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Post by Jenny & Jack on Apr 11, 2017 9:10:13 GMT -7
He received surgery for a ruptured disk on Friday (4/7/17). They found a bruised nerve too. He left the hospital with a Fentanyl patch, a dosage for Gabapentin as well as a dosage for Tramadol. He slept well for the first two days but is having some trouble now. He's pacing and whining and yelping [with upped dose for tramadol] when touched. He can't rest for more than 40 minutes. It's heartbreaking.
I keep reminding myself that he had major surgery and that pain and discomfort is normal. We called the Vet and they up'd his dosage of ▲Tramadol and want him to come in for another Fentanyl patch (which expired today). The new Tramadol dosage seems to be helping him rest. They also gave him Trazadone to help with his anxiety from being separated from my husband while he is at work (that is a whole 'nother post for a whole 'nother thread).
Is this normal for surgery? Is it normal for him to feel higher pain when his Fentanyl wears off? Is it ok to pump him this full of meds?
My husband and I are so worried.
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Post by Romy & Frankie on Apr 11, 2017 12:58:58 GMT -7
Hi, welcome to Dodgerslist. Everyone here has a dog with IVDD so you have come to the right place. I am sorry that Jack had a disk episode. Once the fentanyl wears off then the tramadol and gabapentin are what will control the pain. If these meds are not dosed high enough or frequently enough then the dog will be in pain. Would you please tell us the exact names of meds currently given, their doses in mg’s and times per day given? What was the start dose if on a steroid, date of taper? Please include the all important stomach protector such as Pepcid AC. Phrase the question to your vet this particular way:" Is there a medical/health reason for my dog not take Pepcid?" If there is no reason, we follow vets who are proactive against not eating, vomit, diarrhea, bleeding ulcers by giving doxie weight dogs 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory. What breed is Jack? How much does Jack weigh? When the pain meds are correct, Jack will have relief from pain in one hour and there should be no pain between doses. It is okay to give him the meds that will relieve his pain. He will only be on them for a brief period and the priority should be pain relief. Pain will only slow the healing process. His surgery was very recent and he may be suffering pain from the incision. Are you now doing 100% STRICT crate rest 24/7 only out to potty and the surgeon directed PT? …. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No chiro (aka VOM). What did your surgeon direct for PT and for post-op crate rest? See if there are any other things you can do to make post-op crate rest go smoother with these very useful tips and ideas: www.dodgerslist.com/literature/CrateRRP.htm and www.dodgerslist.com/literature/cratesupplies.htmIs the new tramadol dose relieving his pain? Are you seeing any of these signs of pain; 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, can't find a comfortable position. Arched back. Holding front or back leg flamingo style not wanting to bear weight, head held high or nose to the ground. Currently can Jack wobbly walk? move the legs at all? or wag the tail when you do some happy talk? Can Jack specifically sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up? Is he Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood? A lot of our IVDD dogs are anxious and trazadone can work well for this. Here is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT. www.dodgerslist.com/literature/surgery.htm#medsWhat is you name? I am Romy. It is very scary when our dogs have IVDD. It becomes less so when we learn all we can about the disease. An excellent page to start with is "Overview: the essentials" and then read all you can as soon as possible. Here's the link: www.dodgerslist.com/healingindex.htmHealing thoughts for Jack
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Post by Jenny & Jack on Apr 11, 2017 13:17:46 GMT -7
25 mg ▲Tramadol - up'd to 37.5 mg last night 100 mg ▲Gabapentin - up'd to 200 mg last night Fentanyl patch (expired today)
[15 lbs Tramadol ▲37.5mgs every 7 hours Gabapentin ▲200mgs every 7 hours]
We've been giving him the TRAM and GABA every 7 hours or so.
He is a 15lb Westie.
He is not in a crate.. the Vet only ordered a small room (6x6). He was scooting on the first/second day to relieve his bowels. He is also pacing and unable to sit down, but moving very gingerly. We bought a crate today and will go forward with crate rest.
