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Post by Kim & Rudy on Nov 1, 2020 15:27:32 GMT -7
[Please do not edit this post. Moderator is currently reading and marking post to organize the chain of events and the date each happened on. Please add missing data in a new post. Thanks! ]
[Original subject line:Kim's Rudy, Conservative 10/22 8yo dachshund ]
Rudy is an active 8 yr old male dachshund. He is in great shape and weighs 16lbs.
On 10/22, Rudy was fine one minute and then he wasn't. He was walking with an arched back and I knew the look he had that he was hurting. I took him to my DVM and was prescribed 100mg Gabapentin every 8hrs and a 3 day course of Prednisone 5mg 2xs/day.
The vet wasn't too concerned because he said he still had good reflexes in his hind legs/no paralysis. His pain only got worse the next few days. I noticed he had some weakness in his right front foot. On 10/26 I called my vet but he was on vacation so I went to my mom's vet (DVM) and she did Xrays but could not see any issues. She does believe it is IVDD but could not confirm without an MRI. She prescribed an additional pain medicine called Buprenorphine 0.3mg/ml liquid and I was to give him 0.48ml every 8 hours. He seemed to get some relief while on the meds but there was periods when the pain would break through before the next round was due. Rudy seems to have a side effect from either the pred or gaba that makes him pant and increase breathing rate. It always kicks in after I give those two medicines.
Last night (10/31) was hard. I gave him his medicine at 11pm and by 1am he was yelping, panting, shaking, and salivating all over his bedding.
So this morning 11/1, I took him to an ER vet (DVM MS PhD) and they changed up his medicine. He now has methocarbamol 500mg 1/4 tab/12hrs and tramadol 50mg 1/2 tab every 12hrs. I am to continue with the prednisone and Gabapentin and I should stop the Buprenorpine.
[Moderator's Note. Please do not edit
16 lbs
Prednisone as of 10/22: 5mgs 2x/day for 11+ TBA days, then test taper for: √10/26 pain / √10/26 neuro
gabapentin 100mgs 3x/day
methocarbamol as of 11/1 125mgs 2x/day
tramadol 25ms 2x/day
Pepcid AC ?mg ?x/day as of 11/1
She told me to NOT give any of these medications at the same time and I should space them out at least 2 hours from each other. I gave him the methocarbamol and he had blissful relief for about 3hours and then started trembling again. Then I gave him the Gabapentin and prednisone and now he's panting and breathing fast. I have not tried the Tramadol yet since it has not been 2 hours since I gave the Gabapentin. Do you see a need to space them out like that? Her reason was the sedating effect was too much for each medication to be taken simultaneously. He is on strict crate rest since 10/26 and I have purchased the Pepcid to add to his dosing schedule.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 1, 2020 16:30:28 GMT -7
Kim, welcome, we are glad you are here. A three- day course of pred is not very likely to get all the swelling down in the spinal cord. Tapering days that started on 10/25 are to test if all the swellinggone or if another course of pred is needed. NOTE: lack of strict crate rest could also have caused a re-tear to the early healing disc, more pain, new neuro diminishment in front right foot you saw on 10/26. Is Pred still in the taper or was it put back up at the necessary anti-inflammatory level of 5mgs 2x/day to work on painful spinal cord swelling?The pain meds are too low at a frequency of every 12 hours. That is why you may be seeing pain surface before the next dose.--- while spacing the pain meds is one option, it is NOT the usual vet option. Clearly the 2 hrs apart is not for Rudy! --- each pain meds works on a different kind of pain. So always on kind of pain is lacking is a high enough at every 12 hrs keep pain at bay.-- Read what is the more usual from a Board certified Neuro specialist, Dr. Galle, on the timing of meds: dodgerslist.com/2020/09/02/timing-pain-medications-- ADVOCATE for all three meds (tramadol, methocarbamol AND gabapentin to be given at the same time and PROMPTLY every 8 hrs.PANTING Pred and tramadol, stress AND pain can cause panting.If panting from meds try this:-- Try a fan near crate but not pointed at the dog to help circulate air some. -- Try a frozen broth ice cube to lick on gently because it sounds as though Rudy has a NECK disc episodeDr. Isaacs discusses this issue: dodgerslist.com/2020/06/13/panting-causeFRONT RIGHT LEG Please describe the neuro diminishment the front right foot. Details help us ti visualize what is going on--- does the paw knuckle under--- is the front right leg wobbly in walking?--- crossing over other leg?NECK DISC
Did any of the vets think this to be a disc in the neck rather than in the back? Neck discs just are more painful and can take longer to heal due to the head moving most often with any other part of the body moves.These are the extras you can do at home for a neck disc and won't hurt if it were to be a back disc. dodgerslist.com/2020/05/05/cervical-care-tips/
What are you currently observing regarding pain today 11/1?Three kinds of pain with any disc episode (neck or back). Prompt dosing every 8 hrs keeps the med level in the body at a sufficient level for the dog to heal pain free in comfort round the clock. —Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. There should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, interested in life self when pain is fully under control right up to the next dose.
