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Post by Kelly & Ivy on Feb 19, 2014 18:54:37 GMT -7
Ivy is a miniature dachshund 7yrs old approx. 15lbs. (I know she needs to lose at least 1-2 pounds and it is a work in progress) She has had one cervical surgery at the age of 3yrs and was diagnosed by the surgeon with IVDD. I generally follow my gut any time she seems to start showing signs of a problem. Generally a day or two of Rimadyl will help but this was not the case in January.
1/6 she was showing signs of pain when I got home after work and I gave her half of a 75mg Rimadyl per vet label instructions. After about 15 minutes of sheer panic on my part I decided to take her to the animal ER where they gave her a shot of Buprenorphine. I made an appointment with my vet the next day. She added Tramadol 1/4 of a 50mg and Methocarbamol 1/4 of a 500mg to the Rimadyl with instructions to let her know in a few days how she was doing.
By the following week she was still showing signs of pain so the vet did x-rays and prescribed Prednisone 2.5mg on a 3wk step down. There were no obvious signs of disc problems on the x-rays but she referred her to the surgeon who had done the previous surgery. I didn't follow my gut that said to lock her down during this time. I made an appointment with the surgeon on 2/5 (we had several episodes of snow and ice here in the time between). The technician there told me to restrict all movement so I placed her in the ex-pen per the instructions found here. She was in pain but not presenting with any obvious problems combined with a mix-up with her x-rays (I forgot to pick them up and the vet never received the email from mine) so he sent her home with instructions to allow 2 more days of prednisone then stop all medications. I did not agree with this and gave her a prednisone and methocarbamol when we returned home because she was obviously in pain.
(I apologize for the length of this post.) I did my research on IVDD which lead me to this website. I feel she is not in need of surgery but strict medical and rest restriction in order for her to heal. I contacted my vet, after several attempts and finally frustration the was leading to my changing vets, I managed to have her Prednisone and other pills refilled. I believe she would do well with a longer daily dose of prednisone combined with the tramadol and methocarbamol but am not sure how to express this to the vet.
Ivy is walking well when I allow her out to potty (no more than a few steps allowed) and she wags her tail happily to be out. She is eating well and even sometimes barks at "the boys" (my other 2 dogs) when they get to rowdy. Any input is appreciated. I am feeling somewhat helpless because her pain does not seem to be controlled as well as it could be.
Thanks for listening and again sorry for such a long post! ~Kelly & Ivy
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Feb 19, 2014 20:03:52 GMT -7
Kelly, welcome to Dodgerslist. So we have a better grip can you list the meds she is currently taking, the dose in mgs and how often you give them: 15 pounds Prednisone 2.5mgs ?x/day (how long was the original dose at the anti-inflammatory level of 5mg 2x a day or was it always 2.5 mgs? Tramadol 25mgs ?x/day methocarbamol 125mg ?x/day Pepcid AC? should be 5mgs 2x/day to protect the GI tract. During the time on the anti-inflammatory the pain meds do need to be adjusted so that there is no pain surfacing dose to dose of pain relief medications. Pain deters healing. Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 7-30 days. When the vet guesses swelling might be gone there will be a taper. Usually the first course will be 5 or 7 days and then a test taper. The dose is lowered to less than the anti-flammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too. Rule of thumb is: pain = swelling = more time on Pred, pain meds and Pepcid AC is needed. If there is no pain on the taper then it goes to completion. Then no meds at all are needed. Disc healing will continue for the remainder of the 8 weeks. So obviously it is clear it is not time to be on a taper. --Is this time also a neck disc? If yes, these are the extra you can be doing to help www.dodgerslist.com/literature/cervical.htm-- There should never be any pain if the pain meds are correct. Before discussing pain meds with your vet, these articles can give you good background information: www.dodgerslist.com/literature/healingpain.htmwww.dodgerslist.com/literature/healingsweling.htm-- How much does your dog weigh? What are the exact names of meds currently given, their doses in mg's and frequencies? Anti-inflammatories can increase GI tract damage. 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 doxies 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory and thereafter every 12 hours. This directory very good for learning about each of your dog's meds: www.marvistavet.com/html/pharmacy_center.htm -- If there is pain, dogs can benefit greatly with acupuncture or laser light therapy. These therapies can be be started right away to help relieve pain in addition to getting the right adjustments to the pain meds. So if this therapy is in your budget, seek out a holistic vet. ahvma.org/Widgets/FindVet.html www.serenityvetacupuncture.com/index.php/faq_/ [one vet's overview/prices] Chiropractic is not recommended for IVDD dogs.
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Post by Kelly & Ivy on Feb 26, 2014 19:36:56 GMT -7
15 pounds Prednisone 2.5mgs 1x/day (trying to taper to every other day) dose has always been 2.5mg Tramadol 25mgs 1-2xday as needed methocarbamol 125mg 1-2x/day as needed
I generally go ahead and give both the pain pill and muscle relaxer twice a day in order to keep the pain under control although the prednisone seems to make more of a difference.
