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Post by Jacquelyn & Sonny on Aug 7, 2018 20:18:08 GMT -7
14 1/2 year old senior dog. Normally very active. Weighs 8.2 lbs. Diagnosed with arrhythmia with unknown cause. Slipped disc in his L4/L5. Gabapatin was being given 1 mg every 12 hours. Vet recommended cutting the gabapatin in half to prevent stomach ulcers so it is now being given at .5mg but 1-2x a day. Also on Prilosec 5mg 2x a day. No steroid was prescriped. Anti-inflammatory was only prescriped for one week and is now finished. He was taken to the hospital on 07/19. Started medication on the same day. [Moderator's note: please do not modify 8.2 lbs no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for pain/neuro loss crate rest ONLY started 8/7!!gabapentin 250mg/5ml.: 1ml 2x/day Prilosec 5mgs 2x/day] ★2 Pomeranian named Sonny. My name is Jacquelyn! ★3 Vet said it is likely IVDD but not confirmed. Said he has a slipped disc. He was taken to the vet emergency room at U of Penn. ★5 I believe there is still some pain such as yelping when picked up, nose to ground, some shaking, reluctancy to get out of one position. Heavily sleeping. I have him in a play penn bedded with blankets and pillows to decrease space inside and for comfort. ★6 Eating and drinking OK? Eating when I hand feed him. Drinking too. Not sure about his poop. ★7 He seems okay to walk and able to move legs but for a very short period. Wags tail once or twice a day. ★8 He is still able to squat and lifts his leg to pee when outside.
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Post by Pauliana on Aug 7, 2018 22:11:14 GMT -7
Welcome to Dodgerslist Jacquelyn! Sorry to hear all Sonny is going through! So glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you! **Disc disease is not a death sentence! ** Struggling with quality of life questions? Re-think things: www.dodgerslist.com/index/SDUNCANquality.htmIt sounds to me as if Sonny is having a neck disc episode.. Very,very painful! There is more work for an anti-inflammatory to do.. Pain means swelling is still ongoing! It is the swelling pressing on the nerves of the cervical area that is causing the pain.. What was he taking before for inflammation? He needs to be back on it! Call your vet and have Sonny's medications adjusted ASAP. Pain slows down healing so have no patience with it.. Gabapentin doesn't cause ulcers.. It is a pain reliever.. Anti inflammatory medications such as Steroids or NSAIDS can cause ulcers , so the vet must have been talking about the anti inflammatory.. Is the Gabapentin liquid? Liquid meds are dosed in ML's instead of Mgs.. The bottle should say how many mgs per ml.. We need that info to figure out the dosage Sonny is taking.. He is under medicated for the severe pain of a neck disc episode.. These are the typical pain medications used to treat IVDD to address each source of pain: Tramadol as the general pain reliever. It has a short half life of 1.7 hours and may need to be prescribed at a minimum of every 8 hours. Methocarbamol treats painful muscle spasms. Also prescribed every 8 hours. Gabapentin for nerve pain. Veterinarians are finding this medication works synergistically in combination with Tramadol. Amantadine. When the above three meds have been Rx'd at the aggressive dose in mgs and at every 8 hours, but pain is still not fully controlled, then advocate for the addition of amantadine - allows other analgesics to function more effectively. The Mar Vista vets explain the mysteries of amantadine marvistavet.com/amantadine.pml Both classes of anti-inflammatories require stomach protection. The steroid class is the most powerful of the two classes (Prednisone, Dexamethasone, etc.) The lessor class are the NSAIDs (Rimadyl, Metacam, Deramaxx, etc.) Anti-inflammatories should be accompanied by a stomach protector such as Pepcid AC (famotidine) to avoid serious gastrointestinal damage. For some dogs Pepcid AC is not enought and needs to be accompanied with yet another protector, Sucralfate, when there are signs of GI problems of diarrhea, vomit, bleeding ulcers, bloody stools. An anti-inflammatory, steroid or non-steroid NSAID, can take 7-30 days (exluding any steroid taper days) to resolve all pain. During a test-for-pain steroid taper is the time to watch for any returning signs or increased neuro diminishment. NSAIDs do not require a taper. Pain/neuro diminishment indicates another course of the steroid or the NSAID. After repeated attempts to go off any anti-inflammatory, if pain cannot be totally resolved, surgery becomes a consideration. NOTE: Danger to give a NSAID and steroid together or switch without a 4-7 day washout. Raise food and water bowls to head height to avoid bending down to eat and drink. [photo how to] If you feed kibble, moisten each meal with equal parts water and kibble. Store in the fridge overnight to soften and rehydrate. Before serving, warm slightly in microwave, just to take the chill off. This will eliminate pain from crunching kibble. No chew treats or kongs during recovery. Chewing on those makes the head and neck move a lot and can disrupt the healing process of the disc, causing more pain and more time to heal the disc. Pain meds should be adjusted to give full round the clock 24/7 comfort from pain. Your dog may like a rolled up blanket or bolster where he can choose to rest the head on or lean against. Mary's tip: warm up light-in-weight-100%-synthetic fleece in the dryer to drape over shoulders/neck for coziness. Raise the crate up on a table so there is no need for your dog to to raise the head to look at you or watch the world from his recovery suite. Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to go over to our Main Dodgerslist website as soon as possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. I see you have already been learning alot about IVDD and that is very beneficial for Sonny! You will be amazed with yourself on how well IVDD educated you can become in a such a short time! A quick summary all about conservative treatment and a good road map to follow is at the yellow button pictured below. Follow the rest of the colored buttons in the next days to become the IVDD savvy pet parent your dog will need. www.dodgerslist.com/healingindex.htmimage.ibb.co/dBfFbo/conserv_button5.jpgFiirst things first to get Sonny's pain under control, it will make all the difference in his recovery and will make it easier to you to take care of him.. Please keep us posted.. Healing thoughts and prayers
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Post by Jacquelyn & Sonny on Aug 7, 2018 23:45:40 GMT -7
Hello Paulina! Thank you. I am sorry I didn’t specify earlier but he was diagnosed with a slipped disc in his L4/L5. He was taking Meloxicam. It was prescribed at .5 ml for just thefirst day and then .25 ml by mouth once a day for 6 days. They only gave us 6 days worth and now we are on day 20. Why did they do that?
