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Post by Janelle & Sophie on Oct 11, 2020 14:27:29 GMT -7
QUESTIONS ☆ 1 currently pain? all of the above signs EXCEPT FOR holding legs in flamingo style. During crate rest will starting yelping and trying to get up at which point she is carried outside and finds some relief after potty but then the cycle continue. Tense body all over
☆ 2 How much does your dog weigh? 15.6 lbs at last vet check (grossly underweight) A.. Tramadol 25mg 2x/day given 10am and 10 pm B.. NSAID or steroid? n/a asked vet but did not provide. I believe there may be a fear of damage done to kidneys as she is in kidney failure. I’ve never been told what stage and didn’t know until recently that stages could be diagnosed. C.. Not currently on Pepcid
[Moderator's Note. Please do not edit 15.6 lbs underweight/ 17 y.o. in kidney failure SubQ fluids at home- 100mls every other day. Tramadol 25mgs 2x/day]
☆ 3 -- Not eating or drinking well on her own. We currently syringe feed but she fights us daily. no nausea/vomiting now however before knowing about ivdd she experienced nausea vomiting, diarrhea. Currently she seemed to be struggling for a BM. 10/10 she would rest for 1-1.5 hours then wake yelping and trying to get herself out of bed. Tense body, body tremors. We took her to potty which seemed to offer some relief but then for another 1-1.5 hours when the cycle would repeat. 10/11 finally had a BM which started with three marble sized feces followed by a more “normal” loosely formed waste. SubQ fluids are given at home- 100mls every other day.
4 cocker spaniel (will be 17 on 10/15), Sophie is her name. Hi, I’m her momma, Janelle. Her dad is here too. His name is Josh. ☆ 5 problems August 12th presenting as hunched back, wobbly walk and struggling to poop but with mucous like small bits of stool occasionally and vomiting. Vet felt it was due to and antibiotic (momma thought vestibular disease) she was in at the time to treat infection. Also anti nausea medication and to diarrhea meds. Infection symptoms were not fully resolved and we returned two weeks later and given (baytril) which worsened her symptoms and we stopped the meds as per our vet. 10/02 —>Sophie still showing same symptoms only worsened and then wouldn’t couldn’t walk well (sometimes not at all) on her hind legs. Vet suggested she was just weak bc she wasn’t eating well. Momma suggested spinal problems. Vet agreed and suggested xrays. Our poor dog came back bruised and bloodied and now with blurry xrays and a hip that wasn’t moving as it did before xrays (was informed by vet that it looked like something was going wrong with the hip but couldn’t say) again, the imaging was blurry . Days later momma suspects that her rear left leg has a torn cruciate ligament and as per vet a possible fracture in front paw. There were no signs of injury previously.
Most worrisome were imaging from her spine which showed the possibility of spondylosis and thoracolumbar disc space narrowing. Sent home with gabapentin, fluids but no other course of treatments or therapies. IMO in the vets eyes Sophie’s age hinders her and so whether by his own ignorance on this subject or bc he sees her as “fragile” he does not suggest specialists or a course of treatment for her best overall outcome. I mentioned seeing a neurologist the day of the xrays and the suggestion was brushed off bc she we wouldn’t be eligible for the diagnostics needed to identify where the problem existed. We pushed for a referral this week and he finally agreed. Neurology is scheduling months out due to Covid restrictions and delays. It’s also a 45 minute drive and I worry about Sophie making the trip. Any knowledge we’ve gained or help/ care we are providing has been by our own efforts as our vet showed a lack of knowledge or defeat due to Sophie’s age. As mentioned in another question topic Sophie is in kidney failure. What stage of kidney failure I can’t say as ive never been informed. That diagnosis is (IMO) what is standing in her way of receiving proper treatment. -- General DVM ☆ 6 Sophie last saw vet 10/02 but husband met with him (10/08) to change pain meds as ask about steroids/anti inflammatories
☆ 7 10/04 there were signs of leakage and changing soiled puppy pads throughout the weekend. I was also helping to empty her bladder as she wouldn’t squat and do it herself.
10/06 the problem stopped. She began doing a half squat and peeing on her own she does not lower her head to sniff. In this time period she’s also gone from turning her paws under while walking and needing her posture corrected to be able to do it in her own. However with her recent pin the last couple of days I feel she is regressing. ☆ 8 she can wobbly walk and is using her back legs. Better now. In hind sight the wag of her tail did not happen near as often as it had years ago. It almost never happens now. Her tail was normally very relaxed but now is constantly erect whether she is laying or standing with the help of her sling.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 11, 2020 16:49:29 GMT -7
Janelle, welcome to the Forum. Glad to hear neuro function improvement. But terrible to hear she is in a lot of pain currently. That is not right! No one elderly should have to go thru pain when there are pain meds available. Gabapentin is processed by kidneys. There are other pain meds like tramadol which are processed by the liver. Do you have another vet nearby who is more knowledgeable and thinks like a vet should to help a dog with pain? What about ER to get things corrected, right now, tomorrow? Once the pain meds are correct she should be out of pain within the hour and stay that way dose to dose. Since tramadol lasts in the body for about 8 hours, an every 12 hours dosing is under medication! Often it takes 2-3 different pain meds each addressing a different source of pain to become pain free. Only one pain med and the tramadol being under medicated with a mere 25mgs and only twice a day is why she is still in pain. Find out if accupuncture or laser therapy is available as a means of pain control. Check for Holistic vets in your area. Getting the right diagnosis will aid the right vet in Rxing meds. X-rays do not prove a disc episode. X-rays are to rule out a high suspicion of other diseases (broken vertebrae, vertebrae infection, tumor, and such. Sorry to hear the horror that Sophie must have endured. There are complications with having kidney disease that we are not up on and can't comment on. There is only one disease we know how to help with. IF there is the slightest suspicion of a current disc episode, then the single most important care is the 100% very STRICT limiting of movement. The only way the disc can heal is with time, limited movement. A disc that can heal but instead increased disc tears would then impact the spinal cord and loss of neuro functions: wobbly walking> paw knuckle under> back legs drag> loss of bladder control. Super tried and true tips for setting up the recovery suite, the mattress and more! —> dodgerslist.com/2020/05/14/strict-rest-recovery-process/100% very STRICT rest means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy "whys": __ www.dodgerslist.com/literature/chiropractic.htm ◼︎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. Laser light therapy is contra-indicated with tumors which are detected via xray. 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! ** Another option is to place a pee pad right outside the recovey suite. Put some old peed on grass on the pad so Sophie knows its ok to pee in the house on the pad. This will eliminate carrying her outdoors if you are having issues with carrying
With a disc episode the medications are normally a NSAID (processed by the liver) when the dog can walk. The NSAID works to rid the body of inflamed tissue in the spinal cord.
