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Post by Liz & Bullitt on Sept 13, 2020 20:17:17 GMT -7
[Original subject line: Newbie...mod please correct if need be] Hello, my 10yo neutered make Cardigan Welsh Corgi was diagnosed yesterday 9/12 at the ER vet with IVDD. He was fine at 5:30am, but at 9am he was swaying behind and having trouble walking. Hunched back. No radiographs done. I’m calling our regular vet tomorrow, but I need to know if we’re doing the right thing? He’s in a small xpen with a bed and water, and we carry him out to potty. He’s not allowed to walk...he wobbles too much. 😕 Should I get a back brace? Do I start acupuncture ASAP, or later? Should I have requested radiographs? THANK YOU!! QUESTIONS ☆ 1 Is there still currently pain? ☐ tight tense tummy ☐ Arched back☆ 2 How much does your dog weigh? 38lbsA.. Gapapentin, 200mg, every 12 hours. Prednisone, 10mg, every 12 hours. Pepcid AC, 10mg, with both doses. [Moderator's note: please do not edit
38 lbs.
Prednisone as of 9/12: 10mg 2x/day for 7 days then Sat 9/19 test taper : _pain/_neuro
Gabapentin 200mg 2x/day
Pepcid AC 10 mg 2x/day]☆ 3 -- Eating and drinking great. Increased appetite, actually (thinking from the pred). No nausea, no vomit. -- Poops & pees on his own (assisted standing) fine. ☆ 4 10yo Cardigan Welsh Corgi (Bullitt). My name is Liz. ☆ 5 Specifically got a diagnosis of IVDD from General DVM (with personal IVDD experience). ☆ 6 What was the date you saw the vet for CONSERVATIVE treatment? Saturday 9/12. ☆ 7 Can your dog specifically sniff and squat and then release urine which is bladder control - YES, but needs assistance to remain standing. Hind end collapses. ☆ 8 Currently can your dog wobbly walk? YESMove the legs at all? Some. He does kick/twitch if I tickle his toe hair. Wag the tail when you specifically do some happy talk? YES. He’s very cheerful and tries to walk. It’s actually most difficult to keep him quiet. And I should also ask: I’ve been icing his back. Good idea, or not necessary? |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Sept 14, 2020 6:12:56 GMT -7
Welcome to Dodgerslist, Liz. 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. Know more about us and how we team up with veterinarians: dodgerslist.com/about-team-dodgerslist/Disc disease is not a death sentence! Struggling with quality of life questions? Re-think things: dodgerslist.com/2020/04/18/hope-quality-life/Bullitt is showing signs of pain so you do have a pain emergency that must be dealt with ASAP this morning. Call the ER - any vet there can pull Bullitt's records and adjust his meds. Gabapentin works best when given 3x/day (every 8 hours) so advocate strongly for that. Tramadol is a general pain med that should be added. Methocarbamol works on the pain of muscle spasms. Often it takes all three of these meds 3x/day to get the severe pain of IVDD completely under control. Pain should be completely under control within one hour of giving any new course of meds and should remain completely under control with no sign of pain arising from one dose to the next. On what date will the Prednisone start to taper?The Pepcid AC should be given 30 mins. before the anti-inflammatory and then every 12 hours thereafter for as long as Bullitt is on Prednisone. At this time there isn’t enough research on them for Dodgerslist to support the use of a back brace with an IVDD dog and one should especially not be used during the 8 weeks of strict crate rest. Please refrain from tickling Bullitt's feet while on conservative care as it will cause him to kick and you want to avoid any unnecessary movement to protect the spine from further damage. Same thing with the ice - no need to put anything on Bullitt's spine - the anti-inflammatory will work on getting the swelling down so ice is not recommended. Transport involves risk of too much movement of the spine and should be kept to only the absolutely necessary vet visits. Bullitt has already by examined and prescribed meds and any adjustments to those meds should be done by the hospital that examined him. If the records can be sent by the hospital to your regular vet for his review and consult without an actual exam, that would be recommended. Otherwise, there is no reason for Bullitt to be examined by the regular vet at this point. IF the hospital will not work with you to get Bullitt's pain completely under control, then a visit to the regular vet may be advisable. The risk of transport for acupuncture needs to be weighed against any benefits. You already are doing the most important thing to help Bullitt's spine heal - the strict crate rest. If you can find an acupuncturist who will come to your home, that would be best, but you need to know if Bullitt will lay calmly during the insertion of acupuncture needles. Bullitt is having mild symptoms of IVDD at this time (wobbly walking) so it's really not necessary to consider acupuncture. As for radiographs, IVDD is usually diagnosed based on breed of dog and physical exam. X-rays only need to be done if some other disease is suspected. MRIs and/or CT scans should only be done just prior to surgery as they require anesthesia which can be dangerous for IVDD dogs as it relaxes the core muscles supporting the spine. So it's absolutely fine that no x-rays have been done.