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Post by Connie & Winter on May 25, 2020 10:59:48 GMT -7
My dog, Winter, is currently on a fentanyl drip at an emergency clinic, has been there overnight and is prepping to transfer to a patch so she can come home.
She is a coton de tulear. She weighs 12 lbs. and is 5 years old and started having pain in her lower back 6 days ago 5/19, gradually getting worse to where she did not want to move at all.
She has been on pain meds. and anti inflammatory meds for 4 days [as of 5/12?] but the pain did not lessen so I had to take her in to the emergency clinic.
She has not lost the use of her legs or bowels, just is in a lot of pain. Now, I assume I need to make the decision to take a conservative approach to her treatment or surgery. Would appreciate any advice on this subject as my finances are going to play a big part in the decision making, unfortunately.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 25, 2020 13:57:10 GMT -7
Connie, welcome to the Forum. We have lots of good information to share with you. Getting the full story from with all the details makes it possible to get the proper information to you. Please use exact dates when posting about things. What state are you in.... surgery costs varies greatly among states/high density cities, etc is why we ask. Date she started STRICT very limited movement of be inside of a recovery suite (ex-pen, pack N Play or wire crate)?
Did her STRICT rest include all of these? - no laps - no couches - no baths - no sleeping with you - no chiro therapy - meandering at potty times. Carried her to and from the recovery suite to the potty place and then allowed a very, very few limited footsteps? HINT: A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! **  Date she started pain meds at home? Name of each pain med with mgs dose and frequency given?
Name of the anti inflammatory drug started on what date? dose in mgs? ? times per day. Date any reduction or stop if it started?
Name of the acid suppressor used during the time of the anti inflammatory drug usage (including at the overnight clinic)?
What meds are being given at the Clinic? What date did she go to clinic?
Do read up on the two different treatments to help you discuss things with the vet and to question things you don't understand. Very good page to start your homework: Surgery. Let us know your city. You local vet can refer you to a neuro or ortho surgeon. www.dodgerslist.com/literature/healingsurgery.htmA good recovery suite is essential for healing and helping you care for Winter. Check out our supplies list and tips here: www.dodgerslist.com/literature/cratesupplies.htmAnticipating learning more about Winter with your answers so we know best how to help you. |
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Post by Connie & Winter on May 26, 2020 13:44:45 GMT -7
Hi,
They did x-rays at the emergency clinic that she was just released from cannot tell you what they showed if anything. They started her on prednisone 1/2 tab. every 12 hours to be reduced to every 24 hours in two days.
she's taking gabapentin capsules 100mg. 1 every 8 hrs.
and methocarbamol tablets 1/4 every 8 hours
and she is on a fentanyl patch which needs to be removed or replaced tomorrow morning
She seems to rest comfortably and has no desire to move about until about 1-2 hours before it's time for her next dose of gabapentin and then she is in visible pain again.
[Moderator's Note. Please do not edit
Prednisone 5/26: a taper dose! 2.5mg 2x/day , further tapering on 5/28 √ 5/25 pain/_neuro
gabapentin 100 mgs 3x/day
methocarbamol 125mgs 3x/day
Fentanyl patch expires 5/27
needs GI tract protector, Pepcid AC, on board w/PREDNIOSONE! ]
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Post by Romy & Frankie on May 26, 2020 14:17:16 GMT -7
If Winter is showing pain before her next dose of meds her pain meds are not yet right. Please let the vet know that you are seeing pain before the next dose of pain meds are due and ask that the pain meds be adjusted. When pain meds are right there shoauld be no pain between doses. Winter should not be in pain. Since she is currently still showing some signs of pain, consider asking that the fentanyl patch be replaced with another patch or ask about adding tramadol to her medications. Tramadol is a general pain reliever which we have seen work very well with gabapentin.
How much does Winter weigh? Could you let us know the number of mgs in each full tablet of pred and methocarbamol. These two things will help us understand Winter's situation better.
