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Post by Alison & Che on Jan 17, 2020 11:45:21 GMT -7
[Original Subject Nine Year Old Short Hair IVDD Terrible Pain Medication Issue]
QUESTIONS
☆ pain? yes, immobility, muscular spasms, ginger walking, shivering, yelps, restless walking, arched back, nose to the ground, 2.5mg prednisone is the only reliable pain medication but i have to stop it. 25mg tramadol does not work at all.
☆ 2 15lbs the vet prescribed 2.5mg tramadol every 8 hours 100mg gabapentin every 12 hours 125mg methocarbonal every 8 hours. tapering off prednisone for three more doses every other day. so 1/17/20, 1/19/20, and 1/21/20 will be the last three doses.
dog's cortisol test came out very low. he has been on daily prednisone since septmeber 2019. 2.5mg every twelve hours. in january 4, 2020, i dropped the dose to 2.5mg once a day. then january 10, 2020, i dropped it to 2.5 mg every other day after low cortisol test results came in. days when he is not on prednisone he is still in pain. prednisone dose days his pain begins around 7pm after the morning 8am 2.5mg dose.
he has been getting the tramadol, meth, and gabapentin the whole last two months as well.
yesterday [1/16], veteranarian consult adjusted doses to: 100mg ▲gabapentin every 6 hours, no tramadol, 250mg ▲methocarbonial every 8 hours, 2.5mg prednisose every other day for three more doses (6 more days). then three days wait period. then rimadyl 12.5mg every 12 hours.
rimadyl did not work at the beginning of this episode in november at all so i don't have high hopes.
[Moderator’s Note. Please do not edit
15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest prednisone as of 12/2: 5mgs 2x/day for 6 days, √_pain/_neuro issues as of 12/8: 7.5mgs 2x/day for 4 days still in pain as of 12/12: 5mgs 2x/day for 30 days ; taper 1/8 due to live-rcortisol test results. disc relapse #2 getting on furniture until Dec 15 (not in a recovery suite) Rimadyl to start Jan 24: 12.5mgs 2x/day for ? days. tramadol 25mgs 3x/day STOPPED 1/16 gabapentin 100mgs ▲4x/day methocarbamol ▲250mgs 3x/day]
i have famotidine in my medicine cabinet so i will administer it when i start the rimadyl.
my dogs liver test was high, so now he is on royal canine liver support food. i haven't started it yet because of the pain crisis.
☆ 3 -- he is eating and drinking ok. there is no diahrea but haven't observed much else. i just can't do everything. i feel so pressured by all of this like there is always something i am doing wrong no matter how hard i try. i had to cancel my vacation yesterday because of all this. i am losing energy and hope. it seems like everyone bosses me around and i do all the grunt work and get blamed for all the mistakes. i am totally overwhelmed. i am spending money i don't have including a 2000.00 dollar mri of his back which was "inconclusive" and didn't solve anything or help me at all. i have to work a full time job and then follow this dog around like he is an appendage and suddenly make scientific research of everything he does. i am not assisted by vets or anything. i am appalled they are prescribing ineffective medicine. i just can't believe what is happening. i
i was tricked by the prednisone, thinking he has a lot more healthy than he actually is and now i am in a terribly rude awakening. him too. i just don't understand why they don't have a decent pain medication that is reliable and clear by now. what the hell are the vets spending their time doing? i feel like i am doing their job and they are taking my money. they can't answer the important questions in a meaningful way. terrible con artists all of them, i hate this society.
☆ 4 dachshund, che guevara, my name is alison
☆ 5 d yes, a partially herniated disk from an mri [Veterinary Specialty Center Of Tucson].however, it hasn't done a bit of good to know that. the vet was a dog neuroloigist. he was old school, against laser treatment and acupuncture as having any real healing value. but did say they just help with pain management. told me it did not matter how i picked up my dog, there was no way i was going to make the spinal damage worse with the way i picked the dog up. now i disagree with this
when i sent him some research articles when i was deciding whether or not i should get surgery on my dog, he disappeared, and was nonresponsive after he got his 2000 dollars for the mri and told me he couldn't tell me what to do, that he didn't know. unconscionable, rip off, cons. what is this world made of? these are his kangaroo credentials: dr. cody j. alcott, dvm , diplomate, american college of veterinary internal medicine(neurology & la) , practice limited to neurology, tucson, az. the con is its the only vet in tucson that can do mri's. that is the only reason it is still in business.
what was the date you saw the vet for conservative treatment? september 12 2019. i decided against surgery after reading a bunch.
my dog has bladder control.
i have been way too lenient over these few months. i am prepared to comply with strict crating. i hope its not too late.
currently can your dog wobbly walk? move the legs at all? or wag the tail when you specifically do some happy talk? yes all of the above.
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Post by Romy & Frankie on Jan 17, 2020 14:57:33 GMT -7
Welcome to Dodgerslist, Alison. 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! I know how frustrating it must be to have vets that will not work with you and knowing your dog is in pain is hard.
With IVDD, there is swelling of the spinal cord. It is this swelling that causes the pain and neuro deficits like trouble walking. To reduce this swelling, anti-inflammatories are used. There are two types of anti-inflammatories; steroid type like pred and NSAIDS like Rimadyl. Both will work on swelling of the spinal cord. It may take up to 30 days at a full dose of an anti-inflammatory to eliminate the swelling and therefore the pain. Neuro deficits may take significantly longer to heal because the nerve has been damaged and nerves take a long time to heal. Anti-inflammatories can not heal nerve damage. Time is what does that.
While the anti-inflammatory is doing its work, pain meds are prescribed for immediate relief. The pain meds may not have been right when Che was taking the Rimadyl and so it seemed ineffective. Your Che Guevara's pain meds are not currently right. What was the reason the vet stopped the tramadol? It is a good all around pain reliever for IVDD. The previous tramadol dose, at 25mgs was lower than what we usually see for a 15 lb dog and there may be room have been room to move up on it.
According to the information below: Tramadol 3 to 5 mg/kg (0.5 to 2.5 mg/lb) every 8 hrs to QID (up to 6 times daily at lower dose) Anecdotal reports include 10 mg/kg QID for more severe pain vasg.org/t_drugs.htm#TRAM
Since pred was adversely affecting Che Gevaras, Rimadyl is a good choice. Rather than a three-day washout between the pred and the Rimadyl, we usually see a 4-7 day washout to avoid the chance of GI tract damage from the excess acid produced by any anti-inflammatory.
For how many days was the Rimadyl prescribed?
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.
Giving him the Pepcid AC as planned will help prevent stomach damage. Ask your vet Ask if your dog 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!) The usual dose in doxie weight dogs is 5mg every 12 hours.
