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Post by Caryn&Caspi on Jan 21, 2014 7:42:45 GMT -7
Our 13 year old Chihuahua is having a disc episode and is on 4 medicines but still in pain. He is on Tramadol, Carprofen, Buprenorphine, and Gabapentin. We have a vet appointment tomorrow with his IVDD specialist. The ER vets prescribed his current pain meds. I've asked twice for increased doses or extra medicine and he still has not slept or relaxed. He has stopped whining and moves less today then he did yesterday. I keep thinking the pain should be controlled. Am I expecting too much?
Caspian was diagnosed with IVDD in 2011 in his neck. He has a drunken walk (front legs cross) and we limit movement around the house. He's been on low doses of tramadol and carprofen since 2011. Surgery was discouraged by the IVDD vet. On Saturday, while getting him out of the car, he struggled and fell about 18 inches to the driveway, landing on his right side. For a few hours he was fine and ate dinner and pottied. Three hours later, he was squealing in pain and scooting around on his bedding trying to get comfortable. I started increasing the ▲tramadol to .25 mg about every 3 hours (normally he gets .5 mg every 12 hours). The pain just seemed to increase.
We took him to the ER Sunday (he would not eat) and they gave him a shot of Buprenorphine and Carprofen and increased the ▲tramadol doses to 12.5mg every 12 hours. Soonest he could see his doc was Wednesday. Sunday night he ate and poopied but was still uncomfortable. Couldn't stay settled, scooted and whined. By 10pm, he was shivering and squealing / crying. I called ER and asked if I could decrease the time between ▲tramadol doses from 8 hours to 4 hours. They said yes but it didn't seem to help.
Monday he was still whining from time to time and trying to get comfortable. He ate breakfast. I arranged a blocked off area for him to keep our other dog away from him and went to work. When my husband came home an hour later, Caspian was limping and squealing in his area and the cardboard that had been used to block off his area had fallen. So it looks like it scared him and he hurt himself again. My husband crated him and tried giving him more tramadol at the scheduled time but he wouldn't take it. He snaps and bites and jumps about, which hurts him more, so then he squeals a lot. Monday I called the ER vet again and she prescribed the Buprenorphine in liquid compound. I gave him the first dose Monday night at 6pm with all other meds.
I doubt he slept - he was in his crate next to the bed - and I gave him tramadol at midnight. This morning he struggled against every dose. When I left, he was crated and still but still tensed and in pain, eyes wide open staring at nothing. He didn't eat breakfast.
I know neck pain is extremely painful. I wonder if he is overly sensitive to pain since he may have chronic low pain all the time. I can't tell if he bites and squeals because he's mad or in pain or both. Am I expecting too much? Right now, I just want to have him pain-free. Is that even possible? Might we have a better result with the IVDD vet tomorrow?
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PaulaM
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Post by PaulaM on Jan 21, 2014 8:56:32 GMT -7
Welcome to Dodgerslist. My name is Paula what is yours? Pain meds are not a one size fits all deal. Caspian IS in pain. Why was surgery discouraged? If surgery is to be avoided the pain must be in control at all times. That means dose to dose of the pain meds. Muscle spasm pain is a big part of the pain with a neck disc. Get on the phone this morning this can't wait til tomorrow and advocate for methocarbamol. Quickly read as homework so you can better advocate for this med. It can be given 3x a day. Also with a neck disc often the lesser of anti-inflammatories the NSAID class does not do the trick in getting swelling down. However a switch from carprofen (NSAID) to a steriod at this point is a serious issue. A 4-7 day washout is needed for the safety of the GI tract. Pepcid AC should have been on board all along. So if an emergency (that is aggressive pain meds + NSAID can't get pain in control) is deemed worth the risk of stomach damage then a 2nd protector would be used: sucralfate. How much does Caspian weigh? So basically Caspain is only on two pain relievers that are effective (tramadol and Gabapentin) + an anti-inflammtory: tramadol 12.5mg 8 hours to 4 hours. Gabapentin ?mg, ?x/day is this a liquid or capsule? This one can be given 3x a day with the proper dose per weight Buprenorphine in liquid compound "(it should not be compounded into an oral prep as significant first-pass effect renders it inactive), but its lipophilic nature lends itself to absorption across skin or mucous membranes. Compounding pharmacies can produce a PLO (pleuronic lecithin organogel, or transdermal gel) for application on the inner surface of the pinna or shaved skin on the neck in dogs and cats." www.vasg.org/chronic_pain_management.htm"Carprofen ?mg, ?x/day Pepcid AC a must! The FDA and manufacturer pkg insert indicate gastrointestinal problems are side effects of using NSAIDs. The natural defenses of the stomach to shield against stomach acid is hindered when taking NSAIDs. Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms. Phrase the question to your vet this particular way:" Is there a medical/health reason my dog may not take Pepcid?" If there is no reason, we follow vets who are proactive in stomach protection by giving about 13-20 lbs doxies 5mg Pepcid (famotidine) 30 minutes before the NSAID. As a safety measure for all your dogs meds, it is a good idea to be in the know..this is a good place to start: www.marvistavet.com/html/pharmacy_center.htmThe SINGLE most important care during a disc episode I see has not been done from the start of this episode. Just so we are on the same page, that means: 100% STRICT crate rest 24/7 only out at potty times for 8 weeks as that is the ONLY way the disc can heal. 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 neck and back from moving and putting pressure on the bad disc. Carry him to and from the potty place. Allow only a very, very few footsteps to get the job done. When you get methocarbamol on board, update us on the --names, mgs and frequency for all meds including Pepcid AC Hugs, I know how hard it is to see them in pain. It makes a world of difference once pain is in control. Check this out for very good ideas on the "extras" you can do to help with a neck disc: www.dodgerslist.com/literature/cervical.htmBoth you and your husband will also want to get up to speed on this disease. Knowlege is how to fight the enemy and win! Very good page to start with: www.dodgerslist.com/literature/healingpage.htm
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Post by Caryn&Caspi on Jan 21, 2014 9:31:51 GMT -7
Thank you for such a quick and detailed reply! This latest episode has been difficult.
Caspian is 7.7 lbs. Surgery was discouraged because the IVDD was mild and we were told anything removed would be replaced with scar tissue. This by a vet at Univ of Florida Vet School. He was put on the NSAID and tramadol indefinitely but no crating was recommended at the time.
He only had one other pain episode a few months ago when he seemed to hurt himself barking excessively at the UPS man. With increased tramadol and crating, he was fine after a few days.
I don't know if the fall hurt him and is causing this new episode.
I am not definite the G med if gabapentin (it is at home, i am at work). It is once a day at night for neurological pain. A large capsule.
That is discouraging about the Buprenorphine but does explain why it doesn't seem to be working. The shot of it at the vet was the only thing to give him relief since Sat evening. I will ask for a pill instead and also ask for the methocarbamol.
My name is Caryn. Thank you for giving me some hope in this situation.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jan 21, 2014 10:37:35 GMT -7
Here is another thing to first discuss with the vet regarding gabapentin. The smallest commerial size capsule is filled with 100mgs of powder. Has your vet has filled capsules with a smaller dose for you? If not I would discuss giving Caspi three divided doses of the gabapentin powder each day rather than the entire 100mg capsule 1x a day so that the needed level of gaba stays in the system (elimination half life in dogs is 3-4 hours www.ncbi.nlm.nih.gov/pubmed/3730018)Re: human bioavaiability: "Gabapentin bioavailability 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 for example if your vet Rx is for 30 mg 3x a day, divide the 100mg capsule powder into 3 equal parts by dumping into a creased pieced of paper and with a razor blade move the powder into 3 equal piles. Store the remainder of the powder piles in one of those 7 day pill boxes with a lid for each day. NOTE: both tramadol and gabapentin are very bitter tasting. Once tasted they will be forever suspicious. Make sure you do not transfer any dust from your finger to the outside of the pill treat. I mash a piece of banana, form a ball, make an indentation. Spoon powder dose into well and close up. If necessary drape a piece of thin deli meat around ball for further tastiness!
