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Post by Dawn & Ollie on Apr 10, 2020 6:13:53 GMT -7
Ollie will be 14 years old in May. He is a dauchshund and weighs about 19 lbs. He has had 2 previous back surgeries. One in May of 2013 and then another in September of 2014.
Ollie took a fall a couple of few weeks ago and while we were definitely thinking spine the Vet thought it might also be shoulder or ligament. Anti-inflammatory Galliprant was given along with Tramadol. While this worked for about a week we could see signs that his discomfort was getting worse. I took him for xrays and it looks like he may have some slight decreased space in a couple of his neck vertebrae. Of course an MRI would be needed to really see this. This past Tuesday he woke up in a lot of pain and spent the night at the Vet on IV anti-inflammatory/pain meds, along with steroids. He also received on 4/7/2020 injections of: Buprenorphine .3mg
He came home Wednesday and felt much better.
Of course today the IV meds have really worn off and he is in a some discomfort. He is on strict crate rest only out for potty breaks (which he is carried outside to limit his walking). He is currently on the following meds:
500mg Methocarbamol: 1/2 Tablet every 8-12 hours 5mg Prednisolone: 1/2 Tablet every 12 hours 10mg Famotidine: 1/2 Tablet every 12 hours 50mg Tramadol: 1/2 Tablet every 12 hours 100mg Gabapentin: 1 capsule every 12 hours
[Moderator's Note. Please do not edit 19lbs Galliprant stopped 4/5 Dex inj on 4/7 Prednisone as of 4/7: ?mgs ?x/day for 1 day as of 4/8 taper dose! 2.5mgs 2x/day to test for 4/10 √pain/_neuro methocarbamol 250mgs 2x/day tramadol 25mgs 2x/day gabapentin 100mgs 2x/day famotidine 5mgs 2x/day]
I really do not feel due to his age that he is a good candidate for another surgery. I would really like to treat this via meds and crate rest, so I would like to be very aggressive with this. He is still pain and seems to be most tender on the right side. He is walking fine, but guarded with his head stiff.
This is my first time doing just crate rest and meds. While I know he will be in discomfort while this hopefully heals, I would like some feed back on others that have gone through this. Again I would like to be aggressive with the med and crate rest so any feedback and advise is very welcomed.
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PaulaM
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Post by PaulaM on Apr 10, 2020 6:52:47 GMT -7
Dawn, welcome! Quickly so you can alert your vet asap this am about the pain. Neck discs just are more painful. Thus an aggressive pain med approach is needed that is not being done. Here is what to advocate for with your vet over the phone. Vet visits are a potential for too much movement and then more pressure to the bad disc as the vertebrae move. ANTI-INFLAMMATORY DRUGS---Ollie was sent home on a taper dose of the steroid prednisone. The taper is to test for pain. You got your answer. Not all painful swellilng has been resolved by prednisone. Alert the vet of the pain. Expect the pred to go up to an anti-inflammatory dose for Prednisone ( correction) for a 19 lbs dog 0.3mgs pred X 19lbs = 5.7 mg pred dose. a 15 lbs dog (0.3mgs pred X 15lbs = 4.5 mgs pred. Dosed every 12 hrs Most vets would round the pred dose to 5mgs 2x/day. The course of pred would be something the vet simply must take a guess about. Some will choose a 7-day or maybe a 14-day course and then another taper test to assess if painful swelling is actually resolved or not. PAIN MEDSPlease do not self prescribe for your dog. The vet is the one who knows Ollie, his health issues and is trained to use meds. That is not something you or I are trained in. Below are things to discuss and advocate for with your vet. Pain meds begin lowering to an ineffective level in about 8 hrs. Advocate for an every 8 hrs dosing schedule - Gabapentin advocate for every 8 hrs. - Methocarbamol should be used at the Rx'd higher frequency of every 8 hrs. - Tramadol is way under medicated for a 15lbs dog. Look for dose in mgs to be nearing 50 mgs and every 8 hrs.The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours. Plumb's is considered the "drug bible" of the veterinary world. Tramadol dosing in dogs varies, ranging from 2 to 5 mg/kg every 8-12 hours. The highest dose for maximum analgesic effect in dogs is 10 mg/kg every 8 hours. “Tramadol”. Plumb DC. In Plumb DC (ed): Plumb’s Veterinary Drug Handbook, 7th ed—Ames: Wiley-Blackwell, 2011, pp 1002-1004. NECK DISCS
These are the extra things you can do at home to help with a neck disc: www.dodgerslist.com/literature/cervical.htm QUESTIONS
Methocarbmol which had actually been given every 8 hrs or 12 hrs?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 10, 2020 7:00:56 GMT -7
Removed from status area: He also received on 4/7/2020 injections of: Buprenorphine .3mg
QUESTIONS: Galliiprant was stopped on what date ? What was the name of the IV anti-inflammatory given on 4/7 What was the name of steroid given on 4/7 Methocarbmol which had actually been given every 8 hrs or 12 hrs?
