Sabrina
Helpful Member
My Charley-dog, a Dodger'sList grad enjoying life!
Posts: 471
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Post by Sabrina on Jun 20, 2014 19:15:41 GMT -7
Hi Janice, I'm Sabrina. So sorry you and Jovie have to deal with IVDD, but so glad you've found Dodger'sList! Sounds like consulting with another vet is a good idea. It can be difficult to find a good IVDD knowledgeable vet - here's a page with some strategies/questions to ask: www.dodgerslist.com/literature/VetchkList.htmTramadol has a very short half-life, and for full pain control (that is, Jovie feels zero pain dose to dose) it will likely need to be given at a minimum of every 8hrs - hopefully the vet you speak with tomorrow will be confident in dosing pain meds and be able to help you get the doses/frequencies right for Jovie! www.dodgerslist.com/literature/healingpain.htmDo ask the vet tomorrow about adding Sucralfate to the mix: - Sucralfate is a sucrose aluminum hydroxide compound that forms a gel-like webbing over ulcerated or eroded tissues, thus serving as a sort of a bandage. It is effective in the upper GI tract: stomach, duodenum (upper small intestine), and esophagus. - Sucralfate is best used on an empty stomach and given 30 minutes before administering an antacid. Sucralfate may interact with other drugs including cimetidine and digoxin. Advise your veterinarian of any other medications or nutritional supplements your dog is taking. - Read more here: www.dodgerslist.com/literature/drugs.htm#intestinaldrugsThe goal would be to have Jovie's GI tract protected with Sucralfate and PepcidAC so that she can continue with her anti-inflammatory dose of pred - hopefully the new vet will be confident in dosing all these meds for Jovie! If Jovie isn't drinking enough, you can add in some low-fat, low-to-no sodium broth - my Charley loved his broth warmed up just a little Hoping Jovie stays stable overnight! But if you need help afterhours and there is no one on call at your vet, don't hesitate to call an ER clinic. ))Hugs!((
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Post by Janice & Jovie on Jun 20, 2014 19:46:53 GMT -7
She is drinking again. Cried to go out. Took her out. Drunk walk, only a few steps as needed. More runny bloody stool. Then vomited twice. Is now back in crate resting. No signs of pain. Tail wagging, burrowed under blanket.
First thing tomorrow she will be heading to new vet. Will insist on sultcrafate but I have to admit I am super nervous about giving her anymore prednisone.
I feel like I am not doing anything right. Haven't slept much since this started.
Last vet said he was familiar with disease, but clearly not. I asked for the sulcrafate and he said no need. I should've insisted.
I am keeping a log of all meds, when dispensed and also BM/Urine log as well as any pain noted.
Thank you for your kind words.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,579
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Post by PaulaM on Jun 20, 2014 20:04:27 GMT -7
Janice is it at all possible to get sucralfate tonight from ER? Sucralfate works by forming a gel coat over the disrupted areas of the GI tract PLUS providing an environment for healing of the ulcer. Pepcid AC merely reduces stomach acids which is a good thing as Pred increases stomach acids which can damage the stomach protective mucous lining.
If the vomit and the stools can be brought under control, prednisone may be able to resume. The other class of anti-inflammatories, NSAIDs also need stomach protection.
Quiting Prednisone cold turkey is not done because if steroids are suddenly withdrawn, the body may not have enough cortisol stores from the adrenal glands to support essential metabolic functions. This serious problem would be evidenced by depression, lethargy, anorexia, vomiting or diarrhea. The reason for tapering steroids is a serious health issue to alert the adrenals to again produce their own steroid hormone. So getting sucralfate on board with Pepcid AC would likely either allow her to continue with prednsone or if it is deemed not prudent...then to begin a quick taper off of pred.
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Post by Janice & Jovie on Jun 21, 2014 7:47:03 GMT -7
Jovie had a fairly comfortable night. Up to go to the bathroom once around 2:30am, more bloody stool (not as much though) and hasn't vomited again.
Sh is resting in her crate and we will be heading to new vet shortly. I will update as soon as we get back.
Thank you for the information on the cold turkey quit of prednisone. I am armed with my notes and log.
Thank you
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Post by Janice & Jovie on Jun 21, 2014 12:41:02 GMT -7
Hello Again!
I am so appreciative of all your help!
We took Jovie for a second opinion and the minute we walked in I felt better. The desk ladies were amazing and placed us with the Head Clinic Vet. He said he has treated hundreds of dogs that have recovered with conservative care. He did ask us if we were interested in surgery but it is cost prohibitive at this time.
He prescribed the sulcrafate but was extremely uncomfortable giving her any more prednisone because the bleed began so quickly. She had taken only 3 doses of the prednisone prior to the bleed. One dose Thursday morning and evening and then one yesterday morning.
He said to finish the dose of metronidazole and keep giving the tramadol and the methacarbomal as well.
He will see us back on Thursday and will then begin a course of NSAID since she did not tolerate the prednisone well at all.
I gave him all the history I had. He listened and answered all my questions. I did not feel uneasy after I left him as I did with the other two. He said her prognosis for recovery are excellent. She is already starting to self correct paw placement.
She is resting comfortably and not showing any signs of pain. No shaking, crying or anything else out of character. Eating, drinking and wagging tail.
