PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Mar 11, 2015 12:04:19 GMT -7
Victoria, because Charlie's case is involved, I believe touching bases with a specialist is best. There can be many options. This is one and may not be the correct one for Charlie... just throwing it out to discuss with the vet. Just as people may have to rely on medications to get them through life, so it may be with Charlie that he takes some med(s) long term so that he can be active again in life.
The treatment all depends on what the vet believes is the cause of what you are currently observing, how that relates to CES, etc. We just do not have such a broad knowledge outside of IVDD that we feel we can comment. Hope to hear the vet has better insight and approach for Charlie.
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Post by Victoria and Allison on Mar 14, 2015 15:36:47 GMT -7
substitute dr wont prescribe tramadol, says not on other dr list though it was. they wont call dr. charlie is in alot of pain. this one also said gabapentin is bad with tramadol can you help mr help charlie? i am so upset!!
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Post by Pauliana on Mar 14, 2015 19:08:55 GMT -7
Hi Victoria,
My suggestion would be to insist they call his Doctor or hire a specialist Vet. Charlie has a disease that we aren't trained in.. I think he should visit a specialist to get his pain under control with the correct medicines for him.. Don't bother with that substitute Vet. Is there an ER nearby that you could take him to tonight?
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Post by Victoria and Allison on Mar 15, 2015 6:14:10 GMT -7
It took ALL DAY of arguing and mentioning the medical board and speaking to 4 vets at the place but FINALLY at 6:30 pm I convinced them to at least write a script for enough meds until my specialist vet gets back next week. I just made it at walmart before they closed to get the meds! This IS a specialty clinic! They are even on dodgerslist.org as recommended. The vet I see there said NOT to take Charlie anyplace in the car or it would make Charlie worse. That is why this was so stressful, he could not be moved to see another vet! The vet, I'll call him Dr C, recommended I get a mobile vet and take a blood test before putting Charlie back on pred. I found one who came Friday (he was out of town this weekend so could not help with meds). He is Dr H.. Blood test was normal. He said to double the prednisone for 3 days and he said tramadol manufacturer has upped their regular dose recommendations including saying every 6-8 hrs instead of jusy every 8 hrs. At least Charlie had a restful night. I dont think acupuncture is working for charlie. Do you think I should quit it? How long should it take? Trying to find cold laser mobile to my home.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Mar 15, 2015 6:27:27 GMT -7
I'm glad you were finally able to get the meds that Charlie needs, Victoria, though they sure put you through far too much. Please give us a current list of all meds Charlie is on now, with exact mgs and frequency given. There's no simple answer as to how long acupuncture would take to help. I found that it relaxed my Jeremy right away and it also helped with the pain for at least the rest of that day into the next day. The good thing about acupuncture is that it treats the whole body so should be helpful in that a definitive diagnosis hasn't been made yet for Charlie. But that's completely up to you. If you don't think it's helping, then stop it and see how he does without it. I've never tried it but I believe you can buy a cold laser product that you yourself could use at home. Here is some info on that: www.coldlasers.org/home-equipment/I'm glad Charlie had a restful night. Please keep us updated.
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Post by Victoria and Allison on Mar 15, 2015 14:40:30 GMT -7
Thanks Marjorie, here is the list of current meds: 20 mg Pepcid early a.m., tramadol 50 mg, 3-4 tablets every 6-8 hrs, gabapentin 300 mg every 8 hrs, robaxin 500 mg every 8 hours, then another prednisone evening- two prednisone a day for three days, then back to one a day.
Charlie is acting very weak in rear and he is in pain. He is panting as we speak. His legs look like he wants to cross them in back again as he drinks his water. I just gave him his pain meds and will increase tramadol if panting continues. Dr. H said I could get up to six tramadol every six hrs. Remember he told me they have increased dosage on their packaging.
Charlie does not want to go out to pee often but does go at least two times a day. This is very painful to watch this decline. And honestly there is no explanation like another dog or anything like that. I did get him a big expensive bed by Big Barker but I don't think that is a cause because his decline started before the purchase and that is why I bought it.
Any help appreciated!
