Shawn & Bruno
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M - Dachshund .. Bruno puppy ....Newman RIP
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Post by Shawn & Bruno on Mar 25, 2015 10:37:34 GMT -7
Hello. It pains me to even create a thread given the circumstances. I was part of the Yahoo User Group circa 2010 when my son Newman suffered his 1st major IVDD episode. With the loving help and support from that group, Newman came back to life after 2+ full months of crate rest and medication. We have equipped our house with multiple ramps and have made efforts to keep him from jumping/horse play. However, being a Dachshund, he is always up to tricks and has had 2 episodes (albeit a bit smaller) in 2012 and most recently on 3/21/2015. Here's a quick timeline to provide some background: 1) 9/25/2010 - Newman became unable to fully utilize his back legs on after trying to jump up onto the couch. We took him to the emergency vet who took x-rays showing nothing and said that she believed he had a minor disc herniation and prescribed an oral non-steroidal anti-inflammatory and crate rest for 2 weeks. After three days or so, Newman was clearly better and he could walk better (still with a limp/lameness) and we were hopeful. After a week and not a full recovery, we brought him to our regular yet (10/4/2010) who completely misdiagnosed him. They said it was very serious and said Newman has only deep pain reflex and lacks control of his back legs. They kept him overnight and provided IV solu metrol (steroids). The following morning the vet said Newman only showed a 5% improvement and thus needs to see a neurologist immediately and will probably need immediate back surgery. On 10/4, we brought him to Animal Specialty Center and met with Dr. Berg who confirmed the previous Vet vastly overstated the diagnoses. He said that he is a 2 on a scale of 1-4 where he probably has some disc material pushing against the spinal cord. 1 = inflammation and some anti-inflamatory is used and the dog is OK in 2-4 days, 2 = disc is pushing on the spinal cord and the dog walks wobbly 3 = dog drags legs 4 = paralysis I am paraphrasing this but you get the point. We insisted on crate rest and medication. On 10/14, we got 2 additional weeks of Dex as Newman was progressing but still not playful/happy/affectionate. On 10/24, Dr. Berg said Newman made a "greatly improved" recovery. At this point, he lifts his leg for #1 and squats for #2 and he even wants to play. He was given Dex every other day for another 4 weeks (I need to confirm this as it sounds excessive). On 11/14, Newman was off the Dex and Dr. Berg said that swelling must be done but he could have compression so he said another 2 weeks of crate rest. On 12/1, he grated from crate rest and he was back to my boy. ~~~ 04/15/2012 (2nd Episode) Newman had his 2nd episode as he slowed down immediately after running up in pain and he was in obvious pain (groan/VERY slow). We brought him to the ER Vet and he winced/groaned a bit when they pushed into the middle disc (right where the rib cage ends). He also is a bit slow with flipping his left paw but that could have due to the previous episode where even the neurologist said he might always be 85-90% and a bit slow due to permanent damage. She prescribed Prednisone (6X-5MG) for 1/2 tablet/2X a day for 3 days and then 1/2 tablet once a day for 3 days, and 1/2 tablet every other day until gone and Tramadol (15X-50MG) for 1/4 tablet every 8-12 hours as needed. She also said 4-6 weeks crate rest. 04/19/2012 (2nd Episode Setback) Newman had a set back to his 2nd Episode. It was the 3rd and last day of the twice per day prednisone. I came home from work and he wasn't wagging much in his crate nor would he kiss me. I brought him outside and he was walking as normal but much slower. I put him back in his crate and gave him his famotidine and tramadol. I noticed his back was shivering a bit as if he was in pain. After 20-30 minutes, he started wagging again and would kiss me. I gave him the prednisone and picked up my wife. I took him back outside to use the bathroom again and he lightly yelped as I picked him up. I got upset and put him down to make sure he was still walking OK. He took a few steps and he looked completely fine, and I picked him up to put him back in his crate and he yelped louder.  I called my VET in the morning and indicated I thought compression still existed and she agreed. She did not agree with the 3 days of prednisone so she prescribed 3 weeks and double dosage of prednisone (30X - 5MG @ *1* tablet twice per day for 1 week and *1* tablet once per day for 2 weeks), 3 weeks of tramadol (21X - 50MG; 1/4 tablet @ 3 times per day for 3 weeks), and Methocarmol (8X - 500MG; 1/4 tablet @ 3 times a day). On 06/22/2012, Newman was done with crate rest and he was back again! ~~~ 03/21/2015 My wife and I now have a 6 month old daughter which Newman absolutely loves. He attacks her with kisses every moment and is very protective of her. Unfortunately, on 3-5 separate occasions, he ran up the stairs when the baby cries. I have also been bad in that I let him out to use the bathroom and he goes up/down 3 stairs. I know it isn't much but he does have to "jump" up into the house a foot. That will never happen again either. He has been slowing down but still very playful/affectionate but he needs help with his ramps. I attributed that with him turning 10 but it could be due to his back (e.g. stairs!). He started to groan and move even slower and I noticed some wobbling in the back again so I brought him to the Vet on Saturday morning. To be honest, I am a man's man but I just don't handle issues with Newman well at all. I started to break down in the room with the doctor who assured me it was caught early and it was a 3 out of 10 and was given a Dex and Pain Killer injection. They performed an xray and there are 3 discs that have some narrowing but it was all "soft tissue" which was positive. He received a cold laser treatment and was given a prescription of the typical Dex every other day for 2 weeks and 1/4 tablet of Tramadol for pain. Newman is now on strict crate rest and even though it has only been 4 days of crate rest/meds, I have major concerns: 1) Newman is extremely slow walking outside to use the bathroom. He normally lifts his leg but sometimes he just leans forward for #1 but he does squat for #2. He can walk but is wobbling in his back end (Not like episode #1) but it is noticeable. He seems to be much better at the onset of the steroid and then gets a bit worse the following day. 2) He is extremely lethargic. He will eat/drink but very slow. It took a few days just to get a kiss. His nickname is "Smooch" for a reason. How to determine the cause? Dex? Pain? 3) He groans *ALL* the time even on the pain killers. He always made noise. Does that mean pain? How can a slight stroke of the back (read: fingertips) cause pain? 4) He had one single light yelp a few days ago while pain killer has worn off. Nothing since. 5) Cold Laser Treatment. Expensive but I have the money. But, is it worth it? Google has a lot of positive things to say. Am I just not giving this enough time to see improvement? |
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Post by Debbie Blackwelder on Mar 25, 2015 11:45:15 GMT -7
