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Post by Melissa & Zero+Bowie+Huck on Mar 30, 2020 13:40:03 GMT -7
[Original subject line: Zero, Dachshund - Multiple Bulging Discs] Hello. We’ve been here before unfortunately yet now with specific info regarding what is exactly happening to our boy. Zero is a 12-13yr old (adopted so unsure) dachshund, weighs just under 10 pounds, with years of episodes, most managed medically/conservatively. This last year we’ve had too many that were unsuccessful (ie leaving some neuro deficit in both the fronts and hinds) enough to warrant an MRI and talk of potential surgery.
2 1/2 weeks ago, was his MRI 03/10, strict crate test and meds immediately following. He is currently on 2.5mg of prednisone 2x/day, 5mg Pepcid 2x/day, 200mg of Gabapentin 3x/day and 125mg of Methocarbamol 3x/day.
[Moderator's Note. Please do not edit 10 lbs 13 y.o. MRI 3/10 prednisone as of 3/11: 2.5mgs 2x/day for ? days, then test for _ pain/ 3/30 √ neuo dimishment gabapentin 200 mgs 3x/day methocarbamol 125mgs 3x/day Pepcid AC (famotidine) 5mgs 2x/day]
He pees and poops with no problems and the only sign of pain is twitching in the neck when at rest. His neck symptoms prior to the MRI were knuckling in the fronts, occasionally falling over completely to the side and just general instability in the fronts. They have improved over the last couple of weeks until today, 03/30, when he was super wobbly in the front again. His back symptoms were drunken gait and crossing over his legs which have not improved at all. No worse just the same. The MRI showed 12 bulging discs throughout his neck and back, 2 severe at the base of his neck and 2 severe in the mid back. There is also irreversible damage seemingly in both areas. We are weighing the pros and cons of surgery with our surgeon who did our last dog’s surgery a few years ago. I am at a loss, truly. It’s so frustrating to watch him not get better and to know how risky surgery will be given the extremities and frequency of the problem discs at play. I would love to know if you had any insight or opinions. I’m sure I’m all over the place with our story so please ask any/all questions.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Mar 30, 2020 18:01:35 GMT -7
Melissa, so sorry to hear how much Zero is going through with multi-disc episodes. With a complete med list, I'd be able to comment better. So right now just making a guess that Zero was on a maybe a higher dose of pred than the current 2.5 mgs 2x/day. If that were the case of tapering down pred and then the wobbly front legs-- the taper is to test if there is still swelling that could cause pain and or neuro diminishment. If there was no tapering, then do you have any observation of too much movement, a trip into the vet or anything that might be associated with the new wobbly front legs, a set back to his healing disc? It is a very tricky thing with two areas of severity and which is #1 for you and your vet to figure out if a surgery is warranted and where. The surgeon having reviewed the MRI is the one you would want to place your trust in. If with this current neck episode ~ the regression is due to prednisone tapering, then maybe you'd bring that up for discussion to try another pred course? Valuable info to best discuss prednisone www.dodgerslist.com/literature/healingsweling.htm ~ if Zero incurred too much movement to his disc, that is a set back and indicator for going back to step one on crate rest. With surgery, the offending disc is removed and crate rest is 4 to 6 weeks. ~~Lot's of things for your family to take into consideration and see what the surgeon has to say. QUESTIONS ~ What date did pred start? the orignal dose in mgs at 2x/day? What date did pred go 2.5mg 2x/day? ~ Any signs pain having to do with a neck disc?
SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or moved ◻︎ slow to move ◻︎ tight tense tummy ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions ◻︎ head held high or nose to the ground. ◻︎ 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
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Post by Melissa & Zero+Bowie+Huck on Mar 30, 2020 21:12:13 GMT -7
Thank you for the reply. So right after his MRI is when we started all the meds stated: so on 03/11 we started 2.5mg of prednisone 2x/day, 5mg of Pepcid 2x/day, 200mg of gabapentin 3x/day and 125mg methocarbamol 3x/day. There has been no tapering. We have 30 days worth of prednisone and were playing it by ear to determine when to taper. I’ve been checking in with both the neurologist and neurosurgeon 2x/week by phone and email as to a progress report. Might that have been a lose dose to start with? Truthfully I have not seen significant improvement at the least. While we know there is a lot going on in that little body, I’m wondering if the dose is strong enough. I know it takes time as well so I keep hoping each day for some improvement. [Moderator's Note. Please do not edit 10 lbs 13 y.o. MRI 3/10 prednisone as of 3/11: 2.5mgs 2x/day for ? days, then test for _ pain/ 3/30 √ neuo dimishment ✙3/30 neuro diminishment, disc relapsed extra feeding time movement gabapentin 200 mgs 3x/day methocarbamol 125mgs 3x/day Pepcid AC (famotidine) 5mgs 2x/day]
He’s better tonight at potty time then earlier when I did write as far as his fronts. It’s hard to keep him quiet in his crate at feeding times so perhaps he ✙ barked too much and tweaked himself?? I know very little movement is all it takes sometimes so it’s very possible .