Speak to your vet AS SOON AS YOU CAN about restarting the tramadol at 50mgs every 8 hours. When the pain meds are right, Che will get relief within an hour and stay pain free. There is no reason for him to be in pain. Strict crate rest is the way a disc will heal. So start the strict crate rest today. The 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. I have put today's date as the date Strict crate rest started. 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 Che 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 I know that you are dissatisfied with your vet and needed to vent. Here is some information about finding a new vet: dodgerslist.com/literature/VetchkList.htmI don't think you will need any more imaging. That would only be necessary if the vet suspected the problem was not IVDD but something else. 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 www.Dodgerslist.com website:
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 17, 2020 17:37:26 GMT -7
Alison, I hear what you are saying and can see how you have been thru the ringer as well as Che has! Romy has given you you good information to help you with Che. When in turmoil, it may be helpful to see a quick summary of the actions to take to get things right for Che. Then as time permits, reading is how we owners keep our wits about us, know when any person or profession is offering harmful advice. Conservative treatment is not rocket science. It is, however, a mystery of how the meds work, how rest works til you've done a bit of reading. We are so glad you have joined us and have the opportunity to quickly get up to speed as we point you to a reading here and there that pertains to the right now. Later on you can do that research of veterianery literature if you'd like with a pretty good basic understanding to absorb the more technical stuff. 100% STRICT crate rest 24/7 only out of the recovery suitefor a very, very few footsteps at potty time is the single most important care you can give. The pain meds when right mask pain til the anti-inflammatory can get rid of all the swelling in about 7-30 days. 1. No reason for him suffering with pain. Simply put the pain meds have not beeen right. Advocate for a three way pain med combo: --- tramadol at the max analgesic dose for a 15lbs dog— 50mgs of tramadol promptly every 8 hrs. That 25mgs dose was like not giving any tramadol! What will it hurt for your vet to give 50mgs a try? --- gabapentin then may be able to go to more humane sleep schedule for you --- back to every 8 hrs. OF course if necessary for every 6 hrs. to keep him out of pain, then you would do that. Discuss this with your vet having three pain meds all at every 8 hrs. --- methocarbamol then may be able to go back down to a more normal 15lbs dog dose of 125mgs every 8 hrs. 2. Neither prednisone nor Rimadyl are pain relievers. Simply because it may take 7 to 30 days to accomplish getting rid of all pain. Pred was never Rx'd at anti-inflammatory dose of 5mgs twice a day. It was Rx'd for a taper type dose (2.5mgs 2x/day) back in Sep and used for 7 weeks not being at an effective dose to remove inflammation!!!! Oh, dear, oh dear - could well be the reason Che has been suffering with pain so long. Prednisone is history because of his cortisol blood test??? And also because of liver test. Prednisone is metabolized in the liver. Rimadyl is metabolized in the liver. There is still a concern, then?3. Changing foods while on pred or Rimadyl is a problem. Food changes can cause GI upset as well as Rimadyl or Pred can. Then you don't know if you have a serious problem or just a mild food problem..4. As long as there is pred in his body or he has started Rimadyl, HE NEEDS Pepcid AC 5mgs twice a day---- now.5. THE ANTI-INFLAMMATORY. With out someone explaining just how the Pred or the Rimadyl works, you will be lost. You will miss if the vet is doing something different and not be able to question things. Alison, could you take the time to read this information, to be up to speed in a quick manner?...it is well worth your time in helping Che. LINK: www.dodgerslist.com/literature/healingsweling.htm
Please let us know with the current 1/16 adjusted med list that all pain is being masked dose to dose, round the clock. If not, then call your vet to discuss the changes listed above. gabapentin 100mgs ▲4x/day methocarbamol ▲250mgs 3x/day
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Post by Alison & Che on Jan 17, 2020 21:41:30 GMT -7
[MOVED TO THE FORUM on behalf of Alison 12:44 ESTDefinitely In The Back. So Its Now 10Pm And Che Is Not In Pain. Finally Something Worked Besides Prednisone. So 300Mg Of Gabapentin And 50Mg Of Tramadol And 125Mg Methacarbonol Worked.
Todays Medication Timetable Problem:
6:30Pm: Extreme Pain After Prednisone Wore Off. 100 Gabapentin And 125Mg Meth At 3:30Pm Did Not Stop The Pain From Coming When The Prednisone Wore Off. So
6:30Pm: 200Mg Gabapentin 8:00: 125Mg Meth; 100Mg Gabapentin more Because There Was No Improvement 8:30Pm: ✙ Tramadol 50Mg 10:00 No Pain
So Which One Really Worked? Was It The Tramadol? The Difference Tonight Is Tripling The Gabapentin Dose And Doubling The Tramadol.]
[Posted to this Forum 11:45 EST by Alison:]Wow. THANK YOU FOR ALL THE DETAILED HELP. I have to say you all are amazing. I just don't get how the best people never get paid enough and the cons get paid too much in this twisted culture. I wish I had paid Dodgers List 2200 dollars. Anyway, I spent the whole day organizing my records from the very first spinal episode where Che lost the use of his back legs completely. It was on 9/11/2019. There were some mistakes in the history I provided you. Here is the correction: 9-11-19 Legs completely paralyzed in the morning. Emergency room prescription: Gabapentin 100mg every 12 hours; Carprofen 25 mg every 24 hours. These things were ineffective for pain. 9-12-19 MRI. No neck issues. The disk herniation was middle back and partial. 9-12-19 Neurologist prescribed: Prednisone 3.75mg 1x/day for 4 days Prednisone 2.5 mg 1x/day for a week then Prednisone every other day until 10/7/19 for final evaluation and surgical recommendation. [ALL CAPS are very difficult to read. Below text was converted to lower case.]
10/7/19 On Doctors Orders Stopped All Meds. To Use Gabapentin As Needed And Sparingly. Should Take On Two Walks Short A Day And Let Him Work Up To Being His Habitual Self. Evaluate For You The Quality Of His Life You Can Live With Based On His Abilities.
Alison Hoped For A Complete Recovery Even Though He Had A Bit Of A Left Foot Drag. But That Was Really His Only Symptom. A Little Slower Maybe. Alison Decided Against Surgery, But Had Weekly Laser Treatments Based On Info From Dodgers List.
Slowly Worked Up To Full Walks, Digs, Running, Full Dachshund Mode Just Around House. No Meds.
11/24/19 Spinal Episode After Four Days Of Digging In Forested Area For The First Time With Dog Sitter. Alison Was Out Of Town For 12 Days.
Dog Sitter Tried 100 Mg Of Gabapentin Every 8 Hours. 25Mg Of Tramadol Every Eight Hours. Meds Not Working At All. Full Pain, Would Not Move, Would Not Allow Picking Up. Could Walk To Crate And Then Be Moved A Bit. Sitter Could Not Bring Him To Vet Because Of Pain And Confusion About Situation. Dog Pooped On His Bed. Totally Unheard Of.
11/30/19 Alison Is Back Into Town. Finally Remembered To Give Prednisone. Was Confused About What Meds To Use When I Was Out Of Town.
11/30/19 Pred 3.75Mg Gaba100Mg Two Times That Day Tram 25Mg Three Times That Day No Real Improvement That Day
12/1/19 Tram 25Mg Three Times That Day Gaba 100 Twice That Day Prednisone 5Mg
Finally Got Into The Vet 12/2/19 Tram 50Mg In Desperation Morning Before Vet Appointment, No Clear Change.
Dexamethionine Shot At Vet: Immediate Improvement. Vet Prescribed: 5Mg Pred Every 12 Hours For 10 Days, Then [taper below anti-inflammatory level]: 2.5Mg Pred Every 12 Hours For Ten Days. Then 2.5Mg Every 24 Hours, Then 2.5Mg Every Other Day. 25Mg Of Tramadol 3X Per Day. There Was A Little Improvement.
12/5/19 Got Another Dexameth Shot On 12/5 Because Meds Seemed To Not Be Working. It Appeared The Pain Came Back [on test for pain taper!] Because The First Shot Had Simply Worn Off.
