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Post by Sherry Layman on Jan 1, 2014 19:16:42 GMT -7
If he is pain free now through day six you are safe to try to wean the Prednisone. Worst case scenario you start the wean, he shows pain, you go back up on the Prednisone.
You might try cutting back on some of the pain meds and see if he really has pain that they are keeping under control or if the Prednisone has done its job and he can be pain free with no meds and a Prednisone taper. I would start with either the Tramadol or Methocarbamol (only one to start not both) and if it were me I'd start with the Methocarbamol. Start by cutting a dose in half, if he has no pain try just skipping the next dose completely. If he has some pain just give him the med right away. If you get through a day with no Methocarbamol and no pain you could do the same with the Tramadol, again give it right away if he has pain. You'll have information to give the vet when you talk to them on day 6 and it would ease your mind if he were off some meds and still comfortable.
Please keep us posted on how he's doing. I'm so glad he's finally had some pain free days!
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Post by Lindsey-CoCo's momma on Jan 1, 2014 19:54:30 GMT -7
Lola- best wishes for recovery for Mr. Hurley! SO thankful for a website like this that provides support for us fur baby parents .
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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 2, 2014 6:34:15 GMT -7
Hi Sherry! That's good to know, thank you so much! If he does well today, I will try to be brave and cut back on the Methocarbamol, so maybe only 1/4 tablet in the afternoon instead of 1/2. If he does well in the evening, I will see if I dare to skip the evening dose and see how he does tomorrow morning. If OK, I will then do the same with Tramadol tomorrow. It's scary, taking him off the medication, because we already had one unsuccessful steroid taper... That was going well, until Day 4 of the taper process, so I am uncertain would I see such a short term result? I also wonder how long the Prednisone stays in the system? All the best, also to Coco Lola
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PaulaM
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Post by PaulaM on Jan 2, 2014 8:40:45 GMT -7
Lola, the taper of is mainly done to signal the body to start making its own steroid hormone again. With IVDD the taper is the perfect opportunity to assess how well reduction of swelling is going. When the vet thinks all the swelling might be gone he calls for a taper. Your job at home it is watch for any hint of pain and communicate your observations to the vet. All the IVDD drugs carry with them side effects and thus they are best used only when there is a benefit to using them and no longer. Getting swelling down can range from 7- over 30 days at the anti-inflammatory level. So far your vet has tried a 5 day course and then called for a step down from the anti-inflammatory level (a taper) and now a 6 day course then a taper. We are hoping this taper will show there is no pain, thus no need to be on Pred any longer.
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Lola & Hurley
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Post by Lola & Hurley on Jan 2, 2014 17:54:29 GMT -7
Hi, I think I am going crazy (or not?), still heard a silent yelp this morning when carrying Hurley out to potty. The taper is supposed to start tomorrow. Too early, isn't it?! Also, he was holding his right back leg up again today and would not put the same weight on it than yesterday. I am not going to try lowering any medication today... I am wondering, is the 5mg Prednisone cut in 1/2 twice a day enough for the swelling to go down? He is still holding the tail in a funny position and in a couple of days its been 3 weeks when this started... I will talk to the vet tomorrow, because of the intended taper start, also, we ran out of the Sucralfate yesterday and Hurley's stomach has started making funny noises today. Maybe the Pepcid AC is not enough and I need to ask for more Sucralfate? It is a prescription medication, right? I cannot get it just by walking into a pharmacy?
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Marjorie
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Post by Marjorie on Jan 2, 2014 18:33:16 GMT -7
Not wanting to put weight on his leg is a sign of pain so no, a taper of the Prednisone should not start tomorrow. An anti-inflammatory dose for a dog weighing 14 lbs is 5 mgs 2x/day. And yes, I would ask for more Sucralfate, which does need a prescription.
Since this pain started even before a taper was started, I would speak to the vet about increasing the Prednisone to 5 mgs 2x/day. He also has room to move the Tramadol up to 50 mg. 3x/day.
