|
|
Post by Daniel & Polo on Feb 28, 2019 20:57:05 GMT -7
Hello. My name is Daniel. My husband and I have 2 chiweenies and 1 maltipoo (Polo).
Polo is 9 years old and weighs roughly 13 lbs.
He suddenly started randomly screaming in pain on 1/09/19 and we took him to the vet on 1/10/19.
He was diagnosed with a slipped disc and was (I think) initially prescribed:
12.5 mg of Carprofen 2x/day for 7 days and then 1x/day for 21 days;
100 mg of Gabapentin 4x/day; and
Crate rest.
We weren't exactly sure how strict crate rest was meant to be until we found this site (and Polo is not a very active dog anyway) so we still occasionally allowed him to lie in our laps or on our bed and also let him wander around outside for short periods while he was doing his business.
When his pain did not subside we took him back to the vet on 1/15/19 where x-rays and examination by a specialist were ordered. The x-rays confirmed that he has a slipped disc between 2 of the vertebrae in his neck and the specialist said that surgery was not an option. The vet said the prognosis was not good and I took this to mean she thought Polo might become paralysed due to his condition (although he has not shown any indication of paralysis before or since then).
After the course of Carprofen finished he was prescribed:
5 mg of Prednisone every 2nd day;
Along with the usual course of Gabapentin.
[Moderator's note: please do not edit
13 lbs.
Carprofen as of 1/10 - STOPPED 2/7
Prednisone as of 2/11 (4 day washout): 5mg 2x/day for 7 days then test taper for √1/15 pain!!!/neuro
2/22 True crate rest first employed
Gabapentin 100 mg 4x/day
No stomach protection Pepcid AC prescribed!]
Polo is still eating and drinking and urinating and pooping OK but his (and our) major problem is that he is still obviously in a great deal of pain. He screams out sharply and loudly a number of times per day and night, shivers and shakes a little bit, has shoulder/neck spasms while he is lying down, gets up very gingerly and sometimes totters a bit when he is standing/walking.
We honestly do not think he has shown much if any improvement in the roughly 7 weeks since his nightmare began.
Since discovering this website about 1 week ago [2/22?] we have become much stricter with his crate rest and carrying him to and from his short toilet breaks. I will also be making an appointment to see the vet again tomorrow to ask about putting him on some of the other pain relief medications I've seen mentioned here (specifically Tramadol and Methocarbanal).
I was wondering if the above approach sounds like a good idea and if anyone recommended anything else to ease poor Polo's suffering.
Thanks for your help.
|
|
Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
|
Post by Marjorie on Mar 1, 2019 6:19:11 GMT -7
Welcome to Dodgerslist, Daniel. So glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you. So sorry you were told by the specialist that the prognosis wasn't good. Neck injuries can heal with conservative care if strict crate rest is adhered to for a full 8 weeks. Pain hinders healing and must be brought completely under control. Does the specialist have the following initials after name: ACVIM neurology or ACVS ortho? You have several emergent matters to discuss with the vet ASAP first thing this morning. Rather than make an appointment to bring Polo in and risk too much movement of the spine during transport, can you call the specialist who saw Polo and discuss the following with them? If not, then call the vet who has seen Polo. There should be no need to transport him to the vet. 1. Since Polo still has pain, there is still swelling pressing on the nerves of the spine and therefore an emergent need for the anti-inflammatory dosage of the Prednisone. An anti-inflammatory dosage would be 5mg 2x/day for a period of at least 7 days before starting a taper. Anything less than the anti-inflammatory dosage will not be effective in getting the swelling down. It's the swelling pressing on the nerves of the spine that causes the pain and loss of neuro function. You're already seeing tottering or wobbliness in his walk which is a sign of nerve damage. 2. Polo's pain needs to be brought completely under control TODAY. Neck injuries can be more painful than back injuries and most often need all three pain meds prescribed. That's a very high dosage of Gabapentin - please check the label on the bottle. We usually see 50mg prescribed 3x/day. Tramadol is the general pain med and also needs to be prescribed 3x/day. Methocarbamol is needed for the muscle spasms that you're seeing and also needs to be given 3x/day. Pain should be completely under control within one hour of giving new course of meds and should remain completely under control from one dose to the next or advise vet ASAP so vets can again be adjusted. Signs of pain to be aware of: ☐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 ☐Not their normal perky selves? 