PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 21, 2013 15:51:38 GMT -7
Faith, the going off of Tramadol will be something you and your vet will have to determine. It is guess work. When it is assumed all the swelling is gone, the you either back off or stop the Tramadol. Hoping this time there will be no hint of pain arising.
Adhering to good recovery suite principals means doing everything you can to limit movement of the back. Going on pet stroller rides where the sidewalk or road can be bumpy and vibrate her is not a necessity. But going to a vet visit can be necessary. So on car transport, pad out the crate with rolled up blankets so that when you corner or brake he back does not shift and roll.
Let us know the plan you and your vet have come up with to see if the swelling/inflammation is now resolved completely.
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Post by Nancy & Maisy on Apr 24, 2013 21:32:24 GMT -7
Faith is 3.5 weeks into her 8 weeks of crate rest. I decided to leave the Tram where it was over the last few days. I've been worried because she isn't eating much for the last two or three days. I've had to feed her with my fingers to get her to eat. She has had one and 1/2 full size meals this way each day. The only thing she's been interested in is her little ball of hamburger I put the Tramadol in when I give it to her. She isn't even interested in her vitamin, which she normally asks for. So, I call the vet today to ask if it could be that the 25 mg Tram twice a day isn't controlling her pain well enough. We discussed it and decided to add another 25 mg midday [Tramadol] . I hope this will help her pain and appetite. It was six pm when the vet called back, so we'll start this tomorrow. Later, when I picked her up after her potty break I inadvertently poked her under her right hind leg. YELP! I felt so terrible about it. But I'm thinking it answered my question about her pain level. It must not be well enough controlled.
Does anyone else have experience with this? She has been on crate rest almost 4 weeks, but as Paula has pointed out, she isn't getting the benefits of steroids, so it appears the pain is lasting longer. And I'm sure every dog is different in their healing. She's older, too. Poor little girl.
I'm having one other challenge. When I pick her up, trying to do it as the video shows, she insists on curling her lumbar area, tail under and really doesn't like it if I try to carry her with a flat spine. Any ideas?
Thank you for being here. Nancy
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Apr 25, 2013 12:52:55 GMT -7
She is likely curling her lumbar area because it hurts less that way. The idea is for you to carry her supporting both ends and keeping the back horizontal to the ground. In other words not picking her up under the arms like a baby. Carry her best you can letting her keep her back in the most comfortable position.
The pain is lasting longer because there is no anti-inflammatory on board to expedite getting the swelling down. Faith has only her normal levels of steroid hormone which is not at the anti-inflamamtory level, to try and get the job done.
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Post by Nancy & Maisy on Apr 26, 2013 10:18:28 GMT -7
Thanks, Paula. I feel reassured about how I'm carrying her now. The extra Tramadol is helping. She seems more comfortable and spunky.
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Post by Nancy & Maisy on Apr 28, 2013 22:58:56 GMT -7
I have a question about Tramadol. What is the correct dosage per pound? Faith is 10.5 lbs. She is getting 25 mg 2-3 times/day. I just read online that the dosage should be 1-2 mg per pound. In another spot I read 1-2 mg per kilogram. My vet said it was safe to give her the three doses of 25 mg per day, but after what I just read, I could use some reassurance that I'm not over medicating her.
I also read that a side effect can be loss of appetite. She has lost interest in most foods over the last few days, but appears alert and responsive. I'm trying to figure out what's going on.
Thanks!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on Apr 29, 2013 9:07:53 GMT -7
Nancy, Tramadol has a very wide range of dosing both what is published and unpublished. For example my 13 lb was taking 50 mgs 3x a day. So the dosing for Faith needs to be adjusted via communications with your vet on what you observe regarding pain control and possible nausea. Nausea can be a side effect of Tramadol.
Let us know what your vet advises for nausea, whether it would be at all safe to reduce tramadol by adding in a smaller dose of Gabapentin. These two meds work synergistically to control pain… allowing a smaller dose of each. OR could it be possible the pain/swelling is now gone, testing that by reducing her Tramadol to observe for signs of pain?
What is she eating…hamburger, any broth soaked kibble?
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Post by Nancy & Maisy on Apr 29, 2013 13:05:02 GMT -7
The only thing I can get her to eat at the moment is steak. She has good taste. The problem is that she should be on a low protein diet for her kidney health. I don't like to give the Tramadol without food in her stomach due to the possibility of nausea. So, she gets her steak and then the Tramadol. I bought cans of the prescription low protein foods yesterday and she isn't interested in them. She'll eat only a couple of bites. I normally make a low protein food for her and she won't eat that. Not interested in hamburger the last couple of days. I had been wrapping her Tram in that. Now we're using a pill popper.
She appeared to be in pain this morning and had trouble taking her first two steps during potty break. Her hind legs were unsteady. I gave her 12.5 mg of Tram and she appears comfortable enough now, so maybe I can go down to that dose and see how it goes. I have a call in to the vet and am waiting. I'll let you know what she says.
