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Post by Stephanie & Natty on Jul 28, 2021 10:39:56 GMT -7
[Original subject line: New member and needs advice on muscle spasms]
Hello, my female Boston Terrier (7yrs) has just been diagnosed with IVDD on July 10th. Her treatment she is currently on is Prednisone 5mg (1/2 pill every other day), gabapentin 100mg 2x a day and Metracarbamol 500mg 1/2 pill 2x a day.
[Moderator's Note. Please do not edit
weight? 7 y.o
Cortisone shot on 7/10
prednisone as 7/11 : mgs ?x/day for ? days, then a test taper 2.5mgs every other day for: 7/28! PAIN / _neuro
gabapentin 100 mgs 2x/day
methocarbamol 250 mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/PREDNISONE! ]
She is in a small exercise pen with her bed, she only goes outside to sue the bathroom and we carry her up and down the stairs. we also have elevated food and water dish.
She can walk on all 4 legs, but her hind left leg turns out and she knuckles on that leg. Her stride is slow.
The past 2 night I have noticed some muscle spasms in her back, she gets very stiff when this happens and is uncomfortable. I do massage to her and she slowly begins to relax. Ive noticed it’s happening about an hour before her dose of gabapentin in due. I was wondering if I could dose 3x a day with gabapentin.
I’M very familiar with dosing and meds bec my other Boston has epilepsy.
Any help or advice I would greatly appreciate.
Ty in advance.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 28, 2021 12:00:09 GMT -7
Welcome! Hi, my name is Paula, what's yours and your dog's name? How much does he weigh? Every other day taper of prednisone means your dog is in the test taper stage to find out if there still exists painful inflammation. The answer is YES, because you are noting your dog is in pain: slow walking, muscle spasms. Now is not the time to continue on with the prednisone taper. Call your vet asap now and report pain. The vet will likely call for another course of prednisone. Vet's usually give a 7-day or a 14-day prednisone course and then call for a test taper by lowering the dose and the frequency. During the test taper pain masking pain meds (gabapentin and methocarbamol) would be stopped so you would have had an opportunity to avoid delays in finding out if another course of pred is needed. You can learn all about prednisone as it is a hormone and works quite a bit different than other anti-inflammatory drugs from the non-steroidal class. Excellent reading to be an informed owner how pred is used during a disc episode and how long it may be needed: dodgerslist.com/2020/04/18/steroids-vs-nsaids/PEPCID AC (famotidine) Proactive vets don’t wait til there are red flag signs of: lip licking of nausea, not eating, vomit, diarrhea leading to serious bleeding ulcers, red or black blood in stool due to the extra stomach acids anti-inflammatory drugs cause. 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).  Excellent reading about use of anti-inflammtories during a disc epidode: dodgerslist.com/2020/04/18/steroids-vs-nsaids/ PAIN MEDSIt is the vet's job to prescribe meds. It is your job to be the eyes and ears for the vet in updating on neuro and pain status and to advocate for meds to be adjusted when you observe signs of painLearn the source of pain each pain med targets, how long pain meds stay in the body and the optimal frequecy to keep pain at bay. All info good to have under your belt when bringing up concerns and asking pertinent questions.dodgerslist.com/2020/05/30/pain-medications/Avoid massaging, instead avodcate for pain med adjustments to promptly every 8 hrs and another course of Pred since you are seeing signs that indicate there is still inflamed and painful swelling going on in the spinal cord tissue. We are quite anxious to find out what your vet does to get things right for your dog. Please keep us updated on your progress hopefully soon today. p.s EMAIL ALERTS
Timely communications are needed when helping your dog. How set up a bookmark for your dog's thread for email alerts when you have received a reply: dodgerslist.boards.net/thread/7353/register-bookmark-dogs-post-thread
HELPFUL WRITING TIP: For everyone the most effective way to respond:
-- scroll down to the "Quick reply" typing area.
-- Avoid using the "Reply" or the "Quote" link.
