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Post by Stephanie & Baby on Sept 12, 2020 20:08:18 GMT -7
My 11 year old 14lb doxie Baby, she should be 11lbs, started having neck pain about three weeks ago. She has not lost her legs and has full feeling. She as just yelping and hesitating to walk the first week. I brought her to the vet, as the pain seemed to get worse in 8/31. She was prescribed:
500mg methocarbamol 1/2 tablet every 8 hours
5mg prednisone 1/2 tablet twice Day for 3 days, then taper
100mg gabapentin 1 capsule every 8 hours
250mg metronidazole 1/2tablet 2x a day
Strict rest
cbd infused oil as needed
[Moderator's Note. Please do not edit
14lbs
Prednisone as of 8/31: 2.5mgs 2x/day for 3 days, 9/2 test taper for √9/4 pain/ _ neuro
as of 9/9: for 3 days, then Sat 9/12 test taper: √9/11! pain/_neuro
methocarbamol 250mgs 3x/day
gabapentin 200mgs 3x/day
metronidazole (antibiotic) 125mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/prednisone!]
she seemed to improve until Friday 9/4 when late at night she yelped and seemed to decline over the weekend with a lot of pain tense belly, trembling and not wanting to walk or stand. She is able to walk but doesn’t.
Back to the vet tuesday 9/8. Refilling of scripts, except now 2 capsules of gabapentin 3x day.
last night [9/11] and tonight [9/12] she is screaming in pain for a few minutes when she tries to stand. She can stand but doesn’t want to. She can walk but doesn’t want to. She’s in a lot of pain. I will contact vet again tomorrow but not sure what else to do. It’s three weeks of pain, two weeks of meds and no improvement.
I also have iced and used heat on her back and neck. Doesn’t seem to do too much for help. I’m at my wits end and I’m heartbroken that she’s in so much pain. Not sure what to do next, vet said this could take several weeks to see improvement but I can’t have her so painful for weeks. It’s not fair.
any help is appreciated.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 20:37:15 GMT -7
Prednisone is key to understanding. It appears on the pred taper after 3-day very SHORT pred course, the pain resurfaced on 9/4
Pred should not be tapered when there is pain.
Please fill us in fully on the pred courses. Taper days do not work on swelling
Course 1 started 8/31 2.5 mgs 2x/day for three days (2.5mgs is a taper dose for a 14lbs dog!)
Was there a course #2? ?mgs 2x/day for ? days before a pred taper
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Post by Stephanie & Baby on Sept 12, 2020 20:41:37 GMT -7
She’s been on the prednisone consistently since [9/1]Tuesday. Have not tapered anything. The tapering started last week [KINDLY USE DATES SO we do not make a mistake in understanding] and she then slid back Friday (9/4) during final prednisone. Went back on it Tuesday 9/8, been on it since.
[IS THIS CORRECT? make a new post to explain please, use dates
Prednisone as of 9/1: 2.5mgs 2x/day for 3 days, 9/4 test taper for √9/4 pain/ _ neuro
as of 9/8: ?mgs 2x/day for ? days, then pred test taper ]
I finally got her to calm down and sleep, but it too 2 gabapentin capsules. She wasn’t due for it until 12. Gave it to her at 10 because she was screaming in pain and wouldn’t stand. We got her moved to her bed, she was on the hardwood floor, and she’s calm now. But that pain meds will wear off middle of the night. I’ll set my alarm to wake at 3 to give her more.
Let me know if you need any more info.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 20:46:28 GMT -7
When the pain meds are properly adjusted AND an anti-inflammatory level of prednisone for a 14lbs dog are in use, pain will be in control in ONE hour and stay that way dose right up to the next dose of meds. STRICT REST Please confirm that we're on the same page as to conservative care since Aug 31. STRICT rest means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/ ◼︎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. Extra things you can do at home to help with a neck disc: dodgerslist.com/2020/05/05/cervical-care-tips/ 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. ▶︎ Super tried and true tips for setting up the recovery suite, the mattress and more! dodgerslist.com/2020/05/14/strict-rest-recovery-process/ Knowledge is key! Owner understanding ensures proper conservaitve treatment principals: ▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/healing-the-disc/▶︎ Roadmap for your fridge. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf POTTY TIME strictness 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 Stephanie & Baby on Sept 12, 2020 20:50:00 GMT -7
I just ordered her a crate. I live in a nyc apt and she wasn’t walking around. She’s also not a jumper. She’s been sedentary. I pick her up to take her out to potty. She just stands there or lays in the dirt. When she finally goes I pick her up and carry her in. She yelps and cries sometimes when I lift her.
