Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 15, 2014 0:30:42 GMT -7
Duke is a 9 yr old doxie. We've been through this before, but each time has been different. His first episode was about 4 years ago and started with the wobbly walk. He did not appear to suffer much. Crated 8 weeks and recovered. Second time was a little over a year ago (August) and was cervical with much worse pain. Strict crate rest for nearly 12 weeks with no improvement and had surgery. He recovered after 6 weeks strict crate rest. It happened again this evening while playing at the dog park. This time his pain seems much worse. I took my eyes off him for a minute so I don't know if something happened, but he plays in the smaller yard for small dogs. One minute he was just walking around and the next I heard him screaming and his back right leg was pulled up tight to his body. I took him to the vet immediately and he cried and moaned in pain all the way there. An x-ray showed disk material protruding into canal/nerve root R L6-L7. He is also having muscle spasms. I know pretty much about crate rest being strict and certainly will follow that. I am concerned about the amount of medication prescribed especially for the amount of pain he seems to be in. Before the x-ray the vet gave him a sedative to help with the pain during the xray. She said he still has deep pain sensation and I'm guessing that as long as he holds that right leg in tight, then he does. He does wag when I talk to him. She also did say that the disk material was protruding to the right and is likely not pressing on the spinal cord, but more than likely pressing on a nerve in his right leg or hip which might explain the holding up and spasms.
Meds: She prescribed
Pred. 5mg (1/2 tab) every 12 hours for 3 days, then 1/2 tab once daily for 3 days, then 1/2 every other day until gone (10 tabs total). Tramadol 50 mg (1/2 tab) every 8 hours and Methocarbamol 500 mg (1/4 tab) every 8 hours. I asked about pepcid and wil be giving (1/2 tab) before each pred dose. He weighs 18 lbs and I am concerned the pred is not enough.
Other concerns: He would not eat dinner or drink water. His last meal was 6:30 a.m. It is now 1:20 a.m. so almost 20 hours ago. He has not had water since 4 p.m. I tried getting his meds in wrapped in cheese, but he spit some out because he knows that trick now. He is not even interested in the cheese now. I don't know how much got in because once it sat in the cheese, and after several attempts of him spitting it out, it was hard to tell what is what. Regardless of what he did ingest, it is time for another round and he is just not interested. He won't try to potty. It has been 9 hrs since the incident and he won't move or stand at all. I have tried to carry him out, using a sling under his back end, he will not try to stand at all, so the sling is all that holds up his back end, which must be uncomfortable.
I'd appreciate any advice you have for me. I know I've been through this before, but he seems to be very uncomfortable, more so then the last two times. I've never seem him cry and howl like he did all the way to the vet's office.
thanks so much
Btw, my name is Tracey
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Jan 15, 2014 7:53:55 GMT -7
Welcome to Dodgerslist, Tracey. I'm so sorry your Duke is having such a difficult time. Once his pain is under control, things will go much easier for both of you. It sounds as though Duke has nerve root signature pain. The Methocarbamol is the correct medication for muscle spasms. Dr. Isaacs explains more about that here: www.dodgerslist.com/neurocorner2/rootsignature.htmPlease call the vet this morning and let them know that Duke is still is pain and that he won't eat. Since he just started the Pred and hasn't eaten since this started, I would think the pain is causing him not to want to eat. At his weight, the vet has room to move up to 50 mg of Tramadol every 8 hours and also Gabapentin can be added. Gabapentin works well with Tramadol to get pain under control. Please advocate strongly for more pain meds. In addition, speak to them about increasing the Pred to 5 mg 2x/day. That is the standard anti-inflammatory dose to bring down swelling. Half the dose may not get the job done. They have him on a very short round of Pred (only 3 days before a taper). A taper is done to test for pain to see if the swelling has gone down so if in three days he still shows any sign of pain at all, a taper should not take place. A sling is necessary to steady his hind end if he cannot stand on his own. He may not have bladder control and may need to be expressed. You need to get a hands on your hands demonstration on expressing. Pred causes increased thirst and urination so you'll need to lift and carry him to his potty spot every 2-3 hours while on Pred. The only way we can test for bladder control is to take him to a spot where he's peed before, let him sniff and see if he can release urine on his own. If not, he'll need to be expressed. Here are our tips on expressing that you can view before the vet's demonstration: www.dodgerslist.com/literature/Expressing.htm Tramadol is very bitter so be sure you have no residue from the pill on your hands that would get on the outside of the food that you're hiding the pill in. Peanut butter might work better since it's sticky and difficult to spit out. Though this is Duke's third disc problem, you can brush up on IVDD on our main web page with "Overview: the essentials" and then read all you can. Here's the link www.dodgerslist.com/healingindex.htm100% 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.htmThe very, very lightest least aggressive range of motion and leg massage is necessary for paralyzed legs during conservative treatment once off all meds and there is no pain. The information highlighted in PINK pertains to a dog who can't walk but only after all meds are stopped and there is no pain. www.dodgerslist.com/literature/massagepassiveexercises.htmLaser light therapy, acupuncture and electroacupuncture which sends a microcurrent of electricity to and from acupuncture points (which are really big nerve bundles), can be very beneficial at helping to re-establish the nerve connections in the body. Any one of these therapies can be started right away if in your budget... they not only help relieve pain and inflammation but will kick start nerves to begin regeneration. Find a holistic vet here: ahvma.org/Widgets/FindVet.html www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] NOTE: Chiropractic is not recommended for IVDD dogs. Please let us know what the vets says after speaking to them.
