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Post by Jacqueline & Rigby on Nov 23, 2019 19:30:26 GMT -7
Hello. My name is Jacqueline Cook. I am so grateful to have found this forum. Our dachshund Rigby is 8 years old. We rescued him when he was 5. On October 1, 2019 I took him to the vet because he seemed to be experiencing pain in his neck/shoulder area. We were prescribed prednisone and Gabapentin. Rigby weighs 14 lbs. He was taking 1/2 tab (2.5 mg) 2 X a every 12 hrs for 5 days; to 1/2 tab every 24 hr; to 1/2 tab every 48 hr; etc until he was off it completely. He responded so well to the prednisone alone, we never gave him the Gabapentin at all. We returned for a follow up exam after the 2 weeks of treatment was completed. The Vet was pleased with the outcome.
[Moderator's Note. Please do not edit 14 lbs prednisone as of 10/1: 2.5 mgs 2x/day for 5 days, then taper test for √11/4 pain!/_neuro as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro 11/4 short walk prior to 8 weeks of disc healing time gabapentin 70mg/mL: ? mgs WHIHC? every 8 or every 12 hrs actually given? needs GI tract protector, Pepcid AC, on board w/predniosne! ]
The 4th of November, Rigby had a relapse. We went for a short walk and I had to carry him home because he was in pain. This time hunched over and shaking. I called the vet immediately; took him in. Left with another round of the prednisone and Gabapentin (this time one full tab for 5 days and decreasing the frequency as prescribed above; and we scheduled an X-ray (under anesthesia) for Monday, Nov. 11. We always crate Rigby when we are out of the house. We always carry him up and down the stairs. Preventing jumping on and off furniture has been part of our practice (although difficult with an agile Doxie). Nevertheless, total confinement was not suggested.
The 11th came and the X-ray was “unremarkable”. The upside of everything is the fact that Rigby does not have any of the signs of neurological decline. But the medication’s effectiveness started waning—Wednesday, November 13....he was howling in pain. I stayed home from work to take care of him. Called the Vet, who instructed me to stop weaning Rigby off the meds and continue with a full tablet of prednisone everyday along with the Gabapentin every 8-12 hrs. He instructed us to give it till Monday (Nov 18). No change. No worse. No better. Very painful in the morning...progressively better through the day into the evening. Back to painful in the morning.
When the Vet called on Monday (Nov 18) and heard our report, he referred us to a Veterinary Neurologist. Rigby and I met with him yesterday (Nov 22). The specialist listened to my account of Rigby’s history, did a quick exam and then suggested surgery. He said that he would do the diagnostic (with the dye) first and because dogs have to be tested under anesthesia, it is best to do the surgery immediately if/when the rupture/budge/etc is discovered. The estimate with a two day hospital stay is approximately $8,000.
So, I am hoping those of you who have experience can offer some words of wisdom. Rigby has a healthy appetite, no issues with water intake, tinkles and poops without issue, no unsteady gait or knuckling. He does raise his one paw when seated and sometimes when standing. His tail never stops wagging. Nevertheless, he wakes painful and hunched over. Cries sometimes when trying to eat. I presume because the meds have worn off by the morning. After the meds kick in, he progressively appears to be better as the day goes on. But when we wake each day, it is goundhog day all over again.
I am wondering if there’s hope for Rigby without surgery? Using the conservative approach. I am also concerned about the prednisone and Gabapentin affects long term. We are into our 2nd month and no one ever suggested anything to protect his stomach.
Thanks in advance for reading and for your help! jacqueline
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Nov 23, 2019 20:22:52 GMT -7
Jacquelilne, welcome to the Care and Support Forum. We are really glad you are here. FIRST, pain needs to fully control pain with a more typical aggressive pain med approach. Call you vet or get to ER if need be to get proper adjustments. Make sure the medications are fully controlling pain from dose to dose with no break through in pain as will often happen with and every 12 hrs dose Rigby is getting!. Continued phone feedback to your vet is vitally important until the pain medications have been properly adjusted for your dog. There is no "one-size-fits-all" pain control. These are the typical pain medications used to treat IVDD to address each source of pain: --Tramadol as the general pain reliever. It has a short half life of 1.7 hours and may need to be prescribed at a minimum of every 8 hours. --Methocarbamol treats painful muscle spasms. Also prescribed every 8 hours. --Gabapentin for nerve pain. Veterinarians are finding this medication works synergistically in combination with Tramadol. Again gabapentin needs to stay high enough in the body to help with pain...that means dosing every 8 hrs promptly --Amantadine. When the above three meds have been Rx'd at the aggressive dose in mgs and at every 8 hours, but pain is still not fully controlled, then advocate for the addition of amantadine - allows other analgesics to function more effectively. The Mar Vista vets explain the mysteries of amantadine marvistavet.com/amantadine.pml PREDNISONE Both classes of anti-inflammatories require stomach protection. The steroid class is the most powerful of the two classes (Prednisone, Dexamethasone, etc.) The lessor class are the NSAIDs (Rimadyl, Metacam, Deramaxx, etc.) Anti-inflammatories should be accompanied by a stomach protector such as Pepcid AC (famotidine) to avoid serious gastrointestinal damage of GI problems of damage. Proactive vets don’t wait til there is lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. Pepcid AC (famotidine) blocks the production of acid. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours. Pepcid AC has a very limited potential for side effects. 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). HEALTH ISSUES: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.” marvistavet.com/famotidine.pml ANTIi-INFLAMMATORY drugs are used with a disc episode: An anti-inflammatory, steroid prednisone can take 7-30 days (exluding any steroid taper days) to resolve all pain. During a test-for-pain steroid taper is the time to watch for any returning signs or increased neuro diminishment.Pain/neuro diminishment indicates another course of the steroid After repeated attempts to go off any anti-inflammatory, if pain cannot be totally resolved, surgery becomes a consideration. Please do read the full aritcle so you are well informed to speak up when needed, ask good questions and best understand the approach vet is using. LINK TO READ: www.dodgerslist.com/literature/healingsweling.htmI'm sorry you did not get an Rx for 100% STRICT crate rest 24/7 only out of recovery suite for a very, very few footsteps at potty time. The taper, the walking all revealed there is still inflammed tissue around the spinal cord. So far while Rigby has been on pred for only 15 days.. Five of those days were wasted when he went on a walk and this disc very likely retore putting him back at square one for 8 weeks of crate rest and likley several courses of pred to get all the swellign finally resolved. Let us know, now, you are following STRICT rest: - no laps - no couches - no walks - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times. Carry your dog to and from the recovery suite to the potty place and then allow a very, 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! Bone up on conservative vs. surgery. Most surgeons would try the least invasive of conservative first. Maybe the surgeon was not privey to the fact that there was not strict rest, the walking likely causing a relapse of the early healing disc? Here is where to get a good understanding of conservative and surgery to help you in speaking with vets/surgeons and making a decision: Surgery vs. conservative information: www.dodgerslist.com/literature/healingsurgery.htmLet us know you were successful in advocating for: --pain meds (tramadol, what is the gabapentin dose?, and methocarbamol every 8 hrs. -- Found out if Rigby has no health issues, you went to grocery store to buy Pepcid AC (famotidine) -- You have your recovery suite properly set up to make crate rest go smoothly for the next 8 weeks.: tips, ideas and supplies: www.dodgerslist.com/literature/cratesupplies.htmThere is good hope that conservative treatment can work and it would be the best option if there is any reason health, financial that could make surgery not an option.
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Post by Jacqueline & Rigby on Nov 24, 2019 6:46:44 GMT -7
Good morning Paula. Thank you so much for the quick response. I was in touch with our vet’s office on Friday after leaving the specialist. He is going to call me tomorrow (Nov 25) to discuss the specialist’s report and recommendation. I am working on getting my ducks in a row regarding the conservative approach and enlist his help with this process. I do believe that he will be on board as he was not pushing us in a direction but rather offering options.
Prednisone So, just to clarify a few things regarding the routine we have had him on since November 5 (the date of the relapse). We originally did 1 (5 mg) tablet for 5 days (through Nov 9); 1/2 tablet for 4 days (through Nov 13); then we had the howling episode and Dr Hasco moved him back to 1 tablet daily on Nov 13 and so this is where we are with the prednisone.
Gabapentin Rigby has been on a liquid dose. We used a 70 MG 1ML dose every 8-12 hours from November 5-13. Then Dr Hasco bumped him up to 75MG 1ML dose every 8-12 hours. He has been on this from November 13-present.
Pepcid I went out this morning and purchased the ✙Pepcid Original 10 mg tabs. Rigby is 14 lbs. I gave him have [half?] a tab and am writing you as I wait the 30 mins. Then I will give him the meds described above; his breakfast; and carry him out to potty. I will talk with Dr Hasco about this tomorrow; but between the original episode in October and the increased dosage in November, I did not want to wait.
[Moderator's Note. Please do not edit 14 lbs prednisone as of 10/1: 2.5 mgs 2x/day for 5 days, then taper test for √11/4 pain!/_neuro as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro as of 11/18: 5mgs 1x/day for ? days then test taper 11/4 short walk prior to 8 weeks of disc healing time gabapentin 75mg/mL: 75 mgs 3x/day ✙Pepcid AC 5mgs 2x/day]
The Recovery Retreat Rigby is always crated when we are away from the house. It is a wire one like what you have described here. Friday, I purchased a smaller wire crate and he has been in it ever since with the exception of potty time. So perhaps Saturday (November 23) would be our official start date. He hates it because as soon as his meds kick in, he wants to get moving. Nevertheless, we are sticking to it. The crate is in our bedroom where it’s quiet and he is close when we are sleeping.
I think that’s the latest! Thanks so much for your help! Jacqueline
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Post by Julie & Perry on Nov 24, 2019 7:08:06 GMT -7
Have you tried a pack and play? It's a baby play pen.
My dogs hated being crated but tolerated the playpen much better.
You're doing a great job advocating for Rigby.
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Post by Jacqueline & Rigby on Nov 24, 2019 9:17:23 GMT -7
Hello Julie.
