Lola & Hurley
Helpful Member
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 20, 2013 14:08:17 GMT -7
Hello,
I have an 8 year old dachshund, Hurley (14 pounds), his pain episode started on Monday Dec 16th. I have read everything I could find on Dodgerslist during these years, but desperately need a bit more help regarding the correct pain medication!
Hurley has had IVDD surgery twice, once in Oct 2010 (2 discs, mid back) and again this year, Aug 2013 (1 disc, lower in the mid back). Both times, he has made a full recovery. This 2nd time it took much longer because his right back leg actually was paralyzed the day they did the emergency surgery. In fact, all 3 discs were found problematic in the first MRI, although the 3rd disc was, according to the neurologist, not as severe and in a different location (lower in the back) and was thus not operated until it started causing problems this year to his right back leg (yes, a 2nd MRI was done to confirm this before 2nd surgery and I don't know why they only operated 2 and not 3 discs in the first surgery...) Both times, we went through a complete program of physiotherapy after the surgeries, and this year he also got laser to his back once a week until end of Oct. We did daily exercises to strengthen his muscles throughout Sept-Oct, and beg. of Nov, until he started seeming perfectly normal.
This relapse episode must have started actually already a few weeks ago when we noticed he was licking his left front paw. Since he's been so perfectly fine, does not walk stairs, jump on furniture or anything, we thought it was only a rash or something because we had changed his diet to another brand of dry dog food, so we went back to his normal diet (also dry dog food: chicken and rice). Then, last weekend (Dec 14-15) he started having diarrhea. Not too bad though since he was still able to hold it normally and go out with me 3-4 times a day. We still thought it was because we changed his diet. Then, on Monday Dec 16th, we noted first that he was reluctant to put weight on his right leg, and then in the evening, he cried of pain when I lifted to carry him. I immediately suspected it was his back! He was able to take a few steps to go pee when I carried him out but would cry a bit, and looked miserable. I immediately crated him 100%. The right back leg was cramping, so since I had some Rimadyl for him from the surgery, I gave him 20 mg [Rimadyl] that evening [12/16]. That night he was very restless. In the morning, he would take a few steps outside to pee and poop, when I carried him there, but he would cry of pain, so I gave him another 20 mg and he restlessly slept in his crate throughout that day. As I did not consider the Rimadyl was working or helping (he seemed very painful, and when taken out he would not place any weight on the right back leg, holding it in a flamingo like position), I called the vet that evening to book an appointment for the next morning, gave him one more 20 mg and we restlessly slept that night. He would cry every time he tried to move in his crate to change position.
On Wednesday morning, we went to see the vet. It was a 10 min. drive and Hurley was shaking and panting all the way to the clinic. By the time we got there, he was exhausted because of the stress and pain. The doctor agreed that it must be his back, either a relapse or a new disk rupture, but since he was able to move all his legs, and such little time had passed from the last surgery, he recommended medication. (Note: We have since November moved to another state, this is not the vet/neurologist who did the surgery. He recommended Hurley should be allowed to move around the house if he wants to as that “has been found to help humans with back pain” - I disregarded as I knew what I was told before and had red from Dodgerslist and that he needs to have 24/7 crate rest!!!).
The vet did cold laser on his back and prescribed following meds/supplements/...:
Adequan 3ml twice a week to lower back area 1/2 Duralactin chew, 1 Cetyl M tablet, and 300 mg Omega 3 fish oil every day Tramadol 25mg x 2 (twice a day) Diazepam 1-2.5 mg administered every 6 hours Methocarbamol 250 mg x 3 (every 8 hours) 2 teaspoons of pumpkin daily (to help to avoid stomach problems) Heat & massage Acupuncture & more laser
The Adequan and laser were administered at the vet clinic on Wed morning. Since then, I've been giving Hurley Duralactin, Cetyl M, Omega 3, Tramadol, Methocarbamol, pumpkin, and making a heat bag for him to sleep with as prescribed. The Diazepam I dropped on Thursday since I didn't see it helping him. We haven't done massage as he is not paralyzed and I'm afraid to touch his back or legs, also I think it is not recommended? He has the first acupuncture and some more laser scheduled for today evening (Friday), although I am really worried of moving him and driving him to the clinic, if it will stress him again. He is still really painful when I take him out to potty, yesterday he put a bit of weight on the right leg when peeing – he lifted the left leg instead – which is a good sign (?). Last night, he slept 10 hours non-stop except for Methocarbamol – I woke him up and gave it to him at 3 am as prescribed. Are these good signs? He has been eating and drinking normally all the time. I give him water with his food and additional cup here and there always when he is awake.
Now, my questions are:
1. Since it is so painful for him to stand up or move (he cries of pain) when going to potty, should I ask the doctor to add Gabapentin to the med cocktail? 2. Would it still be helpful to have him on cortisone to reduce the swelling and thus also the pain? The doctor did not want to prescribe it because of possible side effects. Hurley has never had cortisone before, so I don't know much about it except that many seem to have found a positive effect regards to recovery. I will keep him 100% crated but I do not want him to be in pain when he has to go potty. It's now been 3 days since the Rimadyl, so we could start cortisone e.g. on Monday? 3. Can we up the dose of Tramadol? Right now, he gets it only twice a day, and I've read on Dodgerslist that it has a short life, could we go to 8 hour gaps instead of 12??? 4. Does the Diazepam have any other benefit besides sedation? Should I continue using it? He already gets Methocarbamol to relax, and is very calm when crated... 5. Is heat good for the back (if it is a new injury) or should I try cold instead? 6. Is there anything else we can do? 7. We will do another MRI and surgery if needed, when do you think this should be considered, i.e. how should we wait until making a decision?
Sorry about the long message. This is so important to me and I want to make sure I am doing everything I can to make Hurley comfortable and this recovery successful if possible.
