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Post by Alex & Loki on Aug 2, 2019 8:43:46 GMT -7
Loki is 9 years old. This is his second disk episode. The first one was in December of last year, in his lower back. He had a surgery in January and recovered well. This time it's in his neck. He has been on strict crate rest since July 1st. The episode started with occasional yelping. The neurologist put him on 100 mg gabapentin/metacarbamol/tramadol/prednisone every 8 hours. He was showing signs of improvement, but after taking him to the neurologist for a checkup 2 weeks later [7/15], he turned for the worse. He started screaming in pain. We were struggling to even give him medication initially, as he would just refuse to move or take anything. The neurologist added amantadine and told us we can give pain meds every 6 hours and amantadine every 12 hours. He is still on 2.5 mg prednisone twice a day (has been for a month now). The neurologist does not want to increase the dosage of prednisone, and frankly, i'm not sure if at this time it would be doing anything. He is not showing any signs of improvement at all except on some days when he seems to be fine, starts scratching himself, etc., but then screams in pain again and lies on his side shaking. He can walk all right, I understand that cervical disk issues rarely result in paralysis. The vet suggested a fentanyl patch, but we would have to go there every 3 days to have it applied, and i think the worst thing in his condition right now is to move him back and forth, so we declined.
[Moderator's Note. Please do not edit
weight? of mini doxie 8-10 lbs?
7/15 disc relapse with neuro checkup visit
prednisone as of 7/2: 2.5mgs 2x/day for 7 days, 7/9 test taper √7/9 pain!
as of 7/15 rlpse: 2.5mgs 2x/day for 15 days, 7/30 taper test √8/2 pain!
tramadol 25mgs 4x/day
gabapentin 100 mgs 4x/day
methocarbamol 125mgs 4x/day
amantadine ? mgs 2x/day
Pepcid AC 5mg should be 2x/day]
I guess i am just looking for an opinion: we are not considering surgery again. We cannot do surgeries twice a year, considering the price, and considering the number of vertebrae in his back that can slip at any moment. There have been no signs of improvement for a month, (or two weeks if we were to count from the time when he turned for the worse). The pain meds don't seem to work. We are not sure if what we're doing to him is torture. We are thinking of waiting until the end of august, and if he does not turn around by then, we'll have to make hard decisions. We're just not sure if we should make him go through this that long.
Has anyone had similar situation? Did it resolve?
Thank you!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Aug 2, 2019 12:42:30 GMT -7
I'm sorry to hear Loki is have such a problem with his neck disc. What is his breed? How much does he weigh? The med list is key for us to understand things, avoid the discussion going in a wrong direction. --Could you provide mgs and frequency for each of the pain meds. -- What was the start date of pred? ? mgs ?x/day for how many day before a taper started. NOTE: the important days of pred are the anti-inflammatory level. The taper days do not count as the serve a different purpose and are not high enough to effectively fight inflammation. -- Tell us about each additional course of pred ? mgs ?x/day for how many days if there have been other tapers. -- Is he on a must have stomach protector? Pepcid AC (famotidine)? ? mgs ?x/day weight? prednisone as of 7/1: ? mgs ?x/day for how many days, date of taper gabapentin 100mgs ?x/day methocarbamol ? mgs ?x/day tramadol ? mgs ?x/day amantadine ? mgs ?x/day pain caused by transport into vet 7/15 no GI tract protector Pepcid AC on board! Extras you can do at home to help with a neck disc: www.dodgerslist.com/literature/cervical.htm |
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Post by Alex & Loki on Aug 2, 2019 12:50:31 GMT -7
Loki is a miniature daschund.
He has been on 5 mg prednisone, 1/2 pill twice a day, since July 2nd. We attempted to taper a week after he started, but it appeared that he got worse, so we went to the original dose. We have tapered to 1/2 pill once a day 3 days ago. We give it with pepsid (50 mg given 30 minutes before prednisone). The neurologist does not thing we should increase the dosage and that we cannot keep him on it for so long.
Tramadol: 25 mg/every 6 hours
Gabapentin: 100 mg/ every 6 hours
methocarbamol 125 mg/ every 6 hours
Amantadine - not sure of dosage, not home right now - every 12 hours.
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Post by Romy & Frankie on Aug 2, 2019 14:12:08 GMT -7
I am so sorry that Loki is having a neck disc episode especially so soon after the back surgery. It is difficult to comment on the meds without knowing Loki's weight. Dr. Reuben's information on prednisone is in line with what we see many, many vets on this Forum using for a disc episode in terms of dosage. Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily. Dr. Dawn Ruben "Prednisone / Prednisolone" www.petplace.com/DrugLibrary/prednisone-prednisolone/page1.aspx last accessed 8/13/2014 Since surgery is not an option, some vets might want to try a different steroid. Some steroids are stronger than others. Use of a stronger steroid is considered when surgery is not an option and it might be able to get the painful swelling down. Dexamethasone is a more powerful steroid, 10x more powerful than prednisone. You can ask your vet if this might be right for Loki. We are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet. Is the 50mg of Pepcid a typo? Usually it would be 5mg for a mini doxie. |
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Post by Alex & Loki on Aug 2, 2019 14:21:16 GMT -7
Thank you. I will ask the vet about stronger steroids when we go see the vet next time.
