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Post by piaffplease on Mar 22, 2013 16:55:20 GMT -7
My Basset Hound, Mt. Otis started walking slowly on Saturday 3/16, early on 3/17 he yelped in pain and we rushed him to the ER vet at the vet school. They prescribed tramadol, methocarbamol, gabapentin, and trazadone. They wanted us to wait a week to see if these meds and strict cage rest would heal him. They have helped but he is still in pain. We saw our regular vet today and she is starting him on steroids and pepcid. I asked about sucralfate and she said we could try that too if we wanted. My dog has a sensitive stomach, so I wanted that as well.
He is on strict cage rest. He lost his appetite but it gaining it back. He is also drinking ok.
He is still able to walk (for short potty breaks only). His diagnoses is IVDD. I have since read that trazadone has a major drug interaction and asked if I could wean him off of that and she said yes. The vet said she doesnt usually prescribe sucralfate but had no problem with him being on it. She said to give the sucralfate AFTER his meds (prednisone, tramadol, etc). I questioned this and she said again, 30 mins after his meds. Everything Ive read has said 30 mins to an hour BEFORE the prednisone. Years ago when this happened to my other dog, I gave her the sucralfate before meals. We have since moved and are no longer at that vet I used for my previous dog. Is my vet confused? When should I give the sucralfate?
My vet also said there was no need to do a blood panel for Mr. Otis because he is still young (7) and healthy. Also, when should I give the Pepcid? Ive read that pepcid and sucralfate should be given at different times. Is this true? My vet didnt say anything about it.
This board and website has been very helpful so far and Im very glad I found it. Im having a tough time as Im sure everyone does. I went from having a happy Basset Hound that was running around on the farm, so a dog that has a pitiful face all the time. And you know how Bassets look sad to begin with. Any suggestions or advice is appreciated.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 22, 2013 18:41:22 GMT -7
Emily, it sounds like you are a very good advocate for your dog. Self education with IVDD is one of the best things an owner can do. Kudos to you for speaking up for Otis. I know this is an overwhelming time. But things will get into a pattern and routine. With Otis still having the ability to walk he is actually a very good candidate to recover with Conservative Treatment. We see very few Rx for Trazadone, anti-depressant. Were you told the reason for Rxing it? -- Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy? -- What are the exact names of meds currently given, their doses in mgs and frequencies? -- Poops normal firmness - normal color no dark or bright red blood? Sucralfate has two options as to when to give it. Please read the Vet web page I use the most to learn about my dog's meds. Mar Vists Vet addresses your questions. If you need help working out the order with Pepcid Ac and his other meds, let us know. www.marvistavet.com/html/pharmacy_center.htmlI know Otis weighs alot more than our doxies and carrying him to and from the potty place may just not be safe for your back or Otis??? In that case put his crate closest to the door, use ramps no steps or stairs. Another option is to see if he will potty on some astro turf or a pee pad beside his crate. Do what you can to stick with 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks …. No laps, no couch, no sleeping in bed with you, no meandering 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. Your guide to conservative treatment is under the heading Care during a disc episode www.dodgerslist.com/literature.htmConsider adding this comprehensive "must-have" $3 DVD on IVDD to your arsenal of educational resources. Friends, family and those who will be caring for Otis should also watch this DVD; plus don't forget to order one DVD for your vet www.dodgerslist.com/store/DVDorder.htm Give Otis a big hug and kisses. Tell him everything is going to be alright because it will be! He'll read your voice tone, your body language so he needs his pack leader to give him confidence. |
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Post by piaffplease on Mar 22, 2013 19:32:17 GMT -7
Paula, thank you for your reply. I have been through many of the posts and located the pharmacy center webpage earlier today. It has been a helpful website so far. It sounds like I should give the Sucralfate at least 30 mins before the pepcid. What about his other meds? I had planned to give the Sucralfate an hour before his other meds (including the pepcid and predinsone). The vet wanted me to give him the Sucralfate 30 mins after his meds. My old vet prescribed it before I gave the prednisone. We were successful with my other dog in the conservative method.