Faith has always had a long "wind up" before she pees, taking many steps before going. It's difficult to get her to take fewer steps, with either the leash and harness or the ex pen. She still wants to take her 10 steps before squatting. I pick her up right on the spot when she finishes, but I wish I could find a way to get her to take fewer steps before she goes.
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Post by Nancy & Maisy on May 1, 2013 21:10:26 GMT -7
Faith isn't doing well. She's had no appetite for 2 days. I took her to the vet today and yesterday. Her blood work was perfect 2 weeks ago. We did a urinalysis yesterday, checking for kidney infection and UTI. Vet sent it for a culture. She refused lunch yesterday and dinner last night. Vet prescribed Pepcid AC, which I gave last night and this morning. She refused breakfast today. At lunch time I came home and she looked perky. She ate a pretty good meal. She started vomiting an hour later and vomited 4 times. I took her back to the vet. She gave her subcu fluids, an injection of Baytril and one of Cerenia for nausea. Her last dose of Tramadol was yesterday afternoon. I've been watching for signs of pain and haven't seen any. I don't want to irritate her stomach any more. Vet and I agreed that this could be something new and unrelated to her kidneys or her spine. We agreed that if she doesn't start acting herself tomorrow (eating, feeling better) I'm taking her to the vet specialty hospital in Lynwood, WA for supportive care and diagnostics. I'm worried sick about her. She's tired and weak. She's sleeping now and appears comfortable. She's drinking well. Think good thoughts for us.
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Post by Nancy & Polly on May 1, 2013 21:31:50 GMT -7
That hospital in Lynnwood is a great place. They did my Polly's surgery. They have a lot of experience with IVDD. I'm hoping you get some answers very soon.
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Post by Pauliana on May 1, 2013 21:42:31 GMT -7
Keeping Faith in my prayers. Any blood in her stool? Sounds like her stomach is very irritated.. Hasn't she been on Pepcid AC before? Let us know what the specialist has to say..
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Post by Nancy & Maisy on May 1, 2013 21:44:40 GMT -7
They sound like a great hospital. I like that they have so many departments. They can care for Faith's kidneys as well as her back and whatever else may be going on with her at the moment.
I hope Polly is doing well. She's so cute.
Thanks!
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Post by Nancy & Maisy on May 1, 2013 21:50:17 GMT -7
Thanks, Pauliana. No, she wasn't on Pepcid because she can't take NSAIDS or steroids due to kidney issues. She was on Tramadol only. This morning I read that Pepcid is not good for kidney patients. Just goes to show you have to read about every med! It said it could cause heart problems in kidney patients. Right on the bottle it says not to use for kidney patients. I read further and found info saying a reduced dose should be used, but my vet had no idea how much to reduce it. So, I'll ask the specialists for an alternative.
No blood in her stool as far as I know. She hasn't pooped for 2 days now since she isn't eating. I'll keep you posted.
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Post by Sherry Layman on May 2, 2013 7:43:59 GMT -7
I think contacting a specialist or even a second vet perhaps with more knowledge and comfort with these meds is a good idea. Many medications have warnings for patients (dogs and humans) with medical conditions, kidney and liver issues are most common as drugs are processed and excreted in these organs. Caution is always warranted but it doesn't always mean the drugs cannot be used. Sometimes it means a decreased dose is needed sometimes it means a normal dose but perhaps just a little extra monitoring for symptoms of decreased functioning of the organ system sometimes it's simply a caution and no worries at all. It's all based on the patient and the severity of the dysfunction of the organ system that will be affected by the drug as well as the drug being used and it's dose and length of use etc. It's complicated indeed and discussion with a knowledgeable vet is vital. You certainly don't want to put Faith at risk but you also don't want to deprive her of any reasonable treatments or cause her unnecessary discomfort.
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Post by Nancy & Maisy on May 2, 2013 8:45:27 GMT -7
Thanks, Sherry. On our way to the hospital now.
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Post by Nancy & Maisy on May 2, 2013 13:55:31 GMT -7
Faith will be spending the night in the hospital on supportive therapy. I ended up taking her to Durango ER and specialty hosp. in Tacoma, WA. They're a lot closer and I can visit her anytime I want. Thanks to dodgerslist, I found a board certified neurologist there. I called and was told that he's well experienced with IVDD. He will see her later today. The ER vet I saw was good and I spend very little time with the tech beforehand. A good sign, I thought. Faith will have a belly ultra sound today if they can squeeze her in. It may have to be Tuesday. The vet listened carefully to my concerns about Faith's kidneys and meds that might put them at risk. She took all the meds I brought with me, even the Chinese Ti pills Faith takes for her blood pressure. I felt I was well heard and like I was treated like the captain of Faith's health team. She told me what a good job I've been doing with Faith. That felt good. The only concern I had was that she seemed a little surgery happy when it came to the IVDD. I explained that Faith has made a lot of progress with conservative treatment. But, this vet is not the neurologist. I'll talk with him later today, I hope. Faith seemed comfortable pain wise all morning and at the vet. She hasn't had any Tram since day before yesterday. The vet also allowed Faith to stay in her crate, which has become her safe place. They'll leave her in it and put it in the hospital cage. Hopefully, I'll have some answers soon!