The week before I started conservative rest she was on 2.5mg 2xdaily which was then tapered to 1xdaily. I am trying to taper to one every other day per vet instructions but I don't think she is ready. She had a pill on Monday, did well both that day and Tuesday but seemed to be more reluctant to move Wednesday morning when she received another pill. The pain pill and muscle relaxer were both started as 1 2xdaily for three days then as needed. She currently receives 1 every 12hrs as needed. She seems to do ok will longer times between pain meds as long as she has the anti-inflammatory. I asked the vet about adding the Pepcid because sometimes she seems a little nauseated but she told me to use prevacid (lansoprazole). I have not tried either yet and make sure that she always eats a meal with her medicine. She is alert and quietly watches the other dogs play or sleeps comfortably in her pen. Her stool is normal and she eating well. She seems to be feeling much better than she was a month ago and I am hopefully that this is a good sign that it is working. She wags her tail happily when she goes out to potty and seems in much better spirits.
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Post by Pauliana on Feb 26, 2014 22:16:43 GMT -7
Hi Kelly,
So Sorry to hear about Ivy's disc episode.. Ivy hasn't been on the anti inflammatory dose of the Prednisone. The anti inflammatory dose is 5mg every 12 hours.. That is the level of the medication necessary to fight the swelling and as Paula mentioned above it usually takes 7 to 30 days on that dose to get the swelling resolved and it's the swelling that causes the pain.. It is imperative to discuss this with your vet so that Ivy can fight that swelling and inflammation.
Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 7-30 days. When the vet guesses swelling might be gone there will be a taper. Usually the first course will be 5 or 7 days and then a test taper. The dose is lowered to less than the anti-inflammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too.
Rule of thumb is: pain = swelling = more time on Pred, pain meds and Pepcid AC is needed.
If there is no pain on the taper then it goes to completion. Then no meds at all are needed. Disc healing will continue for the remainder of the 8 weeks. So obviously it is clear it is not time to be on a taper.
Also the Tramadol isn't effective at every 12 hours as it has a short half life.. It is far more effective given 3 times a day.. It;s important that Ivy be pain free dose to dose so she can heal in comfort, pain deters healing and Cervical disc episodes are very painful because their head and neck moves every time they move.. Dogs tend to be stoic..and won't show they are in pain unless it is way out of control.
Prevacid takes up to 4 days to become effective and Prednisone is well known for causing ulcers and bleeding in the stomach.. IVDD is more than enough for Ivy to deal with.. Pepcid AC will help her upset stomach and in my book, preventing problems before they take hold is far better than trying to cure them afterwards.. My Tyler's Vet told us that dogs with IVDD have a tendency towards problems with stomach acid and she sent him home with Pepcid AC along with his other medications..
Welcome to Dodgerslist from me.. Sending prayers for Ivy and comforting thoughts for you...
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Post by Kelly & Ivy on Feb 27, 2014 19:39:26 GMT -7
I want to thank you both for all of your help and information! This website has been a source of information and peace of mind for me.
I suspected that the medication was not at the correct dose but wasn't sure if maybe I wasn't just playing the worried owner. I am planning on speaking to the vet about the dosage for the prednisone and hopefully we can get it adjusted quickly to help Ivy get more relief. I think my vet really wants to help but just hasn't treated any dogs this way so she doesn't have the knowledge yet. I started her on the Pepcid this evening and mixed it with a little bit of canned food so she would take it. She normally gets her pills wrapped in a tiny piece of cheese. Can this been done with the Pepcid also?
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Post by Pauliana on Feb 27, 2014 22:29:01 GMT -7
Hi Kelly, Yes the Pepcid can be put in a piece of cheese or other treat that she likes a lot. i usually wrap Tyler's Pepcid in a small piece of lunch meat.
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Post by Kelly & Ivy on Apr 21, 2014 18:05:56 GMT -7
I am sorry I haven't been on to update Ivy's progress but I'm happy to report she is finally being integrated back into the household and is feeling great!! She has been tapered down to 5mg of prednisone every 3rd day and is on limited tramadol and methcarbomal. She has started laser therapy and the vet says she looks great. I can't express enough how much all the help I received here and the information on Dodger's list has meant to Ivy and I. Thank you to everyone!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Apr 21, 2014 21:30:25 GMT -7
Kelly, it is really not a good idea to be off of crate rest and still on pred and pain meds. The true test that all the swelling is gone can't be known until off of all meds and there is no pain. Usually the dog is off meds for a minimum for a full week before being released off of the 8 weeks of crate rest. Why is she still on pain meds. Prednisone is tapered to an every other day dose for the purposes of signaling the body to make its own steroid hormone. On what date did the taper start? Was there an ever an every other day dose? Why is there an every 3rd day dose? www.marvistavet.com/html/prednisone.html
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Post by Kelly & Ivy on Apr 22, 2014 16:38:11 GMT -7
She began the taper to every 3 days a week ago. She was on every other day for two weeks before that. The vet recommended a taper of every 3 days for two weeks and then quitting the prednisone. She actually hasn't had any pain meds in a few weeks. I am sorry for the confusion, I meant to say as needed but she hasn't needed them recently.
I didn't realize that she shouldn't be off restriction so I have placed her back on it. Is there anything I can give her to do so that she is not bored? She is getting very restless. Her pen is right next to the couch so she is able to see everything that is going on and I talk to her constantly.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Apr 22, 2014 19:26:25 GMT -7
I would discuss with the vet about the every other day sufficing for a taper as that is what we see 1000s of vet since I've been here in 2007 doing. I would ask what the thinking behind the every three days dose is. In the meantime you will want to prepare how you will handle graduation day with a slow introduction back to physical activity. A sample schedule is here: www.dodgerslist.com/literature/AfterCrateRest.htm
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