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Post by Dawn & Ollie on Apr 10, 2020 7:03:30 GMT -7
I will advocate to increase the Gabapentin to every 8 hours. Along with increasing the Tramadol to the full dosage of 50mg every 8 hours.
His Prednisolone is not scheduled to be tapered until he sees the doctor again on Sunday 4/12/2020. She said she will evaluate then what should happen with this med.
I will give the ▲Methocarbamol every 8 hours.
[Moderator's Note. Please do not edit Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisone as of 4/7: in hosp ?mgs ?x/day for 1 day as of 4/8: at home taper dose!: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro methocarbamol 250mgs ▲3x/day tramadol 25mgs 2x/day gabapentin 100mgs 2x/day famotidine 5mgs 2x/day]
She will be calling me today for a update and I will speak to her then.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 10, 2020 7:17:00 GMT -7
Dawn the point of the steroid is to be working on inflammation. Ollie DID get a taper dose level for at home!
-- anti-inflammatory level is 5mgs 2x/day -- taper level is anything below. Ollie got an Rx for 2.5mgs pred 2x/day. That is a taper dose that no longer works on swellling. -- Inflammed tissue surrounding the spinal cord is not good. Nerves do not llike being pressured.
There is potentional for nerves to die if too much pressure. We see death of nerves as loss of function. Because the vertebral canal in the neck area is a larger diameter than in the back, paralyzed legs, etc are not so frequent. BUT IT CAN HAPPEN.
Could you call the vet NOW and alert to the situation of pain. Getting the prednisone back up at an anti-inflammatory level is important to do soonest. PLEASE do not self prescribe...the vet must do this. You are just being armed with information to discuss things.
Most vets would round up the anti-inflammatory level of the pred dose to 5mgs 2x/day. The course of pred would be something the vet simply must take a guess about. Some will choose a 7-day or maybe a 14-day course and then another taper test to assess if painful swelling is actually resolved or not.
CAR TRANSPORTs to VET VISITS Any time out of the crate is a dangerous time for a dog going through an IVDD disc episode. Transport to a vet is risky as there is a chance of too much movement. Most vets who understand how strict the crate rest must be will understand that it's too much of a risk to bring the dog in to the office for a follow-up exam.
You can call her to give her status updates on pain and neuro function.So please do speak to the vet to clarify why she feels it's urgent that you transport your dog for an appt. Ask that phone consults be done instead. Vet visits should be kept to the only urgently needed ones.
With urgent vet visits, secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels on either side of the dog to prevent movement or jarring the spine when braking or turning corners.
Prednisone correction for a 19 lbs dog 0.3mgs pred X 19lbs = 5.7 mg pred dose.Many vets would than round to a 5mg tablet given every 12 hrs. The vet would take a guess on how long it might take to get the swellilng down. Maybe a 7-day or a 14-day course. Then do another prednisone taper test to find out. Med card is a handy reference thing to keep in your wallet. Helps to keep meds straight when discussing things with your vet. D/l to print a copy at this link: www.dodgerslist.com/literature/MedCard.pdf Medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds: www.dodgerslist.com/literature/crateRRP/medchart.pdf
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Post by Dawn & Ollie on Apr 10, 2020 13:25:45 GMT -7
Just spoke to our Vet. She is going to make the following changes to his meds; -500mg Methocarbamol: 1/2 tablet every 8 hours -5mg ▲ Prednisolone: 1 tablet every 12 hours (Can go up to 1 1/2 tablet every 12 hours, but wait to see how he does on this) -10mg Famotidine: 1/2 tablet every 12 hours -50mg ▲ Tramadol: 1 tablet every 8 hours -100mg ▲ Gabapentin: 1 capsule every 8 hours [Moderator's Note. Please do not edit Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisone as of 4/7: in hosp ?mgs ?x/day for 1 day prednisone as of 4/8 taper dose!: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro as of 4/10: ▲5mgs 2x/day for ? days, then retest _pain/_neruo methocarbamol 250mgs 3x/day tramadol ▲50mgs ▲3x/day gabapentin 100mgs ▲3x/day famotidine 5mgs 2x/day]Will look into Amantadine as she has used this before. Lets see how he does with this med change first. Also to help with his anxiety, if the increase in Gabapentin/Tramadol does not ease this, then she said she can add Trazadone. Wait to see as the other meds might help as they make him sleepy. He has high anxiety if we are not in his sight at all times. Recheck via phone on Monday 4/13/2020.
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Post by Romy & Frankie on Apr 10, 2020 14:07:37 GMT -7
Excellent that Ollie is now on an anti-inflammatory dose of pred at 5mg 2x daily. For how many days has it been prescribed at that dose? Now Ollie has something working on the inflammation. If Ollie is showing signs of anxiety, Trazadone can help. Trazadone is commonly used for anxious dogs that have trouble staying calm in the crate.