The gabapentin is a liquid at 250mg/5ml. Should I start him back on the anti-inflammatory (we have a little left until we call the vet) and if so, how much? .25ml? Should I request the additional pain medication like tramadol?
How can I raise his round play pen up (Jespet pet exercise playpen)? Should I be using a sling when he goes outside to pee? He also was found to have arrhythmia but the cause is unknown. Is it safe for him to be taking the omeprazole (prilosec)?
Thanks for all your help!!
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Marjorie
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Post by Marjorie on Aug 8, 2018 4:58:25 GMT -7
Hi, Jacquelyn. You shouldn't self-prescribe medication and need to speak to the vet to get Sonny immediately back on Meloxicam today. Pain indicates there is still swelling pressing on the nerves of the spine. It's that swelling pressing on the nerves that causes the pain and can also damage nerves. So it's very important to get that back on board ASAP. The sooner the swelling goes down, the better. You should also advocate strongly for an adjustment of pain meds. Sometimes it takes all three pain meds to get the pain of IVDD under control - Tramadol as a general pain reliever, Methocarbamol for the pain of muscles spasms and Gabapentin for nerve pain. Also you should speak to the vet about the safety of giving Omeprazole since Sonny has arrhythmia. Possibly Sucralfate would be a better choice as a stomach protector. Did the ER vet know about Sonny's arrhythmia? I'm not sure why you want to raise the play pen up? Pauliana was referring to raising food/water dishes up so Sonny doesn't need to bend his head because she thought it sounded like a neck injury. But with a L4/L5 diagnosis, this doesn't involve the neck. You mentioned he has his nose to the ground. Is he able to lift his head and look at you without pain? Does he cry when turning his head? You don't need to use a sling unless he's wobbly walking. A sling stabilizes the spine so he doesn't tip over but if he's walking steady, he doesn't need one. What was the date that strict crate rest was started? Just to be sure we're on the same page about strict crate rest: The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/literature/CrateRRP.htmSTRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: www.dodgerslist.com/literature/chiropractic.htm ◼︎no dragging or meandering at potty times. ◼︎no PT for conservative dogs during 8 weeks to heal disc Any of the vets at the hospital where Sonny was seen should be able to look at his records and adjust meds with a phone call from you. If they are unable or unwilling to get an anti-inflammatory back on board today and adjust the pain meds to get Sonny's pain completely under control, then you'll need to find another vet who is more familiar with treating IVDD or who will work with you on the meds. A neurologist can be consulted just to get the correct meds on board, even with surgery not yet being a consideration. It's best to try to work with the ER vets first since going to another vet will necessitate an office visit. Transport involves risk of too much movement of the spine and should only be done if absolutely necessary. Please let us know what the hospital says after speaking to them today. Healing prayers for Sonny.
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Post by Jacquelyn & Sonny on Aug 8, 2018 11:14:50 GMT -7
Hi Marjorie. Thank you for for your post. I called today and I am waiting to hear back. What is the best way to advocate for meds?
I feel strange telling the doctor what he should be prescribed. He mostly turns his head down when he is sitting up but maybe its because he likes his neck massaged. He does not cry when turning his neck. Do you think .5ml is too little for gabapetin dosage from your experience? Strict crate rest technically started yesterday since he was still coming out and taking short 5 minute walks.