Thank you in advance.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 20, 2013 17:23:02 GMT -7
Hi, Lola, welcome to Dodgerslist. I'll answer each of your questions as numbered. 1. Yes, please speak to your vet about adding Gabapentin. Gabapentin works synergistically with Tramadol. 2. Yes, Hurley definitely needs an anti-inflammatory ASAP. The reason he has pain is that swelling is pressing on his spine. That is what causes nerve damage and must be resolved. Most doctors will prescribe a NSAID such as Rimadyl when the symptoms are mild, like Hurley's are. Steroids are usually prescribed for more severe symptoms, such as bladder loss or loss of leg movement. This link will give you more information about the meds used for IVDD: www.dodgerslist.com/literature/drugs.htm#rimadylYes, if a steroid is prescribed, there would need to be a 4-7 washout period from the last time Hurley was given the Rimadyl. Or he could just continue with Rimadyl. 3. Yes, the Tramadol works best when given consistently every 8 hours. It also can be prescribed at 50 mg 3x/day for a dog of Hurley's weight. Please speak to your vet about adjusting that. 4. If Hurley is calm while crated, I don't see any reason why he should continue the Diazepam. The Methocarbamol will help with muscle spasm pain. 5. You mentioned making a heat bag for him to sleep with. What exactly are you using? Is it just for comfort? Nothing should be applied to Hurley's back, either heat or cold. If you would like something for comfort, we recommend Snuggle Safehttp://www.petstew.com/B00008AJH9/pet-supply-imports-snugglesafe-pet-heating-pad.html 6. I'll address this below. 7. This is our page about when to consider surgery: www.dodgerslist.com/literature/healingsurgery.htmSince Hurley's symptoms are mild, he's a very good candidate for conservative care. So the first thing you need to do is get his pain under control. Speak to your vet about adding Gabapentin and increasing the dosage of Tramadol to 50 mg every 8 hours. Also insist on an anti-inflammatory. As to your vet's fears of side effects, please get your vet's permission to give 5 mg of Pepcid AC (generic is famotidine) 30 minutes before the dose of the anti-inflammatory and thereafter every 12 hours. Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If your vet says your dog has no health issues such as liver, heart, etc to keep him from taking Pepcid AC, then do get it on board. And give the anti-inflammatory with food. That will protect Hurley's GI tract. You might discuss with your vet if this is nerve root signature pain. It is disc caused but instead of pressure to the spinal cord the pressure is on a nerve root exiting down to the leg. This is painful and makes them not want to bear weight. Dr. Isaacs explains here: www.dodgerslist.com/neurocorner2/rootsignature.htmThere should not be any massage or therapy done until Hurley is off of all medications and there is no swelling on the spine. You are right in that it is not necessary for dogs who still have movement in their legs. Once Hurley is off of all meds and has no pain, the very least, slightest massage and passive exercise could be done on the leg that is giving him problems. See massage and exercise #1-4 on this page (highlighted in pink) www.dodgerslist.com/literature/massagepassiveexercises.htm But only after all meds are stopped. Acupuncture and laser are very good therapies and can be done throughout conservative care. As for the supplements Hurley is taking, these are our recommendations for supplements that can be helpful for IVDD dogs: www.dodgerslist.com/literature/Supplements.htmThere is also information on that page about Adequan. Good job on starting the crate rest and not listening to your vet's advice about that! 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks is the SINGLE most important thing you can do to help your dog-- it is the hallmark component of conservative treatment. Carried in and out to potty. No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM). In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc. www.dodgerslist.com/literature/CrateRRP.htmIs Hurley still licking his front paw? Be watchful that licking does not move to biting or chewing….for us with an IVDD dog, there is always the thought of neuropathy and owners need to be aware. This is a good flyer to put on your fridge. www.dodgerslist.com/literature/FridgeInfo81907.pdf We have a very helpful DVD that will educate you, your family members and friends, pet sitters, etc. about caring for an IVDD dog. Please see the link in my signature line. I think that covers all of your questions. Of course, we're here if you have any further questions and will support you each step of the way through this. Please let us know what your vet says after speaking to him. All the best to you and Hurley.
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Lola & Hurley
Helpful Member
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 21, 2013 2:35:58 GMT -7
Dear Marjorie, thank you so much for your quick reply and for giving us assurance that we are doing the right thing by crating him! Also, after I carefully read all your comments, I felt much more comfortable asking the vet for some medication changes. I am very grateful for this site.
We actually met with a different vet this time, since we went for the acupuncture session. This vet immediately said she will prescribe Gabapentin in addition to Tramadol in order to keep Hurley's pain more under control. She also immediately agreed to bring Tramadol up to every 8 hours a day instead of 12 hrs, as I requested. But still only 1/2 portion of 50mg tablet a time. Also, she said Tramadol and Gabapentin can (should?) be taken at the same time. Coming home, I started thinking if this is the best pain solution...? Or should I wait e.g. 4 hours before give Hurley the other one, so that every 4 hours he would get some pain relief?
The vet did not do a full exam on Hurley's pain, since we already knew he was in a lot of pain, but could still move his legs. She did not mention nerve root signature pain. I read all I could find according to your instructions and beyond but is there something else I can do, if it is nerve root pain? As for the front paw, he is still licking it from time to time, I think it could be a tingling sensation there... but how can I know? It has not gone any worse this week, though.
She did first the laser and then also electroacupuncture to his back, needles running along both sides of the spine. It did not seem very painful, only maybe a small sting when first few needles were inserted. I don't know what type of help it can bring but I am hoping for the best.
Because of the pain Hurley was in (it is really painful for him to get up from the floor or move, and he was panting and shaking at the clinic up until when we started the laser, then he relaxed), the vet also suggested we should start Predisone (details below) tomorrow morning. I agreed, hesitantly, since it had only been little over 3 days since I gave him one tablet of Rimadyl. I think she considered the 3 day break enough? (OK, Hurley had only eaten 3 tablets of Rimadyl 20mg in total Monday-Tuesday, maybe that's why?). Anyway, she did immediately an injection of Dexamethasone 4mg/ml and gave some liquid stuff to protect Hurley's stomach. She also prescribed Famotidine 5mg to be given every 12 hours, but to be given 1 hour AFTER the Predisone? Is this correct? She said she does not want the Famotidine to be given beforehand as it would prevent the Predisone from doing its full effect.