[New tramadol dose] It is not completely relieving his pain. We are seeing the following symptoms: yelping when picked up or moved can't find a comfortable position Holding front or back leg flamingo style
He is walking with only a slight wobble. No tail wagging. Tail is tucked... always.
He is urinating normally.
Everything is normal.
My husband just called to report that the higher dosages of medications are sedating Jack and allowing him to rest. I am still very concerned about his pain level and the fact that he is yelping when being lifted.
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Post by Romy & Frankie on Apr 11, 2017 14:02:59 GMT -7
I am glad that Jack is now resting . The fact that Jack is yelping when picked up shows he is still in pain. Sometimes it takes three medications working together to fully relieve pain. This is the combination we most frequently see for good pain control; Methocarbamol for painful muscle contractions; Tramadol Rx'd 3x/day as the general pain releiver;Gabapentin for nerve pain also Rx'd 3x/day. The dose of tramadol is on the low side for a 15 pound dog. Veterinary pharmacologist Bruce KuKanich, DVM, PhD, DACVCP: "Tramadol is rapidly eliminated from dogs after oral administration. Recent studies are suggestive the bioavailability of tramadol in dogs is lower than originally determined and the dose of tramadol needs to be increased with dosages from 5 - 10 mg/kg PO q 8-12 hours in dogs to maintain similar plasma drug concentrations as those in humans." New developments in opioids: old drugs and some future directions (Proceedings)" DVM360. Nov 01, 2009 By Butch KuKanich, DVM, PhD, DACVCP veterinarycalendar.dvm360.com/new-developments-opioids-old-drugs-and-some-future-directions-proceedingsJack's 15 lbs converts to 6.8kg. If the pain meds have been correctly Rx'd Jack's pain would be in control in one hour and remain that way dose to dose. We are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet. Please let your vet know that Jack is still in pain and ask about the dosages. I am glad that you have gotten a crate. Post-op crate rest is important. It is important not to overdo things while all the surgical sites are healing. Dr. Isaacs , ACVIM (Neurology) mentions "The soft tissue dissection associated with surgery typically takes 4-6 weeks to mend." You can read the rest of the answer about post-op Crate Rest here: www.dodgerslist.com/literature/surgery.htm#restPT It is very scary when our dogs have IVDD. It becomes less so when we learn all we can about the disease. An excellent page to start with is "Overview: the essentials" and then read all you can as soon as possible. Here's the link: www.dodgerslist.com/healingindex.htm
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Post by Jenny & Jack on Apr 11, 2017 14:13:26 GMT -7
In other words, this can be a normal part of the recovery process? I was/am very concerned that he'd ruptured another disk.
I have no problem advocating for a higher dosage of Tramadol, although the double Gabapentin and 38.5mg of Tramadol seems to be working. If he starts experiencing more pain, I will call the Vet and ask about another increase.
Do you recommend another Fentanyl patch? That really seemed to help him.
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Post by Romy & Frankie on Apr 11, 2017 14:30:20 GMT -7
It is certainly possible that the surgeon did not get all the disk material out, which sometimes can be hidden, and this is the cause of the pain. There have been some dogs on this list that had to have a second surgery very close to the first. If you feel this is possible, please ask the surgeon as soon as you can.
Many dogs have post surgery pain. Jack's seems to be on the higher end of the scale. It is okay to use a Fentanyl patch if that is what Jack needs. Don't hesitate to treat his pain.
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Post by Jenny & Jack on Apr 11, 2017 14:40:22 GMT -7
Thank you so much. I really hope that we do not need a second surgery. The surgeon that treated him is well-respected and was very thorough. I hope that he shows some sign of progress over the next couple of days.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 11, 2017 17:24:43 GMT -7
Hi, my name is Paula, is yours Jen? Do not have any patience with pain at all. When the pain meds are correct, pain is gone at max of one hour and stays that way dose to does. So if you see pain, report it immediately. It can take about 2 weeks for the surgery caused swelling to subside, til then pain meds are required to be at the right level to give full comfort.
Please let us know how Jack is doing later tonight and in the morning ...does he have full pain relief.
