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Post by Judy & Bunny on Nov 24, 2016 9:40:53 GMT -7
Hello all and thanks for this great site.
I have a miniature five year old Dachshund named Bunny in considerable pain. I'm doing my best to keep it under control until she can be seen by a specialist next week.
Her pain seems to be focused predominately in the neck area. To give a better picture of things, here's a bit more info:
**First noticed issues Monday night more than a week ago. She seemed to be in distress and when I picked her up, I noticed her neck was "jumping." This was underneath close to her chest. Had her to the vet at noon on Tuesday. Saw my regular vet's associate - very young - first year practicing : ((
She manipulated her head around with no resistance from Bunny, said it looked like she'd had a neck injury of some sort, gave her a laser treatment,
Bunny's weight?
prednisone tabs as of 11/14: ?mgs ?x/day for X days? and
liquid Gabapentin. ?mgs of Gabapentin in 1mL? ?mL dose ?x/day
Tramadol ?mgs ?x/day
Valium ?mgs ?x/day
She progressively worsened. I found your site and recognized many symptoms so began restricting her movements and asked for a referral to a neuro. Vet said without paralysis, she wouldn't be a surgical candidate but I just wanted more informed overall treatment and pain management. My regular vet returned and wanted to see her. I brought her in and after feeling , moving and palpating everything, her opinion was that Bunny's distress wasn't related to the spine but something else. She did X-rays and blood work but could find nothing... even told me to take her home and treat her as usual. She is dead wrong!
Bunny is trembling and shaking, ears straight back, neck spasming, back hunched and is capable of walking but will not when the pain is at its worst. I demanded better pain management and am giving her Tramadol and Valium along with the Gabapentin, but there are still windows where it's horrible. I expect to see a specialist next week but need to keep her as comfortable as possible in the meantime, so any advice would be appreciated. She's now refusing her meds so I've got to force them on her. Very traumatic for both of us.
I suspect she was not prescribed as much as would be optimal for her pain also.
Thanks, Judy
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Nov 24, 2016 10:20:14 GMT -7
Judy, welcome to Dodgerslist. You have an emergency today to get to ER and get the pain meds properly adjusted. There is no reason for pain when there are options to adjust meds to keep pain from surfacing nearing the next doses. Please tell us all the detail of dose in mgs and how often you are actually dosing. Has there be a drop, a taper of prednisone since the orgianl dose/frequency as of 11/14? Bunny's weight? prednisone tabs as of 11/14: ?mgs ?x/day for X days? and liquid Gabapentin. ?mgs of Gabapentin in 1mL? ?mL dose ?x/day Tramadol ?mgs ?x/day Valium ?mgs ?x/day -- All pain meds with the typically very pain ful neck disc episode require a vet to Rx for 3x/day. --With pain Prednisone should not be tapered yet, but stay up on the level called the "anti-inflammatory" dose. Taper days do not help resolved swelling. -- Important information to have under your belt so you can strongly advocate for meds being adjusted today: 1. Pain meds www.dodgerslist.com/literature/healingpain.htm2. Prednisone with IVDD www.dodgerslist.com/literature/healingsweling.htmPEPCID AC to protect against prednisone. Stress, change in routines and prednisone all cause extra stoamch acids. Pepcid AC suppresses the extra stomach acids that anti-inflammatory drugs cause. So we follow the vets who are proactive in preventing nausea, vomit, diarrhea, blood stool, bleeding ulcers from progressing to life threatening perforated stomach lining. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours and giving the anti-inflammatory with a meal for added protection. Get Pepcid AC at the grocery store but FIRST do ask your vet in this particular way: Is there any health reason (heart, liver, or kidney) my dog may not take Pepcid AC (famotidine)? Know all about your pet's meds, reading IS important: www.1800petmeds.com/Famotidine-prod11171.html and marvistavet.com/famotidine.pml CRATE REST. Let us know you are on the same page about crate rest. The hallmark component of conservative treatment is the crate rest part. With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. That 6 weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.
