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Post by Romy & Frankie on Sept 1, 2017 15:18:00 GMT -7
Tramadol is a pain reliever only. The pred works on the swelling in the spinal cord which causes the pain. The tramadol is to keep Nelli out of pain and therefore give pred the time to do its work which could be up to 30 days.
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PaulaM
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Post by PaulaM on Sept 1, 2017 17:00:00 GMT -7
Roxanne, prednisone is not like any other drug...it is actually a hormone that regulates body systems. So it must always be under the direction and supervision of a vet. When pain meds are correct, the cause of the pain is still there because swelling still exists, it is just pain is masked. Pain meds do not work on swelling they just provide comfort while Prednisone takes 7-30 days to resolve all painful swelling. MONITORING NEURO FUNCTION As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. √Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. Paws knuckle 5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost 8. Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. See photos of the varying degrees of neuro diminishment here: www.dodgerslist.com/literature/healingnerves.htm
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Post by Roxanne & Nelli on Sept 2, 2017 4:43:03 GMT -7
Good morning (maybe not). Nelli looks to feel much better this morning. She is walking better, peppier and has a good appetite. However, as suggested early on, I have been diligently watching her stool. In the beginning she didn't poop for three days. I had her on chicken and rice (from when I thought it was a stomach problem vs back). I began to give her pumpkin on Tues, Aug 29 and since, her stools have been loose (but not what I'd call diareaha (sp?). The last time I gave her pumpkin was yesterday (Friday, Sept 1) morning. I also started transitioning her back onto her kibble. This morning, her stool is still loose and I see what looks to be a very little bit of blood (three tiny spots, not streaking or excessive). Last nights poop was clear. I believe I read somewhere on this site that this could be an emergency situation? As noted previously, local vets are off until Tues due to the holiday weekend and the nearest emergency vet is two hours away. If I took her to the vet, how would this be treated (new meds, surgery, etc.) NOTE: I have been giving her sulfracate on an empty stomach, followed by pepcid ac 30 minutes later, then her meal and the prednisone 30 minutes after that...twice a day...since Monday, Aug 28.
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Marjorie
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Post by Marjorie on Sept 2, 2017 5:51:21 GMT -7
You're giving the sulfracate and Pepcid correctly. This treatment is what is given for GI tract distress such as you're seeing. The fact that she's worsening (now blood in the stool) is of some concern after being on this treatment since August 28. I think you should give the ER vets a call, explain the situation and see what they suggest. Even though they haven't seen Nelli, they should be able to tell you whether this is an urgent situation or not. They may just tell you to continue with the same treatment.
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Post by Roxanne & Nelli on Sept 2, 2017 6:00:57 GMT -7
Thank you Marjorie. I don't know if you read the entire thread but your team expressed concern about Nelli being perscribed an NSAID and Prednisone at the same time. Although there was only a one-day overlap, there was no wash out period. Would this information give you additional cause for concern or would you give same guidance? Thank you again!
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Marjorie
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Post by Marjorie on Sept 2, 2017 6:23:33 GMT -7
Yes, I'm aware of the inappropriate use of a NSAID and steroid without a washout period. Sucralfate and Pepcid need to be given when that type of anti-inflammatory treatment has been prescribed. The fact that Nelli has worsened while on the Sucralfate and Pepcid is of concern. So I think a vet's direction is needed.
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Post by Roxanne & Nelli on Sept 2, 2017 6:46:22 GMT -7
Thank you again Marjorie....I'm on it!
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Post by Roxanne & Nelli on Sept 2, 2017 9:39:29 GMT -7
Just returned from vet. She looked at her stool under the microscope and couldn't find blood but didn't doubt there was the small amount I observed. She said her stool was too loose. She told me to put her back on a bland diet, swapped Pepcid AC for ✚Metranedyole (based on her writing), and added Propectalin for her loose stool.
Told me to continue monitoring stool and if the amount of blood increases, to call her (anytime over the weekend). Back home and resting...both of us!
