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Post by Deb & Maisie on Nov 14, 2020 7:12:45 GMT -7
[Original subject line: 11 year old female beagle] Hello. I hope I'm posting in the correct place.
Our Maisie is a senior dog we adopted in 2016. She may be 10, she may be 11. It's hard to know. She i also my first dog and my husband's 3rd. Neither of us have experience with IVDD.
Currently on meds: - Prednisone: 1x/day. 5mg. Tapering for 10 days. We are on the 3rd day.
- Gabapentin: 2x/day. 50mg.
[Moderator's Note. Please do not edit
weight?
Prednisone as of 11/11: ?mgs ?x/day for ? days, date? of taper test: _pain / _neuro
gabapentin 50mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/prednisone! ]
Some background
A few years ago, she had cried out when we would pick her up and cradle her (like a baby). Brought her to the vet and she was given supplements: Movoflex, Dasaquin, and 1/8 tsp of Welactin (fish oil). Within a few weeks she was back to normal.
Starting roughly 10/31/20 we started to notice some changes which progressed:
But she would happily go on walks.
Bathroom business is and remains normal (though now she is on pain meds and anti-inflammatory).
This past Tuesday evening 11/10/20, she suddenly got up from her bed (on the floor) and started to tremor. No sounds, just tremors. Then because she had sat on command earlier, we thought she was ok but this time, eager to please, she lay down as an alternative.
I made an appt to see the vet the next day 11/11/20.
Maisie walked and did her business as usual and we visited the vet.
Vet said something about IVDD but no more detail. I wasn't sure what to ask! Prescribed steroids and anti-inflammatory (listed above). Told me to make sure she rests (but no other detail). - They took blood to see if she qualified for dentistry.
That evening, I gave her the prednisone and gabapentin. All good through the night.
Next morning, 11/12/20. All fine. I didn't give her the gabapentin because the vet said it wasn't a requirement.
At around 11:30 a.m., 11/12/20, Maisie let out a scream of pain that tore my heart apart. I wasn't there to witness what happened but when I found her she was sitting to one side and screaming. So I placed her on her side and she stopped. A few minutes later she wanted to get up and again, screaming pain. So I placed her on her bed, which is on the floor) and she was calm. I called the vet immediately but didn't talk to her until about 2 p.m. In the meantime, I gave her the gabapentin (advice from technician) straight away.
At 2 p.m. I gave her an early dose of prednisone (vet's instructions, last dose was 5p.m. 11/11/20). The rest of the day and evening, she slept only to get up (no pain - yay) to do her business and eat. At 9 p.m. (since I was crashing and couldn't stay up until 11:30 p.m.) I gave her gabapentin.
As of this morning, 11/14/20, all good, so far. I'm about to give her the gabapentin at 9 a.m. She did her business. I carried her out the door and she walked to her spot. I also carried her into the house (there are two steps). She ate. And now sleeping.
All night, I researched and found this forum. Research can be scary because of all the things people recommend.
I learned there are different stages of IVDD. Based on what I found, she may be in the 1-2 stage. Good grief. I feel like a failure. I love this dog and it is crushing me.
Anyway, Monday I want to call the local care therapy place to see if she is a candidate for acupuncture, hydro therapy, and whatever else that is integrative.
Questions:- I'm also wondering about CBD oil? But there's so much information, I am overwhelmed. I found this but not sure. market.dogsnaturallymagazine.com/products/cbd-oil-for-dogs?variant=31421397434415
- I put her in her soft crate since she wants to be at every food possible event in the kitchen and gets scared running when rain comes or excited when someone rings the doorbell. Is this the right way to go?
- Anything else I'm clueless to ask?
I would appreciate any advice.
Thank you in advance. Deb |
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,722 
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Post by Marjorie on Nov 14, 2020 7:40:54 GMT -7
Welcome to Dodgerslist, Deb. 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/Maisie needs to be on immediate strict crate rest, carried out to potty with only a very, very few steps allowed at potty time, and then carried back to her crate for a full 8 weeks. Too much movement and the damaged disc could tear more or rupture, causing more pain and nerve damage, possibly even permanent nerve damage. More on strict crate rest below. No hydrotherapy, no chiropractic, no PT. As for acupuncture, transport involves the risk of too much movement of the spine and the benefits of treatment need to be weighed against the risk of transport. Maisie can still walk and has no nerve damage at this time so she what she needs most right now is strict crate rest. It will help us work together with you and avoid offering ideas that could cause harm or lead the discussion in the wrong direction delaying help for your dog — please share a bit more detail with us: ❖1 Is there still currently pain? ☐shivering, trembling ☐yelping when picked up or moved ☐reluctant to move much in crate such as shift positions or slow to move ☐tight tense tummy ☐can’t find a comfortable position ☐Arched back ☐ Holding front or back leg flamingo style not wanting to bear weight ☐head held high or nose to the ground ☐Not their normal perky selves? Full pain relief is expected in 1 hour and stays that way dose to dose. If not in control your vet needs to know asap to adjust meds. ❖2 MEDICATION How much does Maisie weigh?