Hello and Welcome to Dodgerslist! My name is Debbie. I know how you feel about Newman, we love our sons and daughters. Sounds like from what I have read that Newman's condition is not as bad as it could be. This is the normal deterioration of functions: As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions . When nerve healing begins, often it follows the reverse order. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails scuffing floor 4. Paws knuckle ( Sounds like Newman is here)5. Legs do not work (paralysis, dog is down) 6. Bladder control is lost 7. Tail wagging with joy is lost 8. Deep pain sensation, the last neuro function You got Newman to the vet in time to stop the progression of Neuro functions. Now the important thing is continue the meds and crate rest. Crate rest as you know is 8 full weeks of 100% Strict crate rest 24/7, only out to potty and carried back in forth for that. By reading your post I think you are letting him walk back and forth to potty, if you are you need to stop this. Keep pee time to a minimum with very few steps. Put up a wire pen outside to keep him contained if it starts to be a problem. Can you give us Newman's list of medications and how often given, plus Mg's? The Tramadol dose may not possibly be enough or you need to add another pain medication. Tramadol is a general pain reliever, Methocarbamol is a muscle relaxant and Gabapentin is for nerve pain or hard to control pain.. These three are the ones most commonly used for IVDD disc episodes.. For more reading on pain control so you can discuss this with your Vet: www.dodgerslist.com/literature/healingpain.htm☐ If there is pain or neuro diminishment, dogs can benefit greatly with acupuncture or laser light therapy. These therapies can be be started right away to help relieve pain and to also to kick start energy production in nerve cells to sprout. So if this therapy is in your budget, seek out a holistic vet. ahvma.org/Widgets/FindVet.html Chiropractic is not recommended for IVDD dogs. I did not see Pepcid AC mentioned. If you are not giving it then ask you vet, "Is there any medical reason why Newman can not take the stomach protecter PEPCID AC?" We follow proactive vets and give our approximately 13-20 lbs doxies 5mg 30 minutes prior to Prednisone. Signs of pain are: 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. Do you know the location of his disc issues? Could it possibly be in the neck? |
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Shawn & Bruno
New Member
M - Dachshund .. Bruno puppy ....Newman RIP
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Post by Shawn & Bruno on Mar 25, 2015 12:52:16 GMT -7
Thank you for the fast reply. He currently passes the knuckle test as he flips his paw back over. His noticeable symptoms are: He moves very slow but that could be due to steroids/pain medication (or pain in general), slight wobble walk (he is slightly unsteady on his feet but it appears better right after the Dex), and just lack of affection but that is expected. You are correct. I use it as a 'judging' period but it is minimal. I walk behind him and pick him up immediately after the job. I'd guess he 'walks' for less than 1 minute total including the dseconds. He likes to "look" around. I could put a harness on him so he doesn't feel the need to explore. Dexamethasone (.25MG dosage; 7 pills total given every other day for 2 weks) Tramdol (50MG dosage; 1/2 pill 3 times a day for 6 days but currently taking ~1/4 pill) He used Methocarbamol in his 2nd episode due to the back spams. I didn't request it as he doesn't appear to have spasms. Even an animal chiropractor? I wonder why he was recommended by the vet? This www.littlecritterschiropracticservices.comI didn't even bring it [Pepcid AC] up as I already have it on hand. Newman is smart. He bites the treats to check for pills.  I cannot tell the difference between shivering and trembling but there is definitely movement. He has always groaned and had back "movement" of some type even when a happy/healthy boy. I wonder if that meant he always had some pain or just him? He had a single light yelp a few days ago when he wasn't on the pain medication yet. Yes. He is very slow to move but that can be due to 1) Steroids 2) Pain Medication 3) Pain 4) Can he know he is injured? I just don't know root cause given the other variables. When I use the pain killer, he is just a zombie. The 1st was near the shoulders, the 2nd was in the middle, and the 3rd was the lower end. The doctor said the upper one wasn't bad. I believe the middle was the worst. He has always had a slight hunch. I wish you folks lived near me. After the previous vet misdiagnosed him, I don't trust these people. |
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PaulaM
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Post by PaulaM on Mar 25, 2015 13:37:52 GMT -7
Shawn, disc disease is a painful disease during an episode. Dogs do all they can to avoid showing pain, so that when you see signs of pain, the dog IS in pain. Neuman is suffering with pain by the slow to move and lethargic. Painful muscle contractions also usually accompany a disc episode. So I would advocate asap for getting Valentino relief from the needless pain he is enduring. Pain meds need to be given promptly on schedule so that pain never has a chance to arise. When a vet guess all the painful swelling has been resolved, there will be a test. It is called a taper (reduction of Dex) at that time pain meds are then stopped to have a very fast and clear picture if any hint of pain would surface. You need to let the vet know that the every other day dose is having Newman show diminishment of neuro functions (wobbyling) on the off day for Dex. It is clear that dex is not staying at a high enough dose, discuss a dose that can be given every day. What do you mean by pain meds make him a zombie....what exactly do you observe. A combo of pain meds may mean less of each can be used yet pain is still controlled. Discuss adding methocarbamol for painful muscle contractions (may feel like you would feel with a stiff neck.. painful to move) Discuss adding gabapentin to the mix as it works synergistically with Tramadol and vets are finding good success with pain control. Crate rest is rest for the purpose of the spine (back) not moving. It is the movement of the vertebrae that push on the weak disc. Chiro pushes on vertebrae defeating the purpose of crate rest. Know your chiro with IVDD dogs: Dr. Isaacs, DVM, ACVIM (Neurology) explains why chiropractic therapy is contradinated with a dog suspected of being born with IVDD or one known to have it: www.dodgerslist.com/literature/chiropractic.htm |
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Shawn & Bruno
New Member
M - Dachshund .. Bruno puppy ....Newman RIP
Posts: 45
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Post by Shawn & Bruno on Mar 25, 2015 20:52:06 GMT -7
I give him his pain medication at ~7:30AM, 6PM, and near midnight when we go to bed. There is no tapering off as the Vet said .25MG every other day does not need to be tapered off. I have increased the dosage from 1/4 pill to 1/3 pill and he is still extremely slow. He had the same response in 2010 when he was on the Dex. It really messes with his personality. However, I am still concerned he is pain due to the groaning/slowness.
~ 10.6lbs. He has never had a weight problem. He is also a "short" so the back is on the shorter side.
3/21 (At Vet);
Dexamethasone Injection
Torbugesic 50ml
3/22:
[10.6 lbs]
7 [pills] - Dexamethasone .25MG (Every other day) [I have increased the dosage from 1/4 pill to 1/3 pill
Tramadol (50MG dosage; 1/2 pill 3 times a day for 6 days but currently taking ~1/4 pill)
Pepcid AC (5MG every time he gets a pill)
Is it clear? He had a bit of wobbyling when the vet saw him. I also have very limited time to watch him walk. One thing is for sure: He is very slow. There are times when he walks perfectly fine outside with only a slight unsteadiness. I should note that sometimes he lifts his leg and sometimes he leans forward. He squats perfectly fine. Is there a negative to increasing the dose?
He just lays in his crate nearly all day long without much interaction. He just stares out his crate like he is in a trance. He will whimper sometimes and other times he just sits and is completely quiet. No kisses. No bark (maybe a chirp or too). That's not my Newman. It is pronounced when he is on the pain medication too. We observed similar behavior in 2010 with Dex: lethargic, not affectionate, etc. It is different that he doesn't have much of an appetite or desire to drink water unlike last time where the Dex made him hungry/thirsty.
Thank you. I will use the money on cold laser therapy instead [of chiro].