Oh, as for the Pepcid AC, she said that the heart arrhythmias it can cause are far more common in people than in dogs. She promised she would not add any meds without discussing with me first. All in all, a good experience so far.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on May 2, 2013 17:09:00 GMT -7
Sounds like you have Faith in a great care hospital. Keeping you both in thought and prayer!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on May 2, 2013 17:57:35 GMT -7
We are all sending positive wishes for Faith to find out what the cause of vomiting. Good news on the no pain and off of Tramadol... the swelling is gone and now the disc just needs to finish healing.
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Post by Nancy & Maisy on May 2, 2013 22:37:04 GMT -7
Thanks to all of you for your support, thoughts and prayers. I got devastating news tonight. Somehow, Faith's kidney values have skyrocketed over the past 16 days. I was called by our regular vet just 2 weeks ago and told her values were nice and low... almost normal. I have been working on getting and keeping them down for almost 2 years with good success. Tonight the ER vet called to say that her BUN is 217, when it was just 39 and her creatinine is 3.9, when it was just 2.7. They have never been this high before. I'm so sad and upset. She said the neurologist thought her neuro function was coming along very nicely, she isn't in pain, has good mobility. He thought an MRI would only confirm that it was a ruptured disc that is healing. Her belly ultrasound was clear except for her kidneys, which look quite damaged and chronic. I don't understand what could have caused this. And in such a short period of time. The only things that have been different from our normal routine are the crate rest/lack of exercise and Tramadol. Or maybe the Gabapentin had a delayed effect. She was off of that well before her last blood draw two weeks ago. I'm devastated. Sorry if I sound dramatic, but I just didn't expect this and it is such a huge setback. She is staying til tomorrow night for fluids and nausea control. When she comes home I'm amping up the kidney healing program I've done with her and plan to give it my all. I so don't want to lose her. Keep us in your thoughts.
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Post by natureluva on May 3, 2013 6:51:06 GMT -7
I am PRAYIING for Faith and sending good vibes!!! Please let us know how she is when you can. Hugs, ~Lisa
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Post by Pauliana on May 3, 2013 9:03:58 GMT -7
Sending Hugs over the miles and lots of prayers for Faith. She is getting the best of care and I hope they put her back on the road to recovery with her kidneys.
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Post by Linda Stowe on May 3, 2013 11:11:12 GMT -7
Thinking of you now and sending healing thoughts to you and Faith.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,549
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Post by PaulaM on May 3, 2013 11:18:42 GMT -7
Please keep us updated, we are all thinking the most positive of thoughts for Faith and warmest of hugs to you...stay strong... you are the very best mom!!!
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Post by Nancy & Polly on May 3, 2013 13:05:28 GMT -7
Good thoughts aimed your way. Stay strong.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on May 3, 2013 14:24:11 GMT -7
Keeping you both in thought and prayer!
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Post by Nancy & Maisy on May 3, 2013 16:53:48 GMT -7
Visiting Faith now. Good news! BUN down to 98 and creatinine is 3.5. Much better than yesterday. She ate! She ate at 1:00 and I just fed her again. I'm very happy with the progress the last 24 hours has brought.
I had to educate the staff here about her IVDD when a tech carried her out to ser me tucked under his arm. I'm sure they think I'm hard to please and picky, but it had to be done. its important to visit, not just to ser them, but to be sure they're being treated correctly. Thank you all for the support. It has helped so much.
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Post by natureluva on May 3, 2013 17:03:43 GMT -7
Hurray!! SO happy to hear that Faith's kidney values have lessened. What a relief. :-) Good for you for telling the techs how to correctly hold your IVDD dog. I do the same thing - in fact, I tell the techs beforehand how my dog should be held. Speaking of that, do you have our IVDD dvd yet? It is only $3 including shipping. It's great to have on hand to show to family/friends/petsitters so they will know what they can and cannot do with your dog and how they can help: www.dodgerslist.com/store/DVDorder.htm Also, you can order FREE IVDD literature here to pass out to vets, doxie owners, etc.: www.dodgerslist.com/literature/litorder.htm We look forward to your next update. Best wishes, ~Lisa
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Post by Nancy & Maisy on May 3, 2013 19:23:52 GMT -7
The problem id that I DID educate the admitting vet. I guess you'd really have to talk to each group of staff at shift change. I educated every staff member I spoke with today and finally got one to write it down in red ink on her chart. I could tell she'd been placed in a sink for a quick nsth. They agreed to use waterless shampoo from hereon out... I hope.
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Post by Nancy & Maisy on May 3, 2013 19:26:10 GMT -7
Oops, quick bath. And Lisa, thanks for your support! I have tried ordering the CD twice but somehow the process broke down at payment. Ill try again.
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Post by Linda Stowe on May 3, 2013 20:58:39 GMT -7
Nancy, email me at lstowe1@tx.rr.com and I can send you a DVD.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on May 4, 2013 13:11:03 GMT -7
I am so glad that she is showing improvement- way to go Faith!
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