethasone and Prednisone are steroids. There should have been a 4-7 day wash-out period between giving the two. Poops OK - normal color, firmness, no dark or bright red blood? Be sure to increase the amount of Pepcid AC as indicated since there was no wash-out period. If his poops are not normal, Sucralfate can also be added as a second stomach protector. No, a taper of the Prednisone should most definitely not be started as there is still pain. Pain indicates that there is still swelling and as long as there is still swelling, the anti-inflammatory dose (5 mg 2x/day) is necessary. At any time during a taper, if signs of pain re-appear, the anti-inflammatory dose must be started again. It can take 7-30 days for the swelling to resolve. Bladder/bowel control loss is a sign of neurological damage. Swelling pressing on the nerves of the spine can cause nerve damage. The fact that Bandit now has better control of his bladder/bowels indicates that Prednisone is doing its job and is starting to get the swelling down. However, the pain that he's showing indicates that the swelling is not yet completely resolved. It's imperative to have the correct vet advice, which can make all the difference in Bandit's recovery. If your vet cannot get Bandit's pain under control today, I strongly suggest that you try to find a vet who is more familiar with treating IVDD. A consult with a Board-certified neurologist may be necessary just to get the correct pain meds on board so Bandit can heal in comfort. Not all general vets are comfortable treating IVDD as they just don't see enough cases of it. His recovery suite should only be large enough for him to stand up, turn around and lie down with his legs extended comfortably. The less movement of the spine, the better. Think of the recovery suite as a cast for his spine. You can fill in extra space with rolled up blankets or towels. Please see our suggestions on how to set up a recovery suite: www.dodgerslist.com/literature/CrateRRP.htm100% 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. With this disease self education is critical not just so you make sure the right things are being done for the best recovery but for your own emotions. The unknown is simply a scary place. Get ready to fight this disease now and in the future by knowing all things IVDD. There is no better place to start than on our main web page with "Overview: the essentials" and then read all you can as soon as possible. Here's the link www.dodgerslist.com/healingindex.htmBandit is a very good candidate for conservative care. His pain just needs to be brought under control ASAP. Please let us know what the vet says after speaking to her today. Healing prayers for Bandit. And hugs to you. We truly understand how stressful this all can be.
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Post by Jennifer & Bandit on Apr 30, 2014 13:18:25 GMT -7
Thank you for your advice Marjorie. You really cleared up my concerns about Bandit's pain and now I want to take a no-tolerance stance on it.
I called my vet this morning and described my concerns regarding Bandit's pain, and she reluctantly allowed me to bring up his pain meds. I can now give 14.5 pound Tramadol 25mg/6-8 hours Methocarbamol 250mg/8 hours. She also prescribed me Gabapentin 33mg (up to every 8 hours) but she wants me to start with a minimal dose in the morning and work my way up. Because Bandit is showing some improvement on the Prednisone 5mg/12 hours, I want to keep him on the conservative route as we adjust his pain medication. Pepcid 2.5mg/12 hours
I think she's a little unfamiliar with IVDD, but she's willing to work with me. She does seem to want to refer me to a neurologist to consider surgery because his pain has been so difficult to control.
I think the pain is the biggest thing keeping him from recovery right now. I am 100% willing to consider surgery if his condition deteriorates or if the pain can't be brought under control.
I'll keep everyone posted with how he's doing with the increased dosages and the Gabapentin. Hopefully he shows improvement soon!
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Post by Jean & Mimi on Apr 30, 2014 14:04:01 GMT -7
Jennifer, you have done an amazing job advocating for Bandit - kudos to you!!! And it is good that your vet seems to be willing to work with you which is important. If at any time you feel that your vet is really not working with you, don't hesitate to find a different vet who may have more experience with IVDD. The combination of medications Bandit is getting is a good one. I personally found that gabapentin added as a pain medication (and once we got the anti-inflammatory dose right) made a huge difference. You are doing a tremendous job, Bandit is so lucky to have you as his mom
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Post by Jennifer & Bandit on May 1, 2014 20:40:12 GMT -7
For the past two days I've increased Bandit's Tramadol dosage to 25mg/8 hours. It's seemed to have helped so much! Potty times have been easier and he hasn't made a mess in his crate since increasing his pain meds. Unfortunately, he's yelped in his crate twice at 4AM, typically 6-8 hours after his last dose of Tramadol. I went to the vet's today to pick up Gabapentine which I can give 33mg/12 hours and up to 66mg/8 hours. I gave him an initial dose of 66mg earlier this afternoon and it knocked him out.
