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Post by Vannette & Sissy on Jan 3, 2020 12:04:38 GMT -7
{Original Subject Medical question}
I am Vannette. My dog is Sissy and is a dachshund. She weughts 12 lbs and us 10yrs old. Last night she came in fromm the yard and I knew something was wrong. Sitting with nose up in the air. Ridged and in obvious pain. All the signs were there. Wrapped her in blanket and went to our vet DVM. She is in ALOT of pain, dragging one foot and very wobbly. Dr. Gave her prednisone 5mg to be taken once a day. Plus codeine 1\4 if a 15mg pill every 6 hrs.
[Moderator's Note. Please do not edit
12 lbs
Prednisone as of 1/3: 5mgs 1x/day for ? days, then a test taper to reveal any: _pain / _neuro
codeine 15mg pill: 3.75mgs 4x/day
needs GI tract protector, Pepcid AC, on board w/Prednisone!
The pain meds dont seem to be working very well in my opion. We put her in a doggie play pen with blankets last night when we got home. She is eating and drinking water. But she us only moving [to reposition] from laying on one side to the other. She did pee outside on her own this morning and even pooped a bit. My husband carried her cuz his hands are bigger. She hasnt gone potty for me because I think I cause her pain cuz i gave smaller hands and am not supporting her well. Question....i read on your page about the 3 different meds. Tramadol plus methocarbamol and amantadine. Should i ask the vet for this combo along with the steroids?  Its killing me to see her this way. Thank you!! |
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Post by Romy & Frankie on Jan 3, 2020 14:44:53 GMT -7
Welcome to Dodgerslist, Vannette! We are 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! Disc disease is not a death sentence! Struggling with quality of life questions? Re-think things:
Sissy should not be in pain. Since you are seeing signs of pain like reluctance to move you know that the pain meds are not right. These are the signs of pain we look for; ☐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?
When pain meds are right, Full pain relief is expected in 1 hour and there is no pain between doses.
The medicines we have seen work best with IVDD dogs is a combination of three each attacking pain differently. Methocarbamol for painful muscle contractions 3x/day. Tramadol Rx'd 3x/day as the general pain reliever Gabapentin for nerve pain also Rx'd 3x/day.
Amanadtine is often used along with other pain meds to give an extra benefit and we are seeing many surgeons using it along gabapentin and tramadol. You can read more why this is so: www.marvistavet.com/amantadine
It may be possible to increase the dose of pred to 2x a day. This would be more in line with the anti-inflammatory dose for a 12 lb dog: 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 Dr. Reuben's information on prednisone is in line with what we see many, many vets on this Forum using for a disc episode. Because pred comes in 5mg tablets, often vets will go ahead and prescribe the full 5mg tablet 2x/day
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.
Codeine is not usually an effective pain reliever in dogs. The Veterinary Anesthesia & Analgesia Support Group plus other veterinary professionals say this about codeine: "It should be noted that both morphine and codeine appear to have poor oral bioavailability in dogs and cats, which makes their efficacy questionable. Anecdotal reports of pain relief exist, but the results tend to be inconsistent." www.vasg.org/chronic_pain_management.htm
Please call the vet right away, explain what signs of pain Sissy is showing and advocate for these medicines as soon as possible, today. Sissy should not be in pain. Pain will only slow the healing process.
I am very glad that you have confined Sissy to a play pen. The size of the recovery suite, in Sissy's case a play pen, should only be large enough to stand up, turn around and fully stretch the legs when lying down. If the play pen is larger than that, pad out the extra space with rolled up towels or blankets.
Strict crate rest for 8 weeks is the hallmark component of conservative treatment (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. www.dodgerslist.com/literature/CrateRRP.htmSTRICT means:
◼︎no laps
◼︎no couches
◼︎no baths
◼︎no sleeping with you
◼︎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 Sissy 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!
All dogs on anti-inflammatories are at risk for GI tract damage caused by excess stomach acid. This excess acid is seen with all anti-inflammatories. To reduce the chance of stomach damage a stomach protector, like Pepcid AC is needed. Ask your vet if Sissy has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
The usual dose for Doxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours.
Is she showing any signs of GI Tract problems? No vomiting? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea?
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 as soon as 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:
PRINT OUT this link and tape to your fridge:
--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 site:
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Post by Vannette & Sissy on Jan 3, 2020 15:04:48 GMT -7
Spoke with the vet this afternoon and ge is prescribing the gabapentin but keeps telling me that the tramamen doesnt work as well. Says it turns to codeine anyway just with an extra step. My husband is going to ask about the pepcid when he pucks up the gabapentin.
So i guess we will be doing the steroids (which he increased) and the codeine and the gabapentin.
