Brandi's Oscar 4/10 Conservative NECK? — Michigan

Welcome to Dodgerslist, Brandi.  I'm sorry to hear that Oscar's meds are not yet right. Can you get on the phone now and advocate strongly for Tramadol. Background reading so you can discuss Oscar's immediate needs regarding pain meds: www.dodgerslist.com/literature/healingpain.htm

I would give famotidine at the aggressive range of 5mg 2x a day. His GI tract is under a great deal of stress with the Dex shot and the Prednisone. Oscar certainly does not need another problem of nausea, vomit leading to bleeding ulcers.

How much does Oscar weigh?

Please read about back braces and why they are not recommended: dodgerslist.boards.net/thread/826/back-braces

Leave the spectator stands of blindly following and move to being an active participant in fighting the IVDD enemy. Recognize and ignore harmful advise, play an instrumental role of teaming up with your vet with meaningful discussion, questions and monitoring your dog’s recovery.

Here's the page covering the type of information it takes to become a savvy medical advocate and laid out to allow you go fast as you possibly can. For your bookmarks: www.dodgerslist.com/healingindex.htm

Never give up, stay focused, stay postitive and stay strong! We hope to hear Oscar's pain is masked fully dose to dose of his pain meds. Let us know what you observe: no shivering, trembling, yelping when picked up or moved, not reluctant to move much or slow to move, no tight tense tummy, is his normal perky self now.

Hi Brandi!

Discuss with your Vet that Oscar is still having spasms even with the increase of the Methocarbamol to 3 times a day and with the Gabapentina added.. There might be another muscle relaxer that can be used instead of Methocarbamol.    Pain control is not a one size fits all deal.. The medications need to be customized for Oscar..It can be trial and error at first until the right mix of medications is found, the important thing is to be vocal to the Vet so he is kept in the loop to get things right for Oscar..

We'll be looking forward to hearing the spasms are under control.. Sending comforting thoughts over the miles..

Brandi, if you believe the spasms are pain as is 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, then what you do is contact the ER vet and strongly advocate for the general pain reliever that never was prescribed..... tramadol. Did you have a conversation with the vet about Tramadol yesterday...what did they say?

Can you describe for us exactly what you observe Oscar doing when you say he has a spasm?

Are you now giving 5mg of  Pepcid AC 2x a day?

The vet prescribed
tramadol today. 3x a day starting tomorrow but said to
stop the gabapentin today.
Methocarbamol 3x a day.

His spasms have lessened but he still had a small one this morning. He was able to comfort himself. So far we are still on the Methocarbamol 3x a day. I have a follow up appt on Tuesday with the vet. The pumpkin worked great...maybe too great...



He ended up having a big spasm around 11pm. He did not have his gabapen dose at 8pm per vet. Have to wait til 4am to give tramadol. He won't relax! I'm hoping the tramadol will help him relax.

Vet said discontinue gabapentin instead of taking it with the tramadol. Is that normal? I just want the spasms to quit and I want him to relax...he won't relax so he can't heal and I think he keeps moving so much he twists and has a spasm. The last few spasms I have not seen what he is doing, I have to keep a blanket over the kennel or he will be even more hyper. It has not been while eating. 

I did start giving him Pepcid 2x a day a few days ago.

Tramadol 25 mg 3x a day

any information on acepromazine in conjunction with these meds? My Oscar won't relax

I increased to ▲ 50mg tramadol 3x a day on my own and continued with the gabapentin, staggering them, and I think it might be working however he did have a mild spasm at 1am. So far he has not been able to go 24 hrs with out at least one spasm so I will be addressing that with the vet.

i am pretty sure that because it's taken this long to get Oscar to settle down, he probably needs to be on the prednisone for longer. I feel like we are starting from day one because he hasn't been able to settle enough to let the steroids heal him.

Your vet is clearly telling you tentative doses/switching/stopping of pain meds that he is not comfortable in dealing with the pain of a disc episode. I think it time to find another vet today who can be supportive in aggressive pain meds.

