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Post by Codie & Gus on May 6, 2021 18:19:21 GMT -7
Hi - my dog Gus has previously had 2 IVDD episodes. One in Sep 2017, where he had a ruptured disc and ha surgery to treat, as he was already having partial paralysis of the pelvic limbs. After surgery he returned to his normal self, but just with a slightly more wobbly gait (but nothing that hindered him playing). In Sep 2019 he had an issue with his back, and I put him on strict crate rest with Tramadol, Gabapentin, and Trazadone where he successfully healed.
Last week (4/25), Gus started to keep his head down and was trembling, although never seemed otherwise in pain. This were unusual to his previous back symptoms. He was also shaking his head, so we wondered if he had an ear infection as he was recently groomed. We took him to the vet where they said his ears looked a little sore as did his back and we put him on crate rest and meds for his ear. After a few days he seemed healed and we thought it was his ears (we were wrong). In the last 4 days he seemed in more pain and so I took him to an emergency vet on Tues 5/4 with a neurologist where they confirmed he likely had IVDD somewhere in his cervical vertebra. They prescribed codeine and gabapentin and sent us home for conservative crate rest. Yesterday and today I've noticed him having symptoms of pain (see below) even when on meds. Yesterday I called and asked for a muscle relaxant as I've read here it helps with neck pain; they didn't prescribe it to me until I called again today so he just started that route.
I am relieved he doesn't have any paralysis and is walking normally, but I am very worried he is still having pain and is shaking/restless, even with being on 3 meds. I've read your boards extensively which has been helpful, but is there ever a time where he would need surgery ASAP, even without paralysis, since it is a cervical issue? How long can it take to get him feeling better on this pain routine? Lastly, I am also confused why he didn't get a steroid prescribed. Thank you so much for your help!
1 ☐ reluctant to move much in crate such as shift positions or slow, ginger movements
☐ shivering, trembling
☐can’t find a comfortable position, appears restless
☐head held high or nose to the ground
☐ Holding front leg flamingo style not wanting to bear weight
☐Not their normal perky selves?
☆ 2 15 lbs
A..Started end of day Tues 5/4: Gabapentin Oral (1.25mL by mouth every 8-12hrs), I've been giving it every 8hrs. And Codeine (7.5mg every 8-12hrs), I've been giving it every 8hrs.
Started 2pm today 5/6: Methocarbamol (125mg every 8-12hrs), I just have given him this once so far since we started today.
B.. 🔘 steroid? They didn't prescribe him one - but didn't explain why.
I purchased this but since he is not on a steroid, I have not yet given [Pepcid AC] it to him.
[Moderator's Note. Please do not edit
15 lbs 9 y.o.
Rimadyl last dose date?
no anti-inflammatory Rx'd 5/4
Gabapentin 50mgs/mL: 50mgs (1.25mL) 3x/day
Codeine 7.5mgs 3x/day
Methocarbamol as of 5/6: 125mgs 3x/day?]
☆ 3 --Normal eating - drinking less but I've been mixing water in with his food (because of the neck injury, I'm only feeding him wet food with a small amt of moistened kibble) so he stays hydrated. No bad symptoms.
-- Poop is normal.
☆ 4 Gus is a 9yr old male minipoodle (and I'm his owner Codie).
☆ 5 The main vet was a general DVM, but they consulted a ACVIM neurologist as well. (I only spoke with the main ER DVM).
☆ 6 We saw the vet Tues 5/4 - saw an ER vet as well as consulted a neurologist. They looked, gave him a shot of methadone, and he was released at the end of that night with the meds gabapentin and codeine (amounts above).
☆ 7 Yes, is going to the bathroom outside 3x/day as normal.
☆ 8 Gus can wobbly walk (same walk as before - side effect of first back IVDD incident that required surgery) and can wag his tail (but doesn't often as he is not excited about crate rest).