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Mar 31, 2020 7:10:43 GMT -7
The dosage of the Prednisone sounds correct for Zero's weight: Prednisone. Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily. Dr. Dawn Ruben "Prednisone/Prednisolone" www.petplace.com/article/drug-library/library/prescription/prednisone--prednisoloneSince it's been hard for you to keep him quiet in his crate and there was no taper, it does sound as though he may have re-torn the not-yet-healed disc so unfortunately the 8 weeks of strict crate rest will have to start over as of 3/30. Here are some tips to help calm Zero in the crate. Try to keep a happy voice and face around Zero. Dogs are very sensitive and pick up on our feelings very easily. Tell him everything's OK and that he's getting better every day. And you believe it, too! If these tips do not help, it may be necessary to have the vet prescribe a mild sedative. To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him. It also creates a den like feeling that dogs love. 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 such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price. Place a DAP pheromone diffuser at floor level where the recovery suite is. Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones Use a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. 3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba) Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc. Consider some of these ideas: -- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising. More details on strollers: www.dodgerslist.com/literature/strollers.htm--Caster wheels can be added to a wire crate so the crate can be wheeled from one room to the next so your dog can stay with you. -- Put a garment you have been wearing and have not washed in the crate. -- Nan Arthur, CDBC, CPDT, KPACTP writes: "According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day. Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.] -- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from on high. -- Play classical music or one of the wildlife TV shows. If a dog is jumping up at the sides of the crate, you can lower the ceiling of the crate. Cut a piece of cardboard the size of the top of the crate, punch holes in the corners and tie the cardboard down into the crate to the level of the top of the dog's head when standing. Or cover the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he/she jumps up, he won't be able to see anything. That may discourage him/her from jumping up. www.dodgerslist.com/literature/EmergencyCrate%20Training.htm
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Post by Melissa & Zero+Bowie+Huck on Apr 11, 2020 11:48:02 GMT -7
Hello all. So unfortunately Zero is no better, perhaps a bit worse in the hinds. He has officially been on Prednisone for 4 weeks at 2.5mg 2x/day.
We have tentatively scheduled a surgery 04/14 for this coming Tuesday. I am terrified. We know the risks associated and know that his case is so extremely tricky given the multiple disc sites and severities. At this moment (because my brain changes its mind every few hours) and with the guidance of our neurosurgeon we have elected to do surgery on his mid back, T12-T13 area, which is the most severe area on the MRI, and we believe to have been the site that started his latest neuro deficits. His steady decline in hind leg function seems to reinforce that. I really have no questions just unbelievably stressed and scared that this decision will actually do nothing or more horribly make things worse for him. From our understanding, the medical route is not working and surgery seems to be our best option to help him, though it's still only slightly better then a 50/50 that he will improve. I worry about the dreaded Myelomalacia situation as well which I'm just reading about. Just really here for support. I appreciate your time and thoughts so much.
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Post by Julie & Perry on Apr 11, 2020 12:16:12 GMT -7
Melissa, it sounds like you have a good plan for Zero.
If after 4 weeks there's no progress and even regression, surgery may indeed be best for Zero.
When I start getting stuck in the "what it's" I try to remind myself to stay in the here and now.
For example, right now I see conservative crate rest isn't working. Right now I have a plan for Zero's care moving forward. Right now I have a surgery date and have discussed my concerns with the surgeon/neurologist.
You have obviously done your research and care deeply for Zero.
Sending you both healing thoughts and prayers as you move forward.
((((Hugs))))
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Post by Melissa & Zero+Bowie+Huck on Apr 11, 2020 12:57:59 GMT -7
Julie, thank you so very much. It’s a perfect way to think. I only want to do the very best with him. It’s terribly unnerving to think that the very best has so many potential downsides. I wish we hadn’t waited and perhaps his odds would be much better. We had hoped for a better outcome but clearly that’s not happening with this conservative route.