I agree with Pauliana and Marjorie this really sounds like a neck disc by your observations of such pain especially at feeding times. Please explain "spasm" to us. It is yelping, shivering, won't move the head much or holds it high or nose to the ground? We can't see so we depend on specific detail from you, we don't like to assume anything. This is the same detail you need to share with your NEW vet. That might be a consultation only with a board certified neuro to get pain meds right or it might be another vet in town who is more knowledgeable about pain control. backround reading on how to approach finding a new vet: www.dodgerslist.com/literature/VetchkList.htm

I would STRONGLY advocate to the new vet today about consistent, on time dosing of a combo of pain meds for an 18 lbs dog:
-- Gabapentin 3x a day as it works synergistically along WITH Tramadol. Read about staggering vs. giving all meds at the same time: www.dodgerslist.com/neurocorner2/timingmeds.htm
-- Tramadol 50 mgs 3x/day and find out the option for 4x a day and correct dose if necessary nites or weekend.
-- methocarbamol 250 mg 3x day

-- Prednisone to continue at the ant-inflammatory dose from anywhere 7-30 days. It is a test taper to assess just how long to stay on Pred. Background reading to understand the expectations of pred, tapers, etc. www.dodgerslist.com/literature/healingsweling.htm

Let us know you are doing all the extra at home things as this really, really sounds like a neck disc you are dealing with: Extra things www.dodgerslist.com/literature/cervical.htm including Oscar eating inside the recovery suite with bowls attached at head height.

How is Oscar's poop today, normal firmness, color? Still giving Pepcid AC 5mg 2x/day?

Can you tell us if at some point if surgery could be a consideration for your family?

I think kudos go to you, Brandi, for doing such a good job of advocating on the Tramadol! Nice job!

Discuss with the vet about giving 50mg Gaba at noon today as transition and then another 50mg Gaba at 4:30 pm. That should then have Gabapentin on the regular dose and the same time schedule as Tramadol thereafter.

I would most definately ask for an Rx for sucralfate to be given along with 5mg Pepcid AC 2x a day. Dex is a most notorious steroid well known in the medical community for the GI tract damage it can do. Best to be prepared with sucralfate on board in the tummy today so that if there is the tiniest damage to the mucus stomach lining sucralfate will immedately patch that area and facilitate healing. Sucralfate will not prevent bleeding ulcers but help them to heal. There is required background reading to understand how this med works in conjunction with Pepcid AC and food....it is all about the timing.

When you put water in his kibble are you putting in an equal amount of water as kibble and soaking in the refrigerator overnight? Using 1 teaspoon of plain pureed canned pumpkin 1x/day. Alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato.

You may assess if helping Oscar to relax in his crate is a good approach. Using any oral calmer in combination with a Pheromone diffuser seems to work best.  It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog.

Place a DAP pheromone diffuser at floor level where the recovery suite is. Some brands to consider:
--Comfort Zone (DAP) wall plug-in diffuser 48ml www.petcomfortzone.com/dogs.html
--Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/

Use a diffuser with one oral calmer from below.Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price  
Oral calmers:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
www.vetriscience.com/composure-soft-dogs-MD-LD.php
3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com

Can you give us the details on the visit.  By now you knew we would ask as we are a group who LOVE detail!  LOL
-- Did Oscar get a dex shot? IF yes, then do phone in about an Rx to you local pharmacy for the sucralfate.
-- Remind us what is the current pred dose in mgs, how often you are to give it?  30mg 2x day is a VERY high dose, it is not an anti-inflammatory dose.  You need a 2nd opinion vet on this.

The reason for a neuro consultation is just to have someone with experience in using pain med that this vet is uncomfortable in using. YOu can also look for another general DVM vet in your town who is more IVDD knowledgable.

IF you are going with conservative treatment, then there is no reason to know exactly which disc is the problem by doing a $1000+ MRI. All the discs will receive the same limited movement care with conservative treatment. What you want is a vet who knows their pain meds! So I think your vet is basically saying without using a clear statement that he is uncomforatable in treating this disc episode by his referral for an MRI when you have told  him you are not doing surgery.  An MRI could be used when all avenues of  pain control are in place still pain will not be brought under control and there is a suspicion there could be another disease that mimics a disc problem.

