T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 20, 2019 23:12:13 GMT -7
Rambo is a 16 year old shiba inu. He spent 15 years in a puppymill which complicates things a bit but we are managing. We just adopted him last year.
For the past month, he's greatly slowed down. I assumed old man arthritis type stuff. Earlier this week though, he yelped when I touched his back. His legs were also crossing over a bit.
Vet was thinking severe arthritis but then found an issue in his back that caused him pain so she believes it is a disc issue despite not doing the MRI to fully confirm. He had great range of motion in his legs but knuckled on exam. Problem area is mid back. He was extremely tense during exam but hard to say if symptom of back issue or his anxiety.
He's been getting a bit worse each day in terms of symptoms. He was knuckling only during neuro exam but yesterday knuckled while walking. Today, very bad crossing of legs. Nearly looks drunk at times. Goes and sits down outside at potty time when leashed. Back legs sort of randomly giving out.
He is crated in an xpen. As a puppy mill dog, he only knows to circle and spin in a crate and the xpen seems to keep him most still. At first we were almost doing more harm when picking him up to go outside due to two large stairs we have. Obviously do not want him tk do stairs so we carry him. Still scared of people and thrashes when picked up, bucks, etc., but we are making it work and moving at a snails pace when taking him out to potty on a leash.
I can't tell if he's in pain unfortunately. He is panting a bit but again he's a boy who spent 15 years in a mill and has anxiety. Panting would not really be out of the norm for him. He will zonk out and sleep a while though so that's good!
Weight 24 lbs
Rimadyl 25 mg 2x a day
Gabapentin 100 mg 2x a day. Vet said we can go to 3x a day and we are starting this in the am just to be safe as we don't know if he is panting in anxiety or pain.
[Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day for ? days, then a test taper test stop to reveal if: _pain / _neuro Gabapentin 100 mg 3x/day No stomach protection on board!]
He's also on glucosamine and cranberry supplements. He is a weird pee-er and can hold in urine so cranberry supplement to prevent any UTI. He did poop today (it was normal looking) and has been urinating fine. He's also eating well. Before going on the rimadyl, our vet did do a small blood panel and his liver and kidneys were great.
Are we missing something medication wise? We've done conservative and surgery with prior dachshunds and I don't recall only doing two types of meds. I thought we typically did three.
Should we expect to see worstening of symptoms a bit before getting better? The crossing of legs and back end acting drunk has been getting worse the last two days. Sitting outside is obviously not normal for him so not sure if that is him showing that he is in pain. I'm guessing it may be. Lastly, has anyone tried turmeric just as something else to add as it has anti-inflammatory properties? Again, our vets gut is telling her a disc issue so I hope ok to post here. I understand if not. To me it is clearly a neurological issue of some sort (or causing neuro issues) and the way he reacted when touching his back, I agree with her on a back issue.
Thanks!
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Jun 21, 2019 6:06:05 GMT -7
Welcome to Dodgerslist. My name's Marjorie - what's yours? 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. It's most important that you immediately advise the vet of the worsening of neuro condition if you haven't already. The vet may want to switch Rambo from a NSAID (Rimadyl) to the more powerful anti-inflammatory which is the steroid Prednisone. Such a switch usually requires a 4-7 day washout period but such a switch can be made without a washout period by adding BOTH Pepcid AC and Sucralfate. Please let us know what the vet says about the worsening of neuro function. Even if a switch to a steroid is not made, stomach protection must be given any time a dog is taking an anti-inflammatory. Ask if your dog 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). canigivemydog.com/wp-content/uploads/2011/10/can-i-give-my-dog-pepcid-ac-300x300.jpg  NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.htmlGabapentin has a short half life and works most efficiently when given every 8 hours (3x/day). Since the vet has OK'd giving it 3x/day, please do give it that often. If there is still pain, Tramadol as a general pain med and/or Methocarbamol for muscle spasm pain can be added. Signs of pain to be aware of: ☐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. What was the date you saw the vet for CONSERVATIVE treatment of meds and started 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 ◼︎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. Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over. 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! www.dodgerslist.com/literature/slingwalk.jpg  LARGE DOGS: If your dog is too big to carry, it is still important that the amount of movement to the potty place be minimized. Try a pee pad right outside the crate. Add caster wheels to a wire crate and wheel down ramp over steps to outside. Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho? 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 your ability to learn - 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: www.dodgerslist.com/index/searchBOX.jpgHealing prayers for Rambo. Please let us know what the vet says after speaking to them this morning.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 21, 2019 7:34:53 GMT -7
6/18 is the date when he started crate rest and meds.
