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Post by Tricia & Sherman on Jan 20, 2020 16:28:42 GMT -7
Hello,
Sherman has had 3 previous episodes and has always healed with conservative treatment and 8 weeks of crate rest. He is now 13 and this morning sat down while going to the bathroom and hasn't been able to use his legs. Took him to the vet who said he has no deep pain. The vet recommended a neurologist but also gave me meds.
Gabapentin 100mg (1 tablet every 12 hours) capsules and Rimadyl 75mg (take 1/4 tablet every 12 hours). Although she said no deep pain he has been able to control his bladder and goes outside with the help of the sling. He wagged his tail when my husband came home.
[Moderator's Note. Please do not edit
20 lbs
Rimadyl as of 1/20: 18.75 mgs 2x/day for ? days, then a test stop to reveal any: _pain / _neuro
gabapentin 100 mgs 2x/day ]
My question is, should I call a neurologist? Surgery will not be an option financially for us. Should I just work with the conservative method again instead of paying to see the neurologist who may just recommend trying the conservative method again?
Any help would be appreciated.
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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 20, 2020 18:08:20 GMT -7
Tracy, I'm sorry that Sherman is having another disc episode since his last in 2014. What breed is he? The good news is that clearly Sherman does have deep pain sensation or he would not be able to pee on his own and would not be able to wag his tail with happiness! So if surgery is not an option if a time came that is might be considered, conservative treatment would be the right way to go. As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. Paws knuckle under 5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservativePAIN is all pain in control dose to dose round the clock? If pain would be surfacing, that would be because a very non-aggressive pain med approach in in use so there is plenty of room for the vet to increase. You would advocate that any of the pain meds be given 3x/day (every 8 hours). And advocate that each of the 3 kinds of pain have their own pain med. —Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock.
SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or moved ◻︎ 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 STOMACH PROTECTION is a must Proactive vets don’t wait til there is lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. Pepcid AC (famotidine) blocks the production of acid. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours. Pepcid AC has a very limited potential for side effects. 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!) 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).
 HEALTH ISSUES for you to read up on: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.” marvistavet.com/famotidine.pml
A reason to seek a neuor consult is if your vet is not comfortable in their knowledge of IVDD and would be reluctant to use an aggressive pain med approach. Neuros can help to quickly get the meds right were your vet be uncomfortable doing so.
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Post by Tricia & Sherman on Jan 20, 2020 18:39:28 GMT -7
My name is Tricia and Sherman is a dachshund. So do you think the meds she prescribed are good to get conservative treatment started or should I go to a neurologist?
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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 20, 2020 19:07:52 GMT -7
Tricia sorry for the typo!
If still in pain and vet does not feel comfortable in increased meds, then you need a new vet. Sorting thru your local vets to find an IVDD knowledgeable vet can take several vet visits with Sherman, not good.
So then the faster way to find a vet who knows IVDD meds is a neuro who uses them every day and is trained and comfortable in using pain relievers..
Can you tell us is all pain in control dose to dose round the clock?
So no neuro transport til you have a concrete reason for a vet consult. All car transports are risky to the early healing disc. Staying in the recovery suite except for the very fewest of footsteps to take are of business is how the disc heals. Vets who know IVDD will adjust meds on the phone if you have the abilty to observe and report details. If accupuncture or laser therapy are wanted, then look for a mobile vet to make visits to your home.
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Post by Tricia & Sherman on Jan 21, 2020 4:08:34 GMT -7
Last night Sherman urinated in his crate twice but also went when I took him outside with a sling. He has yet to poop since going down yesterday morning. He also woke up panting and shivering last night. I gave him a 1/2 ✙tramadol 50mg which was not prescribed but I know he took it during his last episode. He drank lots of water and went back to sleep. I am going to call the vet today about giving him the tramadol in between the doses of the other meds if he seems to be in pain.