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Post by Merriem & Spike on Aug 8, 2018 11:24:49 GMT -7
I am going to chime in here. I took Spike to a local vet..not our regular one because I wanted to get a UA Done. In the brief conversation I mentioned all the great IVDD info on this board, and how crate rest can help avoid surgery if the dog is diagnosed properly....he literally blew me away like I didn't know a thing. I know how frustrating a good productive conversation can be.
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PaulaM
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Post by PaulaM on Aug 8, 2018 11:54:33 GMT -7
Jacquelyn, here is useful information about your question for help in advocating. Give specific observations. You know which observations are for pain. SIGNS OF PAIN ◻︎ shivering-trembling ◻︎ yelping when picked up or moved ◻︎ slow to move ◻︎ tight tense tummy ◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions + pain from neck disc: ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves
There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock. When pain meds are correctly prescribed IN ONE HOUR pain will be in control and you would expect no pain to show at all--- full pain control right up to the next doses of pain meds. So if your vet does not increase pain meds, then you speak up about concerns of pain and wanting an increasein dose/frequency, about adding in the more usual complement of pain meds to address EACH source of pain. Pain meds have a short half life and are very likely to NOT control pain dose to dose, round the clock unless Rx'd for every 8 hours! ---gabapentin is for nerve pain promptly every 8 hrs. Please let us know how many mL of gabapentin is being currently given and if the vet makes any change in the mL dose. --- tramadol is the general analgesic every 8 hrs --- methocarbamol is for muscle contraction pain every 8 hrs PAIN MEDS DO NOT work on inflammation The job of pain meds is to give comfort UNTIL the anti-inflammatory can resolve all painful swelling. There is no anti-inflammatory drug on board!!! Advocate for one! Know your anti-inflammatory drugs so you are able to do your best job in advocating. Vets choose an anti-inflammatory during a disc episode to get painful swelling down in about 7-30 days.
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Post by Jacquelyn & Sonny on Aug 8, 2018 13:58:02 GMT -7
Thank you for your reply. I am still awaiting to hear back. The doctor is taking forever to get back to me. In the meantime, I am afraid to give him the prilosec because I don't know how it will affect his heart. Should I hold off? Also, what is the best way to clean my dog since baths are out of the question? Thanks in advance!!
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Post by Romy & Frankie on Aug 8, 2018 14:17:54 GMT -7
If the ER vet you saw was aware that Sonny has arrhythmia and still suggested Prilosec it should be fine to give it to him. If not, I would wait to speak to the vet.
You can clean Sonny with unscented baby wipes or use thi tip from one of our moderators. Brew a cup a green tea and then COOL dampen a washcloth with the green tea. It has a nice clean fragrance and is very soothing to the skin.
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Post by Jacquelyn & Sonny on Aug 8, 2018 17:33:06 GMT -7
So I spoke with the vet and they said this: *Please let me know if this sounds like a good course of action.
I've included an article re: IVDD management by Dr. Theresa Pancotto. This neurologist is a professor at Virginia Tech, where I went to vet school, so I know that she has good information. I was also consulting with a colleague. She agrees that, given that his bloodwork seems good (other than the hematocrit, which we can recheck), he should be fine for Metacam. The omeprazole is a good adjunct for chronic NSAID use. Tramadol would not be contraindicated, but it is indeed not the most potent or useful of opioids, so we can hold off on that. Per this article, "With grade 2 IVDD, Dr. Pancotto will add in gabapentin or methocarbamol, but she thinks methocarbamol only helps dogs with visible muscle spasms. Gabapentin can be useful long term in dogs that you think may be predisposed to chronic pain".
[Moderator's note: please do not modify 8.2 lbs no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for √pain/neuro loss ✚as of 8/8: ? mgs ?x/day for how many days then stop to test for pain/neuro loss crate rest ONLY started 8/7!! gabapentin 250mg/5ml.: 50mgs (1mL) 2x/day ✚tramadol ? mgs ?x/day Prilosec 5mgs 2x/day]
So, at this point, gabapentin, meloxicam, and rest may be most indicated. We can certainly try adding ✚tramadol and seeing if it is of additional help. I'd also recommend, if you're able, to switch your appointment from Thurs the 16th with Dr. Byrd to Wednesday the 15th with Dr. Dickey (as I've familiarized her with your case, and she's familiar with the doctors down at UPENN).
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PaulaM
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Post by PaulaM on Aug 8, 2018 18:13:09 GMT -7
Jacquelyn, good job on advocating for doing something about the pain!! Obviously your vet is not very comfortable with their knowledge of IVDD, but at least she starting doing some research....good for her. It is a start.
You can probably learn a great deal on just one disease and be at the ready to advocate if necessary in the future.
Omeprazole can do a good job at supressing stomach acids Metacam (meloxicam) causes. Our question was: IS omeprazole CONTRAindicated with a heart issue of arhythmia that your dog has? Did you get that specific answer?