Am I correct that Prednisone was started on 11/11 and is 5 mg once a day for a period of ten days and then start to taper? Dogs of the weight of a typical Beagle would require 5mg 2x/day, which is the anti-inflammatory dosage. Anything less than the anti-inflammatory dosage will not be effective on getting the swelling down. It's important to get that swelling down ASAP as it's that swelling and extruded disc material that is pressing on the spine and causing the pain and possible nerve damage. If Maisie is not on the anti-inflammatory dosage according to her weight (see next paragraph), please speak to the vet ASAP this morning about that. 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--prednisoloneWhen you reported pain to the vet on 11/12, what adjustments did the vet make to the pain meds? Was Gabapentin increased or to be given 3x/day. Gabapentin works best when given three times a day to cover pain 24 hours. If there is still pain, Tramadol as a general pain med and Methocarbamol for the pain of muscle spasms can be added. Have no patience with pain as it does hinder healing. PEPCID AC: Anytime a dog is taking an anti-inflammatory, stomach protection must be added. Ask if your dog has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). i.ibb.co/DCN9611/91x-Aj-s00z-L-SY355.jpgDoxie weight dogs: 5mg Pepcid AC (famotidine) every 12 hours. NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. www.1800petmeds.com/Famotidine-prod11171.htmlDodgerslist just doesn't know enough about CBD oil to recommend for an IVDD disc episode. Not enough scientific research has been done on it to determine how effective it would be on pain/inflammation for dogs or as a sedative and what the optimal dose would be. We know what does work (pain meds, anti-inflammatory drug and Pepcid AC) and that's all we can recommend. ❖3 GI Tract problems? —Eating and drinking OK? No nausea/not eating, no vomit? —Poops OK? Normal firmness & color -no dark black or bright red blood indicating bleeding ulcers? No diarrhea? ❖4 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. The crate needs to only be large enough for her to stand up, turn around and lie down with legs comfortably extended. 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. ❖5 DOGs with BLADDER CONTROL: 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. Owner understanding ensures proper conservative treatment principals: ▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/healing-the-disc/ ▶︎ Roadmap for your fridge so the whole family is on board. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf Healing prayers for Maisie. |
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Post by Deb & Maisie on Nov 14, 2020 17:53:50 GMT -7
Hi Marjorie,
Wow, thank you. Let me see and hope I can answer your questions:
Weight: Maisie is 18lbs. Prednisone (10) 5 mg tab. (1 tab) 1x daily for 5 days, (1/2 tab) 1x daily for 5 days, (1/2 tab) every other day At 18lbs and if I did the math right, at 0.3 mg / pound, the prednisone seems spot on (0.3mg x 18pbs = 5.4mg approx).
Gabapentin (14) 50mg tab. (1 tab) 2x daily. So, 1 every 12 hours.
Pepcid - My husband just ran out to get Pepcid (11/14/20) and I gave her 1/2 of 1/2 a tablet as our vet office is closed and I didn't want to give her too much. Crushed it into pumpkin. As far as I know, Maisie does not have any liver or kidney issues. The blood work for dentistry came back normal. I've never been told she has any of those issues. Should I give her more?
[Moderator's Note. Please do not edit
18 lbs
Crated on 11/14
Prednisone as of 11/12: 5mgs 1x/day for 5 days, 11/17 taper test: _pain / _neuro
gabapentin 50mgs 2x/day
Pepcid AC ?mg ?x/day ]
I feel like I'm flying and learning on my own. Scared to hurt her chances of getting better or making things worse :-( Based on her weight (18lbs) is the medication enough? I don't have a way of contacting the vet, only ER.
So here is the timeline. I hope this helps and is more clear:
- 11/11/20 - We notice there is something more serious. I call the vet and make an appointment. I am clueless about what is going on. When I called no one told me it could be IVDD and that it could be more urgent. IF so, I would have gone to the ER.