[Moderator note, please do not edit 13.5 lbs Carprofen as of 8/23 12mg 2x/day for 5 days STOPPED 8/28! Prednisone: as of 8/27: 7.5 mg 1x/day for 1 day as of 8/31: 5mgs a.m/2.5mgs p.m. for 1 day as of 9/1: 5mgs 2x/day for 1day, Self prescribed by owner! then 5mgs/2.5mg for ? days Tramadol 25 mgs 3x/day Sucralfate 500 mgs 2x/day Pepcid AC 5 mgs 2x/day STOPPED! ✚Metronidazole is an antibiotic used to fight bacteria 125mgs 2x/day ✚Propectalin- kaolin, pectin and Enterococcus faecium 2cc 3x/day ]
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PaulaM
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Post by PaulaM on Sept 2, 2017 9:59:30 GMT -7
Roxanne, the blood you saw was black blood or red blood?
There is nothing on board to suppress the xtra acids Pred and stress cause if Pepcid AC is stopped!!
Some vets are using the antibiotic Metronidazole for its immunomodulating effect on the GI tract. If there is GI tract upset, then a bland diet van help too. Had you seen reluctance to eat (nausea)? any vomiting?
Did the vet know you were giving pumpkin?
What is the current on Prednisone that you upped to 5mgs 2x/day on Friday, 9/1? For how many days will it be at that dose, before a test-for-pain Prednisone taper
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Post by Roxanne & Nelli on Sept 2, 2017 10:03:23 GMT -7
Vet said to substitute Pecid with Metranedyole....she said it was to help her stomach.
Carprofen as of 8/23 12mg 1x/day for 5 days STOPPED 8/28!
Prednisone: as of 8/27: 7.5 mg 1x/day for 1 day as of 8/28: 5 mg 1x/day for 5 days as of 8/31: 5mgs a.m/2.5mgs p.m. for 5 days as of 9/1: ▲5mgs 2x/day for 1 days, Self prescribed by owner! Will go back to 2.5 mg pm tonight if she seems okay. Tramadol 25 mgs ▲3x/day Sucralfate 500 mgs 2x/day Pepcid AC 5 mgs 2x/day STOPPED 9/2 Metranedyole 125 mg 2x/day Propectalin 2cc 3x/day
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PaulaM
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Post by PaulaM on Sept 2, 2017 10:20:48 GMT -7
Metronidazole helps alter the profile of gut bacteria in favor of bacteria that reduce ammonia load. Pepcid AC does a COMPLETELY different job...it supresses the acids pred causes, that stress cause. Stomach acids are what are VERY typically known the cause of GI tract problems.
The blood you saw was black blood or red blood?
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Post by Roxanne & Nelli on Sept 2, 2017 11:50:25 GMT -7
Thanks Paula! I missed your first response from 3 hours ago.
The blood is red...and minimal.
I had to take her to the old vet because the new one isn't in until Tuesday. That said, I took a stool sample but she also examined Nelli. Her temperature was fine. She felt her belly...no pain or other problem was mentioned. We discussed the fact that I'd been feeding her a bland diet transitioned her back to kibble yesterday. Yes, I told her about the pumpkin. I also told her she's not vomiting and her appetite is good. I don't know why she wanted me to change from Pepcid to Metronidazole....I assumed it was a stonger form or Pepcid.
Can Nelli take Pepcid AC and Metronidazole at the same time...or should I just stay the course with Pepcid?
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PaulaM
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Post by PaulaM on Sept 2, 2017 13:14:40 GMT -7
Roxanne, it is typical to see a dog on Pepcid AC and have a prescription for Metronidazole, an antibiotic for the many dogs we have on the Forum. My dog was even prescribed to continue Pepcid AC along with Metronidazole
Black blood would have been digested blood from the stomach. Red blood comes from the intestine all the way even to the nearing the anus where some abrasion of this delicate tissue might show a few drops as poop exits.
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Post by Roxanne & Nelli on Sept 2, 2017 13:45:19 GMT -7
Thanks Paula. You're a life saver (literally no doubt!!)
I was planning to go back to the 2.5 mg dose of Prenisone tonight if she doesn't look like she's in pain (not wanting to walk when I put her out to do business). I do have her on Tramadol 3x/day so I'm hoping it will work in lieu of the added Pred.
Sounds like I'd be seeing black blood if she was developing an ulcer from the conflict of meds and she would also be vomiting? Also, how long is she at this risk? It seems like the longer past exposure she goes, she should be at reduced risk...yes/no?
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PaulaM
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Post by PaulaM on Sept 2, 2017 16:55:40 GMT -7
The GI tract damage can happen in the stomach (black blood) and in the intstine (red blood). There is no point past danger. She is on pred so there is good chance that pred alone can cause problems. She is likely past the double jeopardy of carprofen /pred without a a 5-7 day washout.