Thanks for the suggestion. Rigby has always been crated and typically tolerates it well under normal circumstances. It’s having to stay in there when we are home that is so difficult. He just doesn’t understand why we are home and he is stuck in his crate. I actually take it as a good sign as he is still his perky, stubborn self :-) However, I need to ask the vet about prescribing something (I believe Paula or someone in another post identified something) that will help keep him calm. I know that the better he starts to feel, the more difficult crate rest will be.
I will have to look for your postings so I can follow your journey with Perry. I am so relieved to have found this forum. And thank you for the idea. I remain open to all the suggestions I can get :-)
jacqueline & rigs!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Nov 24, 2019 11:30:14 GMT -7
Jacqueline, If the pain meds were correct, then you would not notice "when the meds kick in" that Rigby felt pain free eough to want to move around. The pain meds are clearly NOT right yet. All pain should be fully in control dose to dose, when he has to move such as at potty time. Gabapentin quesitons Would you look at the bottle for the information re: how many mgs of gabapentin are contained in one mL? Also while you may have been given a range of how often to give, we need to know what you are actually giving--- every 8 hrs or every 12 hrs. With Rigby in pain before gabapentin kicks in it definately should be prompty on time every 8 hrs. If you are doing that, then clearly one pain med is not sufficient. Strongly advocate for the more typical approach of covering each of the three different sources of pain with it's own pain med AND all to be dosed every 8 hrs. -- tramadol as the general analgesic -- gabapentin unknown mgs dose should be every 8 hrs for nerve pain -- methocarbamol for the type of pain from muscle contractions dosed every 8 yrs PREDNISONE Depending on the dosage, steroids can be a replacement steroid hormone in dog not able to make sufficient hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive effects for other diseases. For a 14lbs dogs with a disc episode, the usual is to Rx the upper end of the "anti-inflammatory" range. So that may be something to bring up for discussion with your vet as to moving up to 4.2mgs twice a day. Normally a vet would round up to 5mgs 2x/day. The goal is to expedite getting the swelling resolved quicker that the upper range of the anti-inflammatory dose does. A med chart is very useful for noting cause and effects for discussion with a vet and making sure all meds have been given on time. D/l and print from here: www.dodgerslist.com/literature/crateRRP/medchart.pdfWhen you are at home, most dogs LOVE to be in the middle of activity such as the family room rather than isolated in another room. The recovery suite should be large enough that he can fully stretch out his legs when lying down. Any suite that is too large in area, can easily be padded out with rolled up blanket/towels. When pain is fully controlled and if Rigby needs help in being able to relax in his suite, try some calmers: Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives (ACE, alprazolam or trazodone). Of course always keep your vet in the loop on all things you give your dog. Place a DAP pheromone diffusor at floor level where the recovery suite is: --DOG Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/Use diffusor with one oral calmer from below:Oral calmers 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health 2) 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 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.com Glad to hear you are learning all you can to best be able to react to the specialist's report with good questions, better understanding the recommendations, etc. Kudos to you for recognizing the importance of IVDD self education. You are Rigby's best advocate!
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Post by Jacqueline & Rigby on Nov 24, 2019 17:38:34 GMT -7
Hello again Paula.
The Gabapentin is 75 mg. The dose is 1 ML. We have been administering 1 dose every 12 hrs on Wed. Thurs. Fri. Because my husband and I both work those days. Saturday-Tuesday, one or both of us are home and we are able to administer 1 dose every 8 hrs. Nevertheless, the result in the morning is exactly the same regardless of the interval. His wakes painful. I have been thinking that this was due to the prednisone wearing off and even mentioned it to the specialist. He suggested giving him 1/2 tab (2.5 mg) of prednisone at bedtime? I just haven’t felt comfortable about starting this without running this by our own (Dr. Hasco) as he actually knows Rigby. This seems to be in line with what you have mentioned about increasing the dosing on the prednisone.
I am wondering though, is it better to add in something like tramadol instead of increasing the prednisone? Or are you suggesting a both / and?
The Pepcid tabs are 10 mg. I have a pill cutter and gave Rigby 1/2 tab (5 mg) first thing this morning before breakfast. My husband will give him another 1/2 tonight (12 hr interval) as I am at work right now.
As for Rigby’s recovery retreat, we have him in our bedroom right now because we have company staying with us. He gets way too excited (in or out of the crate) when people (guests) are around. He is a social butterfly! We have more company coming for Thanksgiving. We now have 2 recovery retreats set up. 1 in the living room and 1 in the bedroom. I think we are good on this. When all of our company have gone, Rigby will be able to be wherever we are “where the action is taking place” ;-)
Thank you for the calming suggestions. I will check them out. I feel less overwhelmed and panicked tonight. You are a God-send! Jacqueline
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 24, 2019 18:06:39 GMT -7
Jacqueline, for clarity.... it is noted on the gabapentin bottle that there are 75mgs of gabapentin in one mL of liquid?
Getting a sense of these meds is very important in understanding what is going on.
