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Post by Nancy & Maisy on Mar 21, 2015 12:59:14 GMT -7
Hi everyone, I'm back sooner than I'd like to be. My last doxie, Faith healed well from her IVDD episode with your help and now my 2 year old doxie Mowgli is having issues. He has been "fussy" about his flank area on the left side for a while now and yelped this morning when he lightly brushed my toes with his flank (where hind leg meets his abdomen). We just got back from the regular vet. His x-ray showed calcification between T 12 and 13, as well as between L3 and L4 and L4 and L5. The vet said that pain could be radiating to his flank area. She did not see any herniation of the discs, she just pointed out that the disc areas showed as white on the x-ray and not clear. She said his neurological exam was normal. She sent us home with Tramadol prn.
He also has a history of near obstructions (he ate everything he could get his mouth on as a puppy and it was really hard to control. We were at the vet with this 3 times in his first year to have vomiting induced or for x-rays. On today's x-ray his stomach is still full from breakfast he ate 4 hours ago, so this is a complicating factor in diagnosing the source of his pain. We'll fast him and go back for another x-ray to see if he is passing food properly. In the meantime, I am thinking strict crate rest and Tramadol for pain.
Our house and yard are full of ramps which he does not always use. He goes around them sometimes when he's excited.
Doxie. No, no definitive diagnosis. General vet. -- What was the date you saw the vet and started 100% STRICT crate rest 24/7 for 8 weeks?TODAY, 3/21/15 -- Is there still currently pain Occasional yelping when flank is lightly touched.
22 lbs.
Tramadol, 25 mg every every 8-12 hours as needed.
-- Currently can your dog wobbly walk? YES he is moving well, with no neurological symptoms. -- Do you find wet bedding or leaks on you when lifted up? NO -- Eating and drinking OK? YES, eating a little too well. He's a chunker since he was neutered. Now he's always on a diet, poor guy.
-- Poops Normal, with normal frequency, but stomach full of food after 4 hours and a tense, bloated tummy.
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Post by Debbie Blackwelder on Mar 21, 2015 13:44:17 GMT -7
Hello Nancy and Welcome back to Dodgerslist! My name is Debbie. You did a great job on defining Mowlgi's condition but you already have been through this once with Faith. Sorry it has possibly happened again but you will get through it.
Is the Tramadol controlling the pain? You may not know yet since you just got back from the vet. What is his dosage?
If your general vet feels this is a disc episode then what was her reasoning not to start Mowlgi on an anti-inflammatory or steroid? If Mowlgi has a disc problem then he needs the anti-inflammatory asap to work on reducing the swelling around his spinal cord. And of course if he starts the NSAID or steroid then you need to ask your vet if there is any reason why Mowlgi can not take Pepcid AC to protect his tummy while on the anti-inflammatory.
Until you get a definite diagnoses then keep Mowlgi crated to be on the safe side. 100% strict crate rest 24/7, only out to potty and carried back and forth for that. If Mowlgi is not showing any symptoms of IVDD then I would be a little concerned she might have another problem going on, such as internal or any number of things. Did your vet suggest you seek a neurologist for a second opinion or further testing to determine the problem? Did your vet do blood work today to rule out pancreatitis or other issues?
Right now would not be a good time to start a diet. His body needs to be normal right now to fight off whatever is going on, especially if it is IVDD. Later there are some great new dog foods out there to lower weight or you can reduce his normal food in small increments and choose healthy snacks like carrots, green beans, etc.
Pumpkin is magical in helping with constipation but it's the amount of water in the diet that makes all the difference. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.
Please let us know what you find out and good luck to Mowgli
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Post by Nancy & Maisy on Mar 21, 2015 13:57:43 GMT -7
Thanks, Debbie. I sat down to post as soon as we got home from the vet and have been reading up and refreshing my memory since then. I just called and scheduled an appointment with the neurologist who worked with Faith. They got Mowgli in Monday a.m. at 10:30! So good of them. I've started his Tram and he is in his crate, where he will stay except for potty breaks. The vet we saw today may not be knowledgeable enough to know whether this is a disc episode, but I'll get him to Dr. Hicks on Monday and have a thorough eval done and will know more then. I'm sure he'll prescribe a steroid if we find an acute injury. I re-read my IVDD pamphlets and was reminded that x-rays don't always show a herniation or buldge, so made the neurology appointment.