Please let us know what the vet says after speaking to him. Try not to get discouraged. Hurley just needs an adjustment to his meds and more time on them, which isn't unusual.
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PaulaM
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Post by PaulaM on Jan 2, 2014 18:40:27 GMT -7
Lola, you need to report your observations of pain to the vet. If there is still discomfort, then that indicates there is still a need for prednisone to continue working on painful swelling, not time to taper.
There is a range of pred doses used with a disc episode. We observe, as you have, most vets comfortable in treating a disc episode choosing to use the higher more aggressive end of the anti-inflammatory dose at 5mg 2x a day for Hurley's weight. Let us know the result of the discussion with your vet… it is always a good idea to understand the thinking behind a treatment and see if he agrees being more aggressive may help to expedite resolving the swelling.
Yes, sucralfate is an Rx item. For most dogs Pepcid AC is enough protection to avoid the beginnings of the red flag signs such as nausea, not eating, loose/runny stools, blood in stool then moving to life threatening perforated stomach lining. Sucralfate was started due to the switch in classes of anti-inflammatories and no washout. If you feel his tummy is having a problem with Prednisone, I would ask for an Rx to be continue for sure!
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Post by Lindsey-CoCo's momma on Jan 2, 2014 18:46:59 GMT -7
Prayers to Hurley and to you Lola. All things get better with time. Hopefully your vet will adjust meds to make him comfortable
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Post by Sherry Layman on Jan 2, 2014 19:44:11 GMT -7
I'm so sorry it doesn't look like things have improved. But you got perfect advice from Marjorie and Paula on the Prednisone dosing. As Paula said, vets more familiar with IVDD are more comfortable starting at the upper dosing range, vets less familiar tend to start with the lower dose. Don't be shy about having this conversation with the vet (about the dose), it might be just what Hurley needs to get over the hump. My vet once had us come in for an IV dose of steroids when Prednisone didn't seem to be doing the trick so he may suggest that as well. Have the conversation and see what the plan is and keep us posted.
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Lola & Hurley
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Post by Lola & Hurley on Jan 2, 2014 20:05:37 GMT -7
Dear Marjorie, Paula, Lindsay and Sherry, thank you for the quick replies and support! I will call the vet clinic first thing tomorrow morning and explain the situation and ask for changes in medications. I wish there was some kind of an IVDD accreditation for vets... but luckily I found this site.. honestly, do not know where I would be without you all!! Many hugs and good night from Virginia, Lola
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Post by Sherry Layman on Jan 2, 2014 20:16:53 GMT -7
I'm also so very glad you found us and that we've been able to be helpful. Indeed an IVDD accreditation for vets would be spectacular. Fortunately most general vets just don't see it very often. In addition all the various animals they see day to day it's quite a lot of information that they have to keep in their heads. We do have brochures available you can give to your vet that they can give to clients and we also have an educational DVDD you could give your vet. Linda has them, if you are interested let us know. I even carry some of the brochures and some business cards with the website on it in my car at all times and I stick a few of the cards in my pocket when I walk my dogs. I have stopped on the street when I've seen people walking dogs that are at high risk and I pass them out to people at that park. Next best thing to that certification.
Keep us posted on what the vet says. Hoping things turn around soon. I've been in your spot and it's frustrating, hang in there.
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PaulaM
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Post by PaulaM on Jan 2, 2014 20:24:31 GMT -7
We do recommend our DVD on disc disease. U of FL and other referral centers hands one to their surgery patients. Some vets have used them with their vet techs for in-house continuing ed. The "crate rest recovery brochure" helps a vet explain the need for strict rest. The DVD is recommended also for family, friends and others who might be around or care for Hurley in the future. You can order our $3 DVD and ask Linda to send you our free literature here: www.dodgerslist.com/literature/litorder.htmWe await hearing how the vet phone call goes in getting help for Hurley.