12/7/19 [2nd course of ] Pred 5Mg; 25 Mg Tramadol 12/8/19 Pred 7.5Mg Dog Was Still In Pain
12/9/19- 12/11/19 7.5Mg Prednisone. Four Drops Of Rescue Remedy. I Also Tried Hemp Oil Supplements But He Just Got Diahrrea.
Panting, Curving Head, Hunching, Shivering, Licking Paw All Night, He Was Eating And Was Sort Of Acting Normal.
Back To Another Vet:
12/12/19 Until 1/3/2020 Methacarbonol 125Mg 3X/Day
Prednisone [3rd course] 5Mg 2X/Day [ for 21 days] This Worked To Mask Pain Completely.
1/3/2020 Blood Test. High Liver. Cortisol Very Low. Vet Recommends Stopping Prednisone.
[Moderator’s Note. Please do not edit 15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest prednisone as of 12/2: 5mgs 2x/day for 6 day course, √_pain/_neuro issues as of 12/8: 7.5mgs 2x/day for 4 day course still in pain as of 12/12: 5mgs 2x/day for 21 day course ; then tapered 1/8 due to live-rcortisol test results. disc relapse #2 getting on furniture until Dec 15, not 100% in recovery suite Rimadyl to start Jan 24: 12.5mgs 2x/day for ? days. ✙ tramadol 50mgs 3x/day on 1/17 gabapentin 100mgs 4x/day methocarbamol ▼125mgs 3x/day ✙famotidine 5mgs 2x/day ]
1/8/2020 Start Tapering. Pred 5Mg 1X/Day Meth 125Mg 3X/Day
1/11/2020-1/14/2020 Not Sure Of Dosages.
1/14/20 Pred 2.5Mg 1X/Day Tram 25Mg 3X/Day Gabapentin 100Mg 3X/Day
Meth 125Mg 3X/Day
1/15/20
No Pred Meth125Mg 3X/Day
Gabapentin 100Mg 4X/Day
Tram 25Mg 1X/Day
1/16/20 Pred 2.5Mg Meth 4X/Day
Tram 25Mg 3X/Day
Gaba 100Mg 3X/Day
1/17/20 Pred 2.5Mg Meth 5X/Day Gabapentin 100Mg 7X/Day Tram 50Mg 1X/Day
So Far, My Dog Is Now Softened Up But Still Immobile, Not Wagging Or Moving. No Panting, And He Ate A Little But Not Much. He Is Still In Pain. I Just Gave The Tramadol One Hour Ago. Honestly, I Don't Know If Anything Is Working. He Is Just Sitting There Looking Away From Me. Usually He Is Staring At Me All The Time. So Something Is Wrong.
My Summary Is That Nothing Is Working Except Prednisone. I Gave It To Him Today Accidentally So Most Of The Day He Was Not In Pain Until It Wore Off This Evening And Since Then Nothing Has Worked.
The Vet Said He "Hated" Opioids, Tramadol, Because He Did Not Think They Worked And Caused Constipation. I Doubt He Will Want To Give Che More. I Don't Really Care What He Thinks Actually.
I Bought Some Herbs Sweetmeadow, Which Is Supposed To Be A Natural Steroid That Will Help Wean Che Off The Prenisone. I Will Start The ✙Famotide Now, The Herbs In The Morning. I Don't Think The Medication Will Work. It Hasn't Worked This Whole Time. I Will Follow Your Recommendation And See Since I Have No Other Options.
Thanks For Your Feedback. Anything Further Is Appreciated. Obviously I Have Been Very Confused And Just Trying To Stop His Pain.
During The Beginning Of December, I Discovered That My Dog Was Getting Up On The Couch When I Was Leaving The House By Getting Through The Cracks [not in a recovery suite!]. I Had Tried To Arrange The Furniture So He Couldn't Access It But Was Unsuccessful. Around 12/15/19 I Found It Out And Double Barricaded That Couch.
I Also Have Ramps All Over My House Now, So The Jumping Is Not An Issue.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 17, 2020 22:35:58 GMT -7
So very glad to hear Che is out of pain tonight.
Your very long post will take a great deal of time to carefully read and correct what we thought to be true. It is very late at night and I will not be able to read and reorganize what is now to be correct information until the morning.
STOP giving Sweetmeadow it is a NSAID (an aspirin derivitive). A NSAID should never be given at the same time the body contains a steorid like prednsone. There is great potential for bleeding ulcers that can be deadly! Starts with not wanting to eat, vomit, loose stool, bleeding ulcers, black or red blood in diarhea.
In the AM tell the vet you gave increased tramadol (that was to be discussed with the vet, not to be self prescribed by yourself. Tell the vet you gave Pepcid AC and any other changes you made on your own. The vet is responsible for your dog and must therefore be the one to prescribe meds. Your job is to update on observations, give feedback and do your very best to advocate for things you believe are right. So do call the vet and explain accidental giving of prednisone, etc. so he knows the full story.
I'll be anxiously waitng in the morning to know that Che is all right and not given the Sweetmeadow on Sat morning. Fingers crossed for you, Alison, and for Che.
ASKING for your HELP Alison. it would be helpful to only post here on the forum. Do not make private posts as it leaves other moderators out of the loolpl
All caps are very hard to read. Please undo the "caps lock" on your computer. Type in upper and lower case, to make it easier for us to read..
