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Post by Lilla on Nov 2, 2019 3:31:57 GMT -7
[Original thread: Dog in pain and unmoving after surgery] ☆ 1 Is there still currently pain? YES X reluctant to move much in crate such as shift positions or slow, ginger movements X shivering, trembling X yelping when picked up or moved X tight tense tummy ☐can’t find a comfortable position, appears restless X Arched back a bit X head held high or nose to the ground ☐ Holding front or back leg flamingo style not wanting to bear weight ☐Not their normal perky selves? ☆ 2 43lbs 200mg Gabapentin, 100mg Tramadol, and 500mg Methocarbamol every 8 hours. 10am, 6pm, He was also taking 20mg Omeprazole and 1mg Prazosin every 12 hours, but is now only on Prazosin. 10am and 10pm
[Moderator's note: please do not edit 43 lbs. Gabapentin 200 mg 3x/day Tramadol 100 mg 3x/day Methocarbamol 500 mg 3x/day Omeprazole 20mg 2x/day - Stopped Prazosin 1mg 2x/day]B.. On a steroid or a NSAID?…. NO ☆ 3 When he first came home he drank like he was parched and coughed after. He seems to be drinking less, but I am adding more water to food. His nose has been constantly dry. Goes off food the morning after a vet visit. Poop is good, softer because I put pumpkin in his food. ☆ 4 His mother was a Doxie, father unknown - black Lab? Oscar. Lilla. ☆ 5 on Oct 25th Oscar had emergency surgery for a slipped disc and hemorrhage. He had not shown any symptoms of IVDD until acting sluggish the 23rd, by evening on the 24th his legs were wobbly and I took him to the ER. They gave him pain meds and sent him home, but by 4am he couldn't walk. I called his primary vet and they found an available neurosurgeon at VCA. Dr. is VMD, DACVIM☆ 6 What was the date of SURGERY? Oct 25th -- How many weeks did your surgeon direct for post-op rest? 4 -- What did your surgeon direct for clinic or at home PT? bicycling legs, stretches, not much. ☆ 7 Can your dog specifically sniff and squat and then release urine OR- do you find wet bedding or leaks on you when lifted? Both [?], but getting up to go out is painful☆ 8 He can't walk, he has minimal movement, never lost feeling, and wags his tail.As background, on Oct 25th Oscar had emergency surgery for a slipped disc and hemorrhage. He had not shown any symptoms of IVDD until acting sluggish the 23rd, by evening on the 24th his legs were wobbly and I took him to the ER. They gave him pain meds and sent him home, but by 4am he couldn't walk. I called his primary vet and they found an available neurosurgeon at VCA. At 4pm he was in surgery after an MRI. The surgery appeared to be successful, but as soon as he come home on the 27th Oscar was showing signs of pain in his belly when I tried (and failed) to express his bladder. He was also showing pain when I lifted his rear under his tail. On the 28th he only wet his bed and was in pain when moved. On the evening of Monday the 28th I carried him in a basket back to the ER because moving seemed too painful. They put in a catheter and drained his bladder, but they didn't understand how he could be in pain on his meds, his pain should have been blocked. He is a 43lb dog taking 200mg Gabapentin, 75mg Tramadol, and 500mg Methocarbamol every 8 hours. He was also taking 20mg Omeprazole and 1mg Prazosin every 12 hours, but is now only on Prazosin. They told me to consult his neurologist. The neurologist didn't understand how he could be in pain either, and thought he was just being reactive to something he didn't like - trying to express his bladder (which I could never do successfully). He upped the Tramadol to 100mg every 8 hours and told me not to try to express. None of this made any difference. Oscar seemed to be in more pain, now screaming repeatedly with certain movements, instead of grunting or whining. He stopped shifting himself in bed, and when I move him to lay on the opposite side he screams. On Thursday the 31st I carried him back to the VCA to see the neurologist, but he didn't exhibit any of his home behavior. He walk/dragged himself across the room, walked with a belly band, and didn't scream once - although the vet did not touch his belly or lift him at all. He still thinks it is a reactive behavior. He told me not to lift Oscar to walk, to let him start himself and then help with the rear. Oscar seemed like a totally different dog at the vet, but once he was home he seemed like a dog in a lot of pain. He won't move at all on his own, he is doing worse once he is helped up to walk, and both of us feel like we are in hell. He is in pain and distress, and I am exhausted in in distress from hurting him and not knowing how to help. I would so greatly appreciate any advice on how to make Oscar more comfortable, Thanks, Lilla Wells Below are the emails I wrote before and after going to the vet on the 31st:------------------- Sent: Thu, Oct 31, 2019 12:56 pm Subject: Re: Oscar Wells Part 2