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Post by Janelle & Sophie on Oct 11, 2020 17:14:45 GMT -7
My plan for tonight/tomorrow is to immediately research vets in my area who may have experience with IVDD. After I find the right one I will be seeking Sophie’s health records and leaving. I’m at a loss right now as her pain management is so off course. I have a severely pain crippled dog who yelps and yelps non stop. She is in so much pain and so tense her lip has curled in under her canine tooth and has nearly pierced a hole in her lip. At this point I feel the kidneys are secondary until her pain can be managed. I wonder with such complicated diagnoses like IVDD coupled with kidney failure if we will ever be able to get her comfortable again. I understand you can’t speak on kidney disease as it’s not your expertise but does it mean her situation is one that there may be nothing that can be done for her? Since she has kidney disease are you not in a position to speak to the medications i’ve seen mentionEd that could help her pain/inflammation? I just wish I knew the level of severity her kidneys would experience if she was to start on one of the medications and I know you can’t answer that. Without the diagnostic testing needed for a true IVDD diagnosis does that rule her out for any treatment/therapies/help? My feeling from her vet was one of manage her pain if you can or consider helping her cross over. Are You familiar with other members of this forum who like Sophie’s we’re dealing with possible IVDD and kidney disease. I’d like to be able to speak with them if so. I feel helpless looking at my dog so manic with pain and that I can’t do anything for her.
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Post by Julie & Perry on Oct 11, 2020 17:27:44 GMT -7
If at all possible I'd take Sophie into an emergency hospital tonight and get her some pain medication ASAP.
Bring as much of her medical history with you as possible.
My prayers are with you both.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Oct 11, 2020 18:24:31 GMT -7
Janelle, I double, triple agree with Julie. Take your dog right now to ER. It is totally unfair to leave a dog in such Extraordinary severe pain. Pain is not only torture, but it impedes healing.
Let us know what ER says tonight, what they Rx'.
Hopefully you get an ER vet who is far better than your vet in helping with the correct diagnosis re: neuro loss and pain. And the ER vet has enough IVDD common sense and education to Rx pain meds and perhaps an anti-inflammatory if it relates to his diagnosis that your vet lacks.
You NEED to get help for Sophie tonight at ER. Let us know what is Rx'd.
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Post by Janelle & Sophie on Oct 12, 2020 13:21:47 GMT -7
Hello. As per your advice we took Sophie to the ER. We are faced with a tough decision. The vet is concerned with her pain but thought it may be managed with tramadol, gabapentin and a steroid.
We are left torn. We’ve read different articles, like the one that led us to this forum, that said you shouldn’t give up on your dog just because of IVDD. Having read that leads us to ask, what is the oldest dog you’ve seen/heard of diagnosed with IVDD and what was the final outcome? We don’t want to give up on her but we also don’t want her to suffer. We are in a terrible position. We are proud of the life we have had with Sophie. We want to never give up on her. It’s hard to feel confident that you aren’t giving up on her if there’s a chance the pain medications will work. She’ll be 17 in 3 days and I wonder if you have seen dogs her age rest and feel well.
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Post by Janelle & Sophie on Oct 12, 2020 14:04:23 GMT -7
Either way we are going to the ER now to bring her home. I will provide a list of medications they prescribe when we get back. Thanks.
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Post by Julie & Perry on Oct 12, 2020 14:16:14 GMT -7
Give Sophie the pain meds and work to get her pain under control.
Once that's done you can evaluate Sophie's quality of life.
There's always hope!
Sending healing thoughts and prayers.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Oct 12, 2020 14:59:25 GMT -7
Janelle, do let us know what Sophie names of meds given at ER as well as what she is sent home on (name, mgs and how often). She will need an acid suppressor such as Pepcid AC (famotidine) while taking any anti-inflammatory drug ( e.g. a steroid). This med is processed by the liver. Verify with the ER vet if ok for Sophie's other diseases. Pogo lived over 19 years until another disease took himIVDD dogs can live a long life. It is other diseases that are the cause of death. IVDD is not a fatal disease. Let us know what the vet prescribes and if all pain is fully in control in one hour of given the meds and stays that way right up to the next dose. That way Sophie can heal in comfort she deserves and you can care for her without causing her hurt when lifting or otherwise moving her. Skipper pictured approaching 17 years.