- 11/12/20 - 3:30pm Vet appoint. I'm in the car, they [vet personnel] walk Maisie into the office. Vet calls to report that she is giving Maisie Prednisone and Gabapentin. She does not tell me any stage or much else other than that she needs rest. Not strict rest; not a crate, just rest. She does not inform me about minimal to no movement or no stairs. Also, had we known this was a possible IVDD, we would have crated her in the car (!) and now I feel immense guilt that we made her condition worse - (I'm crying). At 5 p.m. I give Maisie her first dose of Prednisone (1 tablet / 5 mg) and first dose of Gabapentin (1 tablet / 50mg)
- 11/13/20 - Approx. 5 a.m. Maisie seems fine. She gets up out of her bed (we placed one on the floor next to the sofa where I self because the vet said the prednisone would cause frequent urination). at 11:30 a.m. she hears me prepping lunch and then I hear a scream. I did not witness what happened but she was sitting on one side (left side) in so much pain that I tilted her to her side on the floor. Screaming stopped. She tried to get up again, and more screaming so I moved her again to her side and back on the bed. I immediately call the vet and the technician told me to give Maisie the gabapentin asap. (I had not given the Gabapentin a 5-6 a.m. because the vet told me if wasn't necessary if Maisie was feeling fine or was too loopy). At approx. 2 p.m. the vet calls to report on blood work (for dentistry). I call and let her know of the incident that morning and the vet tells me to give her an "extra" dose of prednisone. So, I did after I hung up the phone. At approx. 9 p.m. exhausted, I gave Maisie Gabapentin. I did not give her Prednisone at 5 p.m. (the time I gave her the first dose) because again, no one available to answer my question and I was afraid of overdose. No other adjustments were made when I talked to the vet after the screaming episode other than the "extra" prednisone and I'm not sure I got that right.
- 11/14/20 - I find this forum and hoping I'm doing the right thing. I immediately put Maisie in her crate. I didn't read until this evening about Pepcid. I let her walk to the door to do her business but I carry her down the two steps instead of her going by herself. I also pick her up for those two steps after she is finished. She is able to urinate and defecate on her own with no issues. On medication, she seems alert and her usual self.
Positives as of 11/14/20 - Her spirits are good. She is alert and eager to eat everything.
- Potty is good. #1 and #2 - all normal. Our yard is small so she walks at most 6-8ft to find her spot and do her business. She walks back to me and I pick her up to get up the stairs in to the house and then to her crate. No nausea or vomiting.
- No yelping when I pick her up or set her down. No tremors. Honestly, the yelping varies because she is very sensitive to objects that are close to her head. She is sensitive by nature. But definitely no termors and she is able to stand up on her own inside her crate and walk with no issues. As the vet said to me, "She knows her feet". Nose to the ground? She always has her nose to the ground as a beagle? I'm not sure how to answer this. Her head is up when I speak to her and when she wants her snack. I guess her head position is normal. I don't see anything unusual. No tense tummy. Shifting positions? She had some issues getting comfortable last night but she has been comfortable in her crate (it is more flat). No arched back. No flamingo style position.
- She is in her crate all day today (once I learned this is what I was supposed to do!). Only out to potty and I feed her wet food with pumpkin and chicken broth (she doesn't drink water much) because I'm concerned she'll get dehydrated.
re: Therapy - understood. Thank you. I'll hold off. re: CBD - understood. Thank you.
In the meantime, I want to talk with a vet to understand my options for after the 8 weeks of crate rest. I'm also concerned about what happens if during tapering she feels pain again? I think I need a backup plan.
Printed out the roadmap PDF - thank you for the reminder.
Question: We are in the middle of selling our house (!) and need to vacate for prospective buyers (yes, even during covid). How do we protect Maisie and do this? Will she be OK in her crate and in the car?