Hi Dr. Tun, Oscar seems worse today. Yesterday I only took him out at 11am and 9:30pm. At 9:30 he seemed very uncomfortable and peed a few steps out the door, not somewhere he would usually go. Today at 10am he was still in the same position he was last night, usually he will shift sides. I gave him his pain meds at 10, he ate his breakfast, and I waited until 10:30 to try to move him. He didn't even want to sit up, and his whole torso was tight. I rubbed his belly for a half hour to relax him and put on a harness that went around his legs instead of under his belly. Because he was't helping to sit up (he usually will lift his front on his own) I had another harness around his shoulders. With difficulty and some whining I got him up and out to stand and go to the bathroom. He wasn't bearing weight on his back legs very well, and stood frozen with his head up for a long while. Eventually, after 10 or 15 minutes of encouragement, he urinated a large amount. He walked back, and did seem to be swinging his rear legs appropriately. I had to sit him down for a minute and he took the head up posture of pain (he can usually sit comfortably). When I lifted his rear to walk into bed, he screamed the whole way. He lay on the side he had been on all night and when I tried to roll him over and he screamed, and when I shifted his legs under to the other side he screamed and tried to crawl away. By this time it was 1.5 hours since his meds. All of this is an escalation, he is not a screamer unless he is in a lot of pain. The only good thing I can say is that he seems fine as long as he doesn't move, and I did see him kick his rear legs back in a stretch today (lying down) before I took him out.
Is this normal behavior? Should I keep taking him out to pee? I feel like I should take him to a vet except that I don't even want to try and move him without a stretcher.
What do you advise?
Thanks, Lilla Wells
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Sent November 1, 10:30pm
Hi Dr. Tun, Since he's been home Oscar is just as bad as before. He ate his dinner and rested until 11pm. He seemed like he wanted to go out, but I couldn't get him to move on his own at all. I lifted the blanket to help him and he peed some at that, then went out and peed some more. I tried again at 2am, and just getting him to lay on the opposite side seemed fraught with pain. It doesn't even seem like it is just his belly anymore. He didn't change position at all over night, and at 10am he was laying down with is head up, rigid with tension. I waited an hour after his pain pills and he wanted to go out, he had wet the bed a bit, but as soon as his rear end was involved he was squealing in pain. He did pee outside, but he dives back in his bed every time like he is escaping. At 5:30 he was anxious again and I got him up to poop. He would not pee and squealed if I accidentally touched his belly. I had to hold him by his thighs. At 9:30pm I got him to start up, but once again any lifting of the rear had him screaming, even standing in some positions, like it was his hips that hurt. He stands stiff and frozen, shallow breathing. I couldn't get him to pee, I think he was too tense, he just wanted to go back inside. He did pee some on the bed. He basically doesn't want to move his body at all unless he has to. He wasn't too interested in breakfast, but he did eat dinner. He let out a little squeak one time when I placed an ice pack, so he is feeling that.
I don't know how to explain how he acted at the clinic, like I said he seemed like a different dog. At home he seems like a dog who hurts all over. I can pet him and massage him, usually move his back legs, but ever since he came home from surgery he does not want me to move his front legs. I can slide my hand under him, but any shifting of his body to a different position is painful.
I don't know what to do for him, we are both in hell. I did call Holistic Veterinary Care and Rehab in Oakland today, that is where he got physio for his knee, but they can't see him until Wednesday. I just want someone to identify where the pain is coming from. If there a vet forum where someone might have an answer?
