T & Tybo
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Post by T & Tybo on Jul 7, 2019 19:06:06 GMT -7
We started the main taper on Friday. Rambo had no pred yesterday, but I did give him a gabapentin in the morning. The vet didn't push pain meds during the taper, but made it clear we could give it to him every day just to be safe as she really didn't want him in any pain. She said she would leave it to our discretion on what we felt comfortable with, but we also know we need to see how he does off them to see if he is in pain, etc. So, he did have pred today but no gabapentin and has done well.
[Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 Prednisone 20mg tab as of 6/21: 5mg 2x/day for 4 days as of 6/25: 10mgs am - 5mgs pm for 3 days; as of 6/28: 5mgs 2x/day for 7 days, Fri 7/5 test taper for _pain _neuro Gabapentin 100 mg 0x/day on 7/8 Pepcid AC 5mg 2x/day Prilosec 2.5mg 2x/day]
He had some bad diarrhea at the end of this last week. The vet said she didn't think it would have been from the meds as he had been on them nearly 2.5 weeks (and he was on essentially three stomach protectants) - she strongly felt it was mainly caused by anxiety from being in his x-pen, which I agreed with. Rice has helped to bind things up and his poop was more normal today which was good.
We haven't seen any further progress in terms of regaining neuro deficits. We are still at about 75% back to normal. He's just sort of stayed steady for at least a week now. He walks well when going potty, but it's when he's just standing where his legs cross a bit and his body sways back and forth, and his tail is still not curled up like it normally is - but hey - if he's out of pain, happy, and not going backward, that's what is more important for me. I know he will be so excited to go on walks again once we get there. Crate rest (x-pen) is going much better ever since we put a night light on for him at night. It's truly made a world of difference!
Here's to a hopefully uneventful week as we finish the taper!
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PaulaM
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Post by PaulaM on Jul 8, 2019 6:40:04 GMT -7
T, glad to hear you have stopped the gabapentin on the pred taper. Getting delayed information as to whether swelling still remains because a pain med is masking pain is not a good idea. Finding out quickly on the pred taper if painful inflammation remains means all the sooner you could get back on orig pred dose and all pain meds back on board IF, if you should see any hint of pain. Got fingers crossed now with gabapentin stopped, you will not see any hint of pain surface.
Thanks for sharing that a simply nightlight helped Rambo sleep through the night.
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T & Tybo
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Post by T & Tybo on Jul 9, 2019 8:28:35 GMT -7
We took a step back today. Rambo was panting a lot last night and I had no clue if it was anxiety, pain, or residual side effects from the pred the day before. Yesterday he had no meds. Just took him outside and he immediately crossed his back legs, knuckled, and they gave out on him. He sat and immediately laid down panting. Brought him back inside and we aren’t back to square one but close. He’s now laying down in the non normal position. [Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 Prednisone 20mg tab as of 6/21: 5mg 2x/day for 4 days as of 6/25: 10mgs am - 5mgs pm for 3 days; as of 6/28: 5mgs 2x/day for 7 days, Fri 7/5 test taper for √7/9 pain √7/9 neuro ✙Gabapentin 100 mg 0x/day on 7/8 Pepcid AC 5mg 2x/day Prilosec 2.5mg 2x/day]I immediately gave him ✙gabapentin (he wouldn’t stand up to come get the meatball) and I am now waiting for vet to call back. (He did have his taper dose of pred today already with Pepcid/Prilosec). Ugh. . He had been doing so well!! We've continued to of course keep him leashed going outside. He's been walking a bit more outside as he had the diarrhea that caused him to do circles outside, but he's been better for a few days on that front. He still tries getting out of his pen at times but in general, he stays calm in his pen. I have no clue what he does while I'm sleeping, so he could've tried getting out last night and kinked his back again or just laid down awkwardly - who knows - but I really have no clue. He also is a maniac with nesting and fixing his blankets, etc. Even if it's just carpet or pee pads down, he does the same nesting - just a particular guy - but I always cringe when he does it.