I hope I answered everything. Again, I cannot thank you enough. |
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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 14, 2020 20:07:36 GMT -7
Deb, can clarify for us what is the Rx for Prednisone. ---- At the Pred start on Nov 12, does the bottle say to give 5mgs once or twice a day? --- On Nov 12 what did you actually give? 5mgs once or twice a day? --- On Nov 12 what did you actually I've? 5mgs once or twice a day? Pepcid AC for an 18 lbs dog should be 10mgs every 12 hours. What size mgs is one whole Pepcid AC tablet? Are you giving Pepcid AC 10mgs 2x/day as of 11/14 (today)? Monitor for pain. If you see any hint surfacing, it is because, Maise has been Rx'd a lot less than usual for a disc episode. If you are seeing pain, have no patience. Get on the phone to tell what you observe for pain signs. Advocate for: --- 1) Prednisone to be give up at the anti-inflammatory level of 5mgs twice a day for an 18lb dog. Often the course will be a 5-7 day course. THEN a lower level (the taper level) of 5mgs 1x/day will start as the test for pain or neurological diminishment. It appears your vet is starting Maise out on a taper level which normally does not work on swelling in the spinal cord. -- 2) Each source of pain typical to a disc episode be covered and that the med stays at a high enough level through out the day/night— dose to dose of these three pain meds —Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve pain. 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. And what your job at home is at the start of the prednisone taper test: dodgerslist.com/2020/04/18/steroids-vs-nsaids/ IF your vet diagnosed IVDD, and did not tell you to provide the very strictest of rest, Maise was done a disservice. This would mean your vet is not comfortable with IVDD and that it will be YOU who needs to be educated in order to be on your toes to advocate for what is right for Maise. Good reading that book "Honey have you...."! ! ! At the end of the 8 weeks to heal the disc, then your job is to gradually re-introduce her back to family life. At that point, we'll have lots of tips and ideas to do that. Right now stick to very STRICT limited movement and especially at potty time. What you have described is too much walking--- From recovery suite to your arms where you carry her to the potty place. Set her down on an old pee spot if you can. She may only take a very, very few footsteps to take care of business. No walking anywhere— just a few footsteps. For my dog an expen in the grass let my dog know there would only be a few footsteps with the visual of the wire enclosure of about 6 feet in diameter. IF you don't have an expen: Put on a harness to control speed. YOU stand in one spot. The 6 foot leash allows Maise only limited footsteps to take care of business. Then right away as soon as she is finished you lift and carry her back into the recovery suite. Do you have bowls attached inside of suite where she can eat inside there? Let us know what your Plan B is on the additional pred taper step-down on Nov 17 Let us know which your vet wants on the pred taper. -- Stop all pain meds at the same time as the Nov 17 pred taper? OR..... -- Back off pain meds with less frequency or less mgs. Gaining IVDD knowledge will help you care for Maise to have a good outcome at the end of 8 weeks of rest for the disc healing. In addition, more knowledge, for you means less emotional stress. The unknown is a scary place to be stuck in. With the Roadmap handy on your Fridge, you will avoid dangerous detours during Conservative treatment. VIEW, DOWNLOAD and print from here: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf Read as much as you can at the Dodgerslist website. Click on the "Knowledge" menu for starters at dodgerslist.com |
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Post by Deb & Maisie on Nov 15, 2020 7:13:57 GMT -7
Hi Paula, Just now when I tried to give her the gapapentin (the second time in 12 hours - last one was 9pm last night) she screamed in pain. The emergency vet place said since it isn't life threatening they can't see her. There is no emergency contact at the Vet just leaving voice mail. My heart is breaking. I hope she has it in her system, she had trouble eating the pumpkin because she wanted to stand up but it caused her pain and I was so stresed out from her screaming. :Crying:
After thinking, I went ahead and gave her a second prednisone just now (9:10 a.m) after a 2 p.m. yesterday (11/14) based on your note. I'm so furious right now at our vet.
Prednisone:
---- These are the exact instructions directly from the bottle: "Give 1 tablet once daily for 5 days. Then, give 1/2 tablet once daily for 5 days, Then, 1/2 tablet every other day. May cause increased thirst and urination." --- On Nov 12 I gave her 1 tablet (5mg) at 5 p.m. On Nov 13 I gave her 1 tablet (5mg) at 2 p.m.
On Nov 14 I gave her 1 tablet (5mg) at 2 p.m. So each day since 11/12, I have given her 1 (5mg) tablet once a day.
Oh ok. The Pepcid AC, original strength is 10mg. So I'll give her 10mgs 2x/day starting today! Thank you.
[Moderator's Note. Please do not edit
18 lbs
Crated on 11/14
Prednisone as of 11/12: began w/ taper dose!- 5mgs 1x/day for 5 days, 11/17 taper test: √11/15 pain!! / _neuro
gabapentin 50mgs 2x/day
Pepcid AC 10mg 2x/day
Movoflex (1 chew)
Dasuquin (1/2 tablet)
Welaction fish oil (1/8 tsp) ]
Monitor for pain. If you see any hint surfacing, it is because, Maise has been Rx'd a lot less than usual for a disc episode. If you are seeing pain, have no patience. Get on the phone to tell what you observe for pain signs. Advocate for:
--- 1) So, even if Maisie doesn't seem to be in pain on this current dose, should I advocate for a longer [prednisone] period at 1x/day or? I'm confused because of the tapering and scared that tapering off too soon will risk more pain and having to scramble, plus, having to deal with ramping up the dose again? -- 2) Wow, ok. As you know, only Gabapentin was given to us. Nothing about muscle spasms or general pain relief. I also asked about supplements because Maisie is currently on Movoflex for small dogs (1 chew), Dasuquin (1/2 tablet) and Welaction fish oil (1/8 tsp). They said no contraindications so I have continued with those.