SIGNS OF PAIN: ◻︎ shivering-trembling ◻︎ yelping when picked up or moved ◻︎ slow to move ◻︎ tight tense tummy ◻︎ arched back, ears pinned back ◻︎ head held high or nose to the ground. ◻︎ restless, can't find a comfortable position ◻︎ slow or reluctant to move much in crate such as shift positions ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg flamingo style not wanting to bear weight ◻︎ not their normal perky selves
Excellent reading about use of anti-inflammtories during a disc epidode.--- Learn why Prednisone is not a pain reliever, how long it could take to rid the body of all painfully inflamed and swollen tissue around the spinal cord. dodgerslist.com/2020/04/18/steroids-vs-nsaids/ Are you giving Pepcid AC(famotidine) 5mgs every 12 hours as of today?
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Post by Kim & Rudy on Nov 1, 2020 17:24:14 GMT -7
Thank you for your reply. I am so thankful to have found this forum. The Prednisone was never stopped and has been continued with the initial level of 5mg 2xs a day. He has been on this since 10/22.
His pain today has been low since starting his new medications. I do agree that it seems to be a neck issue because of his reluctance to lift his head and/or turn it. His right front paw knuckles over at times when he first stands but when he walks it seems to resolve itself.
Other than being a little weak and wobbly from the medication, his gait seems to be ok, no crossing legs or anything like that. I have not started the Pepcid but I will 30 minutes before his next dose of prednisone. I plan to consult with my vet tomorrow 11/2 and will advocate for increasing the dosing to every 8 hours.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 1, 2020 17:39:20 GMT -7
How many days is he to stay on Pred 5mg 2x/day before starting a taper to test for pain? All vets must take a guess as to how long the pred course is to be. Have low pain is still not good enough. It should be full control of pain dose right up to the next dose. You have described the symptoms of a neck disc! As mentioned they can be very much more painful and thus need for sure an every 8 hr dose for each med. Combining the meds to give at same time is known to be more effective for most dogs. Also a much saner schedule for you. MEDICATION CHART Do you have a med chart set up? **  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 dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdfAre you going to be giving Pepcid AC (famotidine) 5mgs every 12 hours ?
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Post by Kim & Rudy on Nov 1, 2020 20:30:18 GMT -7
When I spoke to my vet on Friday 10/30 she said that we’d discuss tapering off of the prednisone after we see how his pain has been over the weekend. Since it hasn’t been pain free, he will stay on the prednisone for longer.
Yes, he will be getting the Pepcid 5mg every 12 hours.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 1, 2020 21:29:09 GMT -7
Let us know what specifically you are still seeing as signs of pain.
Advocate for each of the 3 pain meds to be given every 8 hours to provide the full relief round the clock Rudy deserves.
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Post by Kim & Rudy on Nov 2, 2020 17:33:35 GMT -7
Rudy’s signs of pain are ears back, hunched back when standing, nose down, yelping. He started 5mg of Pepcid today(11/2). I talked to two vets today, my vet and my mom’s vet. Neither was on board with increasing the methocarbomal to 3xs/day. Though I did get the go ahead to up the ▲Tramadol to 3xs/day.
