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Post by Paula & Lucy on Apr 23, 2014 12:57:30 GMT -7
Hello,
My 6 year old miniature dachshund, Lucy, presented with pain and discomfort on 3/30. We took her to the vet and they prescribed prednisone and cautioned us to not let her jump. By 4/6 she could only wobbly walk and we took her to the emergency vet, as our vet office was closed. The dr. there prescribed methocarbomal (1/4 tab, 3 times per day) and suggested we increase Lucy's dosage to two times a day with the prednisone. She also said that Lucy should have been crated immediately and that going forward she would need to be crated for a period of 8 weeks only to go potty and using a support. The next day I took her to her regular vet where they suggested laser therapy for 6 sessions (3 the first week, 2 the second and the final on the 3rd week; the final being yesterday). Unfortunately, Lucy has shown no improvement and keeps deteriorating. Although her vet repeatedly suggest surgery (at very appointment) this is not a financial option for us. The vet had also prescribed tramadol (1/4 tab 4 times per day). The vet suggested during the second week to taper her off of the prednisone to one time per day, yet Lucy is continuing to deteriorate. 2nd week her tail stopped wagging as frequently. She lost deep pain sensation in her left hind leg, outside toe and she started to chew the nail off, regardless of putting doggy mountain climbing shoe on it doused with bitter apple. I didn't want to have to put a cone on her because she is already so confined I'm concerned she won't be able to move around in her crate at all. However, she is now chewing all toes so the cone must be implemented (would Gabapentin help with this?). Also, the last couple of days she has started having potty accidents as if she isn't able to tell when she has to go. Prior to that she would squeak if she needed to go outside and was taken out immediately. We are now scheduled for an appointment with a different veterenarian for accupuncture on Saturday (4/26). Also, she is unable to sleep through the night. She gets her last dose of medication at 9:30p and will wake up at 1:30a, 2:30, 3:30 or 4a (If i'm lucky!). I have had one night where she slept until 5 am in three weeks. Is this typical? Also, is it common for these pups to deteriorate further prior to healing? I'm very concerned at this point and am having difficulty seeing light at the end of the tunnel for my sweet girl. Any advice would be greatly appreciated!
Medications:
▼Prednisone (1 tab; 1xday)
Methocarbomal (1/4 tab; 4xday)
Tramadol (1/4 tab; 4xday)
Lucy stats:
Miniature Dachshund
10.2 lbs (although she seems much lighter since crating)
6 years old (approx. - she is a rescue)
Adorable
Thank you!
Paula and Lucy
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on Apr 23, 2014 15:35:38 GMT -7
Welcome to Dodgerslist. So very glad that ER vet was very knowledgable about IVDD to let you know it takes time for the disc to heal and that only happens with 100% STRICT crate rest 24/7 only out at potty times for 8 weeks. Chewing is likely neuropathic pains similar to when we sit badly on a foot it gets pins and needles. But with neuropathy it progresses to VERY painful on-fire feelings....the dog knows nothing but to chew off where the pain is. The cone IS necessary and getting on the phone with the vet so you can asap pick up a prescription to gabapentin. More on neuropathic pain: www.dodgerslist.com/literature/neuropathy.pdfThe only caveat I have about liquid gabapentin is if it has been prepared for humans it likely will contain the toxic to-pets-sweetner: xylitol. On the bottle it will not indicate the sweetner. You would have to ask the pharmacist BEORE compounding to NOT use xylitol. If liquid gabapentin is compounded by a vet pharmacy it should contain a safe-for-dogs sweetner but getting it from there can take days.... not soon enough for Lucy. Most all pharmacies carry a 100mg capsule (the smallest size it comes in)... just call around your local pharmacies for the best price and have your vet call in the Rx. Discuss with your vet about Rxing 3x 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) As an example if Rx'd approx 30mg of gabpentin then, 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. 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 drap a piece of thin deli meat around ball for further tastiness! www.equipment4life.com.au/images/products/SDL750.jpg Oral Bioavailability in humans 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.htmlExpressing the bladderThe only way for us humans to know if there is bladder control is with the sniff and pee test. Carry outdoors, set on an old pee spot to sniff it. See if urine is then released. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. If urine comes out after sniffing, there is still control. If you are finding leaks in bedding and when lifted then you'll need a hands on top of your hands lesson today on manually expressing the bladder. YOu'll get more out of the lesson by first reviewing the video and the tips: www.dodgerslist.com/literature/Expressing.htmTapering PredClearly with pain and losing of neuro function this is NOT the time for a taper. The taper is to tell you if all the swelling in the spinal cord has been resovlved. If there is pain you have the answer pred needs more time back up at the original anti-inflammatory dose usually 5mg pred 2x/day.