The vet in her original voice mail said that Maisie had spinal issues related to lumbar and lower back.
[Right now stick to very STRICT limited movement] Ok,understood. I read more last evening and since then I have carried her to the door, down the steps and to her spot(s) as well as on the return. Thank you.
I'll have to get a harness. Thank you.
No, we don't have that kind of space or set up so I hold the bowl inside her crate while she eats/drinks. I hope this is ok? I've been trying to keep her spine straight/even.
Let us know what your Plan B is on the additional pred taper step-down on Nov 17
Let us know which your vet wants on the pred taper.
-- Stop all pain meds at the same time as the Nov 17 pred taper? OR.....
-- Back off pain meds with less frequency or less mgs.
I will definitely keep you up to date. I'm going to call tomorrow to ask about this [plan B & pain meds on begin of taper] because I don't like being unprepared.
Thank you. Yes. I am feeling much better, the more informed I am. I truly appreciate everything ya'll are doing here. In fact, my queries to friends to find out if their dogs have had it has created more awareness of IVDD. |
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Post by Ann Brittain on Nov 15, 2020 7:34:27 GMT -7
So sorry to hear Maisie is in such pain and that the emergency vet is not willing to see her today. I will leave it to some one, on the Forum, with more knowledge of the effects of increasing meds to comment about that. But I would be very careful and call the vet again if Maisie continues to be in extreme pain. The very least they should do is give you information on how much medication can be given safely.
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Post by Deb & Maisie on Nov 15, 2020 8:43:12 GMT -7
Thank you.
We are heading to Cornell Vet hospital in Ithaca to get some answers and advice. The most frustrating aspect of this entire experience is that our vet has given us no information other than treat with meds and then leave us hanging even when I explained Maisie was experiencing greater pain.
I’m angry.
I did give Maisie the extra prednisone at 9:00 am along with the gabapentin. [ 11/15 pred then at 2x/day? ? ?]
[Moderator's Note. Please do not edit
18 lbs
Crated on 11/14
Prednisone as of 11/12: began w/ taper dose!- 5mgs 1x/day for 5 days, 11/17 taper test: √11/15 pain!! / _neuro
as of 11/15 possible owner gave anti-inflammatory dose 5mgs 2x/day? ?
gabapentin 50mgs 2x/day
Pepcid AC 10mg 2x/day
Movoflex (1 chew)
Dasuquin (1/2 tablet)
Welaction fish oil (1/8 tsp) ]
She is lying down In her crate in the car. I’m making sure she is still since she wants to get up.
Deb
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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 15, 2020 8:48:39 GMT -7
Excellent, glad you are seeking another vet's help. Jesse! Pain is, indeed, an emergency!!!!
Hope that this Cornell vet knows their IVDD and will Rx prednisone at the anti-inflammatory level 5mgs 2x/day.
And that this vet will address each source of pain that is very typical to a disc episode: Tramadol as the general analgesic, methcarbamol for the very painful muscle contractions and gabapentin. Advocate for these three at an every 8 hrs dose schedule.
Ask the vet where the disc is— in the neck or the back. You have reported Maisie is very sensitive to touching her head...this may be a NECK disc which can be much more painful than back discs. We'll have tips for you if that be the case--- a neck disc is involved.
Let us know the credential of the Cornell vet seeing Maisie.
--- family general DVM vet
--- specialist DVM vet with advanced neuro (ACVIIM) or ortho (ACVS) education
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Post by Deb & Maisie on Nov 15, 2020 14:51:46 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! ]
Hi Paula,
Update since out visit to Cornell.
We arrived about 11:15 am at Cornell. Maisie was in her crate and pain free. The gabapentin and extra dose of prednisone seemed to have relieved any previous shock to her system at 9:00 a.m.
I talked with a Dr. Wallis and he took the time to explain more to me than our vet.
I did ask him about the following: - Tramadol as the general analgesic
- Methcarbamol for the very painful muscle contractions
- Increased dose of Gabapentin
- Increased dose of Prednissone
- Pepcid AC
Tramadol and Methcabamol — No Rx given. He explained in so many words that both of these he would only prescribe if IVDD was further along. That Maisie wasn't currently presenting as severe. That gabapentin is sufficient.