Quick reply allows you to scroll up and down to a previous post and then back down to the "Quick Reply" typing area to continue your own post. |
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Post by Stephanie & Natty on Jul 28, 2021 12:07:12 GMT -7
My dog Natty, started with prednisone 1/2 pill for 7 days, then 1/2 pill once a day and now on the taper end of 1/2 pill every other. We just had a consult with my vet and he is adding ▲ gabapentin in 3x a day instead of 2. We also have a consult with a neurologist as well. Does this forum recommend back braces? Thank you, Stephanie
[Moderator's Note. Please do not edit
weight? 7 y.o
prednisone as 7/10: taper dose: 2.5mgs 2x/day for 7 days, : 7/28! PAIN / _neuro
gabapentin 100 mgs ▲ 3x/day
methocarbamol 250 mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/PREDNISONE! ]
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Post by Romy & Frankie on Jul 28, 2021 13:22:56 GMT -7
Gabapentin does not last very long in the body and 3x a day is often necessary to provide pain relief. Did the vet prescribe another course of pred? The gabapentin provides relief from the pain caused by inflammation in the spinal cord, but does not work to diminish the inflammation. The pred at the full (not taper) dose is what treats the inflammation.
At this time, there isn’t enough research on them for Dodgerslist to support the use of back braces with an IVDD dog. If you are interested in using a back brace, it is important to work with board certified neurologist (ACVIM) or other vet who is very knowledgeable about disc disease. This is what Dr Isaacs ACVIM(Neurology) tells us about back braces dodgerslist.com/2020/08/14/back-braces-ivdd-dog/ |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Jul 28, 2021 14:12:42 GMT -7
Important information needed:
How much does your dog weigh? If around 15 lbs or so, then your dog was never on the anti-inflammatory level of prednisone, but started 7/10 on a tapering level of 2.5 mgs 2x/day which does not work to get the swelling down.
Does your dog have some other diseases that your vet is keeping Prednisone very low for a disc episode?
What date did the knuckling start?
What date did the left leg turning out start?
It is typical it often takes more than one course of prednisone at the anti-inflammatory leve to resolve swellingl. Taper days do not count in the 7-30 days it may take to resolve all swelling. One 7-day course at a low taper level is not sufficient for pred to do it job!
Depending on the dosage, steroids can be used as replacement steroid hormone at low doses in dog not able to make sufficient hormone, can function as anti-inflammatory drug during a disc episode or high levels provide immunosuppressive effects for other diseases.
The dose in mgs is all important in working with a disc episode:
The reason for a neuro consult would be your local vet is not comfortable in using IVDD meds. A walking dog with still mild neuro diminishment can be a VERY GOOD candidate to heal under conservative treatment with proper use of prednisone, all three sources of pain covered promptly 3x/day
traMADol as general analgesic
methocarbamol for muscle spasm pain
gabapentin for nerve pain 3x/day
The single most important care is at home inside of recovery suite.
It is pretty typical that vets who know IVDD will make medication changes when the owner calls them with updates. Transport to and from the vet can be risky for a dog on conservative care with the potential for too much movement of the spine and pressure to the weak early healing disc.
Vets usually estimate when they want the Prednisone to start to taper (lessen the dosage) and at that time, they also stop the pain meds so a test for pain can be made by your observing for any hint of pain resurfacing. If there would still be pain at the time of the taper, then it wouldn't be time to taper the Prednisone as there is still swelling.
Could you advocate for using the anti-inflammatory level over the phone for Natty (unless Natty has a health reason for using low doses)? Hours matter in getting proper meds on board!
What is the date of the neuro appt?
There may or may not be nerve function improvements (knuckling, leg turning out) in the short time of 8 weeks dedicated to healing the disc. Nerves can take months to heal.
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Post by Stephanie & Natty on Jul 31, 2021 3:51:32 GMT -7
Hello all, Natty is getting better little by little . Her gabapentin is increased to 3x a day, she’s on muscle relaxers 2x a day and steroid treatment along with probiotic to protect her stomach.
