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Post by Tony & Ray on Feb 24, 2019 17:26:50 GMT -7
Ray is a 10 lb mini-dox on conservative crate rest 24/7. He's taking trazodone 1/4 of 50mg tab every 8-12 hrs, Carprofen 1/2 of 25 mg tablet every 12 hours, 1.6ml Gabapentin every 8 hours. He gets 5 mg tablets of famatodine 1/2 hour before the Rymadyl.
[Moderator's Note. Please do not edit 10 lbs Rimadyl (carprofen) as of 2/24: 12.5 mgs 2x/day for 14 days, then 3/10 STOP to test for pain/neuro issues gabapentin 50 mg/ mL: 75mgs (1.5mL) 3x/day famotidine 5mgs 2x/day trazodone 12.5mgs 8-12 hrs]
Ray was on the sofa next to me when the doorbell rang. He jumped up, suddenly yelped a bit, ran down the ramp, yelped, ran partly across the room, yelped and barked, then stopped. I went to him and he was slightly hunched, tail between his legs and when I touched his sides he yelped again. I stepped back a few steps and motioned him to walk to me so I could tell if he was limping and he did with no problem, I touched his sides and got no reaction, then he ran off with no problem as if nothing happened. I decided to take him to the emergency vet anyway where they said they were able to get a small pain response down at his lower back and at his neck. The vet while a DVM seemed to have significant experience with doxies and backs and while offering an x-ray said it often is of minor help and his reactions were clear. She recommended crate rest for at least two weeks with meds and a fellow up with my regular vet at 3-5 days.
Ray has been in crate rest since then, with only trips out to potty, and he is carried there. He seems to have no issues pooping or peeing. He wags his tail on seeing me or when I bring his food. He does ok in the crate but he is normally a very excitable and sometimes whiny dog when he's not getting his way, his signature move is spinning in circles from excitement, hence the sedative. He gets excited seeing other people (he's never met a stranger) so I have to limit guests. He does not seem to be exhibiting any current pain and his appetite is fine. The borrowed crate has an annoying door that he has learned can make a loud bop noise when he hits it with his nose; a crate I will own is on its way and it doesn't have the annoying door and distraction to staying still. I play some dog anxiety music from YouTube at a low volume, it seems to help a bit if only to be white noise to hide the assorted minor house sounds that attract his attention. I work during he day and live alone and he will be crated. I have two neighbors who will help with letting him out a couple times a day the way I described above, and also give him his meds at any appointed time.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Feb 24, 2019 19:09:51 GMT -7
Tony, welcome to Dodgerslist. Your quick action has likely kept mild symptoms mild and ensure a good recovery of the damaged disc. It takes 8 weeks for a disc to heal enough to be safe in moving again. So til graduation date on Apr 20, make sure you give Ray every opportunity to heal the disc, form good secure scar tissue. --Super tried and true tips for setting up the recovery suite (DIY water/food holders, the mattress system and much more): www.dodgerslist.com/literature/CrateRRP.htm --PLUS further guidance on conservative treatment on our "All Things IVDD page: www.dodgerslist.com/literature/healingpage.htm www.dodgerslist.com/healingindex.htmLet us know you and all the kind neighbors have a good understanding of what 100% STRICT crate rest 24/7 only out for a very, very few footsteps at potty time entails. STRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no meandering at potty times. Demonstrate how to lift to support both ends of Ray, and keep the back horizontal to the ground. Very secure way to hold a wriggly dog:
Carry Ray to and from the recovery suite to the potty place and then allow a very, very few limited footsteps. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! MEDS1. How many mg of gabapentin are in on mL of liquid. That information should be printed on the bottle.2. For how many days is the Rimadyl prescription?