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Mar 15, 2015 16:27:58 GMT -7
Are there any other signs of pain other than the panting, Victoria? Panting can be a side effect of the meds. A fan near but not pointed at the crate will help. Also a rice sock from the refrigerator can help them cool by laying their tummy along side of it. Fill a sock with 1-2 cups of rice and tie the end of the sock closed. Try a frozen broth ice cube to lick on. Or panting can be from anxiety. Or it can be a sign of pain. If a fan helps, then it is most likely a side effect of the meds. If you see other signs of pain with the panting such as shivering, trembling, yelping, tensed up tummy, then the panting could be a sign of pain. Dr. Isaacs discusses this issue: www.dodgerslist.com/neurocorner2/panting.htmWhat dosage of Prednisone is being given twice a day (in mgs.)? While on Pred., especially the double dose, he may have to go out more often as Pred causes increased thirst and urination. Has the crate rest been kept very strict? Only allowed as few steps as possible for potty time? I remember there was some discussion that it was difficult for you to go out with him at potty times and you were letting him go out into the back yard. Is that still the case? Please don't get me wrong - I'm not trying to place the blame on you - just trying to understand what's happening. The strict crate rest is just as a precaution in case this is a spinal problem or IVDD to protect the spine from further damage. Too much movement and a not-yet-healed disc can tear more. When does the specialist come back? I hope the additional dosages of Tramadol will keep Charlie comfortable until then. Blessings to you both.
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Post by Victoria and Allison on Mar 15, 2015 20:19:50 GMT -7
Charlie is getting 20 mg of prednisone in the morning and 20 mg of prednisone in the evening- a total of 40 mg a day . This is the first time he has gotten this double dose of prednisone.
Yes, he should be going out more, which I believe is a sign of pain. The first week of his injury in December, he hardly got up at all despite prednisone. If you count in the middle of the night trips, though, he probably goes at least three or four times a a day total.
Also, he used to get up when the housekeeper would come in the morning and he doesn't now. I believe this is another sign of pain. Plus he was kind of moaning or grunting or straining softly under his breath this morning. I thought the weakness of his rear legs and the knuckling under was an indication of pain but I'm gleaning from your response, that is not necessarily true . I can get a fan, the ceiling fan is a little far away and I'll try the broth cubes.
I can't walk at this time so Charlie goes out on his own and yes it is not optimal. I wish I could afford help 24/7 but I can't. I am hopeful that the double dose of prednisone and all these pain meds will help Charlie in the next few days.
I am trying to find a source for mobile cold laser. In the meantime I'll keep at the acupuncture. I have a new nerve injury to my hand. I bring this up because it is one of the most painful experiences I've had, and only gives me more sympathy for Charlie and what he'd may be going through.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Mar 16, 2015 5:23:03 GMT -7
I'm so sorry to hear that you have another medical issue to deal with, Victoria. I know you're doing your utmost best for Charlie. Is it possible to put a harness and leash on Charlie and just let him right outside the door so he's not walking around outside? Or set up an ex-pen outside a door so he can only walk a short bit past the door? It could very well be that too much movement is keeping an injured disc from healing, if this is IVDD. Are the signs of pain you're seeing (and yes, reluctance to move is a sign of pain as is the groaning) happening when you're giving six Tramadol every six hours? I'm sure you'll be letting the vet know if that's the case. Knuckling or crossing of legs is a sign of nerve damage, not pain. If you're seeing a worsening of neuro deficits along with the increased pain and if this is IVDD, then it's likely that the disc has re-torn and is once again pressing on the nerves of the spine, causing nerve damage and pain. Unfortunately, each time the disc is re-torn, the 8 weeks of crate rest must be started over. Hopefully the specialist will be able to give you some input on that upon his return. If the pain meds are being given aggressively enough and are still not keeping the pain completely under control, it might be necessary for the specialist to perform an MRI to see exactly what's going on. If it is IVDD, surgery will release the pressure of the disc on the spine and crate rest following surgery isn't as strict as it is on conservative care, if that's a financial possibility. Surgeons will usually allow some walking to and from potty following surgery and crate rest is usually for only 6 weeks instead of 8. Here's our page on when surgery should be a consideration when dealing with IVDD: www.dodgerslist.com/literature/healingsurgery.htmI do hope that both of you are feeling better today. Please keep us updated.
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Post by Victoria and Allison on Mar 18, 2015 16:07:47 GMT -7
Thank you Marjorie, much to consider. The great news is that Charlie is doing much better since commencing meds again! His rear legs are stronger, he rarely pants, he is much more relaxed and I don't think he is in pain any longer.