We'll see how that goes for now i suppose before I press for change. I thank you and i do wish he would prescribe what you suggested. So we'll see. Thanks again!
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Post by Romy & Frankie on Jan 3, 2020 15:31:10 GMT -7
Good work getting the pred increased and the gabapentin added. Please let us know the exact dosage and frequency of the meds and the number of days the pred is prescribed for.
It is possible that the addition of gabapentin will keep her pain under control. You will be able to tell very shortly after you give the gabapentin if that is enough to keep Sissy out of pain. We know that some vets are reluctant to prescribe tramadol, but we have seen many, many dogs get pain relief from it.
If you are still seeing pain, tell the vet what you are seeing and advocate for an adjustment of medication. Sissy will need your voice.
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Post by Julie & Perry on Jan 3, 2020 15:43:12 GMT -7
There is some research out there that says Tramadol doesn't work.
Many vets believe it.
I am not a vet but both my dogs have IVDD. By taking Prednisone, Tramadol, gabapentin, methocarbomal, and pepcid ac, they were comfortable!!
If Sissy is still in pain with the gabapentin added then I'd push for the Tramadol to be added.
It actually works well together with the gabapentin.
Hopefully your vet will work with you. If not you may need to find another vet.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jan 4, 2020 10:13:18 GMT -7
Vannette, it is important to have no patience at all with pain. Especially so since your vet has plenty of room to move up to a more aggressive medicaiton approach if pain is not covered round the clock.
So we are prepared without delay to comment, would you bring us up to speed on the current medication list:
MED LIST (missing details)
12 lbs
Prednisone as of 1/3: 5?mgs 1?x/day for ? days, then a test taper to reveal any: _pain / _neuro
codeine 15mg pill: 3.75mgs 4x/day
gabapentin ? mgs ?x/day
needs GI tract protector, Pepcid AC, on board w/Prednisone!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jan 5, 2020 9:42:45 GMT -7
Jan 5, 7am MST, Message moved to the Forum on behalf of Vanette:
After receiving the gabapentin Friday she slept very well and woke up happy Sat morning. Good all day until Sat evening when we took her iut to potty. She mived wrong or something and was in slot of pain. Called the vet and her had us
double?[clarify in terms of mgs/frequency] up on the ▲gabapentin and
give an evening ▲steroid.
Sge slept well and woke up feeling better this morning.
Prednisone 5mg 1 to 2 times a day [which exactly is it once OR twice a day frequency?]
Codeine 3.2 mg. Every 6 hours (15mg tablet broke into 4)
Gabapentin 100mg in evening before bed
[Moderator's Note. Please do not edit
12 lbs
Prednisone as of 1/2: 5mgs 1x/day for 2 days
as of 1/4: 5mgs ▲2x/day for 1 day, then 1/5 test taper to reveal any: _pain / _neuro
codeine 15mg pill: 3.75mgs 4x/day
✙gabapentin 100mgs 2x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jan 5, 2020 10:12:58 GMT -7
Vanette, thank you for some detail on the new med list. So glad to hear Sissy awoke this Sun morning feeling better. However, "better" is not good enough! Sissy should be fully out of pain. That is not hint of pain whatsoever IF the meds had been correctly Rx'd. Please do let us know if there is still pain, that would not be right nor fair to Sissy since there is much more your vet could do to provide full round the clock, dose to dose relief from pain when Sissy needs to reposition herself in the suite or go to potty.
MONITORING
PAIN RELIEF:
Please be very watchful for pain with what looks to be a once a day dose of gabapentin. Do know that IVDD pain meds last about 8 hrs in the system at an effective level and then begin to decline. That is the reason vets up on IVDD prescribe pain meds for every 8 hrs. So be watchful that Sissy is not suffering pain as the 8 hrs point arrives and gabapentin begins to decline in effectiveness. Were you given a range of 2-3 times a day you could give this medication?
GI TRACT Damage
What is the stumbling block to getting protection for the stomach on board. Sissy has enough to deal with pain, etc with this disc episode. She does not need another issue of potential bleeding ulcers due to the extra acids Prednisone causes. Please re-read what Romy posted on Jan 3 about Pepcid AC and see what you can do to get this on board today and keep your vet in the loop on Monday.
QUESTIONS
Is Prednisone as of Jan 4 now given promptly 5mgs twice a day?
For how many days is she to stay on the 5mgs twice a day dose?
Is gabapentin now given at 100mgs promptly every 24 hrs? What was the original dose from Friday in mgs and how often you were to give it?
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Post by Vannette & Sissy on Jan 5, 2020 15:46:59 GMT -7
Sissy has been good today. I dont think much pain or no pain. She is really wanting out of her pen today. So the following is where we are at. Hopefully I get this right.