We are continuing with “no massage or therapy”, only laser (next one on Tuesday 24th) and/or acupuncture and strict 24/7 crate rest. He is very thirsty so I am letting him drink as much as he wants – I might need to take him out more often to potty though!? He actually wet his crate-bed a couple of hours after we arrived home because he was drinking a lot after the vet clinic visit. I am hoping it is simply because he drank so much and my husband was not being attentive to his whining - not because of loss of bladder control!?!!?! He can still walk and move all 4 legs, I carried him out to his potty place and he took a few steps, but the bladder was unfortunately already emptied. I can only pray that our visit to the vet was not detrimental to his back...
Summary; changes done to medication:
Predisone 5mg added, 1/4 tablet every 12 hours for 5 days, then 1/4 tab. once a day for 7 days, then 1/4 tab. every other day for 10 days. Famotidine 5mg added, every 12 hours, 1 hour after Predisone Diazepam only if needed, as he is calm at home when crated Gabapentin - dosage? frequency? Tramadol 50 mg 1/2 tab every 8 hours Heat bag stopped (it was a rice bag that I made for him), this was recommended by the first vet and sounded good since he is in pain, but according to your instructions, I am no longer allowing Hurley to sleep with anything warm against his back or leg. Only a normal blanket.
Best, Lola
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 21, 2013 7:16:35 GMT -7
Lola, doctors who practice safe medicine use a 4-7 day wash-out period when switching from NSAIDs to steroid. Please advocate strongly today for the addition of Sucralfate to protect Hurley's GI tract due to the close switch of meds. Sucralfate should be given on an empty stomach, one hour before food and Prednisone so the gel coating action can begin. Pepcid should be given 30 minutes after the Sucralfate (which would be 30 mins BEFORE the Prednisone, not after). She has given a very low dose of Prednisone. We usually see 5 mg twice a day administered. We need to bring out the heavy artillery to fight the swelling on the spine and get that down quickly. The swelling on the spine is what causes the pain and can cause nerve damage as it's pressing on the nerves. Please speak to her today about that. Please let us know what the dosage of the Gabapentin is and the frequency given. It's a good idea to spread the dosage out to three times a day for better coverage. You can speak to the vet about that also. Were capsules prescribed? Keep an eye on Hurley bladder control to make sure that he's able to release urine on his own and let us know how that is going. Steroids do cause increased hunger and thirst so you will need to take him out more often. The licking that he's doing doesn't sound serious. Just keep an eye on it and if the licking becomes more obsessive or turns to chewing, immediately use an e-collar on or in a pinch a lengthwise folded towel, secured closed with duct tape can keep him from reaching his foot until you get vet help. Gabapentin will help with this kind of pain. Here's the page with more info on that just so you're aware of the issue: www.dodgerslist.com/literature/neuropathy.pdfHere's the info re: nerve root signature pain: www.dodgerslist.com/neurocorner2/rootsignature.htmI misunderstood you about the kind of heat you're using. A rice sock is absolutely fine to use. It's not the heat I was concerned about. I thought you were placing something on Hurley's back, which might cause pressure on his back. A rice sock is nice for him to snuggle with. Please let us know what the vet says after speaking to them. And please also let us know how Hurley is doing on these new meds. Pain should be completely under control within one hour after taking the meds.
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Lola & Hurley
Helpful Member
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 21, 2013 9:28:32 GMT -7
Dear Marjorie, This is exactly what I was worried about, the NSAID - steroid switch! Hurley's stomach was making funny noises in the beginning of the night and obviously, all I could think about was if some kind of damage being done in there... I will now call the clinic to ask them about the Sucralfate. However, giving Hurley his medicines this morning, I gave him the Pepcid 30 min. before the Prednisone, to be safe, despite what the doctor prescribed... About the dosage of Prednisone, I now wonder. I thought it sounded too good to be true, the injection and all, and now I am even more worried because you say the dosage is too low! I need to ask the vet clinic about this! Sorry about forgetting to mention, Gabapentin is one 100mg capsule every 8-12 hours. I gave it this morning simultaneously with Tramadol, Prednisone, and Methocarbamol. Now, an hour later, Hurley seems to be enjoying a good sleep. Before that, last pain killer was given at 10:30 PM last night (25mg Tramadol) and this morning, before any meds kicked in, Hurley seemed a bit brighter. Again, difficult to know if it is because of the electroacupuncture, laser, steroid, Gabapentin or what, but I don't care, anything, as long as my little fellow is happier!! Hurley ate well, had NOT wet his bed during the night, and did not cry when getting to stand up in his crate. I took him out and he shook his whole body (like what dogs do when they are wet!), then took a couple of (GOOD BOY!) steps, even placing a bit of weight on the right back leg, then lifting it up to make a huuuuuge pee next to the tree in our garden. Taking a few more steps back into his SturdiBag, and settling in there to be carried back inside, he did cry a little, same as yesterday, but I am certain it is because there were no medication in his system. (By the way, I have used his SturdiBag for carrying him out to potty, I hope that is OK. I am doing all this mostly by myself and I need to open and lock doors on the way out. Hurley gets excited if he sees any other dogs or when coming back inside and seeing his crate he just wants to leap off, so I am so worried I will drop him from my lap, so I am making him lie in the bag instead where he cannot do any damage to himself. It is now our way of also going for vet's visits and in the car. The only bad thing is that he needs to turn around in there, and there is not enough room to do it without curling up a bit (not too much though). Normally, there would not be any problem, and he loves the bag and often goes in and sleeps there, it's just that I am a bit worried it will disturb the healing process in his spine now. All I can hope for is that it's still better than if I dropped him from my lap because he got too excited, or having to constantly place him down and lift him up because of the doors and locks etc. in the building. Instead, he now gets to comfortably lie down until we get to “his” tree outside. If anyone has better tips about how to do this as a 'one-woman' show, living in a condo, let me know!!!) OK, thank you about the rice sock correction! I actually have mainly used it in the mornings next to his right leg before he gets up, to get the blood circulating and to help him to get up in his crate-bed before carrying him outside. I never heat it to be hot-hot, just nice and warm and he usually closes his eyes and seems to enjoy it. So, we will be cautious with his back, and would never place any pressure there. I will get back to you once I've spoken with the vet about the Sucralfate and Prednisone dosage. Fingers crossed... Lola