Do let us know what details on the prescriptions are:
---gabapentin is for nerve pain and the Rx should be for every 8 hours Please let us know how many mL of gabapentin is being currently given and if the vet makes any change in the mL dose or increases the frequency to every 8 hrs.
--Metacam (meloxicam) what is the dose, how many times a day AND for how many days is Sonny to take it. On the stop of Metacam is a test for pain/neuro loss to see if another course is needed.
Have no patience with pain if not in full control in one hour and remains that way round the clock.
Tramadol may not work for all dogs, but we see when added there are SO many who then have pain relief. So while the current thinking is that tramadol is not a good pain reliever, it may well be a good one for your dog.
These meds work together better than they may work singlely. Gabapentin works synergistically with Metacam AND tramdaol. Got our finger crossed for Sonny to be be quickly feeling very comfortable. Let us know what you observe.
Vets who know IVDD, understand the importance of keeping vet visits and the risk of too much movement of the back limited to the utmost important of visits. Often giving a report about pain, neuro status, over the phone can preclude bringing a dog in and still get meds adjusted if needed.
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Post by Julie & Perry on Aug 9, 2018 9:29:04 GMT -7
I've seen good pain relief in both my IVDD dog's with tramadol for general pain, gabapentin for nerve pain, and methocarbomal for the muscle spasms.
IVDD is very painful and almost always has muscle spasms.
I advocate an aggressive approach to medication because I've seen it work.
If you or I were in pain we would want immediate relief!
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Post by Jacquelyn & Sonny on Aug 10, 2018 14:55:31 GMT -7
Sonny seems worse today. I gave him 1ml of the gabapetin (6 am and 2:30 pm [8 hrs apart]) and he yelped a few times when trying to get out of sitting position and also when I tried to pick him up to take him to potty. We are waiting for our appointment on weds to get the tramadol. Why does he seem worse today? He did not yelp like this yesterday.
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Post by Romy & Frankie on Aug 10, 2018 15:27:52 GMT -7
I am not sure why he seems worse today. Did he move more today? Was his med schedule the same as yesterday?
Whatever the reason, he is in pain today and waiting until Wednesday for pain relief is a very long time for Sonny to be hurting. Pain will only slow his healing. Once a dog has been seen by a vet for the disc episode, many are willing to adjust pain meds over the phone. If you explain to your vet that Sonny is yelping in pain she may be willing to prescribe the tramadol without a visit.
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PaulaM
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Post by PaulaM on Aug 11, 2018 8:14:20 GMT -7
Jacquelyn, have you you able to get in touch with your vet to report pain and get the meds adjusted as Romy posted yesterday? Watiing til Wed to take care of pain is not a good idea. Have no patience with pain. It hinders healing not to mention it is torture to endure.
It looks like you are now given gabapentin 50mgs (1 mL) every 8 hrs now? Did those two pain signs appear nearing the next dose of gabapentin?
Please let us know: --- you have advocated for gabapentin at the correct dose be given every 8 hours and got that Rx from the vet. --- you have picked up Sonny's prescription and what the dose is in mgs AND that is was prescribed for every 8 hrs in order to contribute to round the clock pain relief.
IMPORTANT INFO --- Metacam (meloxicam). Knowing for how many days it is prescribed is important to know on several accounts in understanding Sonny's treatment. 1) As of 8/8 with the 2nd course for how many days is that Metacam course? 2) On the stop of Meloxicam is when the vet has made a guess that all painful swelling might be gone. At home it will be your job to monitor for pain surfacing and report the results of test for pain stop of Metacam.
Please help us to understand the meds, why pain, by providing answers to our questions.
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Post by Jacquelyn & Sonny on Aug 15, 2018 13:21:02 GMT -7
Hi. Update as of today. I took Sonny to the vet and she was quite frankly very dire in her assessment. She said the disc will never heal and Sonny will never be able to run around the yard or take long walks in the park again. Her assessment was not hopeful at all, even though Sonny's case is mild and his nervous system function has not been compromised. To be honest, this visit was very disheartening. I was told to keep Sonny on:
Gabapetin every 8-12 hours Added ✚Tramadol 50 mg 1/4 tablet every 6-12 hours End use of Meloxicam and add Galliprant 20 mg at 1/4 tablet every 24 hours (Doctor said it would be a safer anti-inflammatory for longterm kidney function) Prilosec 5mgs 2x a day
[Moderator's note: please do not modify 8.2 lbs no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for √pain/neuro loss as of 8/8: ? mgs ?x/day for 14 days then 8/15 stop to test for pain/neuro loss ✚Galliprant not giving 5mgs 1x/day for 4 weeks? no 5-7 days washout!!!! crate rest ONLY started 8/7!! gabapentin 250mg/5ml.: 50mgs (1mL) ▲ 3x/day ✚tramadol 12.5mgs mgs 3x/day Prilosec 5mgs 2x/day]
She said to come back in 4 weeks. Said if there is not much improvement by then, then there wont be much more as he is an older dog. In my opinion, Sonny seems to have improved but still yelps here and there sometimes when picked up. he tried to stretch his hind leg and loss balance.