Are you saying she doesn’t have a high enough dosage of prednisone? I may have misunderstood.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 20:54:07 GMT -7
The tapering started last week [KINDLY USE DATES SO we do not make a mistake in understanding] and she then slid back Friday (9/4) during final prednisone. Went back on it Tuesday 9/8, been on it since.
[IS THIS NOW CORRECT? make a new post to explain please, use dates]
Prednisone as of 9/1: 2.5mgs 2x/day for 3 days, 9/4 test taper: √9/4 pain/ _ neuro
as of 9/8: ?mgs 2x/day for ? days, then pred test taper
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Post by Stephanie & Baby on Sept 12, 2020 20:58:33 GMT -7
yes that’s correct.
as of 9/8 [9/9], prednisone 5mg tablets. 1/2 tablet [2.5mgs] twice a day for 3 days. Then [test TAPER!] 1/2 tablet 1x per day for 3 days. Then every other day until finished. I have not tapered. She’s been 1/2 tablet twice a day every day since Wednesday 9/9. She got a ✙shot in the vets office on 9/8, so tablets at home began 9/9.
[Moderator's Note. Please do not edit
14lbs
Prednisone as of 8/31: 2.5mgs 2x/day for 3 days, 9/2 test taper for √9/4 pain/ _ neuro
as of 9/9: for 3 days, then Sat 9/12 test taper: √9/11 pain/_neuro
9/8 Robaxin(methocarbamol) Injection
9/8 Buprenorphine(Buprenex)Injection- Duration: 4-8 hr
methocarbamol 250mgs 3x/day
gabapentin 200mgs 3x/day
metronidazole (antibiotic) 125mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/prednisone!]
would taking rimadyl in addition to the meds she’s in hurt her?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 21:14:30 GMT -7
Extreme danger to GI tract to mix a non steroid (NSAID) Rimadyl with a steroid prednisone. What was name of 9/8 shot?When will the recovery suite (the wire crate) arrive? It can't be soon enough. The single most important care is the INSIDE a recovery suite care. Action to take as soon as possible, first thing in the a.m. to phone and alert your vet, the ER vet about the uncontrolled pain. -- Advocate for your vet to use an anti-inflammatory level dose of prednisone. (You should never RX your dog's dose on your own especially with prednisone.) Your vet has the job to RX, your job is to monitor things, be the eyes and ears and advocate when things are not right -- Expect the anti-inflammatory level of prednisone dose to be 5mgs 2x/day. A 3-day course of pred and now adding up to a 6-day course) is not likley to resolve the more painful neck disc episodes by 9/12 Saturday. IN FACT you report pain today! Most vets will make a guess of a 7-day or even a 14 days course AND THEN begin the test for pain prednisone taper. Taper doses are too low to work on the inflammation. It will take prednisone 7-30 days to fully resolve pain. All courses Rx'd will add up and fall in the that 7-30 day range. THREE SOURCES OF PAIN -- Disc episodes can cause pain coming from three different sources. Adovocate for: 1) adding Tramadol as the general analgesic 3x/day 2) Gabapentin for nerve pain is ok. 3) methocarbamol for muscle spasm pain(muscle relaxer) at 250mgs is kinda high. If three-way pain med combo is in use methocarbamol might be able to go to the more typical 125mgs 3x/day. -- PEPCID AC Proactive vets don’t wait til there is lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. Pepcid AC (famotidine) blocks the production of acid. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours. Pepcid AC has a very limited potential for side effects. Ask if your dog 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).
HEALTH ISSUES: “Mar Vista Vet reports: Pepcid AC has a very limited potential for side effects, the reason of release to over-the-counter status. The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities. There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems so it may be prudent to choose another means of stomach acid control in heart patients.” marvistavet.com/famotidine.pml |
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Post by Stephanie & Baby on Sept 12, 2020 21:30:57 GMT -7
My vet said she was on the highest dose of prednisone for her weight.
the shots she got on 9/8 were:
1 Robaxin(methocarbamol)Injection
1 Buprenorphine(Buprenex)Injection
Crate arrives Tuesday. But I can go buy one tomorrow if I had to, but I haven’t wanted to leave her.