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Post by Janelle & Sophie on Oct 12, 2020 17:49:25 GMT -7
We just got home with Sophie. Here is what we w Ere prescribed: ✙Prednisone 5 mg tablet ** Give 1/2 tablet orally once daily for three days then give 1/4 tablet orally once daily for three days then 1/4 tablet every other day for three doses. ▲Tramadol 25 mg tablet 3x a day (every 8 hours) ✙Gabapentin 50 mg capsule 3x a day (every 8 hours)
[Moderator's Note. Please do not edit 15.6 lbs underweight/ 17 y.o. in kidney failure SubQ fluids at home- 100mls every other day. ✙Prednisone 5mg tab as of 10/21: 2.5mgs 1x/day for 3 days, then taper down Tramadol 25mgs ▲3x/day ✙Gabapentin 50 mg capsule 3x/day]
Our experiences with Sophie’s care just keep getting worse. First of all, e COVID stinks. We weren’t allowed into the hospital bc of the virus. It is what needs to happen and is no ones fault but it was terrible to have to leave her. Three hours of waiting and the emergency vet called and said she was really concerned. I knew Sophie was sick but she sounded REALLY concerned.She said the words I used to describe her, “manic with pain” was exactly what she was seeing. And then she said she wasn’t standing on her own and clubbing her back paws? What? We had just taken her potty and she was walking and standing on her own with the aid of a sling of course. This is why I say our experiences keep getting worse. Our main complaint when they checked us in was pain. THEY DIDN'T GIVE HER ANY OTHER PAIN MEDICATION WHILE SHE WAS THERE. I asked if they did when they brought her to us and they said they were sure she got some and to check the paperwork NOTHING! It had been nearly 12 hours and she had only had 25mg of gabapentin. I was heartbroken for my baby girl. One thing I didn’t mention about my girl, she has alopeciaX. She doesn’t have a bit of hair in her body but guess what else Covid took? She wasn’t allowed to wear her warm pajamas into the hospital. An act I thought was so cruel and so stressful for a dog already stressed to the maximum. She was so cold when they brought her too us. And by the way I asked them to please blanket her and was told they’d wrap her in one especially for when they brought her to us. At the end of the ordeal, the stress and confusion were too much for her. We brought home a completely different dog from the ER today and I couldn’t be more sad. My husband raced home, warp speed. I honestly didn’t think she’d make the 18 mile drive. At the very least we wanted to get her home and more comfortable In anyway possible. I figured if it was going to be her time at least she could feel comfort and in no pain. She got all her meds and I gave her fluids. It was like that place sucked every ounce of fluid from her. I gave her a little sponge bath. The medicine is too much in my opinion for her little body. Her birthday is in three days and I was hopeful to celebrate with her one last time. In those days, we would see how she takes the meds. I see now what I didn’t before her trip to the ER. My husband and I are in different sides of the fence which makes it super hard. We both love her more than words could ever describe. I would give any number of my days to have more time with her but I want her to remember the great life we created for her and not the pain. I don’t want it to be seen that I’m giving up on her. I’ve gone into battle for my dog more times than I want to count. Her health, despite the amount care, concern, and love we have her was always a battle. I thought we could bring her home, have the most amazing three days with her, celebrate her birthday and then help her in her way. It kills me to say that. My husband, normally he is the fixer of all things. He will fight the good fight until the very end and never give up. It wouldn't mean suffering bc he would take care of it. It’s a hard position to be in for the both of us. His heart is so big and his love for his girl even bigger. So, our girl is home. For that I’m happy. How long? Who knows? We will use the medication, take away her pain to ensure the most comfort. I pray that the medications will take away the pain and she’ll have time to heal and spend a little more time with us. Only time will tell. But we are glad she’s here and that we can sit by her side and love on her. She’s deserves nothing but the best and we are going to give it to her for how ever many days she has left here with us.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Oct 12, 2020 18:29:05 GMT -7
Janelle, I feel your pain in worrying and being able to care for Sophie's with her many issues. She certainly sounds to be in a very delicate/fragile state.
Let us know if the medications are able to get her into a fully comfortable zone of no longer being in pain.
Let us know if at your local vet, you were allowed to stay with Sophie during the visit til they then they took her away to the X-ray room.
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Post by Janelle & Sophie on Oct 12, 2020 23:36:20 GMT -7
A couple questions...
Is it sometimes the case that the dosage of the pain meds/steroids/anti inflammatory meds need a little finessing in the beginning?
Does the combination of these medications take away all discomfort and pain? Will a dog sometimes experience pain on certain occasions (i.e when picking up the dog) even if the pain medicine otherwise seems to be working?
I’m sure it varies, but in general with a dog taking this course of pain medication what can you expect the demeanor of the dog to be? Is the dog drowsy all day [Sophie observed?]? Do some dogs experience extreme lethargy i.e.too much so to hold up the head [Sophie observed?]? If so is there an unreasonable amount of lethargy our want to see in a dog? Is the lethargy normal? If so, will a dog adjust to this particular set of side effects?
Dogs diagnosed with IVDD sometimes won’t eat or eat well, correct? Does this issue tend to work itself out once the pain is managed? Are there tips to help aid in a dogs nutrition as in other methods to get food into a dog? If a dog is only interested in lying down are there any tips to helping a dog to eat laying down?
Perhaps I missed this information in everything I’ve been reading do dogs with IVDD need to be laying down all the time? On their side? Belly?
I have so many questions. I’m trying to in my own way to get an idea of what’s to be expected during cage rest. If Sophie’s behaviors with the medication are off course of “normal” and because diagnostics are off the table and we don’t have definitive answers maybe it isn't IVDD at all, perhaps something more evil is lurking? I know you can’t answer that of course.
Thank you for the success stories. Seeing stories like that add a little hope...or cautious optimism you take your pick!
As for the question you had regarding Sophie’s visit to the vet for xrays...Sophie was in fact in the room with myself, my husband and the vet before the xrays. The situation is so clear to me bc the fact that he never made mention of the possibility that her symptoms could be a spinal issue, I HAD never really sat well with me. I had done some research and brought it to his attention when he offered the xrays. By the way, before Sophie’s symptoms progressed and she was doing her bit of drunk walking I had suspected vestibular syndrome. He told me that her symptoms didn’t present like vestibular syndrome. Then he began to explain that vestibular syndrome is like dementia or “old dogs syndrome” where the dog experienced a lot of confusion. I’m not a professional and my research may be wrong but I thought those were two different issues, one dealing with the inner ear and one a cognitive distinction. That never sat well with me either. At any rate. She was in the room and bc my dog of course has no hair and we had to disrobe her (she was wearing pajamas) we could clearly see that she was unmarked and had no bruising or bleeding before the xrays. The whole situation makes me uneasy. Had I thought about the positioning that would be necessary for the images needed I would have never agreed to the xrays. On the other hand I think it’s reasonable to expect the professional to question their clients ability to participate in the testing and then immediately stop if doing so could cause undue harm.
I digress, sorry, I’m more than a little angry at the whole of the situation.
I am happy to report that Sophie has been resting comfortably since getting home from the ER. With some care on our end she is ▲looking much better than when we picked her up from their care. The medicines worked very quickly, certainly well before an hour. For the moment I’ll take my happiness in her being home and in comparison to yesterday much more comfortable. We will see what tomorrow brings. I’m going to approach it with cautious, pawsitive, optimism.