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PaulaM
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Post by PaulaM on Jul 9, 2019 9:11:34 GMT -7
T, I am so sorry to hear the prednisone taper revealed not only pain but some neuro diminishment. Clearly it is not time to be in the taper.
Discuss with your vet about using the higher end of the anti-inflammatory range which is more typically used with a disc episode. So for a 24 lbs dog the higher range would be more like 7mgs every 12 hrs. Since the tabs are 20mgs ones, it might be easier to round up to a full 10 mgs every 12 hrs when splitting. Let us know what your vet thinks AND for how many days this new course of pred will be for prior to going on a taper again.
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T & Tybo
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Post by T & Tybo on Jul 9, 2019 15:15:23 GMT -7
Just spoke to the vet. I explained what we saw earlier (my husband saw same thing when he took him out). I also told her how he has been this afternoon which is how he's been for the past week - walking more normally (at least almost how he has been but not quite), and he even rolled around on his back just a bit ago (sigh). Bottom line was I explained I didn't like what we saw this morning.
I inquired, but she did not want him to go back up to what we were at during the height of this quite yet. Plan:
Prednisone - 5mg 2x a day through 7/12 then 5mg 1x a day through 7/19, then 5 mg every other day until 8/5. Gabapentin - 100 mg 3x a day through 7/12 then 1-2x a day through 7/19 Continue with Pepcid/Prilosec
[Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 Prednisone 20mg tab as of 6/21: 5mg 2x/day for 4 days as of 6/25: 10mgs am - 5mgs pm for 3 days; as of 6/28: 5mgs 2x/day for 7 days, Fri 7/5 test taper for √7/9 pain √7/9 neuro as of 7/9: ▲5mgs 2x/day for 4 days, 7/13 taper test for pain/neuro ✙Gabapentin 100 mg 3x/day Pepcid AC 5mg 2x/day Prilosec 2.5mg 2x/day]
If we see him worsen, we can call her and we will talk about going back up but she doesn't want to do that unless we see things worsen. He is so much better tonight so I have no clue if the pred dose from this morning took effect or what the heck happened.
The vet did state that she doesn't like to keep dogs on these steroids long term but with his age - if it's not hurting him and he is doing well on them and making him comfortable, she's comfortable keeping him on them longer.
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PaulaM
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Post by PaulaM on Jul 9, 2019 15:42:14 GMT -7
T, I hope you will be in favor of advocating that when the pred test starts on 7/12 there will not be a delay in keeping pain masking gabapentin on board. Finding out soonest if should be swelling, means all the soon another course of pred can be started to avoid the swelling causing neuro diminishment as well as it can cause pain.
No vet can know how many courses it will take. No vet want a dog on pred once it has done its job. So it is a very prudent idea to try a 5-7 days course or even a 14-day course and then do the pred taper test. It may take anywhere in the rande of 7 to 30 days of anti-inflammatory doses (no taper days) to get the swelling down.
glad to hear Rambo is better. What does better mean exactly? Improvement in neuro function... all pain fully in control?
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T & Tybo
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Post by T & Tybo on Jul 9, 2019 16:10:03 GMT -7
Ok - sorry. I get so confused by the taper. I keep thinking the taper is when it mainly goes to every other day (not necessarily just a decrease, but I do understand now) but yes, I will e-mail the vet regarding no Gabapentin after the 12th to see where we are. I'm guessing she will have no issues. She's been very supportive which is great since we just started at their clinic about two months ago. Usually it can take time to build that trust, but she's been fantastic at listening, explaining things to me. If she's not on the same page as me, she does a good job at explaining her thoughts and recommendations. Yes, he is better neuro wise tonight than what we saw this morning. More in line of where he's been at for the entire past week. Have not seen the knuckling or just laying down outside not wanting to move much. Not seeing the same pain symptoms we saw earlier where he was laying awkwardly, what I believe was a pain pant, etc. He's resting very comfortably now and previously tried breaking out of his pen a bit which is typical for him - especially when he is hungry. Unfortunately today he had to wait a bit for dinner as we did the prilosec/pepcid and later pred. He was not exactly happy with me haha.