Let us know if the more aggressive dosing of pain meds is providing full pain relief for Ollie.
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Post by Julie & Perry on Apr 10, 2020 15:49:00 GMT -7
Dawn, excellent job advocating for Ollie!!
Prayers for healing and comfort.
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Post by Dawn & Ollie on Apr 10, 2020 17:36:53 GMT -7
We will discuss the step down of the pred on Monday 4/13/2020 when I speak with the doctor. I will post the the update after I speak with her.
Luckily I have a really great Vet Office (Newburgh Veterinary Hospital). They have been our Vet since we moved to NY in July 2004. They know their limits and if they don’t know something they will ask a specialist. For his surgeries they referred us to The Animal Specialty Center in Yonkers, NY. Again wonderful staff there too and very knowledgeable.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 10, 2020 20:28:46 GMT -7
Dawn, what a good job you did in presenting what you observed and advocating to get what Ollie needs. Kudos to you! The med list looks very good and would expect that pain will now be in control round the clock. Please let us know he is comfortable with no signs of pain showing through the night and right up to the morning doses. Isn't is nice to have vets take note of what you observe and work with you in helping Ollie Including a phone update on Monday!! Would you consider helping another trying to find an IVDD knowledgeable vet by adding to our 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: QUESTIONSAlong with seeing how many days the new pred Rx will be for at the anti-inflammatory dose, could you check your bill for : -- Galliiprant was stopped on? -- IV anti-inflammatory name? on 4/7 -- name of steroid given on 4/7 Have a good weekend!
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Post by Dawn & Ollie on Apr 14, 2020 6:41:33 GMT -7
Over the weekend (4/11/20 - 4/12/20) Ollie's meds seemed to keep him comfortable. You could still tell he was tentative in his movements and maybe a bit painful, but did not wince in pain when he moved or was picked up. He was still very excited to eat and went to use the bathroom with no problems. He was still over anxious in his crate and was difficult to settle and if we were not careful he would work himself up too much. So, I spoke via telephone with Ollie's doctor on 4/13/2020. To help with is anxiety she has added 50mg ✙ Trazodone taken once daily. In addition, increased his 50mg ▲ Tramadol to 1 1/2 tablets every 8 hours (was 1 tablet every 8 hours). This will hopefully ease his anxiety so he can rest more during this healing process. We will be keeping him on 1 tablet of Prednisolone every 12 hours until Friday 4/17/2020. That is when the doctor will do another recheck via telephone to see how he is doing and discuss any step down if indicated. He is showing side effects of the Pred: Increased thrist, urination, and some panting. [Moderator's Note. Please do not edit 19 lbs / 8.62 kg Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisone as of 4/7: in hosp ?mgs ?x/day for 1 day as of 4/8 taper dose: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro as of 4/10: 5mgs 2x/day for 7 days, then FRI 4/17 retest ✓4/11 pain/_neruo methocarbamol 250mgs 3x/day tramadol ▲75mgs 3x/day gabapentin 100mgs 3x/day ✙Trazodone 50 mgs 1x/day famotidine 5mgs 2x/day]As to questions regarding what he received while hospitalized, I added an image of his bill for your review. His last dose of the Galliprant that he was on previously on 4/5/2020 pm before being hospitalized.
Overall, he is definitely more comfortable so far this week than he was last week.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 14, 2020 8:04:45 GMT -7
Dawn, really nice job your vet is doing in working with you via phone updates. You two are a fine team for Ollie! Also notable is at the hospital with the switch to steroids, the Dex injection included injections of stomach protector, famotidine. I can see your vet is not afraid to use pain meds in an aggressive manner to insure Ollie the ability to heal in comfort by moving up to max analgesic doses of tramadol.
Fingers crossed with a total of 8 days (Dex 1-day course, pred 7-day course) all swelling will be gone. Of course there is no way to know until the prednisone test for pain taper begins on Friday 4/17.
If he still shows signs of pain prior to 4/17, then it would not be time to think about tapering. If with all the pain masking pain meds on board you are not seeing signs of pain, the taper might well begin on 4/17. You and your vet would have blindfolds on about pain unless pain meds are backed off or full stopped at the same time the pred taper starts. --- Let us know if the test taper is to start on Friday, should any hint of pain surface over the weekend you would have a Plan B worked out ahead of time. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again on Monday. An ER visit is very expensive, a "Plan B" is free! -- Let us know which your vet wants for the pain meds on the start of the pred taper: 1) backing off the pain meds or... 2) full stop of pain meds (methocarbamol, gabapentin, tramadol) same time the pred taper begins.