Thanks for your attentiveness in all my rants and questions!
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Mary & Mila
Helpful Member
FEMALE— DACHSHUND
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Post by Mary & Mila on Oct 13, 2020 1:45:17 GMT -7
Hi Janelle, I'd like to add my welcome to Dodgerslist. I am really sorry to read about Sophie's issues. In answer to your question about the meds, when the correct meds in the correct dosages are on board your dog should have no break through in pain. The dog should be then comfortable. Pain hinders healing so don't tolerate it for a second. If you do see any more signs of pain you need to call your vet immediately and inform them. The link below explains the role of pain meds during a disc episode, having been there with my own dog I understand there is a lot of info to take in, all at once, but you'll get there. dodgerslist.com/2020/05/30/pain-medications/You may this link interesting too, it is a question posed by another dog owner regarding pain meds and how they work together. Tramadol and Gabapentin work synergistically i.e. work well together. Gabapentin works on nerve pain, tramadol as a general analgesic. dodgerslist.com/2020/09/02/timing-pain-medications/Sometimes the meds effect a dogs appetite, if this is the case try some tempt Sophie with small pieces of her very favorite food, trying smaller meals more often until she is back to normal. Sophie doesn't have to be lying down on her side or tummy all the time, as long as she is confined to her crate for now, she'll be fine, she may sit up later, dogs will also move around to get more comfortable, I'm not sure where you have her crate, but you may find she'll have more interest in what's going on in the home if she is in a space where she can see you. She's been through a lot for a dog her age, I'm sure after a day or two with no pain, in her own home and lots of TLC she'll start to come round. best wishes Mary
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Oct 13, 2020 5:48:41 GMT -7
If in fact Sophie is showing signs of pain when being picked up, then her pain meds must be adjusted ASAP this morning. Anyone in the hospital can pull Sophie's records and adjust the meds. Speak to them about increasing the Tramadol to 50 mg 3x/day. Also speak to them about adding Methocarbamol, also 3x/day. Methocarbamol is a muscle relaxer that works on the pain of muscle spasms that often accompany IVDD. Have no patience with pain as pain does hinder healing.
Not eating or not eating as well could be a due to pain but it could also be a red flag sign of GI distress caused by the Prednisone. It's imperative that Pepcid AC (Famotidine) be brought on board ASAP today. Please get your vet's permission to give 5 mg of Pepcid AC (generic is famotidine) 30 minutes before the dose of the anti-inflammatory and thereafter every 12 hours. Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If your vet says your dog has no health issues such as liver, heart, etc to keep her from taking Pepcid AC, then do get it on board. If there are health issues that prevent the taking of Pepcid AC, then speak to the vet about getting another type of stomach protector on board ASAP.
As to your questions about lethargy, are you saying that Sophie cannot pick up her head? Gabapentin can make a dog drowsy but not to the point where they can't pick up their head. Do you see any kind of difference in her breathing? Please let us know what you are observing.
Healing prayers for Sophie.
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Post by Janelle & Sophie on Oct 13, 2020 8:06:19 GMT -7
I think I’m trying to find hope in one small situation with Sophie all the while ignoring the bigger picture...
Sophie is nearly 17. Her birthday is in just two days. The medications incapacitate her, no, she is not able to lift her head when she takes them. She cries even with the medications...not cries...SCREAMS! She isn’t retaining n the fluids she is given. Standing up outside to potty was even difficult for her not because of what is going on with the spine and pain but weakness.
My fault as a pet parent may be loving her too much, so much so that I overlook (whether conscious or subconsciously) things that are staring me right in the face. I looked at her paperwork from the ER and was alarmed to see that she is only 10.9lbs. She had been weighed less than a week ago and was 15.6 She is withering, no, has withered away despite our efforts. At this point we are force feeding her. We have to force the syringe into her mouth to get her to eat any food even what we’re her most favorite. If I were responsible as a pet parent would I see that her refusal is more than just not wanting to eatI’m fairly certain I’m not looking at the big picture. To do that would mean I’d have to face the truth. The truth is I know IVDD is not the true culprit here. I think it’s one soldier in the war she is fighting against her body., Her kidneys, age and a life well lived are alongside the fight. They are taking her down. We’ve fought many battles with Sophie through the years and always come out the victor. Today might not be one of those days.
I woke to Sophie’s cries today. She sleeps next to me in a bed my husband made for her. It’s larger than a babies crib, wooden with a ramp, carpeted and painted pink. It fits her bed so she is right there next to me in her bed and I in my own. I woke her with the same banter I do every morning and then I sang to her. It’s a gesture that any other day calmed her, today it did not. She looked me in the eyes. It’s something she hadn't done in the last day. I know the look and I always said I’d never ignore it. There it was. Staring me straight in my face.
I love my girl. She’s been a loyal companion to me. She’s stolen the hearts of everyone she’s met and turned many who thought it was impossible into dog lovers. My father in law says she turned him into “not so much a dog lover but a Sophie lover.” She was funny and sassy and would talk back like a diva if she didn’t get her way. I use past tense when talking if her but she’s still here with me only they are sides of her that we only see glimpses of anymore. The pain of her fading away makes the saying “heartbroken” become less of a saying and more a feeling. I don’t remember what life was like over 17 years ago before I was Sophie’s momma. My husband and I joke, “heck we might not even like each other without Sophie around.” We don’t know what it’s like without her. She was mine before he was mine. He and I are lucky to have had her love for so many years, many more years than others get the privilege of spending with their dogs. I cherish everyday, I wish there were more. Goodness, do I wish there were more.
She is tired and she is weak. I’m laying in her bed next to her now. She’s trembling under two blankets and our heat on full blast. Her stomach is making strange gurgling sounds, legs randomly twitching, her breathes are slow and shallow. I tried putting the taste of food on her lips and she pulled her head away. She’s gotten her new dose of medications with a higher dose (50 mg ▲tramadol) approved by the vet.