Prednisone is not a pain reliever. Its job is to resolve painful inflammed issue over the course of 7-30 days. So in my book prednisone just can't be called a pain reliever for a disc episode. I mentioned discussing going up to the anti-inflammatory level of prednisone during a disc episode is because that is what most vets do. The idea is to work on getting the swelling resolved in a timely manner...lower doses such as Rigby is on drags out the process. Nerves do not like swollen tissue. Often it will compress the spinal cord. The nerves in the cord react by dying (nerve function of legs, bladder, etc are dimished or lost.) So far Riggy has not suffered neuro diminishment. Perhaps a discussion of moving to the upper end of the anti-inflammatory level will expedite swelling resolution for Rigby.
Pain relievers take action in one hr or less. Pain from a disc episode comes from nerves, from muscles, skeletal. Different pain receptors are blocked by different drugs….thus the usual need for several classes of pain meds. Getting dose to dose pain relief will happen in an hour when the meds are right for your dog. Working with your vet, giving prompt specific observational feedback about pain is how the meds are tweaked (change mix of pain meds, adjust the dose in mg and/or the frequency to give) to get it just right for your dog. There is no reason that Rigby should not be provided fully round the clock pain relief benefit from a cocktail of pain relievers.
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Post by Jacqueline & Rigby on Nov 24, 2019 19:20:28 GMT -7
Thank you again, Paula.
What I wrote this morning regarding the gabapentin came directly off the bottle. I will have to look again when I get home. I guess it seems off to you? What is a typical mg and dosage for gabapentin for a 14 lb dog?
Thank you for the clarification on the different medications. This will be very helpful for my conversation with my Vet tomorrow. I really hope and pray that he will get on board with this. I have a potential back up in the event I get any push back.
jacqueline
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Post by Julie & Perry on Nov 24, 2019 20:52:36 GMT -7
When my dogs have an episode they take 3 different medications for pain: Tramadol for general pain 3x daily, gabapentin for nerve pain 3x daily, and methocarbomal for muscle pain 3x daily.
This has worked well to keep them comfortable.
Sending healing thoughts and prayers for you both.
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Post by Jacqueline & Rigby on Nov 25, 2019 5:11:25 GMT -7
Thank you, Julie. I will be speaking with my Vet this morning. I plan to talk to him about adding these to Rigby’s regime. I will post later regarding the outcome of this conversation. I mentioned to Paula...I have a possible back up in the wings if I receive any push back. We appreciate the thoughts and prayers. SO much! jacqueline Good morning Paula. I took a couple photos of the bottle for your review [shows the formula of 75mgs of gabapentin suspended in one mL of liquid]. Please see below. Hope this helps. jacqueline :-)
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Nov 25, 2019 5:47:35 GMT -7
Pain meds should never be given "as needed" but need to be consistently given every 8 hours. I understand that this is difficult given your work schedule. Possibly a neighbor or family member could stop by to give Rigby his meds when you're at work? Or the vet's office may have a vet tech who could be hired to stop by? It's important that the meds be given consistently to keep pain consistently under control. All of the pain meds that Paula previously discussed have a short half life and should be given consistently every 8 hours. If given 3x/day some days and only 2x/day other days, pain may arise and that can hinder healing.
The dosage of the Gabapentin is within the usual dosage given for dogs of Rigby's weight. Gabapentin works on nerve pain. Methocarbamol works on the pain of muscle spasms. Tramadol is a general pain med. It often takes all three of these pain meds to get the difficult pain of IVDD completely under control. Pain should be completely under control within one hour of giving new course of meds and remain completely under control from one dose to the next.
As for the Prednisone dosage, 5mg 2x/day is the standard anti-inflammatory dosage that we see given for a 14 lb. dog. It's important to get the swelling that's pressing on the nerves of the spine down as quickly as possible.
I hope the vet will be able to get Rigby's pain completely under control this morning. Healing prayers for Rigby.
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Post by Jacqueline & Rigby on Nov 25, 2019 12:54:03 GMT -7
Hello Friends.
Here is the where we are at this hour.
Our Vet called first thing this morning, but said he had not received the report from Rigby’s visit with the Neurologist on Friday 22. Nevertheless, I spoke with him about getting the Tramadol and Methocarbamol on board with Gabapentin and Prednisone that Rigby is currently taking. He gave me push back on the Tramadol but said that he would call be back this afternoon regarding the Methocarbamol.
Later this morning I called the Neurologist to inform him that we decided against surgery at this time and inquired about his experience with the conservative approach. I discussed meds with one of his assistants who relayed my message to him and later called me back with the Dr’s recommendation. He ✙Tramadol (12.5 mg every 12 hrs). Along with the Prednisone (5mg am / 2.5 mg pm) and the ▼Gabapentin 75mg/ml every 12 hours. He does not want to up the Prednisone in the evening to 5 mg until we see how Rigby does with the Tramadol on board. The Neurologist is not recommending 3X a day dosing of any of these medications. We have a follow up appointment with him on December 9.