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Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 15, 2014 15:05:02 GMT -7
Thanks Marjorie for your reply. I have not heard back from my vet yet. However, Duke is feeling much better today. I have gotten him to take his pills, he has eaten, and finally gone potty. He also got up and took his first drink of water a few minutes ago. I have gone through 3 veterinarians dealing with this IVDD and all are very conservative in prescribing medication. I don't know what it is. I have not been able to find a vet within a 50 mile radius who will treat more aggressively. I have shared the Dodger's literature with all of them to no avail. I have decided that I know my dog best and what to do for him, thanks to the advice I find here. I have decided to up his Prednisone to 5mg twice a day regardless. I have extra anyway and always keep extra on hand. I will decide when it is time to taper. After his last 2 episodes, I know 3 days was not enough for him both times. So I will wait and see how he is doing. So my questions now are, what is the Dodger's recommended wait time to begin to taper, and should I lower the pain medication first to see if he is without pain before I taper the prednisone?
thank you again Tracey
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 15, 2014 17:01:40 GMT -7
Tracey, we are not veterinarians so do not prescribe medications, we just give comments you might want to discuss with your own vet. Prednisone and all steroids are THE one class of meds that really require vet supervision. The body requires steroids to run vital body functions making this med one you do not want to use without vet knowledge. So where do you live…city, State? Have you searched our vet recommendation directory for an IVDD knowledgeable DVM in your area: dodgerslist.boards.net/board/10/guidelines-postingA reason to go for a consultation with a specialist is when you find a general DVM vet not comfortable in using IVDD meds. So you do need to explain why you want a consult to the specialist. Neuro and ortho specialists can be found at University vet teaching hospitals and private practice hospitals. www.acvim.orgonline.acvs.org/acvsssa/rflssareferral.query_page?P_VENDOR_TY=VETS
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Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 16, 2014 20:57:58 GMT -7
Paula, The nearest neuro vet is over an hour away and I work two jobs so trying to fit that in at this point is not an option for me. I have not asked anyone here to prescribe medications. I have been reading other posts to get as much advice as I can. I figured after seeing some of the moderators here say that "5mg of prednisone is the correct dosage to get inflammation under control for a dog of 12-14 lbs" and that many dogs need longer than 3 days, that might be a good rule to follow. This is one response I read about a 14 lb dog from one of the moderators (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) My dog is almost 19 lbs so based on what I have researched here, his dosage does not seem enough by what is being said. So I am only going on the advice that I have seen here on this forum. I am trying to do the best for my baby and it isn't easy when vets don't want to prescribe. My dog is apparently suffering signature root pain from what was described to me in the first response. He was in so much pain when I took him in they had to give him a sedative. However, that same vet only wanted to prescribe prednisone and methocarbamol. She said he wouldn't need pain meds!!! I said no way, he is in severe pain and I want pain meds. I went through two vets and 12 weeks of miserable unsuccessful crate rest on his last episode and finally had to go to the clinic over an hour away and have surgery. I cannot go through that again and I cannot afford that again. If this progresses, then I will have to surrender him to a rescue. I have tried to get back in touch with my vet but they always call me back when I am in class and cannot take calls. This is frustrating. I live in Biloxi, MS. There are no specialists in this area.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 16, 2014 22:23:12 GMT -7
Tracey, I have asked for help in finding a vet in your Biloxi, MS area who is more comfortable in treating IVDD. I checked the map against the Neuro and ortho specialist directories and there certainly are not specialists near by even in adjacent states. You might call a doxie rescue just to ask the name of the vet who works with the rescue…you might find a vet that way. Then call on the phone to explain your problem and whether this vet can help with meds during conservative treatment because surgery just is not an option.
What is the name of the surgical center an hour away you used? No vet will prescribe meds unless they can see the dog of course…so that is a problem for you in getting to a far away location.
We do observe vets comfortable in treating a disc episode prescribing 5mg of Pred 2x a day for a dog of Duke's size. So that is something you want to shoot for in your discussion with a vet. Since surgery is not an option the only other course of action is to help the dog via medications and crate rest. Have you had a frank discussion since surgery is not an option, then how can the vet help get the pain in control while it can take 7-14 days for most dogs to get swelling down? How can the vet get the swelling down to to help Duke. There are many dogs that on the other hand have had to stay on pred at the 5mg 2x a day for more like 30 days in toto.
