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Post by Jean & Mimi on Apr 12, 2017 7:49:50 GMT -7
Hi Everyone,
Some of the moderators may remember me...my Mimi (mini daschund) had IVDD about 5 years ago. Well I noticed yesterday that she didn't seem herself and was shivering a bit (it was 80 degrees so she was not cold). Took her to the vet right away and vet (the one we love who treated her ivdd years ago) examined her and didn't see any pain on her spine. Mimi is still on one dose of Gabapentin a day for morning stiffness, so vet said to add in a nighttime dose to see what happens. She also said to watch her carefully as it could be the beginning of something.
This am she yelped once. I gave her the gabapentin and she was better, walking and wagging her tail - looking for treats. But, in the back of my mind, I still think something is off. Called vet, telling them possible ivdd. Will crate her as soon as I get home and begin conservative treatment.
The last time, she lost use of her leg and was on prednisone for a long time. I am hoping this time, she will not need the prednisone as long because we have caught it early. She is not acting in any way as weird as she was the first time...she continues to sleep in a dog circle and can roll on her back.
Fingers crossed we caught it early! Thanks to everyone here, I know what she needs:
- prednisone to reduce swelling - tramadol for pain - Pepcid for her tummy - crate rest
I'll keep you all updated 
[15 lbs
Rimadyl as of 4/12: 12.5 mgs 2x/day for 7 days
Gabapentin 40 mgs 2x/day
Pepcid AC 5 mgs 2x/day ]
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Post by Julie & Perry on Apr 12, 2017 8:19:00 GMT -7
Hi Jean. Good for you for catching this early. If you're suspicious of an IVDD episode go with your gut instinct. Best wishes for you and Mimi.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 12, 2017 8:59:06 GMT -7
Jean, so wonderful to see your avatar pop up this morning since we've not heard from you in a long time. But not so wonderful if this is another disc episode. I think you are being very prudent to act like this is a disc problem by crating. With early disc episodes and pain only, it can be a real challenge for a vet to diagnose.
Sounds like pain meds and pred are doing the job of providing full relief from pain.
When you get a chance do update us with the full details of the med list:
Mimi's weight?
Prednisone as of 4/12: ? mgs ?x/day for how many days, then taper
Tramadol ? mgs ?x/day
Gabapentin ? mgs 2x/day
Pepcid AC ? mgs ?x/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 Apr 12, 2017 9:07:51 GMT -7
Jean, so wonderful to see your avatar pop up this morning since we've not heard from you in a long time. But not so wonderful if this is another disc episode. I think you are being very prudent to act like this is a disc problem by crating. With early disc episodes and pain only, it can be a real challenge for a vet to diagnose. Sounds like pain meds and pred are doing the job of providing full relief from pain. When you get a chance do update us with the full details of the med list Jean, ophs maybe I misread and she is not yet on prednisone? When there are mild symptoms of pain only, often a vet will choose a non-steroid--- a NSAID as the anti-inflammatory. When is the last time she had a blood test to verify health of organs to take anti-inflammatory drugs? Answers here: |
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Post by Jean & Mimi on Apr 12, 2017 9:12:14 GMT -7
Hi all,
quick update - just got off the phone with the vet. We are not doing prednisone this time, but going the NSAID (Carprofen) route.
Here is what we are doing:
- Rimadyl 25 mg per day - Gabapentin- 40mg 2x per day - Pepcid - 5 mg 2x per day - Keeping Tramadol in reserve for now. He thinks the Rimadyl will help with her pain, but said to observe her and see. If we still see pain he will immediately give tramadol.
He is doing a minimum of a 7 day dose of rimadyl before tapering. He says because her pain was seemingly relieved from the gabapentin alone, he thinks it is not as severe and with crating, the Rimadyl will work.
Also, she had a senior dog visit in January. She had all of her bloodwork done at that point and her liver/kidneys were perfect.