I do have some diapers if you think I should just leave him in bed, but he does seem anxious about wetting the bed.
Thanks,
Lilla Wells
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Nov 2, 2019 5:18:04 GMT -7
Welcome to Dodgerslist, Lilla. I'm so sorry that Oscar is having so much pain following surgery. It can take a couple of weeks following surgery for the swelling to go down and until then there can be pain. Sometimes we see dogs come home with an anti-inflammatory (NSAID or steroid) to work on that swelling. I would speak to the surgeon about the possibility of trying that to see if it will help. I would also bring in a urine sample to the vet to test for a UTI. UTIs can develop quickly if urine is held for too long in the bladder, either due to not urinating due to pain or bladder loss. UTIs can be very painful, especially when expressing. IF an anti-inflammatory such as a NSAID or a steroid is prescribed, at that time Oscar would also need a stomach protector such as Pepcid AC. At this time, no anti-inflammatory is being given so Pepcid AC is not needed. If the vet does prescribe an anti-inflammatory, ask if there are any health issues to prevent Oscar from taking Pepcid AC and if not, do get that on board. Omeprazole, which has been stopped, is a stomach protector but it can take up to five days to become effective. Speak to the vet about adding Amantadine. Amantadine is something we are seeing neuros Rx as part of the pain med cocktail but it may take a couple of days for it to become effective. Also speak to the vet about applying a Fentanyl patch. "It is important to recognize that there is a delayed onset of effect when using the patches. In dogs it takes about 12 hours to achieve good pain relieving dosages and in cats it takes a minimum of five hours. The effective life of the patch is about 3 days in dogs and up to 5 days in cats. The pain relief from these patches is considered to be moderate, especially in dogs. For this reason it is often necessary to use them as a constant provider of pain control but to supplement them as necessary with a compatible narcotic or an NSAID." www.vetinfo.com/dpain.htmlSpeak to the vet about the possibility of increasing any of Oscar's current pain meds. Here is the dosing guidelines for each med.Gabapentin Dose recommended (empiric) for gabapentin: 10–20 mg/kg every 8 hours Outpatient oral analgesics in dogs and cats beyond nonsteroidal antiinflammatory drugs: An evidence-based approach. KuKanich B. Vet Clin North Am Small Anim Pract 43(5):1109-1125, 2013. Gabapentin bioavailability in humans is not dose proportional; i.e., as dose is increased, bioavailability decreases. Bioavailability of Gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively. www.drugs.com/pro/gabapentin.htmlMethocarbamol (Robaxin) Initially, methocarbamol is dosed at 7 to 20 mg per pound (15 to 44 mg/kg) up to three times daily. The dose of methocarbamol should not exceed 110 mg per pound (300 mg/kg) per day. www.petplace.com/article/drug-library/library/prescription/methocarbamol-robaxin-v Written by: Dr. Dawn Ruben Last Modified: August 11, 2015 Tramadol dosing in dogs varies, ranging from 2 to 5 mg/kg every 8-12 hours. The highest dose for maximum analgesic effect in dogs is 10 mg/kg every 8 hours. “Tramadol” Plumb DC. In Plumb DC (ed): Plumb’s Veterinary Drug Handbook, 7th ed—Ames: Wiley-Blackwell, 2011, pp 1002-1004. Tramadol 3 to 5 mg/kg (0.5 to 2.5 mg/lb) every 8 hrs to QID (up to 6 times daily at lower dose) Anecdotal reports include 10 mg/kg QID for more severe pain vasg.org/t_drugs.htm#TRAMWe are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet. This could be reactionary pain. However, dogs can be very good at hiding pain and often hide it especially well at a vet's office. The surgeon should take your reports of pain at home seriously and do all that he can to get Oscar's pain completely under control. While surgery is a painful thing, this sounds as though it could be more than post-op surgical pain. Sometimes a surgeon is unable to remove all of the disc material in a surgery and we've seen second surgeries necessary. Or even a second disc could have torn since the surgery. Be persistent in getting Oscar's pain completely under control. If Oscar has bladder control, his pain needs to be brought under control so he can go out to urinate without pain. If he does not have bladder control, then his pain needs to be brought under control so you can express his bladder to prevent a UTI. The only way to tell if there is bladder control once Oscar's pain is under control is to bring him to a spot where he or another dog has peed before, support his hind end but not under the belly, let him sniff and see if he can release urine on his own. If he cannot, then his bladder needs to be manually expressed. If you have not as yet had a hands-on-your-hands demonstration on how to express his bladder and if he has indeed lost bladder control, then do get a demonstration ASAP. Here is info on expressing to review prior to your lesson: www.dodgerslist.com/literature/Expressing.htmThe guest board is a temporary Guest courtesy to get immediate help until you can register. I encourage you to register and login. That way all the features of the Forum are available to you, making it faster to reply and get an email alert about replies. It also makes is far easier for us to track your dog and give the best assistance. Illustrated what to expect during registration: www.dodgerslist.com/forumads/RegisterFORUM/register.htmPlease keep us updated on this. Healing prayers for Oscar.
