Stacy’s Fred 10/3 conservative - NECK

Fred is 20lbs and needs to lose a couple. The new vet was fantastic. She sat in the floor with him instead of putting him on the table just so we wouldn’t have to move him. He is now on prednisolone 5mg every 12 hours for the next week then tapers down. ✚Methocarbamol 500mg 1/2 tablet every 12 and ✚Gabapentin 100mg every 8 to 12 hours. I haven’t given the gaba because while he is stiff he isn’t helping or crying. Yesterday was a good day, in fact he almost seemed normal which had me thinking maybe it was a pulled muscle. Keeping him still and in crate was hard as he was feeling better.

[Moderator's note: please do not modify
20 lbs
prednisone as of 10/3: 5mgs ?x/day for 1 day
prednisolone as of 10/4: 5mgs 2x/day for 7 days, then 10/10 taper to test for pain/neuro
✚Methocarbamol 250 mgs 2x/day
Gabapentin 100mg WHICH?: every 8 or 12 hrs. NOT GIVEN!
tramadol ? mgs ?x/day  STOPPED
stomach protection- Pepcid AC?? ]

This morning however is a different story. When I took him out of crate he yelped and is extremely stiff. I’m going out today to grab some Pepcid for his belly. He is eating and pooping ok.

Stacy, help us to understand his med list.

Is prednisolone  to be given 5mgs 2x/day for seven ? days starting from  10/4.  
--- You gave prednisone  5mgs  how many times a day on 10/3


Pain meds have a short half life so each of them usually must be  be Rx'd for every 8 hours  for round the clock comfort.  Usually it will take three different pain meds (tramadol, methocarbamol, and gabapentin)  each working on a different kind of pain to provide dose to dose  comfort from pain.

Let us know which you actually are giving:
--- gabapentin  100mgs every 8 hours or every 12 hours starting today.  It is for nerve pain
--- see about methocarbamol getting Rx'd for every 8 hours with perhaps the dose then being adjusted.  It is for the pain of muscle contractions.
--- Tramadol is no longer being given?   It is the general analgesic!  It if is still given, what is the dose in mgs and how often?
--- Pepcid AC (famotidine) 5mgs   twice a day?

Stacy, I remember you from last time!  I am sorry to hear Fred is having such a rough time!  Once his pain is under control it will make all the difference!

You mentioned in your post the Gabapentin could be given every 8 hours.. please do for Fred's sake, he is in pain! Ask the Vet if Fred could get Methocarbamol with the dosage adjusted for every 8 hours as Paula wrote.. Also ask for Tramadol to be added every 8 hours.. Reluctance to move is a major sign of pain.. Not lifting his head? Did the Vet mention this might be a neck disc episode??  Is he favoring his right FRONT leg?? 

The treatments for a disc episode are the same no matter whether it is a cervical disc or another disc lower down in the spine which is causing the problem: conservative treatment or surgery. A disc problem in the neck can be more painful and may take longer to resolve because a dog moves its head with almost all actions and when any other part of the body moves. That constant movement means that healing can take longer because the neck doesn't get the rest to allow the disc uninterrupted healing.

These are additional things you can do to help with a cervical disc problem during the 8 weeks of 100% STRICT crate rest 24/7 with conservative treatment:

Make sure the medications are fully controlling pain from dose to dose with no break through in pain. Continued feedback to your vet is vitally important until the pain medications have been properly adjusted for your dog. There is no "one-size-fits-all" pain control.

Signs of pain are holding the head in an unusual position...head held high or nose to the ground, using eye to look rather than turning head, shivering/trembling, not wanting to move much or moving gingerly, yelping, tight/tense stomach muscles, holding leg up flamingo style...not wanting to bear weight on the leg.

These are the typical pain medications used to treat IVDD to address each source of pain:

Tramadol as the general pain reliever. It has a short half life of 1.7 hours and may need to be prescribed at a minimum of every 8 hours.

Methocarbamol treats painful muscle spasms. Also prescribed every 8 hours.

Gabapentin for nerve pain. Veterinarians are finding this medication works synergistically in combination with Tramadol.

Amantadine. When the above three meds have been Rx'd at the aggressive dose in mgs and at every 8 hours, but pain is still not fully controlled, then advocate for the addition of amantadine - allows other analgesics to function more effectively. The Mar Vista vets explain the mysteries of amantadine marvistavet.com/amantadine.pml

Raise food and water bowls to head height to avoid bending down to eat and drink. [photo how to]

If you feed kibble, moisten each meal with equal parts water and kibble. Store in the fridge overnight to soften and rehydrate. Before serving, warm slightly in microwave, just to take the chill off. This will eliminate pain from crunching kibble.

No chew treats or kongs during recovery. Chewing on those makes the head and neck move a lot and can disrupt the healing process of the disc, causing more pain and more time to heal the disc.

Fred may like a rolled up blanket or bolster where he can choose to rest the head on or lean against. Mary's tip: warm up light-in-weight-100%-synthetic fleece in the dryer to drape over shoulders/neck for coziness.

Raise the crate up on a table so there is no need for your dog to to raise the head to look at you or watch the world from his recovery suite.

Panting can be a side effect of the meds. A fan near but not pointed at the crate will help. Also a rice sock from the refrigerator can help them cool by laying their tummy along side of it. Fill a sock with 1-2 cups of rice and tie the end of the sock closed. Try a frozen broth ice cube to lick on. Or it can be from anxiety. Or it can be a sign of pain. If a fan helps, then it is most likely a side effect of the meds. If you see other signs of pain with the panting such as shivering, trembling, yelping, tensed up tummy, then the panting could be a sign of pain. Dr. Isaacs discusses this issue: www.dodgerslist.com/neurocorner2/panting.htm

If you're concerned about increasing the frequency of giving Gabapentin because of panting when on it, then speak to the vet about adjusting the Methocarbamol to every 8 hours and adding in Tramadol every 8 hours to see if that's enough to get the pain completely under control. All three of these meds do work best when given every 8 hours. Fred shouldn't be allowed to remain in pain so do let us know what adjustments are made to the meds today. Neck injuries can be much more painful than back injuries and often require all three meds 3x/day to get the pain under control.

Healing prayers for Fred.

Stacy, transport can be risky for a dog going through a current IVDD episode. Most vets who understand the importance of strict crate rest will agree to adjust meds during a telephone consult rather than have the dog transported to the office. Can you speak to the vet by phone this morning, advise of the signs of pain that you're seeing and request that the pain meds be adjusted?

Also since you're still seeing signs of pain, the taper of the Prednisone which should be starting in another day or so should be extended a bit longer. Pain means there's still swelling pressing on the nerves of the spine and still a need for the anti-inflammatory dosage. So do speak to the vet about extending the anti-inflammatory dosage (5mg 2x/day) for a bit longer.

If the vet insists on seeing Fred today rather than doing a phone consult (but I do hope you'll be able to convince him otherwise), be sure to secure his crate in the car and pad it well with rolled up blankets/towels to prevent him from being jostled around too much when stopping or turning the car. And try to keep the movement of his spine to a minimum during the office visit.