Tonight I'm going to give him Gabapentine 33mg, Tramadol 25mg, Methacarbamol 500mg 250mg, and his typical dose of Prednisone 5mg after Pepcid 5mg. Hopefully that'll allow him to sleep through the night and on the road to recovery.
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Post by Pauliana on May 1, 2014 22:07:17 GMT -7
Hi Jennifer! Hope you are keeping your Vet in the loop about the changes you have been making in the timing and dosages of the Tramadol (every 3 hours) and Methocarbamol..(Twice the prescribed dosage).. Remember with Gabapentin being given Bandit should be sleeping better and his pain should be better controlled since it helps to increase the effectiveness of the Tramadol.. A double dose of Methocabamol could be overdoing it.. I am proud of you for being a wonderful advocate for Bandit at getting his pain under control, just be sure to work with your vet as a team! You can help educate that Vet in treating IVDD so the next dog that comes to her clinic, will benefit from what you taught her.. Ask our Founder, Linda for free literature to take to your vet's office and also pass out to other people who have dogs that are at risk for IVDD: www.dodgerslist.com/literature/litorder.htmBe sure to mark that Aspirin bottle for people only! : ) Healing thoughts and prayers..
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Post by Jennifer & Bandit on May 2, 2014 11:25:43 GMT -7
Hi Pauliana! Thanks for pointing out my typo. Bandit is actually on Methacarbamol 250mg every 8 hours, not 500mg. He's on the Tramadol 25mg every 8 hours as well.
The Gabapentin is definitely helping, but we're still experiencing some pain. Last night he yelped after being returned to his recovery area (6 hours after initial dose), but he did sleep through the night (Yay!!!) without issue (second dose). This morning he yelped and held his chin really high when I tried to take him to potty (7 hours after second dose), so I left him alone and gave him with his morning medication. After an hour he seemed to relax and fell asleep. I'll check on him when I go home for lunch to try to take him to relieve himself.
I do think we're on the road to figuring out how to manage his pain, but it's nerve-wracking. I've been comforting myself by reading other posts on the forum, but my plan is to take him to a neurologist Monday if he doesn't show improvement over the weekend.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 2, 2014 14:19:30 GMT -7
Jennifer, glad to read some of those doses were just a typo! So then is this the correct med list? 14.5 pound Methocarbamol 250mg every 8 hours Tramadol 25mg every 8 hours Prednisone 5mg/12 hours Pepcid 2.5mg/12 hours Gabapentin as of 5/1 which I can give 33mg/12 hours and up to 66mg/8 hours. Gabapentin has a relatively short half life PLUS contrary to what we might expect increased dose of mgs may not necessarily mean increased pain control. So discuss about giving 33mg Gabapentin every 8 hours. Reading references: --elimination half life in dogs is 3-4 hours www.ncbi.nlm.nih.gov/pubmed/3730018-- Oral Bioavailability in humans. Gabapentin bioavailability is not dose proportional; i.e., as dose is increased, bioavailability decreases. Bioavailability of Gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively. www.drugs.com/pro/gabapentin.htmlFor a 15 pound dog, Tramadol is being given at a low dose at 25mgs, 3x/day. I would discuss with your vet the possibility to look at Tramadol 50 mgs every 8 hours to give full pain control. Vets are finding good success with the Tramadol/Gabapentin combo in giving full dose to dose pain control. The methocarbamol deals with the pain stemming from muscle spasms so often associated with a disc problem and especially those in the neck. Your remark of holding the chin up and yelping is so often indicative of the disc problem being in the neck. Did your vet tell you where he suspected the problem disc is? In any event you may find doing each of the xtra things mentioned in this article will help Bandit. www.dodgerslist.com/literature/cervical.htmAlso Pepcid AC 2.5 mgs 2x/day is at the low range of stomach protection. We see most vets using the high end of 5mg 2x/day. Not only does Pred itself increase stomach acids but also just the stress from pain, the stress from Bandit's complete change in routine could cause bleeding ulcers just the same as it does for people whose routine has been changed by new job, moving, etc. So I would discuss if there is any reason Bandit may not take the higher range of stomach protection. Hope to hear good news that pain is now being controlled with the new adjustments and combo of pain meds especially with the weekend approaching and your vet will be closed.