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Lola & Hurley
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Post by Lola & Hurley on Jan 4, 2014 13:39:27 GMT -7
Again, thanks for the support. I talked to the vet yesterday - the end result: we should not taper until Hurley has been completely pain free for 3-4 days. We will have to continue the Prednisone as it is because the vet did not agree on increasing it. The noise from Hurley's stomach has stopped, nevertheless, I got and went to pick up some more Sucralfate. The vet said to cut the dose in half, so only 1/4 of a tablet of Sucralfate, twice a day. I wonder why but he just said the 1/2 tablet at a time seems too high. Is this so...?
Furthermore, the vet (and by the way, this is the 5th vet because the prior ones are on holiday) was not happy with the fact that we have given Sucralfate and Pepcid AC _before_ the Prednisone (1hr, 30 min, respectively), and said it interferes or cuts the effect and hence Hurley does not get the full benefit from his 2.5mg Prednisone dose. He strongly encouraged us to give the Prednisone first, and then Sucralfate (and Pepcid AC) after waiting at least 1 hr. This is now what I did this morning, mainly because I don't know what else to do anymore since all five of them refuse to increase the Prednisone dose. So far, no funny noises from stomach, also: no pain thus far today (HURRAY). There was a little bit of pain maybe yesterday but then I found some nut shells stuck on his right back leg paw (from the garden?) so maybe it was because of that, the little yelp and holding his leg up? Anyway if all goes fine today, this would be our Day 7 on the new run of Prednisone, and the first certainly pain free day. Please, fingers crossed...
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PaulaM
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Post by PaulaM on Jan 4, 2014 18:10:17 GMT -7
There are different timings to sucralfate food and other meds. Best is to read and then chose what works for your family's time schedule. This is a very good page to bookmark, the Mar Vista Vet web site: www.marvistavet.com/html/pharmacy_center.htmlSo glad to hear a pain free day today…fingers crossed with your this will be the course of Pred that takes care of all the swelling.
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Lola & Hurley
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Post by Lola & Hurley on Jan 5, 2014 16:15:28 GMT -7
Hi Paula, that's a great website, I've now read everything on the medications we have and I feel more comfortable in changing some of the timings. Also, I believe we could finally start to taper the Methocarbamol, maybe tomorrow, since Hurley has not had any muscle spasms in 2 weeks and his condition is quite stable in the sense that it has not changed for the worse in these weeks (except when we tried to taper the Prednisone). Still no 100% pain free days since we started this 2nd run of Prednisone, he seems to be in a little tiny bit of pain always in the evening when I take him to potty around 8PM (but then again no pain at 10-11PM at last potty time, strange??), I am thinking: it is either the timing of the pain meds or then maybe too "active" evenings. Normally, I've carried the crate into the living room or kitchen because I feel so bad for him when he has to stay in a room all by himself. However, tonight, he will stay in the bedroom all day long, so that we'll see if that makes a difference (when he is alone, he just sleeps, when in the same room with us, he wants to keep a track of what is happening). Since we don't know which part is hurting, maybe sitting or standing up in the crate is bad (?), so it is better he keeps on lying down and sleeping... I'll report later when I know the results of today's experiment...
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Post by Pauliana on Jan 5, 2014 21:50:03 GMT -7
Hi Lola,
Generally dogs do better when they are not isolated away from family.. Let us know how the bedroom experiment goes and if that helps his pain. It would be wise to let the Vet know he is still having some pain.. They can adjust either the dosage or the frequency to help him out.. He needs to be pain free from dose to dose so he can continue to heal.