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on May 6, 2021 19:00:18 GMT -7
Codie, welcome to the Forum. So sorry Gus is dealing with pain. All the pain meds last for about 8 hrs in the body. The reason you SHOULD be dosing every 8 hrs. What is the formula for gabapentin: how many mgs gabapentin are contained in 1 mL of liquid? Should be on the bottle. I would get on the phone now, tonight, asap and report all the signs of pain you wrote about. The the vet on duty will know that the pain medications are not correct. And that there is no anti-inflammatory on board to even get working on the painful spinal cord swelling. If blood work reveals Gus' organs are safe to use an anti-inflammatory then perhaps with this very unusual non-use of one, it maybe ought to be the most powerful class the steroid class. Non-steroid (NSAIDS) are the lessor class. See if you can advocate for the steroid Prednisone. --Advocate for amantadine to be added in. --Not knowing the gabapentin formula can't comment about that. Ask if gabapentin could be increased in mL dose. --Methocarbamol is right on at 125mgs 3x/day, no change needed there. -- We do not see a lot of codeine, best you ask if there is any adjustment there possible. When an actually aggressive use of anti-inflammatory plus pain meds are used and yet the pain can't be brought into control, a surgery may be a consideration. Excellent pages to get under your belt in making decisions conservative or surgery **  Dr. Isaacs answered alot of questions we've had about surgery: dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/More excellent info to help with conservative vs. surgery decisions: dodgerslist.com/2020/02/10/surgery-vs-conservative/ |
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Post by Codie & Gus on May 6, 2021 19:10:23 GMT -7
Hi Paula,
Thanks for your help on this. The gabapentin is 50mg/50mL.
I am calling the vet right now - it's been a struggle to get to talk to them as they've been overwhelmed with people. I'll likely take him to the vet in the next day, but trying to see if I can at least either a) increase codeine depending on what they say to try to help and b) I have rimadyl that they asked me to stop giving him, but wonder if it is okay for him to use, if they won't prescribe prednisone.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on May 6, 2021 19:37:06 GMT -7
What is date of last dose of Rimadyl?
Both classes of anti-inflammatory should not be used close in time. It takes Rimadyl about 5-7 days to leave the body. HENCE why a 5-7 days washout is used before the start of a steroid. This may be the reason for not Rxing prednisone on 5/4. ADVOCATE very strongly that this is a pain emergency. When vet deems it an emergency, the 5-7 days washout time can be dispensed with. BUT ONLY IF: the vet prescribes not only Pepcid AC (famotidine) but also SUCRALFATE to be on board as double GI/stomach protection when 5-7 days washout is not being done. Read to know why you are advocating for SUCRALFATE, the timing with food and the timing with Pepcid AC (famotdine).
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Post by Codie & Gus on May 6, 2021 19:49:04 GMT -7
Apologies - the gabapentin is 50mg/mL.
I called the vet and they let me know that in lieu of a steroid, an ice pack can be attached to the neck - they said they would have to consult with the neurologist who left for the day. In the meantime they let me know that rather than increasing any dose of ▲codeine/▲gabapentin every five hours, I could give it instead of 8. I am hoping this helps as he usually expresses his pain [surfaces] at the end of the window.
[Moderator's Note. Please do not edit
15 lbs 9 y.o.
Rimadyl last dose 5/1?
no anti-inflammatory Rx'd 5/4
Gabapentin 50mgs/mL: 50mgs (1.25mL) ▲every 5 hrs
Codeine 7.5mgs ▲every 5 hrs
Methocarbamol as of 5/6: 125mgs 3x/day?]
