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Post by Modalita & Willie on Oct 10, 2019 18:38:40 GMT -7
Willie had a single day where he drunk walked a bit and we immediately got him in the next day for an appointment. Vet prescribed 2.5mg/day pred 2x a day, scaling back to every other day. Gabapentin is the other daily,forgot dosage.
[Moderator's Note. Please do not edit
15 lbs
Prednisone as of 9/16: 2.5 mgs 2x/day for 7 days, then 9/23 a test taper to reveal: _pain / _neuro
Gabapentin100mgs ▲2x/day no GI tract protector, Pepcid AC, on board w/prednisone!!]
Drunk walk ended same day and never returned. Still shivers [pain!] a little bit, even today although appears to be declining in severity/how often. Hoping that will end by the 30 day time period. ' Dog is 12 year old dachshund- curious if slow recovery out of pain has to do with age...11
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 10, 2019 20:44:37 GMT -7
Welcome Modalita! Glad you have arrived here to join us all. The prednisone taper is a test to find out if another course of pred is needed or not. Clearly another course of pred is needed as you are reporting pain and he is still on a pain masking pain med to boot. First read how prednisone is used for a disc episode so you can be successful in voicing things with your vet from a basis of understanding. Here is the article to read about use of prednisone, what the taper is for, what your job at home is during the prednisone taper: www.dodgerslist.com/literature/healingsweling.htmPlease alert your vet and advise us too, which, if any, other signs of pain you are currently observing: Advocate that any of the pain meds be given 3x/day (every 8 hours) as that is what most effectively gives full pain control during a disc episode: —Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock. SIGNS OF PAIN: ◻︎ YES! 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 It will help us work together with you and avoid offering ideas that could cause harm or lead the discussion in the wrong direction delaying help for your dog — please share a bit more detail with us: ❖2 How much does your dog weigh? A.. Please list the exact names of meds currently given, their doses in mg’s and times per day given. B.. What was the start date of prednisone? What was the start date of the first lowering (tapering) of pred? C. PEPCID AC: Phrase a simple question that you expect a simple "yes "or "no" to it. Does my dog have 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). (NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. www.1800petmeds.com/Famotidine-prod11171.html ) canigivemydog.com/wp-content/uploads/2011/10/can-i-give-my-dog-pepcid-ac-300x300.jpg❖3 -- Eating and drinking OK? No nausea/not eating, no vomit? mgs ?x/day -- - Poops OK - normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea? ❖5 -- Is the vet a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho? ❖6 What was the date you saw the vet for CONSERVATIVE treatment or date of SURGERY? 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. That 6 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.htmLet us know you've been doing STRICT rest since 9/16: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times. - no PT - carrying to and from the potty place. Only a few footsteps to take care of business ❖8 Currently any neuro deficits? does he knuckle under his paws? You will be amazed with yourself on how well IVDD educated you can become in a such a short time! Follow the colored buttons in the next days to become the IVDD savvy pet parent your Willie will need: www.dodgerslist.com/healingindex.htm Look forward to learning more detail about Willie, his meds and getting pain in control with your answers. Bookmark a thread to receive an email alert when someone has replied 1. Go to your Profile> Profile Edit > Notifications: checkmark BOOKMARKS + "instant" email 2. Next, go to the CONSERVATVIE Board: checkmark your dog's thread, then use the ACTIONS button to select "bookmark"  |
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Post by Modalita & Willie on Oct 11, 2019 14:30:41 GMT -7
He's 15 pounds. Right now he's tapered to 2.5mg every other day of prednisone and gabapentin every day.
If he's still shivering today I should increase his pred? Nothing else such as drunk walk or kindling showing.
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Post by Romy & Frankie on Oct 11, 2019 14:55:15 GMT -7
If Willie is showing any signs of pain, like shivering, now is not the time to start the taper. If you are not sure if he is in pain you can look for a secondary sign. These are the signs we look for. I am putting them again here for easy reference- ☐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. Two signs of pain would confirm Willie is in pain.
Please let the vet know that while tapering Willie is showing signs of pain and ask for more time on the full dose of pred.