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Post by Caryn&Caspi on Jan 21, 2014 11:51:57 GMT -7
I think I can cut the gabapentin and extract the powder. Very good to know.
I am waiting for the ER vet to call me back about the buprenorphine. Meanwhile I called our regular vet and was told they always give B either as an injection or as a liquid orally. Mostly for cats. So that is discouraging. I hope the ER vet has a different view.
Husband says Caspian is eating now, which is good. Still working on the additional medicine.
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Post by Caryn&Caspi on Jan 21, 2014 13:01:41 GMT -7
ER vet admitted that oral buprenorphine isn't as effective as injection. She prescribed it because we live 2 hours away and thought it might help. She suggested our local vet could give Caspian an injection.
This site is very helpful. Once we get him past this current episode, I have hope that we can improvement our management of his IVDD long-term. Thank you, thank you.
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Sabrina
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My Charley-dog, a Dodger'sList grad enjoying life!
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Post by Sabrina on Jan 21, 2014 17:04:07 GMT -7
Hi Caryn, I'm Sabrina. I'm so sorry Caspian has IVDD, but I'm so glad you've found Dodger'sList!
Was Caspian's "regular vet" you spoke with the one who prescribed the Gabapentin? If so, did they ok giving it three times daily as Paula described? If you haven't spoken to the vet who prescribed the Gabapentin, do give them a call asap so that they can work with you to get Caspian out of pain.
))Hugs!((
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Post by Caryn&Caspi on Jan 22, 2014 14:49:10 GMT -7
I will have specific dosages later but wanted to update. Husband took off work to take Caspian to vet at UF two hours away. They increased medicines but I don't know how yet (I am at work). They are still hesitant to do surgery - husband wants to do surgery. He feels that is the best treatment. We will discuss it tonight. The MRI was "down" at the vet hospital so that naturally delays the decision.
We have an additional complication in that Caspian has fluid build-up on the spine from syringomyelia - again, difficult to fix through surgery. His small size seems to be an issue for both medical conditions.
I know the goal is NO PAIN but that was not the case last night. It is very hard to give him meds when he is hurting. Any tips? I like the banana idea above and we used peanut butter and even cheese spread and a peace of havarti with peanut butter on it. At midnight, though, nothing worked and he ended up spitting out two tramadol doses after 4 attempts. Since they landed near his mouth and he was biting, I didn't retrieve them.
Also, since the main problems are located at is his neck and base of skull, I placed a cover and a rolled towel in the crate to give him a place to lay his chin so it isn't angled down. Any thoughts on that?
I have to say I've been disappointed this time around with the UF vets. I hope today's appointment went better. I will know when I get home and read the paperwork. Is it usual to have such difficulty finding comfort for our dogs?
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Marjorie
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Post by Marjorie on Jan 22, 2014 17:43:55 GMT -7
You might want to try this - Hide the pill in a small mashed banana ball, a cream cheese ball, liverwurst ball or inside of a sticky marshmallow and sealed so no powder or taste from the pill is on the exterior. Use the three treat method. 2 treats with no meds inside PLUS the med ball. Give plain treat while holding med ball in front of eyes. The idea is your dog will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so he will hurry to swallow the med ball to get to treat #3.
Cervical problems can be quite a bit more difficult to get the pain under control than with back problems. But yes, it can be done. The right mix of meds needs to be found. When you get a chance, please let us know the exact names, dosages in mgs and frequency for each med currently being taken.
Offering him a rolled up towel in the crate in case he's more comfortable laying his chin on that would be fine. I would give him room to also lie down on his side if he's more comfortable with that position.
Prayers for Caspian that his pain will soon be under control.