The vet was in surgery so I spoke to another vet. She is going to pull our vet inbetween patients to ask what she wants to do. I did mention prednisone with Pepcid and sucralfate if needed. I hope to hear back this morning.
He is worse today in terms of neuro deficits going on. Entire back half acting drunk and back legs giving out more from under him.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 21, 2019 7:43:11 GMT -7
T, loosing neuro function is an emergency thing. Moving to the most powerful of anti-inflammatory drugs (a steroid such as prednisone) quickly can help to save damage to the nerve cells. I hope your vet will recognize this fact and not delay in getting an Rx for pred and sucralfate plus your getting Pepcid AC into him quickly as possible. Hours matter when there is neuro loss to prevent it from being possibly permanent. As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. Paws knuckle under 5. Weak/little leg movement, can't move up into a stand 6. Legs do not work at all (paralysis, dog is down) 7. Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. A quick overview of conservative treatment vs. a surgery: www.dodgerslist.com/literature/healingsurgery.htm#surgeryVSconservative
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 21, 2019 8:58:54 GMT -7
Update. Spoke to the vet. She is switching him off Rimadyl and he will now be on:
✙Prednisone 5mg 2x a day ✙Sucralfate 3x a day on empty stomach (Sorry, didn't get mg dosage on phone) ✙Pepcid ✙Prilosec
Continue on Gabapentin 100 mg 3x a day
[Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 ✙Prednisone as of 6/21: 5mg 2x/day for 7 days, Fri 6/28 test taper to reveal if: _pain / _neuro Gabapentin 100 mg 3x/day ✙Pepcid AC 5mg 2x/day ✙Sucralfate 500mg 3x/day ✙Prilosec 2.5mg 2x/day]
At this time, surgery is not an option. He is 16 and spent 15 years in a puppymill. He is nervous with people and doesn't like being handled. The trauma from physical therapy, massage, etc. would simply not be fair to him whatsoever. Granted, I know PT may be needed after strict crate rest but my husband and I just looked at each other and knew surgery wouldn't be an option. The vet said the meds would pretty much be a last ditch effort here.
One note - last dose of Rimadyl was at 7 this morning. She does not want us to start him on prednisone until tomorrow evening. She was obviously very concerned about the switch to a steroid. Should we ask about starting prednisone a bit earlier than tomorrow pm if we get him on pepcid, prilosec, and sucralate asap today?
Side note - THANK YOU for helping us be the best advocates that we can be!
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Jun 21, 2019 9:18:41 GMT -7
Yes, with three stomach protectors on board today, the switch from Rimadyl to Prednisone can and SHOULD be made today. Otherwise, Rambo will have nothing working on the inflammation tonight or tomorrow morning and he's already showing additional signs of neuro loss. He needs the Prednisone ASAP.
Sucralfate should be given on an empty stomach, one hour before food and Prednisone so the gel coating action can begin. Pepcid should be given 30 minutes after the Sucralfate.
Most vets would not operate on a dog that can still walk. If Rambo can still walk at the end of the 8 weeks of conservative care, a gradual reintroduction to walking can be done and walking is a form of PT. So hopefully no other PT will be necessary. Nerves can take a long time to heal so it's a take it one day at a time approach.
Also, did the vet say for how many days she wants Rambo on the Prednisone before tapering? Please also let us know the mgs and times given a day for each of the stomach protectors when you get a chance.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 21, 2019 9:43:16 GMT -7
Pepcid - 5mg 2x a day Prilosec - 2.5 mg 2x a day I will post about Sucralfate mgs once my husband gets home with them.
She is giving us 7 days worth of Pred. She stated she may want to do longer depending on his condition or may taper - but we will re-evaluate after 7 days.
Side note - I know turmeric has a lot of anti-inflammatory properties and is often given to dogs with arthritis. I asked the vet about it at our last visit and she said she's heard wonderful things about it, but would need to research a bit as she personally doesn't have experience with it. Any thoughts on adding that in just for extra anti-inflammatory properties? (obviously still keeping on all meds as prescribed).