Paula to answer your question, I believe the pain was due to him nearing the next pain dose and we have now been doing it [?]every 8 hours instead of closer to every 12 hours.
I hope I can get more hope from this forum as the doctor did the opposite, although I don't want to live in fairytale land either.
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Post by Romy & Frankie on Aug 15, 2018 13:48:22 GMT -7
It is not common for neuro function to return in such a short period of time especially since Strict crate rest started only a week ago. I am not sure why your vet is so pessimistic. We have had thousands of dogs on Dodgerslist and have seen that fuction can retrun but it is often best to think in terms of months rather than days or weeks. There is every reason to hope for improvemnet.
Switching from one NSAID to another without a 4-7 day washout can cause GI issues which can be potentiaolly serious. If there is to be no washout period where neither medicine is in the system please ask the vet about Sucralfate to protect his stomach as well as the prilosec..
Meloxicam can effect the kidneys in some cases. Has blood work shown that Sonny has a problem with his kidneys? Meloxicam has been proven helpful in IVDD while Galliprant has not.
If she is still yelping she may still be in pain. Let your vet know there are still signs of pain.You can advocate for methocarbamol to be added. This med is for muscle contraction pain and works best given every 8 hrs
Please do not give up hope. There is still time for a lot of healing to take place.
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Post by Julie & Perry on Aug 15, 2018 14:33:06 GMT -7
Personally, I would be looking for another vet! There's no reason for such dire predictions for Sonny. All the issues you've described are workable. Don't give up!!
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Post by Jacquelyn & Sonny on Aug 15, 2018 14:36:14 GMT -7
Sonny does not have an issue with his kidneys however she said it could function long term. Should I still ask to be switched back to meloxicam? How do I advocate for this since I was already sent home with these medications?
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PaulaM
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Post by PaulaM on Aug 15, 2018 17:05:08 GMT -7
Jacquelyn, questions so we can be more fully aware of what is going on AND some econcerns to point out so you can follow up on. Penn StateER diagnosed sipped disc. Your appt today was wth your regular vet? This was her first time to see Sonny for the slipped disc episode? Galliprant was developed and tested ONLY for osteoarthritis. Did the vet you saw today indicated a leaning more to arthritis than a slipped disc? NEURO FUNCTION -- Can Sonny still move his back legs, still walk taking footsteps on his own at potty time? -- Did the vet today check to see if there was any delay in returning the back paws to the correct placement on the floor after the vet tried to knuckle under his paw? A delay would indicate some minor neuro diminishement. A big time clue Sonny does have a disc episode and likely not arthritis as the cause of his painful yelping and reluctance to move. So if this is a disc episode you likley would not want to go the risk of swithching meds in mid course! And not switching to a med that has only been tested for arthritis. Switching to Galliprant without double sotmach protection or a 5-7 days washout is subjecting Sonny to unnecessary DANGER! Read the Galliprant info sheet yourself...just as your vet should have done. It takes DAYS for Meloxicam to washout out from the body. To give Galliprant before that happens is the same as give both together! So I would NOT give Galliprant til you do a 5-7 day washout from Meloxicam as there is NO EMERGENCY to risk not doing a washout. There is no pain emergency, there is no neuro loss emergency. There are no safe meds. There are only vets who use meds in a safe way and owners who read about every med that goes in their dog's mouth and is at the ready to ask question, monitor for side effects and get help if something rears up. The FDA explains all this in a very nicely written flyer for you to read: www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm196295.htmCan you see another vet in the same clinic or another clinic to get the meloxicam straightened out 1st thing in the morning. Remember the lack of crate rest until 8/7 has basically negated any prior use of Meloxicam..the disc was not being allowed to heal....continued pain, etc. Did the vet you saw today understand you had not been doing crate rest until 8/7? You really need good support and a clear explanation of what Sonny likely has. When the symptom are mild it can be difficult to nail down a clear disc episode or arthritis diagnosis. Until you know for sure you are not dealign with a disc episode, you must act like it IS a disc episdoe and protect the spinal cord with limited movement.....the single most important care. Would you help me by looking over this med list below and fixing is. IT was a bit hard to understand what exact med(s) was given every 8 hours. It is good you did get a range of hrs to give a med. However for us it is helpful to comment if we know how often you actually are giving each med. 8.2 lbs
Meloxicam as of 7/19 for 7 days but no crate rest prescribed!!! as of 8/8: ? mgs ?x/day for 8 days then 8/15 stop to test for pain/neuro loss ✚Galliprant!!!! as of 8/15: 5mgs 1x/day for 4 weeks? no 5-7 days washout!!!! crate rest ONLY started 8/7!!gabapentin 250mg/5ml.: 50mgs (1mL) 2x/day WHICH??? every 8 or every 12 hrs tramadol 12.5mgs mgs WHICH??? every 6 or every 12 hrsPrilosec 5mgs 2x/day
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Post by Jacquelyn & Sonny on Aug 15, 2018 18:46:45 GMT -7
Hello. I regularly go to Womens humane Society. Today, a vet I never met before saw Sonny. He does not always see the same doctor at Womens Humane Society.