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 18, 2020 8:56:08 GMT -7
Alison, it goes for each one of us (me included!) when we know more we can do better. What you witnessed and can learn from are these things. --- Crate rest is the single most important care for the disc. Che suffered a relapse (retear) of his early healing disc due to stopping of crate rest prior to the full 8 weeks from date of disc episode. He had a relapse when the vet maybe well intentioned but never the less Rx'd the harmful short walks 4 weeks out for the disc episode of 9/11. A 2nd disc relapse appeared to happen again about Dec 15 due to lack of strict 100% 24/7 crate rest. A relapse causes great pain. It requires everything to start back at square one (meds, anti-inflammatory drug, restart the count of 8 weeks rest to heal the disc) --- Owner IVDD self education is very important in recognizing harmful advise and being able to politely say "no thanks." No one in a profession can know every single thing whether that be your auto mechanic, hair dresser, your own physician, your dog's vet. Most DVMs in a general practice see many different species- hampsters, cats, all breeds of dogs, reptiles, birds, maybe even farm animals. They practice many specialties in the course of a day: pediatrics, dentistry, surgery, internal medicine. Is it surprising, that keeping current and indepth knowledge of each and every disease for every species is probably not likely? However YOU can easily become a mini-expert on one very-important-to-you disease. --- Pain masking is complicated. Once pain sufaces it is harder and may take longer to get back in control. Tough pain is best masked by 3 meds to take each of each of the 3 sources of pain. The dose has to be an sufficient number of mgs AND most often the frequency of promptly every 8 hrs. While currently tramadol is controversial, there is still mystery on why it may just work for some dogs, why on the Forum we still see Neuro surgeons prescribing it, why therefore, the best way to determine whether Che's dosage is appropriate is by watching his response to the medication while you're home. Most often vets are prescribing Tramadol at the below max analgesic dose where it is like not giving any tramadol at all! Discuss your observations of 50mgs tramadol one of your past vets Rx'd it at the max analgesic dose of 50 mgs 3x/day. Discuss with your current vet about fully masking pain with an aggressive pain med approach using 3 pain meds every 8 hrs.--- Che is most fortunate that with all the bad that happened to him since Sept 2019, he did not loose leg function again. He is still a good candidate to heal his disc with 8 weeks of true crate rest. Now that you are beginning to see that conservative treatment is not rocket science, however something we owners need to be knowledgeable enough about to be able to seriously commit to its true principals, a dog can heal. --- With the pred taper going below the anti-inflammatory level that works on painful inflammation now PLUS the 3 days of washout before Rimadyl starts, it may take an even more aggressive pain medication approach to keep pain at bay. Disccuss this with your vet and plan that you will be able to phone him to update about pain for further pain medication adjustments during this time of inadequate anti-inflammatory levels in the body (pred taper and 3-day washout). --- Discuss with your vet if a different approach is something to consider. When a vet deems it an emergency to switch to Rimadyl whether for pain or health reasons, then the washout days could be dispensed with and Rimadyl started sooner to get back to resolving the very painful inflammed tissue. HERE IS THE CATCH: no washout days, then double stomach protection would be a must for the double GI tract jeopardy! Not only would acid suppressor Pepcid AC 5mgs 2x/day be on board but also a different acting stomach protector SUCRALFATE as well. Alison you will be best able to advocate/discuss these things with your vet when you can speak from a postion of having read up on things. Please read about sucralfate so you know how it is timed with Pepcid AC, what exactly it does, etc. Here is the link to sucralfate veterinary info: marvistavet.com/sucralfate.pmlAfter phoning your vet, please let us know you were able to present a strong (but polite) successful advocacy: -- three pain meds each addressing a different source of pain. Each Rx'd for 3x/day. Tramadol up at the max analgesic dose of 50 mgs 3x/day. --- if the vet decides to deem the switch to Rimadyl an emergency that both sucralfate and Pepcid AC are on board to protect the GI tract from bleeding ulcers. --- Let us know that your sitter and you understand the need for limited movement of the back the crate provides is crucial to healing the disc. STRICT crate rest means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no meandering at potty times. - only the most crucial and beneficial of vet visits warrant the potential of disc damage in transporting. Seek an mobile vet to come to your home if you want laser or accupuncture. That is how critical 100% STRICT crate rest 24/7 is to the healing disc. - Vets who know IVDD understand car transports are risky and are open to your updates and adjusting meds over the phone.
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Post by Alison & Che on Jan 18, 2020 17:09:26 GMT -7
Hello Romy, Frankie and Paula,
I called the vet today and ran my changes by him. He was OK with it as long as the gabapentin was kept under 400mg per day. He was unaware of the ineffectiveness of Tramadol at the 25mg and when I told him there was a significant reduction in pain at 50mg, he endorsed that dosage at 3x/day; he, surprisingly, approved trying a higher dose of tramadol if needed up to 100mg.
Thanks again for your concern. But I have a confession:
I had issues this morning. I waited eight hours until 4am this morning to give Che his medication, He was in pain again at 4am so 8 hours was too long to wait. At 4am, I gave him:
200mg gaba 125 meth 50mg tramadol
At 6am there still was no reduction in pain, so I gave him more:
100mg gaba 125 meth 50mg tramadol 5mg famotide
At 8am there was no clear change and there was spasming, so I gave him 25mg of tramadol more. He finally fell asleep at 8:10am.
He woke up pain free around 10am. I spoke to my vet and he, surprisingly, approved trying a higher dose of tramadol up to 100mg.
At noon Che was shaking again in pain. I gave him 200mg gaba 125 meth 100mg tramadol
It is 5pm and he is pain free.
[Moderator’s Note. Please do not edit 15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest prednisone as of 12/2: 5mgs 2x/day for 6 day course, √_pain/_neuro issues as of 12/8: 7.5mgs 2x/day for 4 day course still in pain as of 12/12: 5mgs 2x/day for 21 day course ; then tapered 1/8 due to live-rcortisol test results. disc relapse #2 getting on furniture until Dec 15, not 100% in recovery suite Rimadyl to start Jan 24: 12.5mgs 2x/day for ? days. tramadol ▲100mgs 3x/day (can be increased to 100mgs 3x/day) gabapentin 100mgs 4x/day (not to exceed 400mgs total/per day methocarbamol 125mgs 3x/day famotidine 5mgs 2x/day ]
What I know is that eight hours between doses is too long. I thought maybe his stomach hurts and that is why, not sure. But will give famotide half hour before the other meds, and I will be dropping the gaba to 100mg, to 100mg tramadol for the weekend. I am going to find a new vet on Monday.
I don't want to put you in an awkward position, and I know I was acting roguely, some may say recklessly. I take full responsibility. The notion that the tramadol might be too low of a dose was a revelation to me. I was SURE it was ineffective, but because of the brainwashing in this culture supported by doctors about the use of opiods as being soo dangerous, when they are mostly motivated by their professional liability, I can safely say that they are underprescribing at the expense and extreme suffering of my dog. Who are they to do that? Plants belong to all of us, not just them. I know I have a part in this nightmare, but they could have been more forthcoming. Anyway, now you know how noncompliant I can be, and I hope you will still help me. It is solely my fault if anything happens. I understand that. That is part of my emotionality about this. I will take full responsibility for everything that happens to Che. I wish the doctors would treat me with the dignity of knowing I will do that. But of course, they won't and I see how in reality they can't.
Anyway, I wan't going to tell you what I did for fear of scaring you into being worried I will harm my dog with my desperate self prescribing. And I understand that. But I insist that despite the reckless nature of it, last night I learned that my dog's pain can be controlled. And that information is worth it to me, whatever may come. Because I was starting to think he and I were hopeless for all the reasons and mistakes and confusions and limitations that are obvious in my posts. I think another person might be a better nurse to him. But I have no one.
OK. I see now how maybe eight hours could work. As if I had counted 8 hours from the first successful cocktail from last night, that would have put 8 hours at 2:30am and I waited until 4am. I counted from the last part of the dose at 8:30pm. So that may have been a mistake. So today. I will wait until 7:30pm to give the famotide and give 100mg gaba, 125 meth, and 50 mg tramadol at 8pm. Then I believe we will be in normal ranges.
I got a roller crate today, and a back brace.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jan 18, 2020 19:59:11 GMT -7
Alison, good job in presenting a good advocacy case and you and the vet working together getting pain meds right for Che! Kudos to you. If this vet you saw today is open to things you are learning about IVDD and willing to work with you, then why are you looking for a different vet? A new vet will require a Che office visit & exam--- risky to the disc transport. Of course if there is a good reason to find a new vet to improve getting the treatment Che needs, then a new vet benefit outweighs a transport risk. Let us know what your thoughts are on why at this point a new vet? PAIN MEDS +Just so you are aware, if using the max analgisic dose for each of his meds still has Che showing pain nearing the next 8 hrs dose, there is another med that can be added. So keep this in mind to work with your vet to get it on board.When meds are properly used at the aggressive dose and 3x/day but pain is still not fully controlled, then bring to the discussion with your vet the addition of amantadine. Amantadine is something we are seeing neuros Rx as part of the pain med cocktail as it allows other analgesics to function more effectively. Please do not use that back brace at all. Return it to get your money back! The full story on back braces is here as it is good to know the why behind not using back braces with an IVDD dog: LINK: www.dodgerslist.com/literature/Supplements.htmI'm glad to hear you are finding progress in fully covering pain. It can take adjusting to find thw sweet spot for Che. I highly recommend using a med chart to note results with what dose/frequency to more quickly see patterns. Also useful to have the facts when speaking with your vet about meds. D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf
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Post by Alison & Che on Jan 20, 2020 9:48:19 GMT -7
Hi. I guess I can keep the vet I have. The reason I was looking for a new one is that my vet told me he was going out of town and wouldn't be available. I guess he will be back tomorrow. Same for my Mexican vet. Che's pain meds are not working so I just gave him 5mg of prednisone.