Sorry - I was responding to a post earlier where surgery was mentioned in passing with difference between that and conservative treatment. Just meant if it came down to it, surgery is not something we would consider for him. We did do surgery with one of our dachshunds and have done conservative approach a few times with another dachshund we had. We have adopted many dachshunds previously and Dodgers List was so helpful to us in the past. Thankfully I knew to come on here immediately so I can ensure we are doing all we can for Rambo. Again, thank you!!
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Jun 21, 2019 10:02:43 GMT -7
Turmeric does help inflammation but with an IVDD episode, you need to bring in the strong meds like a steroid which you now will have on board. Turmeric can also interfere with Famotidine and increase stomach acids which you don't want to have happen. So it's not a good idea to give Turmeric at this time. pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000932Turmeric is more useful for dogs who are unable to take a NSAID or steroid due to health issues or for long term use. Have you heard from the vet yet about starting Prednisone today? If not, please do give the office another call. It really is important to get it on board ASAP to relieve the pressure on the nerves of the spine to prevent further nerve damage.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 21, 2019 10:34:43 GMT -7
My husband spoke to the vet when he picked up meds. She is ok starting pred tomorrow morning v tomorrow evening, but no earlier. She said no earlier than 24 hours after the last Rimadyl but she wanted us to get him on sucralfate and stomach protectants asap (as in rush home and get sucralfate in him before you do anything else). Anyways, she said risk is too great for him to do any earlier than 24 hours despite fully understanding our concerns.
Thanks so much for turmeric info. We will hold off completely on that.
Sucralfate is 1/2 tab of 1 gm. - 3x a day
Doesn’t say mg but says gm whatever that means.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 21, 2019 10:49:25 GMT -7
T, sucralfate works right away and Pepcid AC works in 30 mins. When it is deemed an emergency to not do the safety of a 5-7 day washout before starting pred, double stomach protection is what vets who know IVDD and the meds do. An emergency means that hours matter. By tomorrow morning it is many, many hours of pressure on the spinal cord. Rimadyl can stay in the body for 5+ days and thus the reason for the normal 5-7 day washout. A 24hr washout is like not doing any washout!!! Nerve cells die when there is pressure to the cord. We see that death as the predictable step by step loss of neuro function. See if you can advocate for getting pred on board now, today. Your vet has subjected Rambo to danger by not doing the 5-7 days washout because she believes there is an emergency in neuro loss But has tripple protected the GI tract. Why not take advanntage and get the spinal cord protected now. Again hours matter. Tomorrow morn is too many hrs away, too much delay in starting pred the med that helps to get that inflammed tissue around the spinal cord reversed. T, a med chart can be a useful thing with so many meds to track cause and effect, plus other things to report to the vet. D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 21, 2019 18:48:41 GMT -7
We ended up starting him on the pred tonight, so I'm hoping all goes OK. We got two doses of the Sucralfate in (several hours apart of course) as well as Pepcid and Prilosec in before we did Pred. I wanted to make sure we could get as much stomach protectants in as possible. He did urinate tonight - he hadn't since this morning, so that is good. Still eating and drinking well. No poop today, but perhaps that is just due to all the meds in his system now.
|
|
Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
|
Post by Marjorie on Jun 22, 2019 4:03:45 GMT -7
Just to confirm, did the vet approve starting the Prednisone last evening? Any advice we give here on the forum is for discussion with your vet and not for your own dosing. If not, be sure to let the vet know that it was started last evening. You've done a great job advocating for getting the proper meds on board for Rambo and your vet seems quite open to listening to your input so that's a real benefit to Rambo's healing.
If you feel that Rambo may have a bit of constipation from the meds, pumpkin can help that. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 22, 2019 7:23:15 GMT -7
Yes, I will keep the vet posted. About 4-5 hours after taking prednisone, you could tell it was helping or at least giving slight relief.. He began trying to get out of his pen, completely thrashing around when being picked up which is normal for him as he doesn’t like people touching him. I fear he’s going to injure his back more when we pick him up but other option is two very large stairs that go outside. We will just keep working on going as slow as possible.