3. It doesn't appear as though a 4-7 day washout period was done when switching from Carprofen (NSAID) to Prednisone (steroid). This was very dangerous. Please advocate strongly for the addition of TWO stomach protectors - Pepcid AC and Sucralfate. Even if a washout period was done, Pepcid AC 5mg 2x/day 30 min before the Pred and then every 12 hours thereafter is needed for as long as Polo is on Prednisone. There are other things that you'll need to do to help Polo's neck heal, such as softening hard kibble, raising food/water dishes. Tips here: www.dodgerslist.com/literature/cervical.htmThe hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/literature/CrateRRP.htmSTRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: www.dodgerslist.com/literature/chiropractic.htm ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment. Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum 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! www.dodgerslist.com/literature/slingwalk.jpg  Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD soonest possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. Your dog will be depending on your ability to learn - excellent video series here: www.dodgerslist.com/literature/theater.htm PRINT OUT this link and tape to your fridge: www.dodgerslist.com/literature/healingpage.htm use the printout as your roadmap to avoid dangerous detours in your dog’s care make notes/highlight to keep yourself on track follow all the links in the next days to become the IVDD savvy pet parent your dog needs. Use the “search box” to easily locate topics over at our Main www.Dodgerslist.com website: www.dodgerslist.com/index/searchBOX.jpgPlease let us know what the vet says after speaking to them this morning. Healing prayers for Polo. |
|
|
|
Post by Daniel & Polo on Mar 1, 2019 20:16:44 GMT -7
Hi Marjorie. Thanks very much for the quick and detailed response.
To clarify something I didn't explain very well in my original post; after Polo finished his course of Carprofen he did have a 4 day washout period, and then began a course of Prednisone at:
5 mg 2x/day for 7 days; then 5 mg 1x/day for 7 days; and then 5 mg every 2nd day.
I spoke to the vet today and she agreed to adjust Polo's treatment as follows:
✙Prednisone - 5 mg 2x/day for the next 7 days (and then tapering);
▼Gabapentin - 50 mg 2x/day;
✙Tramadol - 25 mg 2x/day (at alternative hours to the Gabapentin);
✙Methocarbamol - 125 mg 2x/day;
✙Sulcrafate - 500 mg 1x/day (an hour before meal); and
✙Pepsid AC - 10 mg 1x/day (at bedtime).
[Moderator's note: please do not edit
13 lbs.
Carprofen as of 1/10 - STOPPED 2/7
Prednisone as of 2/11: 5mg 2x/day for 7 days then test taper for √1/15 pain!!!/neuro
as of 3/1: 5mg 2x/day for 7 days, then 3/8 test taper for pain/neuro
2/22 True crate rest first employed
Gabapentin - ▼50 mg ▼2x/day
✙Tramadol - 25 mg 2x/day
✙Methocarbamol - 125 mg 2x/day;
✙Sulcrafate - 500 mg 1x/day
✙Pepcid AC - 10 mg 1x/day ]
I notice the dosages for Gabapentin, Tramadol and Methocarbamol are all 1 less than you had recommended. The vet did say that we could increase [frequency???] the dosages of the pain medications if we thought they weren't effective but should we just go ahead and start them at the higher dosages now?
Thank you for the other information provided too. I wish we had discovered this website earlier.
Kind regards.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Mar 2, 2019 5:45:14 GMT -7
Great job on advocating for these meds, Daniel! Glad to hear that a 4-day washout period was done.
With the amount of pain that Polo is showing, if the vet has indeed given you the OK to give the pain meds (Gabapentin, Tramadol and Methocarbamol) 3x/day, then by all means do give them 3x/day (every 8 hours). Each of these meds have a short half life and don't stay in the body for long, giving pain a chance to rise between doses. Please let us know which you're doing - every 2 or 3 times a day. We're not vets and all information we give you is so you have information to discuss with your vet.
We often see all three pain meds being given together at the same time so I'm uncertain of the vet's reasoning for giving the Tramadol at alternate hours with the Gabapentin. Both were to be given twice a day? If you're giving the three pain meds 3x/day, discuss with the vet giving them together so you're not up all hours of the night giving meds. You all need your rest at night.