Is Winter currently on Strict crate rest? This is what will allow the disc to heal. The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. www.dodgerslist.com/literature/CrateRRP.htmSTRICT means:
◼︎no laps
◼︎no couches
◼︎no baths
◼︎no sleeping with you
◼︎no dragging or meandering at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎At home laser or acupuncture for severe neuro damage is best. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with little to mild neuro diminishment. Winter should be carried to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to a minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!
Since Winter is on pred she will need a stomach protector. All anti-inflammatories like pred cause excess stomach acid which can cause stomach damage. A stomach protector like Pepcid AC can protect against possible damage. Ask the vet if Winter 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)
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.html
Is she eating and drinking OK? No nausea/not eating, no vomit? —Poops OK?
Knowledge is the power to fight the IVDD enemy and win!! The very best thing you can do for YOU, the caregiver, and for your dog is to get up to speed on IVDD soonest possible. Begin absorbing the must-have overall sense of meds, care and how the treatment works. Your dog will be depending on your ability to learn - excellent video series here: www.dodgerslist.com/literature/theater.htm PRINT OUT this link and tape to your fridge: www.dodgerslist.com/literature/healingpage.htm --use the printout as your roadmap to avoid dangerous detours in your dog’s care --make notes/highlight to keep yourself on track --follow all the links in the next days to become the IVDD savvy pet parent your dog needs.
--Use the “search box” to easily locate topics over at our Main website: |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 26, 2020 15:09:16 GMT -7
Connie your Winter's thread was hijacked by Drinel. Please post about Winter only on Winter's thread. It becomes very confusing to have info about Winter on another's thread.
Please read Romy's post above and answer her questions.
Please answer my previous questions and did you read my reply yesterday? Without facts we feel very sad to not be able to help Winter.
1. Prednisone started on what date? dose in mgs? ? times per day. Date the taper (reduction) is to start?
2. Name of the acid suppressor used during the time of the anti inflammatory drug usage (including at the overnight clinic)?
3. What meds were being given at the Clinic? What date did she go to clinic?
Have you phoned the vet to alert them pain meds are wearing off too soon, 1-2 hours before the next dose?
If Pred has tapered already, that would be the reason for pain surfacing. That would indicate another course of pred would be needed THEN another test-for-pain tapering of predisone.
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Post by Connie & Winter on May 27, 2020 8:45:34 GMT -7
prednisone started on 5/26/20 am 1/2 tablet of 5mg. 2x/day. Taper to 1x/day on 5/28 pm
went to clinic on 5/24 am until 5/26 am.
meds given: fentanyl drip then moved to the patch
Methocarbamol 500mg 3x/day
gabapentin 100mg 3x/day
no acid suppressor
Winter weighs 12 lbs. eating and drinking normally, urinating and pooping pretty regularly. Is on strict crate rest.
I will be speaking to the vet about the issues that you have brought up today. The fentanyl patch has to be changed or removed today.
Winter rests comfortably most of the time. She has intermittent bouts of panting....I don't know if that is from pain or side effect of prednisone. She also expresses pain, (yelps a little) when getting in and out of the carrier to get her to her potty place, as well as when she is walking around during potty time.
Winter has been on strict restrictive movement since 5/28/20
I use a harness and leash at the potty area, carry her to the area in a carrier. 3-4x a day. Time walking around usually about 5 minutes or so.
We live in Bellingham, Washington.
Thank you for your input and help.
Connie
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 27, 2020 9:17:16 GMT -7
Connie, had no anti inflammatory shot or IV been given by ER or prior to Prednisone starting on 5/26? " She has been on pain meds. and anti inflammatory meds for 4 days [as of 5/12ish?]" MED LIST 12 lbs True crate rest started 5/28
clinic on 5/24 no anti inflammatory shot or IV?
Prednisone 5/26: a taper dose! 2.5mg 2x/day , further tapering on 5/28
gabapentin 100 mgs 3x/day
methocarbamol 125mgs 3x/day
Fentanyl patch expires 5/27
needs GI tract protector, Pepcid AC, on board w/PREDNIOSONE!