It is prudent to give a course of 7 or so days and then call for a taper when the vet guesses all the swelling might be gone..so the taper is a test to check on swelling. If pain still exists on the taper, then it is known more time on pred is needed back at the original dose. The taper just happens to be a perfect way to inspect swelling with IVDD…the taper is actually necessary to signal the adrenal glands to start making its own steroid hormone (cortisol) which manage vital functions of the body.
When you try to get through to your vet, is it possible to do it through email to avoid phone tag? Ask the vet receptionist for her help in communicating with the vet. Explain your class schedule problem…two jobs and see if she can get you two connected.
As of today how is Duke's pain? What does of Pred is he getting currently?
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Jan 17, 2014 8:27:08 GMT -7
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Post by Linda Stowe on Jan 17, 2014 11:21:32 GMT -7
Tracey, I just got another recommendation from a friend who has Dachshunds. You might give this vet a call and talk with them.
Gingles Animal Clinic in Long Beach (228) 863-8490
I couldn't find a website for them.
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Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 17, 2014 19:50:04 GMT -7
Thanks for trying to help me with a vet. I am not at all unhappy with who we have. She is by far, the best I have found around here. I am just discouraged by the fact that I have to tell them what to do and what to prescribe! And Yes Marjorie, I read that same review about Happy Tails when I was looking for a new vet during his last episode. I switched as a result. Big Mistake!! Dr. Griffin was the first one that was reluctant to prescribe. I did laser treatments with her for several weeks. I brought the Dodger's literature and a video to her to watch. When he continued to decline, she still was reluctant to continue Prednisone past the original 3 days and then taper, she was reluctant to continue pain meds. I had to ask about adding pepcid and convince her to give me the Gabapentin and the sucralfate. After 12 miserable weeks of watching him decline,I finally took him in to the ER hospital and they gave me the referral to the Med-Vet hospital in Mandeville, LA. This is where he had his surgery. www.medvet-cves.com/mandeville. It turns out we were dealing with a cervical episode which explains why it was so bad. They are on emergency basis only. They are not a regular IVDD vet. I really liked the Drs. and the staff, but the dr who did Duke's surgery recommended only 4 weeks crate rest when I picked him up! Of course I knew better and did 6 weeks. Back to the current episode ...Today Duke is not doing well at all. When he originally went down on Tuesday and we saw the vet he was in severe pain and drawing his rear right leg up. I took Wed off and stayed with him. He would not even potty for almost 24 hours. Finally by Wed late evening, he went and I started to notice his tail wagging and he appeared to finally have some pain relief. He actually was starting to put his leg down again. So I went back to work on Thursday. I came home at lunch, took him out, gave meds, and returned to work. Thursday night I noticed again that he was holding his rear right leg up close to his body. I increased his Prednisone to 5 mg twice a day. I got worried about doing that without hearing from the vet, so Friday morning I went back down to half. I also noticed Friday morning before leaving he appeared to be in a bit of pain. I came home during lunch and when I walked into the house, he stood in his crate to greet me. Immediately he fell down and started hollering in pain again. It took me several minutes to get him calm. He was in so much pain I thought he was going to bite me. His leg is trembling and he is having spasms. I did not pick him up or take him out. I forced a pain pill down him, called the vet, went back to work, found other teachers to cover my classes, came home and waited for the vet to call. Here is the new regimen: 1 capsule 100 mg Gabapentin (once a day) 1 pill 5mg Prednisone (every 12 hrs) 3/4 pill 50 mg Tramadol(4 times a day - she said it can be every 4 hours) 1/4 pill 500 mg Methacarbamol (every 8 hrs) 1 pill .5 mg Xanax (as needed) 1/2 pill 10mg Pepcid (before prednisone) I will be home with him through Monday and hope to get this pain under control by then. I will have to return to work on Tuesday. I am thinking of hiring my dogsitter to come sit with him. He seems to be having terrible anxiety when I leave him. He tears up his crate when I leave him. Funny thing is he never does this when I leave for work in the a.m. just after I come home and leave again. Last night I had to leave briefly to get meds filled and he threw such a fit I could hear him barking and howling as I drove off. This could be the reason for his setback today. I'm not sure. I wonder if I might need a smaller crate. I have a 36 x 24 crate. It is big enough for him to lay down, change positions, and maybe have an extra foot of room around him. I have put stacks of blankets inside so his bed is raised to about half the height. I have to do this to keep him from standing on his hind legs when he gets upset. I also have two ex pens but they are larger then the crate. Someone mentioned earlier that this sounded like signature nerve root pain, and provided a link for me to read, which I did. It did not go into much detail though. So I wonder if anyone can share their experience so I know what I am facing. Is this worse than a typical disk episode. Is it worse because the disk is so low (in his lower back)? I am having trouble right now with potty time. He won't put the foot down so he cannot balance. I try using the strap for support, but he won't go with it on. Last time he peed was 6 a.m. this morning. It is now 8:45 p.m. I have tried to take him out, but he just stands there and shivers. One other question...since my vet decided to add the Gabapentin today, will the pepcid be enough? Thank you all so much Tracey