Have you been able to start the Pepcid AC yet? Our dogs have enough to deal with during an IVDD episode without stomach problems.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 11, 2019 15:33:10 GMT -7
Modalita, the vet must be the one to prescribe changing his meds. Your job is to report your observations over the phone of when shivering happens…. — nearing next dose of pred/gaba. — when he has to move such as reposition himself in the suite or when taking a very few footsteps at potty time. — to report any of the other signs of pain such as being reluctant to move much…review the pain signs list and let your vet know if you are also seeing. Details are very important to us in figuring out things and being able to give the right comments to help Willie. QUESTIONS1) The number of days on pred before the taper stared are the important days that work on swelling. Taper days serve a different purpose. On what date did pred begin to be lowered from the first doses at 2.5 mgs 2x/day?2) What is the current dose of gabapentin in mgs? How often are you giving it (once a day, 2x/day, etc.?? 3) If the vet tells you that Willie has no health reason to keep him from Pepcid AC (famotidine), let us know you went to the grocery store to buy the 10mgs tablets to use while he is on prednisone. For a 15 lbs dog, he would be taking 5mgs (1/2 of a 10mgs tab) every 12 hours. 4) Have you been doing strict rest since the start of the episode on 9/16? Knowing strict rest has been employed, helps us to rule out a painful retear of the weak scar tissueSTRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times. - Carrying to and from the potty place. Then only a very few footsteps allowed to take care of business Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep even a slightly wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is used 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! |
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Post by Modalita & Willie on Oct 13, 2019 10:56:39 GMT -7
Okay. A lot to respond to but let's see if I can cover it all.
Just started the ✙pepcid ac per your recommendation.
Willie was strict conservative for the the 3 weeks. I gave him very light outs like putting him on the sofa with me in the last week. (I know I know)
He's been to 2 vets in the last week [Oct 7-11ish?]- one I think is IVDD knowledgeable and a second opinion. They both did similar tests...back pressure with fingers to see pain(unresponsive), watched him walk around the office, knuckling test, etc.
The 2nd opinion doc found a heart murmur and doesn't want to give him another pred burst explaining that given his heart condition and symptoms it wasn't a good path. She believes that the shivering is from something else.
The gabapentin I believe is 100mg. She upped his dose to ▲gabapentin 2x a day.
Pred was 5mg pills split in half (2.5mg dosage)...2x a day for 7 days, daily for 7 days, and he's been 2.5mg every other day for about 2 weeks now.
[Moderator's Note. Please do not edit
15 lbs
Prednisone as of 9/16: 2.5 mgs 2x/day for 7 days, then 9/23 test taper to reveal: _pain / _neuro
Off of 100% crate rest 10/7-11ish?
Gabapentin as of Oct 7-11ish: 100mgs ▲2x/day
Pepcid AC ? mgs ?x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 13, 2019 15:48:58 GMT -7
Modalita, I'm so sorry that a clear prescription of 8 weeks of strict rest was not given on Sep 16. When the disc is still in early stages of forming secure scar tissue, it is easy to break/tear the tissue. Then that would put Willie back at square one of starting crate rest as of Oct 10 when you posted to us.
The reason he was not out of pain at the end of 3 weeks and the slacking of limited movement of the back could well be he disrupted the disc's scar tissue with the lightening of 100% STRICT rest week of 0ct 7?-11?ish which prompted you to a vet visit!
We can never know if he damaged the early healing disc. But we can make sure to give him a full 8 weeks starting Oct 10 just be be sure.
We can know that likely there is indeed swelling around the spinal cord because Willie is still in pain evidenced by shivering. Could you be specific. When do you see shivering? My list of questions are at the end of this post.
HEART MURMUR
In light of the heart murmur issue, did you ask that vet about the use of Pepcid AC specifically? She ok'd Pepcid AC with Willie's heart murmur? She ok'd staying on every other day pred for such an unusual long time of 2 weeks?
Summary of QUESTIONS
1. When do you see Willie shivering. When nearing next dose of gabapentin? When he repositions himself in the suite or has to move such as at potty time? Did the increase of gabapentin to 2x/day, stop the shivering?
2. Did the vet ok Pepcid AC with a heart murmur?
3. Why is Willie still on an every other day pred dose for such a long time. It this continuation of pred every other day instead of giving him an other 7-day course of pred. Every other day pred is not working on painful spinal cord swelling. A bit confusing about the use of pred with Willie in light of heart murmur. Can you explain more?
4. What does 2nd opinion vet think the shivering is caused by?
NOTE: when possible include dates to help us put the pieces of the puzzle together correctly along with your specifid detail. Thanks bunches!
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Post by Modalita & Willie on Oct 15, 2019 20:06:22 GMT -7
Sorry for the slow reply. I've been on travel and Willie has been under the care of my wife. To your questions...
1. I see no effect of gabapentin on Willies shivering. The times seem really random. Could be morning, afternoon. My wife is convinced that when I came home and his activity increased so did his shivering. She is a lot more strict on rehab.
2. We did not get okay on pepcid so did not start it
3. They said continuation of pred as needed on every other day dose. When I informed shivering they said to finish the bottle.
4. Second vet thinks it might be stress related due to significant changes in his routine and life. I haven't been around as much the last couple of weeks and the entire family is moving overseasnin December.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Oct 16, 2019 6:07:49 GMT -7
You and your wife know Willie best, Modalita. When you first posted here on the forum, you asked if Willie's slow recovery out of pain could be due to age so you obviously felt that Willie was still in pain. If Willie's shivering increases when activity increases, then that would indicate that the shivering is due to pain.