Has not had a bloody stool since 2:30am and has not vomited again.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jun 22, 2014 3:57:26 GMT -7
Kudos to you on finding a more knowledgeable vet and getting Sulcrafate on board, Janice! I am concerned, though, that the vet wants to start a NSAID on Thursday. A 4-7 day washout period is necessary when switching from a steroid to a NSAID. Since there is a medical necessity for the switch, please be very sure to keep Jovie on the Pepcid AC 5 mgs 30 mins before the NSAID and every 12 hours thereafter along with the Sucralfate to double protect her. I'm so pleased to hear that she's already self-correcting her paw placement! Wonderful sign of nerve healing.
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Post by Janice & Jovie on Jun 22, 2014 5:42:31 GMT -7
I'm sorry-I didn't fully explain. He had wanted to see her back Friday, the 27th for new meds, but that is the day I leave to go take care of my mom so I asked for a different appointment. He did explain the washout period and said we could go ahead for appointment on Thursday but to not start the meds until next Friday.
So her last dose of prednisone was Friday June 20th 6am and her beginning NSAID will be Friday June 27th.
She has been acting like her old self. No signs of pain and her stool this morning was brown, firm and no blood!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,579
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Post by PaulaM on Jun 22, 2014 8:54:34 GMT -7
Janice very good to hear there will be a 7-day washout going from Pred to a NSAID. Right now then there is really nothing in her system to help get swelling down. So to hear that there is no pain is very good as she really is on a light dose of pain relievers. There is only one way to know if all the swelling is actually gone. That would be to back off the pain meds and observe if any hint of pain appears. Maybe something to discuss with the vet for a Fri test to see if a NSAID would still be needed???
As you can see all IVDD meds can have serious side effects, so no one wants to be using them if there is no job to do. If any hint of pain appears then you know a NSAID is needed. IF no pain appears then no medications (pain or anti-inflammatory) at all are needed.
Even if it turns out a NSAID is needed, I would advocate to continue with sucralfate to ensure continued healing of the damaged areas of the GI tract if that is not already the vet's plan. Remember she was likely given a high dose of IV steroids during the overnight vet stay before being sent home with a lower anti-inflammatory dose of pred pills and only one stomach protector (Pepcid AC). One of the concerns with a high dose of IV steroids is GI tract damage.
7.5 lbs methocarbamol 62.5mg 3x/day Tramadol 12.5 mg 2x/day Pepcid AC 5mg 2x/day Sucralfate ?mg, ?x/day metronidazole
prednisone last dose 6/20 a NSAID to start 6/27
Can your husband join us on the Forum while you are away for a month? We sure would like to continue to hear how Jovie progresses.
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Post by Janice & Jovie on Jun 22, 2014 13:14:59 GMT -7
Metronidazole is .4 ml every 12 hours Sucralfate is 3 ml every 12 hours
I will call him tomorrow and ask about backing off the pain meds for a Friday test. She is still resting comfortably, eating, drinking and letting us know when she nEeds to get out to pee.
I will absolutely advocate for the sulcrafate continuance. That was scary.
I am so relieved, I actually slept last night.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jun 23, 2014 4:13:52 GMT -7
I hope that once Jovie is off of all pain meds today, there will be no resurfacing of pain before Friday and no NSAID will be needed. What great news that would be! Please let us know what the vet says after speaking to him today. I, too, hope that your husband can keep in touch with us while you're away.
My prayers are with you all.
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Post by Janice & Jovie on Jun 24, 2014 5:24:20 GMT -7
She seemed a little uncomfortable yesterday morning so kept up with pain meds. We will see how today goes.
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Post by Janice & Jovie on Jun 26, 2014 18:42:11 GMT -7
Jovie continues to improve. She is no longer taking the methacarbomal and is down to 1 tramadol a day. The vet did seem to think she would benefit from Metacam (she starts tomorrow-last dose of prednisone was 1 week ago, friday the 20th) as when he did the exam she did show some mild discomfort. I am not sure of the exact dosage as it is liquid form and you just fill the syringe to the 7 pound mark for her.
She also continues to take the pepcid and sucralfate.
She is much happier and is acting like her sweet happy self. She is wagging as hard as she can, eating well, no bowel problems at all. She still does a wobbly drunk walk but it is getting better every day (Only when she goes to potty-she is in her crate the rest of the day)
She is being very good with the crate rest. It helps that she is a burrower and a napper.As long as she is burrowed into her snuggly blanket and warm, she doesn't seem to care where she is.
Husband will go to the vet again for a progress check in a week to determine if we should start to taper the metacam and end the tramadol.
I leave tomorrow for a month to take care of my mom. I will update when I can as internet is spotty there.
Thank you all so much for your knowledge. We would've been in big trouble if you all hadn't alerted me to the sucralfate.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,579
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Post by PaulaM on Jun 27, 2014 7:39:58 GMT -7
We hope your husband will be able to join us on the Forum! Metacam is not a pain reliever. It is a Non Steroid Anti-Inflammatory Drug (NSAID) so if there is any hint of pain your husband needs to advocate for getting the pain meds back on board. NSAIDs can take anywhere from 7-30 days to resolved the painful swelling in the spinal cord. In the meantime Jovie certainly does not need to suffer with any pain. Let us know.
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