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jan 17, 2014 21:18:23 GMT -7
If this vet is open to learning what you have learned here, then so be it you have a vet you can work with and get the support you need with Duke. Remember it is YOU who is the captain of Duke's health care team, it is your job to work as a team with the vet you have hired to get things right for Duke. Good vets know that they can't possibly know every disease for all breeds and species, but it is possible for an owner to have done quite a bit of reading to bring that information to the table. Kudo's on getting the meds that Duke needs!! If the Rx is right, pain would be in control in one hour and thereafter dose to dose of the pain meds (gabapentin, methocarbamol and tramadol). With the weekend coming up be sure to contact her Sat before the close for an update. IF, IF there is any hint of pain surfacing before the next dose or pain after moving, then this vet will need to adjust meds. Gabapentin it is reported is not dose proportional. " i.e., as dose is increased, bioavailability decreases. Bioavailability of Gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively" www.drugs.com/pro/gabapentin.html So it would be good to discuss with the vet about dividing the 100mg capsule powder into three equal doses during the day instead of 100mgs 1x a day. To divide open capsule and dump powder into into a creased pieced of paper. With a razor blade move the powder into three equal piles. Store each dose in one of those 7 day pill boxes with a lid for each day. Gabpentin powder as well as Tramadol are very bitter. So watch that no dust transfers to the outside of the pill treat. Or Duke will be forever suspicious. I mash banana, form in to a small ball. Make an indent to place gaba powder or tramadol. Close up and if necessary to make even more tempting, wrap with a thin slice of deli meat. There is room to move up in dose with tramadol. Jane E. Quandt, DVM, MS, DACVAA, DACVECC University of Georgia wriites " Tramadol dosing in dogs varies, with suggested doses ranging from 2 to 5 mg/kg q8–12h. The highest dose for maximum analgesic effect in dogs is 10 mg/kg q8h. www.cliniciansbrief.com/article/tramadol?utm_medium=email&utm_source=Clinician%27s+Brief+eNewsletter&utm_campaign=CB+ENL+110713 Methocarbamol is the drug that works with the pain that comes from muscle spasms. There is room to move up in dose on this drug too. www.petplace.com/drug-library/methocarbamol-robaxin-v/page1.aspxThe nerve exiting the spinal cord is where the disc/ disc material pressuring rather than the pressure happening in the spinal cord canal. So this still involves a bad disc and the treatment is the same. Let the disc form scar tissue for 8 weeks. Hopefully the body will be able to reabsorb enough of disc material or nerves can learn to function around it so as to no longer be irritated and painful. Try a figure 8 sling as males usually don't like a sling touching near the penis. Crate size should allow him to fully stretch out his legs when lying down. Ex-pens are an option to wrap around his mattress as a recovery suite. The reason for Pepcid is to protect against the Prednisone. Pred causes extra stomach acids. Pepcid AC reduces production of stomach acids. We hope to hear from you that the new med Rx is providing the comfort from pain Duke needs. If the pain can be brought under control, you can care for him and he can potty without experiencing pain.
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Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 18, 2014 7:17:49 GMT -7
Thanks Paula, The vet thought one full 50 mg Tramadol was too much for him. I did ask if we could go up. She only went up to 3/4. I gave the Gabapentin in one full dose yesterday, but took your advice and split into 3 doses for today. Right now I am using a turkey hot dog and cream cheese. By hollowing out a piece of hot dog, filling with powder, then cover the hole with cream cheese, he doesn't suspect.
You say pain should be under control and he should go potty with no pain so does that mean he should feel comfortable with putting his leg down? I started the new medication regimen yesterday afternoon. This morning, he is still holding his right rear leg up close to his body and I still see a bit of shivering. He isn't crying. He went 24 hours without peeing. From yesterday morning 6:30 until this morning when he finally did go. But still hasn't pooped since Thursday night. My vet is closed today and Sunday, but they are open on Monday, and I am off. So I need advice on whether I should go ahead and call or take him back in on Monday. Oh btw...Duke's favorite vet and mine is her fill in guy now. He moved to the ER hospital, but I've learned he will be there on Monday. He is not an IVDD vet but I feel better with him. So he will be there on Monday. I'm going to go out today and pick up those leashes and try to make a sling like that one.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Jan 18, 2014 7:47:36 GMT -7
Yes, holding his leg up to his body and not wanting to bear weight on it is a sign of pain, as is the shivering. Pain should be completely under control and he should be his usual perky self within one hour of giving pain meds. Duke's pain medications are still not right. Pain necessitates an emergency call to the vet so the meds can be adjusted.