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/STRICT means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy whys: dodgerslist.com/2020/04/22/chiropractic/?highlight=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. Carry 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!  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. ﹆1 Remove yourself from the dark scary unknown. Be in command of the 4 phases of healing, what to expect with pain, with swelling, disc and nerve healing. Get up to speed: dodgerslist.com/healing-the-disc/ ﹆2 Two FRIDGE FLYERs to print out a) Help all of your family recognize emergency signs and action to take. dodgerslist.com/wp-content/uploads/2020/07/emergency-fridge-flyer2.pdf b) Avoid dangerous detours with the Conservative Roadmap for your fridge: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf﹆3 Excellent IVDD video playlist: www.youtube.com/playlist?list=PLGTcmjenJIkUNy9ke7IvPlFIMKFfjBSen ﹆4 At the MAIN WEBSITE, use the orange SEARCH bar feature to easily access the treasure trove of more IVDD information. You will feel so very empowered to help your dog! dodgerslist.com/Please let us know what the vet says after speaking to them this morning. Healing prayers for Bullitt. |
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Post by Liz & Bullitt on Sept 14, 2020 18:05:43 GMT -7
I’ve called both the ER vet and our regular vet about adding Tramadol...everyone is in surgery and can’t talk 😢, so I’m waiting for a call back. I even have some Tramadol on hand, ready to go...I just need to know the correct dosage. 😣
We have a Neuro appointment next Wednesday [9/23] at VSC Seattle. Also have an appointment with his regular DVM on 10/6 - the soonest we could get appointments. Darn you, COVID.
Bullitt has some use of his hind legs now, so keeping him quiet is becoming a challenge. When he had TPLO surgery, we had the same issue...and resorted to sedatives to keep him from jumping up and being crazy on his new knee. I’m going to ask my vet about either sedatives again or Benadryl...although I suspect the Tramadol would be sufficient.
His appetite is still great, but he is really bored. I’m working half days this week to monitor him. Thanks all for listening to my panicked cry!!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Sept 14, 2020 19:24:32 GMT -7
Liz, keep contacting ER as they should be open and one of the vets there can access Bulllits files to RX gabapeinin at every 8 hrs and to add in Tramadol and Methocarbamol each at every 8 hrs to provide round the clock relief from tense tummy muscles and the arched back pain.
Basically Bullit was under medicated for pain by ER. Disc episodes typically involve three different sources of pain as Marjorie explained. The Rx for gabapentin deals only with nerve pain and at 2x/day usually will not provide all day relief. Advocate for every 8hr Rx.
---- Tramadol is the general analgesic at every 8 dosing
---- Methocarbamol is for the often muscle spasm pain also every 8 hr dosing.
With the relatively mild symptoms of wobbliness, Bullit can be a good candidate to heal his disc with STRICT rest and with time self repair the wobbliness nerve damage. STRICT rest is the key component of conservative treatment and getting the pain full in control.
What benefit are you expecting from a 9/23 neuro appt that outweighs the risk of too much movement for Bullit's healing disc during a transport?
Please keep us posted when you make contact with any of the ER vets on duty tonight. Likley your vet would not contact you til morning.
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Post by Liz & Bullitt on Sept 14, 2020 21:40:10 GMT -7
I think I misunderstood? I was thinking sooner, rather than later, for the neuro consult?
No call back from regular vet, and I’ve just tried calling the ER vet again, and to say I’m annoyed is an understatement. Either I would have to bring him back in (NO), or try calling back at midnight. This is ridiculous!!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Sept 15, 2020 5:13:30 GMT -7
Yes, that is a ridiculous response from the ER, Liz. You paid them for an exam and they should be immediately available for any follow-up adjustments that need to be made to the meds that they prescribed. Any of the vets there can pull Bullitt's records and upon hearing that what they prescribed is not getting the pain under control, immediately make adjustments to the pain meds. Keep trying and advocate strongly on Bullitt's behalf. The ER is the best choice as they have already examined Bullitt. Too much movement during transport and exams and the damaged disc could tear more, resulting in more nerve damage, loss of bladder control, paralysis, possibly permanent. So advocate by phone when at all possible.