I just started the Tram a 1/2 hour ago. Since his only signs of pain are the occasional yelp when his flank is touched and a tense tummy, can I look for tummy relaxation as a sign that the Tram is controlling the pain or is there something else or more that I can look for to know that it's working?
Other questions: Mowgli hasn't shown any neuro symptoms. Is tenderness is the flank area a common symptom of IVDD? At 2 (he just turned 2 in February) he is so young to have IVDD. I've read that some dogs are born with it and I really hope this is not the case with him, but with 3 discs potentially involved, I'm very concerned that this might be the case. I spose all I can do right now is wait for our appointment on Monday to get some answers.
Thanks for your reply!
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Post by Debbie Blackwelder on Mar 21, 2015 14:11:24 GMT -7
Nancy, I added a little more information to my original post so go back and read it again. Signs of pain are Shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy, head held high or nose to the ground, not normal perky self.
What is the dosage of the Tramadol? And did your vet do blood work? I await the answers from my first post, updated. Sorry, you are quick.
If you knew positively it was IVDD then I would want the steroid started ASAP but then again he is showing no signs other than pain in the flank. Anything is possible where pain is concerned, nothing can be ruled out. In my own personal experience with my four wieners who have had three IVDD surgeries I can tell you that two of them have pancreatitis and their symptoms sounded so much like yours but I'm not a vet.
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Post by Nancy & Maisy on Mar 21, 2015 14:44:07 GMT -7
No, nothing's for certain at this point. He has been eating, drinking, peeing, pooping and playing and being his normal "go for it" little self except for the flank pain. I believe that pancreatitis often causes loss of appetite and/or vomiting and that's not going on with Mo. Still, I really do wish we'd done some blood work. The vet didn't suggest it and I meant to ask, but we were busy discussing the x-ray, etc.
I'll be happy once we see the neurologist and get some more information. This doesn't seem to be an emergency IVDD situation or other type of emergency, so I'll keep him on crate rest and see the doc on Monday.
I'm sorry the Tram dosage is 25 mg every 8-12 hours prn. thank you! |
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Post by Debbie Blackwelder on Mar 21, 2015 16:14:13 GMT -7
Can you tell if Mo's pain is better? You are correct about the throwing up with the pancreatitis. My Annie will throw up clear liquid if she does not get her PEPCID AC each day but she did have a lot of pain in the beginning. The throwing up was not regular but present. However if she got ANY fat in her diet she would cry endlessly in pain. She continued to eat like a pig.
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Post by Nancy & Maisy on Mar 22, 2015 9:31:41 GMT -7
If Mowgli proves to be having an IVDD episode I'm going to set up a recovery suite. Is a 3" thick memory foam mattress too thick? Most of those I'm seeing online are 3 or 4" thick. I saw the link you have to a 2" one, is that the thickness of choice?
Is "as long as the dog and 1.5 times as wide" a good rule of thumb for a suite for conservative treatment? He has been fairly quiet in his airline crate (which he's used to being in while we're not at home). I think it must be the Tramadol. Normally he's a very active young dog and he's quite mobile. I'm a little concerned he won't get the rest his back needs to heal (if this truly is a disc injury) in a recovery suite, yet would like him to feel less confined if he has to do 8 weeks. I saw the suggestions for restricting height so he can't jump up on the sides of the ex-pen (I have 2 and so would use one of those as his suite as well as one in the yard for pottying). And I can take up extra room with a rolled up blanket. Any other suggestions for a young, spunky dog in a suite?