I will text the vet tomorrow with the update. The crying in pain gets worse each time.
ill give her more cbd infused oil as well. My vet did say it could take a month to see improvement and she said we control her pain until it does. But the pain isn’t being controlled and I don’t know how to help her.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 21:33:57 GMT -7
Essential tool for monitoring MED CHART **  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 here: dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdfThe pattern I see is at the end of each 3-day course of pred, the painful swelling is still there when the taper starts. 2.5mgs pred 2x/day is at the lower end of the anti-inflammatory-range. With a disc episode the 5mgs 2x/day higher end is mostly used. Does your dog have some health issue why your vet is choosing the lower end?
RECOMMENDED reading to understand anti-inflammatory drugs. Why not to mix a NSAID like Rimadyl with any steroid (e.g prednisone), stomach protection and more: dodgerslist.com/2020/04/18/steroids-vs-nsaids/?highlight=anti-inflammatory
Transports into a vet visit are always a risk to the disc of too much movement. Vets who know IVDD will take phone updates and adjust meds on the phone. This is why it is important you have the ability state your case clearly with dates, observations to best communicate and advocate for things.
I hope your giving the pain meds will get her thru the night until you can phone your vet to get prednisone corrected and hopefully tramadol added. STOMACH protection is important--- if no health reasons to not take, go to the grocery store to buy Pepcid AC with only one active ingredient- Famotidine. 5mgs even 12 hours.
Please keep us posted in the a.m. and what the vet does and says.
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Post by Stephanie & Baby on Sept 12, 2020 21:36:39 GMT -7
Thank you.
no health problems to prohibit her from medications. Other than this and she’s a little chubby, she’s in perfect health.
I’ll update when I speak to her tomorrow.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 21:48:25 GMT -7
I'm Paula, what's your name and your dog's? Depending on the dosage, steroids can be replacement steroid hormone in dog not able to make suffiennt hormone, can function as anti-inflammatory drug during a disc episode or provide immunosuppressive effects for other diseases. This formula is very typical to the prednisone dose vets who know IVDD are reported as using in member posts. 14lbs/6.35kg dog x 2mgs pred =12.7mgs dose per day. With pred the dose is typically given at 1/2 the dose twice a day. So 6.35mgs pred is rounded down to the 5mg tablet. For example: 14llbs/6.35kg dog gets 5mgs pred 2x/day for a 7-day course.
Again don't Rx prednisone yourself. Your job is to advocate for things, hire the right vet.
CDB oil when on the big gun meds may not be a good idea! We just don't know enough about CBD oil to recommend for an IVDD disc episode. Not enough scientific research has been done on it to determine how effective it would be on pain/inflammation for dogs or as a sedative and what the optimal dose would be. We know what does work (pain meds, anti-inflammatory drug and Pepcid AC) and that's all we can recommend. Make sure your vet is aware of all medications and supplements you are giving. Herbs, supplements, potions can adversely interact with the necessary big gun medications your vet has prescribed for a disc episode. Read about meds humans should not take with CDB oil. Research for dogs is on-going and may in the furture line up with the meds for humans that are contraindicated with CDB oil. www.healthline.com/health/cbd-and-drug-interactions-what-you-need-to-know |
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Post by Stephanie & Baby on Sept 12, 2020 21:50:58 GMT -7
My name is stephanie. My dogs name is baby.
ill ask about the prednisone dosage tomorrow and let you know. I’ll get the Pepcid tomorrow.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 12, 2020 22:04:01 GMT -7
Do you have a friend who can loan you a portable baby's Pac N Play, an ex-pen and bring it to you so you are not leaving Baby alone not in any recovery suite? Thrift shops are inexpensive sources for baby things.
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Post by Stephanie & Baby on Sept 13, 2020 4:52:35 GMT -7
Yes. We will find that today.
She is alert and tail wagging this morning. Slept the whole night through and didn’t wake up or cry. But that’s likely due to all of the pain meds.
I find she is ok in the mornings and all day and then at night she is bad [pain]. At least the o
last 3 nights.