It is a very good idea to be knoledgable on just how an anti-inflammatory like Rimadyl is used with a disc episode. Things like what is your job at the end of the prescription. What if pain surfaces at the end of the Rx? Excellent info to give you some background to discuss things with a vet: www.dodgerslist.com/literature/healingsweling.htmWith several people involved in giving meds, it would be a very good idea to set up a med chart.A helpful device to make sure all doses have been given and a place for the giver to note any cause/effect type things. A good summary for times you needs to update the vet via a phone call. Download a sample as a guide in setting up one for Ray: D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Feb 25, 2019 6:15:28 GMT -7
I'd just like to add one thing, Tony. Since the vet found painful spots both in the neck and back, it would be helpful if this is a neck injury to raise the food and water dishes so Ray doesn't have to bend his neck down to them, moistening hard kibble, etc. More info here: www.dodgerslist.com/literature/cervical.htmHealing prayers for Ray.
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Post by Tony & Ray on Feb 25, 2019 6:59:14 GMT -7
Thank you! His water dish in the cage is at head level; I hold his food dish for him at head level. I am going to raise his regular food and water dish for when he's out of the crate. I use a slow feed bowl as he's a power-hoover; I will start moistening the dry kibble. I'm also replacing his harness, removing his collar altogether and putting ID on the harness, and his crate is about 2 1/2 feet of the ground on a table so he doesn't have to raise his head. Good stuff, thank you! Luckily Ray was crate-trained from the beginning. He is about 15 inches long body, the crate is 17 inches wide. The next size down is 13, too small; it's 22 long right in line with your guidelines so I think that's good. So I have bed pads, cut down polartec blankets, etc all ready! I had actually already read Dodgerslist in advance just in case, I've had doxies before but this is the first disc issue. Luckily Ray's pretty cooperative and not wiggly, he's just very enthusiastic about pretty much everything. Great idea on the med chart! The Gabapentin is 50 mg/ml, 1.5 ml 3 times a day. The Rimadyl (carprofen) is 50 mg, 1/2 tab 2x/day, 14 days, I think I mistyped it originally. Good followup info on the Rimadyl, thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Feb 25, 2019 9:59:11 GMT -7
Tony, LOVE hearing of your efforts to be prepared if a disc episode would ever happen. That explains your knowledge to go ahead and get a vet diagnosis right away just to be sure.
So the stop test for pain of Rimadyl will happen on Sat 2/9. Might be good to phone your vet ahead of time to work out a Plan B should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free!
Pain= another course of Rimadyl + all pain meds, GI protector back on board. No Pain= no need of any meds...just finish out the 8 weeks of crate rest for the disc to heal.
Please do keep us posted on how things are going, as you are back at work and neighbors are helping.
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Post by Tony & Ray on Feb 25, 2019 17:48:26 GMT -7
A better pic of Ray and the blanket The guide isn't clear, Ray has a nice crate pad plus the red Polartec blanket, a feather- light material. He sometimes rucks it around, and when I got home today he was under it asleep which he likes to do. As you can see in the pic he never leaves it laid out flat, but its not uneven like between cushions on a chair or couch. Is this ok or should i remove it and just leave him with the pad? Thank you for all your help and advice.
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Post by Pauliana on Feb 25, 2019 18:54:53 GMT -7
Hi Tony!
The blanket is fine, most Doxies like to burrow under and ruck up their blankets so that is natural.. We usually suggest synthetic fleece blankets because they resist water and dry quickly.. I am not sure if Polartec resists water.. Since he has bladder control and doesn't dump his water bowl, that might not matter so much..
It's wonderful you were so prepared and knew what to do when he showed symptoms of a disc episode.. I am sorry this happened to Ray but he is so lucky to have you to care for him and great neighbors too!
Great he is not in pain with his meds as they are now.. If you see any signs of pain please do contact your vet to adjust his meds... The pain signs are: Shivering, yelping when picked up or moved, head held high or nose to the ground, tight tense tummy, holding leg up flamingo style., reluctant to move or slow to move, not his perky interested in life self..
Healing thoughts!
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Post by Tony & Ray on Mar 1, 2019 4:06:23 GMT -7
Hi! Ray had a few times this week when he did a quick "yip"!