That said, he did say that he thought the initial doze of gabapentin was too low and that there was space for her to increase. He has increased her ▲gabapentin from 5mg / 2x daily to 10mg 2x / daily. [NOTE ERROR: gabapentin 50mgs was increased to 100mgs]
He also gave me an Rx for ✙Trazadone (50mg - 1 tab). And he did express concern that giving her the increased dose of gabapentin plus the trazadone would bonk her out so to only use it as needed.
He also did consider that since Maisie is medicated that her pain may be masked because he didn't notice any pain when he palpated other than perhaps an indication toward her lumbrosacral area.
No xrays.
Question 1: Maisie is highly reactive to thunderstorms. I forgot to ask if giving her one Trazadone would be ok. I don't want to make her too loopy? I'm just concerned her panic would end up hurting her…
Question 2: (Pepcid) I forgot to follow up on this question. I also realized that the store bought version has more than just famotidine (famotidine, calcium carbonate, magnesium hydroxide). Is that ok? I think my husband didn't pay attention to just getting the "original" and got the "dual action".
Prednisone -- no increase in Rx. He was concerned of the longer term damage and told me to continue as prescribed. The next dose is to be at 9am tomorrow.
So we are now on the following:
▲Gabapentin 100mgs 2x/day Prednisone 5mg 1x/day
Movoflex (1 chew)
Dasuquin (1/2 tablet)
Welactin fish oil (1/8 tsp) Bravecto (flea and tick) 1x/12 weeks
Inteceptor Plus (heartworm) 1x/month
Pepcid AC 10mg 2x/day -- I gave her 10mg this afternoon. But forgot to ask Dr. Wallis.
[Moderator's Note. Please do not edit
18 lbs 11 years old
Crated on 11/14
Prednisone as of 11/12: began w/ taper dose!- 5mgs 1x/day for 5 days, 11/17 taper test: √11/15 pain!! / _neuro
gabapentin ▲100mgs 2x/day
✙Trazadone 50mgs ?x/day
Pepcid DUAL ACTION 10mg 2x/day giving another product with: (famotidine, calcium carbonate, magnesium hydroxide).
Movoflex (1 chew)
Dasuquin (1/2 tablet)
Welaction fish oil (1/8 tsp)
Bravecto (flea and tick) 1x/12 weeks
Inteceptor Plus (heartworm) 1x/month]
He did say that if she has another episode screaming in pain, that it could be she just tweaked something and if she calms down after a bit, it should be ok. But, if the pain is more prolonged, to call and possibly bring her in again.
Also, he said to go with the "dog in a box" conservative method. He repeated the advice here. Minimal to no movement -- potty and straight to crate. No sofas, cuddling, beds, etc., No exceptions for six weeks. I think I'll do the full eight.
I'm hoping to get an email write-up of all of this soon and perhaps the chance to follow-up.
In the meantime, another vet at our vet's office called me back and told me to call tomorrow to update her. I think I'm going to move us to another vet. This experience was just horrific on so many levels.
Oh, IF this should head to surgery, which I hope it does not, an estimate was anywhere between $3500-4500. I hope it never comes to surgery. She is 11 years old. |
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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 15, 2020 15:09:43 GMT -7
Pepcid AC (famotidine) contains only one active ingredient: famotidine. With those other active items that is not the correct product.  Deb, can you clarify the name of the med that was increased to 10mgs. Gabapentin as written or was this prednisone? What are the credentials of the cornell vet? family DVM vet OR.... a neuro (ACVIM) surgeon or an ortho (ACVS) surgeon? |
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Post by Deb & Maisie on Nov 15, 2020 15:25:05 GMT -7
Yes. He increased Gabapentin.
I am to give 2 tablets of the first Rx (50mg) 2x/day
Then, when I run out of those, give 1 tablet (2nd Rx) 100mg tablet 2x/day.
No change for Prednisone.
Trazadone is 50mg 1-2x /day as needed but warned that the combination of increased Gabapentin with Trazadone would make her extremely loopy and bonked out.
Credentials I'm sorry, I didn't have a chance to ask. There's so much to juggle with covid restrictions. I don't know.
Yikes does that mean I am harming her???
We'll have to locate just famotidine. The link you shared with me, they are out of stock.
I'm feeling helpless and now overwhelmed that I'm not doing the right thing. I feel like I'm not getting the right assistance from people who are supposed to be the experts in my town. I can't force them to give me prescriptions.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Nov 15, 2020 16:55:39 GMT -7
Deb, can you phone around and see if there is the name brand Pepcid with just one active ingredient (famotidine) Or a brand X product with one active ingredient (famotidine) in your area. No use using a product with other stuff that is not needed when just famotidine alone can do the job. For example calcium carbonate can cause constiptation and that is the problem you are seeking to solve with pumpkin.