Date of last Rimadyl- 5/1, which may be why but they also didn't mention anything. I asked the neurologist to call me whenever they are able to discuss reallocating meds and will be sure to advocate for skipping the washout period if this is indeed a reason why.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on May 6, 2021 20:17:56 GMT -7
Personally I would NOT attach anything to the neck, during a neck episode! Let Gus lean on an ice pack or a warm blanket from the dryer to see which helps most. -- bag of frozen veggies wrapped in a towel for an instant ice pack Make an ice pack with a ziplock bag fill with 2 parts water and 1 part rubbing alcholol. The alcohol will keep the water from freezing solid so it will be more comfortable to lean on. Wrap ice pack with cloth/towel and allow Gus to lean on or rest his head there. -- blanket from dryer rolled up to rest head on or lean against 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.pdf**  |
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Post by Codie & Gus on May 10, 2021 9:59:58 GMT -7
Hi - just an update! Gus is luckily doing MUCH better. I was a bit frantic over the end of last week and considering surgery - the only issue was that all vet centers were at capacity around me - nobody could really talk to me, and neurology appointments were 6 weeks away  The only option I had was to send him to the ER again, and they said they'd likely tell me the same thing as I heard during my first visit, since he could still eat/drink and had normal use of limbs. I was at my wit's end, and scheduled appointments across state lines for CT scans (even then, it was 2 weeks out). Fortunately, Gus's pain eventually went away late last week. He no longer is hanging his head, isn't "flamingoing" his front paw, and sleeps through the night. Still rarely has tremors, but it almost always happens in his crate rather than next to me on the floor (just outside crate so no movement), so I think it's partially anxiety induced. The vet still won't give me presnidone - they both mentioned the washout period from the Rimadyl as well as being against using presnidone for this type of injury. They did say if Gus is still having pain at the followup they'd considering giving it, but his follow up isn't until 5/24 so I doubt that will happen. In the meantime, we are continuing with the strict crate rest as well as the▼ gabapentin/▼codeine/▼methocarbamol routine (although I have already decreased this to 10hrs/day due to his pain relief). [Moderator's Note. Please do not edit
15 lbs 9 y.o.
Rimadyl last dose 5/1?
no anti-inflammatory Rx'd 5/4
Gabapentin 50mgs/mL: 62.5mgs (1.25mL) ▼every 10-12 hrs
Codeine 7.5mgs ▼every 10-12 hrs
Methocarbamol as of 5/6: 125mgs ▼every 10-12 hrs]Although I am very sad he had to endure pain for a few days even on medication, I am relieved that it appears the worst is over and he is on his way to meaningful recovery! Thank you for all your help Paula and the rest of the board. I wouldn't have to known to advocate for methocarbamol unless I read through this forum, and I really do believe it was very helpful to Gus. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on May 10, 2021 10:54:28 GMT -7
please clarify what pain meds you reduced to what:
Gabapentin 50mgs/mL: 62.5mgs (1.25mL) every 10 hrs
Codeine 7.5mgs every 10 hrs
Methocarbamol as of 5/6: 125mgs 3x/day?
As long as Gus requires pain meds, that means spinal cord swelling still exists, but is mearly being masked/covered up by pain-masking meds.
There is nothing on board to work on the root cause of the swelling, just stuff to cover up swelling's pain.
IF no steroid prednisone anti-inflammatory, then advocate for non-steroid NSAID Rimadyl anti-inflammatory.
-- Ask for a 7-day or or 14-day course.
-- Then when anti-inflammatory course stops, all pain meds would stop to give proof if all swelling is gone or still exists and then yet another anti-inflammatory course.
With any anti-inflammatory Pepcid AC would need to be on board.
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Post by Codie & Gus on May 10, 2021 12:21:05 GMT -7
I guess I don't know if Gus requires pain meds, as I haven't taken them off, but was trying to taper to lessen effects, especially since they were so heavy. I have not reduced the amount, but went from administering every 6 hours to every 10-12hrs.
[owner responds to 5/10 med list question]
Gabapentin 50mgs/mL: 50mgs (1.25mL) every 10-12 hrs
Codeine 7.5mgs every 10-12 hrs
Methocarbamol as of 5/6: 125mgs 10-12
Can NSAIDs be given with methocarbamol?
I should also mention that since my vet was not willing to give me any anti-inflammatory, I was looking for alternative methods - he is scheduled for cold laser therapy on Wednesday, and I've also been giving slight rubs for relaxation.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on May 10, 2021 13:44:34 GMT -7
I guess the question is when will it be time to know for sure if there is actually spinal cord swelling that needs to be attended to?