[Moderator's Note. Please do not edit
20 lbs
Rimadyl as of 1/20: 18.75 mgs 2x/day for ? days, then a test stop to reveal any: _pain / _neuro
gabapentin 100 mgs 2x/day
✙tramadol 25mgs ?x/day
needs GI tract protector, Pepcid AC, on board w/ Rmadyl! ]
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Jan 21, 2020 6:39:35 GMT -7
Hi, Tricia. Meds should never be given "as needed" but should be given consistently to keep pain completely under control 24/7. Gabapentin works best when given 3x/day (every 8 hours) as it has a short half life. The same thing for Tramadol so if that is prescribed, it should also be prescribed 3x/day (every 8 hours). Methocarbamol, which works on the pain of muscle spasms that often accompanies IVDD, can be added, also 3x/day. Sometimes it takes all three pain meds to get pain completely under control, which is your goal this morning. Pain hinders healing so have no patience with it. How much does Sherman weigh? Be sure to take Sherman out right before bed. It may be that he doesn't have complete bladder control so may not be able to completely empty his bladder so that bladder fills up quickly after going outside. Most dogs will not urinate where they sleep and will hold it until they go outside. If you continue to find wet bedding or if Sherman leaks on you when picked up, you'll need to get a hands-on-your-hands demonstration from your vet on how to express the bladder. Finding wet bedding or leaking when picked up could indicate that the bladder is overflowing and that's not healthy for the bladder. Here's more info on how to express for your review in case you need it: www.dodgerslist.com/literature/Expressing.htmSometimes the meds can cause constipation. If you feel he's constipated, pumpkin can help to loosen stools. Give one teaspoon of pumpkin for every 10 pounds of body weight per day. Add equal parts water to each kibble meal along with plain canned pureed pumpkin 1x a day. Note alternatives for constipation: really ripe mashed fresh pear, just take off the peel; microwaved and mashed peeled sweet potato. We're looking forward to hearing what adjustments the vet has made to the meds and that Sherman's pain is now completely under control. Pain should be completely under control within one hour of giving the new course of meds and should remain completely under control from one dose of pain meds to the next. Healing prayers for Sherman. |
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Post by Tricia & Sherman on Jan 21, 2020 14:03:02 GMT -7
I am still waiting for the vet to return my call about the meds. Sherman is 20 pounds. He has been urinating when taken out and not wetting in his crate. If he takes the meds 3x a day instead of two, is it the same dosage? I want to make sure I understand when I am talking to the vet. I am a little disappointed because she had me feeling like he was a lost cause and needed to get a wheelchair.
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Post by Romy & Frankie on Jan 21, 2020 15:08:33 GMT -7
Good news that Sherman now seems to have regained bladder control. Bladder control bodes well for future healing.
The pain meds would usually be the same dose, just more frequently.
It is way too early in the healing process for a wheelchair, a lot of healing can still take place.
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Post by Julie & Perry on Jan 21, 2020 17:44:29 GMT -7
Tricia, unfortunately many vets seem to be quite pessimistic when it comes to IVDD.
Sherman sounds like he's doing well and there's every reason to be positive about his recovery.
Sending you healing thoughts and prayers.
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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 21, 2020 19:44:00 GMT -7
Tricia, let us know the 2x/day gabapentin which has Sherman showing pain BEFORE the next dose has now been replaced with an every 8 hrs (3x/day) schedule.
The Rimadyl, NSAID, would NOT be changed to every 8 hrs. It is fine as Rx'd.
FOR HOW MANY DAYs wlll Rimadyl be given? It is important information to know how long the prescribed Rimadyl course is.
All pain meds Rx should be given promptly on time never inbetween other doses "if needed"
Pain meds are needed every 8 hrs to keep their level up in the body that every 12 hours does not.
Pain meds can be dosed at the same time promptly every 8 hrs.
TRAMADOL is too low for a 20 lbs dog. Adovocate for the max analgesic dose of 50 mgs every 8 hrs. The med acts as the general analgesic.
GABAPENTIN deals with nerve pain. Again advocate for every 8 hrs. The vet will tell you if preferred at the 100 mgs dose or different.
METHOCARBAMOL is to deal with painful muscle contractions typical with a disc episode. Also every 8 hrs.
When a combo of meds are used the ability to control pain is well known to be far greater than use of only one pain med.
Let us know, too, that his stomach is being protected with Pepcid AC 5mgs twice a day.
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Post by Tricia & Sherman on Jan 23, 2020 13:40:57 GMT -7
We are now doing the two pain meds (▲gabapentin and ▲tramadol) every 8 hours. The Rimadyl has enough meds for 16 days. Sherman is still urinating when taken outside with a sling. No crate accidents. I had to express his bowels because he has not pooped on his own or had an accident. Gave him 2 teaspoons of pumpkin yesterday and today so hopefully that will loosen the stool to go on his own. He has shown no signs of pain for the past two days since we have gone to pain meds 3x a day. I have searched for someone to do laser light therapy in my home but have not found anyone in my area that does house calls. My vet does it but I was trying to avoid traveling in the car with Sherman. It was helpful with his last incident so I may have to drive him to get the therapy.
[Moderator's Note. Please do not edit
20 lbs
Rimadyl as of 1/20: 18.75 mgs 2x/day for 16 days, then 2/5 test stop to reveal any: _pain / _neuro
gabapentin 100 mgs ▲3x/day
tramadol 25mgs ▲3x/day
needs GI tract protector, Pepcid AC, on board w/ Rmadyl! ]
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Post by Romy & Frankie on Jan 23, 2020 14:11:00 GMT -7
I am very happy to hear that changing the meds to 3x a day has relieved Sherman's pain. The pain meds can be constipating so giving the pumpkin is a good idea. If you think the benefit of the laser treatment outweighs the risk of the transport, bring Sherman in. To make the trip as safe as possible pad out his crate with rolled up towels or blanket so that Sherman will not shift in the crate as you turn a corner or brake.
Are you giving him the Pepcid now?
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Post by Tricia & Sherman on Jan 24, 2020 4:19:00 GMT -7
I give Sherman a ✙pepcid 30 minutes before his Rimadyl dose. He pooped last night outside with the sling. Seems like the pumpkin did the trick. I am going to take him this afternoon for laser light therapy session.