If the Gabapentin had no affect on the shivering, then either the dosage wasn't correct (works best when given 3x/day and was only prescribed 2x/day) or Tramadol and/or Methocarbamol were also needed to get the pain under control.
Like Paula, I am confused as to why the vet doesn't want to put Willie back on the anti-inflammatory dosage of Prednisone due to the heart murmur, yet has given such a long extended taper off of it. Also, if the vet doesn't feel that the shivering is due to pain, why is the pain med Gabapentin still being given? These are questions that you need to ask the vet and get a good understanding of their thinking.
Usually it takes 30 days for the swelling to resolve. However, in Willie's case, the anti-inflammatory dosage was given for 7 days, there was still a sign of pain at that time, yet the taper started so Willie was only on the anti-inflammatory dosage for 7 days. That's the only dosage of Prednisone that would have been effective on getting that swelling down. Finishing the bottle of a taper dose of Prednisone is useless and would have no effect on the swelling. Also, there was a lapse in strict crate rest that could have re-torn the disc so the swelling couldn't resolve.
Since the vet would not OK the usage of Pepcid AC apparently due to the heart murmur, check with them as to what stomach protector they would OK to protect Willie's GI tract from the side effects of Prednisone. The side effects can happen suddenly and can be quite severe so it's always best to be proactive and protect against the side effects rather than try to heal the side effects once they occur.
At this point, you should speak to the vet ASAP about the concern that the shivering is due to pain and that another 7-day course of Prednisone, along with a stomach protector that would be good to use with a heart murmur, is needed. Since the Gabapentin did not help the shivering, Tramadol as a general pain med can be added and/or Methocarbamol which works on the pain of muscle spasms.
Please let us know what the vet says after speaking to them this morning.
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Post by Modalita & Willie on Oct 19, 2019 0:00:16 GMT -7
So I finally got a hold of the vet yesterday (remember I'm dealing with a small window due to time differences)- I tried to be delicate with my questioning however she would not budge at all. I call the head vet who did the initial review on Willie instead of the vet who viewed him this past weekend.
On the gabapentin, the notes answered the increase in dosage was given due to anxiety levels in addition to possible pain. They both were adamant that the back is well on its healing path and the reactions tested negative.
She is okay with Pepcid AC with the pred. She suggested the heart murmur is likely not something that is chronic, but rather came up during the appointment due to stress.
I've lost confidence in this vet, but it's a short term relationship as we are moving ironically on 12/11. On a positive note- my wife has reported after putting Willie back on strict conservative that she is observing a reduction in shivering over this past week.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 19, 2019 5:13:59 GMT -7
I'm sorry that your vet isn't willing to work with you and address your concerns. Even admitting that the heart murmur wasn't likely chronic, it's confusing as to why she wouldn't give another round of Prednisone in the event the shivering is due to pain (swelling pressing on nerves of spine). Would the vet agree to adding Tramadol and/or Methocarbamol to see if in fact they would have an affect on the shivering which would help determine if the shivering is due to pain?
Hopefully the fact that the shivering has decreased rather than increased during the taper of the Pred is an indication that it's due to anxiety rather than pain. There are no other signs of pain to definitively diagnose pain. Of course, the resumption of strict crate rest and limitation of movement could be a reason for the reduction in shivering should it be from pain. When there is still swelling pressing on the nerves, mostly pain is seen when movement of the spine occurs.
You might want to consider getting a second opinion now from a Board-certified neurologist to determine the presence of pain and whether another course of Prednisone is needed or not and whether the pain meds should be adjusted to get the pain completely under control. Should the shivering be due to pain/swelling pressing on the nerves of the spine, the tapering dose of Prednisone will not be effective on that swelling. Plus pain hinders healing and you don't want Willie to be in any pain.
Good to hear that Pepcid AC has now been approved. Please confirm that Pepcid AC is now on board, 5mg 2x/day given 30 min. before the Prednisone and then every 12 hours thereafter for as long as Prednisone is on board. How many days do you have left of the Prednisone?
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Post by Modalita & Willie on Oct 21, 2019 11:13:23 GMT -7
I'll have to check with my wife on remaining dosage. She did confirm continued sporadic shivering but is continuing the conservative.
I tried to reach my normal vet. neurologist, Dr. Jones, at Southern New Hampshire Vet Referral Clinic who is EXCELLENT, however she's been on maternity leave for the last month plus. They have a backup doctor they are trying to get in there but not sure if he is licensed to fill in. Unfortunately the only other neurologist in the area in on the South side of Boston (50 miles away) and my wife can't drive there. This is a really difficult situation!
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Post by Romy & Frankie on Oct 21, 2019 11:44:38 GMT -7
I am sorry that the neurologist is too far away. That does make it difficult.