These are the extras you can do at home to help with a neck disc: www.dodgerslist.com/literature/cervical.htm
Super tried and true tips for setting up the recovery suite: www.dodgerslist.com/literature/CrateRRP.htm PLUS further guidance on conservative treatment on our "All Things IVDD page: www.dodgerslist.com/literature.htmSTRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times. Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! www.dodgerslist.com/literature/slingwalk.jpg |
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Post by Judy & Bunny on Nov 24, 2016 20:21:06 GMT -7
Thanks for the feedback, Paula! Bunny weighs 15 lbs. Here's how her meds have been prescribed:
11/15/16 - Prednisone 5mg - 1/2 tablet every 12 hours for 5 days, then 1/2 tablet every 24 hours. When the senior Vet examined her on 11/22/16, she told me to discontinue this, along with her pain meds. I disobeyed on the pain meds but did not on this one. Her first day off this med was 11/23/16.
11/15/16 - Gabapentin susp (liquid) - 25 mg/ml - Give 1.4 ml every 12 hours
11/18/16 - Bunny had deteriorated since first vet visit and was having too many painful episodes. I asked for more pain meds and for a muscle relaxer in particular. I'd requested this state first visit due to the visible spasms in her neck but was told they didn't want to sedate her too much. They added in
Tramadol - 50mg. - 1/2 tablet every 8 -12 hours (I go with 8 on this one.)
Valium - 2 mg. - 1 tablet every 12 hours (I also give this one a little earlier if needed).
I'm hoping to have an appt. with Bay Area Specialist early next week and just want to keep her as pain free as possible.
[15 lbs
Prednisone as of 11/15 2.5 mgs 2x/day for 5 days
Gabapentin 25mgs/mL: 31.25 mgs 2x/day
Tramadol 25mgs 3x/day
Valium 2mgs 2x/day]
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Post by Pauliana on Nov 24, 2016 22:49:54 GMT -7
Hi Judy, Bunny is under medicated for pain for a 15 lb dog. She needs to be seen ASAP by a board certified Neurologist. This should not wait. It's not only torture for Bunny but the pain is slowing down her healing. They see many cases of IVDD daily and know that neck disc episodes require more aggressive pain management. Here is some info on how to find the right Vet to treat Bunny and it has a search engine to find one in your area: dodgerslist.com/literature/VetchkList.htmThe Prednisone was stopped too soon. There is nothing working on the swelling. Pain means swelling is ongoing and pressing on the nerves of the spine. When the swelling is gone the pain will be gone.. The dose we see normally with Prednisone is 5mg every 12 hours. With Prednisone there must be a taper for health reasons. Usually the first course of Prednisone at the anti-inflammatory level will be 5 or 7 days and then a taper. To have a clear picture on a steroid taper, pain meds are also stopped or backed off too. The steroid dose is lowered to less than the anti-inflammatory dose. The owner's job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. Immediate feedback to the vet about any pain is necessary. Often a "plan B" with your vet is decided on so that if the pain happens at night, weekends or holidays when the vet is not open, the owner knows what action to take, what meds to give til the vet can be contacted again. A "plan B" can save an expensive ER trip. I feel for you having such problems with Bunny's current Vet.. She is not experienced enough with IVDD. Most DVMs in a general practice see many different species- hampsters, cats, all breeds of dogs, reptiles, birds, maybe even farm animals. They practice many specialties in the course of a day: pediatrics, dentistry, surgery, internal medicine. Is it surprising, that keeping current and in depth knowledge of each and every disease for every species is probably not likely? However YOU can easily become a mini-expert on one very-important-to-you disease. dodgerslist.com/literature.htmHealing thoughts and prayers! |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Nov 25, 2016 9:51:04 GMT -7
Judy, I agree with Pauliana, the meds are not right and need adjustment today not waiting next week. Do what you can do either strongly advocate with the young vet or get in with another vet at same practice or go to another practice, ER to get help from pain today. PREDNISONE Prednisone as of 11/15: 2.5 mgs 2x/day for 5 days Advocate for another 5 day or longer course. Taper days do not count towards the 7-30 days (5mgs 2x/day) as per Dr. Reuben and what we see vets who know IVDD also use: PAIN MEDS If not given at the appropriate dose per weight of dog AND 3x/day, not likely to control pain 1. Gabapentin 25mgs/mL: 31.25 mgs 2x/day Advocate to be used 3x/day 2. Tramadol 25mgs 3x/day Way under medicated in dose level. The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours. Look for the Rx