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Post by Megan & Abby on Apr 5, 2014 11:03:29 GMT -7
Abby is a 9 1/2 yr old doxie who has a history of disc episodes due to IVDD and now we are back at it. This time is different, though, because this is the first time that it is in her neck.
I came home at lunch yesterday to take her out and she was shaking. After taking her out, I wrapped her in a blanket and petted and massaged her until she fell asleep. After work, I came home to find her shaking again. I did the same thing to get her to stop, but this time her chest/shoulder muscles kept twitching. I kept her still all night and took her to the vet this morning where I got the bad news.
She is back on 13 lbs Tramadol Metacam (using Famotodine to protect her stomach).
She is also on strict crate rest and we will be increasing the frequency of acupuncture and laser therapy treatments (we had not stopped them, but had decreased them). The other thing we are doing is heat since her muscles get so tense from the pain. Usually, I use a small bean bag-type heating pad that you warm up in the microwave for her. However, the one I have that is long enough to wrap around her neck is too heavy to use on her neck and my electric heating pad is too big. Does anyone have any ideas of products that would work? Or a DIY idea? She weighs just under 13 lbs, so it doesn't have to be really big, maybe 12 inches long? It just has to be lightweight.
Thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Apr 5, 2014 11:34:11 GMT -7
Megan, sorry to hear Abby is having another disc episode. Likely tramadol alone will not be controlling pain especially with a neck disc as they can take longer to heal and are more painful. So I would first quickly do background reading and then get on the phone to get the right meds on board before the vet closes today. Otherwise you'll need to see ER if Abby is showing any of these signs of pain: shivering, trembling, yelping when picked up or moved, reluctant to move much or slow to move, tight tense tummy, head held high or nose to the ground, not normal perky self? When you can update the med list to include mgs and how often you give. The bean bag is fine, let her lean up against it or put her head on it if she wants rather than doing any wrapping or touching of her neck. Snuggle Safe is a commercial product that will keep warm the whole night. www.valleyvet.com/ct_detail.html?pgguid=E53AAF66-347A-4789-AFCC-5D6FA77ED8B6&item=30459&ccd=IFP003&utm_source=froogle&utm_medium=free&utm_content=30459 Here are the other things you can do to specifically help with a neck disc "Tips for the cervical disc" I'm giving you this link because it will offer you refresher information on dealing with this disc episode. Since your vet is so light on pain meds, makes me think he is not really comfortable in dealing with a disc episode. Hence your need to be a savvy IVDD dog owner. Here's the link to bookmark and find those cervical disc tips: www.dodgerslist.com/healingindex.htm
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Post by Megan & Abby on Apr 7, 2014 18:09:18 GMT -7
Abby is on 13 lbs .35 mg Metacam one time daily 25 mg Tramadol every 8 to 12 hours. famotidine ?mgs, ?x/day
She is acting like she has no pain at this point, so I am just trying to keep her still. She is crated and I just have to give her lots of attention to keep her calm. I wish there was some way to give her something to do that wouldn't put her at risk, she's so used to always having activities to do.
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Post by Pauliana on Apr 7, 2014 20:57:07 GMT -7
Hi Megan,
I know it's hard to watch them be bored but rest is what she needs most and believe me your loving attention is helping to ease her boredom.. You can put her crate on a table so she doesn't have to move her head up to watch over you.. There are ways to make it bearable.. Play soothing music for her.. Put a crate or ex pen recovery suite in different rooms of the house, so she can be with you where ever you are.. or for a change of scenery..
Tramadol is best given every 8 hours because it has a short half life.. Every 12 hours would not be effective especially with a neck disc.. Be sure to advocate on her behalf with the Vet should her pain increase.. Glad she doesn't seem to be in pain for now..
Healing prayers headed your way..
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Post by Megan & Abby on Apr 21, 2014 18:44:47 GMT -7
Sorry, I've been offline for a while. Abby was doing great with her meds and acupuncture, she was pain free and anxious to get back to normal. I took her outside this morning and she stumbled over some uneven ground in the backyard. Apparently, that was enough to put her back where we started. I feel awful because I couldn't get out of work to get her to the vet, though I did talk to them on the phone. When I got home from work, she was crying anytime she moved at all. After giving her the Tramadol and Metacam, she was finally able to lift her head without crying and I could take her outside to potty. She has finally gone to sleep (off and on) with her head slightly propped on her bean bag and I put her blanket over her. Normally, I would move her crate to my bedroom at night so she could sleep next to the bed, but I'm so afraid to move her that I think I'll keep her where she is in the living room and sleep on the couch so I'm near her.
I have been using the heating pads that are air-activated and stick to your body (I remove the sticky part) and laying it across her neck. I'm just wondering if I can just let it lie on her or if I should remove it after a period of time, like 15 minutes.