IT is not a good idea for you to be upping and downing pred doses! The vet should be prescribing the dose and telling you how long the course should be for. . This one med you do not want to be messing around with.
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Post by Roxanne & Nelli on Sept 3, 2017 14:52:34 GMT -7
Went to South Paws CritiCare in Northern Virginig. Left an 9:30 am just got home (5:30 pm). My goal was to get the prednisone prescription correct and deal with blood in her stool.
Dr. Olsen, DVM, reviewed Nellie's issues and did an exam that revealed back pain at the thoracolumbar junction but no neurologic deficits at this time. Her rectal exam revealed small amount of blood-tinged mucus. She is likely straining to defecate at home because of the inflammation in the colon.
Dr. Olsen said since she had signs of pain for 10 days despite medical management, she said I need to see a Neurologist--they may suggest an MRI and surgery if her pain is intractable. Blood work was done but won't be provided until Tuesday.
She told me to discontinue prednisone (just stop, no taper). Also made the following changes to medications:
Tramadol: 25 mg 3x/day (same); Gabapentin: 50 mg 3x/day (new), ▼Metronidazole: 62.5 mg 2x/day (half prior), ▲Sucralfate: .5 gm 3x/day (increase), ProPectlin: 2cc's 3x/day (same), ✚Prilosec: 10 mg 1x/day for 10 days (in lieu of Pepcid AC 5 mg 2x/day).
[Moderator note, please do not edit 13.5 lbs Carprofen as of 8/23 12mg 2x/day for 5 days STOPPED 8/28! Prednisone: as of 8/27: 7.5 mg 1x/day for 1 day as of 8/31: 5mgs a.m/2.5mgs p.m. for 1 day as of 9/1: 5mgs 2x/day for 1day, Self prescribed by owner! then 5mgs/2.5mg for 1 day as of 9/3 STOPPED w/o taper Tramadol 25mgs 3x/day ✚Gabapentin 50mgs 3x/day Sucralfate 500 mgs ▲3x/day ✚Prilosec 10mgs 1x/day Metronidazole ▼62.5mgs 2x/day Propectalin- 2cc 3x/day ]
Apparently she was more concerned with blood in stool than disc. She said Pred could be stopped cold turkey because she wasn't on a high enough dose long enough to cause a problem. Not at all what I thought would happen and I'm worse than I was when I left this morning. Have you ever heard of such a thing??
------- Post by Roxanne & Nelli on Sep 2, 2017 at 7:35pm Understood and thanks of the information. Will keep her on the 5 mg in am and 2.5 mg in pm.
Post by Roxanne & Nelli on Sep 3 at 7:12am Heading to South Paws CritiCare in northern VA this am with Nelli. Took her out twice in the middle of the night to do business. She assumed the poop position but nothing coming out. Leg is weak again this am. She looks miserable....it's killing me!
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PaulaM
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Post by PaulaM on Sept 3, 2017 17:57:58 GMT -7
Roxanne, when a vet is not comfortable in their knowledge of IVDD, you would expect them to tell you so in so many words by referring a walking dog to a specialist,
A specialist is not just for a surgery, but to get meds on board a general local vet is not comforatble in using. Neilli needs help not just with prope pain meds to give her full comfort from pain, but common sense use of prednisone so there does not have to be a another dangerous switch to the other class (NSAIDs). With a cold turkey stop of pred, there is nothing working on swelling. So you might expect there to be more pain, meaining an aggressive pain med approach should have been prescribed. especially with the holiday and not so easy to get vet help other than expensive ER visits.
Let us know if the addition of gabapentin will hold pain at bay til you can get in with a knowledgable IVDD vet or seek that neuro consult because you can't find any generals who know IVDD maybe earliest possible on Tues????
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Post by Roxanne & Nelli on Sept 3, 2017 18:47:40 GMT -7
It sounds like you don't think the addition of Gabapentin is aggressive enough for pain relief. I'm in line with your thinking on cutting out Pred and not having anything working on swelling. Given all you know about this case so far, what would you do if Nelli was your dog?? Her evening dose was 2.5 mg...should I administer tonight to get her closer to Tuesday?? Does the fact that she has blood in the stool worry you? I know you're not a vet....
BTW, since starting the ProPectelin, her diahria has settled down. She hasn't had a BM for 20 hours which is good but I can't determine if, or how much, blood is in her stool.