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Dec 21, 2013 10:18:53 GMT -7
Lola, it sounds like the liquid protector given at the time of the Dex shot may have been a slurry of sucralfate?? Good that you are calling to get sucralfate on board for home use too. There are different options for timing of sucralfate with Pepcid AC, with food. So that is why you will want to read this to see what will work best at your house: www.marvistavet.com/html/sucralfate.htmlDo let us know what your vet thinks about giving Gabapentin at 100mg vs. a lower dose every 8 hours and stepping up Tramadol to 50 mgs 3x a day for a 14 lbs dog. If Hurley is crying in the morning with needing to move for pottytimes, that sounds like his meds are wearing off before next dose of pain meds in the morning. Pain meds are just one of those things that need tweaking, feedback to the vet to get it just right for each dog…every dog is individual in their needs. Here is some information you can discuss with the vet in trying to come up with a good med plan for Hurley: Vets may have not considered Gabapentin powder in the capsules as being dividable into smaller doses like a tablet. 100mg capsule of powder can be emptied into a creased pieced of paper and with a razor blade move the powder into equal piles. Store the remainder of the powder piles in one of those 7 day pill boxes with a lid for each day. Photo of pill box www.equipment4life.com.au/images/products/SDL750.jpgGood job on using the SturdiBag. For the short period of a trip to potty or to the vet he does not need to be able to turn around in. I bet Hurley does like his sock to lean against or to rest his head on! You might want to wrap it in a towel so it's not too hot for the skin and as insulation to make it stay warm longer. Snuggle Safe is a commercial product that will keep warm the whole night, my Clark LOVES to sleep with it especially with these cooler winter days. tinyurl.com/4jk2cx7
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Lola & Hurley
Helpful Member
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 21, 2013 11:34:34 GMT -7
Marjorie, HORRIBLE to read about the neuropathy! I am in shock!!!!! I will definitely keep a close eye on Hurley. He seems to be doing good now, no licking. Maybe the Gabapentin is helping, or the acupuncture. I called the clinic and I am waiting for yet another, 3rd, vet to call me back on the med adjustments. Xmas is coming and Dr. #1 and Dr. #2 went for holidays. Luckily - at least - the clinic is open 24/7 even during the upcoming holidays.
Paula, thank you for joining Hurley's thread! Maybe it was sucralfate! It was white powder dissolved in a small quantity of water, does that sound right? But why would Dr no. 2. say: “I will give this to Hurley now to protect his stomach since I do not have Pepcid AC here, but you should use Pepcid AC at home (and not this?)”. Strange. Maybe Dr. no. 3 will be able to answer when he/she calls back?
All I hope for now is a pain-free Xmas for Hurley. I had so many gifts planned for him, but I think now the only one he will get is a Snuggle Safe... thank you for the tip!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Dec 21, 2013 13:04:31 GMT -7
We are just very protective of the GI tract/stomach lining. Since there was a switch from Rimadyl to steroids and even though there was a washout, we see many vets still being proactive and so we follow those vets…with TWO stomach protectors. There are dogs who did not switch anti-inflamamtory classes where, Pepcid AC was not enough when not eating, loose stools happened and Sucralfate was added. Pepcid AC normally does a very fine job for most dogs. So we just do not like to take any chances…who needs another problem of bleeding ulcers on top of dealing with a disc episode?
I do think the slurry was sucralfate given with the Dex shot.
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Lola & Hurley
Helpful Member
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 21, 2013 18:56:05 GMT -7
Hi again. I am sorry to say I am not sure if things are better or worse.
The 3rd doctor was hesitant to make changes to the medications without consulting the other two doctors, but did agree that it does not hurt to add Sucralfate. I got it now and gave Hurley 1 pill [Sucralfate] (1g) mixed into water and will continue to give one each 8 hours according to instructions.
I also spoke to him about the dose of Prednisone. Dr. #3 said 5mg every 12 hours is “too much”, but he would be comfortable going up to 2.5mg. Hurley is not doing any better towards this evening: two hours after giving him the Tramadol, Gabapentin, and Methacarbamol, it is still very painful for him to move. This is now day 5. I am hoping the higher dose of Prednisone tonight will help. The Dr. did not agree to increase the dose of Tramadol, actually, I don't know what to do about that anymore. They all mention I could bring him to the clinic for a pain killer "injection” if needed. I do not understand.
Hurley did poop 4 times today (no constipation or diarrhea). Twice on both times we went out. And he did not cry very much when arching his back. However, the second time we came back in, he became very anxious and would cry when trying to move and would not settle in his crate, also the Sucralfate was bubbling in his stomach (?). I waited for that to settle (noise-wise) and then gave him 1/4 of a tablet of Diazepam so that he would calm down. I hate giving him the Diazepam but moving around must hurt him even more... Honestly, I feel like I am back to zero. I have a million lists of what meds to give to him and how and when and I am trying to keep a record of all the changes but I am not sure if I am doing it right or wrong. I am mostly worried about why he gets anxious about 1 hours after I've given him the pain meds (so strange). Should I give him the Tramadol, Gabapentin, and Methacarbamol at the same time or separately... I think they worked better separately, but Dr. #2 said they should be given at the same time. How can I change now this pattern without causing more trouble to Hurley... I am committed to do the best I can, but, I just feel like crying.
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Sabrina
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My Charley-dog, a Dodger'sList grad enjoying life!
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Post by Sabrina on Dec 21, 2013 20:59:08 GMT -7
Hi Lola, I'm Sabrina. I'm so very sorry to hear about Hurley's episode, and that he is still in pain.