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Post by Pauliana on Apr 21, 2014 21:38:03 GMT -7
Oh no, I am so sorry to hear about Abby's relapse. It is necessary to restart her 8 weeks of crate rest beginning today.. Carry her out to potty and limit her to only a few steps. When they start to feel better, they think they can do more than they should do and that is when accidents happen.. Make sure she is pain free dose to dose or inform the Vet right away.. Not a good idea to put anything on her neck.. Consider a rice sock to rest the head on or lean against. Fill a sock with 1-2 cups of dry rice. Knot the end. Microwave for 1-2 minutes. Test in crook of your arm for warm not hot temperature. Wrap in a towel so it's not too hot for the skin and place in crate. Let your dog snuggle against when you are present to supervise in case your dog has a desire to munch on the warm rice. Note: human heating pads can get too hot burning skin on an IVDD dog. Snuggle Safe is a commercial product that will keep warm the whole night. www.valleyvet.com/ct_detail.html?pgguid=E53AAF66-347A-4789-AFCC-5D6FA77ED8B6&item=30459&ccd=IFP003&utm_source=froogle&utm_medium=free&utm_content=30459Healing thoughts and prayers..
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Apr 21, 2014 21:41:44 GMT -7
Megan, so sorry to hear about the set back at potty time and the uneven ground. Is her potty place a fenced in 6 foot diameter area or do you use a 6 foot leash attached to a harness to limit the number of foot steps she can take while you stand in one spot? I'm not familiar with the heating pad you describe. I would not put anything on her neck. Let her choose to lie her head/neck on a warm bean or rice sock. Fill a sock with 1-2 cups of dry rice. Knot the end. Microwave for 1-2 minutes. Test in crook of your arm for warm not hot temperature. Wrap in a towel so it's not too hot for the skin and place in crate. Let your dog snuggle against when you are present to supervise in case your dog has a desire to munch on the warm rice. Note: human heating pads can get too hot burning skin on an IVDD dog. Let us know how she is in the morning that the 25mg Tramadol every 8 hours is still controlling pain. If not you need to advocate for increased mg of Tramadol. Perhaps even adding in methocarbamol to deal with the type of pain stemming from muscle spasms so often associated with a neck disc. Background reading for discussing things with the vet: www.dodgerslist.com/literature/cervical.htm
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Post by Megan & Abby on Apr 22, 2014 7:23:42 GMT -7
Abby had a bad morning. When she woke up, she seemed to feel better...there was no crying or shaking, she was giving kisses and didn't want to be hand fed. I took her outside then brought her in and put her back in the playpen. After she ate and I spent some time petting her, I picked her up to put her in her crate before going to work (I usually only allow her in the playpen if she is supervised since it is open at top). As I was moving her, she started crying, so I immediately put her back in the playpen where she continued to cry and scream for a few minutes until she finally found a position that lessened the pain.
I will be calling the vet to ask about increasing or adding to her meds. What else can I do?
Also, I'm wondering if I should be considering surgery with this level of pain or if I should wait it out. I know our vet will probably recommend a consult with the surgeon, so I want to be prepared.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Apr 22, 2014 8:32:35 GMT -7
Her meds I would say need to be first adjusted to the normal aggressive pain med usage which they are currently not at. Do your homework with background reading here in prep for discussion with the vet: www.dodgerslist.com/literature/healingpain.htm know the three pain meds typically used www.dodgerslist.com/literature/healingsweling.htm understand what the dangers are if a switch between classes of anti-inflammatories So the questions I would ask: Tramadol, is 50 mgs 3x/day the highest range for this med? Can we use it now to get full pain control? Methocarbamol, neck discs often have muscle spasms associated, can we get this on board now? Gabapentin, since vets are finding good success with hard to control pain by adding this to the mix, are you on board using this med if pain is not under control within the hour and does not stay that way dose to dose of the above two. If you have a vet not willing to use aggressive pain meds, then I would seek a new vet who knows IVDD in your community. If none are available, then a consultation with a neuro who works with pain meds all day long and knows them would be a good idea. You will have to make it clear to a surgeon whose training is surgery, that the consultation would be about using meds first, meds a local general vet did not feel comforatable in using. Approach to finding a new vet: www.dodgerslist.com/literature/VetchkList.htmDiscuss ALL your options for each pain med in regard to dose in mgs, how often. You want the knowledge that at night or when the vet is closed on weekends how much you could increase pain meds. If this vet is willing to use all three meds (tramadol, methocarbamol and even gabapentin if necessary to add to the combo) and pain can be controlled, surgery could be avoided. Read up on surgery vs. conservative so you can participate in discussion with the vet, know in advance all your options if at some point surgery should be a consideration: www.dodgerslist.com/literature/healingsurgery.htmLet us know what transpires with the phone call. Hopefully your vet will be comfortable in upping the pain meds dose and adding in one to two other pain meds.