I dont think that he is still in pain. He yelps every once in a while when he takes his first step to go potty, but is then fine. He does still walk slowly. He had a panic attack at the vet and yelped for 10 seconds or so. He hasnt done that since we first brought him in. I think he was very stressed at this vet (vs the ER vet). Once we got him back in the car, he was totally calm.
He was given the trazadone because he wasnt able to sleep/calm down. As I look back, I think he was just in pain. We are tapering it now. I asked if there were any drug interactions and was told "no". Once I started researching his meds, I saw that the drug interactions between trazadone and tramadol was listed as major, so I was concerned.
Mr. Otis weighs 50lbs and I am carrying him in and out. Its not a far walk and he is good about being carried. I want him to take as few steps as possible.
He just got his appetite back today. Last time he pooped it was runny and had a small trace of blood in it. I told this to the vet today and she didnt seem concerned. He is peeing normally. Ive tried giving him canned pumpkin to help his tummy but he was turned his nose up at it.
Im by his side 24/7 and Im trying to stay strong for him. Its so hard to see him like this.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 22, 2013 21:17:56 GMT -7
Emily, I am so very glad you are getting sucralfate on board. Runny poop, blood in the stool, lack of appetite are all the clues that point to stomach acids are causing a problem. Just like people, dogs can get stressed (change in routine, pain, etc.)... ulclers. Then you add an acid producing steroid (what is the name of the steroid, the dose in mg and the frequency you give it?) and Otis needs double stomach protection.
I do think Otis is still in pain (yelps with movement, walks slowly) He pain meds are not yet right. Have no patience with pain. It should be in control within an hour and there after dose to dose. A disc episode is a very painful event.
We are at a disadvantage to help you without specific details. We are a group who LOVE details:
-- What are the exact names of meds currently given, their doses in mgs and frequencies?
Based on the Mar Vista Vet site info for sucralfate:
Give Sucralfate on an empty tummy 1 hour before feeding or 2 hours after feeding
Give Pepcid AC 30 minutes after Sucralfate
30 minutes after Pepcid AC give the steroid , Tramadol, methocarbamol along with a meal
Sucralfate, as you read, is activated with stomach acids, so to me it was better to give the sucralfate 1 hour before eating.
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Post by piaffplease on Mar 23, 2013 12:28:51 GMT -7
Paula, Otis is on
Gabapentin (1 pill, 100 mg, 3x day)
Methocarbamol (1 pill, 500 mg, 3x day)
Tramadol (2 pills, 50mg, 3x day)
Sucralfate (1 pill, 1 gram, 2x day)
Pepcid (1 pill 10mg, 2x day)
Prednisone as of 3/22 (1/2 pill, 10 mg, 2x day for 4 days then 1x day for 4 days, then every other day for 16 days)
Trazadone (1 pill, 50mg, 2x day) We are starting to wean off of this and are currently at 1 pill a day
He starts on the steroids tonight. He just went out and had a good solid poop with no blood. He ate a normal sized breakfast of his kibble this morning. Ive been told that there is nothing else they can give him for the pain (by both the ER vet and my normal vet). Once the steroids kick in it will help him to feel better since it will reduce the inflammation. Is that correct?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 23, 2013 12:42:23 GMT -7
Why are you waiting til tonight to get Prednisone started working?
Your vet is trying a very short course of Pred for four days. Be on the watch for pain arising, indicated the swelling has not been reduced. The vet would need to know that information asap to get him back on the anti-inflammatory dose for a bit longer before trying another taper.
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Post by piaffplease on Mar 23, 2013 15:47:46 GMT -7
He was on a NSAID prior to this happening so we needed to wait a week until the NSAID was out of his system. How long is normal for a dog to be on pred before tapering? I thought 4 days was short as well and the vet said to call her if we start tapering and he gets worse.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 23, 2013 16:10:26 GMT -7
Yes, vets who practice safe medicine look for a 4-7 day washout of one class of anti-inflammatory (NSAIDs) before switching to the other (steroids)
Often many dogs can get the swelling down in a total of 1-2 weeks on an anti-inflammatory before the dose is lowered/tapered. While other dogs may need more like a month. There is no normal...it is all try a taper and see what the score is on pain.