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Post by Dawn & Ollie on Apr 18, 2020 17:59:08 GMT -7
So I had another phone follow up with the doctor today 4/18/2020. Ollie is feeling better and pain is definitely being managed. The addition of the Trazodone (1 pill at night) and increased Tramadol (1 1/2 tablets every 8 hrs) has done wonders keeping him calm and quiet. He does get excitable between 5:30 and 8 pm. Very hard at that point to keep him calm as Dad is usually getting home from work, feeding time is at 6pm (and those Pred food cravings are in high gear), plus we are eating our dinner. But once dinner is over he gets his 8 hr meds at 8 pm and starts to calm. By the time he gets his 12 hr meds at 9 pm he is out and sleeps well through the night. He is having the panting effects from the Pred also. Vet said if we can put up with the food crazies, thirst, peeing a lot, and panting for one more week, she would like to continue on the same med schedule. She wants to be sure he has some good heal time. We call in again for another check in on Friday 4/24/2020, where I expect to start tapering down on the meds. So far I'm very happy with the progress. Today we had to hold him back from trying to run in his bathroom area, so I know meds are working. We are going into week 3 of crate rest, so at least 5 more weeks to go.
[Moderator's Note. Please do not edit 19 lbs / 8.62 kg Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisone as of 4/7: in hosp ?mgs ?x/day for 1 day as of 4/8 taper dose: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro as of 4/10: 5mgs 2x/day for 7 days, then FRI 4/17 retest ✓4/11 pain/_ neuro as of 4/18: 5mgs 2x/day for 7 days, then Sat 4/25 retest _pain/_ neuro methocarbamol 250mgs 3x/day tramadol 75mgs 3x/day gabapentin 100mgs 3x/day Trazodone 50 mgs 1x/day famotidine 5mgs 2x/day]
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 18, 2020 18:22:12 GMT -7
Dawn, things seem to be going well at your house. So good to hear the more aggresive pain med approach is keeping all pain at bay.
How long to stay on pred is just a guess. Many vets do take a 14-day course of pred for the guess. So got fingers crossed there will be a taper on Sat 4/25 and you will not be seeing any pain. Do let us know which your vet will call for upon the 4/25 taper backing off of all the pain meds or full stop of them. Pain meds mask pain taking longer to find out if painful swelling is really gone.
Keep up the good work you are doing in caring for Ollie's healing disc! Look forward to your next report.
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Post by Dawn & Ollie on Apr 24, 2020 8:06:18 GMT -7
Hello
So during our weekly update (Thursday 4/23/2020) our Vet made the following med changes. She started the step down on the Pred. She wants to do this very slow so he will go from taking 1 tablet every 12 hours to 1 tablet in the am and 1/2 tablet in the PM. So he got his first [pred] step down dose (1/2 tablet) in the PM of Thursday 4/23/2020. This will continue on until Friday 5/1/2020. Then as of Friday 5/1/2020 it will decrease to just 1 tablet in the am a day until 5/8/2020. Then there will be another follow up call to discuss what the next step down will be. She said to call her if he seems to not take the med changes well.
Meds as of the night of 4/23/2020 through 4/30/2020: [pred taper begins, one pain med backed off] -500mg Methocarbamol: 1/2 tablet every 8 hours -5mg Prednisolone: 1 full tablet in the morning and 1/2 tablet at night (Was previously taking 1 Tablet every 12 hours) -10mg Famotidine: 1/2 tablet every 12 hours
-50mg Tramadol: 1 1/2 tablets every 8 hours (Edited by Dawn: 5/24/2020 typo said 1 every 8 hrs)
-100mg Gabapentin: 1 capsule every 8 hours -50mgs Trazadone: 1 pill once a day (pm)
[Moderator's Note. Please do not edit 19 lbs / 8.62 kg Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisone as of 4/7: in hosp ?mgs ?x/day for 1 day as of 4/8 taper dose: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro as of 4/10: 5mgs 2x/day for 7 days, then FRI 4/17 retest ✓4/11 pain/_ neuro as of 4/18: 5mgs 2x/day for▼ 5 days, then THURS 4/23 retest _pain/_ neuro methocarbamol 250mgs 3x/day tramadol 75mgs 3x/day gabapentin 100mgs 3x/day Trazodone 50 mgs 1x/day p.m. famotidine 5mgs 2x/day]
Meds as of 5/1/2020 through 5/8/2020: [continued pred taper, no changes to pain meds] -500mg Methocarbamol: 1/2 tablet every 8 hours -5mg Prednisolone: 1 full tablet in the morning -10mg Famotidine: 1/2 tablet every 12 hours -50mg Tramadol: 1 1/2 tablets every 8 hours (Edit 5/27/2020 Typo said 1 every 8 hours) -100mg Gabapentin: 1 capsule every 8 hours -50mgs Trazadone: 1 pill once a day (pm)
His condition has remained unchanged since my last post. Pain seems to be managed well and he is pretty comfortable over all. He is food and thirst crazy still (peeing constantly). I have noticed also some muscle weakness that I am thinking due to the Pred side effect, and not due to his injury. Ii will be able to tell more as we wean him off the Pred. And still has extreme anxiety between 5:30 pm and 8 pm every night. At 8 pm he gets his 8 hour meds and starts to ease down. After his 9 pm meds he is relaxed again.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 24, 2020 9:29:05 GMT -7
Dawn, the purpose for the prednisone taper test is to find out as soon as possible if all painful swelling is really gone. No one should want a dog on prednisone when there is nothing left for it to work on. Pred's job is to work on swelling/inflammation. Pred is an unusual med. It is a hormone similar to what the body produces but used at a higher dose level called "anti-inflammatory dose" when used with a disc episode. The body normally makes a far smaller dose that assists with running normal body function. In order to let the body know to again make its own hormone, there must be a tapering off of pred.... can't just abruptly stop giving prednisone.