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Post by Romy & Frankie on Sept 13, 2020 5:46:51 GMT -7
Good news that Baby was able to sleep through the night. If the pain meds allow her to sleep in comfort they are doing their job. Baby should not be in pain because pain will slow the healing process.
Let us know what the vet says when you speak to her.
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Post by Stephanie & Baby on Sept 13, 2020 11:02:45 GMT -7
Spoke to vet today, she said she believes baby’s dose of prednisone is the correct dose and doesn’t think going up is the answer.
suggested that we can add in something like codeine or tramadol
I got the ✙Pepcid today and gave her 1/2 a 20mg pill.
[Moderator's Note. Please do not edit
14lbs
Prednisone as of 8/31: 2.5mgs 2x/day for 3 days, 9/2 test taper for √9/4 pain/ _ neuro
as of 9/9: for 3 days: no taper test √9/11 pain/_neuro
methocarbamol 250mgs 3x/day
gabapentin 200mgs 3x/day
metronidazole (antibiotic) 125mgs 2x/day
✙ Pepcid AC 10mgs 2x/day]
she ate. Made potty. Is sitting comfortably in her bed. She can still walk and wag tail.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 13, 2020 11:17:25 GMT -7
What did the vet prescribe for Prednisone as of today 9/13: ?mgs ?x/day for how many days, then re-test for pain Are you giving Pepcid AC 10mgs twice a day? Which is the vet going to prescribe for the still uncontrolled pain? -- CODEINE— "Codeine is not a recommended analgesic for dogs or cats. It is generally only available in combination with acetaminophen (Tylenol) which makes it completely unsuited to feline use. Its use in dogs is discouraged as most dogs lack the CYP2D6 enzyme primarily responsible for the conversion of codeine to morphine, its most active metabolite....It should be noted that both morphine and codeine appear to have poor oral bioavailability in dogs and cats" www.vasg.org/chronic_pain_management.htm-- TRAMADOL codeine's poor availability when given orally may be the reason we see report on this forum vets using tramadol |
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Post by Stephanie & Baby on Sept 13, 2020 12:12:14 GMT -7
Nothing about her scripts have changed. Same dosage as noted previously. Not tapering. I’ll speak with her again tomorrow.
Also playpen arrives tomorrow. She’s resting still and comfortably. Pain is uncontrolled at night it seems.
yes began the Pepcid, 1/2 20mg tablet 2x a day with the prednisone.
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Post by Stephanie & Baby on Sept 14, 2020 11:07:01 GMT -7
Update. Only one painful episode last night. It was after I brought her back from her potty break. I laid her down on her bed and she had an episode. Lasted a minute of her crying very loudly. She calmed down and I gave her her dosage of Meds earlier by like 30 minutes.
She slept through the night and today has been alert. Did potty. Ate and sleeping on and off.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 14, 2020 14:18:08 GMT -7
Do you now have the Tramadol in your hands? IF not why the delay?
When will the Tramadol be started in order to attempt to get the pain finally fully in control round the clock?
When the pain meds are right for Baby's needs there will be no pain dose to right up to the next dose.
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Post by Stephanie & Baby on Sept 14, 2020 14:51:40 GMT -7
I have to go to the vet tomorrow to get more methocarbamol meds. I’ll likely get it then. She had a pain free day today. Is in her playpen sleeping.
Question though, how safe is the tramadol? How safe is all of these pain meds for her?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 14, 2020 19:33:22 GMT -7
Stephanie, there just are NO SAFE MEDICINES. The safety factor is twofold. --- A vet who uses then in a safe manner. Often a blood panel will be taken to see the health of organs. --- The other safety factor is the owner stepping up to the plate to read up on each med their dog takes. A info sheet should come with each med Rx'd, but that doesn't often happen. My go to bookmark for drug info is this veterinarian website.: The Mar Vista Veterinary Pharmacy Center: www.marvistavet.com/pharmacy-center.pmlLeaving a dog in pain due to under medicating for pain for a very painful disease is a bad thing on many levels. Dr. Petty, DVM, CVPP, CVMA, CAAPM, CCRT is a past president of the International Veterinary Academy of Pain Management and is a frequent lecturer at local, state and national conventions. |
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Post by Stephanie & Baby on Sept 15, 2020 8:54:29 GMT -7
Pain free night and so far today [9/15]. Resting comfortably in her play pen. She as barking to get out but no go! Refilled the methocarbamol and gabapentin. [Vet said to give her an extra 100mg gabapentin if she shows pain. ] Vet says to up the gabapentin if she shows pain again and then we will go to tramadol if that doesn’t work.