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Shawn & Bruno
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M - Dachshund .. Bruno puppy ....Newman RIP
Posts: 45
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Post by Shawn & Bruno on Mar 25, 2015 22:24:38 GMT -7
Newman has taken a turn for the worse. He hasn't really eaten/drink all day except for some 2% milk w/ water. I brought him out to use the bathroom and he was able to lift his leg and then he stopped walking and just stood there. I flipped his toe over (it is wet out if that matters) and he was very slow to turn it over. I picked him up and he yelped. I got the vet on the phone who said to give him another .25 Dex (I just gave him .25 a few minutes ago) and another in the morning. If we don't see some improvement 12/24 hours, then we need to get MRI/Cat Scan to see what's going on. 12/24 hours? He was lame in his left leg (same one) in 2010 and .5 DEX for nearly 1 month and strict crate rest brought him back. Could this just be a weak dosage? Or, is his body not responding? I am losing him |
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Shawn & Bruno
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M - Dachshund .. Bruno puppy ....Newman RIP
Posts: 45
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Post by Shawn & Bruno on Mar 26, 2015 5:55:45 GMT -7
I gave Newman 2 - .25MG Dex (1 pill was due in the AM but the Vet requested 2 to be given), 1 - 5MG Pepcid AC, and 1/2 tablet Tramadol around 2AM. I was finally able to get him to take a few sips of water. I slept on the ground next to his crate. I took him out of his crate at ~8AM and he was wagging his tail and he went outside to use the bathroom. He was noticeable better on his legs (Similar to when he came back from the Vet on the Dex injection and the following pill the next day). His was was fairly smooth and he even lifted his left leg to urinate and was fairly steady for 3-5 seconds albeit that his left leg is the strong leg. I brought him back in and he is sitting in his crate next to me as I wait for his 10AM appointment. The Vet gave me the impression that I must prepare myself for potential surgery if he doesn't respond to the increased meds and/or increased diagnostics such as MRI. However, there's some hope that the low DEX dosage is the culprit for Newman not responding as he did last time. I am going to insist on a conservative approach including daily DEX dosage (.5MG?) for 3+ weeks including increased pain management.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Mar 26, 2015 6:00:04 GMT -7
You are not losing Newman, Shawn. He just needs an adjustment in meds. Not eating or drinking all day could be a sign of pain OR it could be a red flag sign of GI distress, which is a side effect of the Dex. Reluctance to move and yelping when being picked up are definitely signs of pain. The lying in his crate, being completely quiet and not his perky self are signs of pain. He doesn't want to move or do anything because it hurts when he does. The Dex works on reducing the swelling that's pressing on the nerves of the spine causing pain. It can take 7-30 days for that swelling to resolve. Meanwhile, Newman's pain needs to be brought completely under control TODAY. The vet has prescribed Tramadol 25 mg 3x/day; however, you've reported that he's only getting half of that. Please give Newman the 25 mg 3x/day. Please speak to the vet this morning about adding Gabapentin, which many vets have found works very well with Tramadol. Also Methocarbamol works on the pain of muscle spasms. Newman's pain should be completely under control within one hour of taking the mix of pain meds and should remain completely under control with no sign of pain from one dose of the meds to the next. The reluctance to move should stop when his pain is fully under control, there should be no yelping when picked up and Newman should be his usual perky self. I would also speak to the vet about adding Sucralfate due to Newman not eating/drinking as a second stomach protector. Continue with the Pepcid AC 5 mg 2x/day. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/html/sucralfate.htmlAlso speak to the vet about prescribing a dosage of the Dex to be given every day. When given every other day, there are days when Newman has nothing working on the swelling. When my Jeremy has a disc episode, he gets Dex .25 mg twice a day for 3 days, then once a day for 3 days and then every other day for 3 dosages; however, he's 3 times the weight of your dog so the dosage would be less for Newman. However, whatever the anti-inflammatory dose would be for Newman should be given on a daily basis, usually twice a day. At some point, the vet would call for a taper of the Dex to see if there is still swelling. If pain returns during the taper, then Newman would be returned to the original dosage for a bit longer. Pain = swelling = more time on all meds. What Newman is currently on would be the end of a taper dose. He needs to be on an anti-inflammatory dosage of Dex every day to get that swelling down ASAP. The sooner the swelling the resolves, the better as it's the pressing on the nerves of the spine by the swelling that causes neuro deficits. Nerve healing can take months, not hours. What needs to be improved ASAP is Newman's pain so the pain meds need to be adjusted this morning. MRIs or CT scans are only done just prior to surgery. These tests require anesthesia which can be dangerous for a dog with IVDD as all core muscles supporting the spine are relaxed. You have opted for conservative care, which is an appropriate treatment due to the fact that Newman can still walk. An appropriate dosage of both the Dex and pain meds need to be prescribed so Newman can relax without pain in his crate with a full 8 weeks of strict crate rest so the disc can heal. Is the vet a general DVM or a specialist (ACVIM neurology or ACVS ortho)? Not all vets are familiar with treating for IVDD as they don't see enough cases. It doesn't sound as though your vet is comfortable in treating IVDD. A specialist has more knowledge and can be consulted about getting the proper meds on board. Getting the correct treatment for Newman will make all the difference in his recovery. You can tell the specialist that you're just there for a consult, that you are proceeding with conservative care and not looking for surgery and just need advice as to the proper meds. Board-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals. With emergencies of paralysis many hospitals waive a referral by your general vet & have ER night and weekend hours. Locate other board certified neuros/orthos: ► www.acvim.org/►https://online.acvs.org/acvsssa/rflssareferral.query_page?P_VENDOR_TY=VETShttps://online.acvs.org Dodgerlist Members' vet recommendations - dodgerslist.boards.net/board/10/guidelines-postingPlease let us know what the vet says this morning after speaking to him or whether you'll be able to get an emergent consult with a specialist. Healing prayers for Newman. |
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PaulaM
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Post by PaulaM on Mar 26, 2015 8:39:24 GMT -7
Shawn, I'm sorry I got your name and your dog's name incorrect in a previous post another moderator pointed out to me. I wholeheartedly concur with the good comments Marjorie has made. --Do not take any chances about the red flag sign of not eating/drinking. Dex is notorious for the damage it often does to the GI tract. Strongly advocate for getting a 2nd stomach protector on board today asap: Sucralfate. Give Pepcid AC 5mg 2x/day as the manufacturer indicates it lasts from 12-24 hours. Newman needs the highest level of Pepcid always in his system while on Dex. -- Know your Dex. Read the entire article on Dex marvistavet.com/html/dexamethasone.html so you can best advocate for Newman. ▷ During a disc episode you are describing worsening neuro function (knuckles, pain not himself) in relation to the lessening amt of Dex in his system. Dex lasts for about 2-2.5 days. As the time passes there would be less and less dex in the system. Discuss a mg dose that can be given everyday to keep the amount in the system more even. -- Pain meds with a disc episode need to be optimal (aggressive) and given promptly on schedule...not as needed, not reduced in dose until the time of the taper. Newman IS suffering in pain (yelping not moving much, not himself) -- YES, Dex needs to be tapered for the same health reasons all steroids are slowly reduced as you read in the Dex article above. The Dex taper, however, ends with an every 3rd day dose. --- A consultation/ 2nd opinion with a specialist is not just for surgery. I can be made because you want to verify your local general vet is using optimal medication doses, combinations that surgeons use all the time Ortho specialist directory Neuro specialist directory |
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Mar 26, 2015 9:10:17 GMT -7
I see that you gave an update, Shawn, just as I was typing my reply. Good job on your decision to advocate strongly for an every day dosage of the Dex. It may not have to be given for a full three weeks. Dex is a very strong steroid and usually a vet will try a taper after a week or so to determine whether there is still swelling. At the time of the taper of the Dex, all pain meds would also be stopped so a true test for pain can be made. If there is no pain at the end of the taper, then the swelling has resolved and no further meds are needed. If pain returns during the taper, then all meds must be again started. Pain = swelling = more time on all meds.