to be: Tramadol at 50mgs 3x/day 3. Valium 2mgs 2x/day Valium may not work the same in dogs. Most vets we observe on this Forum are using methocarbamol for muscle spasm pain. Advocate for Methocarbamol 125mgs 3x/day PEPCID AC to suppress stomach acids Stress of enduring all this unnecessary pain for so long, change in routines and any anti-inflammatory all cause extra stoamch acids. Pepcid AC suppresses the extra stomach acids that stress and anti-inflammatory drugs cause. So we follow the vets who are proactive in preventing nausea, vomit, diarrhea, blood stool, bleeding ulcers from progressing to life threatening perforated stomach lining. The usual dose of Pepcid AC (famotidine) with a disc episode is 5mgs 2x/day for doxies (0.44mg mg per pound every 12 hours) and giving the anti-inflammatory with a meal for added protection. Get Pepcid AC at the grocery store but FIRST do ask your vet in this particular way: Is there any health reason (heart, liver, or kidney) my dog may not take Pepcid AC (famotidine)? Know all about your pet's meds, reading IS important: www.1800petmeds.com/Famotidine-prod11171.html and marvistavet.com/famotidine.pml |
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Post by Judy & Bunny on Nov 26, 2016 11:07:29 GMT -7
Paulina & Paula - I have been asking for referral to a specialist since my first visit. I wanted to be in line for an appointment should it be needed. Thanksgiving didn't help much! My vet has already been corresponding with a specialist and we will be seen there next week. Bunny was given a steroid injection yesterday morning by my regular vet and she hoped to see a big difference by early afternoon. We didn't, but she was significantly better by early evening. The vet also increased the Gabapentin to 3x and said I could increase the Tramadol to a full tab. I'm not sure at this point what needs to be done with the steroids. Another injection? Restart the oral meds? Will the injectable steroids necessitate the need for stomach protection? I asked the vet yesterday before she administered the injection and she said she'd be okay for that one. Thanks again - so much! Judy
[15 lbs
Prednisone as of 11/15 2.5 mgs 2x/day for 5 days
Dexmethasone injection on 11/25 and 11/28
Gabapentin 25mgs/mL: 31.25 mgs ▲3x/day
Tramadol ▲50mgs 3x/day
Valium 2mgs 2x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Nov 26, 2016 11:55:51 GMT -7
Judy what was the exact name of the steroid injection on 11/25?
Now with gabapentin 31mgs 3x/day and tramadol 50 mgs 3x/day being given at an aggressive dose and 3x/day, let us know if pain is being fully controlled dose to dose or when Bunny has to move to reposition herself in the crate, go potty, etc.
What did the regular vet say about changing to methocarbamol?
Steroids are hormones. No matter how they enter the body they circulate the body and it is necessary to be proactive to protect the GI tract with Pepcid AC 5mgs 2x/day. That is why we explain to ask the question in this very particular way. Does my dog have any health issue to keep him from using Pepcid AC? There are some vets who just are not appreciative of all the things that stress out an animal (change in routine, pain) which can increase stomach acids AND then you add a med that increases more stomach acids like a steroid, very likley setting the dog up for GI tract problems.
The injection is a fast way to get the steroid up to level and working. Steroid injections are followed up with usually oral prednisone to complete a 5, 7 or longer day steroid course. Injections require the risk of transport to a vet. No pred tablets were prescribed by the regular vet to follow up the injection? Call the vet and ask for pred tablets to complete the number of days for a steroid course.... you don't want Bunny to further suffer over the weekend or have to pay big bucks to an ER vet for help because inflammation resurfaced over the weekend.
Please do give us the details of what "was signficantly better" means.
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Post by Judy & Bunny on Nov 28, 2016 20:42:11 GMT -7
Paula - The injection was Dexamethasone. It was administered Friday, 11/25 about 10:30 a.m. Vet said I should expect to see a difference by 1:00 pm if Bunny's condition involved the spine. I didn't see a noticeable improvement until closer to 6:00 pm. She went from being extremely stationery to trying to venture off her blanket and climb in my lap and reach up to my daughter's face for kisses. She was much less tense, ears relaxed rather than laid straight back and tried to walk more steps when going to potty. Unfortunately, the vet didn't follow up with a continued course of oral steroids until I asked about it. She had another injection of the same at 12:30 this afternoon. Again, there was a noticeable difference by 6:00 pm with the same type of behaviors.