[Moderator's Note. Please do not edit 10 lbs Rimadyl (carprofen) as of 2/24: 12.5 mgs 2x/day for 14 days, then 3/10 STOP to test for √ 2/25 pain/neuro gabapentin 50 mg/ mL: 75mgs (1.5mL) 3x/day famotidine 5mgs 2x/day trazodone 12.5mgs 8-12 hrs]
He has no other symptoms, he eats, pottys, walks etc. fine, tailwag, no visible shaking etc. but it appears the yips were neck related, one when he turned awkwardly in the crate, and the other times when he was trying to move under or manipulate the fleece blanket. So I've removed the blanket and he has his 2 1/2 inch padded fleece covered crate pad. He's been getting his meds regukarly. Is there anything else I should do? He's due for a vet visit tomorrow, luckily my vet is just 10 minutes away.
Post by Tony & Ray on Feb 25, 2019 at 7:19pm Thanks! I looked up synthetic fleece blankets and it appears that's what I call polartec [😊]. Thank you for the quick response and information.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Mar 1, 2019 7:12:42 GMT -7
Tony, Ray is telling you in the only way that he can with his yips that he still has pain. Pain needs to be brought completely under control with NO sign of pain from one dose to the next. Neck injuries are often more painful than back injuries and usually require three pain meds to get the difficult pain under control - Tramadol for general pain, Gabapentin for nerve pain and Methocarbamol for muscle spasm pain - muscle spasms often accompany neck injuries. Please speak to the vet ASAP this morning about adjusting Ray's pain meds. Pain hinders healing so have no patience with it.
Most vets who understand the importance of strict crate rest will accept status updates by phone rather than bringing in the dog for an office visit. Transport involves risk of too much movement of the spine and should only done for very necessary vet visits, such as increase in loss of neuro function. Please call your vet this morning and advocate strongly for an adjustment to pain meds without an office visit.
Please let us know what your vet says after speaking to them this morning.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Mar 1, 2019 9:48:01 GMT -7
Tony, in addition to the one pain med (gabapentin) on board and the ones Marjorie suggested to discuss with your vet, Rimadyl needs to be back on board.
We understood from you that Rimadyl was to be stopped on 2/9 as a test for pain and is no longer on board. I can take 7 to 30 days to resolve all painful swelling. It is prudent to try a course (7 or 14-day course) and stop to assess if there is pain. No one wants a dog on Rimadyl any bit longer than having achieved the benefit of all swelling gone.
Reporting signs of pain over the phone can eliminate the danger to the early healing disc of a transport in. Let us know what the vet Rx's over the phone so we have an accurate medication list.
MED LIST - please let us know if the past info about Rimadyl is correct + what is the new Rimadyl Rx of today? 10 lbs Rimadyl (carprofen) as of 2/23: 50 mgs 2x/day for 14 days, then 2/9 STOP to test for √ 2/25 pain/neuro as of 3/1: ??? gabapentin 50 mg/ mL: 75mgs (1.5mL) 3x/day famotidine 5mgs 2x/day trazodone 12.5mgs 8-12 hrs
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Post by Tony & Ray on Mar 1, 2019 12:50:44 GMT -7
Hi, all. I had a long talk with my vet (she's familiar with Dodgerslist and has no problem with talking about it) and she wants to continue Rimadyl, Gabapentin, and add ✙Methocarbonal; I hadn't stopped teh Rinadyl yet as we're at that one-week date and so another week. Also, she wants to add a low dose of ✙Valium with option to increase if needed, partly because she knows Ray and Ray can be a bit anxious. The Trazodone is mild and didn't seem to have all that much impact. I don't have the doses if changed of the Rimadyl and Gabapentin as I have pick up the prescription. We will do a check in a week on the Rimadyl. She wants to consider Tramadol if the Rimadyl is stopped. I don't have the dosages as I haven't picked up the prescription yet but will follow up.