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Post by Romy & Frankie on Apr 11, 2020 13:39:54 GMT -7
I know how stressful it is to make the decision for our dogs to have surgery, but for Zero it may be a good way forward as his neuro functions continue to diminish. T12 and T13 are definitely sites which would cause weakness in the hind legs. I think that Julie's thought on trying to focus on the present may help lower your stress level. Surgery will immediately remove the pressure on the spinal cord which causes the pain and neuro diminishment. Surgery will not heal nerves that are already damaged but when the pressure is relieved the nerves can start to self heal. Nerves are slow to heal but over time heal they can. Myelomalacia can occur in dogs that do not have surgery as well as those who do so it should not be a consideration for deciding on surgery. Dr. Andrew Isaacs, DVM, ACVIM (Neurology) answers some questions on surgery our members have had here: www.dodgerslist.com/literature/surgery.htmPlease keep us up to date on Zero. We will be wanting to hear.
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Post by Julie & Perry on Apr 11, 2020 14:16:35 GMT -7
Melissa, someone once told me " Don't should on yourself!"
You love Zero and are doing your best for him.
Treatment plans can change.
For whatever reason conservative crate rest didn't work this time.
Often it does. Now your next step is surgery.
Tell yourself, I am doing my best. Zero is loved. We will make it through this. Breathe and repeat.
As an anxiety sufferer and loving dog mom, I understand.
Hang on and do your best to care for yourself.
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Post by Melissa & Zero+Bowie+Huck on Apr 12, 2020 13:27:19 GMT -7
Thank you so much for your thoughts. This is incredibly terrifying and we are trying very hard to remain hopeful that we can help him with this surgery. The waves of doubt come and go and are brutal. I will keep you posted. Please keep little Zero in your thoughts.
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Post by Judy & Vesper on Apr 12, 2020 23:37:50 GMT -7
Melissa please remember to breathe. You are doing what for now would be the best for Zero. Just concentrate on that. Will be thinking of you and Zero tomorrow.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 13, 2020 4:26:54 GMT -7
Prayers for you, Zero and the doctors, Melissa, that all will go well with the surgery.
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Post by Romy & Frankie on Apr 13, 2020 11:35:24 GMT -7
Best wishes for a successful surgery for sweet Zero. I will be thinking of you both tomorrow.
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Post by Julie & Perry on Apr 14, 2020 8:43:18 GMT -7
Melissa, keeping you and Zero in prayer today. God be with Melissa and her family. Give them peace and comfort. Help Zero have no complications and the maximum benefit. Amen.
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Post by Melissa & Zero+Bowie+Huck on Apr 15, 2020 8:53:50 GMT -7
Hi all. We postponed the surgery by a day so it is actually happening today. We are on our way right now with our little man and are beyond terrified. If I can please ask once more to keep all of us in your thoughts and prayers I would so appreciate it. 💖 Thank you.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 15, 2020 9:55:50 GMT -7
My thoughts and prayers are with you all.
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Post by Romy & Frankie on Apr 15, 2020 13:00:26 GMT -7
Thinking of you and Zero today.
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Post by Melissa & Zero+Bowie+Huck on Apr 15, 2020 19:28:01 GMT -7
Surgery went well! Our doctor is very pleased. Three major compressions were relieved and 5 others were cleaned out for preventative measures. Now the recovery begins and the healing starts. We’ll keep checking up on him tonight but a major hurdle was passed today. Thank you for all your well wishes!!! Please keep them coming!!!! We soooooo appreciate it.
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Post by Julie & Perry on Apr 15, 2020 19:33:34 GMT -7
I'm so relieved and happy for you. Have been keeping you in prayer. ((((Hugs)))
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Apr 16, 2020 4:38:52 GMT -7
Such wonderful news, Melissa! So glad that the surgery went well.
Healing prayers for Zero.
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Post by Romy & Frankie on Apr 16, 2020 8:09:15 GMT -7
I am so happy to hear this excellent news!
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Post by Melissa & Zero+Bowie+Huck on Apr 16, 2020 11:13:32 GMT -7
amazing update this morning! our little man is eating, peeing on his own and has movement in both legs, though the right side is delayed. he isn't getting up on his own but when helped the movement he does have is super promising. the surgeon is encouraged and flat out said the progress is better then expected! it's incredible news and we are enjoying a moment of relief. we know we have a long road ahead of us and still not at all out of the woods but we are trying to embrace this victory and be kind to ourselves. YAY ZERO OUR SUPER WEENIE!! your thoughts and prayers are so very VERY appreciated!!!!
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Post by Romy & Frankie on Apr 16, 2020 13:01:41 GMT -7
Having made so much progress overnight is wonderful! That is really excellent news.
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Post by Melissa & Zero+Bowie+Huck on Apr 19, 2020 9:25:49 GMT -7
Good morning! We brought our boy home last night, 4/18. We had to express his bladder because he wasn’t going on his own. Very stressful but my husband got it! Zero had a big, perfect looking poop also last night which is great news. His hind is super weak and he needs help with a sling to attempt potty, the right hind worse then the left. I forgot what this part of the journey was like! How long do you want until you try expressing him bladder again? Also how long is it an absolute emergency if we aren’t able to do it, ie having to go to the hospital and have them do it? Thank you!!
