Donna's Dickens 12/18 Surgery Italian Greyhound

Donna, welcome to Dodgerslist.  If this is a disc pushing on the spinal cord and causing pressure to the nerves, it would be a very painful thing.   Dicken's would then be under medicated for pain.  We are not as familiar with greyhound breed and meds so our comments are based on those for dachshunds. For example one of our moderators is a vet tech and reminded us that sighthounds such as Dickens can easily get chilled & stressed and their metabolism may be slower to process meds out from the body than other breeds.  You may want to seek out a consultation with a specialist, a neuro specialist, as a 2nd opinion at some point to get the best advice, to rule out other diseases that can mimic a disc problem or if the pain will not be brought under control.  Would surgery be a consideration for you family if needed?

What city/state do you live in?

For a 12 pound dachshund vets do prescribe more aggressive pain meds with tramadol going up to 50 mgs every 8 hours.  Vets understand that full pain control may require a combo of pain meds.  Methocarbamol to address the type of pain so often associated with a disc episode…muscle spasms. If aggressive use of tramadol and methocarbamol are still not fully covering up pain, then vets are finding good success by adding in gabapentin.  So you will need to give feedback to your vet on your observations of pain so the meds can be further tweaked to get it just right for Dickens.  Background reading on pain before speaking with your vet: www.dodgerslist.com/literature/healingpain.htm

The FDA and manufacturer pkg insert indicate gastrointestinal problems are side effects of using NSAIDs. The natural defenses of the stomach to shield against stomach acid is hindered when taking NSAIDs. Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms. Phrase the question to your vet this particular way:" Is there a medical/health reason my dog may not take Pepcid?" If there is no reason, we follow vets who are proactive in stomach protection by giving doxies 5mg Pepcid (famotidine) 30 minutes before the NSAID. Pepcid is generally considered a safe-over-the-counter suppressor of stomach acid production for a healthy dog and good insurance.
We ask that all members read about each med their dog is on or may take as a safety measure. This directory is in alpha order:
www.marvistavet.com/html/pharmacy_center.htm

If this is indeed a disc episode, then Dickens would be a good candidate to recover under conservative treatment with 100% STRICT crate rest 24/7 only out for a few footsteps at potty time.  It takes 8 weeks of limited movement the recovery suite provides to give the disc a chance to self heal by forming good secure scar tissue.

Get ready to fight this disease with this current episode and in the future by knowing all things IVDD. There is no better place to start than on our main web page with "Overview: the essentials" and then read all you can as soon as possible. Here's the link www.dodgerslist.com/healingindex.htm

We look forward to learning more about Dickens and what changes to pain meds have been made plus the stomach protector (Pepcid AC)

If pain can be brought under control, then Dickens can be a good candidate for a good recovery under conservative treatment and avoid a surgery.

The important thing today is to get his pain fully under control with adjustments to meds…. if it takes a call to ER, Sunday today, then that is the thing to do. Pain is not just torture, but is actually detrimentally affects the body and hinders healing.

Also make sure that stomach is being protected from the Rimadyl with Pepcid AC (famotidine) on board today as well.. Dickens does not need another problem on top of dealing with a disc episode.  Just like people can get stressed out with change in routines/emotions where some get ulcers, dogs do as well.

First trying aggressive pain meds is the order of the day. Rimadyl or the other class of anti-inflamamtories (steroids such as prednisone) just takes time to do the job of getting the inflammation down. It can take 1-2 weeks+ on a steroid or a NSAID to get all that swelling down. In the meantime with a disc episode, aggressive pain control is a must.