One more question, I know the steroids made her pee a lot more frequently - do the nsaids do that too? I cannot remember.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 12, 2017 9:42:53 GMT -7
All sounds good with a recent blood test, a 7-day course of Rimadyl then a test-for-pain stop. Do ask on the stop of Rimadyl whether your vet wants to back off of gabapentin since she has been on it for such a very long time or a full stop so that you will have a quick and accurate way of observing for signs of pain. It can take 7-30 days to resolve all painful swelling. Always prudent to try a course and then determine if a further course is needed. All these anti-inflammatory drugs do carry with them adverse side effects. The steroid class can cause extra thirst and do require tapering off to signal the body to make its own steroid again. The non-steroid class, the NSAIDs, do not have the side effect of causing extra thirst. NSAIDs do not effect steroid producing adrenal glands so no taper is required. How much does Mimi weight now? Pepcid AC is 5mgs 2x/day. 30 mins before the Rimadyl. Giving a Rimadyl with a meal is added stomach protection. If you are like me, when a disc episode happens, my mind may forget some things, kinda turns to mush. Here's a quick summary on conservative treatment you might like to glance at: www.dodgerslist.com/literature/healingpage.htmDo keep us posted on continued full pain relief once all the meds are on board. Hugs to Mimi. |
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Post by Jean & Mimi on Apr 13, 2017 5:10:53 GMT -7
Well, last night was fun (um not so much). She is miserable in her crate...lots of scratching, whining and looking pathetic. No jumping or anything, just miserable. The last time the crate was easier because she was in so much pain and had lost neuro function. Last night there was no pain when I got home (and remember at this point the only med she had during the day was her gabapentin) and I gave her all of her meds (Pepcid, Rimadyl, Gabapentin). She scratched to go out to potty around 3 am. When I picked her up, there was no yelping, shivering etc. She went out (a few steps) and then I picked her up again. She started to shiver, but I think it was because she was chilly (you know doxies love their warmth). When I put her back in her crate (ex-pen), I touched her and she stopped shivering once she was among her blankets. When hubs took her out this am, there was no shivering at all, so I really think her pain (what there is of it) is controlled - she was just chilly. I know this is the right thing for her. This may have been a minor incident or a precursor to something that could have been a big deal. I will deal with weeks of her being cranky in her crate than have her not be able to walk |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 13, 2017 11:13:32 GMT -7
Jean, good report --- no pain! You may have to help Mimi be able to relax in her suite. Have you tried any of the calmers in the past? Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price. 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.drsfostersmith.com/product/prod_display.cfm?pcatid=13043 --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, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.php Relaxation Music for Dogs! Here's the playlist for all 70+ "tunes"
Dr. Becker, DVM, explains
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Post by Jean & Mimi on Apr 14, 2017 9:44:37 GMT -7
Update - we have added ➕tramadol to the mix. We noticed some shivering as it got close to dosing time for Rimadyl. So now or medications are as below:
Rimadyl - 12.5 mg 2x per day
Tramadol - 25 mg 3x per day
Pepcid - 5mg 2x per day
No neuro deficiency- will still doggy flap even while shivering. Otherwise once she gets the rimadyl her personality comes back. She sleeps in her normal positions including the "circle". So just keeping on keeping on. I suspect she may need longer than seven days on the Rimadyl
[15 lbs
Rimadyl as of 4/12: ? mgs ?x/day for 7 days
Gabapentin 40 mgs 2x/day
➕Tramadol 25mgs 3x/day
Pepcid AC 5 mgs 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 Apr 14, 2017 11:09:46 GMT -7
Jean, good eagle eye noting pain. After the addition of tramadol/stop of gabapentin, if her personality only comes back with a Rimadyl dose, then the pain meds are still not yet right.
How much does Mimi weigh?
Why did the vet stop gabapentin, it treats nerve pain associated with a disc episode? Tramadol works as a general anesthetic and in fact it happens to work synergistically when used with gabapentin?