If you ask would Dr 3 would he contact Dr 1 and/or 2 about Hurley's doses of Tramadol and Prednisone? It sounds like Dr 3 may not be as confident with dosing these meds for a disc episode. I know it can feel as if you are always on the phone with the vet!!! But as pain hinders healing, if Dr 3 needs to consult 1 and/or 2 in order to get aggressive about treating Hurley's pain that should happen asap so that Hurley can be pain free asap.
Do you know the name of the injected pain med that they are offering to give Hurley?
))Hugs!(( - Sabrina
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Post by Pauliana on Dec 21, 2013 21:12:06 GMT -7
Hi Lola, It's so frustrating and upsetting, I totally understand, especially hard on the emotions when your dog is in pain and you only want to make it better.. Been there, with Tyler.. He has had two episodes, one that required surgery in January and the other in July, was treated conservatively. I don't know what I would have done without Dodgerslist, I was a basket case.. He's doing great now but I learned a lot over both episodes and all the reading I do here! 5 mg of Prednisone every 12 hours is the anti inflammatory dose for dogs Hurley's size. That is what we see commonly prescribed for Dachshunds and other similar sized dogs. He is still in pain because of the swelling and he needs that dosage to get the swelling down. Prednisone isn't a pain killer but it does take down the swelling that causes the pain, it takes time for it to work and that is why the Tramadol, Methocarbamol and Gabapentin are used for comfort from pain. When the vet guesses the swelling might be gone, he or she calls for a taper and then the dose is lowered gradually.. During the taper watch for signs of pain and if there is pain, return to the 5mg dose for longer time.. If there is no pain, that means the swelling is gone and no further medications will be needed and continue crate rest for the remainder of the 8 weeks. www.dodgerslist.com/literature/healingsweling.htmSoothing thoughts headed your way..
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Lola & Hurley
Helpful Member
2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 22, 2013 8:57:56 GMT -7
Hi Sabrina, Hi Pauliana, thank you so much for your support!!! I am feeling somewhat better after having slept a full 7 hours. Only once did we wake up, Hurley was switching position early in the morning and I guess the medication was wearing off so he let out a yelp. So, I decided that today I will space the Tramadol and the Gabapentin so that he will get first the Tramadol and then 4 hours later the Gabapentin. That way, he can get something for the pain every 4 hours. I am also going to split his daily food into 3 portions instead of 2, so that he has something in his stomach all the time, protecting from the damage the pills may cause. I am now consistently starting with the Sucralafate slurry to empty stomach, then 30 min. after, the Pepcid AC, and then 30 min. after, the food and medications. I feel I have an alarm clock ringing all the time, and I can't get much else done besides preparing meals and cutting meds, but I am so grateful I can stay at home with Hurley (I am supposed to work from home but have postponed all my projects until Hurley feels better). I cannot imagine what people in a similar situation do when they have to leave for work in the morning and leave their puppy alone. My heart goes out to them! Actually, crating 24/7 should be easy, so I guess it's me. I'm constantly trying to make sure he is nice and cozy and has his little blanket over him and is the water fresh and does he lick his paw etc. My husband thinks I am going crazy and I try not to fuss but I can't help it. Hurley is my baby.
Sabrina, you are right, I do feel like I am always on the phone with the vet, but I don't really mind, I will keep on pushing them until Hurley gets better!!!!! We are meeting Dr.#1 on Tuesday (24/12) for more laser. If the situation stays like this, I will ask him to increase the Prednisone further and Tramadol, too. The latter has not yet been adjusted at all since it was prescribed on Wednesday, I can't comprehend why they are so reluctant. When cutting the Tramadol into two, as I am only allowed to give him a half, I find myself trying to “accidentally” cut the tablet badly, so that I could choose the bigger chunk. (I know, it's silly, the tablets are so small that a few grains do not make much difference, I do acknowledge that..). I will also ask what injection pain med Dr.#2 and #3 were talking about. I would rather go with an increase of current medication rather than putting another med in the cocktail.
Right now, the situation is not worse. Actually, Hurley did not say anything when he got up this morning, and did quickly his potty outside without any major issue. His bad leg (the back right leg) was not as stiff as yesterday, I think, but I am not 100% sure. Sometimes I think I see some improvement, but then I start questioning myself: was it really, or am I just imagining, because I so badly want him to get better?
Lola
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 22, 2013 10:04:13 GMT -7
The restlessness started again 1 hour after this morning's medication!!! I know now for a fact that it must be the Tramadol, since I have not yet given him this morning's dose of Gabapentin, and having given him the Methocarbamol on its own last week, it did not cause any side effects. Also, the afternoon dose does not include Prednisone (given only twice a day) and he gets restless also 1 hour after the afternoon dose. Has anyone else experienced anxiety after Tramadol? I studied this online and it seems some dogs react like this. What happens is that Hurley does not find a good position in his crate, is turning around (and that hurts! Shouldn't the pain be in control after 1 hour?!??!), is looking at me, whining, breathing is a bit faster (but not panting). It stops after 15-30 minutes but is heartbreaking! I guess there is no other alternative to Tramadol? Should I consider asking the doctor if we could switch to a liquid form of Tramadol, would that absorb faster and give less side effects? He had liquid Tramadol after his last surgery and I didn't notice side effects... I know the Tramadol is working on the pain because after the anxiety stops, he goes to good mode / sleep and that lasts for several hours.