The prednisone taper test really does not work when there are meds on board blind folding you and the vet about red flag signs of inflammation possibly still going on (pain signs).
At the begin of the pred test on Thurs 4/23, the only change to the pain meds is the tramadol. ---tramadol (general analgesic) was backed down to 50mgs 3x/day. -- Methocarbamol (muscle contraction pain) Still the same til 5/8 (15 days of blindfold!) ---gabapentin (nerve pain) Still the same til 5/8 (15 days of blindfold!) This doesn't give you a clear picture when monitoring for pain. If you would see pain, that is an indicator to get back up to the anti-inflammatory pred dose asap in an effort to protect the spinal cord. Some vets prefer to back off pain meds rather than a full stop of them. Normally each couple of days a reduction.
Prednisone does not aid the body in self healing of nerves. The body does that all by itself with time.
Prednisone when tapered is below the level that works on inflammation.
Tapers are needed to signal the body to begin making it's own hormone. It is also a perfect window for the vet and owner when the pain meds are stopped/backed off to assess whether another anti-inflammatory course or to continue on with signaling the body.
Can you share the reason behind not letting you monitor for pain and possibly, if proved with evidence of pain, getting back to the necessary anti-inflammatory level?
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Post by Dawn & Ollie on Apr 24, 2020 9:51:31 GMT -7
I asked about backing down on the other meds and she said she preferred to do the small pred adjustment and see what happens. I will call and discuss what you mentioned above. Thank you so much for all your help and insight!!!!
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Post by Dawn & Ollie on May 26, 2020 11:52:46 GMT -7
Hello, sorry it has been awhile since our last update. We have had a couple of emergencies that have kept us busy. I did ask the doctor about why only stepping down on just the prednisolone first and she said that stepping down first with the pred and see how he does. Then look at what the next step down should be. That way she can see clearly what med is having what effect. It actually worked and made complete sense when you see what happened during his second step down below. The first step down of the pred starting 4/23/2020 went well. He was taking 1 pred tablet (5mg) in the am an 1/2 tablet in the pm. This went on through 4/30/2020. Pain was still managed well and he was very comfortable. The second step down starting 5/1/2020 (1 pred tablet in the am only) started off fine. But by 5/3/2020 you could tell he was uncomfortable and holding his head very carefull y [during first attempt at taper] I made the decision to go back 1 step (which doctor said I could do based on how it went) and we went back starting ▲ 5/4/2020 to 1 full tablet in the am and 1/2 tablet in the pm. We continued this through 5/9/2020. On 5/9/2020 Vet telephone consult I told her that the second step down did not go well and she then said starting 5/10/2020 to give as follows: 1 tablet in the am/1/2 tablet in the pm for two days, on the third day give him only a tablet in the am. We did this schedule starting 5/10/2020 through 5/19/2020. So basically, 2 days then 1 day and so on. Then on 5/1/2020 we started with 1 tablet in the am. So far it is going wonderfully. Our next Vet consult to discuss the next steps will be on 5/29/2020. Nothing on his other meds has changed except for the ➖ Trasodone 50mg [stopped last night]. His anxiety and pain levels seemed to have dropped significantly, so this drug was really zoning him out. Last night 5/25/2020 I did not give him his nightly dose to see how well his anxiety would get. He was calm and alert and looked much better. So recap as of today he is on the following daily meds; 5mg Prednisolone - 1 tablet every 24 hrs (am) 500mg Methocarbamol - 1/2 tablet every 8 hours 10mg Famotidine - 1/2 tablet every 12 hours 50mg Tramadol - 1 1/2 table every 8 hours 100mg Gabapentin - 1 capsule every 8 hours 50mg Trasodone - 1 tablet as needed (currently have on hand but not giving) Again sorry for the delay in posting. I have another dog having difficulties with COPD and CHF. And then another dog that was just dx with adenocarcinoma, which we are just treating palliatively. All doxies ages 14 and over. Plus an elderly family member that is in rehab....its been quite a time in quarantine!!!!