PainShivering, 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, can't get comfortable are the sign of pain. This means the pain meds may well need some adjustment so that in one hour there are no signs of pain and it stays that way dose to dose of the pain meds. Stomach protectionCortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. This directory very good for learning about each of your dog's meds:
www.marvistavet.com/html/pharmacy_center.htm Outside of 100% STRICT crate rest 24/7 the next important thing for you to do is self education. Self education with this disease is critical. Knowledge is to make sure the right things are being done for best recovery. And for yourself, knowledge lets you step out of a very scary place…"the unknown" and the toll it takes on your emotions. Get ready to fight this disease with this current episode and in the future by knowing all things IVDD. There is no better place to start than on our main web page with "Overview: the essentials" and then read all you can as soon as possible in the next day or two. Here's the link www.dodgerslist.com/healingindex.htmWe anxiously await hearing that gabapentin is now on board for the very painful neuropathic pains. Please list for us all the meds with the number of mg for each dose in addition to the frequency. Never give up, stay focused, stay postitive and stay strong! You and Lucy will get through this bump in the road of life. |
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Post by Paula & Lucy on Apr 23, 2014 18:57:31 GMT -7
Thank you for the helpful information! Calling the vet first thing tomorrow for gabapentin and procuring a cone to keep the sweetly from munching her toes. Is she waking up in the middle of the night due to pain do you think?
Medications:
Tramadol 1/4 of a 50 mg tablet, 4x per day
Methocarbomal 1/4 of a 500 mg tablet, 4x per day
Prednisone 1 5mg tablet, 1x per day (going back to 2x per day every 12 hrs)
Pepcid AC 1/4 of a 10mg tablet, 1 hour before prednisone
Emergency vet gave Carafate but her regular vet said to use Pepcid
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on Apr 23, 2014 19:59:51 GMT -7
I'm sorry to hear you were not able to get a phone call into the vet today about gabapentin to get that pain under control. If you see chewing going on tonight, fold up a towel lengthwise and place around neck secured closed with duct tape. If necessary get to the ER vet. Neuropathic pains are serious business. We have had dogs chew off their penis, their leg.
Carafate would not reduce stomach acids as Pepcid AC does. However carafate is an important GI tract protectant addition when Pepcid AC is not sufficient. Carafate works by being Johnny on the spot to put a gel coating over any disruption of the stomach lining and aid in healing. Not eating due to nausea, vomiting, bloody red or black poop are the signs to watch for that the 2nd protector needs to be on board pronto.
I think not being able to sleep during the night is due to pain. Pain is a BIG deterrent to healing and just can't be allowed for that reason as well as it is torture. Pain control is not a one size fits all deal. Working with your vet with a timely communication of what you observe, lets the vet know if adjustments are still needed to get pain control perfectly right for Lucy.
Please let us know first thing in the morning that the gabapentin is on board so that Lucy does not need to suffer any longer.
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Post by Paula & Lucy on Apr 27, 2014 13:04:26 GMT -7
I am happy to report that Lucy has been on gabapentin for four days and is occasionally licking her wounded foot but no longer chewing it. Yes, she can get to it even with a cone on her head. So I wrap it in a blanket in addition to the cone to keep that to the bare minimum. As for her pain she is now on an every four hours dosage and is doing MUCH better! She also had her first acupuncture appointment yesterday (Saturday, April 26th). It went very well and she handled it well. The DVM/Acupuncture therapist was very hopeful of Lucy's prognosis and we are hoping that the acupuncture will relieve the inflammation so she can start gaining ground. As for her sleeping habits...well, she is still up at 4am, but as she is so much more calm overall with the new pain management regimen, its not a huge deal, just a minor inconvenience. I am thrilled that her pain is finally being managed and am so hopeful that her healing can now begin. Thank you Paula for your guidance and words of encouragement!!