[Moderator's Note. Please do not edit was underweight @ 15.6lbs; week later ▼10.9lbs lbs / 17 y.o. in kidney failure SubQ fluids at home- 100mls every other day. Prednisone 5mg tab as of 10/12: 2.5mgs 1x/day for 3 days, then 10/15 taper down Tramadol ▲25mgs 3x/day Gabapentin 50 mg capsule 3x/day]
I know she’ll be comfortable for awhile. Im not giving up on her. But I’m am giving her the respect and dignity she deserves for all she’s done for me through the years. I’m giving her that with my understanding that sometimes there are some things that just can’t be fixed. I don’t know when/if I’ll actually have to make a phone call if she needs it. I hope I’ll find the courage if necessary. . But I know I can’t continue to force her to keep fighting when she is so weak and tired and ultimately I can see what she it is what she wants.
I pray I’m not making the wrong decision either way I’ll likely never forgive myself. But if there’s one thing Sophie’s taught me its how to be selfless. This may be my true test and I owe it to Sophie to score an A+...
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Oct 13, 2020 9:43:29 GMT -7
If the increased dosage of Tramadol isn't getting Sophie's pain completely under control, do speak to the vets about adding Methocarbamol ASAP. And with the gurgling in her stomach, do also speak to them about adding a stomach protector such as Pepcid AC. Here we are all about education as knowledge is power. I am most reluctant to share information about another disease that could happen on top of any kind of severe spinal cord injury. Let me clarify I do not share this information to scare you but so are not in the dark if you would see concerning signs. Not all vets know this disease so it would be important to have a discussion with your vet even if just to relieve your concerns this is not M. The cause of M or how it progresses is still unknown. It is important that owners are also familiar with symptoms in order to promptly get vet help at any hour of the night or day. Although Myelomalacia was thought to be rare, we are finding that perhaps it is not as uncommon as once thought. Many vets have never observed a case of Myelomalacia so you might want to print out the symptoms listed below so you can discuss and have a plan.With Myelomalacia, what happens basically is that the spinal cord starts to die from the point of the spinal cord trauma moving forward toward the head. It is very painful and if it continues to progress up the spine, it will eventually shut down breathing. Here are some of the symptoms that are used to diagnose Myelomalacia and the symptoms that evolve as it progresses. It can happen fast, within hours. Should your dog be developing myelomalacia that is ascending (moving up towards the lung – not descending – and getting near to the lungs which will cause respiratory paralysis), you would want to help him cross to the rainbow bridge to spare a very painful death. Deep pain sensation nor leg function not returning right away alone are not symptoms of myelomalacia. Myelomalacia can be easily confirmed by your DVM with the following: * about 3-4 days into recovery, they become painful. Within the first week, they are in a LOT of pain. * development of excruciating pain (more than just pain from the original disc herniation) • even the strongest pain meds do not help • once the symptoms begin continued death of the spinal cord happens fast.. in a matter of hours, requiring prompt ER vet help and prevent suffering that will only end badly in death. • hyper-esthesia (over-reaction to any touch sensation on body) * acute disc extrusion with no deep pain sensation * loss of anal tone, the anus hangs open, (anal flaccidity) and areflexia (below normal or no reflexes) * loss of cutaneous trunci reflex at a level more cranial to a previous evaluation over a period of hours to days with or w/o surgery * development of fever (normal rectal temperature is 100.5 to 102.5 degrees Fahrenheit) * sudden twitching or jerking of the neck and/or head * loss of voice, hoarse bark * can't hold body up, can't hold head up * increased respiration/ labored breathing as the nerves to the lungs begin to shutdown • On an MRI, extensive high T2 signal (brightness) within the spinal cord (>6 vertebral lengths) has been associated with myelomalacia in the setting of a disk extrusion. www.dodgerslist.com/literature/myelomalacia/3t-myelo-misdxb0002.tifIf she develops a fever, also dogs with M are in so much pain, they are hyper sensitive to touch and the pain meds don't work for it. It would be very obvious that she is in agony. If she develops those symptoms, take her to ER. But do also be aware that Sophie is not yet on aggressive pain meds so it may just be that the pain meds are not yet right. You described Sophie's breathing as slow, not increased so that may be due to pain - pain can cause shortness of breath. She may not want to move to hold head up due to pain. I'm hoping and praying that M is not developing but just having a hard time getting pain under control.
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Post by Janelle & Sophie on Oct 13, 2020 18:10:48 GMT -7
Thank you for the information. I am a researcher through and through. I will be busy tonight so if M should come into play I am prepared. I appreciate you being forthcoming and honest. Being left in the dark doesn’t sound like a place I want to be when it comes to M. When you spoke of it i was reminded that the ER doctor mentioned Sophie’s brain and how it’s responding during the episodes of pain. My gears started to grind when you mentioned M and her the brain and if the two are related. Interesting.
As for Sophie today, she’s been sleeping the entirety of the day. I actually mentioned to my husband that “she did this weird head twitch” and she had more twitching of the legs all day. Tremors come and go. There is no real change to her breathing than it was before. It’s slow and seems like there is a lot of time in between breathes. She does have a more hoarse cry at times, something new I also pointed out to my husband earlier. She also has a sort of small crackle sound from the mouth here and there. She is puffing air into her cheeks and holding it there when she’s doing it.
The pain meds did seem to work through the 8 hours until the next course this time around. We’ve noticed when she needs to go to the bathroom her cries will start. Bowel movements are especially upsetting to her. Picking her up still causes the crying so if possible I’ve been helping her relieve herself. Standing on all four legs continues to be a struggle since our trip to the ER. She does have more color than when she woke today. Hydration is the same but her kidneys of course are to blame for that. I believe that SubQ fluids may be needed daily. 100 mls every other day is not enough at this point. She’s eaten a little and drinking more. I’ve found that soaking a paper towel in water and dripping it in her mouth works best for her since she is laying down all the time. The wane and ween of it all is very confusing. Just as soon as you think it may be her end she turns around slightly and gives us hope.