Thank you! |
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Post by Pauliana on Mar 22, 2015 10:39:23 GMT -7
Hi Nancy, The right recovery suite size is one that Mowgli can stretch out his front legs and 1 and half times his body. Here is the info on setting up a recovery suite: __ Mattress: Soft firm mattress of some sort: 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 can be cut down and stacked for several recovery suite locations. Egg crate foam is another alternative __ 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. __Calmers: Normally these calmers are not a problem to help your dog relax in the recoverey suite, but always let your vet know of everything your pet is taking. A dog that is rambunctious in the crate defeats the purpose of crating. It is better to have the edge taken off than facing paralyzed legs with too much movement. Using any oral calmer in combination with a pheromone diffuser seems to work best. It takes several days for these to start working. Other product brands may be available in your area or on-line… just comparison shop by the active ingredient(s) and qty Place a DAP pheromone diffuser at floor level where the recovery suite is. Some brands to consider: --Comfort Zone (DAP) wall plug-in diffuser 48ml www.petcomfortzone.com/dogs.html --Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/ Use a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. 3) Bach's Rescue Remedy is a liquid herb combo to help with relaxation 4) Plain Benadryl (Diphenhydramine) with no additional active ingredient added is an over the counter item. The wrong dose can have dangerous side effects, so your vet needs to prescribe the proper amount for your dog. Avoid if glaucoma, lung disease, heart disease, some forms of thyroid disease, prostate disease or high blood pressure. |
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Post by Nancy & Maisy on Mar 22, 2015 11:11:17 GMT -7
Thanks, Pauliana. I have some Composure and plan to use it. He's very quiet in his airline crate thanks to the Tramadol. I gave my Adaptil diffuser away after Faith passed and now wish I hadn't!
If he is moving too much once in the recovery suite, despite my best efforts, he'll just have to stay in the airline crate. He's very used to it and should be fine. We'll try the recovery suite, just so he can feel less isolated and because it's easier to get him in and out of a suite than the crate
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Post by Nancy & Maisy on Mar 23, 2015 14:49:08 GMT -7
We're back from our appointment with Dr. Dan Hicks at Blue Pearl in Tacoma, WA. He believes it is a bulging disc and recommended conservative treatment, with 4 weeks of crate rest followed by physical therapy (hydrotherapy). He said Mo's neuro exam looked almost perfect, but confirmed what I told him I thought I've been seeing - a slightly shortened gait behind and some bunny hopping when he accelerates. I am wondering about the length of crate rest. I was planning on 8 weeks and told him so and he was fine with that, but his discharge notes said 4 weeks. Do you all know of dogs that recover completely and whose discs really heal in 4 weeks, vs. 8, with a bulging, rather than herniated disc?
Meds:
Metacam, 20 lb. dog dosage once daily for 1 week
Pepcid AC (my suggestion)
Tramadol 25 mg prn [every 8-12 hrs] (stop if possible and administer if he shows signs of pain)
Gabapentin: he gave me a script to fill if Mo appears to be in pain and the Tram isn't controlling it well.
He didn't feel that an MRI was indicated right now and of course, no surgery right now. He said that it is somewhat likely that this will go on to become a herniated disc, but he is hoping it will heal with the NSAID and crate rest. I asked how complete a healing we might expect and he said that if the fibers of the disc can mend, that would be wonderful, but it's possible there are already extrusions. He believes the disc is pressing on a nerve root and creating a pinched nerve effect for Mowgli that is intermittent, thus his intermittent yelping. Today, for example, even tho' the vet exam called for him to skip his morning Tramadol, he showed some concern when we touched his left flank area, but didn't vocalize at all.
I am to call if pain persists after the week of Metacam (yelping at being touched) or if new pain symptoms show or if he deteriorates neurologically.
He asked for blood work and sent me back to the general vet to get it to save me some money. When I mentioned dodgerslist he said "Oh, yeah, I know all of the people there"! lol
Went straight to general vet for bldwk: we're looking at thyroid as Dr. Hicks wants Mo to lose weight and said we need to get to the bottom of why his diet hasn't accomplished this. When I got there Dr. Lum came out with the radiologist's report from Saturday's x-ray. It stated, "Mineralization of the disc space between T11 and T12 is noted along with subtle disc space narrowing at L3/4. No bone lysis or vertebral malalignment is otherwise seen." And "Conclusions: A definitive cause for the patient's discomfort is identified. No obvious subcutaneous soft tissue swelling or any other evidence of trauma is noted, though this does not totally preclude its presence. Mineralized disc material at T11/12 is consistent with degnerative disc disease though this could also be an incidentatl finding without obvious neurological or spinal discomfort reported in this region."