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Post by Caryn&Caspi on Jan 23, 2014 7:28:30 GMT -7
His new prescription: 7.7 lbs. Prednisolone 3 mg/ml - give 0.5 ml by mouth twice a day for 7 days, then give 0.5 ml by mouth once a day for 7 days, then give 0.5 ml by mouth every other day for 7 days, then stop. DO NOT GIVE RIMADYL/CARPROFEN WHILE ON THIS DRUG Omeprazole - 1ml (3mg) by mouth once daily. This drug can help prevent stomach upset during steroid use. It can also help with excess spinal fluid problems with dogs who have COMS. Gabapentin 25 mg capsules - 1-2 capsules by mouth every 6-8 hours for pain. Tramadol 50 mg tablets - 1/4 tablet by mouth every 6-8 hrs as needed for pain. Diazepam mg tablets: 1 tablet by mouth every 6-8 hours as needed for muscle spasms and neck pain.
Even just increasing the dosages of tramadol and gabapentin have helped and today he adds the diazepam and omeprazole, which will be even better. And then steroids can start tomorrow afternoon. Obviously, we stopped the rimadyl/carprofen yesterday.
The crating and time are helping as well. The vet said the fall probably sloshed spinal fluid in the COMS cavity and/or knocked disc material against spinal column causing the pain episode. I was getting both dogs out of the car, one at a time, but my attention was still divided between them when he struggled and slipped. It was good to go for the exam, too, since we got clarification on the IVDD and syringomyelia. I thought the IVDD was more extreme and the syringomyelia less extreme, but the opposite is in fact the case. The good news is that both are manageable.
Marjorie, I love the three treat idea and can't wait to try it. At midnight, he tried biting at the plastic knife holding peanut butter wrapped gabapentin and ended up getting it right where I wanted it in his mouth. But I'd rather avoid biting episodes, which can stress his neck (not to mention my fingers).
This forum is so helpful and I'm so glad I found it. I'll update after we've added the new meds.
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Post by Jean & Mimi on Jan 23, 2014 8:06:48 GMT -7
Caryn, I am so sorry that Caspi is going through so much. I know how upsetting it is to see our babies in pain. I am certainly not an expert in medications, and I know our moderators will comment further, but I think you may need to give more time for the rimadyl/carprofen to wash out of his system. It should be a minimum of a 4-7 day washout - it seems you are describing maybe a 48 hour washout. Again, our moderators will comment further, but this is something you may want to consider. Here is a comment from Paula's earlier post...."However a switch from carprofen (NSAID) to a steriod at this point is a serious issue. A 4-7 day washout is needed for the safety of the GI tract." Hope his pain gets better quickly...keep up with the crating
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jan 23, 2014 10:11:33 GMT -7
Caryn, did you ever get Pepcid AC on board? If not, then I would get it on board now…verify Caspian has no health issue to prevent using it. Pepcid AC will protect the stomach while Omeprazole is reaching peak effectiveness over the course of 3-5 days. [The oral bioavailability of omeprazole PRILOSEC is initially low (approximately 35-40%) but increases to about 65% in the first 3-5 days of administration.[6,7] www.medscape.com/viewarticle/508018
The reason for the 4-7 washout is without a washout both Rimadyl AND the steroid will be in the system at the same time. Sometimes the risk of switching without a good washout outweighs the risk of GI tract damage. If it is deemed an emergency to cut out the 4-7 days washout then double protection is prudent. Donna Mensching, DVM, MS, DABVT, DABT, Petra A. Volmer, DVM, MS, DABVT, DABT writes: A third measure to minimize the potential for ulcerative effects is to administer sucralfate, which reacts with hydrochloric acid in the stomach to form a protective paste at the site of ulceration.So this is what I would discuss with your vet about providing optimum GI tract protection with only an approximate 2 day washout. What time on 1/22 was the last dose of Rimadyl given? --- Getting Pepcid AC on board til omeprazole reaches peak effectiveness --- Adding Sucralfate to the mix. There is a timing to this med with food, with Pepcid AC, so you'll need to do your homework. www.marvistavet.com/html/sucralfate.html So glad to hear the pain med adjustment is now giving pain relief!!!
