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Post by Brian & Gracie on Jun 12, 2019 17:08:59 GMT -7
I just had Gracie see the vet. She is a wire hair dachshund.about 15 lbs. 9 years old. I care home after work today and she wasn’t able to use her back legs. She was hiding under the deck. Here is the treatment she is being given. I’m looking for any advice or suggestions. I’m familiar with IVDD but this time around it’s another vet and different medications.
During the vet visit 6/12: Laser therapy level 1 Fentanyl patch 12mcg/hr Take home prescriptions: Rovera 25 mg every 24 hrs Methocarbamol 125 mg every 8-12 hrs
[Moderator's Note. Please do not edit 15lbs Rovera (carprofen) as of 6/12: 25mgs 1x/day for 10 days, Sat 6/22 SToP as a test for _pain/_ neuro Fentayl patch as of 6/12 expires in 5 days on June 17 methocarbamol 125 mgs every 10 hrs no GI tract protector Pepcid AC on board! ]
Also she shows some pain response in her right hind leg and she can wag her tail very well. I’m trying to decide what stage her disc disease is at.
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Post by Pauliana on Jun 12, 2019 18:25:12 GMT -7
Welcome to Dodgerslist, Brian! Sorry to hear Gracie is having another disc episode.. Currently can Gracie wag her tail when you specifically do some happy talk? Is Gracie taking Pepcid AC 30 minute prior to the Rovera? If not her tummy needs to be protected from the side effects of the Rovera.. The pain and body changes of IVDD can cause stress. Stress can lead to excess stomach acid which can cause damage to the GI tract. To help prevent stomach damage from excess stomach acid a stomach protector like Pepcid AC should be used. Ask the vet if Henry has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). Are the medications currently controlling Gracie's pain from dose to dose? The signs of pain we look for are; ☐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. When is the Fentanyl patch to be removed? 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. 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 ◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment. Can Gracie specifically sniff and squat and then release urine which is bladder control – OR- do you find wet bedding or leaks on you when lifted which are indication of an overflowing bladder and loss of bladder control? Pred makes a dog eat, drink and pee more. They usually have to pee every 2 0or 3 hours... If a dog becomes unable to empty their bladder we must help them by expressing. That means applying pressure to the bladder greater than the strength of the urinary sphincter to force urine out Overflowing bladders need to be expressed to avoid UTIs. Review video then get a hands-on-top-of-your-hands expressing lesson. www.dodgerslist.com/literature/Expressing.htmA very few footsteps while outside on a potty break.. I had the same problem with Tyler as he likes to walk before pooping.. What I ended up doing is carry him to his favorite spot and set him down there.. That helped! You could also set up an ex pen outside so he knows that's as far as he can go... 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 get up to speed on IVDD soonest possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. Your dog will be depending on you! - excellent video series here: www.dodgerslist.com/literature/theater.htm--PRINT OUT this link and tape to your fridge: www.dodgerslist.com/literature/healingpage.htm--use the printout as your roadmap to avoid dangerous detours in your dog’s care --make notes/highlight to keep yourself on track --follow all the links in the next days to become the IVDD savvy pet parent your dog needs. Use the “search box” to easily locate topics over at our Main www.Dodgerslist.com website: Healing thoughts and prayers for Gracie...
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Post by Brian & Gracie on Jun 12, 2019 18:31:14 GMT -7
I gave her an initial dose of her meds without the Pepcid ac but I’ll start that. She can definitely wag her tail very well and responds to a pinch in just one of her hind legs. The fentanyl patch comes off in 5 days.
She only got her first dose of meds about an hour ago but she has relaxed quite a bit compared to earlier when she was in a lot of pain. I believe she falling asleep now.
Thank you. Let me know if there’s anything else.
It was exactly 1 year ago today that I joined here because my Hank had the same problem.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jun 12, 2019 18:51:39 GMT -7
Glad to hear the meds have her in comfort now.
Could you fill us in on some missing details: Rovera (carprofen) as of 6/12: 25mgs 1x/day for ? days, then SToP as a test for _pain/_ neuro For how many days is she to take Rovera?
methocarbamol 125 mgs WHICH? every 8 OR 12 hrs?? Good to know there is a range you could dose methocarbamol. But how often are you actually giving it--- every 8 or every 12 hrs?
Let us know when you have Pepcid AC on board, the mgs and that you are giving it 2x/day.