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Post by Jean & Mimi on Apr 22, 2014 9:07:34 GMT -7
I wholeheartedly agree with Paula. Many of the dogs have had great success with the addition of gabapentin to the tramadol. Please let us know what your vet says. Healing thoughts for sweet Abby.
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Post by Megan & Abby on Apr 22, 2014 9:52:08 GMT -7
The vet told me to give her .15 mg Metacam now and .5 mg Metacam at her normal time tonight (about 6:30). He does not want to add anything until we see if that works. Thoughts?
I should mention that she weighs 13 pounds and when determining dosage, they base it on a slightly lower weight since it would be her ideal weight.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Apr 22, 2014 10:03:22 GMT -7
You have your answer this vet is not comfortable in treating a disc episode.
The anti-inflammatory, Metacam, can take anywhere from 7-30+ days to resovle the painful swelling that is going on in the spinal cord. Pain relievers act within the hour WHEN they are correctly prescribed.
We don't wait for pain control with IVDD, we are agressive with pain meds.
From the Veterinary Anesthesia & Analgesia Support Group: Pain takes a tremendous toll on our patients. Some of the negative conditions associated with pain include V/Q (ventilation/perfusion) abnormalities, increased metabolic demand, tissue catabolism, impaired immune function, increased risk of sepsis, delayed wound healing, prolonged convalescence and cardiovascular stress. Additionally, studies in humans suggest that improperly controlled acute pain may precipitate a chronic pain syndrome that can be very difficult to control. Above all else, we have an ethical obligation to provide humane care to our patients.
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Post by Megan & Abby on Apr 22, 2014 18:10:38 GMT -7
I've had other issues with this vet like him giving Abby vaccinations that I didn't approve. The only reason we continue to go there is to see the other vet in the office who is more knowledgeable, but she was out today.
Abby seems to be doing ok as long as I don't pick her up. Of course, she needs to go out to potty so the pain starts again at that point. I am picking her up by her chest and her stomach/back end. Is there any different way I should hold her now that she has neck pain?
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Post by Megan & Abby on Apr 22, 2014 19:05:04 GMT -7
I just took her outside and brought her back in with no screaming or crying! Yay! She gets another pain pill in 30 minutes, so I'm hoping that will help her get some sleep. When dealing with these issues, it's all the little improvements and accomplishments that matter. She gave me kisses when we walked back in the house...a sign that she's feeling at least a little better.
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Post by Megan & Abby on Apr 24, 2014 15:59:49 GMT -7
Abby got worse again. We went to the vet and she had so much pain that they were unable to do her acupuncture and laser therapy. I have to call the surgeon first thing in the morning. They gave her a shot of hydromorphone. She also wants me to switch from Metacam to Prednisone. I voiced my concerns about that and she said because the pain is so bad she doesn't think we can wait and that the change is necessary. So I have to give her Sucralfate now, wait two hours and then give her Prednisolone, Famotodine and Gabapentin. Her last dose of Metacam was at 7pm last night.
I'm really worried because she recently had 2 teeth removed and they had issues with her heart slowing down too much while under anesthesia, so I'm not sure how surgery will go.
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Sabrina
Helpful Member
My Charley-dog, a Dodger'sList grad enjoying life!
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Post by Sabrina on Apr 24, 2014 17:28:10 GMT -7
Hi Megan, I'm so sorry to hear of Abby's pain. I'm very glad that she's on Sucralfate to protect her upper GI tract. The Famotidine should be given 30 min before the pred. Pred, as an anti-inflammatory, can take 7 - 30+ days to address the swelling that is causing Abby's pain. What did your vet say about adding Methocarbamol to relieve pain from muscle spasms? As there is a heart concern with anesthesia, it would be well to try to be as aggressive as possible with the pain meds (under a vet's RX, of course). While none of us can prescribe dosages, there are lots of folks here who are very knowledgeable and can advise you what to advocate for with your vet (hence, all our questions about doses and frequencies!) I hope that the surgeon you speak with will be confident about using pain meds to the max to see if Abby can avoid surgery. Do you know what type of surgeon you will be speaking with? It is good to deal with a Board-certified specialist - either neuro (ACVIM) or ortho (ACVS) - as that is a good standard by which to measure competence and training. Veterinary Internal Medicine (ACVIM) is the official organization of the veterinary specialist of neurology among several other specialties. American College of Veterinary Surgeons (ACVS) veterinarian who has been board certified in veterinary surgery and is called a specialist in veterinary surgery www.dodgerslist.com/literature/VetchkList.htm))Hugs!((
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Post by Megan & Abby on Apr 24, 2014 17:55:52 GMT -7
Abby's been prescribed the following:
13 lbs Sucralfate 1/2g twice daily 30 minutes after other meds Famotodine 5mg once daily -will give 30 min prior to Prednisolone Prednisolone 5mg twice daily Gabapentin 100 mg every 8 hours Tramadol 25mg every 8 hrs
I did, in my meltdown at the vet's, forget to ask about the other med for spasms.