Moderator's Note. Please do not edit 19 lbs / 8.62 kg Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisone as of 4/7: in hosp ?mgs ?x/day for 1 day as of 4/8 taper dose: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro as of 4/10: 5mgs 2x/day for 7 days, then FRI 4/17 retest ✓4/11 pain/_ neuro as of 4/18: 5mgs 2x/day for 5 days, then THURS 4/23 retest √5/3 pain/_ neuro as of 5/4: 5mg am 2.5pm for 2 days retest 5/6 methocarbamol 250mgs 3x/day tramadol 75mgs 3x/day gabapentin 100mgs 3x/day famotidine 5mgs 2x/day]
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Post by Romy & Frankie on May 26, 2020 13:13:42 GMT -7
Good news that Ollie is currently doing well on his taper. I hope that the spinal cord inflammation has now been fully addressed.
Since Ollie no longer regularly needs the trazodone to keep him calm you can use it only for situations where you expect him to get particularly anxious.
I am sorry that your other dog has been diagnosed with cancer and your relative needs rehab. IVDD and other sick family members in addition to quarantine is a lot to handle When I was listing the meds I noticed that you had tramadol as 1 1/2 (75mg) tablet every 8 hours. Has tramadol been increased since the 50mg on 4/23 or is it just a typo?
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Post by Dawn & Ollie on May 31, 2020 18:03:28 GMT -7
Hi Romy...The Tramadol was increased on 4/13/2020. See my post on 4/14/2020 where we also added the Trasodone. The post on 4/24/2020 is a typo. He is on 1 1/2 tablets every 8 hrs since 4/13/2020.
[tramadol 75mgs 3x/day]
Office follow up 5/31/2020. So Ollie has been feeling pretty good neck wise so I made the call for an actual office follow up. Thank goodness I did. As far as his neck the doctor says it is looking good. He showed no pain as far as his neck. Ollie has skipped breakfast the past couple of days. In fact, he seemed a bit off all week. I thought the step down to one pred a day was the issue. Plus they gave him his Methocarbamol for another vendor. The pill was bigger and it seemed like he didn’t take to the change well. It has been difficult to get him to take his meds all week. Upon his follow up today she noted abdomen pain on palpation. She took blood and his pancreas and liver values were extremely high. He is staying overnight at the Vet to treat for possible pancreatitis. At this time she says she is unsure what caused this. I had been trying all sorts of things to hide pills in...peanut butter, Cesar Wet dog food, Vienna sausages, anything to get him to take pills. She seems to think the GI upset was there prior to me trying things out for pills. Although that stuff may have exasperated the issues. Will see how he is tomorrow 6/1/2020.
He also received a cold laser therapy treatment on his neck today 5/31/2020. I am thinking about doing this 2 to 3 times a week. What are your thoughts on this? Also, there is a doctor that does acupuncture, I am considering this option also once he is more stable. The acupuncture is not at my regular Vet, it is at another Vet near me.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
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Post by Marjorie on Jun 1, 2020 4:48:19 GMT -7
I'm sorry to hear of this additional complication, Dawn. Prednisone is notorious for causing GI distress and one of the side effects of steroids (prednisone) can be pancreatitis! Sometimes Pepcid AC (Famotidine) isn't enough. When GI distress occurs with the use of a steroid such as Prednisone, it's time to also add Sucralfate. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/sucralfate.pmlPlease be sure to keep us up to date on any developments such as the fact that Ollie's appetite was off this past week as we can help with things like that and would have recommended Sucralfate right away. As for laser therapy and/or acupuncture, the risk of transport needs to be weighed against the benefits of treatment. In looking back through your posts, I didn't see any reference to nerve damage or difficulty walking. The only symptom that I could find was that there had been pain which is now under control. Is that correct? If so, then there would not appear to be any benefit to be obtained from these type of treatments and it would be best to keep Ollie safe in the crate. Healing prayers for Ollie.
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Post by Dawn & Ollie on Jun 1, 2020 15:44:09 GMT -7
6/1/2020. - Just got off the phone with the Vet. Ultrasound showed his gallbladder is 75% full of bile. This is what is causing his pain in his abdomen. He does also have pancreatitis, but it is secondary caused by the gallbladder issue. Oral meds cannot manage his pain at them moment, so they are keeping him overnight and treating the ailments, along with giving him injections for pain. She said they use light sedation for the ultrasound but he still showed discomfort during the procedure. But he is eating well and said his pain is being managed, along with his IVDD. I will know more tomorrow what is happening and when he can come home. A lot going on with my little guy all at once.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 1, 2020 18:05:56 GMT -7
Ollie is under good care...wonderful to hear pain is being managed. Hope soon pain meds can be transistioned to oral meds and Ollie can come home.