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Post by Jenny & Jack on Apr 12, 2017 6:11:58 GMT -7
Jack loves his crate! We put his favorite blanket in it and a tiny pillow and he didn't want to get out.
He seems to be responding well to his new dosage of medication. The trazadone especially helps him to relax. He slept, in his crate, through the night. He seems to be very comfortable with the dosage and his new little home.
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PaulaM
Moderator. ![*](//storage.proboards.com/forum/images/stars/star_magenta.png) ![*](//storage.proboards.com/forum/images/stars/star_magenta.png)
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 12, 2017 8:12:25 GMT -7
Wonderful news that Jack is in comfort with the increase in meds and is accepting his recovery suite.
We are a small little friendly group...we just go by first names...what's yours?
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Post by Jenny & Jack on Apr 12, 2017 8:39:26 GMT -7
Jenny. ![:)](//storage.proboards.com/forum/images/smiley/smiley.png) This group is an absolute blessing. Thank you. You've offered me so much peace of mind.
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Post by Jenny & Jack on Apr 17, 2017 6:54:16 GMT -7
Update on Jack - He is doing MUCH better. We started to see a change on Friday and he just got better and better over the weekend.
Now he won't stop moving and we're having a hard time controlling his energy and keeping him calm! He wants to play and run and jump and it's frustrating!
He is having his staples removed on Monday, 4/24. Should we expect him to feel some pain after that? or will he feel even better?
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Post by Valerie & Macy on Apr 17, 2017 9:10:05 GMT -7
Hi Jenny-
My dog was up and ready to run free about 2 weeks after surgery, but def be careful. She was ordered to have 8 weeks of crate rest and although difficult, she did it for the most part. We did have to give her a mild sedative for a couple weeks, but she became used to the crate. We actually used a pen which was more comfortable for her. So glad to hear Jack took to the crate so easily!!! Macy had a bit of a relapse with pain 4 weeks after surgery due to over exerting herself. She had to go back on Prednisone, Tramadol, and Valium (used as a muscle relaxer) for about 2 weeks, but recovered just fine after that. These pups just don't realize they had major surgery and that it takes a while for everything to heal inside. Sounds like Jack is doing great and I know how difficult it must be to keep him calm! My parents have a Westie as well and he has always been a ball of energy.
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PaulaM
Moderator. ![*](//storage.proboards.com/forum/images/stars/star_magenta.png) ![*](//storage.proboards.com/forum/images/stars/star_magenta.png)
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 17, 2017 9:21:44 GMT -7
Jenny, for how many weeks does your surgeon want for crate rest plus his directed PT? What is your vet directing for PT now that Jack is so mobile. Sometimes the PT is the walk to and from the potty place. Removal of staples is something that Macy will not likley even notice. Tell us more about when you are having problems controlling his energy.... at pottyt time, while in his recovery suite. Details will help us to come up with some ideas for you. During crate rest Dr. Becker, DVM, explains the need for mental exercise since running around is not yet allowed. "During your dog's mandated rest time for recovery, her movements will be restricted, but her mind will still need stimulation. Teaching her tricks and games appropriate for her temporary physical restrictions will help relieve boredom." Do choose only the activities that can take place inside the recovery suite and do not more movement that what your surgeon has directed. Dr. Becker's "Help Keep Your Pup Happy When She's on Crate Rest" and Dr. Horwitz' video demoing mind stimulation activities on the Dodgerslist "Emergency Crate Training" page: www.dodgerslist.com/literature/EmergencyCrate%20Training.htm A harness and 6 foot leash will control speed and keep your dog from running off 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!
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Post by Jenny & Jack on Apr 17, 2017 11:59:12 GMT -7
For PT we were directed to start with very short leash walks and to take Jack further distances every week. i.e.. to the corner.. then halfway down the block and back... then around the block.. etc.
He never lost feeling in his legs and has been able to move this entire time and he is normally VERY energetic.. to go from having felt so bad to feeling better probably feels so good for him. He wants to chase birds and run in circles. I have to admit, it's nice to witness him back top normal. It's been such a long time and he suffered so badly. It's somewhat of a relief for his Mom and Dad.
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