Oh, I forgot to mention...she is on 50mg of Gabapentin 2x/day. Her veterinarian wanted to see how she responded before increasing the dosage. It is liquid suspension with bacon flavor and no xylitol. Thank you again!
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Post by Sherry Layman on Apr 27, 2014 14:45:49 GMT -7
You might want to re-read Paula's information about the Gabapentin. Timing of drugs is every bit as important as dosing. Each drug is removed from the body at a different rate, timing the doses so that drug levels remain therapeutic is vital. If doses are stretched too far apart it's like having no drug at all in the body for a period of time.
Gabapentin is dosed three times per day because of it's quick elimination from the body. You would be better off to divide the 100mg total daily dose into 3 doses rather than 2 as it will give more effective symptom relief. Again, read Paula's information above. Given that the medication is a liquid it would be very easy to consider the total daily dose and divide in three rather than two.
Keep an eye on the licking of the wound on the foot as this can prevent healing as well as lead to infection. There are so many types and styles of collar now days. If you are not using the old fashioned full sized hard plastic type it may be you need one to prevent her from getting to the foot.
Prior to her 4am waking does she sleep well? Does she seem to be in pain when she wakes?
I'm glad you were able to start the acupuncture, it can be a huge benefit.
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Post by Paula & Lucy on Apr 28, 2014 19:04:19 GMT -7
She does have a hard plastic type after I tried the inflatable type, however she can still lick her toes! She does sleep well prior to the 3 or 4a wake time. She typically needs to go potty first thing and then gets pain meds shortly thereafter. I hadn't dosed out the gabapentin to 3x per day as her vet said that it lasted for 12 hours....hmmmmm.
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Post by Paula & Lucy on May 19, 2014 16:14:14 GMT -7
Its been a while since I posted! So almost a month later...Lucy has been doing acupuncture treaments twice weekly with remarkable success. I can't believe how she has turned around in the past three weeks. Incredible! She will be getting off of prednisone Tuesday which is a huge relief. She walks outside in her harness and her back legs move like she's walking! She can't, of course, she doesn't have the muscles strength. She is also now getting bathtub physical therapy which should help her strength those muscles of hers. Little Miss Lucy is also sleeping through the night again and today I actually had to wake her up, haven't had that happen in 7 weeks. Thank you for all of your support during this time! I was at my wits end and was surely going to "lose it" if I hadn't received encouragement and support. THANK YOU!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,571
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Post by PaulaM on May 19, 2014 19:29:22 GMT -7
Paula, please STOP the bathtub therapy. Discs take 8 weeks to heal...disc healing is the priority to avoid set backs and damage to the spinal cord. Muscles will bulk up again when all 8 weeks of 100% STRICT crate rest have been completed. Until then no laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. Only a very, very few minimal footsteps to take care of business. No baths, no water therapy, no chiro (aka VOM). In other words do everything you can to limit the vertebrae in the back from moving and putting pressure on the bad disc.) Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep your dog's aligned and butt from tipping over. A harness and 6 foot leash will control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!  The purpose of crate rest is to act as a cast of sorts to let the disc heal… only limited movement of STRICT crate rest allows that to happen…there are no meds to heal a disc. Immediate neuro improvement may or may not come during the 8 weeks of crate rest… as nerves may take more than 8 weeks to heal. So you are savvy about conservative treatment this page is a wonderful place to get a good overview of each of the phases of healing: www.dodgerslist.com/literature/healingpage.htm Hope to hear you will be able to follow all the informative links and complete your readings in the next couple of days. Knowledge is power with this disease to avoid harmful treatments suggested by the well meaning but uneducated about IVDD. This "Disc Disease" DVD is a wonderful way to help other family members understand and even others who might be around or taking care of Lucy: www.dodgerslist.com/store/DVDorder.htmPlease keep us posted, Lucy is going in such a good direction of healing so 100% STRICT crate rest til graduation day can save Lucy a setback. |
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