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Lola & Hurley
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Post by Lola & Hurley on Jan 6, 2014 15:28:20 GMT -7
Hi Pauliana, I agree, I do not wish to keep him isolated... but he still hears what is going on, all doors are open and I try to be in the same room with him as much as I can. I think, the children running around and front door opening and closing, it is just too much excitement for him at this point... He needs to focus not on who is coming to visit but sleeping and resting... Overall, I think our experiment is working well!!!! Yesterday he was much better in the evening, and today so far no pain. Also, he slept 8 hours without having to go potty last night, and today overall, I feel he is much calmer in his crate. Hurray!! Also, today I have tapered the Methocarbamol to 1/4 tablet instead of 1/2 tablet every 8 hours, I do not notice any pain returning, so I guess we could soon drop it altogether? Based on what I have read, Methocarbamol does not require a long taper... I think R-E-S-T is the key, even if I think he has been doing that in his crate, he is a sneaky fellow, always up to something... So, now he knows: we have one place outside for potty and nothing else, and bedroom is for resting & sleeping, nothing else! We are getting there... Slowly
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Sabrina
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Post by Sabrina on Jan 6, 2014 17:51:29 GMT -7
Hi Lola! I'm so glad to hear Hurley's having a pain free day!
Did any of the vets want Hurley off of the methocarbamol? I know that for my dog his methocarbamol was only decreased when we tapered the prednisone, even though my boy never had any visible muscle spasms.
And a huge pat on the back for heading up Hurley's healthcare team with all the different vets during the holiday season! He's a lucky boy to have you watching out for him!
))Hugs!(( - Sabrina
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Lola & Hurley
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Post by Lola & Hurley on Jan 6, 2014 19:42:55 GMT -7
It is strange, the same little squeak every evening at this time when I take him out to potty, usually this happens outside before he does his evening "business". I am starting to suspect it could be related to: he needs to poop? He also is a little bloated this time at night. Should I try changing his diet or is the bloating just because of the medications? I am feeding him dry kibble, divided into 3 x day because of meds (normally he would get 2 x day). Yesterday evening, I gave him some minced meat, and this problem did not occur... So, maybe the last of the 3 portions should be something lighter, like rice or chicken...? I need to go back to investigation mode... Somehow, I am starting to suspect it is not pain as such... I keep a steady 8 hour gap between pain meds and he only lets out a yelp at this hour. Obviously, I understand the stomach is closely related to the back, so it is also very likely that it is still the back issue... But why not then when he does his morning or afternoon poop... So strange... (I feel very stupid even writing about this, but luckily I notice that I am not the only one with "stomach issues" on this website...! ) Sabrina, thank you for your support! Basically, the vets "dropped" us because we moved... they are not getting any business from us anymore and I could sense they were getting annoyed taking my daily phone calls, so I just got instructions to taper the Prednisone when he has been completely pain free 3-4 days and to find a new vet where we are at. Hurley has been static since around Dec 29th, no change for better or worse, he walks just fine I think, no problem or pain getting up or standing or sitting, so I was thinking to try to get some of the pain related medication slightly down before I start tapering the Prednisone to see if he is still in pain. I thought the Methacarbamol is the safest one to start with. Ideally, I would want to put him on a lower Prednisone dose by the end of this week because he has already then had over 20 days on steroids, but understand that might not be realistic because I'm currently unable to figure out this evening yelp thing...
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Post by Sherry Layman on Jan 6, 2014 20:13:00 GMT -7
The evening yelp thing does sound bowel related to me if that's the only time he does it. Perhaps something about positioning or pressure somewhere on his belly combined with the need to poop is a little uncomfortable. If that is the only time he's doing it I'd likely assume it's not his back.
It is good if you can get the pain meds stopped before the Prednisone taper. You don't want to taper if you know they are still in pain. Try skipping something tonight and see how he feels in the morning. I think starting with the methocarbamol makes most sense as well as it's a muscle relaxant and once pain has been relieved the muscles usually relax and stay relaxed.
Did you ever move his crate to a more common living area so he is not so isolated? Though he needs to "rest" this doesn't really mean sleep under these circumstances, just physically be confined so he doesn't injure his back which is what the crate is doing. Dogs are pack animals and isolation is very detriment to their mental well being. Just being able to hear what's going on in the rest of the house is not sufficient, he really needs to be with "his pack" as much as possible. I used to keep the crate on the coffee table (put a towel under so you don't scratch the table) so my dog had a great view of the activity in the house and also when I was on the couch I was close to him. At night I carried the crate to the bedroom and placed it beside the bed so he was close then also. It can get to be a hassle but the day they are free from crate rest makes it all worth while.