He slept well, pooped this morning, and had his normal stance when he urinated. Back legs still giving out a bit, etc. but there was no worsening of neuro loss that we noted.
I certainly know we aren’t out of the woods but I’m thankful no worsening overnight.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 22, 2019 8:50:10 GMT -7
T, glad to hear no worsening of neuro functions since the start of pred yesterday evening. LIMITED MOVEMENT ISSUES I, too, am very worried about his behavior at potty time. Can you change up things to protect his disc? -- How about placing a pee pad right outside his recovery suite. -- Secure some old urine on a piece of paper towel and store in a zip lock bag til needed. -- At potty time he would then only walk a couple of footsteps out of his suite to the adjacent potty pad. -- On the pee pad you will have placed the urine scented papertowel on the pee pad to let him know it is OK to pee in the house on the pad. Another dog's urine would be best if you can obtain some as Rambo will mostly have a good desire to mark over it! PAIN OBSERVED? Can you give some detail about the meaning of pred "giving slight relief last night". Are you saying you are observing pain? If yes, then clearly one pain med (gabapentin) is insufficient. Normally it takes 3 different pain meds each to address the typical sources of pain with a disc episode. Do call your vet IF, you are observing any pain, pain nearing next dose of gabapentin (for nerve pain), or when he has to move. Advocate for the other two pain meds be prescribed: -- tramadol as the general analgesic 3x/day -- methocarbamol for typical muscle contraction pain 3x/day 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.
Let us know which IF you do observe painfulness: ◻︎ 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 ◻︎ 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 GI PROTECTION Just checking to make sure of optimal GI Tract protection with the dosing order: Sucralfate requires stomach acid in order to form its protective gel coat over any damaged area. ~Ideally give Sucralfate on an empty tummy at least 1 hour before feeding or 2 hours after feeding ~If possible, sucralfate should be given 30+ minutes prior to the administration of Pepcid AC and Prilosec. ~Give Pepcid AC/Prilosec 30minutes before Prednisone ~Give prednisone with a meal. Pred could be given along with pain meds IF also due at that time. resource: www.marvistavet.com/sucralfate.pmlTEST PRED TAPER on Fri 6/28 With the taper scheduled to begin, you will want to be up to speed on what the pred taper is all about to be in the best position to ask questions, be part any discussions with your vet. Good info for you to read: www.dodgerslist.com/literature/healingsweling.htm --- Let us know what your and your vet's Plan B is. --- Let us know if your vet is amenable to a phone update on Friday to avoid risky transports in with things than can be addressed by phone. Transport to a vet involves risk of too much movement of the spine with potential to then damage the early healing disc, especially with a large dog and one who thrashes around being picked up! The benefits of the treatment need to be weighed against the risk of too much movement. It is not until the taper starts that pain/neuro might be revealed that day or some days after as pred begins to be lowered in the body. So Friday may or may not be too early to know if pred has fully done it's job or not. --- Let us know which your vet wants on the begin of the Fri 6/28 pred taper test (backing off all pain meds or the full stop of them.) This is done to determine if the swelling in the spinal cord is really all gone. It is this swelling that causes the pain and neuro deficits. If the dog is still taking pain meds it will mask the pain that indicates the swelling is still there. If the anti-inflammatory and pain meds are both stopped and no pain surfaces the swelling is gone and only the remaining period of crate rest is needed. If pain returns when these meds are stopped, more time on all meds is needed. Prednisone's job is only to get the swelling around the spinal cord resolved. It is mother nature and Rambo's body which will do the job of self repairing nerves with time.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 22, 2019 14:10:07 GMT -7
We really have no clue if he's in pain. No yelping, no tight tummy, no shivering/trembling. He pants from time to time but that is normal for him, so it's hard to stay there. He is not restless and just zonks out. He also nests and works to rearrange bed/blankets to his liking with no issue that we see - changes positions easily. We will keep a close eye on things though. When we come in the room where his x-pen is, he does get up right away with ease which is normal for him. He is sleeping a lot and I'm guessing pretty tired from all the meds (plus, he's old and sleeps a lot as is) - so hard to say on the normal perky self part. His normal perky self outside would be bouncing through the yard. He's obviously not doing that since he's on a leash, so it's hard to say.