[Moderator’s Note. Please do not edit 15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest disc relapse #2 getting on furniture until Dec 15, not 100% in recovery suite prednisone previous courses negated upon a disc relapse of 12/15 as of 12/12: 5mgs 2x/day for 21 day course ; then tapered 1/8 due to live-rcortisol test results. as of 1/20: 5mgs 2x/day until vet help is available Rimadyl to start Jan 24: 12.5mgs 2x/day for ? days. tramadol 100mgs 3x/day (can be increased to 100mgs 3x/day) gabapentin 100mgs 4x/day (not to exceed 400mgs total/per day methocarbamol 125mgs 3x/day famotidine 5mgs 2x/day ]
I think that will work and just keep him out of pain for the day. I am out of ideas.I have emailed and called all the vets I know and get no help or solutions or availability. I called a home vet and nothing. And I can't transport him like this. He screams if I even come close to him. I am going back to prednisone until I can get a real veterinarian who really cares about dogs and not their own bank account and wean him later.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 20, 2020 10:30:53 GMT -7
Alison, I'm so sorry getting vet help at this critical time is so difficult leaving you having to make medication decisions on your own. With Tues being a non-holiday, wishing you good fortune in finding a vet or that Jan 18th vet back open again to prescribe the right meds for Che. Clearly with signs of pain it is not time to be off of an anti-inflammatory drug. A vet needs to give consideration to this pain issue as a sign of emergency to use the double GI tract protectors (Pepcid AC + sucralfate.) Double GI protection is a safety measure enabling expediting back onto an anti-inflammatory drug without days of washout.
Keep us posted and let us know if the pred 5mgs has brought pain back in control
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Post by Alison & Che on Jan 20, 2020 11:25:21 GMT -7
I am looking for a house call vet for obvious reasons.
I had a huge cry yesterday, rueing the day I thought I could handle a dog. But now I am a little better. A mouse infestation, mixed with all this, and the feeling I can't focus enough to work my job makes for a lot of anxiety. You are so important to me, the work you all do here. If I didn't have you I would be being gouched at a new vet right now in desperation.
I am waiting for the vet to call me back. He is not really eating much either. And I just discovered your are not suppose to feed turkey or red meat with tramadol because of the serotonin syndrome risk. And guess what his treats are made of.... Yikes. I swear its like there are landmines everywhere and no support fire.
Hi. I just discovered the prednisone pill at the bottom of the crate. Che spit it out. But by now he is at least not whining and screaming when I approach or pick him up. He is shivering periodically. I don't know if that is pain, probably combined with his low energy and lack of movement. Anyway, because he spit it out, I thought, OK. I am going to call my backup vet again and see if she has any bright ideas. Its weird. I am seeing a pattern. Totaly pain at his dosage time in the morning at 7am, then it takes a whopping three and a half hours for the pain meds to kick in. They last until 5pm and then another three hours for anything to work. I have been trying to dose him earlier so the meds don't wear off but I can't seem to catch up. 1:00am to 7am, 7am to 1pm, 1 pm to 7pm, 7pm to 1am.
I have reduced my dosages to every six hours. Gaba 100mg, ▼tram 50mg. Last night I gave him 250mg of Meth instead of more tramadol.
[Moderator’s Note. Please do not edit 15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest disc relapse #2 getting on furniture until Dec 15, not 100% in recovery suite prednisone previous courses negated upon a disc relapse of 12/15 as of 12/12: 5mgs 2x/day for 21 day course ; then tapered 1/8 due to live-rcortisol test results. as of 1/20: 5mgs 2x/day until vet help is available tramadol ▼50mgs ▲4x/day (can be increased to 100mgs 3x/day) gabapentin 100mgs 4x/day (not to exceed 400mgs total/per day methocarbamol 125mgs 3x/day famotidine 5mgs 2x/day ]
He was calm this morning, but delevelped pain when I carried him out to pee. He is not peeing much, and when he does it is alot. Luckily he peed last night. I was worried. He hasn't pooped in two days. I started giving him pumpkin last night and once this morning. I notice he needs to walk to decide or feel he needs to poop. Should I let him walk a little more to wake up his bowels?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 20, 2020 13:19:39 GMT -7
Alison, some signs can fall in both a list of pain signs and other things such as anxiety, etc.
So the way to ascertain for sure is to watch for other pain signs to help confirm. ---when he shivers, if you place a dryer warmed towel over him, does he relax...then maybe his is chilled. -- when he shivers, is his belly tight tense (refered pain), then he IS in pain. -- not moving much because of the side effect of sedation from his higher doses of meds. If when he does move he is not vocalizing/yelping, then perhaps not moving is due to sedation. You will have to be a good detective on this one.
So look at the signs of pain to see if one or more additional signs of pain are happening when he shivers.
SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or has to move ◻︎ slow to move ◻︎ tight tense tummy ◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves
Re: turkey/beef, he is likely eating enough qty to have worries. Since he is not eating much, better to make it quality food rather than treats. Boiled hamburger or piece of chicken (chill, discard fat disk on top. Sprinkle meat crumbles over kibble soaked in the meat broth.) If all he will eat are the treats, then better he has those then nothing to eat. You'll just have to be the judge.
Once pain surfaces it can take a longer time to get back under control.
POTTY TIME Keep the footsteps to the very fewest to take care of business. Give him 1-2 mins to poop, if nothing, then try again in an hour. Protecting the early healing disc is a priority of limiting movement (too much walking)
Is your city Tuscon? Perhaps another member may see your post and offer a vet recommendation for conservative treatment-- maybe a mobile vet, too.