Also a correction to your presciption edit....After the one-time dose of 7.5 mg on 8/27, she was on a 5 mg 1x/day dose until it was increased on 8/31.
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Post by Pauliana on Sept 3, 2017 22:04:53 GMT -7
Roxanne,
I'm not Paula, but here are my two cents. Nelli may not poop for a couple of days because of the diarrhea. Blood in the stool is always a concern but thankfully Sucralfate is on board to help heal the damaged area. Prilosec takes a day or two to become effective but once it is, it works well.
When there is no Prednisone on board, it can mean an increase in pain because there is nothing working on the swelling that causes the pain. So keep watch on Nelli for signs of pain, if you see any pain, call the Vet to have the Tramadol and Gabapentin adjusted and hopefully find a specialist that is more IVDD experienced to get Prednisone back on board at the right dosage with a proper taper. (Prednisone should always be supervised by a Vet. It regulates body systems. Steroids are far different than other anti inflammatories. ) By then the Sucralfate and Prilosec will have her GI tract and stomach protected..
Here are the pain signs for easy reference. •restless, can't find a comfortable position •slow or reluctant to move much in crate such as shift positions •shivering-trembling •yelping when picked up or moved •tight tense tummy •arched back, ears pinned back •not eating due to too much overall pain •not their normal perky selves
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PaulaM
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Post by PaulaM on Sept 4, 2017 8:04:25 GMT -7
Let me chime in to add to Pauliana's on target points!
The vet you saw may not have had the history of meds we have been tracking here to see what an absolutely a-typical, likely non-useful approach with prednisone??? We track the number of days on at the anti-inflammatory level, not taper days. Steroids are not counted when they are on less than anti-inflammatory levels, the taper doses. For a 13.5 pound dog the usual dose for a disc episode is 5mgs 2x/day. AGAIN it is a vet who should prescribe, not you self prescribing. Your job is to advocate, hire an IVDD knowledgeable vet. So far there has been 5 days of carprofen, and 4 days of prednisone...that totals 9 days. All this in short spurts and sputters, up and down!!! The usual with a vet who has confidence in their knowledge of IVDD is to give a 5-7 day course (not a one day course!!!) then do a test-for-pain Prednisone taper and stop of pain meds. If any hint of pain resurfaces that is proof for the vet to know to give another 5-7 day course or even a 14 day Prednisone course. No pain, then finish the taper to signal the adrenal glands to start making their own steroid hormone to regulate body systems.
Carprofen as of 8/23: 12mg 2x/day for 5 days STOPPED 8/28! Prednisone: as of 8/27: 7.5 mg 1x/day for 1 day as of 8/31: 5mgs a.m/2.5mgs p.m. for 1 day as of 9/1: 5mgs 2x/day for 1 day, Self prescribed by owner! then 5mgs/2.5mg for 2 days as of 9/3 STOPPED w/o taper
Can you give us an update on pain today? If the addition of gabapentin is preventing pain from showing, then that is very good. IF there would be pain, then it is clear the pain meds would not yet be right, need further adjusting.
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Post by Roxanne & Nelli on Sept 4, 2017 8:58:42 GMT -7
Please add to your list of Prednisone: As of 8/28: 5 MG 1x/day for three days. This somehow got dropped off. Does this make a difference?
Will report on pain soon...in the hospital with hubby for chest pains. Friends are seeing to Nellis med schedule. I think the stress is getting to him too.
Paulina...understood on insufficient doses of Pred vs what is normal. I will see a neurologist tomorrow or Wed and advocate for appropriate levels.
What about blood in stool though. That was Critical vets main concern. Which is the bigger emergency I'm dealing with here?
One more thing....how does one find/hire an IVDD knowledgeable vet? I'm on my 4th vet in a week trying to get to the correct dose of Pred. Still not there and currently advised to stop cold turkey! Is a neurologist a sure thing?
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PaulaM
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Post by PaulaM on Sept 4, 2017 11:21:37 GMT -7
5mgs pred 1/xday IS a taper dose! So it is not counted in the 7-30 days it may take an anti-inflammatory to resolve all swelling. Taper doses are to test for pain to see whether another course is needed or not.