Pain should be completely under control within one hour of giving new course of meds. If there is still pain with the new meds and assuming pain meds are being given every 8 hours, the dosage of the Tramadol can be increased to 50 mg.
Prayers that Polo's pain is now completely under control so he can rest and heal in comfort. Please let us know how he's doing today.
|
|
|
|
Post by Daniel & Polo on Mar 5, 2019 23:14:13 GMT -7
Polo Update:
The first and BEST news is that, to the best of my knowledge, Polo has not screamed or cried or even whimpered in pain once since we began his new treatment regimen. :-)
For the first time, this seems like an obstacle he can hopefully overcome rather than one that would lead to us making a painful decision after months of watching him suffer.
Initially, we had him on pretty much the treatment schedule recommended by the vet:
Prednisone 2 x 5 mg / day
Tramadol 2 x 25 mg / day
Gabapentin 2 x 50 mg / day
Methocarbamol 2 x 125 mg / day
Pepsid AC 1 x 10 mg / day
Sucralfate 1 x 500 mg / day.
However we noticed he still had spasms in his neck/shoulder occasionally and didn't seem as 100% comfortable/at ease as a relaxed dog with no pain would. So after a couple of days of that regimen we increased [3/5] it to one that we think matches the recommendations of this website Also, to give specific dates, Polo was on the initial (reduced) treatment on 3/3/19 and 3/4/19 and began his increased treatment on 3/5/19.
Prednisone 2 x 5 mg / day
▲Tramadol 3 x 25 mg / day
▲Gabapentin 3 x 50 mg / day
▲Methocarbamol 3 x 125 mg / day
Pepsid AC 2 x 5 mg / day
Sucralfate 1 x 500 mg / day.
[Moderator's note: please do not edit
13 lbs.
Carprofen as of 1/10 - STOPPED 2/7
Prednisone as of 2/11: 5mg 2x/day for 7 days then test taper for √1/15 pain!!!/neuro
as of 3/1: 5mg 2x/day for 7 days, then 3/8 test taper for pain/neuro
True crate rest 2/22 first employed
Gabapentin - 50 mg ▲3x/day
Tramadol - 25 mg ▲3x/day
Methocarbamol - 125 mg ▲3x/day;
Sulcrafate - 500 mg 1x/day
Pepcid AC - 10 mg 1x/day ]
So far, Polo seems to be responding very well to this treatment. The spasms have stopped and there don't seem to be any indications of pain.
He is also on strict crate rest however we sometimes have an issue when we take him out to do his number 1s or 2s. We carry him to one of the spots he might normally use but he then decides he wants to do it in one or two other places. This is especially difficult with his number 2s. I was wondering how many steps he might be allowed to take before risking re-inflaming his injury?
Thanks again for any help.
I forgot to mention that the Tramadol, Gabapentin and Methocarbamol are all at 8 hour intervals. The Prednisone and Pepsid AC are roughly every 12 hours. And the Sucralfate is 2 hours after the evening Tramadol, Gabapentin and Methocarbamol and 1 hour before his dinner.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Mar 6, 2019 6:25:58 GMT -7
Wonderful news that Polo's pain is now completely under control, Daniel! So very glad to hear it. Great job on advocating for what Polo needs.
To limit steps at potty time, use a harness (no more collars for Polo!) and a 6' leash and stand in one spot. Or you can place an ex-pen outside or make a 6' potty area with push-in-the-ground plastic fencing. That will give a physical and visual boundary where potty needs to be done. Only a very few steps should be taken during potty time.
It would appear that the taper of the Prednisone will start this Friday, 3/8. At that time, the pain meds should also be tapered or stopped so a true test for pain can be made. What instructions has the vet given you about tapering or stopping the pain meds during the taper? Having pain meds on board during a taper of the anti-inflammatory would make it difficult to determine if there is still pain/swelling. You'll need to be on the alert for any sign of pain returning during the entire taper of the Prednisone. Should you see any sign of pain return, you'll need to immediately alert your vet (or better yet, have a back-up plan already in place of what you should do) so all of the original meds can be re-started for a bit longer. Pain means there's still swelling pressing on the nerves of the spine and still a need for the original dosages of meds. Swelling can take 7-30 days to resolve so it's not uncommon for 2-3 tapers to be tried before swelling is gone.