NEURO FUNCTION -- Can Sonny still move his back legs, still walk taking footsteps on his own at potty time? YES! -- Did the vet today check to see if there was any delay in returning the back paws to the correct placement on the floor after the vet tried to knuckle under his paw? Not that I noticed. if she did, she did not say anything.
Sonny absolutely is diagnosed with a slipped disc. That is from the findings of of UPENN after he was Xrayed! I do not know why she would prescribe something that is for arthritis. I am calling again in the morning to resolve this. I will not give him any Galliprant with what I know now.
Please see my edits below:
Meloxicam as of 7/19 for 7 days but no crate rest prescribed!!! as of 8/9: .25 mgs 1x/day for 8 days then 8/15 stop to test for pain/neuro loss ✚Galliprant!!!! not giving: 5mgs 1x/day for 4 weeks? no 5-7 days washout!!!! crate rest ONLY started 8/7!! gabapentin 250mg/5ml bottle of liquid Giving [50mgs] (1mL) 2x/day Was initially every 12 hours but we switched to every 9/-10 hours because of pain tramadol 12.5mgs mgs Bottle says 6-12 hours, what do you recommend? I have not given yet. Prilosec 5mgs 1x/day
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PaulaM
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Post by PaulaM on Aug 15, 2018 19:18:37 GMT -7
Oh my that's a lot of different vets then. If possible you may want to consider finding a primary DVM vet for your senior gal at some point. That way one vet follows all visits and has a relationship with Sonny. While another vet could read her file and prescribe, it is just not the same as having followed a patient and having had eyes and hands on exams, etc. Especially good to have with a senior gal. Also YOU develop a relationship with the vet you have singled out to hire to be on Sonny's IVDD health care team. That, too, is important. It's a people/dog business! Tramadol lasts for about 8 hours. So I would start with every 8 hours. Let us know how the pain goes especially since she is out of meloxicam for the morning dose tomorrow??? More pain relief might be indicated until meloxicam can be reinstated. Gabapentin also lasts for 8 hours, that is why at every 12 hours it was not helping! Let us know what the next vet will say about getting back on meloxicam. It can take 7-30 days for it to get all swelling down. Due to lack of crate rest til 8/7 she has really only had one 8-day course of meloxicam. So do not be disheartened that another course is needed. At the stop of Meloxicam, then you at home are to notice any pain surfacing indicating even another meloxicam course would be needed. Usually both pain meds would be stopped or backed off to allow you to be clear in assessing for pain. So when you get the next Meloxicam course prescribed, ASK which does that vet want a backing off or full stop of pain meds when the meloxicam stops. This page will have you in the know and best able to converse with vets about the use of an anti-inflammatory drug such as meloxicam during a disc episode: www.dodgerslist.com/literature/healingsweling.htm
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Post by Jacquelyn & Sonny on Aug 18, 2018 10:18:20 GMT -7
Hello. It has been a very stressful few days to say the least. My mom and I are exhausted taking care of Sonny. This is not easy. So the update is, today finally, we picked up the meloxicam. I was wrong about not having a lot of meloxicam left over. We actually had enough to take him through until even tomorrow if needed so he has been on the meloxicam at .15mg each day. Sonny should stay on this for how long? The vet told us that his shaking and panting was not due to his stomach but pain and said we could get an MRI to see if it's gotten worse. I don't think this is necessary as it would just tell us what we already know. What do you guys think?
Also, Sonny had constipation early this morning. I am afraid maybe the prilosec is not enough? Not sure whats going on, but definitely some GI issues today and he has been wimpering. It's so hard trying to figure out through trial and error why he is crying. Please advise... thank you.
[Moderator's note: please do not modify 8.2 lbs/3.72 kg no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for √pain/neuro loss as of 8/8: 1x/day for 14+ days then stop to test for pain/neuro loss crate rest ONLY started 8/7!! gabapentin 250mg/5ml.: 50mgs (1mL) 3x/day tramadol 12.5mgs mgs 3x/day Prilosec 5mgs 2x/day]
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Post by Alix & Gretta on Aug 18, 2018 10:30:18 GMT -7
We are about a month ahead of you in the process, and I promise it gets easier. Those first few weeks are so rough. You are doing a great job!
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Post by Romy & Frankie on Aug 18, 2018 15:06:35 GMT -7
I know how very hard it is to care for an IVDD dog and you are doing a good job taking care of Sonny.