It also states that all of the digestive organs appear normal and to see a neurologist, which we of course have already done. Dr. Lum will call with bloodwork results and will get the radiologist report and bldwk results to Dr. Hicks. This afternoon I'll be going to get Pepcid and setting up our recovery suite.
My question for you guys right now is, do we start our 100% crate rest over as of today's date since Mo was gait tested and moved a lot at the vet? Oh, and also, what about this 4 weeks of crate rest recommendation for a bulging disc?
Thank you!
Dr. Hicks also said that while 3 years old seems young for IVDD, it's not uncommon (sure I'm preaching to the choir here; I was really hoping to have 8-10 years of IVDD free time! Ah, best laid plans. lol) He said it's largely gentetic; with genetics being "the loaded gun" and whether the trigger gets pulled is dependent on things like jumping off beds, etc.
Also I wasn't thinking correctly when I said Mo was 2. He is 3 and his b'day is 2/4/2012. I guess I just can't believe that he's three already!
So, we're nervous and worried and want to do everything right for Mo right out of the gait to give him the very best chance of not having to go through a herniation. My husband is beside himself; he loves this little dog SOOOO much. I will post a pic of Mo soon, as well as my 1 year old female, Maisy Faye (her middle name is in honor of Faith, who's avatar picture I just can't quite get myself to replace yet.)
I'm off to pick up Pepcid and get supplies to set up his recovery suite with; all the while fighting back the tears.  I realize that we're lucky to have a normal neurological situation; just so worried now that the vet has said it's somewhat likely the disc will go ahead and rupture.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,556
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Post by PaulaM on Mar 23, 2015 15:58:19 GMT -7
Glad to hear Dr. Hicks feels Mowlgi's disc can heal with conservative treatment. And good job on suggesting the Pepcid AC during the use of Metacam! We watch what vets all over the country prescribe for conservative treatment. We've been observing this since 2002 and there have been multiples of 1000s of dogs passing though our Forum. A disc is mostly cartilage with basically no blood supply. Bones have a rich supply of healing blood in which to heal. Most broken bones are set in a cast for 6 weeks for the bone to heal. With conservative treatment the crate is like the cast to provide limited movement while the disc is busy forming scar tissue. Discs take longer than bones to heal due to their being avascular....little blood supply.... we observe dogs having the the best potential of forming that secure scar tissue with a full 8 weeks. When crate rest is less we often see a dog starting too much movement before the scar tissue is strong and relapses sadly happen requiring starting crate rest all over again from the start. Sure you can cheat on crate rest time and maybe Mowgli will have Lady Luck on his side then maybe he won't. If you guess wrong Mowgli will suffer pain, you'll have more vet bills and maybe even the damage will be so severe a surgery will br necessary. When you think about 8 weeks it is a blink of an eye in the life span of a dog to ensure full disc healing. We have noted in the subject line that crate rest started on 3/21. The job of a NSAID is to get all the painful swelling down. It can vary dog to dog anywhere from 7-30 days. The pain meds are Rx'd promptly and regularly so that Mowlgi does not suffer from needless pain. So how are you going to know if the NSAID has finished getting all the painful swelling down? Well at the end of the week as the Dr. said stop the Metacam. Also pain meds are stopped (Tramadol and Gabapentin) so you will be able to easily assess if Mowlgi is showing any hint of pain (yelping, shivering, trembling, yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy, holding leg flamingo style not wanting to bear weight, Not the normal perky self." If you observe no signs of pain, then no meds are needed.... just the balance of the 8 weeks to let the disc self heal. |
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Post by Nancy & Maisy on Mar 23, 2015 16:20:17 GMT -7
That is exactly what I thought you'd say and no, no interest here in cheating on the crate rest time. With Faith it was 8 weeks and the only reason I asked is that Dr. Hick's rec was the 4 weeks. I was checking with you to see if treatment ever varies based on the severity of the disc injury.
I'm a little nervous about the short course of Metacam. When I asked Dr. Hicks about it, he said that we want to pulse dose it when needed as indicated by pain. He said he worries about side effects and doesn't want to over prescribe. My worry is that one week of decreased swelling is a pretty short period of time and Mo's pain has been so intermittent and random, really, that he could be in whatever amount of pain he has been in and we wouldn't know because the only sign he has shown is a loud scream on 3 occasions, NOT every time his flank is touched. So how will I know if he's still having pain if he doesn't happend to get touched at just the right moment and scream again? He has had no trembling, hunching, shaking, shivering and he has been very perky all along and yet, he has a bulging disc.