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PaulaM
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Post by PaulaM on Dec 22, 2013 10:24:48 GMT -7
Lola, pain upon wakening does indicate meds wearing off too soon. The short term improvement you are looking to see is full pain control. Nerve improvement may or may not come during the 8 weeks of crate rest which is dedicated to letting the disc heal. Tramadol can have side effects for some including agitation and anxiety. Is the tramadol given with food? LIquid or tablet has the same ingredient, show have same effect. Did you see this effect when timing Tramadol and Gabapentin together? Timing of pain meds: www.dodgerslist.com/neurocorner2/timingmeds.htm Vets do have many options for pain medications to find what works best for each dog. Your feedback and a vet willing to work with you is what is needed. I would not complicate things by feeding 3x a day. It is the sucralfate AND the Pepcid Ac that will be doing the major work of GI tract protection. It gets pretty complicated with so many meds, a good chart can help ensure no doses are missed and done on time. Here is a sample chart www.dodgerslist.com/literature/crateRRP/medchart.pdf14 lbs Prednisone 5mg added 12/18: 2.5mg every 12 hours for 5 days, then 1/4 tab. once a day for 7 days, then 1/4 tab. every other day for 10 days. Famotidine 5mg added, every 12 hours Diazepam 1-2.5 mg every 6 hours ?? this is also a muscle relaxer like methocarbamolMethocarbamol 250 mg x 3 (every 8 hours) Gabapentin - 100mg capsule every 8hours Tramadol 50 mg 1/2 tab every 8 hours Sucralfate (1g) slurry every 8 hours The reason your vets are not wanting to prescribe an increased dose of tramadol is that they are clearly telling you they are not comfortable in treating a disc episode nor how meds are safely used with IVDD. So if pain is not being controlled, you need to seriously look to hiring a vet at a different clinic who is comfortable with this disease. "finding a vet"" www.dodgerslist.com/literature/VetchkList.htm There is no reason for a dog to be in pain when vets have so many options with pain meds (dose, frequency and combo) to get it right for Hurley during the days/weeks it will take a steroid to resolve all the painful swelling. Let us know, if you are still seeing pain today, that on Monday morning you have found a vet who knows the importance finding the right combo of pain meds, extending pred for a bit longer. There is no one size fits all pain relief…each dog is different and a vet must be willing to adjust the meds.
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 22, 2013 12:27:48 GMT -7
Thank you Paula, I totally agree! The clinic we've been to now, they seem to know (something) about back pain, but do not perform these types of surgeries and have no MRI equipment. They have NOT recommended crate rest, which is a big red alarm sign. In my opinion, waiting them to agree on this medication is not working, and then refer us to an expert, ... well, I just can't wait!!!! Therefore, I called the nearest vet neurological center where they perform MRI on dogs to ask for advice, unfortunately they are closed on Sundays. I then called the nearest surgical center and found a reputable vet who has been conducting spinal surgeries with 40 years of experience (but is not a neuro specialist? I'm not sure). He offered a free consultation for Hurley first thing tomorrow morning to go through his current state and all his medications so that we could find a suitable level of pain killers, or/and if deemed necessary, he says he will make the referral to the neuro center, which is open again tomorrow. Hurley's situation is now stable, only some pain if/when he is moving, so I asked my husband to look after him while I go buy a better, transportable crate. The SturdiBag has been great first-aid, but it's a tiny bit too small for him to comfortably turn around, I don't like it when he goes into it and out from it because he needs to turn inside and it can hurt. It will be easier for me if he is in a transportable crate all the time, I can carry that out and then back in, no need for extra movement.
I give Tramadol with food. Same side effect, when Tramadol and Gabapentin were given together. I discontinued the use of Diazepam because Hurley was reacting better to Methocarbamol. I will discuss all of these with the vet tomorrow. Here is a list of questions I am thinking to ask him:
- How severe is Hurley's condition? (I am looking for him to do the proper neurological tests to find out what all might be wrong, especially the right back leg) - Does he recommend continuing the meds+crate rest or MRI (+ possible surgery)? - What modifications can we do to the medications (dosage, timing, especially Tramadol + Prednisone + Gabapentin) in order to decrease the spinal swelling and to get the pain under control? - Is there anything we can do to reduce the Tramadol side effects (i.e. anxiety) - Who can I call in case of an emergency? (This 2nd clinic is only open during office hours)
If you have other question suggestions, please do not hesitate to add!!! Thank you all, on my AND Hurley's (!!!) behalf!!!
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PaulaM
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Post by PaulaM on Dec 22, 2013 13:15:57 GMT -7
Lola, kudo's to you… you are taking the bull by the horn and being active in getting help for Hurley in the morning and preparing your questions ahead of time! I would refresh yourself on surgery vs. conservative so you are clear when surgery should be considered during conservative treatment. Note the order of loss of nerve functions so you have a general understanding of worsening neuro function. www.dodgerslist.com/literature/healingsurgery.htm It is of course only a board certified neuro (ACVIM) or ortho (ACVS) who can advise on surgery for your dog. General vets refer when they feel it is important to seek a specialist opinion. When they have tried their most aggressive pain meds and yet they still can't get pain fully under control. You may want to print out this list of meds that may be used but not all of them with a disc episode in case you want a quick reference at the vet's office. One that we have seen used but not on that list, discuss if it might be a alternate to Tramadol, is BUPRENORPHINE (Buprenex) www.petplace.com/drug-library/buprenorphine-buprenex/page1.aspx It is given as a shot, but we have seen vets prescribing for home use compounded into a gel to be applied on the inside of the ear flap. It is supposed to be ineffective as an analgesic when swallowed.that is why shots or a transdermal gel. Discuss what the vet thinks about root signature pain. www.dodgerslist.com/neurocorner2/rootsignature.htmDiscuss other pain meds that Hurley may not have side effects from (anxiety) that he is having with Tramadol.
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Lola & Hurley
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Post by Lola & Hurley on Dec 22, 2013 21:28:01 GMT -7
I think Hurley loves his new canvas crate. He is much calmer. He has had one before, we used it for his surgery recovery, so I thought it might be what he would prefer. It has mesh on 3 sides so he can still see out and 2 handles so that I can carry him outside. I also bought an orthopedic memory foam and I think it makes it more comfortable for him to stay lying down.
This far, no worsening, but still pain when he moves. Thank you for the tip related to Buprenorphine, although I think I might have resolved the anxiety issue related to Tramadol by giving him 1/4 of a Diazepam at the same time. No anxiety 1 hour after. At least something positive.