Please do also advocate for the Sucralfate as both Paula and I have recommended as well as aggressive pain meds.
You mentioned increased diagnostics such as an MRI. MRIs are usually only done just prior to surgery. They require anesthesia which is dangerous for a dog with IVDD as all core muscles supporting the spine are relaxed. So since you have decided to continue with conservative care with the proper administration of the anti-inflammatory and aggressive pain meds, there would be no need for an MRI at this time.
Please let us know what the vet says after your appointment this morning. Stay strong and stay positive.
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Shawn & Bruno
New Member
M - Dachshund .. Bruno puppy ....Newman RIP
Posts: 45
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Post by Shawn & Bruno on Mar 26, 2015 10:11:51 GMT -7
I cannot thank you enough for all your help. I haven't slept but a few hours the last couple of days and it has been quite emotional. I took Newman to the same vet at 10AM and he started off by saying that he could do a cat scan to give a more detailed view of the back ($700 vs. ~$900). However, he said it was not necessary because Newman was clearly progressing after I showed him a video of Newman using the bathroom in the morning. I brought in all of Newman's vet visits from a puppy. In 2005 (4 years old), Newman had a leg/back problem and the xrays clearly show left leg/hip dysplasia where the bone is slightly out of the socket. Unfortunately, the xrays from his major 2010 episode are on disc but no program exists to view them. He looked at xrays taken by him on 3/21 and he said the T5/6, T10/11, and T8/9 had narrowing but not bad and it was just soft tissue. He noted the 7 10/11 being the worst which is directly in the middle of his back where it has a slight bump. He said the "lumbar spine was clean and that L2/3 is a usual issue" but not with Newman. He started down his back with his fingers and Newman went straight down when he got to the middle. He performed the toe flip test and Newman passed on every single foot which is a big improvement from the previous night. He agreed that he increased dosage of Dex has made a big difference! Newman got a cold laser treatment and the doctor says I should see improvements in 3-5 days but wants a follow up in 7 days as well as cold laser treatments every 2-3 days but didn't specify for how long. This sounds like overkill but I was extremely upset when we spoke at 1:30AM so he is probably pushing every available option. He also mentioned the Animal Chiropractor but I am not going to go that route given the information in this thread.
He prescribed the following medication:
24 X Dexamethasone 0.25MG (1 tablet, 2 times per day for 4 days; 1 tablet, 1 time per day for 8 days, and 1 tablet every other day for remainder for a total of 20 days
10 X Gabapentin 100MG (1/2 capsule, 2 times per day)
20 X Methocarbamol 500MG (1/4 tablet, 2-3 times daily)
Vetri-Science Vetri Disc Talets (http://www.amazon.com/Vetri-Science-Laboratories-Vetri-Disc-Capsules-Count/dp/B0002TR5SO) Is this necessary?
I asked why not the Dex .5MG dosage that Newman was treated with in the past and he said it only had a 12-18 hour life even though it stays in his system for 2 to 2.5 days. This will ensure Newman always has active steroids to reduce the compression. I mentioned Gabapentin and he mentioned the difference between that and Tramdol but it escapes my mind. He was clear that he wants me to only give Newman Methocarbamol unless Newman is still in pain and then switch to the Gabapentin. He doesn't want to over medicate Newman. I wonder if he wasn't completely sure I would keep Newman under complete crate rest. He said the Dex should immediately help with the pain as it will keep the compression down unlike the previous every other day dosage. He said if Newman is in immediate pain to give him Tramadol and bring him in immediately. He did not mentioned Pepcid and I didn't bring it up as Newman's stoll looks better. I noticed the Pepcid was from 2013 so I got him a new package. He went outside and urinated while standing on his "bad" leg and walked MUCH better. His stoll looks nearly normal. As of right now, Newman is in much better spirits. He is resting comfortably in his crate right next to me with very little groans and has eaten his dry food and drank water a few times. I am cautiously optimistic but this must be good news given where we are now compared to last night.
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Post by Pauliana on Mar 26, 2015 15:39:50 GMT -7
Hi Shawn!
Glad Newman is more comfortable now. If he was my dog would give him both the Gabapentin and the Methocarbamol because there are different types of pain. Methocarbamol is for the pain of muscle spasms
and Gabapentin is for nerve pain or hard to control pain. Both of which can happen with a disc episode. Keep in mind that any pain at all slows down healing. It is ok if he sleeps on the pain meds, sleep is a good thing and very healing. Believe me when he is pain free he will be more responsive when he is awake.. When my Tyler was in pain, he wouldn't eat, he wouldn't move, he wouldn't respond to us at all. Once his pain was under control it made all the difference in the world.
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. There should be blood work first to assess liver and kidney health.
All anti-inflammatories (steroids or NSAIDS) can damage the stomach and other parts of the gastro intestinal tract. Proactive vets don't wait til there is nausea, vomit, diarrhea leading to serious bleeding ulcers from the extra stomach acids a steroid or a NSAID causes.
The usual dose of Pepcid AC (famotidine) with a disc episode for doxies is 5mgs 2x/day (0.44mg mg per pound every 12 hours.) Get at the grocery store but FIRST do ask your vet in this particular way: Is there any health reason (heart, liver, or kidney) my dog may not take Pepcid AC?
Pepcid is generally considered a safe-over-the-counter suppressor of stomach acid production for a healthy dog and good insurance. Dogs don't speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach.
Healing and comforting thoughts..
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Shawn & Bruno
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M - Dachshund .. Bruno puppy ....Newman RIP
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Post by Shawn & Bruno on Mar 26, 2015 18:32:05 GMT -7
I took your advice and gave him the 1/2 tablet of Gabapentin and he seems to groan less. He eats his dry food and some of his wet food and drinks water here and there. I expected more given the Dex. He gave several Newman-ish type barks when my wife got home which was good to hear. I took him outside to use the bathroom and for my wife to see him walk. She said he doesn't look as good as the video I took in the AM (6 hours after the 2 - .25MG of Dex though). He is a bit wobbly in the back end and slow but still better than last night where he wouldn't move nor flip his toe over. However, it is raining pretty good and he hates to get his paws wet. Our concern is why aren't we doing the daily .5MG of Dex like the 1st major episode that was successful.
He is relaxing next to me and eating his dry food as I type this. He seems calm with little groans when I pick him up and nearly none when I touch his back or his face. He still seems a bit "slow" or tired but that can be attributed to everything he has been through and all of the meds. Should I be concerned that he isn't walking as good as the AM where he almost seemed normal? Or just assume it is an uphill battle with bumps in the road to recovery?
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PaulaM
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Post by PaulaM on Mar 26, 2015 19:47:16 GMT -7
Shawn I do not understand your vet's reluctance to use aggressive pain medication. You see with the gabapentin addition it does help to control pain. The usual with this painful disease is to use Tramadol and Methocarbamol and gabapentin all together. Pain stems from different sources, thus the need to use different pain meds. Gabapentin works synergistically with Tramadol. Methocarbamol addresses the specific pain of muscle contraction.