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Post by Caryn&Caspi on Jan 23, 2014 14:12:56 GMT -7
Last dose of Rimadyl was 6 am on 1/22. Prednisone is recommended for 6 pm on 1/24. I will ask vet about the wash-out and about Pepcid AC. I assume the Pepsid would be what I would buy at any store? Or is it also a prescription?
Called vet and she said if his pain has improved, to wait until Saturday to start the prednisone. The rush was based on his extreme pain. She also said pepcid ac was a good idea.
Thank you!! Looking forward to a peaceful recuperating weekend.
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Post by Caryn&Caspi on Jan 25, 2014 7:11:31 GMT -7
We had a new development starting Friday midday. When we take Caspian outside to potty, he walks on his "elbows" on his front legs more. Occasionally he stands / walks correctly, but he's much more wobbly than normal. (He has had a cross-legged walk for 2 years). Contacted vet and she said to start the steroid this morning (Saturday) instead of waiting until evening. (Last NSAID was Wednesday AM) She is concerned about neurological weakness. She also said to massage his legs and bicycle them a little before going out. I am now worried that the elbow walking makes it hard for him to feel the urge to poopy.
I usually give meds, feed meal, then go potty. Can take about 30 minutes from taking med to going potty. Would waiting longer to go potty help anything? He's not in pain while pottying.
Has anyone had experience with front leg weakness?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jan 25, 2014 9:22:57 GMT -7
Sorry to hear this. Yes, with a neck disc it can affect the nerves that go out to the front legs. Make sure Pepcid AC is on board. What is the dose of Prednisone in mg's and how many times a day are you to give it. you can fashion a sling to support the front legs so Caspian can potty. Use this concept but instead of rear legs, use for the front legs: www.freewebs.com/dmroster/lyonpuff.html I would keep to the same med schedule. Good job on monitoring and updating the vet!!! As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions . When nerve healing begins, often it follows the reverse order. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails scuffing floor 4. Paws knuckle 5. Legs do not work (paralysis, dog is down) 6. Bladder control is lost 7. Tail wagging with joy is lost 8. Deep pain sensation, the last neuro function,
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Post by Caryn&Caspi on Jan 25, 2014 9:47:30 GMT -7
Prednisone is .5 mg every 12 hours for 7 days. And we are doing the Pepcid AC, as well. Plus the Gabapentin, Tramadol, Omeprazole, and Diazepam as listed above. I really hope the prednisone helps.
And healing can begin with the 8 weeks of crate rest and medicines, right? Surgery still on the table but vet and we all want to try the conservative treatment first, it seems. It isn't as clear a decision given the fact that ruptured discs start hardening up and make surgery more difficult as time goes on.
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Marjorie
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Post by Marjorie on Jan 25, 2014 11:52:45 GMT -7
It's the hope with conservative care that the damaged disc will be reabsorbed into the body. If the anti-inflammatory does its job of reducing the swelling, then there will be no pain as it's the pressure on the spine that is causing the pain. Once the swelling is gone and the pain stops, all meds can be stopped. The disc can heal with scar tissue forming over it, which takes 8 weeks. There are no guarantees with conservative care, as there are no guarantees with surgery. Here is our page regarding when to consider surgery, as well as our page regarding surgery. Reading these will help you be armed with the knowledge that you need in the days ahead. www.dodgerslist.com/literature/healingsurgery.htmwww.dodgerslist.com/literature/surgery.htmAre you sure the Prednisone is .5 mg and not 5 mg? 5 mg 2x/day is the anti-inflammatory dose. I understand that Caspian is very small but that still is an extremely low dose. Please review this list of current meds to ensure that we have it correct. Plus, we like to have it all in one place so we can find it easily. 7.7 lbs.Prednisone .5 mg 2x/day for 7 days Pepcid AC 5 mg. 2x/day Omeprazole - 1ml (3mg) by mouth once daily. Gabapentin 25 mg capsules - 1-2 capsules by mouth every 6-8 hours for pain. Tramadol 50 mg tablets - 1/4 tablet by mouth every 6-8 hrs as needed for pain. Diazepam mg tablets: 1 tablet by mouth every 6-8 hours as needed for muscle spasms and neck pain.