Thank you also for the tip re: medication chart. I have now prepared a full medication chart including when, what, and how much, changes to all medications, treatments like acupuncture and laser etc. also I made a “pain” chart where Dr.#4 can see (in colours! I used different shades of red) how Hurley's pain and leg movement has been evolving – or worsening. I listed all my questions next to each medication or issue and hope he will be able to answer them all or refer us to a neurologist as he promised. I really hope and wish we can get help on this pain issue tomorrow... Tomorrow, it's been exactly one week that Hurley's been experiencing pain and I can see in his eyes that's it's starting to really wear him out.
Good night to you all and thank you for the support!!
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Marjorie
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Post by Marjorie on Dec 23, 2013 9:10:40 GMT -7
Prayers that all will go well today and that the vet will answer all of your questions and re-adjust Hurley's meds so his pain is under control. His pain should be completely under control within one hour of taking the meds. Hopefully, he will soon be able to recover in comfort.
All the best to you all.
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 24, 2013 8:37:47 GMT -7
Hurley's pain is now under control. He was admitted to an animal hospital yesterday morning for a full day of thorough examinations (neurological, x-rays under light anestesia, orthopedic etc., everything but the MRI and surgery). I was heartbroken to leave him there but silently hopeful that we could get some answers by the end of the day. This 4th doctor deals with IVDD cases and spinal surgeries which was important in order to get advice on Hurley's case and to make sure they treat him with utmost carefulness (especially during anestesia, his back is so, so vulnerable...!) I called in during the day to check up on him. I knew he was in good hands, but of course, I always worry, especially when leaving him somewhere.
At the end of the day, the x-rays revealed nothing (he has perfect little dachshund back and legs) and his neurological tests came back clean. The doctor identified that the pain is LIKELY in Hurley's leg, not his back. However, he said there is a possibility that something is wrong with his back and it causes pain in the leg when pressing it ever so slightly, but it is very rare. The conclusion? Hurley most likely has a torn ligament in his leg!!! That can also be very painful, especially when trying to move or put weight on it. He recommended anti-inflammatories would work better on the leg issue (if it is the leg), but because we were already on the steroids, he said we could continue on that and not do another wash out period. Also, as he could NOT rule out the possibility of a spinal issue based on x-rays, we decided it is best to do the rest of the Prednisone (and stomach protectant), to be on the safe side, and to watch out for any returning pain when tapering. Otherwise, doctor's orders for torn ligament are the same as for a back injury: crate rest (although only 2 weeks for ligament!), pain medication (Tramadol, Gabapentin) and relaxation (Methocarbamol). The doses were not adjusted because he was doing so well when we went to pick him up (I do not understand...), but we can call back to adjust if needed. I believe we will have no choice but to do the full 8 weeks of crate rest, because there were no conclusive findings as to whether it is the back or the leg.
Coming home, Hurley was thirsty and hungry. Out at potty, he was much happier, even put a little weight on the leg which was hurting earlier. I have not heard him let out a yelp since yesterday morning. I also feel better now. We are going for some more laser treatment today, as he is still in the middle of his 6 month recovery period from the last surgery, even IF it isn't his back that is hurting now. I am carefully optimistic since he seems better.
I think I did / am doing right treating Hurley for his back (even if it would be his leg). There is not much difference, except for the crate rest period, and we are going to go with full 8 weeks. I hope this is it, and no more doctor's appointments - or PAIN for that matter! - and I can keep on updating on his (positive) progress during the upcoming 7 remaining weeks of his crate rest.
Peaceful holidays to you all...
Lola, and Hurley
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StevieLuv
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Conservative Treatment 3x. It really does work!
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Post by StevieLuv on Dec 24, 2013 10:05:29 GMT -7
Hi my name is Maureen. I have been catching up with Hurley's story and am so happy that you finally have a great Vet and some answers! Prayers for an uneventful recovery period and I think that you are very wise to err on the side of caution and treat him for the full 8 weeks. Seasons Blessings to you both
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 24, 2013 12:09:26 GMT -7
Thank you Maureen for your support and happy holidays to you, too!
Our update: Dr.#1 we saw today did the laser (back & leg) and overall examination and gave us further instructions for tapering of meds. He says he still thinks that it is the back (and not the leg). I don't really care anymore since we might never know which one it is, as long as Hurley is doing better, that's all I care about!! Tomorrow is the last full dose of Prednisone and then we start tapering it down. Fingers crossed! Hurley will continue on laser and electroacupuncture until end of this week (+ more if needed) and we are keeping him on all the joint supplements and Adequan injections also. He has gained a bit of weight since we started the crate rest, or it might be the water that he is constantly drinking because of the medications, I am trying to balance with his diet... (he gets special treats because of the pills he needs to swallow)...
I agree with what most of you are posting on this website. NEVER GIVE UP, ALWAYS SEEK HELP FROM AN IVDD PROFESSIONAL and DO NOT EVER HESITATE to get a second opinion if you are unsure! And trust yourself! If you feel something is not right, it probably isn't!!!!!
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
Posts: 135
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Post by Lola & Hurley on Dec 25, 2013 10:14:42 GMT -7
More good news. Yesterday late night Hurley "marked" a spot with his feet outside (he really put the dirt flying - I of course immediately told him to stop). Also, for the first time, he also "made" his own bed with his little paws in the crate before lying down for the night. Hurley slept a full 7 hours without complaints. He was very eager to get up and go potty this morning, also very hungry. No pain. I will start tapering the Prednisone tomorrow according to doctor's orders. Fingers crossed. Hurley seems to have an understanding of the situation but a strong will to get better. Very special little dog, I must say.
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StevieLuv
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Post by StevieLuv on Dec 25, 2013 18:02:13 GMT -7
Those are great signs!! Fingers crossed for an easy an uneventful taper.