Rays current meds as of 3/1/2019: ✙Methocarbonal 500mg 1/4 tab 3x/day ▲Gabapentin 100mg 1 capsule 3x/day Rimadyl 25mg [tab]: 1/2 tab 2x/day ✙Diazepam 5mg 1/4 to 1/2 tab every 6-12 hours
Ranitidine famotidine [ correction 20 mg, 1/4 tab or 5 mg] 2x/ day.10mg 1/2 tab 2x/day 1/2 hour before any of the above if they coincide
[Moderator's Note. Please do not edit 10 lbs Rimadyl as of 2/24: 12.5 mgs 2x/day for14 days, then 3/10 STOP to test for √ 2/25 pain/neuro gabapentin capsule ▲100mg 3x/day famotidine 5mgs 2x/day ✙methocarbamol (muscle relaxer) 125 mgs 3x/day ✙Diazepam (muscle relaxer and anti-anxiety) 5mg tab: 1/4 to 1/2 tab every 6-12 hours
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Mar 1, 2019 17:18:43 GMT -7
Tony, we could use your help in sorting out the thinking behind the new Rx's. When referring to meds would be helpful to clarify size of tab in mgs, and then state 1/4 or 1/2 tab as the dose. There was some confusion over the Rimadyl dose that is now become crystal clear. Rimadyl (25mg tab) IS being dosed at 1/2 tab (12.5mgs) 1. You report pain of yipping that Rimadyl still has work to address. ----For how many days will he stay on 1/2 of a 25 mgs tab (12.5mgs) 2x/day then a stop to test for pain? Still scheduled for March 9 stop? 2. What was the reason to switch from newer generation, more effective, famotidine to older one of Ranitidine? ---Do read about famotidine: www.marvistavet.com/famotidine.pml --- How many mg in a full Rantidine tab.... 10 mgs? Let us know how the addition of methocarbamol and the increase of gabapentin does to provide full pain relief.
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Post by Tony & Ray on Mar 1, 2019 17:48:36 GMT -7
I'm sorry, I'm very stressed with this and other stuff.
The Rimydal is 12.5 2x a day, unchanged from the start on 2/24.i see 50mg got in there in the middle on 2/25 post, that's wrong. There's still an evaluation point just as when this started. The spell check changed the famotidine and I didn't catch it, I don't know what the other is. The famotidine is unchanged, 5mg 2x/day. My apologies.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Mar 1, 2019 17:58:16 GMT -7
I can understand having stress, no problem. We just want to make sure we have the facts correctly. Thank you!
Rantidine is a stomach protector, but not as good as the newer generation famotidine. Glad there was no change in that department!!
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Post by Tony & Ray on Mar 1, 2019 18:27:41 GMT -7
Me Too! BTW, for your folks on a budget, if they can get the 2 - 100 cap package of famotidine at Costco they will pay 1/3 less than what they'd pay for the same generic at Walmart or Target.
My pill cutter can do quarters nicely, I've had it for several years, the Costco is 20. I will try looking on Amazon to see if I can find it, there's no name on it. I have to quarter the diazepan. I'll let you know how it goes although at this point Rays anxiety and whining is ss bigger issue I hope the diazepam will help with.
Do you or Dodgerslist use Consumerlabs.com?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Mar 2, 2019 11:11:39 GMT -7
Yes, the Costco generic famotidine is way less expensive. My Costco carries one that is a 20 mg pill. So if a dog would need 5mg, that is awfult tricky to cut that pill down. So then the Walmart/Target option might be better if it comes in say a 10 mg tab. How are you doing splitting your Costco famotidine...what size is the whole famotidine tab?
Tony, we do not have a sub to Consumerlabs.com.
Could you clarify about the famotidine you give Ray. --- How many mgs does a whole famotidine tablet contain? --- Are you giving 1/2 tablet of that famotidine tablet?
For a 10lbs dog the dose of famotidine should be 5mgs every 12 hrs.
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Post by Tony & Ray on Mar 2, 2019 12:23:02 GMT -7
[Pepcid AC correction] 20 mg, 1/4 tab or 5 mg 2x/ day.