[Moderator's Note. Please do not edit
16 lbs
Prednisone as of 10/22: 5mgs 2x/day for 11+ TBA days, then test taper for: √10/26, √11/2 PAIN!! / √10/26 neuro
gabapentin 100mgs 3x/day
methocarbamol as of 11/1 125mgs 2x/day
tramadol 25ms ▲3x/day
✙Pepcid AC 5mg 2x/day as of 11/2]
I’ve noticed a new symptom today(11/2). He seems to have a small muscle spasm/twitching on the left side of his neck just above his shoulder. It’s more pronounced when he’s relaxed on his medicine. Is this anything you’ve seen?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 2, 2020 20:25:47 GMT -7
Kim, your vets (from the same clinic?) are clearly not comfortable in their knowledge of IVDD and the meds. It is heartbreaking that going on 9 days that Rudy is needlessly enduring pain. From your description of pain it has been increasing, more signs, new signs. Have you been able to stick with very STRICT limited movement at potty time to prevent the disc from worsening causing more pain?After the increase of tramadol 25mgs to 3x/day, did that help with pain ? IF you are not able to present a successful advocacy for getting those pain meds adjusted, then consider hiring a new more knowledgeable vet. You may have another clinic in your town or a nearby one? Otherwise a specialist consult can well shortcut finding that more knowledgeable vet. Let them know your local vet is not comfortable in using pain meds and your dog needs help. ---- A consult with a neuro (ACVIM) or ortho (ACVS) specialist is not just for the purpose of a surgery. It is also when the family DVM vet is not comfortable in using pain meds, you seek a consult to get those pain meds adjusted properly. Board-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals or private practice. Directory for Veterinary surgeons (ACVS) and neuro surgeons (ACVIM): find.vetspecialists.com---- See if there is a vet in our Member's Recommendation Directory near you: dodgerslist.boards.net/board/13/member-reported-surgery-costs-recommendationsADVOCACY POINTS if pain is not being controlled. CAUTION, it is the vet's job to RX medication. It is not the job of the owner to self prescribe but to bring to the table the pain signs you observe and discuss adjusting meds. Reading references are so you have some basis of what to expect.tramadol Advocate for a dose more approaching the MAX ANALGESIC dose. Advocate to give a try with moving up to a full tramadol tablet: 50 mgs 3x/day
NOTE: The Max analgesic dose for 16lb/7.26kg dog would be:
10mgs tramadol x 7.26kg dog weight = 72.6mgs tramadol 3x/day
The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours.Tramadol Reading Reference methocarbamol Look for the new vet who has more comfort in their IVDD knowledge to Rx methocarbamol at an every 8 hour schedule.
NOTE: reading reference that pain meds have a similar short half live and thus the reason vets Rx at every 8 hours during a disc episode.
Pain meds short length of time in body reading reference Hoping you can present a good advocacy case for adjusting the pain meds properly with current vet over the phone. Hiring a new vet would require a vehicle transport as they would need to examine before Rxing. |
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Post by Kim & Rudy on Nov 3, 2020 12:53:42 GMT -7
Rudy had a very good (pain free) night and morning today (11/3). I feel that my dosing schedule has taken shape to where his pain is covered 24/7.
I can increase the ▲Tramadol because my vet did tell me that I could go up to a whole pill (50mg) 3xs [tramadol]a day if the 1/2 tab wasn't enough.
[Moderator's Note. Please do not edit
16 lbs
Prednisone as of 10/22: 5mgs 2x/day for 11+ TBA days, then test taper for: √10/26, √11/2 PAIN!! / √10/26 neuro
gabapentin 100mgs 3x/day
methocarbamol as of 11/1 125mgs 2x/day
tramadol ▲50mg 3x/day
Pepcid AC 5mg 2x/day]
I'm not sure the reasoning behind not wanting to increase the methocarbamal doses but I will see if I can get one of them to agree. The vets are from 2 different clinics. I feel like he gets the most relief from the methocarbamal, even more so than the tramadol pill. He was able to walk steadily to use the restroom every few hours and seems to be a bit happier.
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Post by Romy & Frankie on Nov 3, 2020 14:36:53 GMT -7
Good news that Rudy is now pain free and seems happier. Have you raised the tramadol to 50mgs?
I am not surprised that methocarbamal is very helpful. Methocarbamol works very well on painful muscle spasms which are often seen with neck disc issues.
Remember to keep his walking for potty time to the absolute minimum. It is the inactivity enforced by crate rest that heals the disc.
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Post by Kim & Rudy on Nov 5, 2020 16:04:19 GMT -7
11/5 Rudy is improving daily! My vet has approved to increase his ▲methocarbamal 125mg every 8 hours. He is comfortable and healing (I hope). He is a little more perky each day so I know he’s feeling better. Now the challenge of keeping him quiet in the crate begins. He wants out!! We are continuing all other meds for the next 7 days then we will begin the taper of prednisone.
