Sarah's Beau 11/25 conservative GRAD 1/20

-- Did a board certified specialist?  Yes, the vet I went to used forceps and squeezed his toes extremely hard and didn't have much to any pull back

-- Date carprofen started? 11/25/19     Carprofen stopped on Dec 1?
yes
A. Is he in any pain due to stopping carprofen? I don't think he is.. Sometimes I can't tell if his "shivering" is him in pain or sniffing out but no crying from him..
    Were his pain meds increased? No I was not advised when I told the vet I wanted to stop the carprofen. the only thing she did mention is that more studies show using the carprofen instead of prednisone 

B. Let us know more why the switch to Prednisone. .. ? I feel there were no results with the carprofen. Last episode he was on prednisone and within the week he was able to stand and almost walking, now he has no desire so I don't feel it is working even though I know this stuff takes times. I just feel we had better results. 

-- The prednisone will start Sunday December 8 not sure yet the rest of the details as I will find out when I pick up the script saturday when he goes for laser therapy. I also will have pepcid on board 5 mg 2 times a day 30 min prior to the prednisone dosage

The vet was just a DVM. He is on 110% crate rest. He only comes out for me to express him give him quick loving and back he goes. I take him out for appointments too. I notice when I take him out to express his back legs start to shake. I am not sure what that could be a sign of though but hoping it is some type of positive. He honestly doesn't seem unhappy frustrated that he can't walk or move like he wants to but he still seems pretty happy. I have seen SOME tail wagging from him as well. I have a small dog crate to transport him to and from the vet and I am extremely careful. I am trying to stay positive and hope that I can rehab him back like I did before just this time is worse than last time but I have seen so many posts in groups that I am in who have done conservative treatment and their dogs be in the same boat mine is in and they recovered. I know it will take time just seemed 3 years ago he bounced back a little faster.

Today was first laser therapy treatment hopefully it will work. I picked up the script for prednisone and I think its too much for a dog that is 17 lbs. She has 10mg 2 times a day for 14 days then 1 pill a day for 14 days then 1 pill every other day til gone... Still in good spirits but not walking will start prednisone with pepcid Sunday

Sarah, very smart of you to recognize that 10 mgs twice a day is way over the anti-inflammatory dose for prednisone it is more like the dose used for autoimune diseases, maybe cancer too. The higher dose of pred, the more danger the GI tract is put in.

I think this whole thing of doing a switch from a NSAID to prednisone when there was no emergency has left Beau without any anti-inflammatory on board for days not working on the swelling, IF indeed there might still be any swelling left. It has left you and the vet not even knowing if all the painful inflammation is gone and no need of any anti-inflammatory drug.

How vets who know IVDD use anti-inflammatory drugs.
-- After one course of an anti-inflammatory drug such as the 6-day course of carprofen, then to find out whether another course is needed, the vet should call for the stop or backing off of the pain meds that mask pain. If any hint of pain should arise, then it is known that another course of anti-inflammatory is needed. If no pain, then naturally no other courses of carprofen or any other anti-inflammatory is needed. In fact no meds at all are needed, just the theraphy of limited movement for the balance of the 8 weeks to get the disc to heal. Nerves will self heal but usually at a much slower rate than a disc heals. So one ought to think in terms of months rather than days/weeks about nerve healing.

Since carprofen has beens stopped, perhaps you could do a real test stop, by backing off the two pain meds. Observe if you see any hint of pain. If yes, then you and the vet would know with clarity that another course of an anti-inflammatory is needed (whether that be one from the steroid class such as prednisone or continuing on with carprofen).

With two pain masking pain meds on board, if you would see signs of pain then you have an obvious answer that another anti-inflammatory course is needed. If you don't see any signs of pain it can be due to the pain masking qualities of gabapentin and methocarbamol basically blindfolding you to to facts about existance of pain.

Sarah, if you are going to proceed with prednisone you will either need to have a chat with your vet about the high dose concern....advocate for the anti-inflammatory level of it. OR you need to hire a new vet who will work with you and be the supervising vet while on pred. Pred is one drug no one should fool around with. No owner should think they know how to use it. Each disc episode is different, as a dog ages his metabolism is different, etc. Beau needs to have a vet in charge if he is to take prednisone.

Prednisone is a synthetic hormone drug. The body makes its own hormone called cortisol. It is a life giving drug in running the body. Prednisone suppresses the body's production of cortisol. Beau needs to be under the supervision and care of a vet while on Prednisone. Please do not take any chances with his health. It would be best so that no extra transports to a new vet are needed if you can work with the vet you have.

Sarah, a suggestion.   You might want to recheck with your vet on the dosage.  If you are reading from the bottle or package, pharmacies  have been known to make mistakes.  

