Jeanette's Brinkley 5/7 conserv.NECK— Staffie- UK; GRAD 7/2

Good to hear that pain meds have been adjusted and I do hope that Brinkley's pain is now completely under control. Neck injuries can be so painful so please do let the vet know if you still see any sign of pain so the meds can be adjusted again.   Pain should be completely under control within one hour of giving new course of meds and should remain completely under control from one dose of meds to the next.  Tramadol and Gabapentin work best when given three times a day as Paula mentioned. Neck injuries often cause muscle spasms and Methocarbamol is the pain med for that. Brinkley should be able to eat moistened kibble without it causing pain. Pain hinders healing so have no patience with it.  Paula gave more detailed info on pain meds so please review that, too, when speaking to the vet.

On what date is the vet starting to taper the Prednidale? If there is still any sign of pain at all, that means there is still swelling pressing on the nerves of the spine and it is NOT time to taper the Prednidale. Pain = swelling = more time on the original dosages of all meds. More info on the anti-inflammatory phase of IVDD:
www.dodgerslist.com/literature/healingsweling.htm

It's really very important to get a stomach protector on board with the Prednidale.  There can be such serious side effects that can worsen quickly so we follow vets who are proactive and prevent GI tract issues before they happen rather than try to heal them after they happen.    Please speak to the vet today about getting Famotidine on board ASAP.

Good to hear that you're moistening his kibble.  Be sure to moisten each kibble meal with equal parts water and kibble. Store in the fridge overnight to soften and rehydrate. Before serving, warm slightly in microwave, just to take the chill off. This should eliminate pain from crunching kibble. If there is still pain when eating softened kibble, then pain meds need to be adjusted.

More tips, such as no chew toys or Kongs, raising food/water dishes to head height, etc. here:
www.dodgerslist.com/literature/cervical.htm

Please keep us updated on Brinkley's status and please confirm that he is now pain free. Healing prayers for Brinkley.

Reluctance to move is a sign of pain so please speak to the vet ASAP about the pain meds. As mentioned, both Gabapentin and Tramadol work best when given three times a day. Methocarbamol should be added to work on the pain of muscle spasms. With neck injuries, all three meds are usually needed to get pain under control. There should be no sign of pain from one dose of pain meds to the next.

Please keep in mind that strict crate rest was only started on May 13. Any time prior to that just can't be counted. Being allowed to move around would have been counter productive to the work that Prednidale had to do.

How are you doing getting Brinkley out to potty? Too many steps at potty time can prevent the damaged disc from healing or can cause more damage, more tearing of the disc. Normally with a dog that is of a weight that can be carried, we would tell you to carry him in and out to potty. Do you have his recovery suite close to a door so he can just walk a very few steps out to potty? It would be best if you could train Brinkley to go on a pee pad placed right outside of his recovery suite. Lay down a pee pad WITH the addition of urine or urine-scented dirt from another dog or from Brinkley on top. Always save a used piece of pee pad in a ziplock bag to use at potty time. Brinkley can learn it is ok with you to pee on the pee pad, be sure to use the command go potty and when he does give lavish praise.

Buckling of the front legs is from nerve damage.  Nerves can take a very long time to heal, think more in terms of months, even a year or more. But they can heal with the right treatment.

Please let us know what the vet says after speaking to them about the sign of pain that you're seeing and what adjustments to meds are made.

Jeanette, please speak to the vet ASAP this morning about adding BOTH Sucralfate (Carafate) and Pepcid AC (Famotidine) for the red flag signs of GI distress that Brinkley is showing. I'm not familiar with Zitac but I do know that Sucralfate and Pepcid AC work well. Pepcid AC suppresses the excess acid that Prednidale causes and Sucralfate offers a healing environment and bandaids the damaged area. If the vet feels that Zitac is a good stomach protector, please advocate strongly that he also prescribe Sucralfate (Carafate).

Please, please put euthanasia out of your mind. Brinkley is in the very early days of his healing. Nerves can take a long time to heal but they can heal. GI distress can certainly heal with the right meds on board. Please give him the chance to get better.

Gabapentin can cause drowsiness. If you feel that Brinkley is too lethargic, do speak to the vet so his meds can be adjusted. However, do keep in mind that sleeping and resting is what Brinkley needs right now. Some dogs get very distressed during crate rest and try to move too much and need to be sedated so it's a good thing that Brinkley can rest and heal. Did Brinkley's ability to stand and walk worsen when the Gabapentin was moved to 2x/day? Sometimes it can be a fine line getting the correct meds on board that will mask all pain but not cause too much lethargy. The vet may be able to decrease the dosage of Gabapentin with the addition of Methocarbamol.