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Post by Ann Brittain on Apr 19, 2020 9:56:16 GMT -7
Hi! I'm glad to hear you were able to take Zero home. He looks like a cute and happy boy in his photo.
We found expressing Buster after his surgery required practice. I'm glad your husband is catching on. Here is a link that includes information and hints to help you through the process.
www.dodgerslist.com/literature/Expressing.htm#bladderexpress
Expressing Zero's bladder regularly, especially if he is drinking a lot of fluids, is important. You can feel when his bladder starts to fill up. We expressed Buster first thing in the morning, around noon, just before dinner and before bedtime. If you notice any leaking at all, that indicates his bladder is overfull. You really want to avoid that because of complications that can occur including urinary tract infections and skin issues. If it is clear that his bladder is full and you're unable to express his pee, I would call his vet.
I learned, when expressing Buster, to be calm and encouraging to him. If you try and you don't think he's emptied, wait a minute or two and try again. Use the flat part of your hand to steady one side and put pressure on the other side with a flat hand. Never dig your fingers into his side or apply extreme pressure. Although it can take a lot firmer pressure than you think to get him to go. Just be careful and consult your vet if there are any problems or concerns. Also taking him to a spot where he normally pees or where other dogs have peed may help stimulate his natural instincts and help you express him successfully.
Take care and good luck!
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Post by Judy & Vesper on Apr 19, 2020 23:39:48 GMT -7
I am so glad to hear the operation went well and Zero is home. Remember that healing takes time, and not to worry to much and expect to much too soon. Once he is cleared by the vet, Hydrotherapy is an excellent modality to get his strength back and to build up his muscles. Laser therapy also works well. Passive exercises are also beneficial, especially for the hind leg that has a little trouble. It just stimulates the muscles. Please ask your vet when you can start with these modalities. Do NOT start with these modalities before consulting with your vet.www.dodgerslist.com/literature/healingacupuncture.htm www.dodgerslist.com/literature/watertherapy.htm
Keeping his core muscles strong will benefit him immensely. Swimming your dog during the summer times, keeping him fit and his weight down is very important, in order to protect him from further injury. So happy he is better. Good luck
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Post by Melissa & Zero+Bowie+Huck on Apr 20, 2020 19:04:07 GMT -7
Hello! Happy to report that Zero is peeing and pooping on his own which is a huge relief. I did have a question about pain however and hoping anyone could offer their insight. I have voicemails/emails into their doctors but unfortunately no one is responding as of yet.
He had a Fentanyl patch that was put on on the surgery day, 04/15 and was due to come off this morning, 4/20. We did take it off and then transitioned him this afternoon to ✙Buprenorphine which was applied on his one ear flap. The dose was 0.05ml.
He had been also on Gabapentin (200mg) and Methocarbamol (125mg) when we took him home on Sat, 4/18, through until now.
[Moderator's Note. Please do not edit 10 lbs 13 y.o. 4/15 surgery ✙Buprenorphine to ear flap gabapentin 200 mgs 3x/day Stopped methocarbamol 125mgs 3x/day Stopped Pepcid AC (famotidine) 5mgs 2x/day stopped ]
So currently he is not on those two meds because I don’t know if it’s intended to be taken with the Buprenorphine. He does seem uncomfortable though. Can’t seem to settle like he’s been. I don’t want to give until I hear from either doc however in your experience are there any known interactions? Thank you!
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Post by Julie & Perry on Apr 20, 2020 20:06:27 GMT -7
Zero sounds like he's in pain.
Is the surgeon or your vet on call?
Medication and drug interactions are something a trained professional needs to handle.
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Post by Melissa & Zero+Bowie+Huck on Apr 20, 2020 20:25:58 GMT -7
Agreed. No one’s calling me back and it is insanely frustrating.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Apr 20, 2020 20:53:56 GMT -7
Melissa, Fentanyl which he just came off because the patch had expired is an opiod. Buprenorphine is an opioid acting as the general analgesic which some vets do use. It is most effective in absorption when applied on the ear flap.
Gabapentin addresses nerve pain Methocarbamol addresses muscle contraction pain.
It can take about 2 weeks before all the surgical caused painful swelling is gone. Until then the pain meds are on board to give Zero comfort from any pain. Did the gabapentin - methocarbamol come with a range of doses? You might try giving one of the lessor doses til you can hear back from the vet to perfect adjusting the meds for you.
How often are you to apply Buprenorphine to the ear flap?
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