I did speak to a vet though. She gave the go ahead on ✙Tramadol (we have some at home from another dog) if we feel he is in pain. 50 mg and he can take up to 3 times a day, but she stated that if in pain, just start him on one a day and see how he does.
[Moderator's note: please do not edit 24 lbs. Rimadyl as of 6/18: 25mg 2x/day - Stopped 6/21 Prednisone as of 6/21: 5mg 2x/day for 7 days, Fri 6/28 test taper to reveal if: _pain / _neuro Gabapentin 100 mg 3x/day ✙Tramadol 50 mgs 3x/day but not given yet. Pepcid AC 5mg 2x/day Sucralfate 500mg 3x/day Prilosec 2.5mg 2x/day]
Yes, our schedule is example: 6:00 a.m. - Sucralfate 7:00 a.m. - Prilosec and Pepcid AC 7:30 a.m. - Gabapentin and Prednisone (plus full meal)
We think the timing is correct there.
Yes, the vet who initially saw him is scheduled to call me on Tuesday just for a general check-in (this vet office is extremely good about following up on everything). We will then speak later in the week to discuss taper, etc. She has made no mention at all of any follow-up appointment but said we'd speak by phone, so I will make sure we address by phone.
|
|
|
Post by Romy & Frankie on Jun 22, 2019 14:37:39 GMT -7
Thrashing when picked up is normal behavior for him? In that case it doesn't sound like he is showing any signs of pain. The problem with the thrashing is it is too much movement for an IVDD dog. The pee pad with another dog's urine on it worked well for Frankie when he was on crate rest. Until I put the paper towel with the other dog's urine on it, he wouldn't use it.
Your schedule with the Sucralfate is fine. Is it a similar schedule at night?
For the tramadol, if he is not showing signs of pain, it isn't necessary to add it. It may be that the gabapentin alone is controlling the pain.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 23, 2019 19:36:22 GMT -7
Yes. Night schedule is same. We also do an extra dose of sucralfate mid day as the vet wanted us doing that 3x a day. Yes, thrashing when being picked up is completely normal but he did not thrash today.
He actually does well in his xpen and doesn’t seem to be in pain. When we take him out, we think he might be in pain. He pants and I just don’t think this is his normal puppy mill survivor anxiety now which he has. The fact he has to be close to us so much might be causing anxiety while going potty.
Tonight he was panting outside and he might have been panting because he had to poop and couldn’t run off to poop. This is why it’s just so hard to tell if it’s pain or his general anxiety. I did notice his curled up tail is down lower which of course means he could be in pain. We think he might be in pain. It’s hard to describe and I really am not 100% sure.
Regarding Tramadol. Vet said we can start at 50 mg once a day. Could do 3x if needed for pain, but start at one time a day. Do you know how soon tramadol begins to take effect? I’m just not sure when we should do tramadol or how long that med stays in system and works.
Current meds schedule. 6:00 am - sucralfate 7:00 am - Pepcid and Prilosec 7:30 am - prednisone and gabapentin and food 1:00 pm - sucralfate 2:00 pm - gabapentin 8:00 pm - sucralfate 9:00 pm - Pepcid and Prilosec 9:30 pm - prednisone and gabapentin and food
Where should be put tramadol if we do once a day? Even if around 2:00 am, we don’t care. Just whatever might be most beneficial.
Still eating and drinking well. Peed and pooped outside. Sleeping well. Legs still crossing and giving out at times. Knuckling at times but mainly on one side. One side does seem weaker and it was like that at the vet as well. Not seeing any further neuro loss at this time. He’s been steady there since he started prednisone - no further neuro loss.
To add. Right now he seems completely normal and in no pain as he sits in his pen. He just stood up, circled once and laid down comfortably. He seems more painful when outside or else he’s just hot, has anxiety, and is not in any pain. I wish he could talk and tell me!
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 23, 2019 20:34:44 GMT -7
T, sometimes we can not know for sure if the dog is suffering with pain. You could try an experiment to add in tramadol and see if the suspicious pain panting, lowered tail subsides.
The usual pain meds used wtih a disc episode have a short half life. That means these drugs begin leaving the body at less than effective level after 8 hrs. Thus vets who know IVDD and the pain it can cause, prescribe these pain meds to be given promptly every 8 hrs. It will take about an hour or less to get pain in control and should remain fully in control when pain meds are dosed promptly every 8 hrs. (tramadol, gabapentin and methocarbamol).