Since Gracie is not on the steroid, prednisone, but on the non-steroid Rovera she will need to be let out to pee every every 4-6 hours IF she has bladder control. Can you confirm bladder control? ---- Can she sniff and then choose to pee on that spot when you carry her to and from the potty place? ---- Are you finding no urine leaks in bedding? And that she does not leak on you when lifted?
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Post by Brian & Gracie on Jun 12, 2019 18:56:29 GMT -7
Rovera is for 10 days then “as needed for pain control”.
The vet said 8 to 12 hours on the methocarbamol. I will do every 10 for now.
I’m doing 5 mg of ✙Pepcid 30 min prior to medication.
[Moderator's Note. Please do not edit 15lbs Rovera (carprofen) as of 6/12: 25mgs 1x/day for 10 days, Sat 6/22 SToP as a test for _pain/_ neuro Fentayl patch as of 6/12 expires in 5 days on June 17 methocarbamol 125 mgs every 10 hrs ✙Pepcid 5mg 1x/day ]
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Jun 13, 2019 5:04:59 GMT -7
Hi, Brian. Rovera is not a pain med but rather is an anti-inflammatory. The only way it helps pain is that it works on getting the swelling down that causes the pain. An anti-inflammatory is given until the swelling pressing on the nerves of the spine resolves, which can take 7-30 days. It's guesswork as to how long to give an anti-inflammatory so it's given for a certain period of time, such as the 10 days prescribed here, and then stopped along with all pain meds to see if pain returns. If no pain returns with the stopping of the meds, then you have proof that the swelling is gone and there is no longer any need for meds. If pain returns, then all meds again have to continue at their original dosages for a bit longer until another test for pain is done. At the end of the 10-day dosage of Rovera, Methocarbamol should also be stopped so a true test for pain can be made. So do speak to the vet about also stopping the Methocarbamol at the end of the 10-day dosage of Rovera so a true test for pain can be made. Otherwise having a pain med on board would make it difficult to determine if there is still pain/swelling and still a need for the Rovera. dodgerslist.com/literature/healingsweling.htmMethocarbamol has a short half life and does work most efficiently when given every 8 hours. So if giving it every 10 hours does not consistently and fulling control the pain or if pain arises between doses, do give it every 8 hours. If giving Methocarbamol doesn't completely control the pain, then do discuss with the vet adding Tramadol as a general pain med and/or Gabapentin for nerve pain. The Pepcid AC should be given 5 mg 30 mins before the Rovera and then every 12 hours thereafter for as long as Gracie is on the Rovera.Keep an eye out for pain as the Fentanyl patch starts to lose efficiency: "It is important to recognize that there is a delayed onset of effect when using the patches. In dogs it takes about 12 hours to achieve good pain relieving dosages and in cats it takes a minimum of five hours. The effective life of the patch is about 3 days in dogs and up to 5 days in cats. The pain relief from these patches is considered to be moderate, especially in dogs. For this reason it is often necessary to use them as a constant provider of pain control but to supplement them as necessary with a compatible narcotic or an NSAID." www.vetinfo.com/dpain.html
Please continue to keep us updated. Healing prayers for Gracie.
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Post by Brian & Gracie on Jun 13, 2019 9:10:42 GMT -7
Thank you for the help. I decided to give the ▲Methocarbamol every 8 hours. Gracie seemed pretty uneasy last night so I gave it at 8 hours and will continue to do so for now. I'll give the ▲Pepcid AC 5mg every 12 hours as well.
[Moderator's Note. Please do not edit 15lbs Rovera (carprofen) as of 6/12: 25mgs 1x/day for 10 days, Sat 6/22 SToP as a test for _pain/_ neuro Fentanyl patch as of 6/12 expires in 5 days on June 17 methocarbamol 125 mgs ▲3x/day Pepcid AC 5mg ▲2x/day ]
I'm not certain about her bladder control right now. I've taken her out several times and only this morning did she pee just a small amount. I was attempting to express her bladder and I'm not sure if she intentionally controlled it or if it was me. She's not got much of an appetite and not drinking much, though she quickly scarfed a little bite of chicken I gave her just to test her appetite.
Her right rear leg responds to a pinch and has just the tiniest amount of strength to move some at the knee and hip. Her left leg appears totally limp and non-responsive. As I said earlier, she has a very strong tail wag.
