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Post by Chris & Coco on Sept 14, 2018 19:00:51 GMT -7
11 year old male dachshund. 8 pounds, Showed typical pain response of lowering head, shivering, and crying (screaming) Took to vet where rads showed disc narrowing between c3 and c5. No calcified discs. Vet performed laser therapy and torbutrol injection for pain.
Sent home with metacam 1.5 mg, once a day .22 cc and buprenorphine .3 mg, up to 4 times a day,.1 cc. 5mg Pepcid ac once a day. [Moderator's note: please do not modify 8 lbs Metacam as of 9/8: 1.5mgs 1x/day for how many days?, BEFORE a test-for-pain stop buprenorphine 0.3mgs ?x/day Pepcid AC 5mgs 1x/day ElleVet]
Also, no sleeping in my bed. (I’m sleeping on floor next to crate) all furniture is blocked and all stairs blocked. Dog door blocked.
I carry him outside to go pee and try to limit his movement. He can walk, pee, and poop on his own. No collars, only harness. I give him a heated (slightly) neck roll to put his neck or head on if he wants but do not keep it in crate. Food and water elevated per vet instruction. I also was prescribed ellevet, which is dog cbd oil. 6 drops twice a day. This started on September 8, so he has been in treatment for a week. Has showed pain response a lot at first but now maybe once a day [pain]. He didn’t show pain yesterday but he did today and I think it was because he was scratching at his gate and tugging/ tearing at his crate pad. (Flat memory foam covered in soft fabric.) Sides of crate I wove a soft blanket strip through the wires up 5 inches from bottom so his body doesn’t have to touch the sides of crate bars. This treatment is different than my other dog Fritz who went down in 2013. Back legs paralyzed, 6 months strict crate rest. Full recovery, no relapses, no weakness.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 15, 2018 7:27:09 GMT -7
Chris, welcome to the Forum, sorry to hear Coco, too, is having a disc issue. Thank you for providing all the important details so we know best how to comment!! Alert your vet to the signs of pain still not being covered round the clock, dose to dose. With a neck disc very typically each of the three sources of pain would need to be covered. These pain meds have a short half life and if not prescribed for every 8 hrs, pain is likely to be relieved fully dose to dose -- How often are you actually giving buprenorphine? NOTE: " The first-pass effect typically removes 85 to 95% of opioids absorbed from the gastrointestinal tract. This explains why buprenorphine and butorphanol are such ineffective analgesics when swallowed." www.vasg.org/newer_options_for_chronic_pain_management.htm-- Instead of buprenorphine, ask for TRAMADOL which is better absorbed orally. -- Advocate for a muscle relaxer METHOCARBAMOL to deal with the typical muscle contraction pain of a neck disc. -- Advocate for GABAPENTIN for nerve pain -- See out aCALMER for Coco to help him relax in his recovery suite: 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 (ACE or trazodone). Of course always keep your vet in the loop on all things you give your dog.
Place a DAP pheromone diffusor at floor level where the recovery suite is: -- DOG Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/Use diffusor 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 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com Here are the extra things you can do at home to help with a neck disc: www.dodgerslist.com/literature/cervical.htmFor how many days has Metacam been prescribed before the stop of it as a test for pain?
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Post by Chris & Coco on Sept 15, 2018 14:56:25 GMT -7
Update. Vet revisited the pain issue. Prescribed gabapentin 30mg 1cc twice daily. Prednisone 5 mg 1 tablet once daily. Discontinue metacam. Continue with the buprenorphine and cbd oil. Bought a calming diffuser kit and will be buying one of the calming pills. Coco received a corticosteroid injection. Dexamerhasone 4mg 100ml. He is resting comfortably. I will ask about tramadol instead of buprenorphine.
[Moderator's note: please do not modify 8 lbs Metacam as of 9/8: 1.5mgs 1x/day for 8 days stopped 9/15 ✚Dex shot on 9/15! no washout no double stomach protection!! ✚Prednisone as of date?: 5mgs 1x/day for ? days, then test for pain/neuro ✚gabapetin 30 mgs 2x/day buprenorphine 0.3mgs ?x/day Pepcid AC 5mgs 1x/day ElleVet]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 15, 2018 17:21:13 GMT -7
Chris you have a dangerous situation on hand. A switch to a steroid without a 5-7 days washout Or when deemed an emergency when there has been loss of leg function then a vet would do an immediate switch and minimizing the risk by providing double stomach protection of adding SUCRALFATE to Pepcid AC.