If he's still walking, bearing weight on all four legs, and the yelp in the evening is the only question about pain I think you're ready for the weaning of the Prednisone...obviously when he's been in this great condition for the 3-4 days as your vet instructed.
Keep us posted!
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Lola & Hurley
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Post by Lola & Hurley on Jan 6, 2014 20:50:21 GMT -7
Thanks Sherry for the encouragement! Yes, Hurley has been with us / me 24/7 throughout this whole ordeal, I've moved his crate to where ever I am, from kitchen to living room to study, and of course he also sleeps "with us" i.e. in his crate on the floor next to my bed. But we were wondering if it is too much excitement for him during the day because people are coming and going and things are happening and since we couldn't figure out the evening yelp thing we decided to experiment with "stricter" rest. It's now been two days his crate is not moved around from the bedroom (and well, I have also basically stayed in the bedroom because I just can't leave him... ), and there is no difference in his condition. So I am safe to move the crate around in the house tomorrow. I am now going to skip the Methocarbamol dose completely (lowering did not show any pain returning and yes, muscles are relaxed) and test lowering the dose of Gabapentin tomorrow. It is in a capsule, so if I want to cut the dose in half, I have to open the capsule, but it should work, right? By the way, I read from somewhere that Gabapentin should not be abruptly stopped, but tapered during 2 (!!!) weeks... Can it really be? I'm not even sure if I have enough Gabapentin to last 2 more weeks...
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Lola & Hurley
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Post by Lola & Hurley on Jan 7, 2014 6:03:44 GMT -7
I must report: Hurley scratched his right ear with his right back leg this morning in his crate!! It is HUGE for us!!! We are in the beginning of the 4th week of our journey, have now dropped the Methocarbamol, and this morning, cut the dose of Gabapentin in half (1/2 capsule). I am quietly optimistic that we could start tapering the Prednisone at the end of this week. I am so proud of my boy! His recovery is not textbook material but he's holding on and getting there... We just needed a bit more time, with all that he's been through... <3
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Post by Sherry Layman on Jan 7, 2014 6:48:20 GMT -7
How exciting every time they do something new! There is no such thing as a "textbook" recovery with IVDD. Every dog has his own schedule, we hope for the fast result but we have some here that have taken over a year to regain function of their legs. We never give up and we never gauge one case against another. We always believe there is hope for recovery.
The Gabapentin needs to be slowly weaned when being used for seizure control. Since Hurley was on it for pain control and also for a relatively short duration (he hasn't been on it for months or years) it does not need to be weaned. If he is still on the Tramadol I would stop that one first then the Gabapentin. But if you've already started on the Gabapentin go ahead and continue removing that one first.
Let us know how it goes getting him off the meds.
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Lola & Hurley
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Post by Lola & Hurley on Jan 8, 2014 12:31:52 GMT -7
I never give up either! Thank you Sherry for the helpful advice on Gabapentin. I cut the dose in half yesterday, no difference, so Hurley is now off of not only Methocarbamol but also Gabapentin. Only Prednisone and Tramadol continue (+ the stomach protectants and supplements). What do you think, should I taper the Tramadol before starting to taper the Prednisone? It is now Day 11 of the Prednisone new run, there has been no change in condition since we started this new run. He still lets out a little yelp at evening potty time, but I am pretty sure it is the stomach and maybe a little constipation due to almost 4 weeks of crate rest. Otherwise, no signs of pain and his legs seem to be functioning quite well, no visible weakness, he would like to sniff around and walk outside, which is of course forbidden...!
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Post by Sherry Layman on Jan 8, 2014 12:59:08 GMT -7
No need to taper the Tramadol. Skip a dose and see how he tolerates it. Skip the dose when you will be home to observe whether he has pain so you could give it if needed. Don't skip the morning dose then leave for the day, you don't want him to be in pain all day with no relief.