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Post by Romy & Frankie on Jun 13, 2019 13:17:01 GMT -7
I am glad that you are giving the Methocarbamol every 8 hours. This medication does not last that long in the body and may need to be taken 3x a day for full pain relief. The fentanyl patch will become less effective over time. If you are seeing any signs of pain, please let the vet know so that the pain meds can be changed as needed. Pain will only slow her healing.
Not having much of an appetite and not drinking much can be signs of stomach damage that can be caused by any anti-inflammatory, in Gracie's case Rovera. I know that you are now giving Pepcid AC every 12 hours and that should help protect her stomach. If she continus not wanting to eat or drink much please speak to the vet about adding Sucralfate to her medications in addition to the Pepcid AC. Sucralfate forms a gel-like webbing over ulcerated or eroded tissues and acts like a bandaid for the Stomach and will give Gracie's stomach extra protection.
There is no need to try a pinch test on Gracie. The pinch test can result in too much movement of the spine. The pinch test is used to see if a dog has DPS (Deep Pain Sensation). DPS shows that the brain can send a signal to the body through the spinal cord and is an indicator of the return of other neuro functions. If Gracie can do a happy tail wag she has DPS so no additional testing need by done.
Keep carrying her outside to try the sniff and pee test. Bladder and bowel control are typically the next neuro function to return after the happy tail wag.
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Post by Brian & Gracie on Jun 13, 2019 13:46:54 GMT -7
She does have some bladder control. She is leaking some in the crate but when I take her out she will go on her own.
I’ll keep watching for pain signs.
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Post by Romy & Frankie on Jun 13, 2019 13:51:36 GMT -7
Gracie's bladder control appears to be returning. This is excellent news! You can do a quick express check after she finishes until you are sure that she can empty her bladder fully. That should her keep her bedding dry.
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Post by Brian & Gracie on Jun 17, 2019 6:28:48 GMT -7
Overall, Gracie is doing fairly well. Her pain seems to be managed very well with the medication schedule I've posted. By now, her Fentanyl patch should be losing its effectiveness and she's still resting very well and staying in pretty good spirits (lots of tail wagging). In the last 24 hours, her eating has really picked up.
She was whining this morning so I took her out and she used the bathroom. I was wiping her up after her potty break and I had moved my hand away from supporting her rear for a moment and I was very happy to see that she kept her back end held up there herself using both legs for a few seconds.
She also attempted to walk a few steps this morning. She just kept her back legs mildly stiff and just dragged her back knuckles forward. It wasn't pretty and I had to assist to keep her stable, but it at least resembled something like walking.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jun 17, 2019 7:37:56 GMT -7
Brian, attempting to move her back legs is good nerve repair progress! And also good to hear her GI tract is doing better with her appetite coming back now.. The Fentanyl can mess them up appetite wise and of course there is always the #1 suspcicion that the anti-inflammatory Rovera is a culprit in damaging the GI tract. Looks like the test for revealed pain or setback on neuro function stopping of Rovera will be on Sat June 22. Could you bring us up to date on how your vet is doing it? --- PAIN MEDs? Normally when the vet guesses swelling might be gone there will be a stop of anti-inflammatory and the pain meds. Your vet Rx'd a 10-day Rovera course and then a test stop. Your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain (shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy, holding leg flamingo style not wanting to bear weight). To have a clear picture on a stop, pain meds are also stopped or backed off too- How will methocarbamol (for muscle contraction pain) be handled?Rule of thumb is: pain = swelling = more time on non-steroid anti-inflammatory (NSAID), pain meds and Pepcid AC needed. -- PLAN B? Always have a plan in place with the vet during a test for pain stop on what you should do should pain surface or if there is any dimishment of neuro function. Have enough meds on hand should that happen over a weekend or evening when the Vet is closed, to save an expensive ER visit.
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Post by Brian & Gracie on Jun 17, 2019 10:02:46 GMT -7
I talked to the vet and they said to use my judgement basically as far as backing off or stopping the Methocarbamol. I have enough of both the Rovera and the Methocarbamol to resume them if pain surfaces this weekend 6/22 when I stop the Rovera.
I plan to taper the Methocarbamol starting Tomorrow 6/18 to every 10 hours, then I'll do every 12 hours 6/19 and 6/20, then a single dose Friday night 6/21 before stopping all medication on 6/22 to monitor for pain and neuro function.
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Post by Brian & Gracie on Jun 20, 2019 6:38:15 GMT -7
Just a quick update. Gracie is doing well on the Methocarbamol taper and she is wobbly walking for 3 or 4 feet before losing her balance.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jun 20, 2019 7:41:44 GMT -7
Brian, glad to hear you are not reporting pain as methocarbamol is being reduced and stopped on 6/22.