*3.2mg codeine every 6 hrs
*100mg Gabapentin 1 capsule twice a day
(morning and evening)
*5mg prednisone started 1\2\2020 and
1\3\2020 & 1\4 increased to twice per day and 1\5 back to once until the 1\9 we go to every other day for 3 doses
*added 5mg ✙pepcid twice a day
[Moderator's Note. Please do not edit
12 lbs
Prednisone as of 1/2: taper dose!: 5mgs 1x/day for 2 days
as of 1/4: anti-inflammatory dose: 5mgs 2x/day for 1 day, then 1/5 test taper to reveal any: _pain / _neuro
codeine 15mg pill: 3.75mgs 4x/day
gabapentin 100mgs 2x/day
✙Pepcid AC 5mgs 2x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jan 5, 2020 17:00:34 GMT -7
Vannette, prednisone after one day at the proper anti-inflammatory dose on 1/4 is now being tapered!
The proper way to test taper for pain is to stop the pain masking pain meds. Since only one actual day (1/4) at the anti-inflammatory dose (5mgs 2x/day) would unlikely be realistic to think all the swelling would be gone, would make no sense to be trying a test for pain taper on 1/5 and stopping the pain meds.
Please be highly aware of Sissy showing pain on the taper dose of pred.
Vets who are comfortable with their knowledge of IVDD, take a guess at a more realistic time to get swelling down. They take a guess that it might take a 7-day course (5mgs 2x/day) or even a 14-day course. I do not believe I have ever seen a vet make a guess of a 1-day course of pred!
So being in the taper with pain masking meds on board, blinds everyone to the actual facts about painful swelling. Maybe there is still work that pred needs to do but can not when in the taper. Thus the protection to nerves is being delayed while in the taper with blindfolds on. Does this make sense to you. Something to convey your concerns, your questions. Ultimately you just may need that neuro appt.
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Post by Julie & Perry on Jan 5, 2020 18:15:08 GMT -7
My dogs have had many episodes. They always need at least 14 days of Prednisone at the anti-inflammatory dose before tapering.
Often dogs need up to 30 days of Prednisone.
During an IVDD episode the disc material is pushing in on the spinal cord. This causes pain and swelling. Nerves don't like this so they can start to die. This is when nerve damage occurs.
Steroids are a powerful medication that must be used carefully. However, it's vital to use it long enough to let it do it's job, which is to reduce the swelling.
I realize you're trying your very best to help your pup. It's like being thrown into the deep end of the pool and either learning to swim or drowning! It could be that your vet just isn't comfortable treating IVDD. If that's the case seeing the neurologist ASAP is very important.
Best wishes to you and Sissy.
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Post by Vannette & Sissy on Jan 5, 2020 19:02:53 GMT -7
Maybe i did not state corrrctly about the prednisone. We are continuing on with the once a day until the 9th of jan before tapering off. However i. Be in touch with hum on monday and probably tuesday etc. The dr had said to us to check ti see if should continue on ir whatnot.
Especially after talking with you all i will most diffently let him know we should continue on another week.
But i do have a question....if the disk IS pressing on the spinal cord which then is causing the pain and inflammation...even with the anti-inflimation meds....is the disk going to stop pushing in the disk without surgery???
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Post by Julie & Perry on Jan 5, 2020 19:40:19 GMT -7
With conservative crate rest what you're trying to do is keep your dog calm and resting in order to get the disc material that's pressing on the spinal cord to pull back and get away from the spinal cord. It takes longer than with surgery and you have to be much stricter.
Conservative crate rest does work in many cases. Generally, some of the factors when surgery is considered if
1. You can afford it
2. Your dog can't walk and doesn't have bowel or bladder control
3. Pain isn't able to be controlled
4.You've tried crate rest and your dog got worse.
So, many factors depend on crate rest or surgery.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Jan 6, 2020 6:48:18 GMT -7
The anti-inflammatory dosage would be the 5mg 2x/day dosage and that was only given for one day. 5mg 2x/day is the dosage that should be given for 7 days before trying to taper down from it. So Sissy is in the taper phase of the anti-inflammatory taking 5 mg only once a day. Having pain meds on board will make it difficult for you to know if there is still pain/swelling and still a need for the anti-inflammatory dosage (5mg 2x/day). Pain meds are usually stopped during the taper so a true test for pain/swelling can be made. More info on the inflammation phase of IVDD for your discussion with the vet this morning: dodgerslist.com/literature/healingsweling.htmSURGERYThe purpose of surgery is to take the pressure off of the spinal cord by removing the disc material causing the compression. Surgical decompression allows a normal blood supply to return to the compressed spinal cord and for neurologic recovery to begin by the body self-healing nerves. CONSERVATIVESeeks to relieve swelling/compression of the spinal cord with an anti-inflammatory. Over time the hope is that disc material where it should not be will shrink back enough so that pain resolves and nerves can start to self repair. Reference reading conservative vs. surgery : www.dodgerslist.com/literature/healingsurgery.htmMany dogs recover with conservative care. Since Sissy can still walk, she is a good candidate for conservative care. Not many surgeons would operate on a dog that can still walk. Please let us know what the vet says after speaking with them this morning. Healing prayers for Sissy.