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T & Tybo
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Post by T & Tybo on Jul 20, 2019 13:14:28 GMT -7
Just a quick update. Rambo hasn’t had any gabapentin since the 12th and we just decreased prednisone to now every other day. Hopefully he will be off all meds completely by this upcoming Friday. Rambo is doing as well as can be expected. He’s walking a bit more normally and his tail is now mostly curled up which is normal. We still have a bit to go as he has also lost a lot of strength but he is doing well and he’s got much more pep in his step. He’s feeling so great that he escaped his pen the other day. Pulled the door up which he has done before but this time pushed the latch over to open the door. Found him asleep in his favorite spot. May need to invest in zip ties. Haha. He continues to roll on his back like a crazy man despite my desperate pleas not to Here’s to hopefully a boring pain free week so we can then finish out his crate rest in a few weeks.
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Post by Romy & Frankie on Jul 20, 2019 13:29:58 GMT -7
I am very glad to hear that Rambo is doing well, walking more normally.
Any loss of strength should be made up quickly once Rambo returns to activity.
Luckily, Rambo showed no ill effects from escaping his pen. Too much activity will put his healing disk at risk. I agree that it is a good idea to use something to fasten his crate more securely. It would be awful if he were to relapse.
Rolling on his back is behavior that will be difficult to stop. You may be able to distract him with a treat or something when you see him do this but if it hurt he would not be doing it.
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T & Tybo
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Post by T & Tybo on Jul 30, 2019 20:22:14 GMT -7
Ugh. We had a set back. To note - Rambo has been doing extremely well. Plateaued at about 80% back to normal which worked for us. Rambo was happy, in no pain, and working to finish up crate rest.
Yesterday I was bringing Rambo out on his leash - as I was getting ready to pick him up to take him out, he tripped over some things I had on the ground (my fault for leaving it out) and that caused him to fall forward onto a new tile floor next to that which completely freaked him out while I tried to stop him from skating on the floor (I hadn't put a carpet runner down as I didn't expect him to be on that floor any time soon since we always carry him out and in) - it was a freak accident all because I left something on the ground not thinking. Picked him up and brought him out. Knuckled immediately outside. We came back in and he went to sleep. Woke up and was back to what his new normal has been. He was fine all afternoon and night. At lunch today, he knuckled and laid down outside (nothing triggered this specific lunch episode such as stumbling over something). Brought him in and acted fine again with no knuckling and he has been fine all night - even trying to get out of his pen.
The vet put him back on meds. 5 mg of Pred 1x a day from 7/31 - 8/2 then 5 mg 1x every other day until 8/10. I do understand this is the taper dose and not a dose to reduce swelling - but he has shown zero signs of any issues since after the issue at lunch earlier today, so perhaps that might be why she wanted this dosage - I'm not entirely sure. We can give ✙Tramadol or ✙Gabapentin if he's showing pain using our discretion (and if things worsen, we would call her and likely go back to the higher dosage he was on), but he's acting more normal, and hasn't knuckled since noon.
[Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 Prednisone 20mg tab as of 6/21: 5mg 2x/day for 4 days as of 6/25: 10mgs am - 5mgs pm for 3 days; as of 6/28: 5mgs 2x/day for 7 days, 7/5 test taper for √7/9 pain √7/9 neuro as of 7/9: 5mgs 2x/day for 4 days as of 7/31: 5mg 1x/day for 3 days; Sat 8/3 test taper for _pain/_neuro relapse 7/30 --tripped ✙Gabapentin 100 mg 3x/day- being given? ✙Tramadol ??mg ??x/day - being given? Pepcid AC 5mg 2x/day]
Definitely frustrated as this was all my fault. Also confused as to how he knuckles and then soon after (literally minutes) is back to his normal self. I am used to seeing that slow progress forward so I'm a bit confused right now. I mean certainly good news he seems his new normal tonight but it's just a bit confusing.