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Post by Caryn&Caspi on Jan 25, 2014 15:59:30 GMT -7
The prednisone says prednisoLONE on the bottle and is 0.5 ML every 12 hours for 7 days. If that is too low, let me know as I will be talking to the vet again tomorrow. The others doeses above are correct. And Diazepam is 2 mg tablets every 6-8 hours. I just realized the Gabapentin said 1-2 tablets every 6-8 hours.
So:
7.7 lbs. prednisoLONE .5 ML 2x/day for 7 days Pepcid AC 5 mg. 2x/day Omeprazole - 1ml (3mg) by mouth once daily. Gabapentin 25 mg capsules - 1-2 capsules by mouth every 6-8 hours for pain. Tramadol 50 mg tablets - 1/4 tablet by mouth every 6-8 hrs as needed for pain. Diazepam 2 mg tablets: 1 tablet by mouth every 6-8 hours as needed for muscle spasms and neck pain.
Since he has not pooped in almost 48 hours, I'll be giving him 1 teaspoon of canned pure pumpkin and soaking his kibble in water. Should I add 1 teaspoon of water, too, just to be safe? I'm a little unclear as to the way the pumpkin instructions are worded in other posts. I was feeding him about half the amount of food as he was getting before the episode started, but the prednisone is certainly making him hungry now. He gets about 1/5 cup of the following mix: kibble soaked in water/wet chunks of canned (Blue)/canned white chicken now. Will add the pumpkin and 1 teaspoon of water.
Please send thoughts of a nice poopy tonight - outside would be best but anywhere is fine at this point!
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Post by Pauliana on Jan 25, 2014 20:23:09 GMT -7
Hi Caryn,
I would go back to the amounts you were previously feeding him. He needs all the nutrients he can get to help with his healing. The medications are constipating but the pumpkin and water with his food should help him poop soon..
Sending good luck wishes over the miles..
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Post by Caryn&Caspi on Jan 26, 2014 7:22:39 GMT -7
Caspian poopied early this morning sometime between 12 and 6, probably around 5:30. We were so happy! Now that his appetite has picked up, we're back to feeding the normal food amounts. So now the front leg weakness is a concern. He just had his third steroid dose about 20 minutes ago. I'll be contacting the vet this morning about that, too.
Happy poopy dance!
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Post by Caryn&Caspi on Jan 27, 2014 16:01:09 GMT -7
Caspian standing today after not standing all weekend. Need advice.
Over the weekend Caspian had the following meds:
7.7 lbs. prednisoLONE .5 ML 2x/day for 7 days Pepcid AC 5 mg. 2x/day Omeprazole - 1ml (3mg) by mouth once daily. Gabapentin 25 mg capsules - 1-2 capsules by mouth every 6-8 hours for pain. Tramadol 50 mg tablets - 1/4 tablet by mouth every 6-8 hrs as needed for pain. Diazepam 2 mg tablets: 1 tablet by mouth every 6-8 hours as needed for muscle spasms and neck pain.
He was walking on his elbows and by Sunday wouldn’t stand to pee. I don’t know how he poopied since he would not do it when we were around. He poopied in his crate near the door Sunday morning and again Monday morning.
The vet called this afternoon and I told her about his front leg weakness. She said the meds weren’t working as they should and wants to do an MRI tomorrow and Wednesday. It is a 2 day process. And costly – $2,000 to $3,000.
When I came home at 5:30, 9.5 hours after Caspian’s last meds, he was standing and barking at me. Then he twirled on all 4 legs (he twirls when happy). I took him outside to pee and he did so standing up. No elbow walking. He is also alert and himself, which he was not over the weekend. Over the weekend he was groggy and a wet noodle. But he was only on all 5 medicines plus Pepcid AC for Saturday and Sunday. Today is day 3.