Look on our main website for a retangular search box. in "finding an IVDD vet" You will want to read that article.

Hi Brandi,

Neuro Vet's see more cases of IVDD cases daily than a general DVM vet.  They are more experienced at pain control and much more knowledgeable on IVDD.  Make it clear that surgery is not an option that you wish to continue conservative treatment and need help for the spasms and getting the medications right.   My Tyler goes to a Neuro Vet when he has a disc episode and to a DVM vet for everything else that isn't IVDD related.

Be sure to give the Pepcid 30 minutes before the Prednisone and every 12 hours thereafter. Always give the Prednisone with a meal.  Be sure to tell the Neuro about the medications he is on and the dosages  and about his previous treatment with his current Vet.. Ask him about an RX for Sucralfate...

Let us know how the Neuro appt goes..  

This is what you do now. You get on the phone to find a NEW different local general DVM vet to support you with conservative treatment for the balance of the 8 weeks:  www.dodgerslist.com/literature/VetchkList.htm You are staying the course with conservative treatment, you are hiring a vet who will support prednisone for as long as it takes to get the painful swelling down and be aggressive with continuation of pain meds until that happens.

Remember a surgeon is trained to be a surgeon and they often believe surgery IS the only treatment for a disc episode...so that is not unexpected to hear he thought surgery was the only option even when you told him is was not an option for you.  You can do the best job of hiring the right vet for the job when you are firm in your knowledge about meds, conservative treatment, etc. 

Dr. Nancy Kay, DVM, ACVIM remark are dead on for our IVDD dogs! "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdf

Arm yourself with handy reference material to d/l print out and keep with you:
www.dodgerslist.com/literature/MedCard.pdf  and pages to re-review to firm up your self education:
www.dodgerslist.com/healingindex.htm



Know when you  have an emergency...post on your fridge:  www.dodgerslist.com/literature/FridgeInfo81907.pdf

The two week course of pred at 5mg 2x a day is just an assumption that all the swelling will be gone. It is the taper that gives the true story if another course of 5mg 2x a day is needed or not.

I would STRONGLY advocate to the new local general vet today about consistent, on time dosing of a combo of pain meds for an 18 lbs dog:
-- Gabapentin 3x a day as it works synergistically along WITH Tramadol. Read about staggering vs. giving all meds at the same time: www.dodgerslist.com/neurocorner2/timingmeds.htm Did you discuss with the neuro about the correct dose of gabapentin for a 3x a day dose?

-- Tramadol 50 mgs 3x/day and find out the option for 4x a day and correct dose if necessary nites or weekend. Did you discuss with the neuro aobut the 4x a day option and what that dose would be?

-- methocarbamol 250 mg 3x day or Valium Xmg, ?x/day.  Valium would be used for keeping the type of pain that stems from muscle contractions/spasms.  So it definately would NOT be used on an as needed basis.  By the time pain surfaces you would be too late in administering pain meds.

-- Pepcid AC 5mg 2x/day to protect the GI tract

When you have time please update this med list for us:
18 lbs
prednisone as of 4/19 to 5mg 2x/day for7 days
Methocarbamol STOPPED 250 mg 3x daily
famotidine 5 mg 2x/day
gabapentin 100mg 3x a day
Tramadol 50mg 3x a day
Valium  x mg, x/day

What is the status on observing pain now. Any signs nearing next dose, after moving?

Hi Brandi,

 Methocarbamol and Valium should NOT be used together.. They are both (muscle) relaxants.  Valium is also used to ease anxiety.   To use the Valium you must stop giving Methocarbamol. 

What is the dosage and frequencies given of the Valium?  Hoping it eases his muscle spasms since Methocarbamol wasn't working for Oscar. 

Oscar has not had a spasm in about 48 hours! I am very optimistic that he is getting better!

he is very restless in his crate though...I'm going to get the diffuser to see if that helps. 

Thank you very much for all your continued support!