*Note - he was just rolling around on his back again like he's feeling great (and we haven't even started meds yet as we are starting prednisone in the a.m.). Is this normal to feel back to normal like this? Could he have these types of things randomly long term where he does great for a few weeks then randomly knuckles if he tweaked it but then feels fine? Feeling extremely confused - especially because he seems back to his new normal now and we didn't even restart pred yet!
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Marjorie
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Post by Marjorie on Jul 31, 2019 6:19:59 GMT -7
I'm so sorry to hear this, T. Knuckling means there was something pressing on the nerves of the spine causing the nerves to be damaged. Since there was a fall and then knuckling, that would indicate that the not-yet-healed disc re-tore. The fact that he was better after a rest would indicate that the disc did not tear a lot and only mild neuro damage was done, which is good. However and unfortunately, since there are signs that the disc did tear again due to the fall, the 8 weeks of strict crate rest need to start over. 8 weeks is how long a damaged disc needs to heal and form secure scar tissue and this is a new tear. The 5mg of Prednisone 1x/day is an anti-inflammatory dosage, only at the low end. Since Rambo seems to be doing better now without it even having been started yet, that may well be sufficient. A 3-day course is a very short course and the swelling may or may not yet be gone by then. You'll need to be on the lookout for any sign of pain or worsening of neuro function when the Prednisone starts to taper off and if you see any sign of pain or worsening of neuro function such as knuckling, you'll need to immediately alert the vet so Rambo can be immediately brought back up to the anti-inflammatory dosage for a bit longer. Prednisone. Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily. Dr. Dawn Ruben "Prednisone/Prednisolone" www.petplace.com/article/drug-library/library/prescription/prednisone--prednisolonePain meds should never be given as needed but need to be given consistently to keep pain consistently under control. Should you see any sign of pain, please start giving the pain meds consistently, preferably 3x/day. I see he previously was on Gabapentin 100 mg 3x/day. What dosage of Tramadol was prescribed and how many times a day? Please let us know if you see any sign of pain and if what pain meds you're giving. The fact that Rambo laid down outside after knuckling could have been from some pain so do keep your eye out. Here are the signs of pain again for your reference: ◻︎ restless, pacing, can’t find a comfortable position ◻︎reluctant to move much in crate such as shift positions ◻︎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. ◻︎looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to pain of moving jaw with a neck disc or pain of back disc ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎not their normal perky selves Please don't forget to give the Pepcid AC again now the Prednisone has resumed. Continue to give that twice a day for as long as Rambo is on any dosage of the Prednisone. I know this is discouraging but it could have been a much worse relapse. Healing prayers for Rambo.