It isn't just Tramadol that needs to be added. Gabapentin needs to be prescribed 3x/day so it covers pain all day. Methocarbamol to work on the pain of muscle spasms also needs to be added. So advocate strongly for all three pain meds to be given 3x/day.
IF, if, the ER vets can make the proper adjustments to Bullitt's pain meds and get his pain under control, then there's no reason for a neuro consult or for an exam by the regular vet unless Bullitt's neuro loss should worsen. The anti-inflammatory is given until the swelling resolves (7-30 days), the pain meds are given to mask the pain until the anti-inflammatory gets the swelling down and the 8 weeks of strict crate rest are done to heal the damaged disc.
If the ER vets will not work with you this morning to adjust the meds and get Bullitt's pain completely under control, then advocate strongly that the neuro see you TODAY and not wait until 9/23. They must reserve openings for emergency patients and pain is an emergency. Bullitt must not be allowed to remain in pain until 9/23. Pain hinders healing so have no patience with it. If the ER vets will not work with you on meds and you absolutely need to take Bullitt to another vet, then the neuro would be the better choice over the regular vet as they see more cases of IVDD and have a better understanding. However, not all neuros are familiar with conservative care so make it clear once you get in to see the neuro that you only need a consult to get the meds correct and are not looking for surgery. With the mild symptoms that Bullitt is having, he's a good candidate for conservative care. Of course, if the regular vet will agree to see him today, then go there. Do whatever you can to get Bullitt's pain under control today, preferably by phone.
In the following post, I'll give you some tips to help calm Bullitt during crate rest. If trying these doesn't help, then it's better for a dog on conservative care to be given a mild sedative than to move too much in the crate and suffer a relapse or more nerve damage.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Sept 15, 2020 5:16:48 GMT -7
Try to keep a happy voice and face around Bullitt. Dogs are very sensitive and pick up on our feelings very easily. Tell him everything's OK and that he's getting better every day. And you believe it, too! Here are some tips to help calm Bullitt in the crate. If these do not help, it may be necessary to have the vet prescribe a mild sedative. To calm your dog in the crate, it would be a good idea to cover the top with a towel. That should mellow him. It also creates a den like feeling that dogs love. Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives such as Acepromazine, Trazodone, etc. Of course always keep your vet in the loop on all things you give your dog. Other product brands may be available in your area or on-line… just shop by the active ingredient(s) on the label and the quantity for best price. Place a DAP pheromone diffuser at floor level where the recovery suite is. Dogs: Adaptil (DAP) wall plug in diffuser 48ml www.adaptil.com/us/Products/ADAPTIL-Calm-Home-Diffuser with dog pheromones Use a diffuser with one oral calmer from below: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed 2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. 3) Bach's Rescue Remedy is a liquid 5-herb combo to help with relaxation (Star of Bethlehem – Orithogalum umbellatum, Rock Rose – Helianthemum, Cherry Plum – Prunus cerasifera, Impatiens – Impatiens gladulifera, Clematis – Clematis vitalba) Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc. Consider some of these ideas: -- Many members have found a pet stroller to solve the whining problem because the stroller can be wheeled from room to room as you go about your activities. Pet strollers, however, should only be used when you are directly supervising. More details on strollers: www.dodgerslist.com/literature/strollers.htm--Caster wheels can be added to a wire crate so the crate can be wheeled from one room to the next so your dog can stay with you. -- Put a garment you have been wearing and have not washed in the crate. -- Nan Arthur, CDBC, CPDT, KPACTP writes: "According to the book, Stress in Dogs, by Martina Scholz & Clarissa von Reinhardt, the most well-behaved dogs get 17 or more hours of rest and sleep per day. Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a high-value food reward. Wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. " [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.] -- If your dog won’t get too excited seeing what’s happening outside, during the day try putting the crate on the coffee table or the dining room table so there will be a view out a window and a better perspective on what is going on in the house from on high. -- Play classical music or one of the wildlife TV shows. -- Fill a Kong with soft dog food and freeze. Put part of the dog's total daily dinner kibble in the Kong to lengthen time to consume dinner. Good low cal snacks are carrots, apples, or frozen green beans, licking a frozen low sodium broth ice cube. Good thick low salt/no fat chicken broth is full of cartilage-building proteins and amino acids. Freeze it up into cubes for easy access as you need it. Fun and keeps the body hydrated: place cubes in a bowl for licking. If a dog is jumping up at the sides of the crate, you can lower the ceiling of the crate. Cut a piece of cardboard the size of the top of the crate, punch holes in the corners and tie the cardboard down into the crate to the level of the top of the dog's head when standing. Or cover the top of the crate with a blanket or towel, bringing the blanket/towel down to the level of the dog's eyes so when he/she jumps up, he won't be able to see anything. That may discourage him/her from jumping up. dodgerslist.com/2020/05/14/strict-rest-recovery-process/dodgerslist.com/2020/02/24/tips-to-help-with-recovery-suite/ |
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Post by Liz & Bullitt on Sept 15, 2020 9:20:58 GMT -7
I finally got through to a vet (regular DVM), well, she passed the message to the tech - to add in ✙Tramadol.