[Moderator's Note. Please do not edit 14 lbs prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro as of 11/18: 5mgs 1x/day for 5 days as of 11/23 neuro: 5mgs am/2.5mgs pm for ? days, then test taper 11/4 short walk prior to 8 weeks of disc healing time ✙tramadol 12.5 mgs 2x/day gabapentin 75mg/mL: 75 mgs ▼2x/day Pepcid AC 5mgs 2x/day]
Our Vet called back...he is not going to prescribe Methocarbamol as he too feels that we need to see how Rigby does with the Tramadol on board. We did discuss the 8hr vs 12 hr interval for the gabapentin dosing...and he reiterated that he wrote it that way because “it is to be given according” “as needed”...I am getting frustrated with him....I just don’t think he has experience with IVDD dogs...I am losing my confidence in him more and more everyday.
I have calls into two other Vets in my area. Starting the interview process....
That’s the latest.....
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Post by Julie & Perry on Nov 25, 2019 13:18:55 GMT -7
OK, I'm not a vet but I have two dogs with IVDD and have been dealing with it for years.
Unfortunately, neither of the doctors you're dealing with are comfortable treating IVDD.
If they were they would know IVDD is very painful in multiple areas.
I appreciate you are doing the very best you can.
Keep pushing and I wholeheartedly agree with you that it's time for an IVDD savvy vet to take over Rigby's care!
Sorry you're having to go through this resistance and lack of support.
Hang in there and keep pushing and looking.
Best wishes to you both.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 25, 2019 14:10:40 GMT -7
Jacqueline, oh my, so sorry to hear of such conflicting information. It surely does make a HUGEdifference like the difference between night and day to have an IVDD knowledgeable vet on board to work with an owner up to speed on IVDD. Then there is good support from the vet and a vet who can see the owner is all in on the game of defeating IVDD having done their homework! That is the exact combo of teamwork this boarded specialist wants for all dog owners: In addition to this good summary of each phase of healing, the time, the things that allow healing, etc. at www.dodgerslist.com/literature/healingpage.htm do check out other pertinent things to know: -- Finding an IVDD vet: www.dodgerslist.com/literature/VetchkList.htm-- tentativeness about pain is not something the IVDD knowledgeable vets we follow prescribe to! So this is where we come from here on the Forum about a disease that is known to be painful...we side with Dr. Downing. Robin Downing, DVM, CVA, DAAPM is one of only four veterinarians in the world to hold the Diplomate credential in the American Academy of Pain Management - the largest interdisciplinary pain management organization in human medicine: "It is always better to use a multi-modal approach to pain management." And we also side with the World Small Animal Veterinary Association (WSAVA) guidelines as well: " We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt" see: www.wsava.org/WSAVA/media/PDF_old/jsap_0.pdf Scroll down for table of contents At this point what are you actually given regarding: -- gabapentin as needed every 8 hrs? or every 12? hrs as per your local DVM -- Tramadol. Know that currently the thought going around and the reaction to a study is to not Rx tramadol. That study on Beagles only, if read to the end concluded— " Different breeds of dogs might not or only poorly respond to treatment with tramadol due to low metabolism of the drug...The non-opioid mechanisms of tramadol do not provide antinociception in this experimental setting. This contrasts to many clinical situations described in the literature, where tramadol appears to provide useful analgesia" Kögel B1, Terlinden R, Schneider J. Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs.Vet Anaesth Analg. 2014 May;41(3):297-304. doi: 10.1111/vaa.12140. Epub 2014 Feb 27. www.ncbi.nlm.nih.gov/pubmed/24576316
-- another says: "Several studies have looked at the procession of tramadol after its absorption into the body, and it seems that each dog's metabolism of the drug is different. Therefore, the best way to determine whether your dog's dosage is appropriate is by watching your dog's response to the medication while you're home." Tramadol for Dogs: Uses, Side Effects, and Alternative Treatments. Originally written by Keren Perles. Updated by Rachel Murphy on 27 June 2017. www.care.com/c/stories/6487/tramadol-for-dogs-uses-side-effects-and-alternative-treatment-options/-- While none of us here on the Forum are vets, we have watched over 10,000 vets now since 2002. Owner's report the prescriptions and give observations how the pet reacts. When the following two reference sources are followed at the MAX ANALGESIC dose, most dogs do stop exhibiting signs of pain. The below references explain the usual in controlling pain is to Rx Tramadol at the higher end of the mg range AND promptly every 8 hours. Something, indeed, to alert the vet to IF, Rigby's pain is still not being controlled and discuss moving to the MAX ANALGESIC tramadol dose by his lbs weight converted into kg (kiligrams). Transporting a dog is always a concern for too much movement to the early healing disc scar tissue. Vets who know IVDD and conservative treatment welcome updates by phone, adjusting meds by phone rather than insisting on a transport into their clinic. But if it has to be done to hire a new IVDD knowledgeable vet, then the risk to the disc is worth it to get him out of pain. If possible would be best if your own vet is willing to learn what you have learned here, consult with a colleague at his college, etc. as then you two can communicate about pain, get Rx's over the phone. A third option is if you still see pain, the neuro will be accessible or another vet there can look in Rigby's file and Rx adjustments to the pain meds to get him in dose to dose full relief form pain. Please let us know if per happy chance the very low dose of tramadol working in conjunction with gabapentin can provide pain relief right up to the next doses of the pain meds within in the hour of starting the new Rx's. If not, have no patience with pain, be a squeaky but polite wheel in presenting a successful advocacy of properly adjusting pain med for Rigby's needs.