We have the date of 5/13 as the date that strict crate rest was started but you mentioned that Brinkley has been on strict crate rest for 2.5 weeks. What date did strict crate rest start on?

Hang in there, stay strong. Healing prayers for Brinkley and for strength for you.

Thank you so very much for your replies.  Today has been a very rough day, we love our boy so much it hurts to see him like this.

I will try to answer your questions to give you a clearer picture of where we are.

The prednidale - today is the 4 week of Brinkley being on 12.5mg twice a day with no tapering yet.  After speaking to the vet today he said he might start to taper on Friday but didn’t say what the new dosage would be. So he has been on the same dosage since 20th April with no taper.

I will ask the vet for SUCRALFATE tomorrow, but I suspect I won’t get very far, I did ask him today, but he said to see how Brinkley gets on with the Zitac first and then he will review.  He is a nice guy but I fear is knowledge is minimal in this area and he is reading up on what we are asking him before he will commit.  I won’t give up though.

The crate rest - although we did limit his activity when he showed first symptoms we fully committed to the recovery suite on 7th May, do I count that as day 1?

Methocarbamol - also have asked the vet for this but again he wants to see if Brinkley responds well to the Gabapentin and Tramadol.

Brinkley has picked up this afternoon 5/7, back to pain free with no discomfort, went out side to relieve himself and stood the whole time with no help, although he was wearing his sling and was carry to and from the toilet area. 

Big thank you you from us for ALL your support both with the meds advice and emotional, it means so much to us that there are people out there who understand.  I will read up on all the information you have been so kind to share with me and update you on Brinkley as much as possible.

Thanks again, Jeanette, Dan, Brinkley and his best pal Dakota.

20th May

What a roller coaster couple of days we have had with Brinkley.

After a bad morning on the 18th with stomach pain, Brinkley settled down and was pain free, resting really well, going to the bathroom and we seemed to be making progress and felt optimistic for the first time in weeks.  Then last night we feed him his kibble (soaked with water) ready for his tablets at 9 and within 15 mins we had signs of stomach distress again.  He try’s to yawn but it’s not a yawn, don’t know how to describe it, then it looks like he has got acid reflux.

I should say at this point that Brinkley was born with stomach issues, he has been on a soya based diet since a puppy, he can only eat bland food, he hasn’t ate normal dog food or any meat for years as it gives him chronic stomach pain.

This lasted for hours, we could get anything down him but water, he was unable to stand, so we couldn’t get him to potty either which normally helps.  He finally fell asleep around 11pm, woke again in less pain around 1am tried to get him to take a tramadol but he wasn’t having any of it.  Woke this morning at 5am in no pain and had a very wobbly wee then straight back to his bed and sleep.

Going to call the vet again this morning, I just hope we are reading the signs right and it is his stomach, he showed no signs of shaking, was licking his lips [nausea] and his stomach was pulsing and bloated and very hard so I am pretty confident it is GI distress.

Just got off the phone with the vet, and you are right he wants us to start to taper the ▼Pred to 12.5 once a day, from today [5/20],

[Moderator's Note. Please do not edit
23kg/50.71 lbs
born with stomach issues
true crate rest started 5/7 (work of previous doses of pred as of 4/20 negated!)
Prednidale as of 5/7: 12.5mgs 2x/day for 13 days, then 5/20 test taper for: _pain/ _neuro
gabapentin 400 mgs 2x/day
tramadol 800mg tab: 400mg 2x/day
Zitac (cimetidine) as of 5/16: 200mg 3x/day]

but he would not prescribe the sucralfate or anything else for his stomach, no idea why ? I really pushed him on the meds but he wants to keep him on the Zitac for 3 more weeks at least, I asked what that would do, the reply was heel the stomach so let’s just stick to the one thing.

Brinkley is doing much better so far today, and he keeps trying to do little stretches whilst lying on his side, I hope that’s a good sign. He is moving around on his bed to get in a comfortable position but finds going from lying to standing very difficult so we always help him, he only stands when he wants the bathroom and his very wobbly walk hasn’t changed, but baby steps.

I did ask the vet about the pain meds, vet asked if Brinkley is walking freely most the day?!  I explained that Brinkley can hardly stand most the time and he is in a pen to heal, the vet seemed shocked to hear this and said to continue both twice a day, I explained that if he takes both the Gabapentin and tralieve [?] he is asleep 23 hrs a day and very drunk, so he said to try the steroid in the morning and the Gabapentin twice a day. 