Was the frequency of the Gabapentin decreased, Sarah? We had it listed as twice a day. Gabapentin works most efficiently when given three times a day (every 8 hours) so do speak to the vet ASAP about giving it three times a day. Tramadol can also be added. Pain should be completely under control with no sign of pain from one dose of meds to the next. Pain hinders healing so have no patience with it.

Each disc episode can be quite different from prior episodes. The nerve damage sustained is according to how much spinal compression there is. The fact that this disc problem is taking longer to heal does not mean that it won't heal - it just may take longer.

Try to keep a happy voice and face around Beau as dogs are so quick to pick up on our feelings. Tell him every day that he's getting better and you believe it, too!

Please let us know what the vet says after speaking to them this morning.

Sarah, I'm sorry to hear your mind is so upset believing Beau is suffering.  See if these points can add to your IVDD knowledge to benefit your mind and determine the exact nature of Beau's suffering.

1. Legs shake when lifted.  Can you confirm you are seeing an actual sign of pain by noting if there are also other signs going on around the same time?  Please also note if observations happen nearing the next dose of the pain meds (methocarbamol and gabapentin)
◻︎ not their normal perky selves 
Review reading about pain control: www.dodgerslist.com/literature/healingpain.htm
    A. Since you have an Rx for a max of gabapentin 3x/day.  Have you been giving 3x/day since you believe Beau is suffering?  
    B. What changes did you note in comfort from pain when you give 3x/day?

2. PREDNISONE Swelling will cause pain until the anti-inflammatory prednisone has been able to fully resolve. Until swelling is resolved using an aggressive 3x/day pain med dosing ensures that no pain will surface (no suffering) nearing the next dose of med. Pain arising would clearly indicate the need for 3x/day pain med dosing and the need for a 3rd or 4th pain med to be added to the cocktail.
    IMPORTANT: For how many days is Beau to remain on the anti-inflammatory level of Prednisone 5mgs 2x/day prior to doing the test for pain prednisone taper?  
   WHY IMPORTANT: as soon as the pred taper reveals there is no more pain/no more swelling then it would be safe to being a very, very light least aggressive range of motion can begin. Important as this light ROM can help to keep the joints flexible and circulation up in the muscles. No one wants a dog on pred when there is no work for it to do (resolve swelling). All that remains is the adverse side effects.   Review Reading about use of prednisone and the test taper: www.dodgerslist.com/literature/healingsweling.htm

3. NERVE REPAIR As Marjorie indicated each disc episode can be very different from the last one or from another dogs' episode. Right now 3 weeks since nerve damage is still quite early in the nerve healing department. Once nerves have been damaged such as in Beau's current case, we need to think in terms of months rather than days/weeks for the body to self repair nerves. The single most important care you can give right now is to ensure his back (spine) move as little as possible. Being inside of the crate (except for expressing times) ensures a very excellent environment for the disc to heal. Limit vehicle trips as there is always the potential for excitement, too much movement for that early healing disc. 
   
4. IDENTIFYING NERVE FUNCTION vs. reflexes Electrical signal messages from the brain travel down the spinal cord out to limbs, bladder, tail, etc. Before those signals can travel successfully, damaged nerves have to self repair from the point of injury from the bad disc through the nerve pathway to reach the paw, reach the bladder. Nerve growth can be one millimeter per day. So a twelve inch nerve span damage might require year or so to grow in order to make the connection complete from brain to that rear paw.
   For us humans to be able to distinguish between reflex and brain directed, we have to see some sort of head level involvement with the tail, with a limb or with release of urine so we know the movement was done with purposeful thinking.
--- Sniff (head level nose) then release of urine would be brain directed.
--- Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail movement during potty time can often be a reflex
--- Itchy sensation at at neck and then tries to scratch would be purposeful movement. Tickling paws, etc. can cause reflex leg movements.

Look forward to learning if Beau is currently suffering with pain.  Right you are at the end of 8 weeks of focusing on disc healing, if his nerves still need more time to self repair, that will not matter to Beau. He'll just get on with the business of enjoying life with the assist of a wheelchair if need be!



 

Sarah, you describe what we continually advise to be on the alert about. When there are signs of pain nearing the next dose of pain meds— that is because the pain meds are not yet right.

--- Gabapentin (as are other IVDD pain meds) begin wearing off after 8 hrs. That is the reason we strongly advocate for getting your vet to Rx for 3x/day. You have that permission to give gabapentin 3x/day. What is the reason you are not doing this? Have you discussed what is the normal dose if given every 8 hrs (3x/day) with the vet? If you give gabapentin promptly every 8 hrs and still see signs of pain nearing the next dose, then the problem is not each source of pain is being covered.