|
|
|
|
Post by Daniel & Polo on Mar 8, 2019 12:02:07 GMT -7
3/7 third relapse of healing disc Hi Marjorie! Sorry about the delay in replying. Polo's recovery has been up and down this week so we weren't sure what his status was for an update. To clarify something from your previous post though - I think you have mistakenly noted in your summary list that Polo began his Prednisone on Friday 3/1 and would therefore begin his taper today (Friday 3/8). He actually began this second course of Prednisone on Sunday 3/3 (and would normally therefore begin his taper on Sunday 3/10 I think). First the good news; we have successfully built a little enclosed area in our back garden and Polo seems to have adapted well to using it for his toileting. Now for the bad news; Polo's pain has well and truly returned. :-( He gave a couple of short, sharp shouts yesterday and last night and now today seems to be experiencing almost the same intermittent high level of pain he was in before we began this new pain treatment. [Moderator's note: please do not edit 13 lbs. Carprofen as of 1/10 - STOPPED 2/7 Prednisone as of 2/11: 5mg 2x/day for 7 days then test taper for √1/15 pain!!!/neuro as of 3/3: 5mg 2x/day for 7 days, then 3/10 test taper for √ 3/7!pain/neuro PaTrue crate rest 2/22 first employed Gabapentin - 50 mg ▲3x/day Tramadol - 25 mg ▲3x/day Methocarbamol - 125 mg ▲3x/day; Sulcrafate - 500 mg 1x/day Pepcid AC - 10 mg 1x/day ] We wonder if there might be one or two causes for this relapse: 1. Since the IVDD is in his neck, even crate rest might not be enough to prevent him from moving and therefore damaging the discs in his neck again; and/or 2. We have people coming and going from the house all day (nurses and visitors for some elderly people my husband cares for and workpeople for the home renovations we are doing at the moment) and Polo gets very threatened and defensive whenever there are new people in the house. There is unfortunately little we can do about the second issue other than keep him confined to a room at the back of the house where he is least likely to be disturbed (although he whines when he is left alone for a long time), and for the first issue we don't know what we can do other than raise his food and water bowls (which we have done). We also wonder if our medication schedule is appropriate. I believe I've read on this site that pain medications are only effective for a short period [CORRECTION! half life is short- HUGE diffference!!] ( around 2 hours I think?). Is our schedule of giving them together every 8 hours insufficient then? Here is our treatment schedule for reference: 9 am: Gabapentin (1 x 50 mg), Tramadol (1 x 25 mg), Methocarbamol (1 x 125 mg), Pepsid AC (1 x 5 mg), Prednisone (1 x 5 mg). 5 pm: Gabapentin (1 x 50 mg), Tramadol (1 x 25 mg), Methocarbamol (1 x 125 mg). 7 pm: Sucralfate (1 x 500 mg). 8 pm: Pepsid AC (1 x 5 mg), Prednisone (1 x 5 mg). 1 am: Gabapentin (1 x 50 mg), Tramadol (1 x 25 mg), Methocarbamol (1 x 125 mg). Finally, since Polo's swelling has obviously not actually reduced yet, can we leave him on his current full course of Prednisone beyond this Sunday (rather than tapering), and if so, how long can he stay on that drug? Sorry for the long ramble. I'm waiting for the vet to call me back and wanted to get down a lot of my thoughts while doing so. It's great to have this board to discuss these issues on! |
|
PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Mar 8, 2019 13:04:38 GMT -7
Sorry to hear what sounds like the early healing disc may well have had a relapse with too much movement, since all pain had been fully controlled by meds and then the pain resurfaced. So you know it is not time to begin a pred taper. Half-life of a drug can be complicated regarding how long the medication takes to eliminate from the body via liver or kidneys, how long it stays at a level that is effective. Here a very simplistic idea of how that might work. Imagine a med that has a half-life of 30 minutes, for example. If starting out with 30mgs of it, 30 minutes later there will be 15mgs remaining, and in another 30 minutes only 7.5mg remaining and so forth. Every 8 hours is correct dosing for the pain of a disc episode for gabapentin, methocarbamol and tramadol. ADVOCATE with your vet for Rxing the Max analgesic dose of Tramadol. WARNING... the vet's job is to prescribe and adjust meds (not your job). Your job is to be the eyes and ears for him at home and alert to changes in neuro, pain and advocate for meds being adjusted. My 13 pound doxie for example was prescribed the max analgesic dose of tramadol 50 mgs every 8 hrs. If getting pain meds at the max will not control pain, then if it would be a consideration for your family thought about a surgery might be an approach. Do study up surgery vs. conservative and be prepared to discuss things with your vet -- www.dodgerslist.com/literature/surgery.htm-- www.dodgerslist.com/literature/healingsurgery.htmClearly Polo just can't be allowed to be rambutious for whatever reason. If takes him being slightly drugged then so be it. Calmers can take days to work and work best when two different ones are used. Prescription sedsedativesataives work right away. Discuss all with your vet. 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:
Oral calmers:
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 |
|
|
|
Post by Daniel & Polo on Mar 22, 2019 19:19:18 GMT -7
Hi Paula. Thanks very much for the above information. Sorry for the delayed response. My computer has been inaccessible for the last two weeks while our home is being renovated.