Call your vet asap now or go to ER and STRONGLy advocate for sucralfate. Sucralfate works differently than Pepcid AC to gel coat the damaged areas of the stomach and aid in healing. Pepcid AC works to suppress acids.
Dex is a very strong steroid and well know in the medical community for the damage it can do to the GI tract. Now there is BOTH Metacam and Dex in his body. Metacam can take 5-7 days to washout out!
GI tract damage: not eating, nausea (lip licking) moving to loose stool, bleeding stomach ulcers, black or red blood in diarrhea moving to a deadly perforated stomach lining.
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Post by Pauliana on Sept 15, 2018 21:54:08 GMT -7
Chris,
Pepcid AC should be given 30 minutes prior to the Prednisone and give Pepcid AC again 12 hours later.. Sucralfate is a must, as Paula said...
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Post by Chris & Coco on Sept 22, 2018 13:04:53 GMT -7
Meds: prednisone 5mg. 1/2 tab daily started 16 Sept with full tab for 5 days then 1/2 tab 5 days decreasing to every other day ✚Diazepam 5mg 1/2 tab every 8-12 hours (2 to 3 times daily) started 18 Sept ✚Tramadol 50mg 1/4 tab. 8-12 hours (2 to 3 times daily started 18 Sept ✚Methylcarbomol 500mg 1/2 tab (2-3 times daily) just prescribed today 22sept. ✚Gabapentin 250mg 1/2 ml 2 times daily Cbd oil 6 drops twice a day. Calming formula vetriscience snack colostrum as needed. Usually once or twice daily. Spoonful of pumpkin twice daily. Pepsid ac 1/2 tab twice daily
[Moderator's note: please do not modify 8 lbs Metacam as of 9/8: 1.5mgs 1x/day for 8 days stopped 9/15 Dex shot on 9/15! no washout no double stomach protection!! Prednisone as of 9/16: 5mgs 1x/day for 5 days, then 9/21 taper test for pain/neuro ✚Methacorbamol as of 9/22: 250mgs 2-3x/day ✚gabapetin ?mgs/mL? ?mgs (0.5mL dose) 2x/day ✚Tramadol 12.5mgs 8-12 hours ✚Diazepam 5mg 1/2 tab every 8-12 hours Pepcid AC 5mgs 1x/day]
No pain response yesterday or today. Confined to 25 square foot space due to serious issues with closed crate. Tugging and scratching at crate door. If I leave crate door open, he will rest comfortably inside and come outside to get water from communal bowl. Normal bowel movements, good normal poops, peeing fine. Great appetite. Walking normally. Continuing to carry outside to pee and poop. I am starting his 3rd week of crate rest.
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Post by Romy & Frankie on Sept 22, 2018 14:28:33 GMT -7
I am glad that Coco is no longer showing signs of pain. Now he can heal comfortably.
It is really important that Coco moves as little as possible. It is the immobility enforced by strict crate rest that heals the disk. We often use the analogy of a cast for a broken arm. The cast keeps the arm from moving so the broken bone can heal. The crate keeps the dog from moving so the disk can heal.
Coco should be carried to the potty place and then a leash and harness can be used to make sure only a few steps are taken while pottying.
Was the Methocarbamol prescribed today because Coco was showing signs of pain? If he was showing signs of pain today, it is not a good time to taper the pred. This is because pain means that there is still inflammation in the spinal cord. This inflammation is what the pred treats.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 22, 2018 19:54:38 GMT -7
Chris, I agree with what Romy says above about not being time to taper. Coco is obviously still in pain if methocarbamol was just added today AND YET the test for pain prednisone taper goes on.
This is NOT the time to taper prednisone, you and the vet very obviously know there is still spinal cord swelling going on. Can you phone the vet and discuss getting back on the dose of prednisone that works on swelling 5mg 1x/day? ---Taper doses of prednisone are not longer addressing the serious condition of swelling in the spinal cord area. --- When nerves are pressured by swelling they react by dying. We see nerve cell death as lossing neuro function. Something to avoid. -- It can take 7-30 days at the anti-inflammatory dose to fully resolve swelling.. So far Coco has been on a mix of different anti-inflammatories for 14 days.