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Post by Alison & Che on Jan 20, 2020 14:56:43 GMT -7
Do you mean he is not eating enough to have worries, or he is eating enough to have worries? Che says thank you. Hi Paula: I finally some feedback. My general vet in Mexico said no more 100mg Tramadol, too much. I had a call from two traveling vets: 1. He said, start the rimadyl tomorrow morning if the last prednisone was yesterday morning. Didn't think the the sucralfate was necessary in this situation. Said he had "never" seem Amantadine do anything important. He said don't expect the pain meds to work, they are too weak for the situation. The antiinflam is really the only real solution. So start ASAP. 2. Second vet said if prednisone is working then give it to him in an emergency situation. Said to pet his face like a mother dog and that helps him heal. Said to sit with him and be with him. That will help him heal. Said that if the Rimadyl doesn't work, go back to prednisone. Focus on his pain free end of life experience. Why does it take two hours for the meds to start working? 100 Gaba, 250 Met, 50 tram, 5 fam: kicked in from 7am dosing around 10:30pm. Why is this? This has happened for several mornings. I then do the same dose at 1pm and by five or six he is in pain. Like these meds take forever to kick in and then they are immediately eliminated. Its so weird
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 20, 2020 15:41:10 GMT -7
Allison, Che is likely not consuming enough beef/turkey to be a problem with tramadol. Treats in general are not good nutrition. So getting him to eat his kibble with boiled hamburger patty or boiled chicken--- each de-fated, deskinned. Put crumbled meat on broth soaked kibble to entice him to eat balanced kibble. For a 15 lbs dog 50mgs of tramadol is typical to what we see prescribed at 3x/day. Do not take any chances with a switch to Rimadyl. Adovate very strongly for double GI tract protection: Pepcid AC + sucralfate. Che just does not need any other problems on top of all he is dealign with don't you agree? In a perfect world you would stay with prednisone. You need a vet to re-read the blood test results. Do you have a copy of the blood test results to share with one of the other vets? 1. confirm the level of cortisol in the body. Too MUCH steroid could cause a disease and the need to get off it. I really do not have any knowledge to be able to comment on what you said about there being too little cortisol (steroid) in Che's blood and the need to get off of prednisone. You need another vet to confirm what the blood test results mean. 2 You were told the need to get off of prednisone because of high liver levels. Rimadyl is also processed by the liver and would also be the same concern. Che IS indeed having problems with pain because there is no longer any anti-inflammatory on board. Once pain surfaces it IS more difficult to get it back in control. With a washout vets increase the pain meds to compensate. most of the time it works. When it dos not like with Che, THIS IS WHY I SAID a vet should seriously consider deemimg this an emergency: 1. Double stomach protection 2. dispense with washout 3. Start an anti-inflammatory Any switch back to prednisone (steroid) from Rimady (non-steorid) would require the same 5-7 days washout period. Prednisone is the most powerful over the lessor Rimadyl. Prednisone is normally used when there is neuro diminishment. Rimadyl is normally selected when there is pain only. These sentences are kind of a summary from the page I encourage you to re-read so you are best in the know and can discuss things with a vet: www.dodgerslist.com/literature/healingsweling.htm
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Post by Alison & Che on Jan 21, 2020 9:36:45 GMT -7
Hi Paula:
Thanks again for your help. I had a traveling vet come to my house yesterday. He said: Start on Meloxicam today 48 hours after last pred dose,. He sold it to me in liquid. 15# dose once daily and he showed me on the dropper how to measure it. If dog is eating then stomach is protected. No need for stomach meds. No need for tramadol or gabapentin, both don't work well or for very long; he was fine with keeping the Meth but on the lower dose of 125mg 3x/day.
He thinks I should have Che out of the crate and on a leash for short easy walks when I can supervise him. So on a leash for all activity. And crate him when I leave. He said this is for movement so the dog feels tired at night. Crated all day makes then not sleep well. Then they don't heal.
Biggest thing. Che's weight is a life and death situation. He needs to lose weight immediately otherwise his weight will reinjure his back. He put him on 1/2 cup Royal Canine Satiety per day and only vegetables or chicken broth for treats. He wants me to track his weight every two weeks and I am looking for a .3 lb reduction every 2 weeks as ideal.
He seemed to favor the use of 2.5mg prednisone every other day as a permanent thing. He was not concerned at all about side effects on the liver. He said the test results showed the liver was working fine.
He said that the high and low cortisol were all the result of testing while Che was on prednisone. That in order to determine liver function, one would test after the pred is out of the dog's system. But he said he was not worried about that at all. He advocated surgery.
And in lieu of that he advocated prednisone on and off. Since I was already at the end of the taper, he said OK lets see if NASAIDs perform adequately. But he doubted it. So I am to call him on Thursday/Friday because I should know by that time if they worked. If not then I can choose surgery or prednisone at lower levels.
It made sense to him that Che had reason to have the relapses so at this point it is not a pure degeneration of the spine but due to too much activity. So he was hopeful that things could improve with restricted activity and healing time. But mostly weight loss was his emphasis.
I hear you about the stomach meds and will be obtaining them from my other vet today before I give the NSAIDs. Although, I am hankering to give Che the Melox. now.
Yesterday, I was able to completely mask his pain with the pain meds. He did not have pain from 10:30am to now, so almost 24 hours. The dosages were from 7am when I awoke and he was in pain: 6.30am 5mg Famotide, 6.45 100mg gab1, meth1 250, 50mg tram1. it took until 10:30 for him to sleep and be out of pain. 1.15p 5mg fam 1:45p 50tram2, 250 2meth2, 100 gab2 3:15pm 50tram3, 250 meth3, 100 gab3 10p still no pain, 50 tram4, 250 meth4, 100 gab4 4am 5mg fam 4:30p 50mg tram5, 100 gab5, 250 meth5
[gabapentin = 500mgs in 24hr period methocarbamol = 1250 mgs in 24hr period tramadol = 2500 mgs in 24hr period]
It is 9:15 and he is not in pain. It looks to me that the higher dose muscle relaxer is making a big difference.
[Moderator’s Note. Please do not edit 15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest disc relapse #2 getting on furniture until Dec 15, not 100% in recovery suite prednisone previous courses negated upon a disc relapse of 12/15 as of 12/12: 5mgs 2x/day for 21 day course ; then tapered 1/8 due to live-rcortisol test results. as of 1/20: 5mgs 2x/day until vet help is available tramadol 50mgs 4x/day (can be increased to 100mgs 3x/day) gabapentin 100mgs ▲5x/day= 500mgs!!! (not to exceed 400mgs total/per day methocarbamol ▲250mgs 3x/day famotidine 5mgs 2x/day ]
Nevermind, he just started whining, so his back started hurting again. So for sure the meds only last 5.5 hours at the most probably less time.
OK. I won't give the NSAIDs. I am waiting for the other vet to prescribe Sucra and I will go pick it up at his office.
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Post by Alison & Che on Jan 21, 2020 10:14:36 GMT -7
I am surprised no vet has said anything about Che being fat. I mean this vet was appalled and said he was WAY overweight and if he saw a neighbor feeding him treats he would really stop them and give him a piece of his mind. Like it was really obviously abusive. I got a roller crate, a travel crate. I think Che can ride in that in the backyard or for short tiny walks in front. I get the bumpiness is not good. I read that post. I also get that that can happen way down the road, not anytime soon, so I don't want to think about it. I have decided to do 100 % strict crating still. I think you ladies have seen alot more than any individual vet I have consulted. I think that counts for more. And I think you have seen success with 100%. The other vet I spoke to, talked about how dogs generally like crates, they are not like us. I will do alot of enrichment with Che while he is healing (primary goal). I also heard from another lady here that changing food during an NSAID switch can create problems. I understand this too. I am going to chicken broth popsicles in the KONG and will change food a little later. I think the medication switch is more important and short term. The food switch is more of a long term solution. But every vet I talked to is on board with the NSAID trial. So I think that is a clear next step. I just of course want to do it right. i just don't get why noone will prescribe morphine or lidocaine or something really strong. They don't even suggest it.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 21, 2020 10:36:34 GMT -7
Alison, as you probably already recognize from your readings on IVDD, this mobile vet has no clue about IVDD. He is offering you some extremely DANGEROUS to Che's disc advice. --- At this point in time the BIGGEST thing is limited movement to the disc. --- all diets MUST wait until after all 8 weeks of crate rest. Changing food while on big gun meds is just plainly a VERY, VERY bad idea. Then you have no idea if there were to be GI tract sign if you are dealign with something serious as progressing to bleeding ulcers or a simply matter of change in food can cause same issues. DO NOT CHANGE HIS FOOD. Continue with his normal kibble!!!! --- no vet worth their salt would ever, EVER encourage the use of both prednisone and a NSAID at the same time as a normal thing. When there is an emergency and pred is still in the body, but a quick move to a different anti-inflammatory is needed then it is worth the risk but with double GI protection. This vet must always be taken with a grain of salt UNTIL you have done your research to figure out if what he is advising is in the best interest of Che, what's true and what is dangerous. That is a hard road to toe when one is overwhelmed, emotional, tired, etc. Having a real IVDD knowledgeable vet on Che's health care team is like the difference between night and day. --- Do you have the blood test results in your hand? Can you scan and show us. I do not have knowledge enough but perhaps we can find out what the test numbers might mean.