Thanks for the update.
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Post by Dawn & Ollie on Jun 3, 2020 11:06:49 GMT -7
Ollie came home last night (6/2/2020) with meds to not only treat his IVDD in the neck but also to treat the gallbladder and pancreatitis. He was fine when we left the Vet. When we go home he refused to eat. Within 2 hours he seemed very painful. I took him back to the Vet first thing this morning 6/3/2020. Vet was shocked at how painful he looked. He refused to eat his breakfast for me and would not let me give him his meds. She palpated his abdomen and no pain, pain was back in his neck again. She is keeping him overnight. She said is feeling much much better but was not taking his oral meds well. She wants to be sure he is comfortable and taking oral meds well before she sends him home.
It is very difficult treating multiple issues. So his Pred will increase once he gets home, she would like to give him 10mgs twice a day. This is for the IVDD and the Pancreatitis. As soon as I know exactly what his meds will be I will post them tomorrow.
Do I post all his meds including the others added for the gallbladder and pancreatitis? Everything just seems to morph into one thing, and I am really scared of loosing site of the IVDD with everything else going on. I am actually very thankful that I have this Forum to help keep me focused.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 3, 2020 11:50:30 GMT -7
Dawn, multiple issues do make it a challenge. Glad your vet is on top of making sure pain will be in control when Ollie is back home.
--Add all new meds --let us know which have had a change up or down in frequency OR --up or down in dose.
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Post by Dawn & Ollie on Jun 5, 2020 15:38:21 GMT -7
[6/5/20 9:30 EST update]
6/5/20 9:30 pm. Seems better tonight so far. He is due for his 8 hr meds at 11 pm. Fingers crossed all goes well tonight. =================== I have attached the hospital records for the time Ollie spent in the hospital (5/31/20 to 6/2/29) for Gallbladder/pancreatitis and then again on 6/3/20 - 6/4/20 for neck pain. We are feeling defeated. Once Ollie gets home his pain comes back. When he arrived home on 6/4/20 we were had the following Med schedule: Starting 6/4/20 PM: 100mg ✙ Amoxicillin - 1 tablet every 12 hrs 250mg Urosodiol - 1/2 tablet every 24 hrs 10mg Famotidine - 1/2 tablet every 12 hrs 100mg Gabapentin - 1 capsule every 8 hrs 50mg Tramodol - 1 1/2 tablets every 8 hrs 500mg Methocarbomol - 1/2 tablet every 8 hrs 250mg ✙ Metronidazole - 1/2 tablet every 24 hrs 50 mg ✙ Trasodone - 1 tablet once a day as needed then starting 6/5/20 adding the following: 5mg Predisolone - 2 tablets once a day in the am 60mg ✙ cerenia tablet once daily pm 2 hrs before meal I gave him his pm meds (only gave 1/2 dose of Trasodone) on 6/4/20 and all was going well. At about 10pm that night while on a potty break I noticed his back right leg nails would drag a couple of times and then saw him knuckle a couple times. He seemed in distress by 11:00 pm so I gave him the other half of his Trasodone dose along with 1/2 a tablet of Predisolone. That seemed to work and he slept peacefully throughout the night. This morning 6/5/20 we got up for breakfast and morning meds. While on potty break he knocked a couple more times, but onLy a couple of times and his back end is a bit weak. He slept most of the day and when awake seemed comfortable with no more knuckling. I spoke to the doctor to tell her about the new knuckling and she said he is at his max dose on meds and could not increase. That if he continues to get worse it might be time to have a discussion on what is best for Ollie. Again tonight he seems a bit painful and agitated. I called the Vet and asked if I could start splitting the Predisolone dose. 1 in the morning and 1 at night to see if that makes a difference. We will start splitting the Predisolone dose 6/6/20.He is 14 years old and with everything else going on with him, plus being it’s his neck Surgery just isn’t a viable option. We are keeping him on strict crate rest and keeping up on the meds and we will see where this goes. We haven’t given up, but we really feel upset. Moderator's Note. Please do not edit 19 lbs / 8.62 kg Galliprant stopped 4/5 Dex inj on 4/7 w/famotidine injections in hospital Prednisolone as of 4/7: in hosp ?mgs ?x/day for 1 day as of 4/8 taper dose: 2.5mgs 2x/day to test for ✓4/10 pain/_neuro as of 4/10: 5mgs 2x/day for 7 days, then FRI 4/17 retest ✓4/11 pain/_ neuro as of 4/18: 5mgs 2x/day for 5 days, then THURS 4/23 retest √5/3 pain/_ neuro as of 5/4: 5mg am 2.5pm for 2 days retest 5/6 as of 6/5: 5mg 2x/day for ? days then retest for _pain/_neuro methocarbamol 250mgs 3x/day tramadol 75mgs 3x/day gabapentin 100mgs 3x/day ✙Amoxicillin 100mgs 2x/day ✙Metronidazole 125mgs 1x/day ✙Cerenia 30mgs 1x/day ✙Trazodone 50mgs 1x/day famotidine 5mgs 2x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Jun 5, 2020 19:02:14 GMT -7
Dawn, hoping to hear Ollie continues to be better pain wise right up and through the next dosing time at 11pm. We've got out fingers crossed too!