[Moderator's note: please do not edit
38 lbs.
Prednisone as of 9/12: 10mg 2x/day for ? days then test taper :_pain/_neuro
Gabapentin 200mg 2x/day
✙ tramadol 50mgs 3x/day
Pepcid AC 10 mg 2x/day]
I’ve given up on that ER vet and won’t be using them again. Unless I take him to VSC Seattle for another ER visit - a good 45 min drive from home. There is no other neuro vet available in Western WA that we’re aware of, so I’m stuck. Either I wait until next week, or take him now for an ER visit...but seeing as how we’re at hour 72 after onset, I think we’ve missed the window for successful surgery. Or not. Honestly, I don’t know anymore.
He does have some movement in his hind legs now, and can stand for a bit. His back isn’t as arched, and his belly isn’t taunt anymore. I think that means the meds are helping? His attitude is still pretty chipper, although frustrated. Having had his prior surgery, we’re well versed on keeping him busy throughout the day. He just is refusing to rest and stay still. If the Tramadol doesn’t help, I’ll ask about Trazadone.
At close to 40lbs but 3’ long, we can’t wheel him in a stroller, as that would require extreme bending of his back. He’s currently in a small xpen with a round bed...he can turn around, but that’s about it. We’re managing the best we can in the circumstances...I just want to make sure we’re doing ALL we can. 😢
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Sept 15, 2020 10:18:53 GMT -7
Liz when you can let us know the mgs and times per day on the tramadol. Your mind may be doing the same as what a lot folks do. When the mind does not have facts it creates scenarios of negativity. Knowledge is the key when dealing with disc disease. Here's a quick summary --- Recovery suite needs to have room that he can fully stretch out lets when lying down as well as to be able to easily turn around. --- if your dog can move his hind legs with purpose (attempt to move up into a stand) then by definition he has more degree of function than the last remnant of neuro function- deep pain sensation (DPS). If you are putting him into a stand and he can stay there that is a reflex, not brain directed. --- The hour mark that really matters is in regard to DPS and nothing else. Have no idea what 72 hours is in reference to. Deep pain sensation, the last neuro function, is a critical indicator that nerves can still heal on their own. There is a window of 12-24 hours from loosing DPS after a dog has lost bladder control, lost all use of legs that surgery to decompress the cord could STILL be successful--even after that time surgery is often successful. The spinal cord is very fragile, the more hours that pass with continued pressure to the cord, the less chance for nerves to regenerate and/or the longer it can take to self repair nerves if the damage is not so severe to be irreparable. Unfortunately, general DVM vets (even ER vets) do not see enough cases of IVDD daily, to become really proficient in giving the neuro exam and correctly interpreting what they see about DPS. Therefore precious time is lost in wrongly identifying deep pain sensation. Only take the word of a board certified neuro (ACVIM) or ortho (ACVS) about DPS when there is loss of leg function. QUESTIONS to pinpoint current neuro function.
1. Can he move up into a stand by himself?
2. Can his legs still move in a walking motion (even if wobbly) as you indicated on 9/13?
3. Do his back paws knuckle under?
4. Does he use his back legs to reposition himself in the suite?
--- Find all orthos (ACVS) and neuros (ACVIM) in your area. find.vetspecialists.com/Please give your mind the full facts to work with and aid you in your decision making by visiting this page: dodgerslist.com/2020/02/10/surgery-vs-conservative/ |
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Post by Liz & Bullitt on Sept 15, 2020 12:22:11 GMT -7
Tramadol dosage is 50mg every 8-12hours. Can increase to 75mg every 8-12 hours.