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Post by Jennifer & Bandit on May 2, 2014 17:13:32 GMT -7
Thanks Paula. I didn't understand the specific drug efficacy of the Gabapentin, so it's good to know that we're better off using less but more often. I'll observe Bandit over tonight and give a call to the vet tomorrow before they close to ask whether we can up the Tramadol if there's additional pain.
Bandit's disk issues are definitely stemming from the lower back, but he may have additional pain in his neck. This is definitely minor compared to his back issues and only seems to flare up when he is in a lot of pain. While he is in the crate, he seems very comfortable. Typically he only yelps or shows signs of pain after he is placed back in his area after a potty session. He will then keep his chin raised for 10-20 minutes before relaxing and placing his head completely onto the mat. It's this practice that made it difficult for me to determine whether his pain was managed for the first couple of days. After reading Dr. Richards' comments, I'm inclined to dose liberally as opposed to conservatively. I would rather Bandit be a little out of it and heal than in pain but alert.
I'll also ask my vet about a higher dose of Pepcid. To be honest she did not even prescribe it. I started dosing Bandit independently after reading about the practice on Dodgerslist. When I told my vet, she seemed to think that taking Prednisone on a full stomach is enough to prevent the GI issues. Luckily I started relatively soon after giving Pred, so Bandit's stool is still normal colored and the same consistency.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on May 3, 2014 4:46:29 GMT -7
When my Jeremy is in extreme pain from a disc episode, he also tips his chin up but his issues were also in the back, not the neck. So Bandit may not specifically have pain in his neck and the raised head may be a sign of pain in the back for him. Signs of neck pain can be a raised or lowered head, reluctance to eat dry food, pain when eating, pain or reluctance to move head. However, it wouldn't hurt to try the tips that Paula suggested in the link above in case there is also neck pain. www.dodgerslist.com/literature/cervical.htmPlease let us know how Bandit's pain is today. Healing prayers for Bandit.
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Post by Jennifer & Bandit on May 3, 2014 11:12:52 GMT -7
Unfortunately, Bandit's condition is still unstable. He shows unwillingness to let me carry him to go potty and lost bladder/bowel control in his recovery area last night. He has been quiet through the night and shows activity at moving his blankets around to create a nest, but otherwise seems even more unwilling to walk. He also seems more wobbly on his feet, though that may be just the copious amounts of medication.
It seems like most affected pups on this forum show a relatively quick recovery time after starting the Prednisone. Bandit has been on it for 10 days and seems about the same... Some days it even seems like he's worse. I'm disheartened by his lack of progress and worried about the lingering pain. I think we're managing it a lot better (no yelps since starting the Gabapentin) but he's not as comfortable as I would like. Carrying him to go potty is still a struggle every time, though he seems very comfortable in his recovery area otherwise.