[Moderator's Note. Please do not edit
20 lbs
Rimadyl as of 1/20: 18.75 mgs 2x/day for 16 days, then 2/5 test stop to reveal any: _pain / _neuro
gabapentin 100 mgs 3x/day
tramadol 25mgs 3x/day
✙Pepcid AC ? mgs ?x/day ]
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Post by Julie & Perry on Jan 24, 2020 9:07:49 GMT -7
Tricia, I found laser light therapy very helpful for both my dogs as they had grade 4 episodes.
As Romy said, be very careful transporting and getting in and out of the crate.
I also kept my hands on my dog the whole time they were doing the laser.
Sending healing thoughts and prayers.
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Post by Tricia & Sherman on Jan 26, 2020 5:00:21 GMT -7
I am running low on the pain medications and will be contacting the vet tomorrow. How much more medication should I ask for?
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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 26, 2020 9:06:50 GMT -7
Looking at Sherman's med list, I see the Rimady test stop to see if there is any pain still existing starts on Wed, Feb 5.
There is a good chance that the 16-day course of Rimdyl may well have resolved all swelling. The number of Rimdayl days in a course is all a guess. It is the test stop that gives an accurate report!
Rule of thumb is:
pain = swelling =another course of Rimadyl, pain meds and Pepcid AC, then another test
So unless you are running out of the other meds on his meds list which SHOULD be given until the Feb 5 test stop of Rimadyl, then you would, indeed, need to get enough of those meds to last til Feb 4th (same as the last dose of Rmdayl) Make sense?
Are you up to speed on Rimadyl's test stop?
--- What are you supposed to monitor for?
-- Pain meds mask (blindfold) the task of observing Sherman. On Feb 5 which does your vet prefer
__ Full stopping both pain meds (gabapentin, tramadol)?
__ Begin backing off pain meds in dose/frequency given?
-- What is your plan B should pain surface Feb 5 or even days after the 2/5 stop. FYI: It can take 5-7 days for Rimadyl to fully leave the body.
Where to read up on how Rimadyl works along with the full story on the part you will play in the test stop: www.dodgerslist.com/literature/healingsweling.htm
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Post by Tricia & Sherman on Feb 5, 2020 20:26:39 GMT -7
Sherman is showing some improvement. He moves his legs and knuckles when I have him on the sling with his feet barely touching the ground. The vet gave me 14 more days of ✙ Rimadyl and we have done 4 laser treatments. He is getting more frustrated with staying in the crate which I take as a good sign that he wishes he could move around more. He can pull his legs underneath him as he turns in his crate. We are still giving the Gabapentin and Tramadol along with the Pepcid 30 minutes before his Rimadyl doses twice a day.
[Moderator's Note. Please do not edit
20 lbs
Rimadyl as of 1/20: 18.75 mgs 2x/day for 16 days, then 2/5 test stop to reveal any: _pain / _neuro
as of date?: 18.75 mgs 2x/day for ✙14 days,
gabapentin 100 mgs 3x/day
tramadol 25mgs 3x/day
Pepcid AC ? mgs ?x/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 Feb 5, 2020 22:07:15 GMT -7
Tricia, oh dear, you are giving conflicting information and it is very confusing. Please help us understand. • Rimadyl test stop was to be on Feb 5. • Rimadyl was instead extended for 14 days. • Rimadyl's only job is to get rid of painful swelling. It does not help nerve repair • You report Sherman is feeling in good spirit, improved neuro repair. • Why was Rimadyl then extended for 14 more days? • What day did you start giving this 14-day course of Rimadyl on Feb 5 or ....? There are no safe medicines. No one wants a dog on Rimadyl one bit past the benefit of riding the body of all painful inflammmation. The test stop of pain masking pain meds along with the stop of Rimadyl is the proof to find out if another course of Rimadyl is needed. Rule of Thumb Pain= another course of Rimadyl + all pain meds back on board. No Pain= no need of any meds...just finish out the 8 weeks of crate rest for the disc to heal. The full details on how Rimadyl, 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.htm |
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Post by Tricia & Sherman on Feb 6, 2020 4:22:44 GMT -7
The vet recommended the extension so we never did a stop. Should I stop and watch for signs of pain?
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 6, 2020 5:49:37 GMT -7
Tricia, so very glad to hear of the improvements that you have seen! Wonderful news. You would need to discuss the stopping of Rimadyl with your vet to get a good understanding of why he recommended an extension. Usually a test stop of all meds is done in 7-14 days. Sherman has been on the meds for 16 days. Yes, do speak to the vet about a test stop of Rimadyl to see whether there is still pain and still a need for meds. Please also speak to him as to whether he would prefer to also stop all pain meds when the Rimadyl is stopped or taper off of them. When the anti-inflammatory (Rimadyl) is stopped, pain meds should also be stopped or at least tapered off of as having pain meds on board will mask any pain that you need to see and the sooner you can determine the status of the swelling, the better. More information on the inflammation phase of IVDD here: www.dodgerslist.com/literature/healingsweling.htmPlease let us know what the vet says after speaking to him today. |
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