Please let us know what the vet says after speaking to them.
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Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 18, 2014 19:01:07 GMT -7
The vet was closed today. She did tell me when I spoke with her yesterday that I could move the pain meds up to every 4 hours if necessary. I'll try that. He seems to be trying to put his leg down today. I also made the sling with the two leashes. It is much better but he still won't poop! Last time was Thursday night in his crate while I was out. I am going to try pumpkin. One other question. Can pepcid only be given 30 min prior? I mean could it be given earlier than that? If so, how much earlier? I am trying to come up with a med schedule for when I return to work on Tuesday and it is hard to schedule all these dosages around my work schedule.
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Post by clewis on Jan 18, 2014 19:33:36 GMT -7
Tracey --- I have had 2 Dachshunds experience the nerve root signature pain in rear legs that is associated with a bulging disc or disc material affecting a nerve root in the leg. In human terms, it is like dealing with a sciatica nerve issue --- and most humans that I know who have dealt with this describe it as being very painful!
I found that gabapentin and methacarbamol were probably the key meds when dealing with nerve root signature pain. Of course, they were used in conjunction with the other meds you have listed for Duke. I have to agree with Paula --- it seems the methacarbamol dosage may have some room for tweaking, BUT YOU MUST CONSULT WITH YOUR VET!
I realize that you like your current vet, but perhaps a specialist may be a consideration. Also, look into the use of acupuncture or cold laser therapy for pain relief. These are just suggestions.
I had one dog whose nerve root signature pain issue was resolved with conservative, and the other dog required surgery to "clean up" the disc material that was "clogging" around the nerve root --- no amount of meds were going to make that go away .. The way that the disc material was discovered as being "clogged" around the nerve root was through a CT Scan. I will say this, as a hard lesson learned from the dog who needed surgery to resolve her nerve root episode, waiting the 6-8 weeks for conservative to hopefully work did not work in her favor. The extra time only allowed the disc material to become more difficult to "scrape off" the nerve by the surgeon. I hope my description makes sense ...
Both of my dogs are 10 and 11 years old now and are walking, talking little fools today. Both had a board certified orthopedic surgeon involved with their care. So --- there is hope!! The key for Duke is to get the pain managed; the question is how ...
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Tracey & Duke
New Member
Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
Posts: 44
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Post by Tracey & Duke on Jan 18, 2014 20:33:20 GMT -7
clewis, thank you for that explanation of the root signature pain. I have been waiting for that answer as I have no idea what the future is for Duke. We have had 3 disc episodes in 5 years and each was very different. It sounds like it would be nice to learn earlier than later if the clogged material is an issue. Can you tell me what the cost of your CT scan was? I now feel the same about the cervical episode we had. After the 10 weeks of crate rest, he needed surgery anyway. I am really unable to pay for another surgery at this time as I am still paying the last one off. I originally put it on Care Credit, but there was no way I could pay that off after the year and they refused to extend the time, so I had to transfer the balance to a lower interest credit card.
I think I have asked this question on a previous episode but do not remember if anyone answered. If a disc issue is resolved through crate rest, can that same disc cause a problem later? And the same question for the disc he had the surgery on? I know I have to protect his back for the rest of his life and, trust me, I do. I have blocked all of my furniture for the last year and a half since his last surgery. I do not even sit on my own furniture! If I do and rarely do, then I use a ramp for them to come up, but I have even quit using that months ago because they tend to want to run down or jump over.
Due to his current dosing schedule, I now have 8 alarms set (because I didn't do so well on memory today) on my phone beginning at 6 a.m. and ending at 12 a.m. so the only sleep I get is 12 a.m. to 6 a.m. I don't know if anyone has any suggestions for a better timing of meds but my work schedule is 7a.m. to 3 p.m. so I have to try and work around that. I have a dogsitter stopping in around mid day starting Tuesday when I go back to work. I'm just not sure if all meds have to be spaced evenly out or not. For ex: I know pain meds must but do all others? Below is my current schedule:
6a.m. Pepcid/Tramadol 6:30 a.m. Prednisone/Gabapentin/Methocarbamol 12 p.m. Tramadol 3:30 p.m. Gabapentin/Methocarbamol 6 p.m. Pepcid/Tramadol 6:30 p.m. Prednisone 10:30 p.m. Gabapentin/Methocarbamol 12 a.m. Tramadol
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Post by Pauliana on Jan 18, 2014 21:27:00 GMT -7
Hi Tracey!