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T & Tybo
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Post by T & Tybo on Aug 7, 2019 23:52:01 GMT -7
Sorry I haven't updated. A day or two after I wrote last, things got worse neuro and pain wise and we upped the pred dosage (5mg 2x a day) for a few days and put him back on gabapentin (we did not do Tramadol). As of 8/6, we are back down to 5 mg once a day and no longer on the gabapentin. The 5 mg 1x a day of Pred taper will go until 8/13 and then we go 1x every other day until 8/20. He is still on a stomach protectant. [Moderator's note: please do not edit 24 lbs. 16 y.o. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 Prednisone 20mg tab as of 6/21: 5mg 2x/day for 4 days as of 6/25: 10mgs am - 5mgs pm for 3 days; as of 6/28: 5mgs 2x/day for 7 days, 7/5 test taper for √7/9 pain √7/9 neuro as of 7/9: 5mgs 2x/day for 4 days as of 7/31: 5mg 1x/day for 3 days; Sat 8/3 test taper for √8/1pain/ √8/1 neuro relapse 7/30 --tripped as of 8/1: 5mgs 2x/day for 5 days, then 8/6 taper Pepcid AC 5mg 2x/day]He's remaining steady neuro wise now. No more knuckling but no glaring improvement in terms of his walking - just sort of weak. We aren't back to where we were prior to the relapse neuro-wise, but doing better than right after the relapse. I know it just takes time and patience. Doing well pain-wise and doesn't appear to be in any pain since we stopped Gabapentin. Our vet did mention a fear that this may be a recurring thing he deals with - more frequently than not. I do not know what type of IVDD he may have, but I did read one type can be worse on seniors and is more likely to result in continual back problems in geriatric dogs. At this point, I want to wrap him in plastic bubble wrap and never let his feet touch the ground. I'm sure Amazon sells plastic bubble wrap by the rolls. Just kidding. Sort of.
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PaulaM
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Post by PaulaM on Aug 8, 2019 8:46:25 GMT -7
T, glad to hear taper of pred continues to show no pain and off all pain meds. It will be the final days of pred you will be able to reliably verify all painful inflammation is really gone.
Good to hear neurologically that knuckling has stopped--- good sign of nerve self repair! With time it would be expected that his weak legs will also improve.
Geriatric dogs, like geriatric people, can experience the normal aging and wear and tear on discs. Once he is graduated, a gradual building up and then keeping his core and back muscle in shape with walking may be very helpful.
Keep us posted as the pred comes to a stop. Fingers crossed no pain, no neuro step backwards will appear.
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T & Tybo
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Post by T & Tybo on Sept 14, 2019 18:58:52 GMT -7
Just a quick update on Rambo! We completed the taper of meds, and Rambo has been doing well (knock on wood). He's turned into a crazy man - play bowing by himself, rolling like crazy on his back - just loving life and ready for some freedom! Today we came home and he spilled his water bowl everywhere and had moved his x-pen a foot or two. I'm fairly sure he was trying to escape his x-pen again.
We decided once we are good to go, we will always keep him on a leash in the backyard as he likes to do zoomies back there and we are fairly certain a major zoomie episode originally contributed to this. We will also always carry him in and out to avoid two very large stairs. Even though he can't stand being held, he is no longer bucking at us and seems to trust us more (even though he still doesn't like it). Just with his age, we will take extra caution with him.
A few months ago when this first happened, I called our vet about something but she was not in the office. Instead, I spoke to another vet who pretty much stated we may need to consider euthanasia. We are so fortunate that we were familiar with IVDD, had been through this before, and of course had Dodgerslist. It hasn't been easy, but we are so happy for our boy who will be turning 17 soon!
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Marjorie
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Post by Marjorie on Sept 15, 2019 4:26:16 GMT -7
Wonderful to hear that Rambo was able to be successfully weaned off of all meds and that he's feeling so well! Yes, crate rest can be a challenge once a dog starts to feel well again. Only a little more than a week left (9/23) and you can gradually start to give Rambo more freedom. His stamina and muscle strength will need to be very slowly built up again. In preparation for graduation date, do take a look at the following link. There's a schedule on that page that I found very helpful when my Jeremy graduated from conservative care. www.dodgerslist.com/literature/AfterCrateRest.htmAnd here's our link on how to make your home back friendly if you haven't already seen it. A ramp over those two large steps may be an alternative to carrying Rambo since he doesn't like to be held. www.dodgerslist.com/literature/protectback.htmIf Rambo is still spilling his water bowl, here's an idea that might be helpful. www.dodgerslist.com/literature/cratesupplies/bowlHLDR.jpgPlease do stop back to our forum on graduation day so we can celebrate with you and Rambo. 17 years old is a wonderful age for a Shiba Inu and I know Rambo has wonderful loving care.
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