The surgeon I was referred to is board certified orthopedic and did his residency in both ortho and neuro. I will express my concern to him regarding anesthesia.
Regarding the Sucralfate...I was told to mix it in a little water in a syringe and shoot it in her mouth. Is that necessary? She is not cooperative with that and I don't want her to fight back and hurt herself more.
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StevieLuv
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Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Apr 25, 2014 6:31:23 GMT -7
Will she take the sulcrate as a pill wrapped in a treat? The vet may be asking you to dissolve it so that it gets to work faster. My dogs hate syringe medicines too, so maybe you can smash the pill and mix the powder in a bit of wet food - works pretty much the same as dissolving it. Just catching up with Abby's story and will be keeping her in thought and prayer.
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Post by Megan & Abby on Apr 25, 2014 8:17:37 GMT -7
I did end up just wrapping the Sucralfate in some bread and she took it. The local surgeon doesn't have time to see Abby, so we are about to make the drive to Iowa State, they can do surgery today.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 25, 2014 8:23:53 GMT -7
Our thoughts will be with you and Abby as you drive over. Were you ever able to get methocarbamol (for muscle spasms) on board via phoned in Rx to you local pharmacy?
Pad out her crate with a rolled up blanket or towels so her body will not shift as you take a corner or brake.
Keep in touch when you know more about the how the surgery went.
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Post by Megan & Abby on Apr 26, 2014 11:59:26 GMT -7
Abby's surgery was delayed until this morning due to other emergencies they had. It went well and she is now in ICU. They will start to decrease her pain meds after 24 hours and, if she is handling it well, they will move her to "ward" with a Fentanyl (sp?) patch. If everything goes as planned, I will be able to bring her home on Wednesday or on Tuesday is she does exceptionally good.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Apr 26, 2014 13:48:24 GMT -7
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Post by Megan & Abby on Apr 26, 2014 18:25:08 GMT -7
Thanks for sharing those links. I just got off the phone with ISU and they said she is sleeping comfortably now, but appears to have hyperesthesia as whenever they try to touch her anywhere, she screams. I would love to hear about anyone's experience with this.
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Post by Pauliana on Apr 26, 2014 20:21:13 GMT -7
Hi Megan,
Do they now have the Fentanyl patch on her? Some dogs react badly to the patch and become agitated or anxious. Not sure if this is the reason for Abby's screaming and extreme pain. Sounds like she needs her pain medications changed or adjusted. Did the person that called from ISU say what could be causing it?
Prayers for Abby and for you and family, please keep us posted!
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Post by Megan & Abby on Apr 26, 2014 20:30:27 GMT -7
They do have the Fentanyl patch on her and are continuing the IV Fentanyl, as well, and adjusting it as necessary. She is not agitated, just can't be touched. The way it was described to me was that the hyperesthesia causes a pins and needles feeling because it's a result of the nerve being pinched by the disc and that is what is causing her screaming. I am praying that this feeling she is having resolves very soon.
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Post by Pauliana on Apr 26, 2014 20:33:20 GMT -7
Gabapentin would help the pins and needles nerve pain she is having.. I am on it for that reason and it's a great med for IVDD dogs with nerve pain.. I am sure they know that, but it wouldn't hurt to ask about it.
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Post by Megan & Abby on Apr 26, 2014 20:56:35 GMT -7
Thank you for that advice. They will be calling me at 8am tomorrow to give me an update; if she is still having the issue, I will bring up the Gabapentin. At this point, I am willing to try anything to help her feel better and heal.
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Post by Pauliana on Apr 26, 2014 21:20:24 GMT -7
I'll keep Abby in my thoughts and prayers and hope she is feeling better by morning.
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Post by Megan & Abby on Apr 27, 2014 7:47:57 GMT -7
Abby has improved. They are now able to pet her and take her temp with no problem. She didn't want to move around when they took her out, but she is drinking and wagging her tail and selectively eating (only eating the tastier bits of kibble). They were going to try to soften her kibble because it usually helps at home and, if that doesn't work, they are going to try to feed her cooked chicken. They are still hoping they will be able to move her out if ICU today. One concern is the storms that are moving through today since she is usually scared and wants to hide. They are going to give her a "shelter" that they usually use for cats which will allow her to hide if she wants to. Hopefully, she doesn't react too much to the storms.
This past week has been such a roller coaster! I know it's not over, yet, but I'm hoping that the improvement overnight is at least a sign on healing and she is on her way to being my happy, energetic little girl again.
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Post by Pauliana on Apr 28, 2014 21:26:36 GMT -7
Hi Megan!
How is Abby doing? Is she still in the hospital? Hope the storms didn't frighten her too much..
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