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Post by piaffplease on Mar 27, 2013 8:02:49 GMT -7
Mr. Otis is starting to feel better now that he is on the steroids. He isnt back to his normal self, but he is sleeping better and doesnt seem painful. He is running low on his methocarbamol and gabapentin and the vet called in the presciption to Walmart so I could pick it up. Ive been reading a lot on gabapentin and was wondering if the capsule form of gabapentin had xylitol in it. Supposedly the liquid form does have it but I wasnt able to find anything about the capsules. I am getting the gabapentin at a human pharmacy (I got them at the vet school originally) and I want to make sure what I give him is ok. Is there any place I can find this info out? or does someone know?
He starts his taper of the steroids tomorrow. Im nervous that the intial dose was too short. I have updated my vet on his progress and she still wants us to taper. So, we will see how he does.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 27, 2013 8:28:10 GMT -7
Emily, when gabapentin is compounded with a liquid they add the sweetner, which could be xylitol. With the gabapentin capsule the only ingredient is gabapentin... no sweetners added.
When a taper starts mosts vets will also taper back on the pain meds as well to get a clear picture is pain arises. So starting a new pain med when also starting a pred taper seems counterproductive in assessing pain.
If you are currently seeing pain, it is clearly not time to taper as there is still swelling. Do report all signs of pain to your vet - shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy, holding leg flamingo style not wanting to bear weight.
Often it takes being at the anti-inflamamtory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going by observing for pain.
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Post by Pauliana on Mar 27, 2013 8:42:25 GMT -7
Hi Emily! If you haven't picked up the prescriptions yet, when you do, ask the Pharmacist about whether the capsule form of Gabapentin contains Xylitol or not. From what I have read, it's only the liquid form that can contain Xylitol. However I read on Marvistavet.com: "Gabapentin oral suspension is sweetened wit xylitol
which has toxic properties in the dog. The issue can be avoided by having liquid formulations compounded rather than using the commercially available oral liquid." from www.marvistavet.com/html/gabapentin.html
That would have to be done by a compounding pharmacy.
Hope this helps!
Pauliana |
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Post by piaffplease on Mar 27, 2013 8:57:09 GMT -7
Thanks Pauliana. I I read that note as well. When I googled "oral suspension" and looked at the images, only liquid meds came up. I have not picked up the meds yet and will ask the pharmacist. Hopefully they will know.
Paula, I assumed that Gabapentin capsules didnt contain xylitol but couldnt find anything that said that. Thanks for clearing that up. He isnt starting a new pain med, just continuing the old ones since he ran out. But these are usually tapered as well? I will see that the instructions are on the bottle when I pick them up and then ask if they should be tapered. Thanks for all the info!!
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Post by piaffplease on Apr 5, 2013 12:51:12 GMT -7
Mr. Otis is doing much better! He is on the last taper of his steroid treatment and is pain free. Ive called the vet, but not heard back about reducing his pain meds. He is on 1 Gabapentin, 2 tramadol, and 1 methocarbamol, 3 times daily. Im hoping to make that 2 times daily and then taper the tramadol again to 1 pill, twice daily. How long after the steroid treatment is over should the pain meds continue? Or should he be off them all together by then? He has 4 steroid pills left, and he is taking 1 every other day. So in 8 days we will be done with the treatment. He will still have 4 weeks of cage rest left when we finish the steroids.
I was also wondering about how active he can be after he is off cage rest. I know he will need to take it slow for a while to build his muscles back up, but in the future, say 6 months from now, how will life be like for him? He LOVES to run. Will he still be able to safely run on a leash?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 5, 2013 13:31:44 GMT -7
The true picture of how swelling is doing on the taper is of course to be off pain meds. No pain = no swelling = finish the taper and no meds at all are needed. If you were to observe any pain on the taper, then you vet needs to know as steroid plus pain meds would need to continue a bit longer before trying another taper. Our Disc Disease 101 core readings have just the answers you are wanting to know about plus more ideas on making your home back friendly upon his graduation day on May 12th. Running is a good exercise with the caveats noted there. Here's the link: www.dodgerslist.com/literature.htm#aftercrateSounds like Mr. Otis is going on a good path of recovery and will be enjoying a good summer with his family. |
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Post by piaffplease on Apr 11, 2013 19:44:23 GMT -7
Not long after I wrote my last post, Mr. Otis starting hurting again before we even had a chance to taper the pain meds. We ▲bumped him back up to half a pred pill (10 mg) once a day for 5 days. We started tapering that on Tuesday. So, he didnt get a pill on Wed, and he got a pill today. He is starting to act a little painful. He is walking slower and panting more.