I will keep Bandit on his current medications but I'm going to make an appointment with a neurologist on Monday. A second opinion on his condition would reassure me no matter the diagnosis. If anyone in the San Diego area has a vet recommendation, I would love to get some names.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 3, 2014 11:49:50 GMT -7
Loss of neuro function is something to monitor closely and keep your vet updated promptly (or ER on weekend/nites) As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails scuffing floor 4. Paws knuckle 5. Legs do not work (paralysis, dog is down) 6. Bladder control is lost 7. Tail wagging with joy is lost 8. Deep pain sensation, the last neuro function, a critical indicator for successful surgery. Surgery can still be successful in the window of 12/24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. So if surgery is an option for your family get to a neuro or ortho asap. Can you tell us with the urine in his bed last night, do you also find he leaks on you when lifted? Do his legs now not move at all, do his paws knuckle? He no longer sniffs and then releases urine? Those signs would need prompt reporting to your vet. Or perhaps was the urine in bedding least night due to not being let out in time? Did his pain meds change... did you get permission to give Tramadol 50mg 3x/day? How much gabapentin and how often are you giving it? Prednisone can take anywhere from 7-30 days to get painful swelling down. While pred works there should not be backward steps... not increasing pain nor neuro function loss...if that happens the vet needs to know. Not wanting to be lifted could mean he remembers it used to hurt and he anticipates it? Are there other confirming signs of pain: shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy, not normal perky self? Look into Care Credit now just in case things go into crisis mode and surgery is needed. It is best to know all your options, financially and where surgery would be done, ahead of time rather than scrambling for that information in an emergency. No or low interest credit for veterinary costs can be obtained from Care Credit. You find out online if you qualify: www.carecredit.com/faqs.htmlBoard-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals. You can locate others in your area here: www.acvim.orgonline.acvs.org/acvsssa/rflssareferral.query_page?P_VENDOR_TY=VETS
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Post by Linda Stowe on May 3, 2014 13:08:07 GMT -7
Hi Jennifer, I got this name from one of the Dachshund rescues in San Diego: Dr Robin Levitski-Osgood at Veterinary Specialy Hospital in Sorrento Valley
Hope this is close to you.
Linda
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Post by Jennifer & Bandit on May 3, 2014 18:56:30 GMT -7
Thanks Linda for the vet rec. I'll definitely look into contacting him. Luckily I have an appropriate savings account and a CareCredit account (from a broken leg in Bandit's puppyhood days--he has definitely cost me a pretty penny in vet bills!).
Today was a better day for Bandit. I think the increase in pain meds is interfering with his bladder control but he hasn't had any accidents today. I also saw him walking around in his recovery area to find a cooler spot to sleep in, so definitely no paralysis. I also saw him lifting his leg so he could lick himself, so I'm inclined to think there hasn't been further loss of neuro-control.
Our new medication schedule is as follows:
Prednisone 5mg / 12 hours Pepcid 5mg / 12 hours (30 min before Prednisone) - increased from 2.5mg Methocarbamol 250mg / 8 hours Tramadol ~37mg / 8 hours - increased from 25mg Gabapentin 33mg / 8 hours - started 2 days ago
There are definitely good days and bad days as we're figuring out his medication schedule. He's still reluctant to move and he associates being picked up with pain. I'm just having difficulty determining if he's getting better because I get so many mixed signs--he might hold his bladder overnight one day but refuse to let me pick him up for potty, or he might be great all day and then cry in the middle of the night. So I'm definitely taking it day by day. I'm hoping that when we settle on a med combo I'll begin to see more positive changes.
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Post by Pauliana on May 3, 2014 21:18:26 GMT -7
Hi Jennifer, Prednisone causes excessive thirst and urination.. On Pred they have to go potty at least every 3 hours.. At night urine production slows down but during the day make sure she can go out to potty more often. Have you watched this video on how to lift and carry Bandit? Thus may help: Keep on working with Bandit's Vet or the new Vet until the Medication combo works to get his pain under control.. It sometimes takes trial an error until the right combo is reached.. Once pain is under control then he can heal! Pain slows down healing.
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Post by Jennifer & Bandit on May 4, 2014 0:10:28 GMT -7
Hi Pauliana. The biggest issue with taking Bandit out to potty is that I can't convince him to stay standing for long periods of time, or at all. The best he'll give me is a sit, which means that to carry him I have to align his spine for him. I think that's why he cries out in pain sometimes, because I'm hurting him in the process. Any suggestions on how to get him to stand so I can lift him securely?
On the plus side we haven't had a single doggy scream/yelp session in two days (since the Gabapentin), which means his pain has become a lot more manageable. Little victories!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 4, 2014 12:02:48 GMT -7
Jennifer it is still possible to hold and lift Bandit in the seated position with one hand under the chest and the other supporting his butt. He may feel more comfortable with his back at the same low angle as when he is sitting. He may have learned that it is painful to have you pick him up and is anticipating learned pain. Does he still shiver or yelp when you lift him now for potty?