The Gabapentin has been increased to 3x daily, Tramadol to 50 mg 3x daily and I have 1/2 a Valium left for bedtime tonight. I also added in half a tab (5mg) of Famotidine. Vet recommended this once daily and also agreed to the Methocarbamol at 1/4 tab 2-3 times a day. Since Bunny will finally see Dr. Banwell at Bay Area Veterinary Specialists in the morning, I'm holding off to see what regimen he prescribes. I'm really looking forward to having her in more expert hands and hope he sees her as a good candidate to continue the conservative course.
[15 lbs
Prednisone as of 11/15: 2.5 mgs 2x/day for 5 days
Dexmethasone injection on 11/25 and 11/28
Gabapentin 25mgs/mL: 31.25 mgs ▲3x/day
Tramadol ▲50mgs 3x/day
Valium 2mgs 2x/day] last 1/2 tablet 11/28
Methocarbamol at 1/4 tab 2-3 times a day
half a tab (5mg) of Famotidine 1x/day]
Thanks again for the great advice and if there's anything you could suggest for our visit tomorrow, I'm eager to hear it!
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Post by Pauliana on Nov 28, 2016 22:50:47 GMT -7
Hi Judy, Very glad to hear that Bunny is beginning to feel better with her medications having been adjusted. But all that progress can be undone in a minute if she is not on crate rest. I know it is hard to wrap your head around confining Bunny but it is the one gift you can give her so she can heal her disc. I had the same feelings when my Tyler was diagnosed.. our dear one who is in the middle of all we do.. but I soon found out that was the best thing for him and we had a crate or recovery suite in every room we spent time in so he would always be with us. He didn't mind, he loved his crates. In fact when he has a disc episode he is the one who goes into his crate all by himself. It's his safe place and healing place. The best tool for healing short of when surgery is indicated is – Crate rest— 100% STRICT crate rest for 8 weeks. That means 24/7 in the crate except for potty breaks. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no Chiro, no VOM. The rest of the details of doing crate rest: www.dodgerslist.com/literature/cratesupplies.htmwww.dodgerslist.com/literature/CrateRRP.htmOne reason some vets may be reluctant to give a full prescription of time is knowing many owners will not follow through. Perhaps not fully understanding the reason for it, is why people tend not to do it. Observation of 1000’s of Dodger dogs over years, has shown a conservative approach to crate-rest time, results in fewer relapses. Dodgers prefers the safer, more conservative recommendations of neuros and other vets using 6 or 8 weeks for crate rest. • Don’t Administer or prescribe analgesics or steroids without assuring that the owner understands and is committed to adequate confinement of the dog .Also discuss that when the dog starts to feel better, he still needs to be confined to prevent further extrusion of the disk and sudden relapse with potential for profound worsening of neurologic status. sturgisvet.com/smallanimalclinic/managingdiskdisease.htmlGreat that Bunny's appt with Dr Banwell is tomorrow morning.. If you don't plan on surgery be up front with him that you need help with medications for conservative treatment. Let him know all the medications and dosages and ask for his advise on what he recommends.. Please let us know how it goes! |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Nov 29, 2016 8:35:51 GMT -7
Please let us know which you are actually giving when a range has been Rx'd. Also any changes to the med list, like getting another course of Pred tablets BUT up at the anti-inflammatory dose (5mgs 2x/day) not the taper dose of 2.5mgs. Pred pills avoid the risky business of transporting to the vet. Anytime out of the recovery suite is a danger to the healing disc. When a transport is for a very good reason that can't be attended to with a phone conversation with the vet, then pad out the crate with a rolled up blanket or towel, os Bunny doesn't shift when you corner or come to a stop. Things like adjusting meds is something that you can report signs of pain to let the vet know the meds are not get right and you can pick up the Rx and fill at your local pharmacy if the vet's in-house pharmacy does not have.
15 lbs
Prednisone as of 11/15: 2.5 mgs 2x/day for 5 days
Dexmethasone injection on 11/25 and 11/28
Gabapentin 25mgs/mL: 31.25 mgs ▲3x/day
Tramadol ▲50mgs 3x/day
Methocarbamol at 1/4 tab 2-3 times a day Are you promptly giving 125mgs (1/4 tab) 3x/day?
half a tab (5mg) of Famotidine 1x/day Are you giving a 5mgs dose 2x/day not 1x/day?
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