LIVER issue or not? Cortisol issue or not? -- Liver. If there is really no liver issue then staying on pred is the better choice. It eliminates a dangerous switch without a washout. Pred is belongs to the most powerful class of anti-inflammatory drugs. If there is no liver issue then why would want to go to the lessor power class of a NSAID?? What if the lessor NSAID does not do the job, then a switch back to pred is needed! --- Once there has been a switch to ANY non-steroid NSAID then you have a real need to again do a safety of 5-7 day washout. Switching back and forth willy nilly when there is not a real liver issue shows a vet to be very uncomfortable in their knowledge of IVDD.
SUMMARY -- Need to get at the real truth of the blood test re: liver and cortisol levels with a vet that can be trusted to interpret correctly. -- If no liver issue exist, the sticking with prednisone 5mgs every 12 hrs is the anti-inflammatory level. -- if no coritsol level issue exists, then another reason to not do a switch to lessor NSAIDs. -- Strict 24/7 rest is critical. You have already witness Che being sabotaged with the vet who back on 10/19 rX. short walks. DO NOT go there again with any vet. Those vets do not know IVDD as you plainly have learned the hard way. -- With pred on board (or if correct blood test interpretation really does indicate a need to use a NSAID) hopefully you can use a safer, but aggressive pain med RX approach for a 15 lbs dog. TRAMADOL 50 mgs every 6 hrs GABAPENTIN 100 mgs every 6 hrs METHOCARBAMOL 125mgs every 8 hours.
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Post by Alison & Che on Jan 21, 2020 10:51:54 GMT -7
Wait. He never said to use the NSAID, just the prednisone every other day as a normal thing. Maybe that wasn't clear. I have scans of the tests. How do I upload? This is a copy paste: VetScan ALP 968 * 20-150 lJ/[ A_LT 61 10-118 UF~ AMY 226 200-1200 ~t TBIL 0.3 0.1-0.6 mg/at BlJN 11 7-25 mg/dl CA 11 .2 8.6-11.8 mg/dl FOS 5.1 2.9-6.6 mg/dl CRE 0.4 0.3-1 .4 mg/dl -- GLlJ 128 * 60-110 mg/dl /~ )NA+ 150 138-160 "'moll~ . CJK+ 4.1 3.7-5.8 mmol7T-; ;::TP 6.9 5.4-8.2 gfd[· ,_, gtdr'~ ::1GLOB 2.4 2.3-5.2 \ ~CONTROL DE CALIDAD OK , J'.HEM 0 LIP 2+ !CT 0OK. Here are the JPG of his 1/3/20 blood tests:
This is the cortisol results from 1/3/2020:
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 21, 2020 11:01:01 GMT -7
Nutrition is never more important than during healing. The body actually needs additional protein and nutrients because the body is calling upon its reserves to fuel all the many repair jobs that have to be performed so that healing can take place. Now is no time to be restricting and denying the body that badly needed nutrition by reducing portions. Just like people should avoid too many treats like potatoes chips, etc so should Che avoid treats that are low in good nutrition but mainly just calories! If you want to give a treat make it a low cal one: small piece of apple, carrot, frozen green bean, a frozen meat broth ice cube to lick on in a bowl. DIET program It takes 3-4 months to safely drop excess weight by cutting food intake slowly and adding exercise that will be permissible after graduation from crate rest. Feed the amount for the proper weight the dog should be. At the end of crate rest, graduation, then you can start a diet if needed. No need for the more expensive "diet" kibble. Products described as “diet”, “lite” or “reduced-calorie” may not be the best choice. just feed a good quality normal kibble at a 10-15% reduction of food. That slight reduction plus being able to exercise upon graduation will take the weight off in a safe manor. Optimal weight?
• You should be able to feel ribs but not see them when pet is standing.
• Pet should have an hourglass figure when viewed from top.†
• Your veterinarian can also help you determine when your pet has reached an optimal weight More .detail on loosing weight and choosing a quality food to fit your pocketbook: www.dogfoodadvisor.com/dog-feeding-tips/dog-lose-weight/ Diet article: www.dodgerslist.com/literature/nutrition/Overweight.pdf
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Post by Alison & Che on Jan 21, 2020 11:04:05 GMT -7
The travelling vet said the levels that indicate a failing liver are not evident.
All the elevations are the result of the dog being on 5mg of prednisone 2x/day.
So the body wasn't making cortisol. He said the only way you would know is if the dog was off prednisone.
But he said he was not worried because all the liver function numbers were just fine.
All four prior vets seem to assume it is always better for the dog to not be on prednisone. So they just seemed to agree that a transition was in order. They never questioned it. And perhaps the Mexico vet said that long term use can cause hormonal disease, so long term use is not a good choice.
But this travelling vet said prednisone every other day can last for years with no Addisonian crisis. And it is the best anti inflamm for disk disease available. And that pain meds aren't really the solution, anti inflams are.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 21, 2020 11:10:02 GMT -7
Prednisone, a glucocorticoid, every other day now at this point is not right. Right now there is swelling that needs the benefit of prednisone at the anti-inflammatory level (5mgs 2x/day) The taper level (every other day) is way below the anti-inflammatory level so it is NOT WORKING on any inflammation.
"Glucocorticoid dosages depend on the condition that is being treated. Glucocorticoid dosages can be classified as physiologic replacement, anti-inflammatory, immunosuppressive, and shock doses [steroid blasting]. "Glucocorticoids: what are the current recommendations? (Proceedings)" DVM360. Nov 01, 2009. By Butch KuKanich, DVM, PhD, DACVCP
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Post by Alison & Che on Jan 21, 2020 11:25:18 GMT -7
Yes. He said that. He said it (pred) would need to be higher until the crisis is over and then used over the long term. OH. I see what you are saying. So then what does it do over the long term? Che had a bowel movement yesterday or today in his crate. So that was two days constipation. But looks like the pumpkin was working. So I am happy about that. Giving just 1/2 teaspoon. This is the dollbaby you are helping. He says thank you ma'am! Much appreciated! I say hello from the dry haven of Tucson, Arizona, where the dogs are the best in the world!
