Janice's Annibell relaps? 6/29 Conserv. GRAD 8/24

Welcome to Dodgerslist, Janice. We are so glad you’ve joined us all. We’ve got valuable information we’ve gleaned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you.
www.dodgerslist.com/literature/CrateRRP.htm
All anti-inflammatories cause excess stomach acid which can lead to stomach damage. To minimize the chances of this damage a stomach protector like Pepcid AC should be added to the medications. Ask your vet if Annibell 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).
www.1800petmeds.com/Famotidine-prod11171.html
www.dodgerslist.com/literature/uti.htm
and here:

--make notes/highlight to keep yourself on track

Janice, just so you know euthanasia for a disc episode is not a treatment!

For how many days is the Rimadyl for?
Is all pain fully in control round the clock with pain meds at twice a day doses?  If not advocate for for 3x/day dose.  Did you contact the vet, what adjustment to the pain meds were made?

Is there a health reason Pepcid AC (Famotidine) is not on board with the Rimadyl as Romy explained?

Asking how long to take the NSAID Rimady is an excellent question. Understanding the treatment means you can better monitor and ask questions.  Really short answer at the test stop of Rimady

Janice,  a 14-day course of rimadyl is pretty typical and safe handling of that med.  It is the stop  on May 14 that proves if another course is needed or not.  I do not know what's the purpose for obtaining another month of meds would be when there has not been a Rimadyl test stop on 5/14 along with the full stop of the pain meds or backing them off to know where swelling stands.  Good reading or re-reading to "get" how anti-inflammatories.  There is a lot of new stuff  that can be overwhelming to obsorbe in one read:http://www.dodgerslist.com/literature/healingsweling.htm

Keeping her comfortable is a matter if the pain meds are right. If she has pain, then the vet needs your feedback to adjust meds.
-- adovcate for 3x/day for methocarbamol and gabapentin. 2x/day is not likely in many cases to control pain 24hrs a day.
--Advocate  for tramadol every 8 hrs.

You had written about trembling, yelping with lifted. What did the vet do to change the meds? Is that pain now fully manage dose,  to right up to the next dose now?

Good job on getting the Pepcid AC on board!

The single most important care you can give is the 100% STRICT crate rest 24/7 only out of the recovery suite for a very, very few footsteps at potty time. Just as  Romy above outlined how to approach the crate rest part with good specifics to guide you.

Janice, the disc takes 8 weeks to heal. That is the reason for 8 weeks of 100% STRICT crate rest 24/7 only out for a very, very few footsteps at potty time. 12 weeks of rest is not a good idea unless there is an usual reason such as too much movement and the disc relapsed (early dealign scar tissue re-tore). Then the previous weeks would be negated to start at square one in the count for the disc to heal again.

MEDS are only used when there is something to work on. Painful inflammation needs an anti-inflammatory drug. Comfort from pain needs pain meds. When the stop test of Rimadyl proves no inflammation exists, then no meds of any kind are needed. 

WHEN ARE PAIN MEDS BACKED OFF or FULL STOPPED during a disc episode?
Assume a painful disease is, indeed, painful!  So pain meds are used right up to the Rimadyl test stop on 5/14. THEN, they are either backed off or full stopped. To go up and down now with pain meds prior to the test stop is not fair to Annibell!  If the vet feels he wants to change his guess about a 14-day course of Rimadyl, then the test stop could be at say a 5-7 day mark (5-7 day course) to see if all pain is really gone. No one wants any animal taking Rimadyl one bit past the point when all inflammation is gone. Rimadyl has some serious side effects.   Again, I encourage your reading so you have the ability to discuss concerns with the vet, ask good questions, etc.  www.dodgerslist.com/literature/healingsweling.htm

Why going up and down with pain meds is not a good idea during a painful disc episode. Stopping of pain meds waits til the Rimadyl test stop for pain.

So this is where Dodgerslist comes from here on the Forum about pain...we side with the World Small Animal Veterinary Association (WSAVA) guidelines : "We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt."  

What other professionals to say about assuming a painful disease IS painful and not withholding pain meds, reducing mgs or frequency during the disc episode,  stopping and starting them in days.  



FILL US IN ON MED LIST
We are really afraid do assume anything about med prescriptions. Getting accurate information means we are at the ready should you mention a problem to provide you with an accurate comment. We are really in the dark as to what the exact changes to the meds were made. Would you cite the date of the changes, the name of the med plus mgs and times per day. 

What changes did the vet make AND on what date?
-- methocarbamol in mgs and how often to give
-- gabapentin what mL dose do you give now?  how many times a day?
-- minocycline  how many mgs each dose?  how many times a day?

Let us know if your advocacy on behalf of Annibell was successful in continuing pain meds til there is a planned stop of Rimadyl to test for pain.

Is her pain now fully masked with the adjustments the vet made to her meds?

Is the addition of the 3rd dose of gabapentin keeping Annibell pain free?

Pain indicates that there is still swelling pressing on the nerves of the spine and still a need for all meds at their original dosages. It usually takes 7-30 days for the swelling to resolve; however, sometimes it can take longer.

Please fill us in more on what's been happening with the meds since you were last on the forum.
Originally you had told us that the Rimadyl would be stopped on 5/14. Was a test stop of all meds ever done before 5/27? Did pain arise at that test stop and therefore meds were resumed and again stopped on 5/27?

Has strict crate rest continued since you were last on the forum? Has there been any time when Annibell could have had too much movement of the spine which could have caused more tearing of the not-yet-healed disc, thereby causing the pain?

Thanks for the feedback! The doctor said to continue meds for another two weeks and then we will test again and go from there.