How long do most dogs who come thru the forum with a bulging disc, as opposed to a full herniation stay on the Metacam?
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Post by Pauliana on Mar 23, 2015 20:59:09 GMT -7
Hi Nancy,
Every dog is an individual.. What works for one may not work for another so there is no generalized answer on how long a dog should stay on Metacam or any anti inflammatory. It is all based on how Mowgli responds once the Metacam is stopped. The pain medications are stopped also, as Paula said in her post. If Mowgli yelps, or screams as he has in the past, then that would be your answer to go back on the Metacam via a phone call with your Vet. If you would rather let him know you are uneasy about stopping the Metacam so soon in his treatment perhaps he would be willing to give Mowgli a little more time on it. If not, stop the Metacam as instructed but be quick to call him if Mowgli responds with pain and tell him what you have observed.
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Post by Nancy & Maisy on Mar 23, 2015 23:03:27 GMT -7
Thank you. I realized that Mo doesn't have to get to the point of yelping before I would call once he's off the Metacam; he gives other signals, too, like looking back at your hand and his side if you touch it and has even growled a few times. I feel better after putting this together in my mind; more certain that I'll be able to tell.
Mo is in his recovery suite as of early last evening and likes it much better than the airline crate. To my amazement, he's being pretty quiet. I gave him a Composure last night and it seemed to make him sleep through most of the evening; I didn't expect it to quite do that and I began wondering how he was feeling in general. This morning I noticed for the first time, some rhythmic pain contractions of his body and back; you know, when they kind of squeeze themselves then release, squeeze and release, so I immediately gave him his 25 mg Tramadol. Again, this is the first I've seen of this pain response. He had a lot of activity yesterday, with the 2 vet appointments, etc. I'm watching him closely. I'm fortunate in that I can work from home a couple of days per week thank goodness.
He took his Metacam and Pepcid well last night.
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Post by Debbie Blackwelder on Mar 24, 2015 9:23:07 GMT -7
Nancy, if Mo is experiencing muscle spasms and that sounds like what you are describing then he may need a prescription called Methcarbamol. Methcarbamol treats muscle spasms stemming from aggravated muscles due to nerve trauma related to the spinal cord inflammation. Did the Tramadol fully control the pain this morning? Yesterday very likely put a stress on him since he is recovering from IVDD. Call your vet and tell him about the spasms and discuss the Methcarbamol. It might be the case he just needs it for a few days to get over his trip.
Mo is very fortunate to have someone who loves and cares for him and did I mention, he is a beautiful boy!
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Post by Nancy & Maisy on Mar 24, 2015 10:24:04 GMT -7
Thanks, I'll discuss with the vet. Mo's sleeping now and seems comfortable. It does seem like the Tramadol really puts him to sleep. I hope this is normal. He's 22 lbs and getting 25 mg.
Thank you, that avatar pic is actually Faith, my last doxie love. She recovered well from an IVDD episode and I lost her a while later to renal failure. I'll post a pic of Mowgli soon.
I'm trying to decide whether he would be safer and better off in his airline crate when I leave the house. He's very comfy in his suite, but has more room to move, could decided to jump up, etc., when the mailman comes by and I wouldn't be here to supervise. I think I'll move him to his airline crate when I need to go out. I'll worry a lot less.
4 hours later update:
I talked with Dr. Hicks, told him what I saw this morning and asked about the Methocarb. He suggested I stick with the pain meds and see if it controls the pain, which it is. I have a script for Gabapentin if it's needed to help control it at any point. He said to see if he feels better after a couple of days of pain meds and then try to scale back if possible.
The Tramadol is making Mo really sleepy and I asked about that. He said it's okay short term.
Bldwk came back today as all normal, no low thyroid. The only raised value was Lipase. This was fasting bldwk, so I asked about cutting out fat from his diet and the vet agreed that was a good idea. He has eaten lots of beef in the past, but recently it has been poultry, so that's a step in the righ direction. He loves cheese and while he doesn't get a lot of it, I think we'll cut that out for the time being and stick with carrots, apples and green beans (all of which he loves). We have cut his food servings by 25% at the vet's request while he's on rest. I give more veggies with meals to make up for the amount of meat and kibble cut.