Has Newman had a recent blood test that indicates he can't take pain meds your vet is reluctant to use, to verify his organs are healthy enough to take Dex at the more aggressive dose (0.25mg 2x/day for 4 days) he is now on then a taper?
When nerve functions are diminished and in a matter of hours dex is given there might be a quick reversal of nerve diminishment back to normal. But once nerves have been severely damaged then it will take time to regenerate/regrow the dead nerve endings to bring back normal functions. The idea with steroid treatment is for there to be no further diminishment of nerve functions. Loss of nerve function and pain signal the medical treatment is not right and needs adjustment asap.
Is Newman inside of his recovery suite while he is eating?
Is the current vet treating Newman, Dr. Berg the one who Rx'd Dex 0.5mg 2xday? If not, maybe you want a 2nd opinion to verify the use of pain meds and steroid.
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Shawn & Bruno
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Post by Shawn & Bruno on Mar 27, 2015 6:45:29 GMT -7
Hi Paula,
I am giving both Gabapentin and Methocarbamol twice per day. I'll ask the Vet when I see him next. I suspect he doesn't believe he is in strict crate rest and says he prefers a small amount of pain to ensure the dog isn't animal active as "the don't know any better". There's a noticeable difference in his personality when he comes off the pain medication and he is in pain. The groans are more pronounce and he is lethurgic. With both medications in place, his personality is completely back. He used his bad leg today to stand on to urinate and he was steady. He made a few quick steps after he got done defecating that I stopped immediately. This is extremely promising but I am sticking to the strict crate rest, cold laser treatments, and follow up visits to let the vet inspect him.
We open his crate and put the food at the edge or inside. He is content as long as he sees us. He sleeps through the night quietly too as I constantly peek over.
The current vet is Dr. Cattiny of Pompton Lakes Animal Hospital (http://www.pomptonlakesanimalhospital.com/).
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PaulaM
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Post by PaulaM on Mar 27, 2015 8:38:19 GMT -7
Shawn, having a dog in pain is archaic and old school thinking. Vets up to speed on current thinking about pain control are on the same page with this board certified specialist's thought: "Treatment of pain in animals suffering from intervertebral disk herniation is important not only for humane reasons, but also to prevent some of the chronic changes that occur when the painful stimulus is left uncontrolled." Loretta Bubenik. DVM, MS. DACVS School of Veterinary Medicine Louisiana State University, Baton Rouge, LA www.ivis.org/proceedings/navc/2005/SAE/227.pdf?LA=1The crate IS the means to provide limited movement of the back not having a dog in any pain. So it is up to you to either find a new vet who is "in the know" about current thinking about pain control or have the ability to strongly advocate for keeping pain control with the current vet. If you are reporting pain nearing the next dose of pain meds, that means the meds are not right. Contact your vet this morning, report your dog’s symptoms, and discuss adjusting the doses. Methocarbamol, Tramadol and Gabapentin have a short half life. These meds a usually prescribed by a vet to be given every 8 hours (3x/day) so that there is no pain between doses. 10.6 lbs Dexamethasone as of 3/22: 0.25mg 2 times per day for 4 daysGabapentin 50mg 2x/day Methocarbamol 125mg 2- 3 times daily Tramadol 25mg 3 times a day Pepcid AC 5mg 2x day Based on the above med list you have given us, these are ideas to discuss with the current vet or a new one you would hire who is more IVDD knowledgable: ◢ Dex was prescribed for a four day course, then a taper yesterday on 2/26? Since you are still describing pain before next dose of pain meds, it is not time to taper Dex...there is still swelling going on that needs to be resolved. Remember it can take a total of 7-30 days up at the "anti-inflammatory" 2x dose to resolve swelling. So do not be dismayed that a four day course was not enough. It is prudent to try a course and then call for a test taper. No one wants a dog on steroids any longer than necessary. Signs of pain makes dex necessary. ◢ The same 100mgs of daily gabapentin could be divided into three parts to keep the med more evenly in the body. Discuss with the vet about dumping 100mg capsule into a creased sheet of paper. Divide powder into three equal piles of about 33mgs each. Store each 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 drape a piece of thin deli meat around ball for further tastiness! ◢ Discuss actually giving Methocarbamol as prescribed above every 8 hours ◢ Discuss actually giving Tramadol as prescribed above every 8 hours  |
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Shawn & Bruno
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Post by Shawn & Bruno on Mar 27, 2015 10:51:17 GMT -7
I think Newman was just being lazy/baby as he doesn't appear to be in pain now. He is eating and drinking like a pig and wags his tail when I look at him. I expect him to get bloated from the heavy drinking like his 1st episode but at least he is happy. He seems to be OK with both Methocarbamol and Gabapentin at the same time even though the VET advised differently. I will speak to him on Sunday when Newman goes in for cold laser treatment. I expect him to be on board with this approach as I will make clear I am crate resting him.
The medication was altered starting Thursday where Dex is giving twice per day so he has ~18 days to go.
Great advice on the Gabapentin! How do they expect me to cut the capsule without it going everywhere? We are cutting it and scooping it back into the 1/2 end and then putting it in his mouth really quick.
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PaulaM
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Post by PaulaM on Mar 27, 2015 12:21:14 GMT -7
Shawn Thursday (3/26) you wrote: 24 X Dexamethasone 0.25MG (1 tablet, 2 times per day for 4 days; 1 tablet, 1 time per day for 8 days, and 1 tablet every other day for remainder for a total of 20 days1 tablet of 0.25mg given 2x per day is approaching the anti-inflammatory dose. Your writing above indicates you would do this for 4 days. When the dose or frequency is reduced, then it is no longer approaching the anti-inflammatory range. Can you clarify if the 0.25mg dex 2x/day is now going to be given for an 18 day course, then a taper? Dex can be a most wonderful drug in getting inflammation down. It should not be use any longer than necessary because it carries alot of side effects in addition to the dangers to the GI tract. The way to determine how long to use dex is simple. The vet will call for a reduction of Dex away from the anti-inflammatory dose, a taper, when he guesses there is no more pain. Along with the taper, pain meds are stopped to give a clear and fast picture about pain. If you would see any hint of pain resurfacing with the stop of pain meds and taper of Dex, then the reporting to the vet, lets him know there is indeed a need to extend the anti-inflammatory course of pred for a bit longer. Often vets will try a taper at these points: 5-7 days, 14 days point. Some dogs do get all the swelling down in 7 days, while other end up on the anti-inflammatory dose for as long as 30 days. Each dog is individual. The taper test is the only way to know whether to extend Dex or go to conclusion of stopping it. Again no one wants a dog on Dex any longer than necessary. If there is no pain on the taper it can go to conclusion of an every third day dose then to a full stop. Please read this veterinary information here: www.marvistavet.com/html/dexamethasone.html |
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Shawn & Bruno
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Post by Shawn & Bruno on Mar 27, 2015 13:39:51 GMT -7
Are you suggesting that .25MG 2x per day is not satisfactory?