The test-for-pain stop of Rimadyl on Wed, Apr 19 is for you to report any sign of pain resurfacing so the vet can call for another course of Rimadyl. In order to be able to give a quick and accurate assessment if unmasked pain should reveal itself, vets either call for the stop or the backing off of pain-masking pain meds. Which does your vet want?
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Post by Jean & Mimi on Apr 14, 2017 11:46:24 GMT -7
Sorry, I forgot the Gabapentin! She is still taking that at the dose noted earlier. I am adding in the tramadol this afternoon to get her on the correct spacing for the medication.
Since she got her meds at 7 this am she has been herself. Her tramadol will be given at 3:00. That will allow us to assess pain level this evening prior to Rimadyl dose. If no shivering then pain control has been maintained.
She weighs 15 lbs.
As for the test next week, we will back off the pain meds and the rimadyl to asess pain/healing.
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Post by Jean & Mimi on Apr 14, 2017 16:53:44 GMT -7
Update...gave tramadol at 3 got home at 7 to shivers. I wonder if the rimadyl is at the right dose? It should be 1 gram per lb 2 x per day. She is 15 lbs but is only taking 12.5 g 2x per day. I am just trying to find the solution. She is getting relief from the rimadyl (ie she stops the shaking within 20 min after dosing) and then acts "herself" after an hour. She also got her gabapentin. I will continue with the tramadol and call the vet tomorrow. What else can I do?
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Post by Julie & Perry on Apr 14, 2017 17:10:18 GMT -7
Jean, is Mimi taking Methacarbomal for muscle spasms? That is usually given during an IVDD episode. And as you said, I'd check she's getting high enough doses of her other med's.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 14, 2017 17:14:43 GMT -7
Jean, the Rimadyl is at the right dose per weight of 15 lbs. Do not self prescribe Rimadyl. We do not consider rimadyl to be a pain reliever, because it can take 7-30 days worth to get all the painful inflammation resolved. Pain meds correctly prescribed give relief in one hour and continue to provide full pain relief dose to dose.
There are three kinds of pain typically with a disc episode. Hence the reason three different pain meds are prescribed: tramadol, gabapentin and methocabamol for the typical pain from muscle contractions.
What is not right are the pain meds. IVDD pain meds have a short half life and normally do not control pain unless the vet has prescribed the correct dose AND prescribed for them to be given every 8 hours (3xday)
For a 15 pound dog do advocate with the vet, even ER this evening since we are coming up on a holiday and will your vet be open tomorrow?
-- The dose of 25mgs 3x/day is very, very light
-- Advocate for gabapentin 3x/day
-- Advocate for methocarbamol 3x/day
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Post by Jean & Mimi on Apr 15, 2017 5:31:23 GMT -7
Vet is definitely open tomorrow - i heard them confirming appointments when I picked up her meds. I will ask them about Increasing meds.
4/15 update...we are increasing gabapentin dosage and frequency. We are starting at ▲[gabapentin] 1.0 3x per day and I have permission to go to 1.5 if needed. Going to see the vet this am. We may also add methocarbamol.
[15 lbs
Rimadyl as of 4/12: 12.5 mgs 2x/day for 7 days
Gabapentin 40-▲60 mgs ▲3x/day
Tramadol 25mgs 3x/day
Pepcid AC 5 mgs 2x/day ]
This morning the pain was less. There was no shivering but she was still not herself.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 15, 2017 8:34:58 GMT -7
Jean, often meds can be adjusted over the phone avoiding a risky to the healing disc visit to the vet. You remember the drill when there are times where it is absolutely necessary to transport for a vet visit. Pad out the crate with a rolled up towel or blanket to prevent Mimi's body from shifting when you corner or break.
-- Look for a full 50mgs of tramadol 3x/day for 15 pound Mimi as per the new information that tramadol is generally being prescribed at too low a dose for dogs to be effective.