She’s still standing when we go out to potty and finally takes a step or two and makes. She then Tried to walk a bit but I pick her right up. I also figured out that maybe when I was carrying her the weight was too much on her front which is where her pain seems to be. I’ve adjusted and she no longer cries.
Hoping I have the mix right now for her to stay on a path to heal.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 15, 2020 10:31:41 GMT -7
Stephanie, please always provide the details in mgs and how many times a day the new Rx for Gabapentin is .
We have no way of knowing what "up" gabapentin means. What are you currently giving gabapentin (even if you have Rx permission to "up" it.
Glad to hear she had a pain free night and still during the day today.
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Post by Stephanie & Baby on Sept 15, 2020 11:40:54 GMT -7
Sorry. No medication change today (9/15).
Vet said to give her an extra 100mg [gabapentin] if she shows pain. Not to change the dosage if things are static.
Sorry to be confusing.
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Post by Stephanie & Baby on Sept 16, 2020 13:53:17 GMT -7
9/16. Second full night no pain signs. Third day no pain signs.
Spoke to vet 9/16, starting 9/17 moving prednisone to 1/2 (2.5mg) once per day for next 7 days. All other meds staying same.
[Moderator's Note. Please do not edit
14lbs
Prednisone as of 8/31: 2.5mgs 2x/day for 3 days, 9/2 test taper for √9/4 pain/ _ neuro
as of 9/9: 2.5mgs 2x/day for 8 days; 9/17 taper test: _ pain/_neuro
methocarbamol 250mgs 3x/day
gabapentin 200mgs 3x/day
metronidazole (antibiotic) 125mgs 2x/day
✙ Pepcid AC 10mgs 2x/day]
I’ll check in with vet if she appears worse or at 7 day mark (9/23) to see if continued tapering to 1/2 tablet every other day until finished.
She seems alert, more animated (whining to get out, barking at sirens and her brother wiener dog), still can walk, eating and making normal potty. She’s completely confined to her play pen since Monday (9/14). Vet wants her confined for no less than 3-4 more weeks.
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Post by Romy & Frankie on Sept 16, 2020 14:10:18 GMT -7
Good news that Stella is showing no signs of pain. Please keep a close watch on her for signs of pain reemerging during the pred taper. If she is showing any signs of pain let the vet know as soon as possible.
By completely confining her you are minimizing the risk of further damage to the disc. It takes 8 weeks of strict crate rest for the disc to heal and form strong scar tissue. Dogs that are on crate rest for less than the full 8 weeks are prone to relapse. It would be terrible if that were to happen.
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Post by Stephanie & Baby on Sept 16, 2020 15:54:18 GMT -7
Thanks for the info on the crate rest. Vet did say no less than 4-6, Shes in her 1 week. Vet is also pleased she has no deficiencies. So we are thinking we’re in a good place. But the pain she was in was very upsetting.
Thank you all for your help, concern, and advice.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 16, 2020 16:22:17 GMT -7
The prednisone taper test for pain begins on Thurs. 9/17. Pain meds (gabapentin and methocarbamol) mask pain i.e blindfold you if there would be any existence of pain.
Your job on the taper test is to monitor for any surfacing pain. Pain = swelling not yet resolved. Swelling is what damages the spinal cord and thus the need for quickly assessing about pain to get up on the original dose of pred. It can take anywhere in the range of 7 to 30 days of pred to do the job (taper doses are too low to work and are not counted in the 7-30 days.
No pain surfacing = all swelling is really gone. Continue pred taper to conclusion. Finish the rest of the 8 weeks to get that disc to heal. Mark your calendar for an Oct 26 graduation date!
Which does your vet want on the start of the taper test for pain?
--- to back off the two main masking pain meds on 9/17. Either with a lower dose or down to every 12 hours (2x/day) OR......
--- to full stop both pain meds on 9/17?
Got our fingers crossed the test for pain tapering of prednisone will reveal all the swelling is really gone. Let us know which your vet wants on 9/17 about the pain masking pain meds (full stop or backing off).
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