The 72hrs came from date of onset of leg weakness to today. If I’m reading correctly - since he has bladder control, full use of his tail, and some hind leg movement - that means he still has DPS?
QUESTIONS to pinpoint current neuro function.
1. move up into a stand by himself? Sometimes...more like a crouch.
2. still move in a walking motion (even if wobbly) Yes
3. back paws knuckle under? Yes, but not always
4. use his back legs to reposition himself in the suite? A little bit, but it’s hard to say. It looks like he can scoot a bit.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Sept 15, 2020 12:38:59 GMT -7
Liz, please let us know if there is a problem in accessing the Dodgerslist Website and the links we provide, so we can see about fixing. Nothing is measured from the start of leg weakness. Measurement is from the loss of DPS. "Monitoring info" below was copied from the link provided in my last post: dodgerslist.com/2020/02/10/surgery-vs-conservative/Monitoring Neuro Functions
As damage to the spinal cord increases, there is a predictable step-wise deterioration of functions during a current disc disease episode. When nerve healing begins, often the reverse order of healing takes place. ▪️ √Pain caused by the tearing disc and inflammation in the spinal cord ▪️ √Wobbly walking, legs crossing ▪️ √Nails scuffing floor ▪️ YES, sometimes - Paws knuckle
under ▪️Legs do not work, can't raise up on back legs (paralysis, dog is “down”) ▪️Bladder control is lost ▪️Tail wagging with joy is lost ▪️Deep pain sensation (DPS), the last neuro function, is lost Deep pain sensation is a critical indicator that nerves can still heal on their own. There is a window of 12-24 hours from loosing DPS after a dog has lost bladder control, lost all use of legs that surgery to decompress the cord could STILL be successful--even after that time surgery is often successful. If a dog can wag the tail due to being happy, has bladder control then by definition he would have to have DPS intact. Thank your for providing the full range of the Tramadol Rx. Could you tell us what you are now actually giving? Tramadol 50? mgs each dose Every 8 hrs or 12hrs? |
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Post by Liz & Bullitt on Sept 15, 2020 15:03:58 GMT -7
My hubby gave him 50mg of Tramadol this morning at 9:30am PST. I will be home about 6pm, and will start him on another dose (unless he’s too woozy, then I’ll hold off).
I forgot to mention we’re to taper the pred down to once a day starting this Saturday 9/19, then in a week go to every other day, etc. I’m also going to review his meds with the neurologist.
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Post by Romy & Frankie on Sept 15, 2020 15:15:42 GMT -7
Pain meds work better on a regular schedule. It is harder to get pain under control once it has started than to keep pain from emerging at all.
Please don't hesitate to give him pain meds if he is still a little out of it. Although a dog should not take more meds than needed, it is better for him to be a little sleepy than in pain.
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Post by Liz & Bullitt on Sept 15, 2020 16:44:50 GMT -7
Understood, thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Sept 15, 2020 18:25:15 GMT -7
Thank you for letting us know when the pred taper begins (Sat 9/19) Upon the taper dose, your job is to monitor for re-surfaced pain. Of course if Bullitt is showing any pain before the taper starts, there is no need to do a prednisone taper test for pain. Instead alert your vet about the pain so he can Rx another course of prednisone. The first course was a 7-day course then test taper. Somewhere in the range of 7-30 days of prednisone courses (taper days do not count) the inflamed spinal cord will be resolved. Pred taper test for pain So that you can accurately assess for pain, the pain meds are also either full stopped on 9/19 or backed off. This is your vets choice. Rule of thumb: pain = swelling=
another course of steroid + all pain meds, Pepcid AC back on board. NOTE: Always have a plan in place with the vet prior to a prednisone test-for-pain taper on what you should do should pain surface. Have enough meds on hand til the vet reopens. Should pain re-surface over a weekend or evening when the Vet is closed, a plan B is free and an ER visit is expensive. I hope the addition of Tramadol 50mgs every 8 hrs will keep Bullit in full comfort round the clock. Let us know which your vet wants: full stop or backing off of gabapentin and tramadol on the 9/19 prednisone taper. One 7-day pred course may or may not be long enough to get rid of all painful swelling. So do not be dismayed if say another 7-day or even a 14-day course is Rx'd if you should need to report pain resurfacing. |
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