[Moderator's Note. Please do not edit
weight? 7 y.o
prednisone as 7/10: taper dose: 2.5mgs 2x/day for 7 days : 7/28! PAIN / _neuro
gabapentin 100 mgs 3x/day
methocarbamol 250 mgs 2x/day
needs GI tract protector, Pepcid AC, on board w/PREDNISONE! ]
My question is what do you do besides giving the muscle relaxers to relieve their pain during spasm? Heat/cold? Massage? Any advice is greatly appreciated.
ty, 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 Jul 31, 2021 7:34:51 GMT -7
Natty, I'm sorry to hear Natty's meds are still not right since one med was adjusted on Jul 28 you are reporting muscle spasm pain today. Never have any patience with pain, report pain at once to get meds adjusted. What you do about pain is to take action. --- Phone your vet asap this Sat morning to get help. Pain meds should provide full comfort in one hour or less when they are right. The 7/28 gabapentin adjustment was not enough. --- We are missing info from you, making it difficult to comment. (See questions below)--- Prednisone IF your dog weighs about 15 lbs was never prescribed at the higher anti-inflammatory dose level. It appears that Natty started on 7/10 at taper level which does not work on resolving painful swelling. Advocate for a 7-day or maybe a 14-day course of prednisone at anti-inflammatory dose of 5mgs 2x/day. --- IVDD pain meds stay in the body for about 8 hrs. Advocate strongly for methocarbamol to be Rx'd for promptly every 8 hrs dosing (3x/day doses). --- Any time prednsone is in use, Pepcid AC (famotidine) should be on board. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours. Oh dear! Stephanie, it appears you are not able to see the questions we have been asking about Natty. This makes us sad to not be able to give our best comments without those facts from you. HELPFUL TIP: The Forum is best viewed via the "desk top view" of a mobile phone browser app (Safari, Chrome, Foxfire). Scroll down to the bottom of the screen to click on "Desktop". HELPFUL WRITING TIP: The most effective way to respond: -- scroll down to the "QUICK REPLY" typing area. -- Avoid using the "Reply" or the "Quote" link. QUICK REPLY allows scrolling up and down as you read then answer. Scroll up to a previous post and then back down to the "Quick Reply" typing area to continue your own post. We could be of better help with an up to date med list to give us an accurate picture. FYI: Your 2nd thread "Muscle spasms" was merged into Natty's original thread. This keeps Natty's history all one thread. You can bookmark this link in your device's Browser (Safari, Chrome, FireFox) to quickly return to it in the future: dodgerslist.boards.net/thread/8138/stephanies-natty-conservative-boston-terrierQuestions-- Nattie's weight?
-- What is the stumbling block to get Pepcid AC on board with the use of prednisone?
-- Does your dog have some other diseases that your vet is keeping Prednisone very low for a disc episode?
What date did the knuckling start?
What date did the left leg turning out start?
Could you advocate for using the anti-inflammatory Prednisone level over the phone for Natty (unless Natty has a health reason for using low doses)? Hours matter in getting proper meds on board!
What is the date of the neuro appt? |
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Post by Stephanie & Natty on Aug 1, 2021 4:07:20 GMT -7
Natty weighs 20lbs, on July 10th she was given a shot of cortisone and then July 11th we started her prednisone treatment 2 pills every 12 hours for a week, then 1 pill every 12 hrs the following etc. My vet also prescribed 500mg methacarbomal for spasms. I understand every dog is different with dosing, my question to the forum is what else can i do to help my dog with spasms?
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Post by Ann Brittain on Aug 1, 2021 7:23:23 GMT -7
Sorry that Natty is still having spasms. The tightness that comes along with the spasms indicates Natty is in pain. As others have commented, it is important to get that under control to help her heal. It can be a challenge to get the meds adjusted. We had to work with our vet, for some time, to get Buster's pain under control. It's up to you to keep your vet in the loop and advocate for a high dosage if necessary.