What would you recommend?

It is 4.30pm here at the moment and Brinkley has been able to walk to go to the bathroom 5 times and he has been awake since 7am, just tried to take him out but he is very weak and unable to walk but can stand. He is asleep at the moment and doesn’t seem to be in any pain, his only medication today has been :-

8am & 3.30pm - zitac 
9am - prednidale 

as as we are trying to test for pain.

Another awful 24hrs for Brinkley.  Started tapering steroid [5/20] yesterday and ▼pain killers [mg?/frequency?] to see the true picture.  All was well until later afternoon when he stopped moving around in his pen and couldn’t weight bear.  Around 7.30pm he started showing signs of pain, licking lips [nausea] and a bit of panting but no body shaking, we gave him Gabapentin but this didn’t stop the systems.  No sleep, no movement only lip licking with intermittent panting all night, tramodol at 2am, no change to symptoms.

[Moderator's Note. Please do not edit
23kg/50.71 lbs
born with stomach issues
true crate rest started 5/7 (work of previous doses of pred as of 4/20 negated!)
Prednidale as of 5/7: 12.5mgs 2x/day for 13 days, then 5/20 test taper for: _pain/ _neuro
gabapentin   400 mgs 2x/day
tramadol 80mg tab:  40mg 2x/day
Zitac (cimetidine) as of 5/16: 200mg 3x/day]

We knew he wanted a pee but no matter how many times we carried him outside he couldn’t stand at all so he wouldn’t go, watched so many videos on expressing him but we couldn’t get anything out.  Gave him his Pred 12.5mg (only dose for today) at 6.30 And Gabapentin at 7.30am still no change.

Finally at 8.30 using a front sling, he went to the toilet with chronic diarrhoea. He had been holding his pee for nearly 17 hrs which is not good. His pain symptoms stopped immediately?  He has been in and out all day so far to go bathroom every hour but settles down straight to sleep when he is back in his pen, with no pain symptoms, he has panted when trying to potty but that’s understandable, its hot here today and his little body is worn out.

We don’t ,t know if the pain is from his back or his stomach, phoned vet who said feed light food, and carry on with taper. Virtually no sleep for any of us for 24 hrs, this is so hard on your emotions seeing him in pain for so long. Struggling!

Diarrhoea 

Today was the first sign of diarrhoea, no sign of blood in it.  He has been for 2 very very watery diarrhoea’s this morning, and when he has a pee a little diarrhoea runs out of his bum.

The pains meds are 
Gabapentin 400mg every 12 hours
tramadol 80mg 1/2 tablet when needed no more than once every 12 hours

The vet said to continue to use the painkillers as we taper the steroids if we need to.  Unfortunately our vet tells us, we don’t seem to have discussions on his treatment,.

He hates the tramadol, no matter what we put it in he always manages to split it our, usually only manage to get a 1/4 into him.  Any suggestions greatly received on how to get him to take tablets.  He is a staffy with very strong jaws and very stubborn.

We are trying to give him as much water as possible but once he hasn’t been for a pee for a few hours we try to limit it

Thanks for your last reply, the vet [on 5/21??] has changed Brinkley’s pain relief to

Tralieve 80mg (tramadol hydrochloride) only if required 1/2 every 12 hours
Gabapentin 400mg only if required 1 every 12 hours
Zitac 200mg 3 times a day
Prednidale 12.5mg a day on taper day 3 of 7

[Moderator's Note. Please do not edit
23kg/50.71 lbs
born with stomach issues
true crate rest started 5/7 (work of previous doses of pred as of 4/20 negated!)
Prednidale as of 5/7: 12.5mgs 2x/day for 13 days, then 5/20 test taper for: _pain/ _neuro
gabapentin 400 mgs 2x/day
Tralieve® (tramadol hydrochloride) 80mg tab: 40mgs 2x/day 
Zitac (cimetidine) as of 5/16: 200mg 3x/day]


We have had several consultations with the vet over the past 2 days to confirm the dosage but they insist this is correct, also it was a final no to the pepcid ac, he says that the zitac will protect and repair Brinkley’s stomach so, I’m at a dead end there. The vet said to continue very limited activity and doesn’t seem concerned with lack of mobility.

In the past 48hrs brinkley has only had 1 ▼Gabapentin so his pain meds are reducing but so is his ▼mobility.

After taking his one dose of steroid 7 hours later he becomes very stiff and reluctant to move, will not got to the bathroom no matter how hard we try, so last night he held himself for 15 hours.