I have to say this forum has been a lifesaver throughout the last couple of days. It’s a more comfortable position to be in when you are armed with a little knowledge. Thank you for that. My husband read through all my rants and jokingly said, “ask her where I can send the check!” Thank you for the time you’ve taken to address everything so throughly. That goes for everyone who has responded. You offer some peace of mind throughout the craziness of it all.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 13, 2020 19:40:25 GMT -7
Please do watch over your sweet girl tonight. Changes in breathing are worrisome anytime, but especially if it would be "M"
Be prepared even if it would be in the wee early hours of the morning to take action to get to an ER vet to help her pass before a dying spinal cord moves up to the nerves going to the lungs. Where the lungs and shut down and she would not be able to breathe. One of my dogs did develop M and it progressed rapidly from my suspecting it about 9pm to when I knew at 3am it was time to have a vet confirm and help her. By the time I got to ER, the vet looked up M and was able to confirm what I had reported. I was able to hold her in my arms as she gently passed avoiding the painful stage of not being able to breathe.
Praying it is not M.
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Post by Janelle & Sophie on Oct 14, 2020 0:09:04 GMT -7
We are back at it again today, around the same time as yesterday (1:22 a.m) and Sophie’s has what I’ve labeled a “pain episode”. The last two nights (I only just started to take notice of any pattern) she starts crying. The first thought is she has to go potty. She did urinate and have a bowel movement. However this time after doing so the episode didn’t stop and was far more severe than during the day. I would say the episode that follows is not as severe as when I described her as “manic with pain” but pain nonetheless. Another change that started tonight she started peeing where she is laying. Then she started crying as if to ask me to come change the pad beneath her. She never even opens her eyes despite me carefully cleaning her, removing her clothes and changing the pads on her bed. We were an hour away from her next dose of medication. My husband and I disagree on this but I believe that in her voice I hear what seems to be a horsiness or raspiness. There’s a wheezing on occasion. The horse sound in her voice is a newer sound compared to her normal cry. I wonder if what I’m hearing is indeed the sound like listed in the symptoms of M or perhaps bc of voice strain? Perhaps my mind playing tricks on me after reading the symptoms? Did your dog experience a horse voice? I took a video of the the sound. I thought I might research and see if I could find something similar on the internet to compare. A little over an hour and she’s finally calmed down to a more manageable level. But then starts body tremors and maybe a head twitching or it’s part of the tremors too. An hour and a half later and she’s calm. I just can’t understand the pattern when during the day she was comfortable. Any history of this sort of thing in other dogs before?
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Marjorie
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Post by Marjorie on Oct 14, 2020 5:17:25 GMT -7
The fact that this pain episode occurred an hour before the meds were due indicates that the pain meds are not right yet. There should be no sign of pain from one dose of pain meds to the next. Pain is often worse at night. Please advocate strongly today for the addition of Methocarbamol 3x/day. Has the taper of the Prednisone begun? I know that with the other medical issues involved, the vets may be reluctant to continue Prednisone. However, it can take 7-30 days for the swelling to resolve and until then, the anti-inflammatory dosage is necessary. Anything less than the anti-inflammatory dosage will not be effective on reducing the inflammation pressing on the spine. For a dog of Sophie's weight, we usually see 2.5 mg being given twice a day for at least a week before trying to taper. Pain indicates that there is still swelling. Please speak to the vets about the possibility of increasing the Prednisone to 2.5mg 2x/day for at least a week to get that swelling down ASAP. More info on the inflammation phase of IVDD: dodgerslist.com/2020/04/22/healing-swelling-inflammation/Please also get a stomach protector such as Pepcid AC on board today. Check with the vet as to which stomach protector would be best with the other medical issues involved. Sophie has enough to deal with and doesn't need stomach ulcers to start up. A stomach protector is necessary for as long as Sophie is on any dosage of Prednisone, even during a taper. Peeing in her bed may be due to not wanting to move because of the pain she's in or she may have lost bladder control. You've mentioned before that you help her go potty. By that, I take it to mean that you manually express her bladder. If she continues to urinate in her bed, you'll need to express. You can express her when she's laying down if that works. More info here: dodgerslist.com/2020/05/05/bladder-bowel-care/Continued prayers for you all.
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Post by Janelle & Sophie on Oct 14, 2020 8:07:27 GMT -7
Thank you. ✙Pepcid ac has begun along with prednisone.
[Moderator's Note. Please do not edit 10.9lbs lbs / 17 y.o. in kidney failure SubQ fluids at home- 100mls every other day. Prednisone 5mg tab as of 10/12: 2.5mgs 1x/day for 3 days, then 10/15 taper down Tramadol 25mgs 3x/day Gabapentin 50 mg capsule 3x/day ✙Pepcid AC ?mg ?x/day ]
The ER doc who saw Sophie and prescribed the meds was unavailable yesterday. I assumed that to mean she didn’t work. I will be calling her again today.The day of the ER visit what the doctor at the ER did communicate with me regarding the prednisone and said she was giving Sophie the lowest/healthiest dose for her kidneys.
And now that I type that I’m questioning how she could have known the state of her kidneys to make that judgement call. She was not able to tell me the stage of Sophie’s kidney disease when I asked bc no tests were ever run that day. I’m still searching for a local vet with any sort of knowledge with IVDD after the fiasco with her previous vet. I’m looking for a vet willing to speak about their experience before being a patient, a request that doesn’t seem so unrealistic but yet met with trepidation. Some offices in my area are not accepting new patients at all due to covid.
The vet we had been using did reach out to me saying that he was sorry and felt terrible. That everyone at the office loves Sophie and if she needed any help he would be privileged to do so. The gesture almost pulled me back in bc the struggle to find a new vet has been real. I thought the it was kind on his part to reach out and check on Sophie considering I was pretty aggressive on the phone with him. My husband says I was still too nice. Would it be a moment for him to educate himself while helping Sophie if we went back? Ive been awake for over 24 hours now. I’m hoping to force myself to catch some rest if Sophie is peaceful for even a short time today.
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Post by Janelle & Sophie on Oct 14, 2020 9:30:53 GMT -7
Also, yes I do help her express her bladder. I’m able to help her standing or laying down. Thanks for the video.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 14, 2020 9:32:26 GMT -7
Janelle, what did the vet say the dose of Pepcid AC 2x/day should be in light of kidney disease?