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Post by Lilla on Nov 3, 2019 16:41:46 GMT -7
Thank you for your reply, it really helps to know there might be a solution. I took Oscar to the pet hospital Saturday Nov. 2 because he hadn't peed in 24 hours (except for a few leaks). He got up at night and in the morning and went out to try, but from the moment his rear lifted he squealed in pain. Once he got outside he was too tense to go, even after waiting.
He did pee some in his basket when he saw he was at the vet, and once again would not cry out like he does at home. The vet I saw listened closely and suggested that his pain receptors were overloaded by chronic pain and the new pain of surgery.
She suggested a technique she had just learned at a conference. You give a mild dose of Ketamine over several hours to try and disrupt the pain. She said she has used it for chronic pain, but not for this scenario. She said the Fentanyl wouldn't work right away and the Amantadine would have to be made at a compounding pharmacy, so also not immediately available. I opted for the ✙Ketamine.
[Moderator's note: please do not edit 43 lbs. Gabapentin 200 mg 3x/day Tramadol 100 mg 3x/day Methocarbamol 500 mg 3x/day ✙Ketamine to disrupt pain Omeprazole 20mg 2x/day - Stopped Prazosin 1mg 2x/day]
She also looked at and drained his bladder, which she said was very full even with peeing at the vet. She sent a [urine] sample for testing.
They said I should let Oscar get his front up before I lifted him with a harness around his legs (not his belly) - which I had tried before, but still caused squealing. When Oscar came home at 10pm last night he didn't seem different, but this morning he signaled he needed to go out, started himself, and was lifted without crying!!!! He went poop and came back, in a bit of a rush like he wanted it to be over, but no crying. Four hours later he did the same and peed!! So far so good. He is still not moving in bed, so I have to shift him.
He has an appointment Tuesday with a holistic vet/rehab center where he went before for physio for a loose kneecap. Hopefully they will have some suggestions as well. Again, thank you for the help and support. It is awful to feel helpless when your dog is suffering.
Lilla
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Nov 3, 2019 17:01:58 GMT -7
Lilla, that is just wonderful news that the ketaime technique appears to have calmed the pain nerves!! Still a concern why he is not repositioning himself in his suite. Does he not even try to move a bit with his front legs? Could he still have some discomfort? 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. Do let us know what you observe.
SIGNS OF PAIN: ◻︎ 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 Keep us posted on Oscar progress. If he has the ability to sniff and then make the choice to release urine outdoor on a certain spot, then the next neuro function will be that of trying to do some movement with his back legs. Lilla could you do us a favor? The guest board is a temporary Guest courtesy to get immediate help until you can register. I encourage you to register and login. That way all the features of the Forum are available to you, making it faster to reply and get an email alert about replies. It also makes is far easier for us to track your dog and give the best assistance. Illustrated what to expect during registration: www.dodgerslist.com/forumads/RegisterFORUM/register.htm
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