What ever you can do to limit footsteps at potty time is all the better. The focus is all about getting the disc to heal right now. Movement of the vertebrae when walking is what pushes on discs. Her bad disc only has weak scar tissue forming — too much movement could cause a tear and having to restart from square one.
At potty time you are using a sling as backup to prevent her butt from tipping over when she looses balance?
Gracie is doing quite well in neuro repair with her back legs in such a short time.
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Post by Brian & Gracie on Jun 20, 2019 7:50:59 GMT -7
I wasn't using a sling or anything, but I can hover and keep my hands on her belly as I had been doing earlier when she couldn't walk at all. I'll try to keep her more still in general at potty time as well. Thanks for the advice.
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Post by Brian & Gracie on Jun 24, 2019 4:47:43 GMT -7
Gracie did really well Saturday and Sunday with no medications. Her walking is getting pretty good at potty time with toes not curling under nearly as much. She did surprise me a bit this morning at potty time - twice when I was just about to pick her up (hadn't even really lifted on her yet), she yipped pretty loudly. It's surprising to me because other than yipping twice this morning she's been so happy and relaxed (even after yipping today), taking a lot of naps and just staying very calm all weekend long. I'm going to call the vet when they open to see if they think this warrants going back on medication.
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Mary & Mila
Helpful Member
FEMALE— DACHSHUND
Posts: 218
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Post by Mary & Mila on Jun 24, 2019 4:56:53 GMT -7
Hi Brian, Good idea to phone the vet first thing and report what you saw. It could be one of two things, could be that Gracie needs to be on the meds a bit longer and that with not having them over the weekend she may be starting to feel pain again. Could also just have been a one off, sometimes our dogs yelp for no reason that we know of, and being owners of IVDD dogs we naturally become concerned. I hope it may be just that but discuss with vet to be certain, and let us know how it goes. You are probably familiar with lifting her but just in case. kind regards Mary
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Post by Brian & Gracie on Jun 24, 2019 8:19:11 GMT -7
I talked to the vet and they thought it would be OK to go ahead and put her back on medication for a couple days. I'm going to do 3 days starting today:
125mg ✙Methocarbamol 1x/day for 3 more days 25mg ✙Rovera 1x/day for 3 more days 5mg ✙Pepcid AC 2x/day for 3 more days
[Moderator's Note. Please do not edit 15lbs ✙Rovera (carprofen) as of 6/12: 25mgs 1x/day for 10 days, Sat 6/22 SToP √6/22 pain/_ neuro as of 6/24: 25mgs 1x/day for 3 days, 6/27 STOP test for _pain/_neuro ✙methocarbamol 125 mgs 1x/day ✙Pepcid AC 5mg 2x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jun 24, 2019 8:47:25 GMT -7
Brian, hope the 2nd course of Rovera will prove to have resolved all pain. Glad to see you will be able to more quickly assess about pain with the stop of pain med methocarbamol at the same time Rovera is stopped on Thurs 6/27. Please do keep us posted.
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Post by Julie & Perry on Jun 24, 2019 9:09:18 GMT -7
Don't be discouraged about not being ready to taper.
It's not uncommon for dogs to need several attempts.
Mine always take at least two.
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Post by Brian & Gracie on Jul 1, 2019 12:43:49 GMT -7
Quick update: Gracie is doing great. She's been of all medication since 6/27 and she's staying happy and her walk is now normal. Crate rest continues until 8/7.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Jul 1, 2019 13:55:51 GMT -7
Great news that Gracie was able to be weaned off all meds, Brian! And that her walk is now normal. It's not often that we see a dog who cannot move her legs walking normally just three weeks into strict crate rest - it usually takes much longer. You're doing a great job with her. Stay the course and keep up the great work. We're so happy for you and Gracie.
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Post by Brian & Gracie on Jul 9, 2019 6:56:30 GMT -7
I'm putting Gracie back on Rovera and Methocarbomol for 3 days as she's been showing some signs of pain. Starting yesterday evening, she would yip loudly at various times maybe 3 or 4 times over the course of an hour sometimes it was when she was moving but sometimes she would be laying down and just yip. She was appearing, in general, more uneasy than her normal self she's been for the last couple weeks. Also, she didn't rest as well at night, she spent a good amount of the night awake. She hasn't lost any neuro-functions. She still has a normal walk at potty time (though she is moving just a bit more slowly).