Sucralfate requires stomach acid in order to form its protective gel coating. — "Ideally" give Sucralfate every 8 hrs at 6am, 2pm and 10pm on an empty tummy 1 hour before feeding — Give Pepcid AC and Prilosec at 6:30am and 6:30pm at 30 mins after sucralfate — 1 hr after sucralfate dose at 7am and 7pm, feed a meal. Also give prednisone every 12 hrs — Give pain meds (gabapentin, tramadol) promptly every 8 hrs at 7am, 3pm and 11pm
Are you using a med chart, very helpful in figuring out the maze of every 8hrs, 12hrs dosing schedules? Handy place to make note of times of panting, tail down, etc. in relation to dose times to see a pattern.
Note: both tramadol and prednisone can make a dog pant. Try a fan near but not pointed at the dog to circulate air.
Let us know if you will be dosing tramadol 50 mgs at every 8 hrs and what you observe.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 23, 2019 21:39:40 GMT -7
Can you review times please? You said ideally 6am, 2 pm, 10 pm on sucralfate but then Pepcid Prilosec, prednisone evening doses are as though sucralfate is being given at 6 pm but it’s not with the 6,2,10 unless I’m misunderstanding something which I might be!!
The fact we do sucralfate 3x a day is what makes this all weird. If sticking to 6, 2, 10, - we couldn’t do pred every 12 hours. This is why we tried to change times slightly so we could get as close as possible with the combo of med timings we have here.
Good to know those cause panting! We do have a meds chart. I will begin to make more notes on when we notice certain things including if he was in or out, maybe even if he was sitting or standing, etc.
Thank you!
Side note. The instructions on the Rx bottle from vet say do not take anything at all one hour after sucralfate. I can call the vet tomorrow to see about doing the Pepcid and Prilosec 30 minutes after the sucralfate v 1 hour to try to get meds a bit better timing wise. They were very concerned about the switch to prednisone and protecting his stomach so we’ll see what they say.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 23, 2019 21:51:11 GMT -7
Rx is for sucralfate every 8 hrs (3x/day). 6am, 2pm and 10pm are 8 hrs apart.
Pepcid AC and Prilosec are Rx'd for every 12 hrs (2x/day) So there can not be a match in timing for all three doses of sucralfate. "IDEALLY" you would give Pepcid and Prilosec at least 30 mins after sucralfate. So that only works at the 6:30am time. The next time is actually 4.5 hrs after the 2pm sucralfate dose...just works out that way. Read the Mar Vista link I provided for the full info. Ideally you try to give time for the sucralfate to start forming a gel coat before giving pred and giving a meal. marvistavet.com/sucralfate.pml
There's likley not enough room on the sucralfate bottle to put in all the options in timing with food and timing with Pepcid AC/Prilosec
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 24, 2019 14:45:00 GMT -7
Rambo is doing a tad worse neuro wise today. Still same knuckling and back legs giving out but very clear he is weaker today. He can still go into a standing position but it is taking more effort and once up just sort of worse neuro wise than what we have seen. No new loss noticed such as loss of bladder control or can’t stand - it’s just what he had is worse.
he is still able to rest fine inside his pen. Drinking and urinating well. Eating well. Etc. I actually have been taking video just to monitor progress and big difference in terms of neuro wise yesterday compared to today when I watch video. More than a tad that I said above.
Sorry. That third gabapentin is at 11:30 at night not 9:30. We will make the change to evenings times to ensure the pred is every 12 hours and gabapentin every 8 hrs exactly throughout the day. We will do this before giving tramadol and will then evaluate from there.
We’ve been through IVDD with two dachshunds previously but we’ve never had this many meds. Lol. Thank you for helping me wrap my head around this.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 24, 2019 16:24:39 GMT -7
T, do get in touch with your vet. Always describe in specifics what you observe rather than making general statements of neuro is worse. Discuss if going a bit higher on the prednisone dose for a 24lbs dog is prudent to be aggressive in getting the swelling down if she feels there is actually some degree of neuro diminishment. Could more effort be due to it might be a bit painful to get up? You have not started Tramadol yet, correct?