It would be good to have a vet who is willing to learn about IVDD and to work with you in helping Sophie. Your local vet has examined Sophie for this disc episode. Therefore he can make needed adjustments to meds without requiring Sophie to make any further risky trips into his clinic. Now you have two vets (family vet and ER vet) who have seen Sophie and could Rx med adjustments if needed over the phone. Thursday, 10/15, will be the day there will be a reduction of prednisone. Since pain has never been brought under control, there really should NOT be prednisone taper starting tomorrow! You need vet help via a phone call. ---Discuss the pain you observe. ---Advocate for proper compliment of pain meds to be on board to cover each kind of pain √ Tramadol as the general analgesic √ Gabapentin for nerve pain Methocarbamol for muscle contraction pain very typical with a disc episode. "body tremors, twitching of the legs" --- Prednisone 2.5mgs 1x/day be extended, NOT TAPERED down tomorrow. Please let us know which vet over the phone was able to give you medication help TODAY, asap.
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Post by Janelle & Sophie on Oct 14, 2020 15:54:20 GMT -7
Good news all around. I was able to get the go ahead for the Methocarbamol and the Pepcid AC. ✙Methocarbamol 15 mg/kg twice daily is what he mentioned. Pepcid 5 mg 2x a day. [Moderator's Note. Please do not edit 10.9lbs/ 4.94 kgs / 17 y.o. in kidney failure SubQ fluids at home- 100mls every other day. Prednisone 5mg tab as of 10/12: 2.5mgs 1x/day for 3 days, then 10/15 taper down Tramadol 25mgs 3x/day Gabapentin 50 mg capsule 3x/day ✙Methocarbamol dose 15mg/kg: 75 mgs 2x/day Pepcid AC 5mg 2x/day ]
Although I had some clear issues with this particular vet in the past I made my expectations very clear to him. He understood and is on board. He’s a caring individual but limited to mostly general veterinary knowledge. His ignorance limited our options. He was reluctant or the thought seemed to not cross his mind to reach out to his peers for advice not quick to offer referrals. We found ourselves more than once coming to him with what we suspected was ailing Sophie before he was able to identify the issue. Im hopeful he can use this opportunity and learn about IVDD to broaden the scope of his expertise.
A big win for me is his understanding of limitations transporting Sophie. At her age she is weary of the car in general but I think it’s dangerous and harmful in her condition. My husband was at work and although I have a car we do not leave her at home alone any longer. We did everything we needed to today via text messaging. After a long night and little sleep and a wreck of a house bc all the care and concern has been focused on Sophie I’m going to mark this as a win! I kept wanting to make it to her birthday but the outlook seemed grim. Tomorrow is the day, it’s her birthday! ..HAPPY 17th BIRTHDAY TO MY GIRL!
The office is closed as of now but I will speak about the prednisone tomorrow and keep you posted.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 14, 2020 17:35:03 GMT -7
Janelle, very glad you were able to communicate with your vet and got methocarbamol on board at 75mgs 2x/day. Kudo's to you! Good job! Watch Sophie for signs of pain surfacing as the Methocarbamol wears off in about 8 hrs. If so, advocate for the usual of methocarbamol every 8 hrs (3x/day) How many mgs are in one methocarbamol tablet? Will be watching tomorrow to hear pain is has been controlled thru the night right up to the next dose of pain meds. Also that prednisone 2.5mgs 1x/day has been extended for maybe a 5-7 day course, then a test taper down to see if swelling still exists. With delicate Sophie, short pred courses and then a test makes sure she is on pred no longer than what she actually needs. Help your vet learn more about IVDD. Order our free IVDD literature to give to him to use with his clients here: dodgerslist.com/free-literature-2/ Very happy 17th birthday wishes to you Sophie !!! 🎈
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Marjorie
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Post by Marjorie on Oct 15, 2020 4:44:08 GMT -7
Happy birthday, Sophie! We hope to hear good news today that your pain is now completely under control.
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Post by Janelle & Sophie on Oct 15, 2020 15:39:03 GMT -7
Today has been a pretty good day for pain. She’s been comfortable. The only time she seems to have it is [pain] when she needs to go to pee and poop. I’ve been able to identify the cry that she makes which is good so u can immediately change her pee pad. Pooping is another story. She gets extremely uncomfortable [pooping] at this time.
I’m still awaiting the ER NURSE to return my call regarding not tapering off her prednisone.
Another small victory today, I found a balm I purchased a couple months ago that is a more natural approach but after going to the bathroom I rubbed it on her and it seemed to relax legs and her Body overall. It says it’s a natural anti inflammatory so I thought I’d try it. Another positive is she ate 1/2 a cup of food in one sitting today. Eating has been a real struggle with her. Another struggle we’ve been having are giving her all these pills. It’s become a real source of stress for her despite our best efforts. She’s pretty slick and pops the pills SO QUICKLY out of her mouth. You can put the pill in the back towards her throat, close her mouth gently and breathe onto her nose, think they’re down. Instead she’s managed to regurgitate the pill and often stash it in her cheek to spit out when you’re not looking. I’m happy to take any suggestions you might have. Pill pockets or sneaking them into food bc she’s reluctant to eat lately. She sees us getttung ready for her meds and her anxiety starts. I don’t want it to be such a negative situation for her
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Oct 15, 2020 17:14:43 GMT -7
While on the big gun Prednisone anti-inflammatory drug DO NOT give anything else that is an anti-inflammatory natural or not. Some natural anti-inflammatories are distinctly not compatible (dangerous) with a steroid. Sophie does not need another issue on top of this disc episode. Pain when moving is BIG pain not to be tolerated. Hope for a success in advocating for all pain meds given 3x/day (pred is not a pain med) and that Pred, the anti-inflammatory gets back up to the origami dose. Clearly on the pred taper today, with pain, it is not time to reduce pred via a taper. See if any of these ideas helps with pilling. -- both tramadol and gabapentin are extremely bitter. Wash your hands of any dust after splitting. Enclose these pills in something yummy to further cut the chance of tasting any of the bitterness. Monica Segal, certified nutritionist, offers this great idea in pilling a dog: "Keep life interesting. Dogs are masters at body language, and when you worry, the dog worries too. Feeding a bite of cheese with a combination of dread and hope is unlikely to give positive results. Make it a happy game. Hid a pill in cheese? First tiny bite has nothing it in, second bite has nothing in it, third has the pill and fourth has nothing in it again." www.monicasegal.com/wordpress/?p=1141Put 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 is on the exterior. À la Monica's idea, use the 4 treat method to retrain Sophie to trust you. Prepare 3 treats with no meds inside PLUS one with med in the ball. Give plain treat while holding med ball in front of eyes. The idea is your Sophie will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so she will hurry to swallow the med ball to get to treat #3. #4 plain treat is to make sure she has swallowed pill treat. Dawn & Ollie, members, highly recommend this pill paste (Vetoquinol Care Pill Wrap). Ollie now has no problem taking his meds. Shop on-line for best price- under $15. This veterinarian gives the best demo on how to pill a dog.