You indicated in a previous post that Natty is only out for potty breaks and you carry her upstairs. I assume you're supporting her back as you carry her and have a crate or other activity restricted area for her upstairs. It's important that lifting and moving her around is kept to a minimum.
You mentioned that Natty will be seen by a neurologist. He/she may have other suggestions for treatments or med that could help your dog. Please let us know what the outcome of that visit is.
The thing we have in common, here at Dodgerslist, is that we've all cared for at least one dog with IVDD. Our stories are similar, but the results are not always equal. One thing we know for sure is that healing takes time and patience is the key to getting a dog back to their normal life.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,540
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Post by PaulaM on Aug 1, 2021 8:45:03 GMT -7
Stephanie, look at the methocarbamol bottle. Verify you are to give an entire 500mg tablet. That is a VERY high dose! Often for a 20lb dog the dose would be 1/4 of a methocarbamol tablet which as 125mgs. At one point you reported the Rx dose was 250mgs of methocarbamol twice a day which is also quite a high dose for a 20 lbs dog. You keep asking the same question "what can you do about muscle spasm pain." In the past maybe you were not able to read/see the replies you got. The answer is still the same— The meds have NEVER been right. On the pred taper if there is pain, the taper does not continue as it has been doing! Instead the vet Rx's another 7- or 14-day pred course then another taper to see if pain is really gone. Meds need adjusting. Have you advocated over the phone as suggested and discussed the adjustments noted with the vet? Muscle spasm pain is very likely surfacing because methocarbamol only lasts and is effective for about 8 hrs in the body. Why would anyone not want the last 4 hours also managed? Have you advocated for 125mgs methocarbamol to be Rx'd promptly every 8 hours? IF not why did you not? Another kind of pain is overall pain that traMADol can help with. Since the Rx your vet is using is not working to provide full comfort, what is the harm in making some adjustments so that the RX is right for you dog's needs. It takes experimenting/adjusting meds to get it right. You are the eyes and ears for your vet at home. You report what you see and then advocate. Your vet's job is to help Natty. So far this is not working out well. When can you advocate for using the prednisone anti-inflammatory level over the phone for Natty (unless Natty has a health reason for using low doses)? Prednisone at the anti-inflammatory level for 20lbs dog is 5mgs twice a day. It may take 7-30 days of this anti-inflammatory dose before all swelling is gone. It may take several pred courses. Appears your vet may have Rx'd an anti-inflammatory dose for 7 days on 7/11. RULE OF THUMB on a pred taper
pain = swelling still exists! = back up at anti-inflammatory dose for another 7-day or 14-day course, pain meds and Pepcid AC
QUESTION: :July 11th we started her prednisone treatment 2 pills every 12 hours for a week" 1) how many mgs were in one whole prednisone pill? Tramadol max analgesic dose for 20 lbs dog is in the neighborhood of 50mgs 3x/day Methocarbamol provides round the clock dose to dose relief from muscle spasm pain when used promptly every 8 hrs. 125mgs (1/4 of 500mg tab) is VERY, VERY typical so that the dog is not over relaxed muscle wise. Gabapentin. With this med now at 100mgs 3x/day and if the other meds are adjusted, Natty, THEN will have a good chance of getting pain fully in control. He just can't heal til that happens. If your vet is not comfortable in using IVDD meds, then it is time to hire a knowledgeable IVDD vet, get a 2nd opinion. Strategies for hiring the right vet or getting a 2nd opinion vet to be on Natty's IVDD health care team: dodgerslist.com/2020/05/10/find-ivdd-vet/ NATTY's perspective about her enduring pain since July 28 going on 4 days or more now. Pain expert, Dr. Petty, DVM, CVPP, CVMA, CAAPM, CCRT is a past president of the International Veterinary Academy of Pain Management and is a frequent lecturer at local, state and national conventions. Will be anxiously watching for a good news update that you were successful in advocating on behalf of Natty wether with your current vet or have found a 2nd opinion vet to help. That the pain meds have been adjusted and all pain is fully in control round the clock. |
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