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Post by Jennifer & Bandit on May 4, 2014 15:40:11 GMT -7
Hi Paula. Today I think I figured out where exactly his pain is coming from. It's definitely in his lower back, towards the hips. He actually does not like to have his back perfectly straight. He prefers to have it slightly sloped downwards. I've been carrying him with his back aligned, which is probably putting more pressure on the affected disc. He let me pick him up today and take him out to potty without issue (no trembling), but yelped when I put him back in his recovery area because I set down his front paws first. In the future I'll have to figure out a technique to carry him where his hips don't come up higher than his shoulders. Also, can I just thank everyone on this site, moderators or otherwise, for their continued support? I don't really have anyone else to talk to about this, so even being able to write it down is such a release. I'm going to call the neurologist's office tomorrow to schedule a consult, or maybe talk to him/her on the phone. I looked on their website and they have some good resources, like this overview of IVDD. I'm really looking forward to speaking with a specialist, even though my vet has been great.
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Post by Pauliana on May 4, 2014 21:49:07 GMT -7
I so know how it feels Jennifer having gone through it with my Tyler. Only those who have experienced a beloved dog with IVDD understand all the emotions and turmoil we go through..
Let us know how the Neuro consult goes.. Keeping you and Bandit in our prayers..
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 5, 2014 9:07:23 GMT -7
Jennifer, thanks for the compliment about the support here...that is just the reason the Forum was started! Bandit may still be in pain then if he does not want his back horizontal. There is still room for a 14.5lbs dog to move Tramadol up to 50 mgs 3x/day. Do consult with your vet as that slight increase may make the difference in full pain control. You may find a top opening crate will help you in lifting and setting Bandit back in his crate. How to with step by step illustrations: www.dodgerslist.com/literature/cratesupplies/cratetopconvert.pdf
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Post by Jennifer & Bandit on May 5, 2014 19:17:19 GMT -7
Hi everyone, just an update on Bandit's condition. Last night he seemed great and let me take him out to potty with our modified hold (hips below shoulders) but woke this morning at 7AM (8 hours after last dose) with a few yelps of pain. I gave him his meds, but when I came back home for lunch at 1PM (6 hours after last dose) he yelped/ screamed when he stood up to say hi. I've done a bit more research and I'm going to adjust his pain medications as follows: - Methacarbamol 250 mg/8 hours (no changes)
- Tramadol 25mg/6 hours; 50 mg before bed
- Gabapentin 33mg/6 hours; 66 mg before bed
I had been giving all of these medications every 8 hours, but Bandit's pain comes back right around 6-7 hours, so I'd rather dose him more frequently than more heavily. My vet has okayed the Tramadol QID but I need to call her about the Gabapentin increase. There has been literature (in humans) that showed that Gabapentin QID is safe, so I think it'll be OK.
Also, Bandit has been on Prednisone 5mg BID for 13 days now. How long can I keep him at this dose? My vet had wanted to start tapering after 10 days, but obviously I can't do that because his pain is STILL not well-managed.
I have a consult with a neurologist tomorrow so I'll be back with an update after.
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Post by Pauliana on May 5, 2014 21:53:48 GMT -7
Hi Jennifer!
It can take up to 30 days on Prednisone at the anti inflammatory dose for some dogs to get the swelling down. You are right about not having the taper until Bandit has had his pain under control..
Once the Vet guesses the swelling might be gone, she will suggest a taper and by that time if Bandit has been improving pain wise, then the test taper can begin..At that time pain medications are stopped. During the taper if there is no signs of pain the taper goes to completion and then no more medications would be needed, just continue crate rest.. If there ARE signs of pain, stop the taper go back to the anti inflammatory dose of Prednisone and back on the pain meds quickly.. Have a plan in place with your vet should that happen over a weekend so you are prepared, so Bandit isn't in pain for long.
Thanks for keeping us posted!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 6, 2014 9:31:01 GMT -7
Let us know how the Neuro appt goes.