Change in meds: I have had an awful time getting Ray to calm down since Friday 5pm. He whined and did this grunting huff; he kept standing at whatever end of the crate I was at, bopping the door with his nose, wagging his tail. When I went out of sight after a few minutes he started howling. When hes laying down he still whines and huffs. He clearly wants to get out. When I take him out to potty he is very happy, wants to lick me and is pleased. He slept about an hour last night but otherwise kept this up nonstop, it's like nails on a chalkboard. The diazepam had no impact. I have played dog music, rain sounds, tried covering the crate, moving it closer or further, and other suggestions from the crating instructions to no avail. This is hardly a calm resting state. I talked with the vet when the clinic opened and she felt I had already done anything she'd suggest. She gave me ✙acepromozune 10mg 1/8 or 1/4 tab, once or twice a day as needed; if that's not doing it, I have alprazolam 1 mg 1/4 tab one or two times a day as needed. It can be used with the trazodone but I am trying the acepromozune alone first at the vets direction to see it's impact; it's seems to be starting to calm him, although these work better if given prior to agitated state and not during. I am to not use the diazapam. Stay tuned.
[Moderator's Note. Please do not edit 10 lbs Rimadyl as of 2/24: 12.5 mgs 2x/day for14 days, then 3/10 STOP to test for √ 2/25 pain/neuro gabapentin capsule 100mg 3x/day methocarbamol (muscle relaxer) 125 mgs 3x/day ✙acepromozine 1.25 or 2.5mg 1x-2x/day] famotidine 5mgs 2x/day]
Consumerlab.com is a nonprofit, kind of like a Consumers Reports for otc supplements, etc. They might be supplement retail like younor I, then labratory analyze it for contaminants and to see if the claimed ingredients are in there, and their report will have exhaustive research and data on studies, use, etc. They tested Chondroitin Sulfate supplements including for dogs and found many didn't have the claimed ingredients, some had lead contaminaion. I think Cosequin DS was the only none they approved.
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Post by Romy & Frankie on Mar 2, 2019 14:21:30 GMT -7
Different dogs react differently to different sedatives so ACE might do the trick for Ray. Some of our members have used a pack and play or an ex-pen for a dog that does not do well in the crate. Ray might prefer that type of a recovery suite. My vet also preferred Cosequin DS saying that other supplements might not have enough of the active ingredient. We have some info on supplements for the IVDD dog here: www.dodgerslist.com/literature/Supplements.htm
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Post by Tony & Ray on Mar 2, 2019 17:12:56 GMT -7
Some good news, Ray's been calmer and has actually slept for he afternoon (normal) esp. considering he hadn't slept and was whining which had to be tiring. The 1/4 tab Ace seems to have sedated him hard, I'm going to try 1/8 tab. It's tough to cut that tiny 1/4 in half!
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Post by Pauliana on Mar 2, 2019 17:46:15 GMT -7
Hi Tony,
A pill cutter that you can get from the pharmacy might help cut them, although it is sometimes hard to cut some types of pills even with a pill cutter.. depends on the shape of the pill. Worth a try in the case you don't have one..
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Post by Tony & Ray on Mar 2, 2019 19:05:38 GMT -7
I've got a real good pill cutter but 1/8 is a challenge. I may end up using a razor blade.
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Post by Tony & Ray on Mar 9, 2019 13:52:53 GMT -7
Update: we are continuing with the current medicine slate with a change from acepromozune to xanax. I've had a hard time with getting Ray calmed when I'm home, he seems ok when I'm gone and doesn't get overly excited when neighbors show up to take him out or give him his medication, so it's not a pain thing but rather the desire to get out if the cage and be with me, he's always tended to be a bit of a Velcro dog. So we decided that, although he's not had a pain yip or symptom to continue the Rimadyl at lest another 2 weeks if I can get him calmer and keep him that way. We're continuing the trazodone, using l-theanine 50 mg tablets, 1/2 tab 2x a day and Xanax 1 mg tab 1/4 when needed to settle agitation no more than 2x a day. I have a DAP diffuser, play music and will add a couple lavander essential oil drops on his cage pad. I started using the ✙emergency crate training procedure and he appears to be responding to that fairly quickly!
[Moderator's Note. Please do not edit 10 lbs Rimadyl as of 2/24: 12.5 mgs 2x/day for14 days, then 3/10 STOP to test for √ 2/25 pain/neuro as of 3/10: 12.5mgs 2x/day for 14 days even tho no signs of pain?? gabapentin capsule 100mg 3x/day methocarbamol (muscle relaxer) 125 mgs 3x/day ✙xanax 0.25mgs up to 2x/day for anxiety trazodone 12.5mgs 8-12 hrs famotidine 5mgs 2x/day]
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Post by Romy & Frankie on Mar 9, 2019 14:19:46 GMT -7
I am happy to hear that Ray is responding to the crate training. Have you tried working with a clicker?