If vet reported to you a "small amount of blood-tinged mucus. She is likely straining to defecate at home because of the inflammation in the colon." That seems to be consistent with maybe some abrasion or stressed blood vessels when trying to push poop out. Doesn't sound like a GI tract issue of too many acids which progresses like this: nausea, not eating, vomit, loose stool, bleeding ulcer in stomach (black blood) or intestine (red blood) bloody diarrhea. Tinged (a trace or slight) is not bloody. Sucralfate would gel coat areas of the colon where damaged. Pepcid AC would suppress acid production.
Until you get get in with a neuro 9/5-6 in order to get Prednisone right, monitor for signs of GI tract damage as outlined above. Monitor for signs of pain which would mean calling in asap to advocate for upping meds to fully cover pain: increase low 25mgs tramadol to higher mgs 3x/day, adding in methocarbamol to deal with muscle contraction pain 3x/day, keeping gabapentin on board. Often it will take 3 different pain meds to deal with each different source of pain.
I'm sorry your family is having so much stress and hope hubby is ok and you too.
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PaulaM
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Post by PaulaM on Sept 4, 2017 11:32:47 GMT -7
The first step in hiring an IVDD knowledgable vet is your own self education. This gives you the background to ask questions and understand the answers given indicating the degree of knowledge a vet may have and if you want to hire them to be on Nellie's health care team. The summary article on conservative treatment is a good guideline for finding a vet who is on the same page about conservative treatment: www.dodgerslist.com/literature/healingpage.htmThe article on "Finding an IVDD Vet" has question you can ask. www.dodgerslist.com/literature/VetchkList.htm If you are not sure of what the answer should be, let's talk more here. There is also a member directory of recommendations in the article to check if one might be in your area. I believe to shortcut and get the right meds on board, a specialist would be the best choice for asap. Once meds are right, then you can look for a closer vet, a general DVM vet to hire as Nellie's IVDD vet. FYI there is even controversy among specialists about the use of which anti-inflammatory class to use. Be aware why the battle.... there are two camps with the steroid controversy. Vets whose experience shows how steroids can and do often work to get the inflammation resolved. The other camp based on studies against use of steroids with SCI that are controversial as to whether the studies were flawed or incorrect conclusions. Reliable studies are needed for our dogs. The whole problem with Nelli's case is for no good reason she was taken off of carprofen (NSAID) and incorrectly put on a steroid. Now on pred a switch back to a NSAID is wrought with more risk, more double jeopardy on top of the first double jeopardy....another switch with either: ---- no washout, meaning yet again double jeopardy to the GI tract!!! ---- a 5-7 day washout where there is nothing on board to deal with the swollen, delicate spinal cord. ---- staying the course with a steroid just makes common sense to get on with the business of taking care of the inflammation. Swelling is risky business to the cord as far as potential for loss of neuro functions. So you will have to do your very best to present a good case why to continue pred and continue it back up at an anti-inflammatory dose. Nelli's case has become one of mismanagment and the specialist needs to see what he can do to help get Nellie out of her prediciment the local general vets are not comfortable in managing.
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Post by Roxanne & Nelli on Sept 4, 2017 15:38:52 GMT -7
Thank you Paula (and Pauliana) for all the useful information. I just got home from the hospital (husband admitted for observation) to take care of Nelli. She was happy to see me. When I put her out, she's still walking and wagging her tail...limited though. Also not her perky self but not sure if pain meds may be making her sleepy. My unprofessional opinion is that she's acting pretty much the same with the addition of the Gabapentin as she was with Prednisone...at least for now. I'm still very concerned about possible neuro loss with out the Pred working on swelling.
Still hasn't pooped since I started her on the ProPectalin...so can't judge stool/blood. She ate her whole (bland) dinner and a treat so appetite is good....not throwing up. She's been given her pain and stomach meds today as prescribed, however, she's been given NO prednisone today per the emergency room vet's instructions yesterday. The last time she received pred was yesterday, Sun Sept 3, at 7 am and it was the morning 5 mg dose. (I must admit, I really, really want to give her a 5 mg taper dose tonight but swear I won't!) I believe I have found a neuro in the Richmond area and will seek and appointment ASAP. Thank you again ladies for your time, your patience, and your dedication to strangers in need. You're priceless!
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PaulaM
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Post by PaulaM on Sept 4, 2017 19:55:42 GMT -7
We'll be looking forward to what the specialst says and what he can do to help. Hope there is good news about your husband. You certainly have some stressful things going on in your life. Take are of your self, everyone needs you.