Always be wary of using human dosing for a dog. Each species can have different enzymes for proccessing, can have varying times it takes to eliminate from the body. A safe substance for a human can be deadly toxic to a dog. This is why it is never a good idea to self prescribe, but rather bring things up for discussion with your vet and then look that vet to actually prescribe meds for your dog.
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Post by Jennifer & Bandit on May 10, 2014 19:02:29 GMT -7
Hi everyone. Sorry for the lack of updates; this past week has been a pretty crazy one. On the upside, Bandit seems to be slowly but surely recovering, though we are still having a lot of difficulty with his pain management. On the downside, we may still have to do surgery if Bandit doesn't seem to recover any more on Prednisone alone. I initially had a consult with Dr. Stevenson of Sorrento Valley Specialty Hospital to discuss Bandit's condition over the phone. She gave me the OK to dose Bandit with Tramadol+Gabapentin every 6 hours, even letting me know that there's a huge range for potential dosage in Gabapentin (we could potentially go up to 380mg/day for his weight). Bandit was definitely more alert and in less pain, though potty breaks were still sketchy. Sometimes he was totally fine and sometimes he would still scream. Because of this, I took Bandit in yesterday to have an actual appointment. Dr. Stevenson did a physical examination on Bandit, including forcing him to walk around the office, which he did not like (because we put him on a leash and because he was already anxious from the transport). Though he is definitely not paralyzed, he is a bit wobbly and in pain. Based from his current condition, she guesses that he most likely has a herniated disk that is pressing on a nerve root, which is why he is in so much pain. This kind of injury has a 50/50 chance of healing itself on steroids, and about a 95% chance of full recovery after surgery if the condition doesn't suddenly worsen. She gave me a quote of the procedure, and I (nearly) fainted. The estimated cost for diagnostics alone is $1700 for full body anesthesia and CT, up to $2500 if the CT is inconclusive and we need fluoroscopy. Assuming the CT and surgery takes place in one day, the anesthesia would only be charged once; the cost of the surgery is $4200 on the low end, up to $4800 if there are complications. This doesn't even include the cost of hospitalization, of which he would need probably 1-2 nights of. Here are the exact estimates: Diagnostics, Surgery. Needless to say I was iffy about committing to the surgery right away, especially since he seemed to be recovering! I mentioned my concerns to Dr. Stevenson and she was such a gem. No pressure, no guilt. She let me know that typically she considers no progress at 21 days of Prednisone to be a failure--Bandit is currently on Day 18. However, she wants me to try the full 30 days of Prednisone with our current set of pain meds. I'm welcome to come back in two weeks if we decide that surgery is the only option. So that's where I basically am with Bandit. Hopefully he seems to get better. If not, at least we have a better idea of what to do next. I'm sending tons of good vibes towards Bandit and giving him 14.5 pound 25mg Tramadol/ every 6 hours 40mg Gabapentin every 6 hours with 60mg Gabapentin before bed.
It seems to be working OK! And of course, I'll keep the group updated.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on May 11, 2014 10:06:37 GMT -7
Excellent that pain is coming under control and should stay that way. IF not, do discuss about upping the dose in mgs of Tramadol. Do you see Bandit now wanting to bear weight on his rear leg, kinda holding it off the ground flamingo style which is a typical sign of nerve root pressure? Dr. Isaacs has a photo in his answer about nerve root pain: www.dodgerslist.com/neurocorner2/rootsignature.htmLet us know then if this is the current med list: 14.5 pound Tramadol 25mg/6 hours Gabapentin 40mg/6 hours with 60mg Gabapentin before bed. Methacarbamol 250 mg/8 hours Prednisone 5mg/12 hours Pepcid 2.5mg/12 hours, 30 days use w/taper on May 21 You may wish to investigate Care Credit now just in case surgery is needed. It is best to know all your option ahead of time No or low interest credit for veterinary costs can be obtained from Care Credit. You find out online if you qualify: www.carecredit.com/faqs.htmlWe too have our fingers crossed for no signs of pain on the taper next week. Do know we have had dogs that needed more than 30 days on pred before they saw all the swelling gone. Conservative treatment also depends on the body being able to reabsorb the irritating disc piece enough for the nerves to live with it w/o pain. Surgery goes in to immediately remove offending disc pieces relieveing pressure on the nerves.