[Moderator's note: please do not modify
13lbs
Rimadyl as of 4/30: 12.5mg 2x/day for 30 days, then 5/27 test stop for √5/31_pain/_neuro
                 as of 5/31: 12.5 mgs 2x/day for 16 days,  6/16 retest stop for _pain/_ neuro
Methocarbamol 125mg 2x/day 
 gabapentin 100mg/mL: 75mg 3x/day 
Minocycline. ?mg ?x/day UTI Prophylactic
Pepcid AC® (famotidine) 5mgs 2x/day]

I am having a hard time expelling her bladder the past week and my guess is that it's from the lack of movement in her hind legs (due to the crate rest). I fear she will have a UTI breakout if I cannot expel her every 4-6 hours. Do you have any recommendations to help with this? She currently hasn't expelled urine in almost 10 hours today despite my many efforts.

Hello,

Thanks for the continued support. I wanted to reach out and get your opinion on long term antinflammatory use. My girl was weened off the medication two weeks ago [6/17] and yesterday the  [6/30] flare up returned. She was on strict crate rest the whole time.

This flare up occurred overnight while she was sleeping. The doctor suggested long term use of Rimadyl and the Gabapentin for management.

Have you seen this medication used in this way or are their other alternatives you suggest? He's suggesting them at the doses noted above. Thank you!

[Moderator's note: please do not modify
13lbs
Rimadyl as of 4/30: 12.5mg 2x/day for 30 days, then 5/27 test stop for √5/31 pain/_neuro
                    as of 5/31: 12.5 mgs 2x/day for 16 days, 6/16 test stop for  √6/29  pain/_0 neuro
                     as of 6/29 for new disc episode: 12.5 mgs 2x/day for 30 days, 7/29 test stop for _pain/_neuro
Methocarbamol 125mg 2x/day 
gabapentin 100mg/mL: 75mg 3x/day
Minocycline. ?mg ?x/day UTI Prophylactic
Pepcid AC® (famotidine) 5mgs 2x/day]

Thanks for the quick response! In regards to the flare up, her neuro function has not declined any further. She also is holding her head up okay. Seeing as this occurred shortly after pooping, I do think this one, whether new or recurring is near the back of her spine, where her other injury had been.

The doctor wants to see her in a month if it heals and sooner if any function declines. For now he just renewed the medication the same [?] as before.

[Moderator's note: please do not modify
13lbs   12 years old   Grad on  June 25,   New episode grad date August
Rimadyl as of 4/30: 12.5mg 2x/day for 30 days, then 5/27 test stop for √5/31 pain/_neuro
                ➖Off all meds 5/27 (Rimadyl and pain meds) Pain returned 5/31➖
                   as of 5/31: 12.5 mgs 2x/day for 16 days, 6/16 test stop for √6/29 pain/_ neuro

                                        ➖Off all meds 6/16 (Rimadyl and pain meds) ➖

                    ➖ GRAD day 6/25: slowly introducing walking; Pain returned 6/30➖

                   as of 6/29 : 12.5 mgs 2x/day for 30 days, 7/29 test stop :_pain/_neuro
Methocarbamol 125mg 2x/day 
gabapentin 100mg/mL: 75mg 3x/day
Pepcid AC® (famotidine) 5mgs 2x/day]

I was just concerned when he mentioned about Rimadyl long term because I know that can affect their stomach. Is her current dosage too strong for long term? I know you mentioned you have heard of long term low dose antinflammatories as a treatment method.

Thank you!

Just a reminder to be sure to also resume giving Pepcid AC 5mg 2x/day for as long as Annibell is on any dosage of Rimadyl.

It's good that the dosage of the Rimadyl is the same as before as this does sound like a new disc injury and with a new disc injury and new swelling, the anti-inflammatory dosage is needed now to get that swelling down. You only mentioned Rimadyl and Gabapentin so now that the Methocarbamol has been dropped, please do let us know, as Romy asked, if Annibell's pain is completely under control. If not, then do speak to the vet about adding back the Methocarbamol, too.

And please continue with another 8 weeks of strict crate rest to heal any newly damaged disc. I've added the new date to the subject line of this thread.

June 25th was supposed to be graduation day from the start of crate rest on April 30.

Had she still been on STRICT crate rest during those two weeks 6/16-6/30? 
--- If she had not been on strict rest, what was she allowed to do on graduation day of June 25?

All anti-inflammatory drugs have the same side effects as you read each of the brand name drugs at the FDA website:   animaldrugsatfda.fda.gov/adafda/views/#/nsaidLabels  

 Galliprant® (Grapiprant) so states in the package insert www.elancolabels.com/us/galliprant-with-tear-off
 that is was very specifically designed and targeted for arthritis pain. Dodgerslist was in attendance at a pain seminar. The manufacturer's representative said Galliprant should not be used for IVDD. There have been no studies nor research with Galliprant® use in IVDD. Rimadyl (carprofen), Metacam (meloxidyl) and other canine NSAIDS are more of a "broad spectrum" anti-inflammatory that CAN target inflammation of IVDD.

Jance, could it be Annibell overdid re-introduction back to walking a little too much for her?

Maybe also she was more active in her recovery suite leading up when you picked her up and yelped on 6/29?

Maybe she does not need Rimadyl and pain meds every day for 30 days, if it were to be muscle soreness that was going on.

Maybe you could monitor her in her safe in her recovery suite and see if w/o meds she is not tender, not yelping if picked up? I know the first reaction is always to think it is a new disc episode going on. What are your thoughts on this idea to monitor w/o meds in the recovery suite? Meds can always be resumed immediately upon proof it is not muscle soreness but pain from a new disc episode.

Hi Janice

That is very kind of you, thank you.

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kind regards

Mary