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Post by Vannette & Sissy on Jan 6, 2020 18:05:44 GMT -7
What are your thoughts on adding methocarbam which is a muscle relaxer i guess.
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Post by Julie & Perry on Jan 6, 2020 18:15:31 GMT -7
Because IVDD is very painful it works best to address the pain in multiple areas.
Steroids/Nsaids for swelling, Tramadol for general pain, gabapentin for nerve pain, and methocarbomal for muscle spasms pain.
Adding methocarbomal is a good idea.
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Post by Vannette & Sissy on Jan 7, 2020 6:56:07 GMT -7
What mg methocarbomal do you recommend for my 12 lb dachshund?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jan 7, 2020 9:55:54 GMT -7
Vannette, we are not vets and do not prescribe meds for dogs. What we recommend is IF all pain is still not fully in control would be to advocate for an aggressive pain med approach whilst prednisone up at the anti-inflammatory level dose and frequency (5mgs 2x/day) would continue to resolve the inflammation that is painful. ---- pred can take 7-30 days (excluding all it's low taper dose days) to achieve resolution of swelling/inflamation. ---- While pred is at work, the usual is an aggressive pain med approach so the animal is not needlessly suffering and any pain. That would be a 3-way pain med combo administered every 8 hrs because these pain meds begin leaving the body at about the 8 hr mark. 3 different pain meds because there are typically 3 difference sources of pain. --- IF the current pain Rx's are not working, then ask what does it hurt to try a different approach? This is the approach reported by owners about 10's of 1000's of vets on the Forum using including genral DVM vets, neuro (ACVIM) and ortho (ACVS) specialists: 1. gabapentin for nerve pain 3x/day 2. tramadol as the general analgesic 3x/day. Tramadol is a syntheic opiate. It may be that tramadol is able to improve the effectiveness of other pain meds when tramadol is part of a combo pain med approach. Several studies have looked at the procession of tramadol after its absorption into the body, and it seems that each dog's metabolism of the drug is different. Therefore, the best way to determine whether your dog's dosage is appropriate is by watching your dog's response to the medication while you're home. On this Forum we have reports when tramadol is used in a 3-way med combo @ every 8 hrs, many many dogs are relieved of ALL pain dose to dose. What does it hurt to try to see if it would also help Sissy (IF, if her pain is not being fully controlled?) Quote 1: Robin Downing, DVM, CVA, DAAPM is one of only four veterinarians in the world to hold the Diplomate credential in the American Academy of Pain Management - the largest interdisciplinary pain management organization in human medicine: It is always better to use a multi-modal approach to pain management - - both acute and chronic - - so that you may use lower doses of each agent you have chosen for your pain management protocol. Tramadol has an exceptionally short half-life in the dog (1.7 hours) making it pretty useless unless it is given at least TID. It is not a good choice as the “sole source of pain meds”. It is quite good when it is used in conjunction with gabapentin. 3. methocarbamol for the pain that stems from painful muscle contractions 3x/day. There are factors of weight and health issues the vet takes into account when Rxing any med. For a twelve lbs dog that may mean 125mgs of methocarbamol every 8 hrs. 4. Quote 1: Codeine is not a recommended analgesic for dogs or cats. Its use in dogs is discouraged as most dogs lack the CYP2D6 enzyme primarily responsible for the conversion of codeine to morphine. Veterinary Anesthesia & Analgesia Support Group
www.vasg.org/newer_options_for_chronic_pain_management.htm
Quote 2 : oral bioavailability of codeine in dogs is 4% and morphine was not detected in measurable concentrations. Outpatient oral analgesics in dogs and cats beyond nonsteroidal antiinflammatory drugs: An evidence-based approach. KuKanich B. Vet Clin North Am Small Anim Pract 43(5):1109-1125, 2013.Please let us know what changes to the med list are made after phoning your vet and advocating for adjustments to her meds: prednisone ? mgs ?x/day, pain med names ? mgs ?x/day How is Sissy's pain control today--- any signs of pain? |
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Its killing me to see her this way. Thank you!!