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Post by Janelle & Sophie on Oct 16, 2020 1:02:18 GMT -7
Thanks for the information on giving pills to Sophie. I’m going to attempt the 4 pill method and just keep trying and also but the paste that was recommended. The struggle we are having is that Sophie is refusing all food, even foods she once loved. My husband even baked her a birthday cake, dog friendly of course. She wouldn't eat a bite. She ate about two cups of food today, the most she’s eaten in over a month. Every bit of those 2 cups was force fed bc at this point we can’t afford for her to lose anymore weight. Eating is a double edge sword For us at the moment. I don’t want to make eating a negative experience for her but without forcing her to eat she is withering away. Aside from controlling her pain, putting weight on her is at the top of our priority list. Go in no to the bathroom seemed painful for her today evem an hour or so after having her pain meds. She is fine until she needs to go or maybe when she feels the pressure of having to go. And hour or so is more than enough time for the medications to have been controlling the pain. I told my husband it made me wonder if there is more than just IVDD going on inside her. Do dogs sometimes go on doses higher than what she is in right now? I couldn’t imagine adding more pain medication bc she is basically comatose with her current dosage. Is there another way to structure her pain meds or something else we could do or suggest to the vet to help with this? We are still waiting on a call back from the ER vet. My husband called this evening for the second time and still we have heard nothing. I did not taper her down like directed in hopes she will return the call. If not I’m going to have to ask her regular vet if he could prescribe more prednisone to adjust accordingly so as to not taper down yet.
[Moderator's Note. Please do not edit 10.9lbs/ 4.94 kgs / 17 y.o. in kidney failure SubQ fluids at home- 100mls every other day. Prednisone 5mg tab as of 10/12: 2.5mgs 1x/day for 3 days, then 10/15 taper down Tramadol 25mgs 3x/day Gabapentin 50 mg capsule 3x/day Methocarbamol dose as of 10/14 15mg/kg: 75 mgs 2x/day Pepcid AC 5mg 2x/day ]
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Oct 16, 2020 5:19:46 GMT -7
Janelle, you shouldn't need to wait to speak to the same person at the ER who examined Sophie. Any of the vets at the hospital should be able to pull Sophie's records, review them and make any adjustments necessary to the meds. Pain is considered an emergency and should be treated as such. The hospital prescribed these meds and needs to make adjustments to them whenever necessary. Speak to whichever vet will work with you today to get Sophie's pain under control. It can take several adjustments to get it right. It could be pain that is causing Sophie not to eat but it could also be a side effect of the Prednisone. With some dogs, Pepcid AC is not enough and a second stomach protector - Sucralfate - needs to be added. Sucralfate works in a different way to bandaid the damaged mucus lining and also promotes a healing environment. Sucralfate will require timing with other meds…so do your homework so you can discuss things with the vet: www.marvistavet.com/sucralfate.pmlWhen you do speak to a vet today, whether the ER or the regular vet, do speak to them about the possibility of increasing the Prednisone to 2.5mg 2x/day for a short period. The sooner the swelling that's pressing on the nerves of the spine goes down, the sooner the pain will stop. Prednisone. Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily. Dr. Dawn Ruben "Prednisone/Prednisolone" www.petplace.com/article/drug-library/library/prescription/prednisone--prednisoloneMethocarbamol has a short half life and works best when given every 8 hours (3x/day) so speak to the vet about prescribing this dosage 3x/day.Amantadine: When meds are properly used at the aggressive dose and 3x/day but pain is still not fully controlled, then bring to the discussion with your vet the addition of Amantadine for further control of that tough pain. Pain is a complicated issue. Often it will take 3 pains med for full control. Each pain med works on a different type of pain. Amantadine is something we are seeing neuros Rx as part of the pain med cocktail. The Mar Vista vets explain the mysteries of Amantadine marvistavet.com/amantadine.pml Basically when stressed as our dogs are with a disc episode they may be more susceptible to physical pain. Muscle spasms hurt worse, everything hurts more. Amantadine alone is not an effective analgesic but when combined with the other IVDD pain relievers (methocarbamol for muscle spasms, gabapentin for nerve pain and tramadol as the general analgesic), it adds an extra dimension of pain relief. At this time veterinary experience with Amantadine is rather limited but it seems to be emerging as helpful addition to pain relief regimens for our IVDD dogs. As always be fully knowledgeable about each med by reading the link provided above. It may take several days for Amantadine to become effective. I know this is a lot of meds and I understand how fragile Sophie is but all of these meds are typical for an IVDD episode. You should also speak to the vet about the possibility that Sophie could have a urinary tract infection which is common with IVDD. When urine lies for too long in the bladder, it can quickly lead to infection. While the fact that you see pain when she goes potty could be due to the fact that she's being moved, it might also be due to the fact that it's painful to urinate due to a UTI. See if the vet will accept a urine sample to test for a UTI. You might also want to add some pumpkin to help Sophie defecate, which might make it less painful for her if she has any constipation from the meds. Pumpkin can help firm up stools OR it can help to loosen stools. Give one teaspoon of pumpkin for every 10 pounds of body weight per day. To loosen the stool, add equal parts water to each kibble meal along with plain canned pureed pumpkin 1x a day. To firm up the stool, add pumpkin to kibble and no extra water 1x a day. Note alternatives for constipation: really ripe mashed fresh pear, just take off the peel; microwaved and mashed peeled sweet potato. Continued prayers for Sophie.
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