I started him on Vetri Disc supplement last night. So, our current meds schedule is:
(B'fast at 8:30, lunch at noon, dinner at 5:00).
AM: Tramadol 25 mg
Pepcid 5 mg
both right after breakfast
Noon: Vetri Disc supplement, 2 caps with lunch
Composure sometime in the early afternoon
PM: Tramadol 25 mg
Pepcid 5 mg
Both with dinner
Metacam 15 mins after dinner while food is still in his tummy
He has been waking each morning at 5:30 to go out and poop. I'll assess each morning and give a little food with Tramadol at that time if I observe signs of pain.
Tonight we set up a 2nd recovery suite in the bedroom for a more comfortable night's rest.
4 hours later update:
As you can see in his picture, he's resting comfortably. He's being so cooperative and good.
Questions:
Dr. Hicks prescribed Pepcid 5 mg. once/day. I read on the site here that the dogs get it twice/day. I'm going with twice/day unless one of you recommends otherwise.
Do any of you know of any interactions with the meds he's on (Tram, Metacam, Pepcid)or more than interactions really, is it best to give any of them separately (spaced out over time)?
I just want to be sure. My guess is that one of you would have said something when you read our meds schedule if you saw a problem.
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Post by Pauliana on Mar 24, 2015 20:21:02 GMT -7
Hi Nancy,
Glad Mowgli is resting comfortably on the light dose of Tramadol.. That's the dose my 13 pound dog gets 3 times a day during his disc episodes, but if Mowgli is pain free then it's working for him..If he has breakthrough pain between doses let his Vet know. Keep watch to make sure the spasms don't start again and if they do I would advocate for a muscle relaxer, Methocarbamol. It is commonly used in disc episodes when they involve muscle spasms. Gabapentin is for nerve pain or hard to control pain, it isn't for muscle spasms. I have muscle spasms frequently and I take Gabapentin, so this I know to be true from personal experience. I have to take a muscle relaxer for the muscle spasms.
Pepcid AC should be given 30 minutes prior to Metacam and again 12 hours later. Great you are giving Metacam after a meal.
There are no interactions between, Tramadol, Metacam or Pepcid AC Or Gabapentin.
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Post by Nancy & Maisy on Mar 24, 2015 23:15:32 GMT -7
Thanks for responding, Pauliana. I'll be sure to give the Metacam a full half hour after his Pepcid tomorrow and will give a dose early tomorrow morning. If he's having any pain in the morning, I'll up his Tram to three times per day. I so appreciate your help and all of the info here on the site.
I keep reading each day, have the flyer on the fridge and the meds card in my pocket. I made a meds schedule and put it on the fridge as well.
Mo is really zonked on the Tramadol. It puts him to sleep for 2 hours or so each time. Is this ok? It makes me wonder. |
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Post by Debbie Blackwelder on Mar 25, 2015 5:42:26 GMT -7
Nancy, you are such a good Doxie mom. Keep reading and learning, the more knowledge you have about IVDD makes you prepared when IVDD strikes at any time. Sleep and rest are really good for Mo right now. The least amount of moving he can do is critical in the healing process. He will be ok. Individuals have different reactions when taking pain meds, some sleep while others are wound up. I would say the same goes for dogs also.
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Post by Nancy & Maisy on Mar 25, 2015 9:08:53 GMT -7
Dilemma: I know that acupuncture is helpful for pain and nerve damage, however my concern is the travel, the moving, lifting, etc., that all come along with the trip to my holistic vet to have it done. My experience so far with vets is that they aren't overly careful with the back, as evidenced by their slippery floors and tables and their handling. I don't think they get it. I've seen deterioration in Mo's condition from his 2 vet appointments earlier this week. It makes me want to keep him home, crated and safe. I have a very low powered, vet recommended hand held laser that I can use with him at home (Laseronix laser). For future vet appointments, I'm planning to take a non skid surface (bath mat, shelf liner rubber) to place on the table for him so he's not sliding around. Thoughts? Debbie, thank you. It's reassuring to know that the sleepiness is okay. And thank you for your kind words!  |
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Post by Debbie Blackwelder on Mar 25, 2015 9:54:22 GMT -7
Nancy, you are so correct about a lot of those things. It would be a great idea to carry something for him to stand on while out of the crate. My surgeon had carpet tables for the dogs to stand on when he did the Neuro exams for my dogs.