I know that your vet wasn't willing to work with you but it may be possible for your vet to consult with a neurologist by phone. Normally a specialist would want to see the dog, and they would probably not do a consult with a pet parent by phone. But if your vet has his records and will continue Willie's care a specialist may be willing to discuss his case with your own vet. People doctors do that all the time.
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Post by Modalita & Willie on Oct 22, 2019 12:43:58 GMT -7
Quick update. I went back to vet number 2 (State Line Vet in Nashua, NH) in since we dont have neurologist coverage and vet #1 won't budge from her opinions.
We are restarting Pred 2x a day at 5MG a day for 7 days, scaling to 1x a day for 7 days, and then 5MG every other day for 2 more weeks. This is double the dosage the other vet initially prescribed when this started.
Gabapentin will continue at 2X a day.
[Moderator's Note. Please do not edit
15 lbs
Prednisone as of 9/16: 2.5 mgs 2x/day for 7 days, then 9/23 test taper to reveal: √_pain / _neuro
as of 10/22: 5mgs 2x/day for 7 days, then 10/29 test taper to reveal: _pain / _neuro
Off of 100% crate rest 10/7-11ish?
Gabapentin 100mgs 2x/day
Pepcid AC ? mgs ?x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 22, 2019 12:44:21 GMT -7
Modalita, look over the med list inserted into your post above. In next post advise if all is correct.
-- is Pepcid Ac on board at 5mgs 2x/day?
-- is gabapentin at 100 mgs 2x/day?
If pain is not fully in control in one hr and stays that way dose to dose of one pain med (gabapentin), there will be a need for you to strongly advocate for the typical aggressive use of pains meds.
--- All pain meds Rx'd for 3xday because these pain meds do not stay in the body long.
--- gabapentin 100 mgs 3x/day for nerve pain
-- methocarbamol 3x/day for muscle spacsm pain
-- tramadol as the general analgesic 3x/day
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Post by Modalita & Willie on Oct 23, 2019 10:57:02 GMT -7
That [?] was what was prescribed by the doc. I think he does want to deviate too far from the original cadence, but with a higher dosage. I'm feeling upbeat on this new approach.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 23, 2019 13:57:26 GMT -7
As long as Willie's pain is now completely under control with no sign of pain arising from one dose of the meds to the next, then the meds are correct. If not, you'll need to alert the vet again. Is pain now completely under control? I do hope so!
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Post by Modalita & Willie on Oct 30, 2019 13:05:45 GMT -7
Hi- I wanted to share that since the medicine "surge" we've had 4 shivering free days. We've just completed yesterday the first cycle of 2x a day for prednisone. We are scaling back to 1x 5mg per day prednisone.
[Moderator's Note. Please do not edit
15 lbs
Prednisone as of 9/16: 2.5 mgs 2x/day for 7 days, then 9/23 test taper to reveal: √_pain / _neuro
as of 10/22: 5mgs 2x/day for 7 days, then 10/29 test taper to reveal: _pain / _neuro
Off of 100% crate rest 10/7-11ish?
Gabapentin 100mgs 2x/day
Pepcid AC ? mgs ?x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 30, 2019 16:00:19 GMT -7
Modalita, got our fingers crossed as the test for pain prednisone taper begins today, there will not be any pain surfacing nor any neuro diminishment.
The taper is for you to monitor for any signs of pain and report to the vet asap as then another course of pred would be needed to finish resolving every bit of painful swelling.
What is the dose of Pepcid AC twice a day you are giving Willie for the time he is on prednisone?
The test for pain pred taper allows you best chance to correctly identify about any surfacing pain when gabapentin is either backed off or full stopped. Masked pain by gabapentin keeps you from quickly learning if another pred course is needed.
=-- Which does your vet want backing off of gabapentin or the f ull stop of it today?
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Post by Modalita & Willie on Nov 4, 2019 5:55:57 GMT -7
We were instructed to scale back on ▼gabapentin to 1x a day for one more week. We are a week plus without shivering but we will have certainty when he goes completely off gabapentin. I'm still positive though.
I'm not certain how much he is getting for pepcid ac. My wife was running that with the doc
[Moderator's Note. Please do not edit
15 lbs
Prednisone as of 9/16: 2.5 mgs 2x/day for 7 days, then 9/23 test taper to reveal: √_pain / _neuro
as of 10/22: 5mgs 2x/day for 7 days, then 10/29 test taper to reveal: _pain / _neuro
Off of 100% crate rest 10/7-11ish?
Gabapentin 100mgs ▼1x/day
Pepcid AC ? mgs ?x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 4, 2019 6:52:17 GMT -7
Fingers crossed for a smooth tapering off of pred and no pain to be sufacing! As you point out you can't know the truth of the pred taper test regarding if there is still painful swelling still going on til the gabapentin has been stopped.
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