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Post by Jennifer & Bandit on May 11, 2014 14:19:31 GMT -7
Hi Paula, no "flamingo" leg that's typically indicative of the nerve damage, but last night during a massage I did find the swollen, painful part of his back. The list of medications is also correct except for the Pepcid, which he gets 5mg/12 hours. So far the pain is relatively well managed, save for the tail end of a dose. I already have CareCredit from a previous surgery and some savings, but it's still looking to be a very expensive surgery.
Unfortunately, while massaging Bandit last night I also found a series of painful looking bed sores on his abdomen. I quickly cut the fur from the area and washed and dried his skin. I put on some Neosporin but also ordered barrier cream, and will call my regular vet tomorrow to see if there's anything else we can do. I'm worried that if surgery is necessary that this will still be an issue. Poor Bandit!
I'm giving Bandit until the end of this week to show more healing. Otherwise I think surgery is the way to go.
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Post by Pauliana on May 11, 2014 19:56:35 GMT -7
Hi Jennifer! Here is an article about bed sores in dogs.. www.petwave.com/Dogs/Health/Pressure-Sores/Treatment.aspxTo prevent bed sores it is best for Bandit to have a memory foam mattress in his crate or ex pen recovery suite. Egg crate foam is another alternative. www.dodgerslist.com/literature/CrateRRP.htm 2 inch 4 lb density memory foam mattress to relieve pressure points. NOTE: protect the foam mattress by inserting in a large trash bag and duct taping closed. Tuck in/cover with fleece. www.foambymail.com Check Walmart, etc. for human memory foam bed topper that can be cut down and stacked for several recovery suite locations. __ Blankets and change of bedding: Fleece fabric as a bottom sheet wicks moisture away from skin (have 2-3 on hand) and dries quickly. Inexpensive fleece throw can be cut to sizes at Big Lots, Walgreens 2/$10. You can buy fleece yardage at JoAnn Fabric Store or the like. This is a no-sew project as fleece does not ravel. Layer in this manner: Trash bag enclosed mattress, pee pad*, fleece bottom sheet tucked in all around mattress. *Use human pee pads as they have no scent to encourage peeing. *OPTION to disposable pee pads are reusable waterproof absorbent bed pads: reasonably priced, washable and last a long time. www.allegromedical.com/ ; look for children's disposable bed mats at your grocery store. Cut down the twin size to make several crate size ones. www.dodgerslist.com/literature/cratesupplies.htmThanks for the update.. Will keep you and Bandit in my thoughts and prayers..
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Post by Jennifer & Bandit on May 11, 2014 23:46:18 GMT -7
Thanks for the tip Pauliana. I went ahead and ordered a new 3" foam mattress for Bandit so he can sleep even more comfortably. A lot of his sores are actually in between his inner thighs, probably from his legs pressing together and from a lack of sanitation, since I've only been able to sponge bathe him. After shaving the fur and cleaning the area he seems much more comfortable. Today Bandit was a lot more active and actually walked around his little area, including standing up to eat. Legs are weak, but he's not in any pain. I'm so pleased I could burst
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on May 12, 2014 4:26:49 GMT -7
If Bandit is getting urine on his belly or his legs when he does potty due to not being able to squat properly, the best thing to clean him with his green tea. Green tea neutralizes the acidity of the urine so helps prevent urine burn and leaves a nice, fresh scent. Just brew up a pot of green tea, let it cool and sponge with it. So glad Bandit is no longer in pain.
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Post by Maggie & Daisy on May 20, 2014 18:58:23 GMT -7
Hi Jennifer I hope Bandit is doing better! I to am in SD and was referred to the same clinic for neuro. My dogs disc problem is in her neck. It's absolutely devastating that the surgery is so pricey. I foster here and our area seems higher than others when it comes to vet costs. We haven't seen the nuero yet Daisy seems to be feeling great and showing no signs of the disc problem so I am debating if I need to see the neuro. We also tried The Animal Accupuncture Clinic in sorrento valley and Daisy showed major improvement. I feel her prices are reasonable.
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