The travel is a concern for me also because I have seen first hand what can happen when cage rest is not enforced. This is what my surgeon told me once. He said, "If your dog is walking then I will not attempt surgery, it's just to dangerous, take him home and put him in the crate and give him his meds and as long as his functions don't get worse then do not let him out, other than to pee because every time you move him you are possibly making the problem disc tear worse." I did not even have the option in my home town for laser or acupuncture so once my dogs are in the crate that's where they stay. I have had three surgeries but that was before I knew the warning signs to crate and let them go until surgery was required. To my knowledge Mo is not paralyzed and is doing good, if you feel like he is doing good then don't get him out unless you have to, but I would discuss this with your vet and make sure he is satisfied with Mo's care plan. Hope this helps.
I will let one of the other moderators comment on the hand held laser, I am not sure about that.
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Post by Nancy & Maisy on Mar 26, 2015 0:08:15 GMT -7
I started Mo on Gabapentin today along with his Tram. I wasn't satisfied that his pain was under control with just the Tramadol. I called the vet first to make sure it was okay to give them together. He didn't sleep any longer on the two meds than he did on just the Tramadol. He seems to feel much better and now wants to play. Oh, well. lol
I'm working on perfecting my lifting skills and watched the video 10 times in a row this morning. He still groans sometimes when I pick him up and my guess is that this means his pain still isn't quite well controlled enough. Would you recommend that I call the vet and explain and ask if we can up the dosage? He's getting
Tram 25 mg and Gabapentin 100 mg 3x/day. Or, seeing as how he's only had the combination once so far, maybe I should give the two together a couple more times and see if that gets it under control and call the vet then if he's still showing any signs of pain. Or should it get it the first time?
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Mar 26, 2015 6:42:43 GMT -7
Pain should be completely under control within one hour after giving the pain meds and should remain completely under control from one dose to the next. The vet has room to move up on the dosage of the Tramadol. We've seen dogs of Mowgli's weight getting 50 mgs 3x/day.
Also you had mentioned seeing muscle spasms. Methocarbamol deals with that kind of pain and can be given along with the Tramadol and Gabapentin.
Please speak to your vet ASAP to let him know about the groaning when being picked up so Mowgli's pain meds can be adjusted this morning. Please let us know what the vet says after speaking to him.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,556
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Post by PaulaM on Mar 26, 2015 9:07:05 GMT -7
Nancy, do verify the med list. The gabapentin seems high.
22lbs dog
Metacam as of 3/21, 20 lb. dog dosage 1x/day for 1 week
Pepcid AC 5 mgs 2x/day
Tramadol 25 mg 2-3x/day Which are you now actually giving Tramadol... 3x/day?
Gabapentin: 100 mg 3x/day. You are giving a 100mg capsule every 8 hours---300mgs daily in total?
When pain meds are correct, the pain is in control in one hour and it stays that way dose to dose of Tramadol/Gabapentin. If it is not, then the vet needs to know this information to further adjust meds.
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Post by Nancy & Maisy on Mar 26, 2015 10:14:20 GMT -7
Thanks. I'll email him right now. What would be a more common dose of Gabapentin for a 22 lb dog?
Haven't heard back from vet yet, but looking online, I find that gabapentin dosage for dogs is 11-22 mg/lb of body weight to be given twice daily. 11x22=242 mg, so 100 doesn't appear to be high. Am I missing something?
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Post by Debbie Blackwelder on Mar 26, 2015 14:13:23 GMT -7
Nancy, here is the recommended dose for Gabapentin from KuKanich B Vet Clin North Am Small Anim Pract:
Gabapentin Dose recommended (empiric) for gabapentin: 10–20 mg/kg every 8 hours Outpatient oral analgesics in dogs and cats beyond nonsteroidal antiinflammatory drugs: An evidence-based approach. KuKanich B. Vet Clin North Am Small Anim Pract 43(5):1109-1125, 2013.