Im going to call in the morning and see if I can get an appointment with another vet practice. What is usually done now? Since he responded badly when we did the final taper (once every other day) twice, should we be expected to go back to the original prescription (1/2 a pill twice a day) or the taper amount again (1/2 a pill once a day) or maybe something even more aggressive like 1 pill (20 mg) twice a day?
Do you need to work slowly up when given more steroids or just when you wean them off? Im just trying to get an idea of what to expect so that Im not blindsided with what is suggested.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 12, 2013 11:05:58 GMT -7
Sorry I am a little fuzzy on the pred. As I recall he had a 4 day course on 3/22, then another 5 day course Apr 4-5ish? Both times on the taper the pain meds where never cut back a bit or stopped to get an immediate clear picture on the pain/swelling status? The reason for the taper is a health reason...to signal the body to start making its own steroid hormone which is critical for managing body functions. It just happens the taper is also a perfect window for IVDD patients to assess how swelling/pain is doing. Often it takes being at the anti-inflamamtory dose level prior of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. On the taper the dose is lowered to less than the anti-flammatory dose and that is the time to assess just how well reduction of swelling is going by observing for pain. Rule of thumb is: pain = swelling = more time on Pred needed. Please read this very good overview of surgery vs. conservative, when to decide on a consult with a board certified neuro (ACVIM) about surgery. www.dodgerslist.com/literature/healingsurgery.htm Let us know how the new vet is and what he prescribes and that Otis has his pain under control |
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Post by piaffplease on Apr 12, 2013 13:55:56 GMT -7
We called our current vet today to ask the same question I asked you and she thinks he might need the surgery. We have gotten a consult with the neurologist on Monday and we will see what he recommends.
Otis seemed fine the first time we tapered the meds, but the second time we tapered, he was in pain. We bumped him back up on the steroids but when we tried to taper again, he was in pain. I have a feeling that surgery is the next option.
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Post by Linda Stowe on Apr 12, 2013 14:08:31 GMT -7
Emily, it never hurts to get a consult with a specialist. When pain can't be controlled with anti-inflammatories and correct pain meds, then surgery is always a consideration. To be the best informed, read our article by Dr. Isaacs on surgery considerations: www.dodgerslist.com/literature/healingsurgery.htmDo keep us updated on your visit Monday. If you see any further loss of neuro functions, contact them immediately. |
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Post by piaffplease on Apr 15, 2013 11:44:41 GMT -7
We saw the neurologist today and Mr. Otis is scheduled for an MRI and surgery tomorrow. He has gotten worse and several neurologists agreed that surgery is the next step. Please keep in him in your thoughts and prayers.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 15, 2013 11:56:59 GMT -7
We all will be sending our most positive of thoughts for Mr. Otis' surgery. When you can do let us know how the surgery went.
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Post by piaffplease on Apr 17, 2013 9:46:10 GMT -7
Mr. Otis had surgery yesterday and we heard from the vet at 8pm. The disc material had moved quite a bit and she reassured us that the conservative method wouldn't have worked for him. She called me this morning and he is doing ok. He is very upset and is being very vocal. She thought it was pain at first but he doesnt show pain when she presses on his back or through other tests. He is quiet and happy when someone is sitting beside him. We get to see him this afternoon.
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Post by Linda Stowe on Apr 17, 2013 16:10:02 GMT -7
Good news Emily. Let us know how your visit went.
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Post by piaffplease on Apr 19, 2013 17:56:44 GMT -7
He looked terrible at our visit. He was very stressed. They said he was doing fine and seemed to be resting. They kept updating us and said he was getting mildly better each day. We took him home today. His spirits are better and he isnt in pain. My husband and I agree that his walking is worse than before he went in for surgery. Is this normal? He got out of surgery Tuesday night and its now Friday night.