Look on your paper work, the Cornel vet just may have his name with credentials.
Moving to a new clinic, involves yet other risky to the healing disc transport as an exam would be required. If it is last resort and must be done, then you would, of course, hire a new vet at a new clinic. However, the other vet at the clinic you have been using, has access to Maisie's files and can Rx over the phone without causing another risky transport in to the clinic. Vets who know IVDD, understand the need for STRICT limited movement of the spine. You ought to be able to phone in an update if there were to be pain, and advocate an adjustment. I would call back the vet tomorrow with an up date and get a feeling of her sense of IVDD and comfort in her knowledge.
With you having observed severe pain today, it is likely in two days, Nov 17 when yet another pred taper takes place, all the swelling will not yet be gone. You may see on Nov 17+ sign of pain appearing.
This test for pain thing is wacked out. Cornell vet increases pain med on 11/15 but says to continue with more lowering of prednisone on 11/17. When dogs are on the taper, the pain meds are stopped or backed off for the owner to be able to correctly assess for pain. See if you can work out a Plan B with the other female vet for Nov 17.
---- If pain, can pred go up to an actual anti-inflammatory dose (5mgs 2x/day for a 5- or 7-day course and then a test taper to see how things are going with painful swelling?
Never have any patience with pain during a disc episode. It is completely unfair to have patience...unfair for you having to see your dog in pain and goes without saying not fair to Maise.
Reading resources:
Keeping fingers cross with increase of gabapentin not any hint of pain will surface.
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Post by Deb & Maisie on Nov 15, 2020 19:15:26 GMT -7
Hi Paula,
Thank you ror being patient and kind with my emotions. I wish someone had told me when I had adopted her that beagles are at risk for IVDD and that jumping around etc. was not good for her as a senior dog. All these things we wish we had known!
re: new vet. You are right. I don't want to transport her for another visit.
This concerns me about having to leave the house on Tuesday for people who want to look at our house and an open house this coming Sunday. I'm feeling stuck and having to choose! COVID is not making it easy either.
I had a brief chat with the other vet at our vet's office so I think I will ask her to take our case instead or at least ask her more questions first thing tomorrow 11/16.
I will ask her about the Prednisone. I have not started the tapering. We are still 1 tablet (5mg) / daily. On 11/17, the first taper (1/2 tab / daily) will begin. I'm nervous so will talk to the vet about this: "If pain, can pred go up to an actual anti-inflammatory dose (5mgs 2x/day for a 5- or 7-day course and then a test taper to see how things are going with painful swelling?"
Famotidine. I found a drug store with just straight up famotadine so will pick up tomorrow. 10mg. Maisie is getting alot of pumpkin and loves it.
11/15 @8:30 p.m. I gave her the first dose of 100mg of gabapentin. I hope this works because my sense is that it wears off before the 12 hours are up. She was ok when I picked her up out of the crate and placed her outside to potty but when I tried to pick her up, she started to yelp/scream and wanted to walk instead (she was fine and apparently happier about that - not fast or wobbly. I picked her up to take her up the two steps and once inside she started to yelp/scream again so I put her down and she was fine.
I have no idea. I pick her up between her back legs and under her chin to keep her spine neutral and straight. (Watched videos by vets on how to properly lift) As soon as I put her down and she walked, she calmed down.
Vet @cornell. I was hoping his credentials would be on the email/letter but there is none. I tried to find him on the internet and still nothing.
Thank you for the articles and reading about pain.
Will report back tomorrow. I'm exhausted.