Except the dogs from whereever you live of course. Please understand we get labs and prescriptions in Mexico. It is just 45 minutes from our house. So that's why it is in Spanish. Of course, the MRI and recently since September we have been using an American vet here in Tucson, because transport is a problem [ This is Che with his sister/mom.... deleted post ] Alison hope you'll understand with the intense, postings, we want to stay on topic, keep the posts to just those that pertain to Che's thread.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 21, 2020 11:41:44 GMT -7
Alison, the traveling vet is now being perhaps more accurately reported and is now making more sense. Liver levels up indicating liver failure is not evident. Due to being on pred 5mgs 2x/day. Can't confirm as I do not have knowledge to know if the numbers are ordinary and to be expected for a dog being on pred or if they signafy too high and need to get off of pred. Cortisol level not making coritsolCORRECT! When prednisone in the body, the adrenal glands think there is enough steroid and not need to produce cortisol. The pred taper servers a couple of purposes. 1) signal the adrenals to make their own corisone steroid hormone upon the every other day dose beginning 2) The pred taper provides a perfect window as the taper doses begin to to identify if any hint of pain might surface.' RULE OF THUMB Pain= another course of anti-inflammatory + all pain meds back on board. No Pain= go to completion of pred taper...j finish out the 8 weeks of crate rest for the disc to heal. The full details on how prednisone, an anti-inflammatory works with a disc episode. Good reading to be able to ask the right questions and discuss treatment: www.dodgerslist.com/literature/healingsweling.htmLow dose prednisone long term There are diseases where a dog simply can not make it's own steroid cortisone and they do take low replacement doses for a life time. In cases of a disc episode, there are some few dogs whose disc just will not shrink back enough away from the spinal cord nerves during the 8 weeks of disc healilng. In those few cases a vet will come up with the lowest dose of pred or a NSAID (but never the two together) to provide relief and the ability to enjoy life. Just like some people may take a low dose of a med to get back to enjoying life. No one wants any dog on a steroid nor a non-steroid NSAID any point past the benefit of all swelling gone. There are serious side effects for both these classes of drugs (steroids and NSAIDS). With a disc episode the big gun meds outweigh the risks in effort to control pain and prevent nerves cells from dying (paralysis, loss of bladder control). I'm so, so sorry that pred has been used and negated by dangerous vet advise of walks, not being serious about the STRICT 100% — these tragedies have cause Che suffering and two disc relapse setback during the time his disc was to be protected and allowed to heal. IVDD READING is an IMPORTANT ACTIVITY! I am glad you are asking questions about what you read. Hope that reading is over on the Main Dodgerslist website where our treasure trove of IVDD info resides. LINK: www.dodgerslist.com/healingindex.htm Also do look up each med Che takes at the Mar Vista Pharmacy Library Index (bookmark it for future use www.marvistavet.com/pharmacy-center.pml). The article on prednisone will anwer your question about the serious side effects for prednisone: www.marvistavet.com/prednisone.pml Look up Meloxicam and Rimadyl too.
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Post by Alison & Che on Jan 21, 2020 14:14:45 GMT -7
OK. I just finally got a call from a previous vet who corroborated. Now three vets have said it is fine to go back on the prednisone. And one or two say they don't know if prednisone is always bad.
Anyway, I got a presription for more prednisone, and I will be starting it today at 8pm. Dr. Green said to stop the famotide because it can block absorption of the other drugs, but she doesn't really have a strong opinion, I can give it or not. She will check on the dosage for Meth though she doesn't care for it, it makes them loopy and maybe they will fall, but I can keep it if I think it helps. She says keep the ▼tram but 50x 3times, like you suggested and the ▼gabapentin. She hopes to reduce the dosages once the ✙prednisone takes affect over two [correction: 14]days.She is starting 50mg[correction 5mgs ] 2x a day again.
[Moderator’s Note. Please do not edit 15lbs MRI Sept 12 2019 re: 9/11/19 paralyzed legs disc episode Short walk RX on 10/7 - 4 wks after disc episode!!!! relapsed Disc #1 on 11/24 due to shortened 8 wkd crate rest disc relapse #2 getting on furniture until Dec 15, not 100% in recovery suite prednisone previous courses negated upon a disc relapse of 12/15 as of 12/15: 5mgs 2x/day for 23 days ; then tapered 1/8 due to liver-cortisol test results. as of 1/20: 5mgs 2x/day for 1 day until vet help was available as of 1/21 Dr. Green Rx's: 5mgs 2x/day for 14 days then 2/5 test taper for _pain/_neuro tramadol 50mgs ▼3x/day gabapentin 100mgs ▼4x/day= 500mgs!!! (not to exceed 400mgs total/per day methocarbamol 250mgs 3x/day famotidine 5mgs 2x/day ]
There is some learning to be had here. But I am up to the brim in playing veterinarian technician. I need a break. I know that prescription will work and if it is someone really thinks his liver is in jeopardy well I will cross that road when I come to it. For now 100% crate rest is my plan and lots of pred.
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Post by Romy & Frankie on Jan 21, 2020 14:59:54 GMT -7
Please let us know that the pred at 50mg 2x a day is a typo and it is actually 5mg. 50mgs would be for a dog well over 100 lbs and Che is 15 lbs.
Having an anti-inflammatory back on board means that the swelling in the spinal cord is being treated, so that is excellent.
It is quite likely that the pred, now at the anti-inflammatory dose, will need to be taken for more than 2 days. We usually see at least 5 days before the taper. The taper, while necessary to get the dog back to producing its own hormones, is also a good time to see if the swelling is gone. When the taper is started, many vets will also stop or cut back the pain meds. If pain meds are on board during the taper, they may mask any pain that is surfacing. If that happens, we may think because the pain is gone the swelling is gone, but it is not.
If your vet will allow you to give the Pepcid AC, even if she thinks it is not necessary, give 5mg 30 minutes before the pred and thereafter every 12 hours.
If the meds are now right, Che should be able to rest comfortably in his recovery suite for the rest of the 8 weeks.
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Post by Alison & Che on Jan 21, 2020 15:13:22 GMT -7
Yes. its a typo. 5mg [of prednisone] She said two weeks [prednisone] not two days. I am going crazy and cant type accurately.
OH. My I hope so. You are my angels!!!
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Post by Romy & Frankie on Jan 21, 2020 15:21:16 GMT -7
Glad it was a typo. I am prone to typos myself.
Usually the pred is prescribed at the full anti-inflammatory dose for 5-7 days, although some vets go longer, and then a taper is tried. Does the vet want two weeks at the full 5mg 2x/day for the full two weeks?
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Post by Alison & Che on Jan 21, 2020 17:52:57 GMT -7
I am not sure [about prednisone]. It was verbal. I will get her [Dr. Green] script on Thursday. I am starting tonight with my existing supply. I am going to formalize everything with her on TH. I sent her the MRI and all his blood tests, records, giving her a change to reveiw. Che's dog father is pushing hard for his back brace. He bought it and he thinks it will counteract the issues of weight pulling on Che's back. I told him I am hesitant because you are so against it. What do you think. Should I dig in my heels?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 21, 2020 20:08:34 GMT -7
You will come across people whether they are professionals or lay people who are ignorant of IVDD. Your job in protecting Che is your education (you read the link I gave you, right? and be able to in a polite way say "no thanks" to harmful advise. You can help educate the father by sharing the information you have learned. LInk about back braces and why not to use on an IVDD nor one going thru a disc episode: www.dodgerslist.com/literature/Supplements.htm
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Post by Alison & Che on Jan 26, 2020 7:38:43 GMT -7
Hi Paula. Things were going OK for awhile and now Che is barking constantly from when he wakes up on. I take him out to pee. I feed him. I give him a KONG. And he gets done and starts barking. He will stop if I get in the crate with him and lay down. He will also stop if I take him out and let him sit on the "car" on my lap, which keeps him straight. Its basically a little stiff bed that acts as a flat surface. I carry him around using it. And sometimes will just sit with him with it.
So now I feel he is terrorizing me with demand barks. Not sure what to do. If I ignore him he continues on and on. Now its been about an hour of straight barking. He stops and then starts up again. Please help.
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