Gabpentin has a short half life and often needs to be Rx'd 3x/day.
Here are the links from the Dodgerslist web-page for you to look up Gabapentin:
www.wedgewoodpharmacy.com/monographs/gabapentin.asp
marvistavet.com/html/gabapentin.html
www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2764
www.drsfostersmith.com/Rx_Info_Sheets/rx_gabapentin.pdf
www.drugs.com/pro/gabapentin.html
I am not a vet so I can not help you much in this area of calculating medication, but we see what vets prescribe to other dogs similar to yours, and we see 100 mg prescribed 2 times a day a lot, however I did see another 100 mg 3 times a day on a 19 lb dog. (dodgerslist.boards.net/thread/2671/debbies-roxy-relapse-conservative-beagle). The correct amount to administer can depend on several factors including your dog’s breed and medical history.” So keeping this in mind always follow your vet's instructions, he sees Mo and has his hands on him so ultimately it is his decision.
Now keep in mind I do not know much about diagnosing medicine and I am not a vet but I think it is figured something similar to this, Mo weighs 22 lbs, so:
(22 lbs is equal to 9.98 kg and 9.98 kg x 10 mg's every 8 hours = 99.8 mg's)
So that would mean 100 mg every 8 hours is a starting dose. Please don't quote me - I'm not a vet. We have to trust that your vet knows Mo and is making the right decision for him. Our main mission here is to try to make sure Mo is not under medicated or over medicated based on others we see come through the forum. Your vet ultimately makes the final call on all medications.
I just saw Pauli logged in, she has experience with Gabapentin dosages, she gives it to her dog. |
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Post by Pauliana on Mar 26, 2015 15:23:22 GMT -7
Nancy,
My dog Tyler is 13 pounds and he gets 40mg Gabapentin 3 times a day.. I would follow what is on the prescription bottle and if it isn't clear discuss it with your Vet.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,556
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Post by PaulaM on Mar 26, 2015 18:30:52 GMT -7
Nancy, we learn a lot by watching how vets handle pain issues. Sorry to cause any upset to the apple cart about the Gabapentin. My 17lbs dog used 33mgs 3xday along with a higher dose of Tramaodol. If the current doses of Gabapentin and Tramadol are keeping pain at bay then they are the right doses for Mowlgi.
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Post by Nancy & Maisy on Mar 26, 2015 19:23:51 GMT -7
Thanks. I didn't hear back from Dr. Hicks today but it sounds like the 100 mg 3x/day is fine. Mo isn't lethargic at this dosage. He sleeps a couple of hours, like when he was just getting the Tram and then wakes up and is alert. I'm sure the vet will answer me as soon as he's back in the office. He must have had the day off. He's usually very responsive.
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Post by Nancy & Maisy on Mar 29, 2015 14:11:45 GMT -7
Well, we have survived week one!
When I didn't hear back from Dr. Hicks on Friday, I called the vet hospital yesterday a.m. and got the ok to up Mo's Tramadol. I am giving him an additional 12.5 mgs - [Tramadol 37.5 mgs] 3x/day and his pain seems to be in control; no more grunting when he's picked up or growling when we take off his harness. It's interesting that the 25 mgs wasn't putting him to sleep anymore. Now, with 37.5 mgs he is sleeping again for a couple of hours after getting his pain meds. This is helpful because he was getting pretty cabin fevery on Friday. It's hard for a 3 year old to be crate bound!
I have a question: we finish our 1 week course of Metacam tonight or tomorrow night. Once we're done, do I start tapering the pain meds and see how he does? Or do I continue the pain meds for another week or so and then start tapering? What would you all suggest? My concern is that if I continue the pain meds and the swelling isn't under control, how will I know that and be able to ask the vet for more Metacam? Does Metacam continue to reduce swelling for any length of time after it's discontinued, or can the swelling come back when it is stopped? Worried about this.
I read that the Gabapentin can cause seizures if stopped abruptly. What is the best way to taper it down? I will ask the vet of course, but am interested in your knowledge and experience as well.
Thank you!
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I realize that we're lucky to have a normal neurological situation; just so worried now that the vet has said it's somewhat likely the disc will go ahead and rupture. 