[Moderator's Note. Please do not edit
16 lbs
Prednisone as of 10/22: 5mgs 2x/day for 15+ TBA days, 11/13 test taper for: √10/26, √11/2 PAIN!! / √10/26 neuro
gabapentin 100mgs 3x/day on taper back off
methocarbamol as of 11/1 125mgs ▲3x/day on taper back off
tramadol ▲50mg 3x/day on taper back off
Pepcid AC 5mg 2x/day]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 5, 2020 16:16:17 GMT -7
The test for pain prednisone taper will start on Nov 13?
With the test for pain pred taper either the pain meds will be backed off in frequency /mg OR they will be full stopped.
Which does your vet want with the pain meds on 11/13?
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Post by Kim & Rudy on Nov 5, 2020 17:07:31 GMT -7
My vet mentioned that Rudy would probably need to continue the pain management for awhile. She wanted to begin the prednisone taper today but I refused. I told her that I wanted to make sure he was pain free before stopping the Prednisone. She is allowing me to make the decisions (with her guidance), which I’m making based on your advice.
But yes, if all goes well this next week, I will begin to test his pain levels by reducing the pain meds before I taper the prednisone.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 6, 2020 9:24:47 GMT -7
The idea with the pred taper is to take the blindfold off of your eyes re: pain. To avoid delay in finding out the truth if there would be pain. Kim the test for pain on the date of the pred taper is: ---- Prednisone taper starts when (on what date, please)? ---- Both pain meds are also either: 1) full stopped on the date of the pred taper OR... 2) both pain meds are backed off Pain meds handling are the decision of the vet due to length of time they've been taken, if there is concern of rebound pain, etc. So which does your vet want on the same date the pred taper starts (date please) full stop or backing off in frequency/dose? PLAN "B" With any taper, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free! Pain=
another course of prednisone + all pain meds, protectors back on board.
No Pain=
Complete the pred taper...finish out the 8 weeks of crate rest for the disc to heal.
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Post by Kim & Rudy on Nov 6, 2020 21:21:27 GMT -7
The plan is to begin prednisone taper on Nov 13th. I plan to back off of all pain meds but not completely stop according to my vet. Rudy appears to be feeling much better each day. I wonder if I should back off the pain meds now just to test pain or keep the meds at the current dose so he can heal more? He is holding his head normal. He’s still showing weakness in his right front paw. It doesn’t knuckle over like it was doing but he will hold it up some times.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Nov 7, 2020 7:37:43 GMT -7
Please tell us more about Rudy holding his front paw up at times. Holding a paw up, not wanting to put weight on it, is a sign of pain, not weakness. It could be a sign that Rudy has nerve root signature pain. Something is irritating the nerve root as it exits the spinal cord to travel down the leg. Severe leg pain is one of the main symptoms. Here's some info to read as a background for discussion with your vet. dodgerslist.com/2020/08/20/nerve-root-signature-pain/The time to test for pain is when the anti-inflammatory - Prednisone - is tapered. Prednisone works on the swelling that presses on the nerves of the spine which in turn cause the pain. The pain meds mask any pain until the swelling is gone. It's the tapering of the pain meds and the anti-inflammatory together that reveal whether there is still pain/swelling and still a need for all meds. You don't want to stop or taper the pain meds now as you don't want pain to arise again. Pain hinders healing. Give the Prednisone time to work on the swelling and keep pain meds in place until the taper. It sounds like you and your vet have a good plan in place for the taper of the Prednisone and pain meds on 11/13, especially now that it has been revealed that Rudy may have nerve root signature pain. |
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Post by Kim & Rudy on Nov 8, 2020 19:53:45 GMT -7
Rudy is getting a little better each day! He has not shown any sign of pain in days. I have not noticed him holding his paw up anymore. He’s happy and relaxed! However, occasionally he will stand up in his crate and that same paw is still knuckled over. It’s usually when he first stands up and it doesn’t happen every time. When he walks the paw rights itself. I’m very concerned about this and wonder if that is a sign of something more serious or will it heal and get stronger with time?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Nov 8, 2020 21:10:56 GMT -7
Kim, good report no signs of pain and nerve healing is taking place with right front paw knuckling able to correct itself. Nerve healing is slow, but as you are witnessing, it happens! Patience and time will very likely have Rudy walking very close to a normal gait. Mark your calendar for a Dec 17 graduation date!!
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