I talked to the vet and I'm going to give:
Rovera 25 mg every 24 hrs (starting 7/8, ending 7/10) Methocarbamol 125 mg every 12 hrs (starting 7/8, ending 7/10)
[Moderator's Note. Please do not edit 15lbs ✙Rovera (carprofen) as of 6/12: 25mgs 1x/day for 10 days, Sat 6/22 SToP √6/22 pain/_ neuro as of 6/24: 25mgs 1x/day for 3 days, 6/27 STOP test for √7/8 pain/_neuro as of 7/8: 25mgs 1x/day for 3 days, 7/11 STOP test ✙methocarbamol 125 mgs 2x/day ✙Pepcid AC 5mg 2x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 9, 2019 7:26:55 GMT -7
Brian, sorry to hear pain surfacing after being off all meds and no pain since June 27th (11 days). Are you aware of her being too rambunctious, too many footsteps at potty time that may have caused the healing disc a problem?
You got Pepcid AC back on board too?
Let us know the methocarbamol is able to fully control pain. IF not, then do advocate for gabapentin, tramadol every 8 hrs.
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Post by Brian & Gracie on Jul 9, 2019 7:45:20 GMT -7
Thanks and yes I am giving Pepcid AC 5mg 2x/day. It's possible she was just a bit too active at potty times. When I'm at work, I have others who help with her potty breaks and its possible they haven't been quite as careful.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Jul 10, 2019 5:12:44 GMT -7
Unfortunately, when a relapse occurs with pain again arising after all meds have been stopped, that means the disc has torn again. Unfortunately, the 8 weeks of crate rest need to start all over again.
Is her pain now completely under control? If not, then her pain meds need to be adjusted and it would not be time to stop the Rovera today. If there is no sign of pain today, then not only the Rover would be stopped today but also the Methocarbamol so you can determine quickly if there is still pain/swelling and still a need for the Rovera. 3 days is a very short course course of the Rovera so there may still be swelling pressing on the nerves of the spine.
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Post by Brian & Gracie on Jul 11, 2019 12:38:56 GMT -7
After going back on the meds the evening of 7/8 her pain was very well under control after just a few hours and she has been resting very comfortably since then. I decided to keep her on the meds through the end of the day today 7/11 (when talking to the vet, they did not have a specific recommendation... they said a couple days "or so" and "use your judgement", etc.).
[Moderator's Note. Please do not edit 15lbs Rovera (carprofen) as of 6/12: 25mgs 1x/day for 10 days, 6/22 SToP √6/22 pain/_ neuro as of 6/24: 25mgs 1x/day for 3 days, 6/27 STOP test for √7/8 pain/_neuro as of 7/8: 25mgs 1x/day for ▲4 days, 7/12 STOP test methocarbamol 125 mgs 2x/day Pepcid AC 5mg 2x/day ]
Her walking and all neuro functions have remained normal.
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Post by Romy & Frankie on Jul 11, 2019 13:19:48 GMT -7
Gracie seems to be doing well with all her neuro functions remaining normal.
If you are stopping the pain meds today, just watch her carefully and if she starts showing signs of pain you can start her back up on the meds.
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Post by Brian & Gracie on Jul 12, 2019 7:49:24 GMT -7
Well the pain resurfaced last night 7/11 around midnight and Gracie didn't rest very well through the rest of the night. She was fine all day and when we all went to bed but I heard a yelp at midnight and I could tell she wasn't feeling good. I spoke with the vet and now I am continuing the Rovera, Pepcid, and Methocarbamol but I've added Gabapentin 100mg every 12 hours (I can do every 8 hours if I feel its needed).
[Moderator's Note. Please do not edit 15lbs Rovera (carprofen) disc relapse 7/8: 25mgs 1x/day for 4 days, 7/12 STOP test √7/11 pain as of 7/12: 25mgs 1x/day for 7 days, 7/19 STOP test methocarbamol 125 mgs 2x/day ✙gabapentin 100mgs 2x/day Pepcid AC 5mg 2x/day ]
Despite all that, her neuro functions and walking are still good, meaning 95% normal. She has continued all along to have just the slightest noticeable wobble every now and then but you almost don't notice if you're not watching closely - small enough that I've just said she walks normal here in previous posts.
The vet offered a round of laser therapy (she had one round the first day of injury), so I'd appreciate thoughts or experiences with that option.
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