Now that Meloxicam is back on board there will be something that has been proven to work on spinal cord inflammation to help Sonny. A medicine like Meloxicam is usually taken for about 7-10 days.It is then stopped and the pain meds are stopped or cut back along with it. If pain returns when these meds are stopped we know that there is still inflammation in the spinal cord (because that is what cause the pain) and all the meds should be started again for another 7 or so days then stopped to see if pain returns. This may need to be done several times before the inflammation (and pain) is gone.
Shaking and whimpering are signs of pain. Panting can also be a sign of pain. Are you giving the tramadol and gabapentin every 8 hours? These medicines do not last long in the body and often must be given 3x a day to provide pain relief. For panting try putting a fan near the crate but not pointed at Sonny to gently circulate air.
A natural way to help with constipation is pumpkin. To help loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day.
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PaulaM
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Post by PaulaM on Aug 18, 2018 16:52:03 GMT -7
Jacquelyn,
Since there was no stop of Meloxicam and Sonny has been on gabapentin and Tramadol every 8 hours, HAS THE PAIN been in control? If not, then the pain meds are simply not yet right! ---- Get with the U of Penn ER doc today/tonight or another DVM there who CAN read Sonny's file and could prescribe. Advocate strongly for using an aggressive dose of tramadol for an 8.2 lbs/3.72 kg dog IF, IF compatible with arhythmia.
Plumb's is considered the "drug bible" of the veterinary world. Advocate for covering the third usual kind of pain with a disc episode of muscle contraction pain with Methocarbamol every 8 hours.
Tramadol can cause constipation and thus good idea Romy gave about plain pureed canned pumpkin OR alternative of microwaved and mashed white or sweet potato. --- soak each kibble in equal part water/broth --- give 1 teaspoon 1x/day
Tramadol can cause panting. OR panting can be a sign of pain. If not sure look for another sign of pain to help you decide if pain. Try a fan near but not pointed at the suite to help give slight air circulation if panting is caused by tramadol.
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Post by Jacquelyn & Sonny on Aug 29, 2018 4:40:13 GMT -7
Hello. I am back to update on Sonny. I just don't know what is happening. He seems good for days at a time and then suddenly takes a turn for the worst. He did not seem to be in pain so I didn't see the tramadol as necessary even after prescribed up until last night, when he was visibly showing signs of pain such as panting and fear of getting out of the standing position.
This just started yesterday. I don't understand why!I noticed when he does walk a little, he seems to be losing use of his right rear leg. Also a few yelps when going from sitting to standing.
Does this mean more nerve damage has occured? I do notice that he has definitely lost weight and their is less muscle mass on that side, could that be why the leg is so weak? Nevertheless, I am worried and upset because I just when their is improvement, this happens. He is also still on melocam at .2ml. How long should I keep him on this? I feel like it's been a long time now. I must admit, we have been taking him out of his small crate and placing him on our beds at night. Could this be why he's not healing? (We had a big one but bought a newer small one because the initial pen had too much room to roam).
[Moderator's note: please do not modify 8.2 lbs/3.72 kg no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for √pain/neuro loss as of 8/8: 1x/day for 14+ days then stop to test for pain/neuro loss not crating dog Pain and neuro diminishment observed 8/28 gabapentin 250mg/5ml.: 50mgs (1mL) 3x/day ✚tramadol only as of 8/28: 12.5mgs mgs 3x/day Prilosec 5mgs 2x/day]
It's so hard because he is such a active and vocal dog despite his age and so he is non stop barking in the pen and even moving to the point of possibly hurting himself so I get scared and take him out. Or his barking can wake up my brother. He will do things like scratching his bed to get comfortable, not sure if that can hurt him too. Please advise because I am the only one out of my family who is trying to give him the tough love this website recommends to help him heal while everyone else says I am torturing him and he's suffering. So as of last night, I gave him 1/4 of the pill of ✚tramadol and will probably give it to him again since he has taken a turn for the worse every 8 hours. Very disheartened and needing hope right now to pull through. Does this update mean I am at square 1 again?
Ps. Also tried pee pads to prevent taking him outside but that caused a ton of stress and didn't work. He would not go no matter how much I ignored him other than a handful of times so we switched back to taking him outside. I do not use a leash. But I walk by him and monitor him and don't let him run.
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Mary & Mila
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FEMALE— DACHSHUND
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Post by Mary & Mila on Aug 29, 2018 5:30:32 GMT -7
Hi Jacquelyn, I've just been reading up on Sonny's treatment. My name is Mary. Two things in your post stand out for me, firstly Sonny yelps when going from sitting to standing. This is obviously a sign of pain, when this occurs we contact our vet and let him/her know, obviously the meds are not quite right yet and need to be adjusted. When meds are correct there are no signs of pain 24/7. This helps your dog to heal. Pain will slow down healing.Signs of 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 ☐Can’t find a comfortable position ☐Arched back ☐ Holding front or back leg flamingo style not wanting to bear weight ☐head held high or nose to the ground ☐Not their normal perky selves? Full pain relief is expected in 1 hour and stays that way dose to dose. If not in control your vet needs to know asap to adjust meds.The second thing standing out is this: Sonny is sleeping on your bed. Crate Rest The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite, the mattress and more! —> www.dodgerslist.com/literature/CrateRRP.htmI know it's really difficult and they whine and cry in the crate, but is it worth it for a few nights on the bed if Sonny's recovery is being hampered by that? Here is the link on crate rest. It is so important. Bit like a cast on a broken arm/leg.