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Post by Jacqueline & Rigby on Nov 25, 2019 14:15:39 GMT -7
Hi Julie. My stomach has been in knots all day over this. I feel like there’s no one in my area that has experience in treating IVDD. I even called the Emergency Vet today thinking perhaps they might know of someone. She was not any help either. How can this be? It is very common...especially in dachshunds. Additionally, neither Vet mentioned Pepcid today....I told them that I added this to his med routine and how I am dosing....the comment, “Oh, ok...that’s ok.” ? Seriously??? Thank God, Rigby is not getting worse. It has only been 3 days on strict crate rest and 3 days with the 2.5 mg addition of prednisone at bedtime. He did not seem painful when he woke this morning (no hunching, head down, etc). Still a great appetite, pooping and peeing normal, tail wags, etc...I remain hopeful about the addition of tramadol. thanks for your support! I so appreciate it! jacqueline
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Post by Jacqueline & Rigby on Nov 26, 2019 5:19:58 GMT -7
Good morning friends.
Rigby seems to be responding well with the addition of the 2.5 Prednisone(PM) and 12.5 Tramadol. He appeared comfortable this morning (head up, no shakes or spams in his neck and shoulder area, lots of tail wags). He received his first dose of Tramadol (12.5 mg) with his evening meds last night (Nov.25). The Prednisone PM dose was started Nov. 23. Additionally, I spoke with a close friend yesterday who said she would be happy to come by to administer his mid-day does of gabapentin when Christian and I are at work. So, this is what his med routine looks like now:
AM 5 mg Pepcid (every 12 hr) 1 ML (75mg) ▲Gabapentin (every 8 hr) 5 mg Prednisone (every 12 hr: 5 mg AM / 2.5 mg PM) 12.5 mg Tramadol (every 12 hr)
Mid-day 1 ML (75 mg) Gabapentin (every 8 hrs)
PM 5 mg Pepcid 1 ML (75 mg) Gabapentin 2.5 mg Prednisone 12.5 mg Tramadol
Bedtime 1 ML (75 mg) Gabapentin
[Moderator's Note. Please do not edit 14 lbs prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro as of 11/18: 5mgs 1x/day for 5 days as of 11/23 neuro: 5mgs am/2.5mgs pm for ? days, then test taper 11/4 short walk prior to 8 weeks of disc healing time tramadol 12.5 mgs 2x/day gabapentin 75mg/mL: 75 mgs ▲4x/day Pepcid AC 5mgs 2x/day]
I may have to make due with the Neurologist as he is the closest one to me (hour or so drive). However, I am actively searching for a new Vet. I contacted a friend with DRNA who lives 30 minutes from me. She is going to speak with her Vet today. My friend whom I’ve enlisted to help with Rigby’s meds referred me to her Vet. I am waiting for his return phone call. So for now, I am doing the best I can with what I have....
As Thanksgiving approaches....I am thanking God for the Dodgerslist community and all the support I have been receiving as I navigate this unfamiliar territory.
Rigby and I both are so very grateful for all of you! Jacqueline
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Nov 26, 2019 5:57:38 GMT -7
So very glad to hear that Rigby appeared to be comfortable this morning, Jacqueline! That's great news. Of course, should you see any sign of pain in the coming days, you'll need to advocate further with the vet for an adjustment in meds. However, if in fact the vet has now been able to get Rigby's pain under control, it may be best to stay with this vet until after the 8 weeks of strict crate rest is over and then find a vet more familiar with IVDD so as to avoid transport and exam by a new vet while the damaged disc is still healing.
According to the schedule that you gave, Gabapentin is being given 4 times a day. Please confirm how many times a day Gabapentin is being given.
Just to confirm, please also give the Pepcid AC 30 min. before the Prednisone and then every 12 hours thereafter for as long as Rigby is on any dose of Prednisone, even once the Prednisone starts to taper. For how many days is the new dose of Prednisone to be given before starting to taper?
Good news, too, that your friend is willing to stop by to give Rigby his meds while you and Christian are at work! You're doing a great job getting Rigby all that he needs to heal. Kudos!
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Post by Jacqueline & Rigby on Nov 30, 2019 7:49:00 GMT -7
Good morning friends. I pray everyone had a good Thanksgiving! I am pleased to inform you that I have successfully transferred Rigby’s care to an IVDD savvy Vet! Dr Jennifer Fletcher at The Animal Hospital of Dauphin County. She made room in her schedule for us on Tuesday (Nov. 26). She tweaked the med routine and this is what we have been doing since the eve of Nov 26.
Pepcid 5 mg every 12 hrs (2X per day) Prednisone 5 mg AM and 2.5 mg PM (12 hrs apart) ✙Methocarbamol 125 mg every 12 hrs (2X per day) ▼gabapentin 75 mg/1ML every 8 hrs (3X per day) ▲Tramadol 12.5 mg every 8 hrs (3X per day)
[Moderator's Note. Please do not edit 14 lbs prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro as of 11/18: 5mgs 1x/day for 5 days as of 11/23 neuro: 5mgs am/2.5mgs pm for ? days, then test taper 11/4 short walk prior to 8 weeks of disc healing time tramadol 12.5 mgs ▲3x/day gabapentin 75mg/mL: 75 mgs ▼3x/day ✙Methocarbamol 125 mgs 2x/day Pepcid AC 5mgs 2x/day]
Today is officially day 7 of strict crate rest and Rigby has adapted well to the routine. His pain is managed round the clock. Finally!!! Dr Fletcher will be monitoring Rigby’s progress; tapering the prednisone when she feels appropriate; and we have a plan in place that includes Laser Therapy, Acupuncture and other rehabilitation therapies when he is physically appropriate.