However, I must be frank, after seeing absolutely no improvement for a month, we are starting to lose hope. Is it possible that he would ever get better? We are obviously not going to keep him on steroids and pain killers for the rest of his life, especially considering that they are not really working and he is still in extreme pain. Should we keep him suffering like that?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Aug 2, 2019 17:20:04 GMT -7
Alex, please see if we now have all the correct information about the med list. weight? of mini doxie 8-10 lbs?
7/15 disc relapse with neuro checkup visit
prednisone as of 7/2: 2.5mgs 2x/day for 7 days, 7/9 test taper √7/9 pain!
as of 7/15 rlpse: 2.5mgs 2x/day for 15 days, 7/30 taper test √8/2 pain!
tramadol 25mgs 4x/day
gabapentin 100 mgs 4x/day
methocarbamol 125mgs 4x/day
amantadine ? mgs 2x/day
Pepcid AC 5mg should be 2x/dayIF, if, if my guess about Loki's weight is close of 8-10lbs, then here are the choices you have: --- Immediately tomorrow first thing if not ER tonight (do not wait til the next time you have a vet appt--not fair to keep a dog in pain) advocate for another course of an aggressive anti-inflammatory level of prednisone at 0.3mgs x 8 or 10 lbs = 2.5mgs or 3 mgs every 12 hrs. Taper doses do not work on inflammation. Prednisone can take in the range of 7-30 days to resolve swelling. In the mean time pain meds need adjustment to provide comfort from pain.
There is no shame in going for a 2nd opinion to get what Loki needs. Best, of course, is for you to get on the phone with vet/neuro he is seeing and strongly state your case and be successful in advocating for upping pred. A new vet at a different clinic would require transporting Loki.
-- If surgery is not a financial option then why deny Loki the needed prednisone to try and get conservative treatment to work for him. Unthinkable thoughts of death option vs prednisone option is a no brainer.... YES, but of course one tries another course of prednisone! Does Loki have a health issue to prevent prednisone, was his last blood panel show good health of organs?
-- What about your local general vet helping you with Loki. A neuro is not the only vet who can treat IVDD. An IVDD knowledgeable general DVM vet most often are the ones who treat a disc episode.
-- would your general local DVM vet who may be closer and a shorter drive Rx that Fentanyl patch?
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Post by Alex & Loki on Sept 23, 2019 20:18:27 GMT -7
I am happy to say that Loki has completely recovered after 8 weeks in a crate. We did follow Paula's advice and continued with the full dose of prednisone for one more week. [Moderator's Note. Please do not edit
weight? of mini doxie 8-10 lbs?
7/15 disc relapse with neuro checkup visit
prednisone as of 7/15 rlpse: 2.5mgs 2x/day for 15 days, 7/30 taper test √8/2 pain!
as of 8/3: 2.5 mgs 2x/day for 7 days, then 8/10 taper test: NO PAIN !!!!]
He somehow quickly turned around, started acting like nothing ever happened, and a week later we could successfully start tapering prednisone without any more screaming episodes. It is hard to believe that only a few weeks ago Loki was in agony and we were considering putting him down. I hope this gives some hope to those in the same situation. Neck episodes are brutal, take about two months to heal, during which the pain can be so bad that no combination of drugs can help. But they still come out of it! www.dodgerslist.com/forumads/Graduate.jpg |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Sept 24, 2019 6:26:00 GMT -7
Congratulations to you and Loki for finishing all 8 weeks of strict crate rest, Alex! So glad to hear that Loki has completely recovered. Do take it nice and slow with Loki. His muscle strength and stamina need to be very gradually built up again. I found the schedule on the following link to be helpful when my Jeremy graduated from conservative care. You'll also see a list on that page of never-again activities, such as no going up or down stairs or jumping, that will help prevent a future disc problem. www.dodgerslist.com/literature/AfterCrateRest.htmHere's our link on how to make your home back friendly: www.dodgerslist.com/literature/protectback.htmWe invite you to hop on to our educational bandwagon team in any way that makes you happy. Education about disc disease is our number one mission! We wish we did not have to hear of another dog that was put to sleep because of disc disease nor one denied the correct principles of crate rest to help them heal.
--- You've been there, and are doing it....if you see another member on the Forum needing support or information share what you know to be true or point them to one of our many IVDD articles. The "search box" on each page makes quick work to find the right helpful link: www.dodgerslist.com/-- "Share" our FB/twitter/ posts to widen the reach of IVDD knowledge www.facebook.com/Dodgerslist twitter.com/DodgersList-- Hand carry our literature and introduce us to your vet. When in conversation at the grocery store line or wherever you meet breeds most prone to IVDD (Dachshunds, Beagles, Poodles, Spaniels, Shih Tzus, Pekingese, and Chihuahuas) to give out our little cards. Ask Linda to send you our free packet: www.dodgerslist.com/literature/litorder.htm
-- We have a store where you might find something you absolutely need! Our earnings go to paying for our webpage and literature to hand out. www.dodgerslist.com/store.htm-- Don't forget to add a photo to the gallery and 1-2 sentences. Give inspiration to others just starting a scary IVDD journey. Directions to u/l here: dodgerslist.boards.net/thread/2262/put-dodgerslist-photo-gallery-calendarAnd please keep in touch with us. We love updates from our graduates. Prayers for many happy, healthy years ahead for you and Loki. |
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