PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,544
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Post by PaulaM on Aug 2, 2021 21:06:44 GMT -7
Darla, every 4-6 hours you take him out to potty. Pills are given every 8hrs and 12 hrs. I bet every time you pass by the recovery suite you sweet talk him. IF he is lying down or sitting quietly you'd compliment him with a happy "good boy!" Most dogs need to have 16-17 hours of sleep. while humans sleep about 8 hrs. Sleeping is healing time, too! Putting the above in perspective, if he needs more things in his day, try these ideas. Keep in mind he has a neck disc problem. -- Try some training to give his brain a mental workout..brain work can be tiring but a good thing. Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second he looks at you, and then give your dog a food reward. [NOTE: for crate resting dogs, shift your body a bit to change your angle] .... wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give him his reward. [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest.Lo-cal treats are tiny pieces of apple or carrot. To dogs the size of the treat matters not. They work just as hard for a big piece as a tiny piece.] Adapt each activity so that it takes place inside of the recovery suite while you sit on the floor in front of the suite's open door. Stop if your dog is getting over excited and displaying rambunctious behavior of too much neck/back movement. --lip lick. For Gizmo, he will, of course, be inside of his recover suite while you are sitting in front of the suite door.
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Post by Darla & Gizmo on Aug 2, 2021 21:29:05 GMT -7
Great tips, thank you.
Lip licking, I really like that idea. I'll watch the video and maybe start tomorrow.
I taught Gizmo Watch Me years ago encouraging eye contact. We still practice and he will even Watch Me independently with other people we know. He's the best.
Good Night, Darla & Giz
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Post by Darla & Gizmo on Aug 3, 2021 9:22:54 GMT -7
Gizmo seems to be moving his head a little more. No yelping nor pain whimpering.
I just contacted Dr. K regarding Gizmos meds. Gabapentin only 1 more dose (one 100mg capsule & Tramadol, only about 5 doses (4&half 50mg tabs, 37.5mg or 3/4 tab per dose)
I requested more Gabapentin asap.
[Moderator's Note. Please do not edit 13.20 lbs 9.5 y.o. galliprant as of 7/19 20mg tab: 10mgs 1x/day for 7 days, NEGATED with √7/27 relapse pain / _neuro as of 7/28: 10 mgs 1x/day for 20 days, then 8/18 test STOP for: _pain 7/27 Relapsed disc; dog leaped to owner shoulders gabapentin 100mgs 2x/day traMADol 37.5 mgs 3x/day diphenhydramine (generic Benadryl®) 12.5 mg 1x/day famotidine 5mgs 2x/day ]
My plan is to Not take him to any appointments until September 19, 8 weeks from start of crate rest. UNLESS he has signs of increased pain.
Thoughts?
Thank You, Darla & Gizmo
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,544
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Post by PaulaM on Aug 3, 2021 10:22:40 GMT -7
Darla, all I can tell you is the typical way meds are used with a disc episode, the summary. The full information is on this page: dodgerslist.com/2020/04/18/steroids-vs-nsaids/ If you believe Gizmo is showing any signs of pain today [be clear in describing what you observe today?] since his disc relapse and back to square #1 on 7/27 (8 days now as of today 8/3), then Giz should be on all pain meds (traMADol and gabapentin and maybe even methocarbamol and be on a course of Galliprant. Why is it you only feel nerve pain (gabapentin) should be dealt with until the 8/18 STOP test of Galliprant? Most vets will call for a 7-day or a 14-day course of Galliprant and then a STOP test to find out if pain is still actually existing (requiring another Galliprant course, all pain meds back on board plus famotidine). No one wants a dog on Galliprant any more days than necessary to get the benefit of all swelling gone. Galliprant is scheduled for a stop at the end of the 20-day course on 8/18. Aug 18 would be the date to also stop pain meds to get a clear picture if all painful swollen cord tissue is really gone. Please do tell us your thinking and observations and discuss those same thoughts and what you observe with your vet too. Advocate for stuff but also include specific details, what changed, the dates. Ya know, all the same stuff we ask about so we can fully understand from our side of the computer.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,544
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Post by PaulaM on Aug 3, 2021 10:29:58 GMT -7
Why is it you only feel nerve pain (gabapentin) should be dealt with until the 8/18 STOP test of Galliprant? Dodgerslist aligns with those vets on the pain issue about a multi-modal pain med cocktail to address each separate source of pain.. So this is where we stand on this 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." Dogs tend to hide pain as a protective mechanism. A lack of outward evidence does not necessarily indicate that these patients are not experiencing the negative consequences of pain. And we side with the World Small Animal Veterinary Association (WSAVA) guidelines as well: 1. We can’t always know that our patient does hurt, but we can do our best to ensure that it doesn’t hurt. Treat predictable pain. 2. Where a dog is judged to be in pain, treatment should be given immediately to provide relief. Positive response to an appropriate treatment is the gold standard to measure the presence and degree of pain. 3. When pain is moderate or severe, the veterinarian should consider combining drugs that act at different sites in the pain pathway to provide optimal analgesia; Combining different classes of analgesic drugs allows the veterinarian to optimize the management of pain. wsava.org/wp-content/uploads/2020/01/Recognition-Assessment-and-Treatment-of-Pain-Guidelines.pdf
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Post by Darla & Gizmo on Aug 3, 2021 13:34:37 GMT -7
I mentioned urgency of Gabapentin because he will be out after this evening dose. What I took from all I've read throughout Dodgerslist is that he should not be without any pain meds, Gabapentin and tramadol, until reexamination unless he's back to normal, or near normal. Incorrect?