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Post by Victoria and Allison on Apr 18, 2015 13:28:05 GMT -7
He's getting worse! Charlie is not Paralyzed but getting worse. Less and less control! Wouldn't go out today. Peed on bed. Panting alot. On full scale pain meds and pred 2x a day.
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Post by Pauliana on Apr 18, 2015 19:39:21 GMT -7
Hi Victoria!
What does your Vet say about Charlie's current condition? How long has he been paralyzed? Sorry to hear he has gotten worse.. Your last post had mentioned he was doing better. Did he get re-injured or is his CES worsening?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,605
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Post by PaulaM on Apr 19, 2015 8:08:53 GMT -7
Victoria, can you give us some more specifics on the getting worse.
-- Did Charlie see a specialist, did you discuss if an MRI would help to determine his exact problem? -- What are the exact medications he is currently on (the dose in mgs, how often you give each) Include Pepcid AC details too. -- On March 18 you indicated he was back on meds...has he continued on these meds since 3/18 to todate? -- Who prescribed the pred 2x/day (how many mgs)? Was it your local DVM vet or a specialist neuro (ACVIM) or ortho (ACVS)?
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Post by Victoria and Allison on Apr 19, 2015 14:46:55 GMT -7
Just under a week ago the housekeeper left Charlie's pen unlocked. I was asleep with the flu but later saw on my security cameras that Charlie walked out of his pen, slipped all over the tile floor and could not get up. The black dog humped him twice, luckily his back was vertical since he was sitting up during one of those assaults. Then I woke up and somehow managed to get Charlie back into the pen myself, putting rugs under his legs and dragging him. That was about six days ago. He has been progressively worse.
At times there is knuckling under both rear paws. But there is a new overall weakness in his rear that is markedly worse- really wide stride and in his pen with carpeted flooring he falls on his rear which he never did before. He is starting to pee in his bed, but he definitely still has bladder control, because regularly goes out and pees on his own.
Several days ago I hired someone to be there from early evening to midnight so they could take him out with a sling his back. The housekeeper is still here early morning till noon, but this still leaves several hours where I have to open the door for him because I cannot go outside and help him.
The vet at California Veterinary Specialists doesn't seem real keen on giving me advice since he can't make money over the phone, but he'll be back tomorrow from vacation, though his secretary "suggested" I see a local vet. I told her the local vet said he's not comfortable giving advice for an advanced back problem and I should continue seeing the CVS vet. And I don't want to take Charlie in the car to see someone new.
It is a really tortuous for me and Charlie. I go through in my mind all the things that I could possibly do for him and somehow things always come up short for Charlie.
So no one has seen him since this last incident but the real question now is whether major spinal surgery is an option for a 12-year-old dog with an owner that cannot walk. He has been confined now since December.
I am not seriously considering surgery for Charlie but still wondering statistically how older dogs do, in fact -- how do any dogs do after this type of surgery. If he has caudia equina syndrome I don't think the chances of surgery being spectacularly successful are great.
I have devised a plan of my own for now. Last March upping the prednisone from a 20MG per day to 2 a day for three days really helped. So I am giving him 2 preds a day again, not for three days (which has passed), but for five days and reevaluating. I'm going to ask CVS if higher doses (30-40mg per dose) would possibly help him further, though that vet told me he doesn't think prednisone affects inflammation significantly like this group does.
Charlie is now definitely peeing more and eating more because of the prednisone; strangely that never showed up before. Of course this compounds the problem of him getting up and having to go outside more frequently.
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Post by Victoria and Allison on Apr 19, 2015 14:54:48 GMT -7
Answers to Paulina and Paula's questions
Charlie's meds: 1) 1 prednisone 20 MG twice a day [for 5 days]; 2) 1 tramadol [??mg] every six hours; 3) 1 robaxin [??mg] every six hours; 4) 1 gabapentin [??mg] every six hours
Charlie has never had an MRI because surgery was never a serious consideration. The vet said he didn't think I should do an MRI and less I am ready to do surgery if it is warranted.
Charlie has been on prednisone steadily since March, but only pain pills for about two weeks in March. The doses stated above were commenced about five days ago.
It was the local vet the suggested doubling up the prednisone to twice a day. This specialist wanted Charlie on prednisone every other day and it did not seem effective.