Did the vet not wait long enough? His 5th prednisone dose was today at 8 am. The only other change was that I gave 2 gabapentin this morning at 8 instead of 1. Is that the cause of this wonderful improvement? I emailed the vet to ask if we could wait a couple more days on the MRI.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Jan 27, 2014 18:52:25 GMT -7
It's wonderful that you've seen this improvement today, Caryn! Excellent news. The meds are doing their job! MRIs are usually done just prior to surgery. I'm not at all familiar with a two-day process. Only one MRI is necessary. MRIs are not done lightly as the dog needs to be sedated, meaning the trunk muscles that support the vertebrae and defend against further disc damage are out of commission. I would continue to give the two Gabapentin capsules since he did so well today and it's obvious from his behavior that his pain is now under control. I'm sure the vet will be pleased with your updated report of Caspian's status. We're happy about it, too!
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PaulaM
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Post by PaulaM on Jan 27, 2014 19:04:38 GMT -7
It appears the prednisolone began its work to get swelling down enough to reverse the nerve damage you were seeing…. knuckling of the front paws. Yea!!!! It seems you have your answer that pred IS working and the pain meds are also covering pain as they should so that Caspian can heal in comfort. Remember Pred can take 7-14 days for most dogs, but there have been many who just needed more like 30 days to resolve all the inflammation in the spinal cord. Each dog is individual. It is prudent to call for a taper, a test to check on swelling, because no one wants to use these powerhouse IVDD meds any longer than necessary. I think it is now prudent to wait on the MRI and monitor Caspian for no set backs just continued pain free state and no neuro diminishments. I've not ever seen reported that MRI's are a two day process…maybe that was including a surgery?? MRIs are expensive, prices vary across the USA somewhere in the neighborhood of $1500-2000. A 7-day course of pred started on Sat 1/25 and the taper is starting on Feb 1, right? On the taper your job will be to alert to any hint of pain resurfacing. To give the clearest picture on the taper, the pain meds are usually backed off or stopped so they are not masking pain. If there is pain, then the vet needs that info asap so that pred can go back up to the original anti-inflammatory dose for a bit longer. Do not be dissapointed if another course of Pred is needed. Neck discs are more difficult and can take longer to get all the swelling down. So with a taper pending, have you spoken with the vet to know what the plan B is incase you see pain returning or neuro diminishment happening during the weekend. A plan B could mean having extra meds on hand to carry you through the weekend, it could mean having an Rx in hand you could take to the local pharmacy. Always good that all members of Caspian's health care team know what action to take and not be scrambling to ER at night or weekends. Swelling causes not just pain, but as it builds it aggravates the nerve cells in the spinal cord. Nerves do not like being pressured, causes their death resulting in loss of neuro functions such as legs.
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Post by Caryn&Caspi on Jan 27, 2014 20:20:41 GMT -7
Thank you, Paula, for the heads up to plan ahead for the weekend. Yes, the taper starts Friday, Feb 1.
I gave Caspian the 1/4 tramadol, one gabapentin, the diazepam, the omeprazole, all at 5:30, and the steroid at 8 pm, all as scheduled. He is groggy and weaker again. So I wonder if the side effects of the drugs are what is causing the weak front legs. When he was standing at 5:30 and energetic, he had not had any medicines in 9.5 hours, so there were less medicines in his system than there are now (at 10 pm at night.) Due to my schedule, I an now giving him doses three times a day. (Over the weekend it was 4 times a day for those every 6 hours.)
The vet explained that day 1 of the MRI involves numerous tests - blood tests, xrays, maybe an ultrasound, to make sure he is healthy for the MRI. And then the sedation and MRI occur on day 2 (this is at the university vet school hospital.) These extra tests probably explain the higher cost. She did say if something shows up on the x-rays, then they might not need to do the MRI.
The vet said that knowing Caspian's improvement, we can wait or proceed with the MRI, whichever we feel is best. She is cautious, though, and warns he could worsen once meds end.