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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 15, 2020 21:15:44 GMT -7
Deb, not all beagles are born with IVDD. It is about 1 in 4-5 doxie's that are born with it. Don't know the stats for beagles, but maybe be less. No matter it is only upon the first signs of pain that the vet and the owner first learn the dog was born with disc disease. This is why doing as much reading as you can helps your mind to dismiss misinformation when you are aware of the real facts about this disease. It is possible that she anticipates picking her up is painful. Or maybe the way you hold her is painful to her. To me what you have described are true signs of pain. 11/12 was sitting to one side and screaming. 11/14 when I tried to give her the gapapentin..she screamed in pain 11/14 wanted to stand up but it caused her pain...screaming Do monitor for other signs of pain when having to move, when at potty, nearing next dose of the one pain med. Let us know if you see pain and include the circumstances when the pain was observed. This way of communication is also important when you speak to a vet. SIGNS OF PAIN can happen when moving or being moved, nearing next dose of meds:
◻︎ 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
The thing with a disc episode is that it is best to assume it IS pain and get the meds adjusted— a disc episode is a painful thing. The pain meds used with a disc episode stay in the body at a good level for about 8 hrs. That is why vets who know IVDD, Rx in a multi modal way. That is cover with multiple pain meds addressing each of the 3 sources of pain: gabapentin, tramadol and methocarbamol for every 8 hrs dosing. We can't always know if a dog is feeling pain cause they don't speak up like a person would, but we can make sure they are not in pain when dealing with a painful disease. So this is where we stand here on the Forum about pain...we side with Dr. Downing. Robin Downing, DVM, CVA, DAAPM is one of only four veterinarians in the world to hold the Diplomate credential in the American Academy of Pain Management - the largest interdisciplinary pain management organization in human medicine: " It is always better to use a multi-modal approach to pain management." And we side with the World Small Animal Veterinary Association (WSAVA) guidelines as well: " We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt" . www.wsava.org/WSAVA/media/PDF_old/jsap_0.pdf Pumpkin is a high fiber food. With not enough water, poop can be hard, constipated. With extra liquid, pumpkin absorbs the water helping to loosen stool. So a lot of pumpkin does not sound like a good idea-- how much are you giving her? For consttipation give 1 teaspoon per every 10 pounds ONCE a day. So for 18 lbs dog, Maisie could get 2 teaspoons 1x/day. |
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,722
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Post by Marjorie on Nov 16, 2020 6:14:34 GMT -7
Not knowing what videos you've seen online about how to lift a dog, I would just like to share Dodgerslist's video with you on the proper way to lift a dog with IVDD as I'm not sure what you mean when you say that you pick her up under her chin:
Take all that Paula has told you about pain to heart and advocate strongly for an adjustment to pain meds should you see any sign of pain today. I'm very sorry to hear that the vet wasn't agreeable to bringing Maisie up to 5mg 2x/day. The sooner the swelling resolves, the sooner the pain will be gone. Anything less than the anti-inflammatory dosage just isn't effective on reducing swelling.
Prayers that Maisie's pain will be brought completely under control today so that she can heal in comfort.
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Post by Deb & Maisie on Nov 16, 2020 7:40:24 GMT -7
Thanks Paula,
I do have the med tracking sheet, downloaded it from this site. I'm taking alot of notes and a diary.
I called the vet and left a message. My husband and I have concluded that the previous dose of Gabapentin at 1 (50mg) tablet 2x/daily was wearing off 1-2 hours before the next dose. Even this morning Maisie showed some signs of pain (licking, re-positioning, and slight tremors) so I called Cornell and they advised to give either the Gaba or prednisone earlier (both scheduled for approx. 9am ET this morning (11/16).
So even with the 11/15/20 Prednisone at 9a.m. (much earlier than the scheduled 2 p.m.) and the stronger dose of gaba (100mgs) at 9 p.m. she had signs of pain though not as extreme as yesterday morning.
The Cornell vet suggested 1/2 tablet of gabapentin every 8 hours if Maisie is in pain but it isn't clear to me as an additional dose of 1/2 tablet or? I'm going to talk with my vet about this once she calls (She is a different vet we saw for our cat and I like her much better).
I ordered famotidine. Will be picking up later. Straight up. no other ingredients.
We will take it easier on the pumpkin. No one ever told us pumpkin causes constipation. In fact, we thought the opposite was true, that it would help alleviate constipation/hard stools. Sheesh. Though we give her water with her pumpkin and wet food (grain-free) since she doesn't drink much.
More later once I've talked with our vet. Maisie is settled and comfortable.
Marjorie - Thank you.
I'm hopeful my conversation with our vet today will resolve this pain med management today.
Frustrating!
And I'll be watching this video. I've watched several. She has a (emotional) sensitivity when any object is near her face. Our dog has been through a lot in her life, things we have no idea about. Dark jackets, tall men, big arm gestures, etc.
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Post by Jessica on Nov 16, 2020 10:54:02 GMT -7
That's great you are keeping a record of the signs of pain you see. Figuring out the patterns will be very helpful for both you and the vet. It's especially challenging doing everything over the phone as things are now, so the more detail on when and what you observe should help to get everyone on the same page.
It can take some time getting medication adjustments just right. It can be very difficult, but keep up the good work contacting the vets until you feel Maisie is in a good spot.
In an early post, you mentioned Maisie having bloodwork for possible dentistry. Did you notice any pain from her mouth that may be related to dental issues? Or has she always had the sensitivity near her face? Do you notice pain signs toward her neck/face that may be different from pain that may be coming from the lumbrosacral area the Cornell vet indicated?
We'll be keeping an eye out for your next update after speaking with your vet. I hope it goes well.
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