Sad and final Polo update:
Polo passed away in his sleep this morning. My husband and I are obviously devastated. I was definitely not expecting it.
Unfortunately, we could never get his pain under control again after his relapse. Here is the regimen he was on at the end:
9 am: Gabapentin (1 x 100 mg), Tramadol (1 x 50 mg), Methocarbamol (1 x 125 mg), Pepsid AC (1 x 5 mg), Prednisone (1 x 5 mg).
5 pm: Gabapentin (1 x 100 mg), Tramadol (1 x 50 mg), Methocarbamol (1 x 125 mg).
7 pm: Sucralfate (1 x 500 mg).
8 pm: Pepsid AC (1 x 5 mg), Prednisone (1 x 5 mg).
1 am: Gabapentin (1 x 100 mg), Tramadol (1 x 50 mg), Methocarbamol (1 x 125 mg).
Ironically, we had an appointment with the vet today to pick up Amantadine to see if that might improve things for him.
Over the last two months of Polo's treatment, the vet's advice had differed from this site's in two ways:
1. She had said that recent research shows that Tramadol is an ineffective pain reliever in animals and had suggested we take him off it; and
2. If we were going to continue using it, she had recommended staggering the two pain relieving drugs to one every alternate four hours, to more evenly prevent the pain from flaring up again I presume.
I'm not sure how good or bad her advice was but just thought I'd mention it.
I'm also not sure what Polo actually died from; whether it was the pain or something neurological that might have developed or all the drugs he was on or just his broken heart from being locked away from us in a cage for so long. It's horrible to think about.
However, we take comfort in the fact that in the two years since we rescued him, we had been able to give him the loving, healthy, active, social, life that he had been denied for his first seven years.
Thanks very much to everyone at this site for all of your help and advice. We greatly appreciated it. And we will now be much more aware and reactive if either of our chiweenies should develop this awful disease.
Take care.
Daniel
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Mar 22, 2019 20:11:54 GMT -7
Oh, Daniel, I'm so sorry and sad to read your post about Polo. There are many things he could have died of that can't be known, heart failure, etc. impossible to know. Try to concentrate on the positives you brought to Polo in giving him a forever home and all the wonderful memories these past two years you shared with him. Take joy in remembering, all the lovely things Polo taught you as you continue life’s journey. The pain of losing a loved one is great and deserves your attention and time to process. Maybe what Carmen, one of our members, has written about the grieving process will help you, too: www.dodgerslist.com/literature/grief.pdf Your two chiweenies may also need some comfort during this time. Trying to spend extra time and attention with them, it will be good for you as well as for them, playing special games with them, giving them special treats, etc. Let them have Polo's blanket so his smell can help them to understand what happened. My sincere condolences to you and your husband. |
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Mar 23, 2019 6:35:47 GMT -7
My sincerest condolences on your tragic loss, Daniel. What a terrible shock that must have been for you and your husband. I'm so very sorry to hear this. Please don't blame yourself and think it was a broken heart from crate rest. I'm sure Polo felt your love all through his confinement and you need to know in your heart that you were doing what was best for him. As Paula said, it could have been a heart attack, a stroke, so many different things. Try to take it one day at a time. Prayers are with you and your husband that your hearts will heal soon.
|
|
|
|
Post by Romy & Frankie on Mar 23, 2019 12:59:37 GMT -7
I am very sorry for you loss of sweet Polo. My deepest sympathy.
|
|