He will only go when he can walk by himself to his potty area. This is becoming very frustrating, he doesn’t seem to display any pain symptoms, he sleeps comfortably, but will not stand up, and only adjusts his position very infrequently. We have tried using the front sling but he steers us back towards the door to get back to his bed. We have tried to be persistent but it’s a double edged sword because how long do you make him walk around his potty area when your trying to keep his movements limited and its keeps exhausting him.

Jeanette, would be best if you no longer say he is not displaying pain signs. With the vet, with us tell us what you observe.  The fact is that Brinkley IS displaying signs of pain when we read what you observe.  Maybe the vet gets the wrong sense of things if you mention not in pain?

Here is the answer the test taper of Prednidale is giving you:

Brinkley IS in pain! (reluctant to move to potty, reducing his mobility to avoidmoving, stiff) Prednidale at taper doses is no longer working on swelling and the reduction in pain meds is allowing pain to peak thru. 

Pain is an indicator to resume the anti inflammatory level of pred 12.5mgs 2x/day.

His first course was for 13 days. It can take pred up to 30 days (excluding any taper days) to rid the body of all swelling. I know this is tough to work with this vet. See how you can best advocate for Brinkley. 
-- Discuss  the signs of pain you observe and when that pain happens so the vet can diagnose for himself that Brinkley IS in pain on the test taper.  
    » Correlate for the vet the detail of time of last dose  and what time you observe things.  
    »  Same as we want here on the Forum.  Are you oberving signs before the next dose?
    »  A 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

-- Discuss another course maybe a short one of Pred 12.5mgs 2x/day for 5-7 days to try and get all the swelling down.
--  RULE OF THUMB
     pain = swelling = back up at anti-inflammatory pred dose, all pain meds back on board and to original dose/frequency to mask pain fully PLUS  Zitac, of course.

What are the possibilities to get a consultation with a Neuro surgeon (not for surgery) to get Brinkley on the right meds if this vet is not helping Brinkley get out of pain?

Zitac is a stomach protector. It is the older generation one. Pepcid is the newer, more powerful stomach protector. So far with no vomiting, no loose stools, then Zitac may be good enough.

TRAMADOL IS VERY bitter even if in a chew with flavor.  Brinkley can detect it.  You will have to re-teach Brinkley to trust you and the Tralieve.  Start the retraining by giving him some small pill treat look alike balls during the day with no pill inside.  When he begins to trust that treat ball and scoffs it up, then try that very same treat with his pill inside.

Make sure you wash your hands thoroughly of any tramadol particles so you do not transfer those particle to the outside of the real tramadol pill treat.

Put the pill into the well of a small mashed banana ball, a cream cheese ball, liverwurst ball, Gerber Lil' meat sticks, or inside of a sticky small marshmallow and sealed completely so no taste escapes to the exterior. For extra yumminess wrap outside of ball with thin slice of deli meat.
   At pilling time use the three treat method.
   
   Prepare 2 treats with no meds inside PLUS the med ball.
 
    Give plain treat #1 while holding med ball #2 in front of eyes. The idea is your Brinkley will be greedy after the first treat to get the 2nd.
    Immediately hold the 3rd plain treat so he will hurry to swallow the med ball to get to treat #3.   Let us know how Brinkley does with that.

Brinkley continues on with the Prednidale tapering. The taper is a test for pain and for any worsening neuro function.

What are the possibilities to get a consultation with a Neuro surgeon, not for surgery, but to get Brinkley on the right meds since this vet is not helping Brinkley get out of pain the pain of barely being able to lift his head. Neck discs just are a more painful thing. And because of the head needing to move when the body moves generally, it can take a longer number of days then the 13-day Pred course he had on 5/7. It may take up 30 days on Pred. Taper days are not effectively doing much to control the swelling. Brinkley ought to be in comfort round the clock not just a minimal 6 hours a day.

This vet is not comfortable in his knowledge of IVDD.

I agree with Paula that your vet is not comfortable treating IVDD. The way we know this is that the vet is not prescribing the appropriate medications to keep Brinkley out of pain. He should not be in pain. Vets have many, many ways to address pain. When pain is under control Brinkley will be able to heal in comfort.

If it is not possible to get an appointment with a neuro specialist, consider another regular vet. A regular vet who is willing to prescribe the medications that will keep Brinkley out of pain would be a way forward. We have some info on what to look for in an IVDD vet. Some of the material is specific to the US but the column on the right is relevant to dogs everywhere.
www.dodgerslist.com/literature/VetchkList.htm