This is the latest.....:-)
Jacqueline
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Nov 30, 2019 9:39:51 GMT -7
Jacqueline, such good news that all pain is fully in control by your finding an IVDD knowledgeable vet in how pain meds are used! Over time, if you continue to find this vet is a good fit for treating conservatively, please do consider adding her name to our Member's Vets Directory. It sure would be helpful to another trying to locate a vet comfortable wth Conservative Treatment medications for a disc episode. Where to add to the directory: dodgerslist.boards.net/board/10/guidelines-posting vet recommendations: Name of Vet Name of Clinic Street Address City: State or country: Type of vet (general/board certified surgeon, acupuncture, etc.) Comments: It appears that you will be able to mark your calendar for Dec 30 graduation day upon a full 8 weeks to get that neck disc to heal! With no current ambulatory issues, there will likely not be any reason to need physical therapy. The beauty of pills being on board to provide full pain relief, means that you most likely would not need to used other therapies of laser or acupuncture as an adjunct to help control severe pain. In fact with his current meds, IF, if there would be an arise in signs of pain, there is still room to move up the meds to provide more pain relief. I think if you are committed to the principal of 100% STRICT crate rest 24/7 only out of the suite for a very, very few footsteps at potty time, Rigby should be able to avoid any more relapses to the early healing disc. If there a true need for laser or acupuncture, the safer idea would be to avoid those risky-to-the-healing disc transports in to the clinic by hiring a mobile vet who will come to your house. Acupuncture and laser therapies. Those two therapies can also help help to reduce pain when an already aggressive pain med approach is on board making the risk of transport worth the benefit of pain relief. Laser light can help to kick start nerves to self heal by jump starting the process. The laser light energy promotes a photochemical reaction which increases cellular metabolism. This, in turn, expedites cell repair. Warning Laser light is not for use if there is existing tumor or cancer. Your report so far is that Rigby does not have any neuro diminishment...has that changed?
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Post by Julie & Perry on Nov 30, 2019 11:47:44 GMT -7
Hooray!! I'm so happy you've found a vet knowledgeable about IVDD. It can make all the difference.
It's wonderful Rigby isn't in pain any longer. Now he can heal.
Yippee!
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Post by Jacqueline & Rigby on Dec 9, 2019 6:04:52 GMT -7
Good morning friends.
Whew....we made it through Thanksgiving and all the company in our home without issue. Rigby is doing fantastic. The round the clock med routine is managing his pain. Last week (Dec. 3), Dr. Fletcher reduced the ▼tramadol to 2X daily (every 12 hrs). It has been 6 days now and he has responded very well to this slight reduction. We began the prednisone taper today (Dec. 9). 2.5 mg 2X daily (every 12 hrs) vs 5mg am and 2.5 pm that he has been on.
[Moderator's Note. Please do not edit 14 lbs prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro as of 11/18: 5mgs 1x/day for 5 days as of 11/23 neuro: 5mgs am/2.5mgs pm for 16 days, 12/9 test taper 11/4 short walk prior to 8 weeks of disc healing time tramadol 12.5 mgs ▼2x/day gabapentin 75mg/mL: 75 mgs 3x/day Methocarbamol 125 mgs 2x/day Pepcid AC 5mgs 2x/day]
He has received 3 total laser treatments so far and we go for his 4th today. We have established a safe transport routine with Rigby. The Vet comes to the car to get us when they are ready for our appointment. I am very pleased thus far with her and will definitely add her to our list of IVDD savvy veterinarians if she continues to impress me.
to be continued......jacqueline
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 9, 2019 8:26:48 GMT -7
Wonderful that a reduction in the tramadol has not revealed signs of pain, Jacqueline! Now that the taper of the prednisone has started today, you'll need to be on the alert for any sign of pain returning or any sign of loss of neuro function. Should that occur, you'll need to immediately alert your vet so Rigby can be returned to the original dosage of all meds for a bit longer. Pain = swelling = more time on all original dosages of meds. Having pain meds on board will make it difficult for you to determine quickly if there is still pain/swelling. Please speak to the vet about reducing or stopping all pain meds so you can quickly determine if there is still swelling and still a need for the anti-inflammatory dosage of the Prednisone for a few more days. Anything less than the anti-inflammatory dosage will not be effective on reducing the swelling. It's that swelling pressing on the nerves of the spine that causes pain and possible nerve damage. More info on the inflammation phase of IVDD: dodgerslist.com/literature/healingsweling.htmPlease continue to give the Pepcid AC 2x/day for as long as Rigby is on any dosage of Prednisone. From what you've previously told us, Rigby has no sign of loss of neuro function, such as wobbling walking, knuckling, etc. The only symptom he's had is pain which has been under control with meds. As Paula explained, laser treatments can be helpful when there has been nerve damage but Rigby has shown no sign of nerve damage. It would seem that the risk of transport, no matter how safe you're trying to make it, would have little to no benefit at this point. The safest place for Rigby until 12/30 is in his crate. Should too much movement of the spine occur during transport or the laser treatments, the not-yet-healed disc could tear more and Rigby would be back to square one, having to start the 8 weeks of crate rest from the beginning and again with pain and possibly nerve damage. Should that happen, it would be very tragic. Prayers for a pain-free taper off of all meds.