Calmers: Here is a link on some ideas to help calm Sonny in the crate Normally these calmers are not a problem to help your dog relax in the recovery suite, but always let your vet know of everything your pet is taking. A dog that is rambunctious in the crate defeats the purpose of crating. It is better to have the edge taken off than facing paralyzed legs with too much movement.
Is your dog rambunctious?
Ask your vet about Rescue Remedy Pet, Plain Benadryl or some other calming aid. It is imperative that during the healing period the dog rests. Being inside the crate jumping against the crate is not resting. The dog must be calm. Make sure you are not inadvertently training the dog for unwanted behavior. Rewards are food, eye contact, speaking, approaching the crate.
Music: Hours of Relaxation Music for Dogs Great for people too
Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price.
Place a DAP pheromone diffuser at floor level where the recovery suite is.
--Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones
Use a DAP diffuser with one oral calmer from below:
1) ANXITANE® S chewable tabs contain 50 mg L-Theanine
2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine.
-- Put a garment you have been wearing and have not washed in the crate.
If a dog is jumping up at the sides of the crate, you can lower the ceiling of the crate. Cut a piece of cardboard the size of the top of the crate, punch holes in the corners and tie the cardboard down into the crate to the level of the top of the dog's head when standing. Or cover the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he/she jumps up, he won't be able to see anything. That may discourage him/her from jumping up. www.dodgerslist.com/literature/cratesupplies.htm
Calming Meds for the crate
The medications for calming that we see the members vet's use are Acepromazine or Trazadone.
They work and our members have had good results from them..
Wishing you both the very best and a speedy recovery, don't give up or lose hope, you can get through this. kind regards Mary
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PaulaM
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Post by PaulaM on Aug 29, 2018 8:15:29 GMT -7
Jacquelyn, please take to heart the important comments Mary has made in the above post.
It IS hard to stand firm with all about you are not supporting Sonny to heal his disc. YOU keep on keeping to stay the course, YOU insist on protecting Sonny's disc and spinal cord as you are informed and they are very clearly not educated about IVDD!
Get with your vet on the phone to alert him about the neuro diminishment of the right rear leg and the signs of pain. Tell him you have been cheating on crate rest and that is the likely reason. If you don't tell the vet, he may think the meds are not working....that is not the case. The cause is lack of true conservative treatment of which the 100% STRICT crate rest 24/7 is the single most important factor to getting the disc to heal and not affect the spinal cord.
At potty time you MUST either use a leash/harness as you stand in one spot. OR what I preferred was an expen or other wire fence to make a small 6 foot diameter potty place. The FENCE lets them know there will be no unexpected darting off. That you ARE protecting the healing disc and the spinal cord. ALL DOGS DO THE UNEXPECTED. We just have be one step ahead of them in planning protection at potty time.
Get an Rx for a sedative for immediate result and look into the calmers as they can take a couple of days to be effective.
Let us know what your vet says about the back leg neuro diminishement! What adjustments to the med list below AND if we do currently have it correctly interpreted from what you have written:
8.2 lbs/3.72 kg no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for √pain/neuro loss as of 8/8: 1x/day for 14+ days then stop to test for pain/neuro loss not crating dog, on bed at night Pain and neuro diminishment observed 8/28 gabapentin 250mg/5ml.: 50mgs (1mL) 3x/day Still taking? ✚tramadol only as of 8/28: 12.5mgs mgs 3x/day Prilosec 5mgs 2x/day
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Post by Jacquelyn & Sonny on Aug 30, 2018 4:26:11 GMT -7
Thank you for your help. I am going to call the vet today and ask for a sedative. He also has not gone to the bathroom the last day. Do you think this is from the melocam? Is the prilosec not enough? Yes, he is still taking the gabapetin every 8 hours. Prilosec is 1/4 of 20mg pill 1x a day an hour before melocam is administered.
[Moderator's note: please do not edit 8.2 lbs/3.72 kg no crate rest prescribed 7/19? Meloxicam as of 7/19 for 7 days then 7/26 stop to test for √pain/neuro loss as of 8/8: 1x/day for 14+ days then stop to test for pain/neuro loss not crating dog, on bed at night Pain and neuro diminishment observed 8/28 gabapentin 250mg/5ml.: 50mgs (1mL) 3x/day tramadol as of 8/28: 12.5mgs mgs 3x/day Prilosec 5mgs 1x/day]
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