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Post by Roxanne & Nelli on Sept 5, 2017 17:36:16 GMT -7
What a day. After staying awake all night last night worrying about how I was going to juggle Nelli and hubby today, I decided to take another shot with new vet I went to last Thursday that I liked so well (problem though that he was gone for long holiday weekend) because I knew I wouldn't/couldn't get to a neuro today. I got up and was at his office when he opened at 6:30 am. I gave him the emergency room vet's assessment and that she took her off Pred and putting her on Gabapentin...and suggested I see a neuro for an MRI and surgery. He was aghast! "You'd take a dog that is walking to have surgery and possibly end up with a dog that isn't walking??!!"
So, he put her back on pred as previously prescribed (5 mg am; 2.5 mg pm).
[Moderator note, please do not edit 13.5 lbs Carprofen as of 8/23 12mg 2x/day for 5 days STOPPED 8/28! Prednisone: as of 8/27: 7.5 mg 1x/day for 1 day as of 8/31: 5mgs a.m/2.5mgs p.m. for 1 day as of 9/1: 5mgs 2x/day for 1day, Self prescribed by owner! then 5mgs/2.5mg for 1 day as of 9/3 STOPPED w/o taper as of 9/5: 5mgs a.m/2.5mgs p.m. for 2 days, 9/7 assess for increase Tramadol 25mgs 3x/day Gabapentin 50mgs 3x/day Sucralfate 500 mgs 3x/day Prilosec 10mgs 1x/day Metronidazole 62.5mgs 2x/day Propectalin- 2cc 3x/day ]
While I strongly advocated for 5 mg 2x/day, he wanted to give it a couple days to see if there is sufficient reduction in swelling along with the two existing pain meds shes on (Tramadol and Gabapentin) to eliminate the pain. He said if she's not there by Thurs, we can reassess. Okay. We also discussed signs of pain and he agreed her limited movement is a definite sign and that's what I will be evaluating. He also said I could stop the Sucralfate when the prescription for the prior vet is gone in a couple days (what do you think?).
Unfortunately I had to leave her all day and had different people coming in all day to give her her medicine and take her outside. Sometime between her 11 am and 3 pm visits she threw up. It was described as a "very little, rice and chicken...no blood!" (She still hasn't pooped since midnight Saturday night following the ProPectalin for the diareaha she had last week so haven't been able to check for blood in the stool). Just got home from the hospital with hubby and she was very excited to see us...more animated than I've seen her in days. I fed her dinner and her appetite was good. Will be watching to make sure it stays down.
I know this isn't the dose of prednisone you want for her but I feel confident he'll go there if she doesn't come around quickly.
Thanks again...as always, I value your input!
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PaulaM
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Post by PaulaM on Sept 5, 2017 18:59:23 GMT -7
It would be your call on the stop of sucralfate. By now it has been 7 days washout since carprofen. I think Nellie may be dealing with alot of stress with so many people around, in and out. Dogs like routine, changes stress them out. She is on pred which also increases acids. If you see continued what seems to be nausea like vomiting, then I would give the sucralfate. For most dogs Pepcid AC alone does a good job of protecting, for others signs appear and then sucralfate is added to the Pepcid AC. Opphs I see she is on Prilosec, not Pepcid AC. So monitor and let us and the vet know what you see regarding Prilosec alone and how nausea goes---any more vomiting? The new vet sounds like a man who listens and is willing to work with you and Nellie's needs.
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Post by Roxanne & Nelli on Sept 7, 2017 4:54:58 GMT -7
Good morning! Quick update. Took Nelli to Dr Marsten, Warsaw Animal Clinic in VA. Since she still hasn't pooped since Saturday night (midnight), he took an Xray to rule out a blockage. He said there was none and that her bowels did not look backed up. He pointed out two areas along the spine he felt were cause of her pain. One was at the top of the bridge in back. The other, to a lesser extent, was near where her tail starts (can't remember letters/numbers). Since her vomiting seemed to correlate to the Gabapentin, he said to stop that. He did not replace it with anything at this time. He also said to finish out the Sucralfate prescription and stop that (done) but to continue Prilosec. He gave her a shot Cerenia to stop the vomiting.