Those are the details on the bottle provided by the Vet. It sounds like you are suggesting a longer duration of the 2 per day dosage. During Newman's 1st (and worst) episode, Dr. Berg (Yonkers Animal Hospital) prescribed the following Dex medication: 1 - .5MG per day for 5 days, then 1 - .5MG per day for 14 days, and then 10 - .5MG every other day (tapering I assume?) which is a much longer duration. That seems to be quite longer given your 14 day reference below. However, he fully recovered. When I questioned the different approach (2 - .25MG), the Vet said it was to ensure the Dex is constantly working given its 12-18 hour half life which makes some sense. But, I wouldn't know if 2 - .25MG per day or 1 - .5MG is better.
My success has been through you folks so I highly respect your judgement. I am a bit concerned that the Vet is prescribing much less medication that you expect. I suppose that can be due to the fact that he doesn't want to over-medicate Newman. Please note it is very difficult for me to diagnose him. To me, he is obviously getting better as he walks with much better stability (after the increased dosage of Dex), appears to be in much less pain (groans less, eats/drinks, wags, etc.), etc. However, he is drinking water like a fish and is getting bloated like last time so I am sure that doesn't feel good. He is also on steroids, pain medications, disc issue, etc. that all affect his personality making it difficult to truly understand what is going on.
I am planning to see the Vet on Saturday for cold laser treatment so I can discuss whatever you think is appropriate.
To be clear, after 4 days (when the total amount given is less than .5MG per day) it is considered tapering and pain medication should be completely stopped immediately (e.g. on the 5th day, ONLY Dex/Pepcid is given)? If so, I am concerned that Newman will still be in pain and compression would still exist. This is due to the success of the long period of .5MG in the 1st episode and the fact that .25MG every other day did little until a change was made. I just don't know to have an effective opinion.
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PaulaM
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Post by PaulaM on Mar 27, 2015 15:47:52 GMT -7
Shawn with steroids the important part of the prescription is the part before the taper. All steroids must be tapered to signal the adrenal glands to again make their own life supporting steroid hormone. It just so happens that the taper is also a window into how painful inflammation is being resolved or not. Stop of pain meds during the taper gives the fastest clearest picture of whether Dex needs to go back up to the higher anti-inflammatory dose.
The idea with steroids is to use for the shortest time it takes to get swelling fully resolved. Swelling resolves by using the anti-inflammatory dose somewhere in the neighborhood of 7-30 days.
There is always a range of mgs and of frequency when using meds, low and high ranges. Dr. J. Berg is listed as a board certified DACVIM (Neurology) specialist and may have more experiences with IVDD than a general DVM vet with his use of 0.50mgs 2x/day for 14 days. Dr. Berg also knew Newman's medical history and the severity of damage to nerves. Also take into account Newman has since aged 4 more years. Has Newman had a recent blood test that indicates his organs are not healthy to take Dex at the anti-inflammtory dose 2x/day for longer than 4 days if necessary?
So the important part of your local DVM's Rx which is still in the anti-inflammatory range is:
0.25mg Dex 2x/day for four days, on the fifth day then comes the directions on how to taper. If you are still seeing pain arise between doses of pain meds, then it is clear not all the inflammation is gone and not time to taper and of course not time to stop any pain meds. If I count correctly Newman IS in the taper today. Your vet does not know what you see at home, he depends on your prompt phone call of reports of pain on a taper.
When working with decimals it is helpful to put in the place holder zeros so the decimal points will line up to help you compare.
1.00 mg (1mg) Twice as much as 0.50mgs
0.50 mg (.5mg) Twice as much as 0.25mg
0.25 mg (.25mg) Half as much as 0.50mg
If the .25mg Dex 2x/day and the pain meds were keeping pain in control while dex is working on swelling, then that is likely a good dose for Newman. If you are seeing some pain still today, then the four days was not long enough.
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Shawn & Bruno
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Post by Shawn & Bruno on Mar 27, 2015 17:51:02 GMT -7
I assume the Vet knows this but how does he determine how long before taper? In this case, it is 4 days which seems too short given the 19 days he was on it in 2010 with his 1st major episode and how ineffective the every other day of .25MG dosage was. I will see him tomorrow so I need to be prepared. I believe he had blood taken in June of last year during his yearly physical at the same Vet. I did discuss the timeline of Newman's history so he should have some idea. I will discuss this tomorrow. The new dosage of 0.25mg Dex 2x/day for four days started Thursday afternoon when he was re-evaluated. I consider Friday (today) the new start date. He is getting better but my heart says he needs longer but that could be my emotions getting the best of me. Newman's personality is back as he CRIES to get out of the crate to play with the baby. However, I still hear some groans but I am not 100% positive that is pain given his personality. It is soo hard to judge. I have been giving him 2 sets of pills at 7AM and 6PM when I get home from work. They both include the 0.25MG Dex, 5MG Pepcid AC, and either the Methocarbamol (500MG @ 1/4 tablet)/Tramadol (1/2 tablet of 0.25MG per instructions) OR Methocarbamol/Gabapentin 100MG (1/2 capsule, 2 times per day) as he appears to be pain free with out having to give him all 3. I should have asked but I didn't think swapping in the Tramadol for the Gabapentin every other was an issue. Thank you. This is helpful. Sorry to keep questioning you but how do we know that the .25MG of Dex 2x/day is working rather than the .50MG 1/day that was successful in the past? I am guessing tapering will tell the story which I am dreading If the Rx is 10 days of steroids until tapering begins on the 11th day, why not "check" (e.g. STOP pain meds) on the 8th day to check? Why must it coincide with the tapering? Or is that just due to expectations that the 11th day is the 1st pain free day? |
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PaulaM
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Post by PaulaM on Mar 27, 2015 19:06:20 GMT -7
No one knows exactly how long it takes to get the swelling down. Usually it is in the range of 7-30 days being at the anti-inflammatory dose of the steroid.
The vet must guess when to taper. Many vets will choose the 7 day or 14 day point based on their gut feeling/experience and what the owner reports about pain, neuro functions. Your vet has guessed that at the 4 day point the painful swelling may be gone. Only the results of the test taper will give the answer. False answers will happen when the pain masking pain meds are not stopped on the Dex taper.
Before starting use of these high powered IVDD meds it is always a good idea to know the current health of organs with bloodwork. If Newman needs an extention of the four days, it might be prudent to ask about bloodwork.
Ok then I got the start date of Dex wrong? as you write "I consider 3/27 the new start date" So you are saying on Friday 3/27 is the first day Newman got 0.25mg twice a day? Is this now the correct med list?
10.6 lbs
Dexamethasone as of 3/27: 0.25mg 2x/day for 4 days, then tapering
Gabapentin 50mg 2x/day
Methocarbamol 125mg 2-3 times daily
Tramadol 25mg 3 times a day
Pepcid AC 5mg 2x day
Normally each med is given promptly on its own schedule such as 3x/day and not alternated nor dropped/swapped for a dose for another med. Methocarbamol works on pain of muscle contractions. If you drop it, then gaba or tramadol do not work on muscle pain. Same idea with Tramadol and gabapentin... each have their own schedule and each have a kind of pain to target.
When the taper starts on Tues, Mar 31 and should there still be pain, then you can discuss with the vet whether a bit higher on the anti-inflammatory dose range is appropriate to speed things up along with an extension of the 2x/day dose. A two day dose keeps the level in the system more even and is what we see most vets on this Forum prescribing. It comes down to medicine is an art, there often is no one formula. Each vet has their own idea of how to approach things. You must hire the vet who listens and answers your questions and who is IVDD knowledgeable.... you and the vet are a team.