Pepcid AC and other acid reducers work best if given on an empty stomach. Giving it 30 minutes before a meal and then giving the medications immediately following the meal may provide the best stomach protection.
You need more sleep.. I would give the last Tramadol with the other 10:30 medications and then go to bed.. Or try it that way once and see if it works out to cover his pain the whole night.. Worth a try and I hope it works out for Duke and for you.. Let us know.
IVDD is a disease our dogs were born with and some dogs have multiple episodes during their lives and others just have one episode.. My Tyler has had 2, possibly 3 episodes and he is now 4 years old. It can involve the same or different discs. IVDD is a disease and not an injury. The trauma to the spinal cord results from hardening of the discs due to the disease.
IVDD causes discs to age earlier in life. Discs lose moisture and harden and can no longer cushion the vertebrae along the spine. IVDD occurs in breeds such as dachshunds, poodles, corgis, beagles, but it is not limited to just those breeds.
If a dog has IVDD, a disc problem can happen at any age. When the disc has weakened to a certain degree, it will herniate. You may or may not be able to pinpoint a specific incident as causing the start of symptoms. Many dogs that have IVDD have their first episode typically between the ages of 3-7.
Wishing you a good night sleep..
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Post by clewis on Jan 18, 2014 21:32:20 GMT -7
I am going to guess that a CT Scan may be around $800. But not sure ... My dog's CT scan was 3+ years ago. Also, geographic location (I am in Wisconsin) can also see differing costs ...
Tracey --- I do understand the frustration of managing schedules and worrying about our dogs ... It is not easy, but they depend on us. We must stay strong, and if you need to vent --- come to the Forum.
I also understand the concerns about paying for surgeries ... 2009 was my year from hell! I had one dog with 3 disc episodes (two required surgery), and the second dog had a disc issue that required emergency surgery. Some of it is a blur now, but I do remember it as a very challenging year. Add to that one emergency C-section and a stomach bloat ... I did not know which way was up some days. But my dogs made me stronger and I am here today to share what I learned and enjoy my dogs.
As for a disc that recovered from conservative treatment ... I think it can become affected again ... But a disc that had surgery performed --- they usually remove the disc material because it herniated or ruptured. But you would need to check with a specialist for sure on this ...
By the way --- I called my nerve root signature dogs my little Dachshund Flamingos ... (some light humor).
Is Duke's pain under control now with the pain meds schedule and dosages you now have? Let's remember that this episode has only been going on for about 4 days. Yes, I know it seems long and tedious and frustrating! If indeed the disc is bulging, then conservative may have some positive outcome for Duke. My dog that needed the surgery for her nerve root --- her disc had herniated and the pieces of disc material had travelled down the nerve root in her leg. If the meds are tweaked to deal with the pain and inflammation, then hopefully the bulge can get "calmed down". Real inflammation often takes 7-10 days to get under control, so consider that.
Cris Lewis
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PaulaM
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Post by PaulaM on Jan 18, 2014 22:40:49 GMT -7
Tracey, it is best to give meds at optimum times if at all possible. With a work schedule to consider, often we do the best we can.
Pepcid AC is effective for about 12 hours. It has no requirements to avoid food and has no need of an acidic stomach to form a gel coating like some other protectors such as sucralfate. So you can give Pepcid AC at the same as any of the pain meds, at the same time as Prednisone and can give it with a meal. Optimal for Pepcid AC would be to give it 30 mins before Prednisone.
Assuming you leave the house at 6:30 for work and get back home at 3:30, this may be something that will work for pilling. As you see his leg pain is in control (bearing weight, no more shivering) you MIGHT try to go with tramadol every 8 hours, eliminating a midnight dose. In general it is important to be prompt with pain meds so the level of pain reliever in the body is not wearing off.
6am: meal, Pepcid , Pred, Gabapentin, Methocarbamol, Tramadol Noon: Tramadol given by the dogsitter 3:30pm: Gabapentin, Methocarbamol 6 pm: meal, Pepcid, Pred, Tramadol 10:30 p.m. Gabapentin, Methocarbamol Midnight: Tramadol
We hope to hear that foot continues to allow bearing weight in the morning and that the pumpkin has helped with his poop.
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Tracey & Duke
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Post by Tracey & Duke on Jan 19, 2014 12:10:37 GMT -7
Oh Paula.... thank you, thank you! It is such a relief to hear that the schedule can be so simple! I had 8 alarms set on my phone. At least this gets me down to 6, and maybe 5 if I can get him on pain meds every 8 hours. And yes, today he is bearing weight. I do notice he is bearing very lightly on the right leg, but he is taking steps now. He did poop late last night and this morning. I feel I am seeing the light!
And Chris, thanks for your replies. It is so helpful to hear from someone with the same type of disc issue. When the vet did the xray, she said that his was only bulging a bit, but not ruptured. When I called back on Friday, she was looking at his xray again and said she doesn't see anything bad enough to be causing this much pain. We go for a recheck on Tuesday.