TEXT TO DR. K 9AM: This is Darla with Gizmo-ID#2941, we were in on 7/28.
Only one more dose of Gabapentin (100mg x 2 day) Should I get more?
Only 6 more does of Tramadol (37.5mg x3 daily) Get more also?
18 more doses of Galliprant (10mg x1 daily)
Gizmo is moving his head a little more, still seems stiff. He is eating all of his meals but not immediately. He does move slowly around in crate. No yelping nor pain whimpering.
He's still on strict crate rest.
Do you have contact info for Neurologist?
Thank you, Darla&Gizmo
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Post by Romy & Frankie on Aug 3, 2021 13:58:06 GMT -7
Gizmo should have pain meds until he no longer needs them. Stiffness in moving his head and slow to move in his crate are often signs of pain. If you believe he is still in pain he should continue on all the pain meds.
The best time to stop the pain meds is when the galliprant is stopped. At that time, you will be able to tell if the swelling in the spinal cord is resolved. When Gizmo is not taking pain meds or an anti-inflammatory and there are no signs of pain, the swelling which causes the pain is gone. If, when all meds are stopped, pain is seen, more time on all the meds is needed.
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Post by Darla & Gizmo on Aug 3, 2021 20:48:06 GMT -7
K, thank you.
Just Now From Dr. K of Animal Surgery:
>>In this situation, please contact veterinary neurologist for further care.
- Summit Veterinary Referral Center - Blue Pearl - Seattle Veterinary Specialist<<
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,544
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Post by PaulaM on Aug 4, 2021 8:00:01 GMT -7
Darla, if Dr. K never knew about the setback to the disc with that leap, then Dr. K. likely has a very wrong impression of Gizmo's case. He's making recommendations on incomplete information about Gizmo's case.
-- Make it clear you can't afford surgery. (Darla, I really do not even know why you asked about a neuro) -- Inform Dr. K that Gizmo moved too much on 7/27 with a leap onto your shoulders causing pain. That is the reason you sought an appt on 7/28. -- Ask Dr. K to help Gizmo while completing the Galliprant course ending on 8/18. -- Ask that pain control be in place while Galliprant is working on inflammation. -- Inform Dr. K you have greatly improved the STRICT rest situation with a new wire crate, lowered ceiling, etc. -- Inform Dr. K you have learned from the leap you need to be one step ahead of Gizmo in protecting him from too much movement and any more relapse to his early healing disc. -- Inform Dr. about the positive improvement of pain of being able to better move his head. But there is still evidence he still experiences discomfort/pain (write the details you observe) that needs to be covered while Galliprant is doing its job.
OK, I just read it was YOU who asked for a neuro consult. -- Why did you ask for a neuro consult referral? -- You indicate the expense of surgery is not a family option. Anyway Gizmo is going in a good direction of pain healing, proving conservative treatment IS working. It is just that it can take 7-30 days on Galliprant before all swelling is gone. So far since starting at square #1 with that leap on 7/27 , Gizmo has been on Galliprant for 8 days! -- A consult with a neuro would be if your local vet is not comfortable in using pain meds that specialists use every day. A consult could run $125+ for the visit + any tests recommended.
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Post by Darla & Gizmo on Aug 6, 2021 11:05:27 GMT -7
Dr. K suggested a neuro consult when he saw Gizmo on 7/28. He suggested neuro consult again via phone a day or two later when he OK'd Tramadol increase. That is why I asked about Neurologist contact info.
》》》Case notes from 7.29 visit [see Darla's Jul 31, 2021 at 9:05pm post for Case note.]
Gizmos seems more relaxed with discomfort decreasing. He is still on Galliprant, Tramadol has 37.5 mg remaining (3 day taper) and still strict crate rest.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,544
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Post by PaulaM on Aug 6, 2021 11:44:29 GMT -7
Darla, Dr K Notes say "Contact Neurologist ASAP if condition progress" You are reporting condition is not progressing but improving, pain is decreasing. Gizmo should not be having to endure any pain while healing. That is what pain meds are all about, providing relief in a matter of hours when correct from AnY pain while Galliprant takes days/weeks to do its job.
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Post by Darla & Gizmo on Aug 6, 2021 16:11:09 GMT -7
Got it
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