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Lola & Hurley
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Post by Lola & Hurley on Jan 8, 2014 15:56:13 GMT -7
Okay Sherry! I am actually with him 24/7 ;-) so that's no problem! If he is off of all pain medications tonight and in no pain tomorrow morning, I think it is safe to say I can try to taper the Prednisone...!? I'm also giving him a teaspoon of pumpkin twice a day with meals maybe that will help with his stomach...
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Post by Sherry Layman on Jan 8, 2014 18:12:44 GMT -7
I'd say it would be ok to wean the Prednisone starting tomorrow if he's still pain free off the other meds.
Good luck and keep us posted!
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Lola & Hurley
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Post by Lola & Hurley on Jan 10, 2014 10:19:34 GMT -7
Oh, no good news to report!!!!!! Hurley was completely off all pain medications yesterday and doing really well, sleeping and eating normally, walking fine steps when out to potty and seemed a lot more happy overall, he has been alert and barking from his crate to houseguests, so yesterday evening I did not give him the evening Prednisone dose (taper was supposed to start with leaving the evening dose off for a week or so...). He was doing good and slept fine but this morning, waking up, he was in a lot of pain when moving, he was crying!!! Not really knowing what to do, I gave him of course the morning Prednisone dose, but also 1/2 Tramadol pill and 1/2 Gabapentin capsule and consulted another vet here and he said he would instruct keeping Hurley on the ▲ [Prednisone] 2.5mg x 2 / day for several more weeks!!!! He said he usually prescribes the 5mg/day anti-inflammatory for 6-8 weeks... To me, that sounds like a really long time to be on steroids, but of course, how would I know... I would need to go back to my notes, but I think today marks the start of the 4th week Hurley is on steroids (...we started steroids Dec 20th?), and the second unsuccessful taper. It's a lot longer than what the 1st vet prescribed (= 5 days), but I guess we have to adapt as we go along!?!?
It's now been 2 hours since I gave Hurley the pain meds and he seems calm, comfortable and is sleeping.. If still in pain when waking up and when I take him to afternoon potty, I will continue with the Tramadol and Gabapentin every 8 hours and/or adjust as is needed. Nevertheless, I will of course continue the Prednisone this evening, as it is clear that leaving the evening dose off triggered the pain!!! I'm so sad to see the swelling has not disappeared and he is still in a lot of pain without the steroids... I feel like a really bad mommy for leaving yesterday's evening dose off, trying to taper too early... I hope he can recover from this... I am so sad...
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Post by Jean & Mimi on Jan 10, 2014 11:33:27 GMT -7
Hi...My name is Jean and I am not one of our fab moderators but another "mom". My dog Mimi went through several tapers, 2 completely unsuccessful. She was on dexamethosone (which is stronger than prednisone) and was on it for a long time. We did an extended taper for her and she was finally done after 10 weeks (I know you do not want to hear more time in the crate, I know). Please do not stress too much about having to go back on, I wanted to tell you that it can still be ok.
How is he feeling now? Is he pain free again? (((HUGS))) on this whole process and this horrible disease. You and Hurley will get through it. Hang in there!
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Sabrina
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Post by Sabrina on Jan 10, 2014 12:56:37 GMT -7
Hi Lola - I'm so sorry to hear Hurley's pain returned, but please don't feel guilty! With Pred the only way to know if it's done it's job is to taper. You were right on top of things getting him his pain meds this morning! You are doing a great job taking care of your little guy! Like Jean said, some dogs on conservative treatment need longer than a month on the anti-inflammatory dose of the steroid.
My experience with IVDD started last summer, and in my reading since then I haven't heard of an initial course of pred (that is, without trying to taper) lasting 6-8wks. As some dogs with disc episodes are able to successfully taper after just a week or two, going 6-8wks without trying to taper is a long time. Were you able to speak to this local vet about other aspects of care during an IVDD episode? Did this vet sound knowledgeable about IVDD?
As you are able, let us know how your sweet Hurley is doing! Do not feel guilty! You are doing a great job caring for him!
))Hugs!(( - Sabrina
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