Below reference is for you to be able to discuss things with the vet, but definately not change the pred dose yourself. Prednisone is one med that needs to be prescribed by the vet. Pred is a hormone that has anti-inflammatory properties.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 25, 2019 9:03:10 GMT -7
I will call vet to discuss. He is 16 and the vet noted some muscle mass loss in back legs several months ago. It could just be old bones. When I wake up and just need to stretch my legs. It’s like he needs that.
Correct - no tramadol yet as we evaluate him with the new dose times.
---- I spoke to the vet and explained everything we've been seeing. She doesn't want to max him out on pred but does want us to increase to 1/2 tab of ▲Prednisone in the am and 1/4 tab of Prednisone in the pm. So, he will get 10 mg in the a.m., and 5 mg in the p.m. (starting tomorrow morning). We will do this for three days. On 6/29, we will go back to 1/4 tab (5 mg) am and 1/4 tab (5 mg) pm. That 6/29 will now almost be like the start of a taper but she wants to speak later this week. She also confirmed that I will keep him on Gabapentin the entire time - she said she absolutely doesn't want him feeling any pain and said to go ahead with Tramadol if needed - but we spoke that right now, we don't think needed.
[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 6/29: ▼5mgs 2x/day for 7 days, Sat 7/6 test taper for _pain _neuro Gabapentin 100 mg 3x/day Tramadol 50 mgs 3x/day but not given yet. Pepcid AC 5mg 2x/day Sucralfate 500mg 3x/day Prilosec 2.5mg 2x/day]
She believes his age likely has a lot to do with him being slower to get up. Afterall, he is 16. His age will certain impact things. When he lays around for a week doing nothing, his legs will be more impacted in general. She said the increase of crossing legs yesterday is concerning but she said otherwise, things sound good in terms of our approach and was of course pleased with still having bladder control, not down, etc. She thanked me for keeping in such close communication and I wanted to pass that along to each of you who help me (and others) through these issues with our pups.
I do have one question - is it OK to massage his back legs a bit? Specifically if he's standing up? Obviously no pulling on his legs or anything, but just sort of rubbing his muscles on his thighs or rubbing his feet? With his age, I'm wondering if that might just help him a bit.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 25, 2019 9:50:34 GMT -7
T, sounds like your excellent ability to report your observations led to a meaningful discussion in adjusting Rambo's medication therapy. Good job on your part in being the eyes and ears for your vet and being able to join in the discussion to help Rambo. This is the kind of teamwork we hope for each member of the Forum. When pred goes back to 5mgs 2x/day on 6/29, for how many days will that be for before the prednisone test taper begins?Basically, when a dog can walk, can take a few footsteps at the every 4 or so hrs potty times, that should be enough to keep joints flexing and the blood circulation up in the legs. Always the focus during conservative treatment is limited movement to protect the scar tissue trying to form on the disc. Feet rubbing often will cause the leg to jerk —perhaps causing too much movement to the back. Mornings, especially after sleeping all night he might be a bit stiff? If you can be very careful and Rambo is OK with it... these least aggressive of range of motion and massage normally reserved for paralyzed dogs when they are off of all meds and no pain exists might help with morning arthritis stiffness. Only the information highlighted in PINK would pertain to Rambo's stiff morning legs. www.dodgerslist.com/literature/massagepassiveexercises.htm
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 25, 2019 10:39:06 GMT -7
OK - thanks. I will read through that information.
I asked the vet that. She first stated 3 days on the 1/4 then 1/4 (so from 6/29 through July 1st) but then paused and said she wants to talk to me later this week to get an update on Rambo and then we can go from there with discussing a taper.
We are new to this vet clinic having moved from out of state so don't have that close relationship that we typically have with vets (we adopt seniors/special needs pets and are at the vet frequently) - but I've been very impressed with their responsiveness and openness to discuss things. The whole clinic is very transparent. All treatment and surgery rooms are glass walls. Any time your pet is taken back for x-rays, surgery, etc., you can follow your pet and watch the entire thing. The vets are the ones who do blood draws and they are done right in the room with you so the dog doesn't get taken to the back. I can't remember if they are fear free certified, but it's definitely nice to have a vet who is open to talking and discussing things with you!