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Post by Pauliana on Apr 19, 2013 20:04:26 GMT -7
Hi Emily,
Mr Otis is likely very relieved and happy to be home. Even though his walking seems to be worse right now, it often takes 2 weeks for the surgery swelling to go down, after that you will be better able to assess his walking.
What are the current medications, dosages and how often are they to be given, please? Very glad to hear he isn't in pain.
Hope you all have a restful night and Mr Otis feels better day by day..
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Post by piaffplease on Apr 20, 2013 8:24:11 GMT -7
Because he was on the pred before surgery, he is being weaned off of those now. Right now he is on 10mg twice a day. Im still giving him the pepcid. He is also on 150mg of gabapentin 3x a day, and diazepam 7.5mg 3x a day. He also has a fentanyl patch.
He rested well last night and has eaten his meals while at home. He only at twice at the vet. He is glad to be home, he hates the vet. I really hope his walking gets better. I was told there was a 10% chance that his walking wouldnt return to normal, but I was never told that it could get worse. Hopefully he gets better.
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Post by Pauliana on Apr 20, 2013 9:15:56 GMT -7
Emily, Very glad Mr Otis is eating better since he has been home. Tyler didn't eat well at the vet either, that happens quite often after surgery with their tummies upset with anesthetics/ drugs and also they are away from home and family,naturally upsetting for dogs. Now that Mr Otis is home, he can heal in his familiar comfortable surroundings with his loving family in his comfy crate. Did your surgeon recommend 6 weeks of crate rest, that is typical for surgery dogs? I hope his walking gets better with time. Remember nerves take the longest to heal. We have had dogs heal and return to walking after 2 days to two weeks to several months, and one I know of (Goosie belonging to Lisa, Moderator: Natureluva) at 9 to 11 months. Don't give up hope that Mr Otis will walk one day. Please read some our success stories to see the varied healing times of Dodgerslist dogs. C after the story means conservative care and S means surgery. www.dodgerslist.com/monthstory.htm |
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Post by piaffplease on Apr 20, 2013 12:00:15 GMT -7
The vet recommended 4 weeks of cage rest. He goes in for his recheck then. We are committed to 6 weeks though. Even though we've already done 5 weeks of cage rest and 6 more weeks seems like forever, we want to make sure he is healed completely. Do most people do 6 weeks cage rest then start a slow PT or is it 4 weeks and then mostly cage rest with a little PT?
Mr. Otis has lost a lot of muscle already. He was a very active dog that exercised daily. Now he hasnt moved except for potty time.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 20, 2013 12:09:32 GMT -7
with surgery PT can start when the surgeon says. So anytime you are not doing PT, then the recovery suite is the safest place for Otis to finish healing from the surgical procedure itself. PT is always done with supervision, in full control of speed and darting off and slowly so the dog can learn to walk, place the paws right, etc,
6 week is typical, but each surgeon has seen the damage and knows if more than the normal 6 weeks is needed. You know yourself a broken bone needs 6 weeks to mend. They had to cut bone to get to the disc as well as soft tissue of muscles.
Sometimes the PT IS the walk to and from the potty place. What did your surgeon direct for PT?
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Post by piaffplease on May 16, 2013 14:20:31 GMT -7
Sorry for the lag in updates, my computer crashed and wasnt able to be saved. Mr Otis is doing much better and is walking unassisted! He still loses his balance a little but not enough to fall down. He is off all meds and is pain free, yay!!!
We hit the 4 week post op mark Tuesday and he started PT yesterday. He went on a short walk and did very well. He is still on cage rest other than the short times he is doing PT.
We take him back the the surgeon again in 3 weeks to test his urine. It was high in protein when they tested it before surgery. So now that he is off all his prednisone, they want to wait 3 weeks to test it again. Hopefully things will be fine and it was the pred causing the high protein.
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Post by Nancy & Polly on May 16, 2013 17:59:39 GMT -7
Glad you're back in business. We are so dependent on our computers, aren't we? It sounds as though Mr. Otis is well on his way to recovery. I'm so glad. My husband and I watched our Polly run around the yard like a puppy the other day, and it brought us both to tears. We thought we might never see that again. Stick with the crate rest, even though he's feeling better. The last two weeks are tough, but I think they're worth it in the end.
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