Also, the weak "walking" is on the next joint up, what I would call the elbow, and his paws are also bent forward at the knuckle, what I would call the wrist. For almost three years Caspian has had weak front legs and has walked cross legged and sometimes knuckling. We've limited his walking more and more over the past two years, especially the last year, and never let him have free reign of the house, usually carry him from bedroom to kitchen in the morning, even carry him outside, etc. He never jumps (stopped that 5 years or so ago) and hates stairs (like to the couch). But he does love to stand and bark. That is the most physical thing he does but it moves his whole body when he barks. And in the backyard, he occasionally would run for a few feet, but not much.
Knowing you all have our back, so to speak, is so helpful. I was so nervous today at work and it was so great to see some improvement. If the pain drugs, helping him heal, cause temporary weakness, that is a small price to pay.
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Post by Jean & Mimi on Jan 28, 2014 6:33:23 GMT -7
Caryn, just wanted to let you know that my Mimi had to be on steriods for a month (she started healing after a good few days once we got the meds right but it took some trial and error). Don't be discouraged if it takes longer. Each dog is different and it seems like Caspi is doing really well
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jan 28, 2014 6:40:59 GMT -7
Caryn, I see that Diazepam has been prescribed for muscle spasm and neck pain. Diazepam is the generic name of Valium and is a sedative. What we usually see prescribed for muscle spasm and pain is Methocarbamol. In looking back through the postings, I see that Methocarbamol is what Paula had recommended. Was there a reason the vet didn't want to prescribe Methocarbamol? You should let the vet know what you're observing and that you feel it's due to the meds and ask for Methocarbamol. Or, if she doesn't want to prescribe that, ask if an adjustment can be made to the dosage of the Diazepam.
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Post by Caryn&Caspi on Jan 28, 2014 6:54:15 GMT -7
Marjorie, That occurred to me overnight as well, that the Diazepam is probably causing the weakness. I'll ask the vet about that versus methocarbamol. We've postponed the MRI and will see how he does.
Vet agreed that we can try cutting back on the diazepam and see how he reacts. Will do that tonight. That drug was prescribed for the muscle spasms instead of methocarbamol because of the spinal fluid cysts (from syringomelia /chiari malformation) that could also be contributing to his pain.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Jan 28, 2014 11:45:15 GMT -7
Let us know how the cut back on diazepam works in re: to over relaxation of leg muscles. Diazepam can be used as a muscle relaxer for the painful muscle spasm associated with a disc problem. We most often see vets using methocarbamol for those painful muscle spasms. Good that you are keeping lines of communication open with the vet, that is the best way to get the meds just right for Caspian's needs. You are the eyes for the vet to know what is going on.
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Post by Caryn&Caspi on Jan 28, 2014 18:02:03 GMT -7
Tonight was a repeat of last night when I got home at 5:30 - he was standing on all fours. So I gave just half the diazepam (with all the other meds at usual dose) and now, about 2 hours later, he is still stronger than he was over the weekend. He just now went out to pee and took a few steps. He is more bored in the crate now, but he will get used to it. I have him in whatever room I am in.
I feel confident we will get through the week in comfort and he will get a lot of rest. The vet has been great, too, and doesn't seem to mind my questions and feedback.
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Post by Caryn&Caspi on Jan 29, 2014 7:04:57 GMT -7
I'm debating going to the half dose of diazepam. After about 4 hours, Caspian was unhappy and restless - he would not settle down in his crate. He whined, he huffed and puffed (what he does when he is unhappy), he even barked a time or two his "I want in your lap" bark. I think it was mostly boredom, but it could also be discomfort in his neck. At 9:30 when it happened and he would not settle down after about 20 minutes, I gave him a second gabapentin (he'd only had one at 5:30). He settled down then.
Then again at the four hour mark after the overnight dose, at 4:00 this morning, he started doing the same behavior. After 20 minutes or so, we gave him a snack, which he used to get early in the morning when my husband goes to work, and he settled back down.
I am going to try two gabapentin at each medicine time and 3/4 diazepam today and tonight to see how he does with that. It makes me wonder which is better: alert and kind of strong but restless, or sedated and weak.
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