Current Meds: Prednisone: 5 mgs AM; 2.5 mgs PM, Tramadol: 25 mgs 3x/day, Metronidalone: 62.5 mgs 2x/day, Prilosec: 10 mgs 1x/day
So...brought her home and did what he said. She looked a little miserable yesterday. Still have her on a bland diet and fed her small portions (drenched in water) to correspond with administration of meds. She held it down and has not vomited since her last episode about 30 hours ago. She looks like she feels much better this morning; her appetite is good. She's still walking and wagging her tail. She still hasn't pooped. So now re-focusing on back. She still has signs of pain as her movement is limited so will be going back to the vet today to try to get Pred increased to 5 mgs 2x/day. I'malso going to see if I should be doing something to stimulate her bowel?? Would like to avoid adding additional pain meds until we see how an increase in Pred will work for her.
As you know, this has been a totally screwed up situation that has gone on too long. I'm commited to getting it right ASAP.
Quick update. Nelli seems much better day. Barking (haven't heard that in two weeks). Will be giving her the first dose of 5 mg Pred this evening. Have had her outside in the crate and she seemed much happier. Appetite still good! Feeling optimistic.
UPDATE 9/7/17 @ 10:30 AM: Just got home from Dr. Marsten's office. He upped her ▲pred to 5 mg 2x/day. Did not add additional pain meds at this time. Showed me the xray from yesterday again and showed me stool and reiterating it's not a problem. In fact, he said I should begin transitioning her back to her regular diet for nutritional reasons. Got home and put her in her x-pen while taking the crate inside. When I came out, she had pooped....yay!!! It was normal looking...not runny and had no blood. Feeling relieved! I know we're still not out of the woods but at least found the crumbs to follow. Thank you, thank you, thank you Paula and others for keeping me on the right path!
Current Meds, 9/7/17 @ 10:30 AM: Prednisone: 5 mgs 2x/day, , Tramadol: 25 mgs 3x/day, Metronidalone: 62.5 mgs 2x/day, Prilosec: 10 mgs 1x/day
[Moderator note, please do not edit 13.5 lbs Carprofen as of 8/23 12mg 2x/day for 5 days STOPPED 8/28! Prednisone: as of 8/27: 7.5 mg 1x/day for 1 day as of 8/28: 5 mgs 1x/day for 3 days as of 8/31: 5mgs a.m/2.5mgs p.m. for 1 day as of 9/1: 5mgs 2x/day for 1day, Self prescribed by owner! then 5mgs/2.5mg for 1 day as of 9/3 STOPPED w/o taper as of 9/5: 5mgs a.m/2.5mgs p.m. for 2 days, 9/7 assess for increase as of 9/7: 5mgs ▲2x/day for 6 days, , then test-for-pain Prednisone taper Tramadol 25mgs 3x/day Gabapentin 50mgs 3x/day STOPPED Prilosec 10mgs 1x/day Metronidazole 62.5mgs 2x/day ]
Post by Roxanne & Nelli Sep 6 at 4:10am Morning. Up with Nelli. She just threw up...yellow/orange bile. Looking at my copious notes, both vomiting activities followed the Gabapentin. She still hasn't pooped (last time was Saturday midnight diarrhea) so no assessment of whether blood is in stool. Just talked to Dr. Marsten who said to bring her in at 7...gotta go!
last night 9/5 Thanks Paula. I'm hoping I can get her bowels regular and then hoping we can focus just on just her back. Agree, I'm sure the different people in the house today along with both of us being gone all day was stressful for her and I had the same thought that that might be why she threw up. Still concerned that she hasn't pooped for so long and hope that's not why she threw up. I fed her around 7 and she's kept it down. Will report again in the morning! Thanks and have a good night!
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Post by Roxanne & Nelli on Sept 8, 2017 11:46:17 GMT -7
Friday Update. Nelli acts like she feels better. Barking and a little more active...trying to keep her from jumping up in the crate! No change in meds. Thank you again Paula and other moderators for all your help!!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Sept 8, 2017 12:30:18 GMT -7
Roxanne, have you tried the tips from our Supplies list....the one about draping a blanket across the top of the suite down to eye level when sitting? That way jumping up means she will be in the dark. That should quickly distinguish that behavior. Find time to praise her whenever you see her lying down or sitting quietly so she knows that is what you like. When she does unwanted behavior do as dogs do to one another, avoid eye contact, turn your back on her or leave the room. Give her no attention. Even saying "bad dog" is giving attention. The link to the supplies list for other wonderful tips: www.dodgerslist.com/literature/cratesupplies.htm
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