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Shawn & Bruno
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Post by Shawn & Bruno on Mar 27, 2015 20:03:29 GMT -7
This is good to know. I will address this with the Vet and understand why he choose 4 days. I will re-iterate Newman's past Dex history and how the single .25MG of Dex was ineffective. This could him just being conservative but he was conservative with the single .25MG of Dex initially and Newman relapsed.
I assume I will notice fairly quickly if he needs to go back on the meds so I will make sure I have additional meds.
The Vet told me to give the Methocarbamol and then switch to the Gabapentin if still in pain. If still in pain, I should switch to the Tramadol and call him. I am currently giving either a Methocarbamol/Gabapentin or Methocarbamol/Tramadol if I think he is in more pain than expected. The advice here is to use a combination of all 3 which is against the Vets orders which makes me a bit uneasy.
Understood. I will make sure to tell the doctor I think more than Methocarbamol isn't enough and we need more medication given what I see. I will also discuss my concerns for only 4 days given the previous set back.
This is excellent advice. Are you suggesting we keep with the 4 days and then check for pain? It is tough as I am emotional to make the best decision. Part of me says: let's check at 4 to avoid any unnecessary steroid and then I keep thinking about the 19 days of .5MG Dex in 2010 along with the previous ineffective Rx that caused the set back.
Thank you for the help.
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Post by Pauliana on Mar 27, 2015 21:00:38 GMT -7
Hi Shawn, Yes Paula was suggesting you follow the Vet's instructions as to the taper at 4 days to check for pain.. and if there is pain to contact the Vet, or have a plan in place with the vet, should pain occur on what you should do. She also suggested you ask for Bloodwork.. "When the taper starts on Tues, Mar 31 and should there still be pain, then you can discuss with the vet whether a bit higher on the anti-inflammatory dose range is appropriate to speed things up along with an extension of the 2x/day dose. A two day dose keeps the level in the system more even and is what we see most vets on this Forum prescribing. It comes down to medicine is an art, there often is no one formula. Each vet has their own idea of how to approach things. You must hire the vet who listens and answers your questions and who is IVDD knowledgeable.... you and the vet are a team. " "Before starting use of these high powered IVDD meds it is always a good idea to know the current health of organs with bloodwork. If Newman needs an extention of the four days, it might be prudent to ask about bloodwork. " Hope Newman is continuing to feel better.. |
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Post by Shawn & Bruno on Mar 28, 2015 5:48:49 GMT -7
I believe Newman is still in pain as I don't believe the pain medication (switching between Gabapentin 50mg/Methocarbamol 125mg AND Methocarbamol/Tramadol 25mg. As I mentioned before, this is more than the Vet initially prescribed but he groans 4-5 hours after the medication is given. I am going to discuss today with the Vet.
We made a horrible mistake of keeping him in his crate too long. I took him out every 3-4 hours but he wouldn't defecate and then he went nuts in his crate when the baby was playing and he defecated in is crate (A LOT). He then tried to eat it to cover it up. It was absolutely heart breaking. He always goes nuts for the baby so we didn't think anything of it. I took him out to urinate and he tried to defecate but farted (Not sure what better word to use?). He then had diarrhea near midnight but walked perfectly fine and held his leg perfectly fine. He didn't want to walk much at all though which I think is due to some pain. I took him out this morning and he didn't want to walk too much but he walked very nicely and even tried to make a couple of "faster" steps until I stopped him. He is resting comfortably now with wife holding his paw while sleeping next to him. Shouldn't the Pepcid stop the diarrhea or is that just for upset stomach?
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Marjorie
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Post by Marjorie on Mar 28, 2015 6:04:31 GMT -7
Please do speak to the vet ASAP about adjusting Newman's pain meds, Shawn. As mentioned, it often takes all three pain meds, Tramadol, Methocarbamol and Gabapentin, given together three times a day to keep pain completely under control from one dose to the next. Dex is a very strong steroid and sometimes it can take a second stomach protector for double protection. Diarrhea is a red flag sign of GI distress. Before it gets any worse, speak to the vet ASAP about adding Sucralfate, along with the Pepcid AC. sucralfate works in a different way to bandaid the damaged mucus lining and also promotes a healing environment. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/html/sucralfate.html Please let us know what the vet says after speaking with them. And be sure to keep his steps limited to a very few steps at potty time. |
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PaulaM
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Post by PaulaM on Mar 28, 2015 8:07:53 GMT -7
Shawn, I'm sorry to hear that Dex is causing GI system problems. Before diarrhea moves to bleeding ulcers with blood in the stool and then finally a deadly perforated stomach lining, do as Marjorie is advising at the very soonist this morning. Strongly advocate by phone for getting sucralfate on board into Newman's stomach quickly. Dex is very well known in the medical community for the damage it can do to the GI tract. All meds have a good side as well as some adverse side effects. Often Dex does wonders as it is one of the most powerful and fast acting of the steroids.... just what is needed when there is evidence of diminishing neuro functions. You reported some wonderful news that he walked perfectly, held his leg perfectly fine. So most excellent news that his neuro functions are where they should be. However, if you are reporting pain, then that would be a reason to still have a steroid on board to still work on inflammation in the spinal cord. A groan may or may not be pain. Usually there will be two or more signs of pain to help you verify and report pain: shivering, trembling, yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy, not their normal perky selves, arched back. If it is true Newman is still suffering with pain, then I would discuss with the vet about moving to a steroid that is still powerful but not so damaging to the GI system. Ask about prednisone or prednisolone. We see IVDD knowledgeable vets on this Forum using the higher end of the prednisone range and at 2x/day. So for a 10.6 lbs dog the dose may be 3.0mgs 2x/day according to Dr. Ruben below. Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily. Dr. Dawn Ruben Prednisone / Prednisolone www.petplace.com/DrugLibrary/prednisone-prednisolone/page1.aspx last accessed 8/13/2014So in summary the ideas you will want to advocate for are: ■ sucralfate addition ASAP this a.m. to Pepcid AC as added protection from the red flag signs of diarrhea ■ discuss moving to a less GI tract damaging steroid.... move to prednisone since neuro functions are good, but you believe you are still observing pain. ■ If you are observing pain, then the pain meds are still not yet right. It is "the usual/normal" for vets who know IVDD to follow the same pain control approach that Dr. Mathews of the WSAVA Global Pain Council is educating veterinarians about in this 2014 article: "When pain is moderate or severe, the veterinarian should consider combining drugs that act at different sites in the pain pathway to provide optimal analgesia; multimodal analgesia (sometimes referred to as balanced analgesia) is the name given to this approach to treating pain. Combining different classes of analgesic drugs allows the veterinarian to optimize the management of pain, while limiting the occurrence of side effects." Mathews, K., Kronen, P. W., Lascelles, D., Nolan, A., Robertson, S., Steagall, P. V., Wright, B. and Yamashoot a pickle!a, K. (2014), "Guidelines for Recognition, Assessment and Treatment of Pain." Journal of Small Animal Practice, 55: E10–E68. doi: 10.1111/jsap.12200 Journal of Small Animal Practice June 2014 I just saw your question: If the Rx is 10 days of steroids until tapering begins on the 11th day, why not "check" (e.g. STOP pain meds) on the 8th day to check? Why must it coincide with the tapering? Or is that just due to expectations that the 11th day is the 1st pain free day? The ONLY true test of if there is painful inflammation is when BOTH pain meds & steroid are being removed from the body. The time to stop pain meds is when the steroid is being removed from the body, the Dex taper....giving the clearest, truest, fastest test for inflammation. |