Thanks again!
|
|
|
Post by Romy & Frankie on Jun 25, 2019 13:19:23 GMT -7
Taking in senior and special needs pets is a truly wonderful thing to do.
Am I correct in thinking that Rambo is now taking 10mg prednisone in the morning and 5mg in the evening until you touch base with the vet later in the week? At that time a taper will be discussed.
It makes a huge difference when you have a vet open to discussing things with you. We pet parents are really the most important part of our dog's health care team and it is vital that the vet listens and responds to our concerns.
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 26, 2019 10:48:57 GMT -7
Correct. He’s on 10 mg in morning and 5 mg in evening. On 6/29, we will go to 5 mg in am and 5 mg in pm. The Rx says do that dose for 7 days. I still plan to call the vet later this week to discuss how she wants to handle the taper and will refer to the link posted above for guidance in my convo.
Rambo again had a tough time late yesterday afternoon in terms of knuckling, legs giving out, etc. before he gets his pm pred - but an hour after his pred dose when leashed to potty, he was walking without his legs giving out. He doesn’t show pain, just weaker during that specific late afternoon time.
However, he had a fantastic night. For him - not his human parents. Lol. He tried to bust out of his pen, this morning he was barking at us. This is all normal behavior for him. I had to try sleeping next to the pen to calm him down. His trying to bust out is just pushing his face against the pen door but I still stopped him each time he did it so he wouldn’t put pressure on his back. He also watched some Real Housewives so he had something to keep him occupied. Music helps keep him calm as well. While we obviously are wanting to keep him still etc, it felt like we had our boy back.
He also did not knuckle outside late last night or the two times he has been out today so far! Very big news in my opinion as he has been knuckling a bit each time we were taking him out.
I also started very light massage on his hind legs while he is standing after reading the link shared with me above. Some things I wasn’t comfortable doing so I just did one thing on there. I was very careful and he never moved, so that was good. His back legs definitely do seem just arthritic and old. He already has muscle loss back there and I think it is just a chore at times to get standing as once he does he is much better.
Hopefully we continue to see improvement. I’m anxious to see how he does later this afternoon. Obviously still have a long road ahead of us but a little hope goes a long way!
|
|
|
Post by Romy & Frankie on Jun 26, 2019 14:04:37 GMT -7
If Rambo is moving around a lot at night and keeping you up you could try some natural calmers. Try using an oral calmer in combination with a Pheromone diffuser. This seems to work best. It takes several days for these to start working - it isn't immediate. 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. Some brands to consider: --Adaptil (DAP) wall plug in diffuser www.adaptil.com/us/Adaptil/Adaptil-DiffuserUse a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed us.virbac.com/product/behavior/anxitane-chewable-tablets2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.php
|
|
T & Tybo
New Member
M - Shiba Inu/Eskie Mix
Posts: 31
|
Post by T & Tybo on Jun 29, 2019 15:58:34 GMT -7
Just to update. We started the taper on 6/28 - 1/4 tab pred am and pm until 7/5. We will then do 1/4 tab every other day until 7/12.
On 6/30 we will decrease ▼gabapentin to twice a day v three. The vet said to see how he does. She said to use our best judgement and perhaps then decrease pain meds again in a week. She was in no rush to get him off of them.
We've stopped the sulfacrate but will continue other protectants while still on pred.
[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 ▼2x/day Pepcid AC 5mg 2x/day Prilosec 2.5mg 2x/day]
Rambo is still doing well. In fact, he thought rolling around on his back yesterday was appropriate so we stopped that. I'd guess he's already regained about 75% of the neuro loss, and he does better each day. He may be 16, but he says he's got some time to make up for after 15 years in a puppy mill.
Thank you all again. You provide such valuable tools to help us be the best advocates we can for our pets.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,534
|
Post by PaulaM on Jun 29, 2019 17:26:57 GMT -7
T, glad to hear pain is still in control. As a dog feels better it sure can be a challange to make sure they adhere to limited movement. Keep us posted as gabapentin is reduced to 2x/day and with the further reduction of pred on 7/5. Fingers crossed all will go smoothly to the completion of being off of all medications on Friday July 12th!!! All that remains is to get the disc to heal with continued crate rest. Thank you for the kind words...makes our day to know we have helped.
|
|