---Nerves do not like being compressed by swollen tissue. Hence the reason for a NSAID or a steroid asap. It may take 7 to 30 days being on a NSAID like Rimadyl to get rid of swelling.
--- No one wants a dog on an anti-inflammatory any bit past the time of all swelling gone.
--- Short courses of anti-inflammatory drug are used (7-day or 14-day course)
--- Then with stop of anti-inflammatory, pain meds are also stopped to reveal the truth about any remaining painful swelling.
When pain meds are needed they are not given sometimes every 10 hrs or another time every 12 hours. They are given promptly on time. Generally speaking pain meds last in the body for about 8 hours— thus the reason often prescribed for promptly every 8 hrs (3x/day).
Gus' treatment has an unusual use of meds if this is a neck disc.
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Post by Codie & Gus on May 12, 2021 18:36:18 GMT -7
Thanks Paula for affirming my questions re: anti-inflammatories. I was able to convince them at least to give ✙ Rimadyl, especially as I already was previously prescribed. Before administering, I did wait to give pain meds to see if he was still having pain (and that the meds weren't masking things). He did appear to be in more pain - more restless and did yelp once. Fortunately the symptoms weren't as bad as when we first had the injury so improvement, but still. So now he is on the following: Rimadyl 12.5mgs, every 12 hrs Gabapentin 50mgs (1.25mL) every 12 hrs. Codeine 7.5mgs every 8 hrs Methocarbamol 125mgs every 8 hrs [Moderator's Note. Please do not edit
15 lbs 9 y.o.
Rimadyl STOPPED on 5/1?
as of 5/12?: 12.5mgs 2x/day for ? days, then a test STOP for: _pain / _neuro
Gabapentin 50mgs/mL: 62.5mgs (1.25mL dose) 2x/day
Codeine 7.5mgs ▲3x/day
Methocarbamol as of 5/6: 125mgs▲3x/day
needs GI tract protector, Pepcid AC, on board w/!RIMADYL ]My question is - this is a suspected IVDD neck issue . However, I've noticed that he is shaking his head (like when dog's ears are itchy) a lot more than usual. I think this is weird since if he had a disc issue like he's had previously, I would expect him to be reluctant to shake his head so strongly, or at the very least to cry out in pain as he did so. But he hasn't. I know this isn't a catch all for any dog conditions, but I was curious- have you heard about this symptom before with IVDD neck issues? It just seems so abnormal from my previous experiences, but before he's only had back disc issues. I've tried to talk to the vet but they are unavailable |
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Post by Stephanie on May 12, 2021 19:12:54 GMT -7
Hi Codie,
Thank you for the further information.
Paula will address your concerns I highlighted in further detail when she logs back on.
However, I wanted to emphasize with any anti-inflammatory Pepcid AC would need to be on board and I didn't notice it in the medicine list. Is Gus taking any Pepcid? If not, will you be starting this soon?
Thank you.
Stephanie
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on May 12, 2021 20:36:45 GMT -7
Codie, good for you in successfully advocating for an anti-inflammatory (Rimadyl) to be on board!!!! If no health issues of liver, kidney, heart, Pepcid AC should be on board: 5mgs 2x/day. Let us know if his stomach is being protected now.
Just to confirm is this now correct information below:
-- Rimadyl start date 5/12?
-- For how many days is Rimadyl 12.5mgs twice a day?
-- gabapentin 1.25mL dose 2x/day
-- codeine 7.5mgs 3x/day
-- methocarbamol 125mgs 3x/day
PAIN
-- Is all pain masked dose to dose and round the clock now? No yelping, no restless?
-- Still seeing any pain where not wanting to bear weight on one of the front legs? Which front leg?
-- No more holding head high or low?
-- If able to shake head, that would be a good improvement during a neck disc episode.
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The only option I had was to send him to the ER again, and they said they'd likely tell me the same thing as I heard during my first visit, since he could still eat/drink and had normal use of limbs. 