The problem with switching from a the NSAID class to the steroid class (prednisone) of anti-inflammatories is that Dickens would need to go for 4-7 days washout with any inflammatory on board to be working on swelling going on in his spinal cord. I would stay the course with Rimadyl and advocate strongly for pain meds in the proper dose of mg's, the right frequency and the right combo. If pain can't be controlled then I would seek a neuro consult with the potential for a possible surgery to follow. Surgery vs. Conservative information…good to be in the know and understand your options: www.dodgerslist.com/literature/healingsurgery.htm

Can you clarify for us what dose of tramadol you are actually giving now…20 mgs or 15 mgs every 8 hours. Both are really not very aggressive doses for a 12 pound dog. It sounds like both your vets are really not comfortable in treating a disc episode. That means you'll need to get up to speed asap so you can make decisions on hiring another more knowledgeable vet, advocating for full pain control, etc. Veterinary Anesthesia & Analgesia Support Group on Tramadol: www.vasg.org/t_drugs.htm#TRAM

Are you now giving Robaxin (methocarbamol)? dose in mg's? frequency?
Are you now giving BUPRENORPHINE (Buprenex)?
www.petplace.com/drug-library/buprenorphine-buprenex/page1.aspx
www.vasg.org/newer_options_for_chronic_pain_management.htm
Do you now have Pepcid AC on board. 5mg 30 mins before Rimadyl and there after every 12 hours?

With the stop of Rimadyl, there will not be any med to work on inflammation going on in the spinal cord. Be observant of signs of pain nearing next dose of meds, that would call for more aggressive pain meds by alerting your vet to what you observe.

How many days of washout from stopping of Rimadyl to the start of Prednisone did your vet call for?

If the washout is to be less than what vets who look for a 4-7 day washout when there is an emergency need to switch due to loosing neuro functions, you will need to know about sucralfate and strongly advocate this 2nd GI tract med be on board. It requires special timing with food and other meds that is why you will want to be knowledgeable: www.marvistavet.com/html/sucralfate.html

Dickens has an emergency neurology consultation appointment tomorrow at 9 AM.

It is a disc problem. Dickens is scheduled for surgery either tomorrow or Thursday.

Donna, did the neurologist explain why he felt that Dickens needed surgery at this time? Did you discuss with him adjusting the pain medication to get his pain under control and continuing with conservative care? Actually, your last mention of pain indicated that he wasn't showing any signs of pain. Most surgeons will not operate on a dog that is walking. And there was a lot of room to adjust Dickens' pain meds, if he still has pain, such as increasing the Tramadol and/or adding Gabapentin or Methocarbamol.

Please read the following so you can make an informed decision about the necessity for surgery. Surgery has its risks and since Dickens isn't showing neuro deficits, he would be a very good candidate for conservative care.

www.dodgerslist.com/literature/healingsurgery.htm
www.dodgerslist.com/literature/surgery.htm

My thoughts and prayers are with you and Dickens and the doctors, Donna. {{{Hugs}}}

Hi Donna,

I went ahead and moved your topic to surgery to keep all of Dicken's information in one thread.. I am so happy to hear his surgery went well and he is awake and recovering.  

When it is time to bring him home, here is a list of discharge questions to ask.  www.dodgerslist.com/literature/dischargequestions.htm

When the time comes please let us know what medications they send home with him.. Take a deep breath and relax and get some rest while he is at the hospital..

Take good care,

Pauliana

Home!!!

Meds
[12 lbs]

Tramadol 25 mg every 8 hours
Gabapentin 0.4 mls every 8 hours
Methocarbamol 125 mg every 12 hours

He still yelps occasionally when I get him out to potty but laying around he is fine. I do have to say that he is and has always been a drama queen.

Dickens is really wobbly in his back end and his rear feet are knuckling under.

PT - passive at this time by flexing and extending his limbs 5-10 times, three times a day.

Crate rest for until his appointment on Jan 15, 2014

Just a quick update:

On Thursday, Dickens was in a lot of pain. He even yelped when I lifted up his fleece blanket. When I called the clinic on Friday, they increased his Gabapentin by 0.1 ml and added prednisone. Things have been improving since then. The next morning, after the first two doses of prednisone, his left foot was no longer knuckling under and he was trying to stand in his crate. Stitches come out tomorrow.

Dickens' four week post op checkup was today. The neurologist is very pleased with his progress. Dickens can now have supervised time out of his crate (no running or rough housing for at least another month) and can take a 5-10 minute walk daily.