Does the vet think there is still swelling in the spinal cord and therefore the Rimadyl should be continued without a test for pain stop?
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Post by Tony & Ray on Mar 9, 2019 14:48:33 GMT -7
Yes, the emergency crate training specified a clicker and I got one at Petco this AM, did two sessions and he's responding to it. It doesn't hurt that he's super food motivated, and also does quite well at night and always has in the crate. Our decision on the Rimadyl is based on his not being as calm and restful as he should have been and caution over a cervical issue, so we felt another 2 weeks would be good caution and do an examination then. He is not showing any adverse effects and I and rigorous about his famatodine.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Mar 10, 2019 5:55:43 GMT -7
An examination in two weeks with pain-masking meds on board may not be able to tell the vet much, Tony. Plus an examination would involve a risky transport to the vet which may involve too much movement. Neck injuries sometimes do take longer to heal and since Ray hasn't rested well, there may still be swelling and still a need for all meds. But the only way to know if there's still swelling is to stop the Rimadyl and to stop or taper off of the Gabapentin and Methocarbamol to test for pain. Pain would mean there is still swelling pressing on the nerves of the spine. If there is still pain, the meds would need to be immediately restarted and continued for a bit longer and then another test for pain would be made. If no pain returns, then the swelling has resolved and no anti-inflammatory or pain meds would be needed any longer and only the crate rest would be needed. I understand that you're being rigorous about his Famotidine and that's great but no one wants their pet to be on an anti-inflammatory and pain meds for any longer than they need to be.
Glad to hear that the crate training is helping Ray and that you're making every effort to get him to relax in his crate. Kudos to you!
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Post by Tony & Ray on Mar 10, 2019 16:40:20 GMT -7
I have no idea how to "test for pain", and didn't see any directions on the site for this. It looks like we'll get thru his first day without Xanax or the like.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Mar 10, 2019 18:08:52 GMT -7
Tony, good to hear Ray is relaxed in his recovery suite...no need for sedatives. It is a very good idea to be knowledgeable on just how an anti-inflammatory like Rimadyl is used with a disc episode. Things like what is your job at the end of the prescription. What if pain surfaces at the end of the Rx? Excellent info to give you some background to discuss things with a vet: www.dodgerslist.com/literature/healingsweling.htmIn a nutshell at the end of the course of Rimadyl that was scheduled for today, Mar 10, to stop IS THE BEGINNING of the test for pain. Naturally if pain masking pain meds are on board how can you give the vet an accurate and quick assessment about the existence of painful swelling or if no pain is detected? So on Monday get with your vet to ask WHICH he wants as the end of the 14-day Rimadyl course has ended 3/10 "Rimadyl (carprofen) as of 2/24: 12.5mgs 2x/day for 14 days, then 3/10 STOP to test for pain/neuro issues" A. a full stop of gabapentin that masks nerve pain and methocarbamol for muscle contract pain. OR... B. backing off of gabapentin?
RULE OF THUMB Pain= another course of Rimadyl + all pain meds + famotidine back on board. No Pain= no need of any meds...just finish out the 8 weeks of crate rest for the disc to heal.
Let us know what your vet wants for methocarbamol and gabapentin on Monday as the test for pain continues to procede.
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Post by Tony & Ray on Mar 16, 2019 9:15:43 GMT -7
Ray had some significant pain issues even after getting him calmed and after one particularly bad evening and early night was admitted to Gulf Coast Veterinary Specialists on 3/14 for overnight observation and administration of stronger IV pain medication to get him comfortable. The next morning 3/15 he was given a comprehensive exam by board-certified neurologist Dr. Carley Giovanella DVM DACVIM, who then called me to discuss. We agreed we needed to settle what's going on, he reacted noticeably to neck manipulaion but not spine, and so Ray had a full cervical and spinal MRI, and if significant damage was found she would call me but they would be ready to perform arthroscopic surgery without him needing to come out of anesthesia. They do 3-4 a week there. Results: Ray's MRI showed no issues at all in his spine but showed a mild disc herniation between C5-6 left side with accompanying swelling.