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 26, 2013 9:20:32 GMT -7
It seems Santa's gift this year was nothing short of a miracle!!!!!!! Yesterday evening, Hurley lifted his LEFT back leg to pee into a tree trunk - putting weight on the RIGHT back leg (that's the "sick" leg)!!!! He held his leg high and proud!! I am so happy! Still no pain! Strict 24/7 crate rest! Tapering of meds starting today. I so hope it will all end well for him... And, there is one more twist to the story: we need to depart to the east coast tomorrow morning, so Hurley has to lie in his crate for 5 days while we drive there. I so hope I would not have to do this, but we are moving, and giving up the keys to our apartment tomorrow morning and he has to go with us, there is no way to leave him behind. I am going to try to make it as comfortable as I can for him in the crate in the car, and we are going to drive as carefully as we can. The only good thing is that he likes to be in the car and he will see some scenery............
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StevieLuv
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Conservative Treatment 3x. It really does work!
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Post by StevieLuv on Dec 26, 2013 9:24:21 GMT -7
He should do fine on your journey -he's used to being in the crate and he gets to have an adventure with his favourite people. Let us know how the trip goes - he is doing great! !
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 28, 2013 8:54:36 GMT -7
431 miles later... Hurley still doing good. We must stop every 1.5 hours to let him drink and urinate, still no change in that even though we are now in Day 3 of 7 of the lower dose (1/2 tablet once a day). We got new instructions from the Vet no. #2 yesterday (she did the laser and electroacupuncture just before we took off):
Tapering of▼ Prednisone (5mg):
First 1/2 tablet twice a day for 5 days (done!!) Then 1/2 tablet once a day for 7 days (ongoing, we are in Day 3 now, no pain... fingers crossed) Then 1/2 tablet every other day for 7 days Then 1/4 tablet every other day for 7 days
Does this sound reasonable? She said that Hurley's body still thinks it's on the twice a day mode, that's why the excessive drinking continues... It takes time for the steroids to wear off? So, I have a love-hate relationship to this medication.. I can see it is helping him, but I don't like it making him so thirsty! He can drink a big bowl of water and still beg for more (and I give it, my husband says I should control his drinking, but I think Hurley needs to have as much as he needs), and then 15 min later the water just comes pouring out of him... Usually during the last hours of the evening, never during the day or during the night. I don't know why this is but I can see from other threads that it seems to be a common side effect and I should not be worried. I just have a lot of towels for him in case we don't make it out in time... He is not incontinent, it's just that he can't help it, there's so much water in his stomach.
Hurley is putting a bit of weight now on the right leg always when taking steps but still holds his tail a bit up, but curled downwards, I don't know how to explain. It is not in a normal position, nor is it horizontally straight, the tip of the tail is down, it's like as if he is trying to hold the tail down but still has to hold it a bit up, the end result being like a strange U shape.. I wonder if that is an indication of pain or just imbalance?!?!
Today, we have to make it through 630 miles, I'll keep you posted. If anyone knows a good laser/acupuncture vet in the east coast (Virginia), let us know!
And thank you for being there / here for us!!!!
Lola & Hurley
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PaulaM
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Post by PaulaM on Dec 28, 2013 9:36:30 GMT -7
Excellent news still no sign of pain on the Pred taper. Pred does make them thirsty, so he should always have access to water and of course he will pee more often. It will take time for the pred to reduce the level in the body. That reduction will signal Hurley's body to again produce its own steroid at a lower level which the body organs need to function. The taper is also a good window for IVDD dogs to see how well painful inflammation is being resolved. So far so good for Hurley!!
The nerves needs to regenerate so he can send control messages to his tail...give it time...we often think more in months than days/weeks for nerve healing to be accomplished.
Safe driving!
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Dec 30, 2013 1:18:35 GMT -7
Not good!! Signs of pain returning, maybe yesterday evening, I'm not sure, but definitely at least today: a couple of very quiet yelps when moving. Once when I picked him up from the car and another when he walked a few steps outside to potty. First I thought I was imagining, but my husband heard it, too, so it must be true... I am really, really worried. I increased the Prednisone (5mg) back to 1/2 tablet twice a day immediately this evening. How long do I need to stick to that before trying another taper!?!?!? This is what we've now done:
First 1/2 tablet twice a day for 5 days (took about 2-3 days for the pain to disappear) Then 1/2 tablet once a day for 7 days (got to Day 4 of this once pain started returning...) Back to 1/2 tablet twice a day ...for how many days?!?!
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Marjorie
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Post by Marjorie on Dec 30, 2013 5:48:33 GMT -7
It's not uncommon for pain to recur on the first taper of an anti-inflammatory, Lola. It just means that the swelling hasn't gone down yet and more time is needed on the anti-inflammatory. You did fine increasing the Pred back up to the anti-inflammatory level but you have to immediately advise your vet of this development. The administration and taper of a steroid have to be done under a vet's supervision. It will be up to the vet as to how long to continue on the anti-inflammatory level before another taper is tried.
Let us know what the vet says after speaking to them. Try not to worry. What's happening with Hurley right now is not unusual.
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Lola & Hurley
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2 paralyses, 3 surgeries, 2 conservative treatments. Now walking :)
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Post by Lola & Hurley on Jan 1, 2014 17:37:27 GMT -7
Hi again, and happier new year, I wish it will be better for all the little furry patients, there's so much misery associated with having to go through these disc episodes... We got instructions from the vet clinic to try now 6 days of the "max." dosage of ▲ Prednisone and then see if we can start tapering. They will give us a call on day 6 and then we'll see. This is now day 4 of 6. Yesterday, Hurley still let out one small cry outside. Today, I have not seen any signs of pain but I am worried Day 6 will come too soon... Are there any instructions / success stories - how many days should he be completely pain free before starting tapering?!?!? He is still on the daily "max." dosage of Tramadol, Methocarbamol, Gabapentin, I have not changed that since this journey started about 2.5 weeks ago. Recap on Hurley's Prednisone dose: First 1/2 tablet twice a day for 5 days (took about 2-3 days for the pain to disappear) Then 1/2 tablet once a day for 7 days (we got to Day 4 of this process but then pain started returning...) Now back to 1/2 tablet twice a day for 6 days (took 3 days for the pain to disappear, we are now in day 4 = first pain free day)
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