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PaulaM
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Post by PaulaM on Jan 19, 2014 12:46:53 GMT -7
Michelle, thank goodness for cell phone alarms… I know I have had a slew of them set for pilling times too.
It does appear you now have the right combo of pain meds PLUS Prednisone at the anti-inflammtory dose that is significant in pain control. Xrays are best at hard tissue details such as bones. They do not show soft tissue such as the disc nor a peripheral nerve (nerve root going off the main spinal cord). Nerve root signature pain is a bear. Let's all keep our fingers crossed that Pred WILL get the painful swelling down permanently. We'd all like that to be a 5-14 day course of pred. With swelling the only way to know is with a taper where the dose is reduced to lower than anti-inflammatory. Do know that for some dogs it required being up at the original Pred level for a total of more like 30 days.
This course of Pred (5mg 2x/day) started on Jan 17…did the vet already give you an idea how many days before she might want to try a taper to assess swelling resolution? Whenever that taper is called for, make sure you have a plan B set up with the vet ahead of time. Know what to do if you see any hint of pain resurfacing. Know that you have either enough pills on hand or you have a Rx that you could run to the pharmacy should pain happen on weekends when the vet is closed.
Keep up the good work in caring for Duke…we hope to hear continued good news!
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Tracey & Duke
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Post by Tracey & Duke on Jan 19, 2014 19:11:44 GMT -7
When we first saw the vet on Tuesday, her original prescription was 1/2 pill every 12 hrs for 3 days, then begin to taper at 1/2 pill once a day for 3 days, then every other. Since the setback on Friday and increasing to a whole pill, we did not discuss taper at all. He has an appt. on Tuesday and that will be 4 days on the whole pill. I thought that maybe, at your suggestion, I might go ahead and try to cut the Tramadol back to every 8 hours tomorrow while I am still home with him to see how his pain is first. Then I can report what I see to her on Tuesday. Maybe that will help us decide. But I am definitely in no hurry and would rather err on the side of caution and go longer. I will definitely make sure I have enough of all the meds and a plan just in case. I have been reading a little about steroid blasting as a treatment. But I don't hear much about it. Is that something vets are opposed to? Well, I just did more reading on that subject and actually found this article very helpful as well. 12many.com/duchwood/backproblems.html
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Post by clewis on Jan 19, 2014 21:00:51 GMT -7
Tracey; I am aware of steroid blasting, and it is used by some Dachshund breeders as the "go to, quick solution" to IVDD episodes. The author of the article does state that it must be done within a few hours of the beginning of the episode. That is a crucial piece of information! There is steroid blasting and there is the use of IV steroids, and there is the use of oral steroids --- like you are doing now for Duke. Duke is past the window of opportunity for IV steroids at this point, but he does have oral steroids on board to address the inflammation. Glad to hear there is some improvement! Keep the faith, continue to be patient and smile at him --- tell him it is going to be OK! He will feed off your emotions. It is OK to be upset and frustrated, but do it somewhere else, come to the computer, etc. --- just not around Duke. Be sure to continue the strict crate rest so that the bulge can hopefully settle down. The first few days are always the worst, and you have needed to adjust meds, so it takes a little more time. A reminder that an x-ray CANNOT show all that is going on with the disc ... unfortunately. So if your vet says they can't see anything causing that much pain, it is because they don't have the right diagnostic tool. A CT Scan, MRI or myelogram are the tools for that and they are expensive and require the dog to be put under anesthesia. They are usually used on the way into surgery. Hang in there --- you are seeing some improvements! Time and meds are starting to work. Think positive and be sure Duke knows that! Cris Lewis
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Tracey & Duke
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Post by Tracey & Duke on Jan 21, 2014 17:33:56 GMT -7
So Duke has been pretty comfortable these last 2 days. I was supposed to bring him in for a follow-up today, but called and canceled because I am not ready to put him through a move like that just yet. I want to keep him crated for another week before dragging him out just for a follow-up. I am sure there are reasons she needs to see him, but I think there are reasons to keep him home a little while longer, especially since he was in severe pain on Friday.
I just don't understand why the hurry to taper. My vet's office called back and said to start tapering the prednisone to 1 pill a day for 5 days, then 1 every other day. I told them I was not ready to taper prednisone yet, since he has only been on the increased dose since Friday evening. I would like to taper Tramadol first to see if he is in pain. I am at work all day and won't have a chance to see until I get home. I have to rely on the dogsitter to tell me if she saw pain when she came by. I am going to wait until Thursday to begin the Prednisone taper. That way if I am home Sat and Sun with him and he is in pain, I'll be able to see it. Am I just being too cautious now? I just know his last 2 episodes required us to do the Prednisone and Tramadol much longer. She does say to continue the rest of the meds as usual. So just wondering if I should go with my gut or go with the vet?
thanks
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PaulaM
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Post by PaulaM on Jan 21, 2014 19:08:05 GMT -7
Sounds like you have a responsible plan to be there to observe for pain on a taper.