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Post by Jean & Mimi on Apr 15, 2017 9:25:48 GMT -7
So to update, gave her more gabapentin after I spoke with the dr. this am. So far she seems calm and relaxed...not shaking or stressed. Right now she is looking out our back door while trying not to fall asleep.
She will be on the ▲rimadyl for longer because she is still obviously in pain. We are going to go at least 2 weeks before stopping and backing off pain meds. I know my dog is a slow healer.
[15 lbs
Rimadyl as of 4/12: 12.5 mgs 2x/day for ▲14 days
Gabapentin 40-60 mgs 3x/day
Tramadol 25mgs 3x/day
Pepcid AC 5 mgs 2x/day]
Fingers crossed that she will be pain free the rest of the day and tomorrow.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 15, 2017 9:53:46 GMT -7
So which dose of Gabapentin did you end up giving: 1.5 tablets (60mgs) and are you doing that 3x/day?
Hope, too, that will cover the pain dose to dose of both pain meds now (gabapentin and tramadol)
Did you get a chance to discuss a larger dose of tramadol, just in case on Sunday you see pain is not being covered?
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Post by Jean & Mimi on Apr 15, 2017 10:16:51 GMT -7
So we are at 50 mg of gabapentin right now, with the clear to go up to 80 mg if needed. We get the compounded liquid because it is easier for her. I asked about the tramadol, and he would not prescribe more than the 25 mg 3x per day. However, if I see things bad, I have more than enough to go up a bit in that too. We both agreed there are not muscle spasms so no methocarbamol for now. But if things get bad he would prescribe that if we wanted. So to recap:
Rimadyl: start 4/12. 12.5 mg 2x per day. This will go for at least 2 weeks.
Pepcid: 5mg 2x per day
Tramadol: 25 mg 3x per day
Gabapentin: 50 mg 3x per day, with ok to go to 80 mg 3x per day
I got lots of tail wags and crate scratches when I came home (a good sign) and now she is just resting.
[15 lbs
Rimadyl as of 4/12: 12.5mgs 2x/day for 14 days
Gabapentin suspension 50-80 mgs 3x/day
Tramadol 25mgs 3x/day
Pepcid AC 5 mgs 2x/day]
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Post by Jean & Mimi on Apr 16, 2017 7:59:52 GMT -7
Good Morning...we have pain control 😄 I have a very hapoy dog who doesn't shiver and constantly wants pets in her crate. When picked up for potty time, I am given kisses.
Yesterday the little stinker scratched her crate like she needed to gonoutside. Yeah, she just wanted to sit outside for a minute 😂
I forgot how much she hates the taste of Tramadol. It is always a fun challenge not tonget her to spit it out!
Hapoy Easter all!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 16, 2017 8:08:51 GMT -7
Jean, so wonderful to hear full pain relief!!!
Once they have tasted the bitter tramadol they will be quite suspicious. You may have to re-train her to trust you on the tramadol. Split the pill, wash your hands of any dust. Hide the tramadol in some cheese, wash your hands again of any tramadol dust. Wrap the treat with some deli meat to make it extra yummy. First tiny treat has nothing it in, second treat has nothing in it, third has the pill and fourth has nothing in it again.
Happy Easter to your family!
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Post by Jean & Mimi on Apr 16, 2017 17:22:55 GMT -7
Ugh! She was doing fine. I just carried her out to potty before I left for Easter. I had just given her pain meds right before I took her out. I had her in her halter and on a leash for very fre steps. A bee went by her and ahe got scared and ran a few steps. Immediate ahivering and panting. I waited a few minutes. She was still shivering but also wagging her tail at me. I hope she just calms down and lets the meds work. I gave her a little bit more gabapentin to try and help. I feel horrible.
Home now...all tails wags when we got home, desperately wanting attention. Still seemed a bit shivery. Gave her her meds and then sat down next to her crate and pet her. Within 5 minutes of petting no more shivers. I think she needed comfort. She is resting comfortably now.