√  Methocarbamol works on the pain of muscle spasms.
0  LACKING! 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 IF the meds have been properly adjusted! Have no patience with pain as it does hinder healing. 

Advocate that your vet bone up on Tramadol in her Plumb's drug directory, or other reference source.  While there is a current controversy, it appear that for many dogs on the Forum, tramadol prescribed by Neuros and many general DVM vets does help. Below---Kögel's conclusion in his study with only the breed of Beagles and tramadol may shed light on why dogs on this Forum who have been prescribed Tramadol do find pain relief when the dose is at the max analgesic dose and precribed for every 8 hrs.


TRAMADOL: The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours.

Yes you can, but you should give the pepcid ac 2x daily 30 minutes before the Prednisone for stomach protection.

Sarah, look back at my last post. I gave you the Plumb's entry for dosing Tramadol.  The dosing goes by weight in kilograms (kg) NOT pounds (lbs).  A vet will know exactly how to calculate the dose for Beau.    Just to give you an idea, my 13 lbs dachsie was Rx'd a full 50 mg tramadol tablet every 8 hrs.  It is important that you ARE  working with your vet (a vet) in getting meds adjusted. Do not self prescribe medications on your own. None of us are vets and we are not trained in the pharmacy aspects of side effects, what meds should not be given with a disease, what is contraindicated nor the overall body systems and how they work.  Please let us know  when you have phoned your vet (a vet) and have an adjusted pain med list to share.

In that last post, I had asked since the vet did give you a range on the gabapentin for every 8 hrs, had you moved the gabapentin up to 3x/day?  If not, then why not?

QUESTIONS
- Had you moved gabapentin up to 3x/day  as per the dosing range vet gave you?   If not, why not?
- Would you let us know you are not self prescribing tramadol yourself, but are working with a vet in getting the pain meds adjusted.
- Would you let us know  you presented a successful advocacy via a phone call of describing what specific signs of pain you observed and when you see them appear.  

Hi, Sarah. I do hope that giving the Gabapentin three times a day (every 8 hours) will get Beau's pain completely under control today. Pain should be completely under control within one hour of giving any new course of meds and remain completely under control from one dose of pain meds to the next. If not, then do advocate strongly for the addition of Tramadol every 8 hours. It often takes all three pain meds to address each type of pain and get the severe pain of IVDD under control.

Prayers for a pain free day for Beau today.

Everything can feel worse at night. The pain can be disrupting his sleep which makes Beau feel worse. If giving the Gabapentin 100 mgs 2x/day has not gotten Beau's pain completely under control, then you'll again need to advocate strongly with the vet this morning for a change of meds. Gabapentin has a short half life and works most efficiently when given three times a day so advocate that it be given three times a day. She had OK'd that before. Even if she will only agree to giving 75mg 3x/day, that may be what works for Beau. Sometimes giving a lower dose three times a day works better than giving a higher dose two times a day due to the short half life of the med.

Ask the vet if she would be willing to consult with other vets, hopefully a Board-certified neurologist, in an effort to get Beau's pain completely under control. Refer her to the study that Paula recently gave you.

Sorry it has been a little bit since I have been on. He is on 5mg of prednisone with pepcid protector for tummy every other day starting yesterday and 100mg of ▲gabapentin 3 times a day.

[Moderator's Note. Please do not edit
17lbs
carprofen 11/25: 1.25mgs 1xday for 6 days stopped Dec 1
prednisone as of 12/8 5mgs 2x/day for 14 days, then 12/22 test taper to reveal any: _pain / _neuro
gabapentin 100mgs ▲3x/day
methocarbamol 125mgs 3x/day STOPPED sometime end of Dec.
trazadone 50mgs 1x/day
Pepcid AC 5mgs 2x/day] x/day


When he had his last laser treatment and check up on December 31 she said he doesn't seem in pain. I told her he still cries and cries in his cage to the point I have no idea what to do with him. I have check for signs of pain and he doesn't tremble/shiver etc and I don't know if he is stressed out or what. BTW laser therapy of 6 treatments did not touch him show no signs of any type of improvement. People said acupuncture should help . I am just at a loss.. I have been giving him 50 mg of trazadone at night so that he can relax and not keep everyone up from crying at night. His cry is his usual cry of anxiety/stress that he has done for years but it has heightened. I shouldn't say cry but more of a high pitched whine..He doesn't yelp or anything when I pick him up. I have let him scoot around and he doesn't cry or yelp doing that. I think its a huge frustration that he can't walk and that could be contributing to it. I am trying to give him the best life of the rest of the years he will have but I feel like I am letting him down and not doing enough for him. I advocate for him the best I can and try to make him as comfortable as possible.