What date will the pred begin to taper down?
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Post by Dawn & Ollie on Jun 5, 2020 19:11:21 GMT -7
We have no taper down plans at the moment. He has a follow up appointment for both gallbladder/pancreatitis and neck on Tuesday 6/9/2020. We do not have the option of a phone consult as they need a blood sample for his gallbladder/pancreatitis. We will see what happens then.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Jun 6, 2020 5:04:29 GMT -7
Dawn, is Ollie's pain fully under control now? I'm concerned about the vet mentioning "having a discussion" if he gets worse. Knuckling is a mild form of nerve damage. The concern about the new knuckling is that Ollie may have had too much movement with the trips to the vet or at the vet's office and/or the ultrasound and the damaged disc may have torn more, creating the additional pain and knuckling. If this is the case, then unfortunately the 8 weeks of strict crate rest should start over so the newly torn disc can heal properly. We have seen some members who make signs to put on the kennel when their IVDD dog is staying at the vet's office so that all members of the vets' office are aware of the strict limitations of movement that must be followed. That might be an idea if Ollie needs to stay at the vets' office again just to be sure that Ollie is carried in and out to potty with only a very, very few steps allowed at potty time. If appropriate with his other issues, the following pain med additions can be discussed if pain is not completely under control this morning: " Amantadine alone is not an effective analgesic but when combined with other pain relievers, it adds an extra dimension of pain relief." www.marvistavet.com/amantadine.pml-- Amantadine: When meds are properly used at the aggressive dose and 3x/day but pain is still not fully controlled, then bring to the discussion with your vet the addition of Amantadine for further control of that tough pain. Pain is a complicated issue. Often it will take 3 pains med for full control. Each pain med works on a different type of pain. Amantadine is something we are seeing neuros Rx as part of the pain med cocktail. The Mar Vista vets explain the mysteries of Amantadine marvistavet.com/amantadine.pml Basically when stressed as our dogs are with a disc episode they may be more susceptible to physical pain. Muscle spasms hurt worse, everything hurts more. Amantadine alone is not an effective analgesic but when combined with the other IVDD pain relievers (methocarbamol for muscle spasms, gabapentin for nerve pain and tramadol as the general analgesic), it adds an extra dimension of pain relief. At this time veterinary experience with Amantadine is rather limited but it seems to be emerging as helpful addition to pain relief regimens for our IVDD dogs. As always be fully knowledgeable about each med by reading the link provided above. It may take several days for Amantadine to become effective. Also a Fentanyl patch is something that could be discussed with the vet to help control pain. Fentanyl Patch "It is important to recognize that there is a delayed onset of effect when using the patches. In dogs it takes about 12 hours to achieve good pain relieving dosages and in cats it takes a minimum of five hours. The effective life of the patch is about 3 days in dogs and up to 5 days in cats. The pain relief from these patches is considered to be moderate, especially in dogs. For this reason it is often necessary to use them as a constant provider of pain control but to supplement them as necessary with a compatible narcotic or an NSAID." www.vetinfo.com/dpain.htmlAll is certainly not lost. Euthanasia is not a treatment for IVDD and there is no reason for its consideration should Ollie's neuro functions worsen so please get that out of your mind. Also we have seen many dogs that have needed an additional 8 weeks of strict crate rest due to a relapse who have recovered. Stay strong, stay positive and never give up hope! Healing prayers for Ollie.
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Post by Dawn & Ollie on Jun 6, 2020 21:48:53 GMT -7
Ollie is doing much better tonight. The Vet did mention that the car ride may be a factor in his pain increase. Anytime he is at the Vet they carry him everywhere and keep him crated. And yes we have started back to the beginning with crate rest. I saw hime knuckle only once earlier today (6/6/20). We have the appointment on 6/9/20 and I am going to ask if I can give him a good dose of Trasodone before the appointment. Try to get him relaxed and not stress him out.
My Vet and I both have agreed that surgery is not a good option. We are also In agreement Regarding crate rest and meds. She is very willing to keep up the crate rest and meds, but we have a very open relationship, and she just wanted to be sure we were on the same page. It was just discouraging to see such a huge back step. Thank you for keeping us focused. The only time we would think of euthanasia is if his pain cannot be controlled. We do not want him to suffer. She gave me some wonderful pill paste to help get his pills down him. He loves it and pill time is no longer an issue.
I will speak to my Vet again regarding the Amantadine. I will also ask about the Fentanyl patch.
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