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Shawn & Bruno
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Post by Shawn & Bruno on Mar 28, 2015 8:40:45 GMT -7
We are actually moving the appointment till tomorrow morning as my wife is feeling quite ill. Newman's stool was more firm this morning similar to ice cream which is normal for him when he eats a lot of dry food. He is a nut case this morning crying and pleading to be let out of the crate. It is really good to hear the old Newman that I know and love. If you still think I should go, I'll talk to the wife as I want her to speak to the Vet. Yes, he is holding both legs quite well. To be honest, I would say 85% compared to normal but to the untrained eye, you wouldn't know. He walks a bit "quicker" and seems to be well on his feet. The only signs of pain that I can tell are the moans (but he always had some) and some slowness at certain parts of the day that appear to be when the medication wears off (e.g. near midnight; he gets pain medication at 6PM). The other indicator is slowness at that time but it could be just the typical lazy Newman. My wife is concerned we are over medicating him as he didn't use pain medication when he was treated with Dex via the neurosurgeon. "If it is true Newman is still suffering with pain, then I would discuss with the vet about moving to a steroid that is still powerful but not so damaging to the GI system. Ask about prednisone or prednisolone. " I will. " ■ sucralfate addition ASAP this a.m. to Pepcid AC as added protection from the red flag signs of diarrhea" Should we go that route given his latest stool was near normal? "discuss moving to prednisone since neuro functions are good" I will. However, I am concerned it will interrupt his progress. It is worth discussing though. |
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PaulaM
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Post by PaulaM on Mar 28, 2015 10:21:17 GMT -7
Shawn is there a special reason you are now using the quote feature? There is not a need to give the entire quote to which you are replying. A phrase, a sentence is sufficient if you feel a need to quote. Maybe you are writing on a mobile device, then I can understand why. If you see slowness when meds are wearing off then it is prudent to believe Newman IS suffering with pain as a disc episode is very painful. The indicator to use aggressive pain meds is seeing pain. Do not compare another disc episode with this one. Focus on what you are seeing with this disc episode. You and your wife can read our article on the main web page to increase your knowledge of meds with IVDD: www.dodgerslist.com/literature/healingpain.htmYou and your wife can read for yourself any thread on this Forum how pain meds are used by vets who know and respect the need to control pain. All moderators have told you your vet is not appreciative of keeping pain in control. Pain is inhumane, it is morally unacceptable and it slows the whole healing process. Getting pain in control requires prompt feedback by a phone call so the vet knows his Rx is not yet right. If a vet is not willing to use the many options for pain control when you report pain, then one may have to assume the vet is simply not comfortable in his knowledge of IVDD. You own Newman. You are responsible for his care, for hiring the right vet for a disease. We can only share with you what is "the usual" with this disease. I don't know what more we can share with you other than to keep repeating what various moderators have written. You will have to come to your own conclusions and decide how long you are willing allow Newman to suffer with pain. I can tell you when pain meds are properly prescribed the pain will be in control in one hour and stays that way dose to dose of the pain meds. If you see pain, then it is clear the pain meds are not yet right. Since March 21 (8 days) you have been reporting pain not in control and the three pain meds usually prescribed all together 3x/day are not being used to benefit Newman. I'm a stickler for pain being in control. If I gave my vet phone call reports of pain and he was not willing to use all his options to get it in control, then my choice would be to find a vet pronto who is IVDD knowledgeable. I would not let my dog suffer for 8 days when there are options for pain control. I know this is a very emotional disease....our brains can get a bit mushy seeing our dogs not feeling good, we begin to question ourselves, we just want to cry. It is never a bad idea to have a 2nd opinion vet at anytime things do not seem right. We humans often get a 2nd opinion for our own diseases...there is no shame in that. No one vet can know all diseases. Most DVMs in a general practice see many different species- hampsters, cats, all breeds of dogs, reptiles, birds, maybe even farm animals. They practice many specialties in the course of a day: pediatrics, dentistry, surgery, internal medicine. Is it surprising, that keeping current and indepth knowledge of each and every disease for every species is probably not likely? However YOU can easily become a mini-expert on one very-important-to-you disease. All things IVDD: www.dodgerslist.com/literature.htmBottom line is you need a vet now who will listen to you, answer your questions so you fully understand his treatment, do his best to get pain in control. And when the vet knows a disease is out of his league offer to refer you to a specialist. Please let us know what your vet said in a phone call today or what a 2nd opinion vet said after an appt today to report pain (groans, slowness nearing next dose of pain meds). Always be wary of the damage Dex can do to the GI tract. Not eating, loose stools are big red flag signs. Has his food been changed to kibble. We don't recommend changing foods when on meds. Then you don't know with any certainty if Dex is causing the problem or the food. Dex problems require 2 protectors on board asap: Pepcid AC and sucralfate. |
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Shawn & Bruno
New Member
M - Dachshund .. Bruno puppy ....Newman RIP
Posts: 45
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Post by Shawn & Bruno on Mar 28, 2015 13:39:43 GMT -7
Apologies for using quote of the entire message. It is a work habit to not change the original message.
He has dry food (http://www.naturalbalanceinc.com/product.aspx?ProductId=12&product=L.I.D.+Limited+Ingredient+Diets%C2%AE+Potato+%26+Duck+Dry+Dog+Formula&ProductCategoryID=12&category=LID+Limited+Ingredient+Diets+Dry+Dog+Formulas) throughout the day and wet food (http://www.petsmart.com/dog/canned-food/simply-nourish-trade-dog-food-zid36-1028/cat-36-catid-100031;pgid=n.B6mPzNCldSRpB66qkSUE3400001BItle_Z;sid=TtyP8tHqW9KO8oT9Xg7K9uHgrdfTVJSWGc77Zpxl?var_id=36-1028&_t=pfm%3Dcategory) at night. He is eating much more dry food due to the Dex so it is much softer than normal when he defecates.
The Vet was in surgery today and Newman has had his best day so far given his personality, his appetite, bathroom breaks, walking, etc.. He appears to be pain free right now so I didn't think it was necessary to drag the Vet out of surgery. We are going tomorrow for his laser surgery and I plan to talk to him and go over everything.
I apologize for making you repeat. It is my OCD to constantly revisit subjects to ensure I fully understand. I truly believe Newman is progressing and in the right direction. I think there might be a tweak needed to the pain medication and perhaps advancing the Dex past 4 days but I will talk it over with the Vet. I want nothing but the best for Newman and doing my very best to understand the issues and make the best decisions for him.
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I called my VET in the morning and indicated I thought compression still existed and she agreed. She did not agree with the 3 days of prednisone so she prescribed 3 weeks and double dosage of prednisone (30X - 5MG @ *1* tablet twice per day for 1 week and *1* tablet once per day for 2 weeks), 3 weeks of tramadol (21X - 50MG; 1/4 tablet @ 3 times per day for 3 weeks), and Methocarmol (8X - 500MG; 1/4 tablet @ 3 times a day). 