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Post by Jacqueline & Rigby on Jan 6, 2020 7:15:25 GMT -7
Good morning and Happy New Year friends!
I am writing to give a brief update on Rigby. Just to clarify, Rigby began strict crate rest on November 22. The day of his neurological/surgical consult. And so, he is still on strict crate rest until Jan 18. He is doing quite well. Dr Fletcher has him on 2.5 mg of prednisone am and pm. ▼Tramadol 12.5 am only. ▼Methocarbamol 125 mg pm only. 50mg/ml ▼ am and pm. He has remained on the 5mg of Pepcid am and pm since November 22. We have an appointment today (01.06.20) for laser therapy and med tapering. He will go again next Monday (01.13.20) for his final laser treatment and begin water therapy Jan 20 as long as he is still progressing well.
[Moderator's Note. Please do not edit 14 lbs prednisone as of 11/5: 5mgs 1x/day for 5 days, then 11/10 taper test for √11/13_pain/ _neuro as of 11/13: 5mgs 1x/day for 5 days 11/18 taper test for √ 11/18 pain! /_neuro as of 11/18: 5mgs 1x/day for 5 days as of 11/23 neuro: 5mgs am/2.5mgs pm for 16 days, 12/9 test taper as of 1/6: still on 2.5mg 2x/day 11/4 short walk prior to 8 weeks of disc healing time tramadol 12.5 mgs ▼1x/day gabapentin 75mg/mL: ▼50 mgs 2x/day Methocarbamol 125 mgs ▼1x/day Pepcid AC 5mgs 2x/day]
Thank you again for your input and prayers. Who knows where he would be in this process had I not discovered this community!
Best, Jacqueline
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jan 6, 2020 7:50:26 GMT -7
I'm glad to hear that Rigby is doing well, Jacqueline. That's a long time for Rigby to be on meds. Swelling usually resolves in 7-30 days. He's been on meds since 11/5. The taper of the anti-inflammatory dosage of the Pred appears to have begun on 12/9. Is there any particular reason for such a long taper off of meds? Please do know that Rigby should not graduate from crate rest until a few days after ALL meds have been stopped so you have proof as to whether there is still swelling pressing on the nerves of the spine or not. As of this point, you still do not have proof that the swelling is gone. And water therapy just two days following release from 8 weeks of strict crate rest is too soon. Reintroduction to movement must be done very slowly. Rigby's strength and stamina need to be gradually built up again. Should there be any pain after graduation, it would be difficult to determine if the pain were due to too much movement too soon or another disc episode. For reference following graduation from crate rest, here is our page on how to slowly reintroduce movement once the 8 weeks of strict crate rest are finished: www.dodgerslist.com/literature/AfterCrateRest.htmWe've mentioned before that with no neuro loss, it's difficult to understand why laser treatments are being done with the risk of transport. I'm glad that's gone well so far but do continue to be very cautious, especially since you do not know if there is still swelling pressing on the nerves. Adjustments to meds should be done by phone with no need to transport. Please keep in touch with us and let us know what the vet says today about med reduction.
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Post by Jacqueline & Rigby on Jan 6, 2020 9:14:52 GMT -7
Thank you Majorie. I too have wondered why so long on the meds? At this point could you offer a recommendation based on your experience with tapering that I could suggest to when I am there today? We have continued with the laser therapy per the veterinarian’s recommendation and because he seems to be benefiting from the treatments. I will heed your warning about water therapy and let them know that we will not move forward with that until Rigby had had sufficient time to acclimate to movement again. thank you so much!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Jan 6, 2020 11:03:28 GMT -7
Jacqueline, note your concern of being on one of the pred taper levels (5mgs once a day) pred for such a long time and ask for the rest of the taper schedule to be implemented along with further reduction of the meds that mask your ability to recognize pain. Part of the benefit of owners learning about IVDD, meds, crate rest, etc. is that you would then have the ability to question things that would put Rigby's disc at risk and politely say "no thank you." All of life is the weighing of risk vs. benefit. --- what risk is the disc put in for transports to a therapies that he does not need since he has no neuro deficits? --- what risk is there in quickly starting a walking therapy since he can walk and can at home begin a very gradual intro back to building up his muscles. Take a peek at such plan and discuss with your vet. There is nothing wrong with unwater treadmill when used wisely. It is great exercise when there is neuro loss can help the body to learn to walk again. After off all meds and prooved no pain: www.dodgerslist.com/literature/AfterCrateRest.htm
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