1/15 up to pred 5mg 2x a day and a taper called for on 1/21 gives a rather a 6 day course. While it is prudent to do a test and taper so a dog does not stay on pred any longer than necessary, I have to agree likely all the swelling would not be gone in 6 days. So they were on board with your plan to do the taper on 1/23 giving a 8 day course? Do not be disappointed if there is still swelling going on when the range of giving the higher anti-inflammatory dose often needs to be 7-14 days and even longer for some dogs.
We do have our fingers crossed for a good taper!
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Tracey & Duke
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Post by Tracey & Duke on Jan 25, 2014 20:26:03 GMT -7
Ok. Just checking in. Duke is doing fine so far on the taper. I started the taper of Prednisone (down from 1 to 1/2 pill twice daily) and Tramadol (down from 1 to 1/2 three times a day) on the 23rd. Duke is showing no signs of pain, is resting comfortably in his crate, wagging tail, putting foot down and wanting to walk around on potty breaks. So my questions are: 1) The next prednisone taper will begin on the 28th down to 1/2 every other day for 5 more days. Should I taper the Tramadol again? If so, at the same time? Or should I do that earlier to be sure there is no pain before the prednisone taper? 2) Should I also taper or discontinue Methacarbamol and or Gabapentin? My vet did not address this.
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Post by Pauliana on Jan 25, 2014 21:21:46 GMT -7
Hi Tracey,
Yes the pain medications should be tapered or stopped during the Prednisone taper so you can tell whether Duke is actually pain free.. The pain meds would mask the pain. If he does show pain, you would immediately let the vet know and go back to the original anti inflammatory dose of the Prednisone and back on the pain meds.. Good idea to call the vet on Monday and clarify how she wants you to taper the pain medications and make sure you have enough Prednisone and Pain medications on hand in case the taper doesn't work out. If it doesn't, don't be alarmed, it is very common. It just means more time on Prednisone is needed to work on the swelling. If he is truly not in pain as the taper continues, then the swelling is gone and no further medications would be necessary for the duration of crate rest.
Fingers crossed for Duke!
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Tracey & Duke
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Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
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Post by Tracey & Duke on Jan 26, 2014 7:28:36 GMT -7
So I'm not sure about the Methacarbamol and Gabapentin. My idea was to end pain meds before the next taper and while I'm home this weekend with him so I would be able to observe pain. His last Tramadol dose was 1/2 pill at 9p.m. last night. I do not plan to give him any today unless I see pain. Just need to know if I should do the same with M & G. I won't be able to talk to the dr. until Monday. Thanks!
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Marjorie
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Post by Marjorie on Jan 26, 2014 13:20:20 GMT -7
As Paula mentioned, usually all pain meds are tapered or stopped during the taper of the Prednisone so a true test for pain can be made. Any of the three pain meds that he's on - Tramadol, Methacarbamol or Gabapentin - would mask any signs of pain. However, a vet should be overseeing the taper of all of the meds. Is there any way you can reach someone at the vet's office today or do they have someone covering for them? How is Duke doing today with the taper of the Pred and the Tramadol? Please let us know what the vet says after speaking to them and keep us updated on Duke's status.
Prayers for a pain-free taper for Duke.
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Tracey & Duke
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Duke's 15 year doxie companion Daisy has now passed. (May 7, 2005 - May 6, 2020) Kidney failure
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Post by Tracey & Duke on Jan 26, 2014 20:50:01 GMT -7
There is no one at my vet's office on call. I am supposed to have a follow up appt on Tuesday, however, they are currently forecasting a winter storm for the Gulf Coast, Mississippi in my area on Tuesday and Wednesday, and we never get weather like this. If we do, then our entire town will be shut down. I will email them tomorrow morning and hope they reply since I am in class all day. If not, then I will call when I get out. When I last spoke with their office she only said to taper the Prednisone and Tramadol. We went down to half on both on Thursday through Saturday. Today, Duke has had no Tramadol, but I did continue the Methacarbamol and Gabapentin. I will definitely try to get an answer from them tomorrow. Duke seems to be doing very well today. No pain at all on any potty breaks or in his crate. Matter of fact, he is very antsy and demanding to be taken out, but that's not going to happen. Thanks so much for all the advice and prayers.
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PaulaM
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Post by PaulaM on Jan 26, 2014 21:56:39 GMT -7
Good news then about no pain on the taper so far. The true test of a taper is when the pain meds are backed off or stopped too. Look forward to your vet's plan with the pain meds.
Stay safe, hope the storm will not materialize!
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