Is there a medical reason Coco, may no longer have prednisone to get painful swelling resolved?
CRATE rest Limited movement is the key to getting the disc to heal. Water needs to be inside of the recovery area....no walking to a water or food bowl. Would you be able to arrange water in his recovery area?
We anxously await to hear about prednisone.
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Post by Chris & Coco on Sept 23, 2018 8:54:11 GMT -7
Methylcarbomol was prescribed since I asked for it due to this website and it took this long to get. I work 10 hours in the middle of the day, no time to get meds and no one available to take care of it for me. He is going on 3rd day no pain episode. I kept prednisone at 1 tab a day against vet orders (previous scrip) until I make sure he is pain free for at least a week. Added. With a consult vet agreed to keep the 1 tab a day but breaking it up to twice daily 1/2 tab each. He has water in his crate and drinks from that most of the time. The communal water bowl will be put away until this medical issue is resolved. Btw, the communal water bowl was next to his crate.
[Moderator's note: please do not modify 8 lbs Metacam as of 9/8: 1.5mgs 1x/day for 8 days stopped 9/15 Dex shot on 9/15! no washout no double stomach protection!! Prednisone as of 9/16: 5mgs 1x/day for ▲5+ days, then date of taper test for pain/neuro Methacorbamol : 250mgs 2-3x/day gabapetin ?mgs/mL? ?mgs (0.5mL dose) 2x/day Tramadol 12.5mgs 8-12 hours Diazepam 5mg 1/2 tab every 8-12 hours Pepcid AC 5mgs 1x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 23, 2018 9:20:22 GMT -7
Chris, there is no way for you to know/proove for sure all the pain is really gone until a pred taper has begun! The 5-day course of pred the vet Rx'd was a guess. The proof of all pain actually being gone would be during the "test for pain pred taper." Some vets guess at a 7-day or even a 14 day course of pred then give the test for pain pred taper. It really is not a good idea to mess around with prednisone on your own. Be sure you contact the vet and let him know you have extended his 5-day pred guess to now going on 8 days. That you have enough pred to carry out the taper.
Ask your vet which he wants on the test for pain taper of pred: 1) backing off all 4 pain meds (methocarbamol, gabapentin, tramadol and diazepam) OR 2) full stop of all 4 pain meds at the begin of the pred taper.
What date will the pred taper begin?
Thank you for expaining why methocarbamol was just recently started due to a shortage and just being available on 9/22. Since you have not abserved any signs of pain since 9/21, it may well be time to get a true read on pain by beginning the pred taper. Let us know what your vet says when he's open again on Monday.
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Post by Chris & Coco on Sept 25, 2018 8:16:20 GMT -7
My son in law is a vet and is in constant contact with me so I don’t change things with meds on my own. Coco is not in pain. I am keeping him in crate, hoping he will resign to the fact he is in there for awhile and stop fighting it. He has a serious wound on his nose now due to rubbing on crate door. I am treating it per vets orders. I changed my mind on the crating since I caught him on camera climbing on top of the crate to sit on top. Not good. Luckily I was still nearby so I could go home and take him off the crate. Meds are the same as last post except the prednisone which is 1/2 tab twice daily. He gets prednisone with his meals and 1/2 hour before he is given the Pepsid ac. He also gets a teaspoon of pumpkin puree, twice daily to keep his bowels regular. He still has good poops. Vet has also recommended neurological consult if his neck pain isn’t resolved within a week. I can’t afford an MRI so there is nothing I can do about this.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 25, 2018 9:10:56 GMT -7
What date did the reduction, a taper, of pred begin (1/2 of a 5mg tablet 2x/day)?
No way to tell on the test for pain taper of pred if all the pain is really gone when there are still pain-masking med on board.
Ask your vet which he wants on the test for pain taper of pred: 1) backing off all 4 pain meds (methocarbamol, gabapentin, tramadol and diazepam) OR 2) full stop of all 4 pain meds at the begin of the pred taper.
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