Dr. Giovanella explained that sometimes the irritated nerve can over react or get "wound up" which is why his pain reaction seemed in excess of his issue. She did not recommend surgery at all but rather medical management which they've been successful with. So he will be back on strict crate rest, with changed medication:
▲Gabapentin 100 mg 3x a day.(unchanged) for the next 10-12 days then as needed. ✙Tramadol 50 mg 1/4 tab 3x a day for the next 7-10 days,then as needed for pain.
Starting 3/17 (to let the NSAID wash out): Prednisone 5 mg on a tapering schedule, 1/2 tab 2x a day for 7 days, then 1/2 tab 1x a day for 7 days, then 1/2 tab every other day for 7 day.
Famotidine 20 mg 1/4 2x a day, best 1/2 hour before prednisone. (continuing) We're also continuing ▲ 50mg 1/2 tab 3x a day for anxiety/calming.
[Moderator's Note. Please do not edit 10 lbs Rimadyl (carprofen) as of 2/24: 12.5 mgs 2x/day for 14 days, then 3/10 STOP to test for √ 2/25 pain/neuro Prednisone as of 3/17: 2.5mgs 2x/day for 7 days, then SUN 3/24 tapering test for pain/ neuro issues gabapentin ▲100mgs 3x/day ✙tramadol 25mgs 3x/day famotidine 5mgs 2x/day trazodone ▲25mgs 8-12 hrs]
Any medication he was taking prior not mentioned is discontinued.
Last night after returning home he had a difficult night, and by phone a GCVS ER vet after her consulting with neurology recommended going to 1/2 50 mg Tramadol 3x a day, at least until the Prednisone has an opportunity to work. This morning thru 11:00 he has not appeared to have one pain reaction and is calm, a bit sleepy and has mostly napped in the crate.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Mar 16, 2019 9:29:54 GMT -7
Tony, at least you know what is going on...there is still swelling going on in the spinal cord area. Prednisone is from the class of anti-inflammatory called steroids. Steroids are the most powerful of the anti-inflammatory drugs over the other class called non-steroids (NSAIDS). Hopefully this more aggressive approach for the harder to deal with neck disc will see good results in getting the swelling fully resolved.
So glad to hear the addition of tramadol and increased gabapentin are finally giving him comfort while the pred will continue to work on resolving swelling.
The pred taper date of Sunday 3/24 is the test for pain/neuro issues.
The test-for-pain taper of prednisone is for you to report any sign of pain resurfacing. In order to be able to give a quick and accurate assessment if unmasked pain reveals itself. Vets either call for the stop or the backing off of pain-masking pain meds (gabapentin, tramadol). Which does your vet want?
Rule of thumb is: pain = swelling = another course of prednisone, pain meds and famotidine needed.
Always have a plan in place with the vet during a test for pain stop on what you should do should pain surface. Have enough meds on hand should that happen over a weekend or evening when the Vet is closed, to save an expensive ER visit. What is your Plan B you and your vet have worked out together... extra pills, an Rx for a few more if needed from your 24hr pharmacy to tide you over til vet reopens on Monday?
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Post by Tony & Ray on Mar 21, 2019 16:38:07 GMT -7
If we get to the end of the Prednisone, the neurologist indicated she would want to do something different in terms of medication. Regarding the remaining pain meds gabapentin and tramadol I have a taper schedule also; I've also got some extra in case we have a pain return. So far he's responded well to the Prednisone with little side effects except for slightly increased agitation and urination. His urine is clear and no issues with his poop. We're continuing the trazadone since he has issues staying calm esp. when I'm home, otherwise he snoozes. Crate training for calmness is having an impact although we're not totally there yet. DAP pheremone seems to have no impact but Chill-Out does. Music may help when I'm not home, but it seems not to do anything when I'm home.
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