The anti inflammatory dose of prednisone for a 12 pound dog would be 5mgs 2xday. You have reported that on 5/26 she was Rx'd a below level anti inflammatory dose, in fact that is a tapering dose that no longer works swelling. Depending on the dosage, steroids can be replacement steroid hormone in dogs not able to make sufficient hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive effects for other diseases. Sounds as though there is missing information of prior use of anti inflammatory drugs used maybe? Do you have any such info? At any rate, discuss with the vet using the anti inflammatory level of pred since she is still exhibiting pain ( Yelps and likely panting is also a sign of pain as well since she still yelps when moving. Panting if due to pred, try to rule out by this test. PANTING: -- Try a fan near crate but not pointed at the dog to help circulate air some. --Try a frozen broth ice cube to lick on. Dr. Isaacs discusses this issue: www.dodgerslist.com/neurocorner2/panting.htmKeep the potty time to a very, very few footsteps. No walking around fo 5 minutes Carry your dog to and from the recovery suite to the potty place and then allow a very, very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! ** |
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Post by Connie & Winter on May 27, 2020 11:43:26 GMT -7
Part of my problem is getting to talk to her vet. They are very busy and very hard to get through to and to get an appointment. But I will keep trying in regards to the pepcid ac [not onboard yet].
I have a question about potty breaks. Should I get her up and keep her on a schedule, close to what she normally does? Or let her stay resting until she shows signs of needing to go out?
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Post by Romy & Frankie on May 27, 2020 13:07:36 GMT -7
I know that things are different at the vet's office these days, and they may be scheduling appointments further apart than they usually would, but this should have no impact on questions by telephone.
Pred will make a dog want to drink more and therefore pee more. Dogs on pred may need to go as often as every two to three hours. I would not wake her from sound sleep but if she is just resting I would take her out every two to three hours to avoid accidents. When you are taking her to potty, continue keeping the number of footstep to a minimum.
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Post by Connie & Winter on May 27, 2020 16:41:15 GMT -7
on board with the Pepcid AC 5/27/20pm and raised prednisone 5mg.x2 starting 5/27/20pm
No Pepcid AC to be found. There seems to be a shortage of it here. Do I still give the increased dosage?
[Moderator's Note. Please do not edit
Prednisone 5/26: a taper dose! 2.5mg 2x/day , further tapering on 5/28 √ 5/25 pain/_neuro
as of 5/27: 5mgs 2x/day for ? days, then taper test for _pain / _neuro
gabapentin 100 mgs 3x/day
methocarbamol 125mgs 3x/day
Fentanyl patch expired 5/27 no replacement pain meds Rx'd!
vet ok'd famotidine, trouble finding it ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 27, 2020 18:10:00 GMT -7
Connie, good job in getting pred on an anti inflammatory level. Get it started. Hope you will be able to find some store (grocery, mini-mart pharmacy, drug store) who has some famotidine. With a population of Bellinham, Washington 90,665 surely some shop has some. For how many days is the pred 5mgs 2x/day for? What about brand X "Pepcid AC" Brand X will have just one active ingredient (famoditine) same as Brand name Pepcid AC® has. Call around to see who has what on their shelves. Best would be a 10 mgs tablet, then you need only split in two parts for the 5mgs 2x/day dose.  |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 27, 2020 18:13:32 GMT -7
What did they do about the 5/27 expired Fentanyl patch? Any other med adjustments details?
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Post by Connie & Winter on May 27, 2020 19:27:48 GMT -7
I am still looking around for the famotidine....they haven't replaced the patch with anything. Just called in because she is still in a lot of pain,( shaking, standing in the corner of her crate with her head in the corner, and panting) waiting for a phone call back. Thinking I should head to the closest neurologist, 2 hour drive
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on May 28, 2020 6:29:11 GMT -7
A consult with a neuro is not always for the purpose of surgery. Neuros are used to aggressive pain relief philosophy that a vernal vet may not be comfortable in . This practice really dropped the ball in upping pred due to your reported painful inflammation, yet not replacing Fentany with another patch or with gabapentin + tramadol combo pills.
Any vet can write a prescription for famotidine. It can then be filled at your local pharmacy.
Please let us know someone has taken care of Winter.
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Post by Connie & Winter on May 28, 2020 16:15:32 GMT -7
She is getting an MRI right now and will know the results soon then a plan of action from a neuro.
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