Charlie has never been definitively diagnosed with cauda equine syndrome. As I understand it, the main issue of CES is intervertebral disc ruptures. The specialist said it possible the issue is a herniated disc.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
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Post by Marjorie on Apr 20, 2015 4:53:24 GMT -7
I'm so sorry to hear that Charlie has had another incident that has worsened his condition, Victoria. As we've mentioned, when conservative care instead of surgery is chosen for IVDD, the most important part of the care is the strict crate rest. Walking or moving too much can cause the disc to re-tear or not to heal. So it's hard to tell whether the incident caused a tear in a not-yet-healed disc or whether another disc was damaged. The amount of nerve damage done depends on how badly the disc has torn and how much exploded disc material is pressing on the nerves of the spine. We have seen older dogs do well with surgery. Surgery immediately removes the disc fragments that are pressing on the nerves of the spine, which relieves the pressure on the nerves. Crate rest hasn't gone well for Charlie. With surgery, the crate rest is not as strict as with conservative care. It would be OK for Charlie after surgery to walk out to do potty and back to his crate. Also crate rest after surgery is usually only 6 weeks instead of 8. Of course, the other dog who keeps humping him would still need always to be kept separate from him or the results achieved with the surgery will be completely undone or Charlie will keep being injured as any disc in his spine could be deteriorated at any time. Possibly keep Charlie's crate in another room from the black dog so if he does get out of his crate, he would still have no contact with the black dog. Also of course impress upon anyone coming into your home the importance of keeping Charlie crated, which I'm sure you did. Plus an MRI would determine whether something else is going on rather than IVDD. With large dogs, many things mimic IVDD. Without an MRI, it's hard to tell whether Charlie is receiving the right treatment. The specialist would need to take extra care with Charlie's spine during the MRI since all core muscles supporting the spine would be relaxed from the anesthesia. Here's our page on when surgery should be a consideration: www.dodgerslist.com/literature/healingsurgery.htmAlso this page has helpful information about surgery: www.dodgerslist.com/literature/surgery.htmIf you decide against the MRI and continue with crate rest, is there any possibility of training Charlie to pee on a pee pad right outside his crate door? Take some dirt from where he's peed before or from one of the other dogs, put it on a pee pad and tell him whatever you usually say for him to do his business. Here's an article that might be helpful with that: thehousebreakingbible.com/training/indoor-potty-training.htmPlease fill in the blank in the med list above with the exact dosage of each med in mgs. Is Charlie's pain completely under control with these meds? Please be sure to include 5 mg of Pepcid AC 30 mins. before the Prednisone and every 12 hours thereafter to protect his GI tract from the excess acid caused by the Prednisone. Healing prayers for Charlie.
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Post by Victoria and Allison on Apr 20, 2015 8:47:13 GMT -7
Thanks Marjorie! You have given me a lot to think about regarding arrangements and surgery. I'm hoping it doesn't come down to surgery. I think of Pamela and Hendrix's surgery and the painful aftermath and that result scares me. The surgeons said it was because they didn't stabilize the area, but I don't think they can say that with absolute certainty and they admit the results are out of their control, such as scarring and healing. Back surgery, and particularly the lumbar-sacral area, is tricky for dogs and people. We all know of people who have had back surgery and still live in pain.
Here's Charlie's schedule: [85 lb] 1) one famotidine 20 mg every 12 hours; (yes! he has been getting this thanks to dodgerlist!) 2) one prednisone 20 mg every 12 hours for five days, then evaluate; 3) one Robaxin 500 mg every six hours; 4) three tramadol 50 mg every six hours; 5) one gabapentin 300 mg every six hours
Charlie had his best morning today! His face looked normal and relaxed, he got up to eat, and he got up to indicate he had to go out, standing. Also more strength in his back legs and no knuckling seen. I pray this improvement continues!
He has had gas and a bloated stomach last night. He gets pumpkin with his meals. Any suggestions? You may recall the specialist doesn't like to recommend Carafate.
I do think the stepped up prednisone for a short period, like doubling up for three days or five days, has shown to help Charlie, and maybe that's something that would help others, too.
What happened with the pen door, was really not the housekeeper as much as the carabinger lock we use to close the pen. The spring broke and that may have enabled the pen to be opened. This was changed. I honestly watch him like a hawk and have security cameras directly on him and he's only alone when I'm asleep early afternoon and wee hours but still almost every night I get up from sleep to check on him or let him out, such as 12:30 AM the day before and 4:30 AM this morning. It may look otherwise but I'm frenetic about his care.