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Post by Jean & Mimi on Apr 17, 2017 4:58:13 GMT -7
Update Monday 4/17
She was stiff and a bit shivery this morning. It was not time for her meds, but my dr. said I could increase her gabapentin as I needed up to 1.5 and maybe even past that. Before I took a shower at 6, I gave her .3 of gabapentin (maybe 10 or 15 mg). That seemed to take the edge off and when I moved her crate to the living room at 6:45 am, she had stopped shivering and was wagging her tail at me and scratching to get out. I took her out to potty. Peed and pooped - still no shivering when she came back in. I gave her all of her meds, except the rimadyl which was not due until 7:30.
When I checked in with hubs at 7:45, he had given her the rimadyl and said she was doing her standard resting comfortably but if you leave the room her annoyed bark with tail wags.
So, I am officially increasing gabapentin to 1.3 of liquid (about 65-70 mgs) 3x per day. Let's see if this helps and she doesn't do anything stupid like run 2 steps. She is her own worst enemy!
[15 lbs
Rimadyl as of 4/12: 12.5mgs 2x/day for 14 days
Gabapentin suspension 30mgs/0.6 mL: 1.3mL(65 mgs) 3x/day
Tramadol 25mgs 3x/day
Pepcid AC 5 mgs 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 Apr 17, 2017 9:01:04 GMT -7
Jean, glad your vet gave you a range for Gabapentin so you could deal with pain right away. How many mgs of gabapentin are in one mL of the liquid? I found an expen in the grass was far easier to control them at potty time. You are right they do things in a blink of an eye. You can also use some of the poke in the ground garden edging wire fence to form a 6 foot diameter potty place. The visual of the fence plus the physical of it, keeps them from ideas of darting off better for my dog than the leash/harness.  |
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Post by Julie & Perry on Apr 17, 2017 9:44:29 GMT -7
It's great when they feel better but then our pups want to get going again!
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Post by Jean & Mimi on Apr 17, 2017 10:15:45 GMT -7
I will have to try that, although in this case I don't even think that would have helped. She barely ran 2 feet (I was really keeping on her with the leash). So frustrating!
The gabapentin is 5 mg per .1. So now she is taking 65mg of gabapentin 3x per day. I am keeping her at this level for a few days then I may back it down a bit. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 17, 2017 16:08:35 GMT -7
The math doesn't work out with 5mgs for 0.1 mL. Can you double check what the ratio of how many mgs are in what number of mL is for gabapentin.
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Post by Jean & Mimi on Apr 17, 2017 17:20:43 GMT -7
The bottle says that .6 =30 mgs. So I divided 30/6 and got 5. 5x10=50. 5x3=15. So 65 mgs total. Math was never my strong suit. What did I do wrong?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,792
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Post by PaulaM on Apr 17, 2017 19:02:09 GMT -7
We got the same answer. Sorry my brain was apparently not in gear earlier this afternoon.
30mgs gabapentin are in 0.6mL of liquid
1) reduce down lowest mL unit.
Divide 0.6mL by 6 = 0.1mL
Divide 30mgs by 6 = 5.0mgs
2) Convert to whole mL unit:
0.1mL x 10 = 1mL
5 mg x 10 = 50mgs
3) 1.3mL dose = 65 mgs of gabapentin
(1.3mL x 50mgs= 65mgs)
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Post by Jean & Mimi on Apr 18, 2017 5:00:30 GMT -7
LOL, thought it could have been my math too Update 4/18... A good 24 hours pain free Normally my husband would take her out when he gets up at 5:30. This morning, I told him not to do that...to let her wake and move on her own. I think it helped a lot. I just thought of how I would feel if I was trying to recover from an illness and was rudely awakened before I was ready She woke in her crate and was eager for belly rubs (I do not encourage this at all...she just sees me and does it automatically!!!) If I can I try to only let her get to her side then I rub her belly. I also saw the downward dog this morning as a stretch...so very much pain free. Now to just let the Rimadyl do it's job for another week and a half before we try to stop it and to bring down the meds. |
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