I'm going to try to attach online a picture of Charlie's new bed set up. He's had pee/poo accidents and they cause him panic and he tries to get out if his area is soiled so I've put two beds and carpet in between so he has a clean place to sit if that happens.
Regarding the shortened area in my yard, we've tried to think of a way to attach a fence to my house around the slider, but because it's concrete (before the grass)and because we have high winds here, we haven't come up with anything plausible yet.
Thanks again for your help.
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Post by Debbie Blackwelder on Apr 20, 2015 11:42:08 GMT -7
Victoria, I pray he does not have to have surgery but if he does it is not the end of the world. Of course I've only dealt with dachshunds but I have had three surgeries on my pups and they all recovered well with surgery. I myself have also had back surgery and it was a success so I guess I'm on the pro surgery band wagon because it saved my life as well as my pups. Just a thought to share with you about not stressing if it happens. Glad to hear he had a great morning!
Prayers, Deb
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Post by Victoria and Allison on May 7, 2015 20:14:47 GMT -7
Quick update. I really thought Charlie was headed towards going down because of substantial rear weakness, a lot of knuckling under of both rear paws, and the rear legs splaying out, with some episodes of falling on the rear. I've hired people to help walk him out both morning and then evening and he's continued with acupuncture. He was on prednisone twice a day 20 MG for a week. I'm happy to say that he has plateaued and is not getting worse. In fact the last few days have been substantially better. He's happier, not panting, alert, loving his food and the knuckling under has reduced to a couple times a day. He's really soundly sleeping and snoring again . And I love his contented snorts during the day- they have returned. All this with a substantial tapering off of the pain meds that were pretty substantial. We had been up to nearly every 5 hours (per new vet) for tramadol, gabapentin and Robaxin. Now only a couple times or once a day to help him sleep. And tonight I'm not even going to bother. Just praying he will keep this strong and maybe better.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on May 7, 2015 20:21:07 GMT -7
Victoria, how very wonderful to hear things are going in a good direction and there has been improvement in neurofunction and no pain.
So this is now the current med list? famotidine 20 mg 2x/day prednisone as of 4/19 20 mg 2x/day five days, now tapering Robaxin 500 mg 1-2x/day three tramadol 50 mg 1-2x/day gabapentin 300 mg 1-2x/day
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Post by Victoria and Allison on May 7, 2015 20:46:56 GMT -7
The meds: 20MG prednisone once a day.
Pain meds as needed, and I'm going by how he acts. If he is restless and panting and looks real worn and walks poorly with neuro signs I would give every 5-8 hours depending on severity 3-4 tramadol 50mg (vet says up to 6 with new guidelines published by manufacturer), 1 Gabapentin 300 mg. If the worst, I would add the Robaxin 50mg. Again, every 5-8 hours gauged by his behavior and neuro signs.
Last couple days only gave to soundly sleep and today, well NONE and it's his best day ever. I do confess I'm afraid to taper off the pred completely because of continuing knuckling plus I want to see more good days like these last few.
I'll contact the vet that comes to my home and have him visit and advise. CVS, the specialist doesn't even call me back anymore, I guess because they don't get paid since Charlie can't be brought to the office and they have kindly agreed to write prescriptions so I can buy the meds at Walmart to save me money. But I have spent thousands there with other animals.
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Post by Pauliana on May 7, 2015 21:01:20 GMT -7
Hi Victoria! That's wonderful Charlie has had his best day ever and no pain meds.. Great sign!! Thanks for the update!
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Post by Victoria and Allison on May 7, 2015 21:10:30 GMT -7
A tip for others: Charlie absolutely loves to take all his meds!! I mean he looks forward to them!I put the pills in his Royal Canine LP Renal canned prescription food (others can try the non-RX version.) I roll up the food like meatballs and put the pills inside and like Pauliana suggested, have an extra empty meatball follow as a chaser, to make sure the one before with pills goes down. I've heard all pain pills have a very bitter taste, but no problem for Charlie! This has been a blessing with as many as 19 pills a day!
I forgot to add he gets 20mg (not 10mg) of Pepcid aka Famotadine in the morning 20 minutes before first meal or meds and same thing in the early evening 20 minutes before his dinner.
Thanks Debbie, Paula and Pauliana!
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