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Post by Siobhan & Rocky on Aug 16, 2021 12:11:30 GMT -7
Siobhan's Rocky 8/10 conservative-JRT-Ireland; GRAD Oct 5 Devastated to be writing again. 3 months after surgery Rocky is back in his crate. Tuesday [Aug 10?] I noticed he was yelping in pain. Vet has confirmed he has compromised his back again. He was doing so well. We are heartbroken at the thought of another 6 weeks confinement and pain. We havnt had him xrayed as there won't be another surgery. So don't know if it's the same disc or a different one. I have noticed his front legs look very spread out as he must be placing all his weight on them. Strict crate rest and meds and praying his stomach dosnt get as bad as last time. He is on Tramadol once a day. Valium twice a day. [Moderator's Note. Please do not edit 16lbs 4 y.o. JRT name of steroid injection on 8/15 no anti-inflammatory Rx'd on 8/10 Valium for muscle contractoin pain ?mg 2x/day (also may be anti-anxiety) Sat 8/21 course ends traMADol over all analagesic ?mgs 1x/day due to previous bad reaction Sat 8/21 course ends ] He is very low [pain] in himself. He yelps sometimes when he moves yet he can walk easily the toilet so not sure where the pain is. Is it normal for him to regress so quickly?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Aug 16, 2021 14:01:40 GMT -7
Siobhan, I'm sorry to hear of another disc episode so soon. IVDD is so unpredictable. No wonder Rocky is showing pain and so low! 1) He is not on any anti-inflammatory drug. Please phone (to avoid any risk to the disc with a transport) your vet to get on on board asap, Today, Aug 16. Without an anti-inflammatory there is nothing working on the painful spinal cord swelling! 2) His pain meds are pretty light for a disc episode. Advocate that all three pain meds are Rx'd to be given promptly every 8 hrs (3x/day). That is how long pain meds last in the body. Advocate for each source of pain to be covered: -- gabapentin for nerve pain 3x/day -- traMADol is the overall analgesic. Often too lightly Rx'd to do anything about pain. The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours. For a 16lbs /7.26 kg Rocky expect the traMADol dose to be promptly every 8 hrs AND to be at minimum a full 50 mgs traMADol tablet each dose.3) When the anti-inflammatory is Rx'd, an acid suppressor such as Pepcid AC (famotidine) should be on board. 5mgs of Pepcid AC (famotidine) promptly every 12 hours. In addition give the anti-inflammatory with a meal. Pepcid AC (with one active ingredient: famotidine) should be available from your Chemist, your grocery store. There ought not be any sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. It can take several adjustment of meds by the vet til he finds what is perfect for Rocky. Look for your dog to be acting their normal, perky interested in life self when pain is fully under control round the clock.
SIGNS OF PAIN: ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned bac ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions ⚙︎ not their normal perky interested in life selves ➕ if a neck disc: ◻︎ head held high/ nose to the ground ◻︎ 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 up flamingo style not wanting to bear weight
Arm yourself with portable resource to know your meds. This little reference card is handy at vet visits to keep all the meds straight as you discuss things. D/l to print a copy at this link: www.dodgerslist.com/literature/MedCard.pdf i1.wp.com/dodgerslist.com/wp-content/uploads/2020/04/med-card-sample.png **Conservative treatment is different than a surgery which removed disc material where it was not supposed to be.1) The difference between a surgery and conservative treatment of meds, time and limited movement2) Avoid dangerous detours, follow the "Roadmap" for Conservative Treatment. VIEW, DOWNLOAD and print a copy for your fridge from here: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdfWhen Rocky has had his meds adjusted to be fully out of pain, please fill us in on the details. We offer our best comments with all the info about Rocky's meds, use dates when you can, and we love freuent updates to know when he is out of pain.QUESTIONS:• Valium for nerve pain ?mg 2x/day How many mgs is each dose?• traMADol over all analgesic ?mgs 1x/day How many mgs is each dose? • What is the name of the anti-inflammatory? -- ?mgs each dose? -- How times a day? -- For how many days to take? • Let us know you are on board with the single most important part of conservative treatment care- very STRICT limited movement so the disc can heal. And importantly so the mild symptoms of pain only to not escalate to nerve damage of loss of bladder control, back leg paralysis. Rest will be necessarily STRICTER than what is required post-op.
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Post by Siobhan & Rocky on Aug 16, 2021 14:30:17 GMT -7
Thanks Paula. Forgot to say that vet gave him a steroid injection on Sunday [name of?]. He had originally put him down for Tramadol twice a day but changed to once a day due to his bad reaction to meds last time: dodgerslist.boards.net/thread/8063/siobhans-rocky-surgery6wks-ireland-grad?page=2. The tramadol is 50mg once a day. I will ring tomo to see about getting it twice a day. The valium is 2mg twice a day. I thought the valium was to keep him calm? He is eating and drinking normally and mobility is good. He has 4 more days of meds left.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 16, 2021 15:53:22 GMT -7
What is the name of the steroid injection? Some steroids last more than a day or so. that is why we ask for details always.
It is normal to give a steroid shot and then follow up at home with prednisone steroid pills. Why were no pred pills sent home? By now there is likely nothing working on getting all the swelling down. It make no sense to give pain pills to cover up painful swelling but not use the med that gets at the root cause of the swelling -- prednisone pills. How did the vet explain to you the treatment he is giving? Are there health issue with prednisone for Rocky? Is the vet considering switching to a non-steroid pill for at home with a washout out period of 5-7 days?
I'm sorry Valium can be used for muscle contraction pain (it is gabapentin for nerve pain) and valium for other things like for dogs that need bladder expressing.
After re-reading Rocky's post op he had not ever been reported being on traMADol. -- You wrote vomiting with use of non-steroid NSAID Loxicam ...vomit was very likely due to there had been no stomach protection on board! - -Loxicam was stopped on May 27. -- June 9 Rocky vomited and received an acid suppressor Losec (omeprazole). Cause of vomiting never confired. But vet stopped all meds including Losec (omeprasole). Rocky stopped vomiting. -- Perhaps there as a time previous to post-op May 19, 2021 with traMADol problems. What problem did traMADol cause Rocky?
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Post by Siobhan & Rocky on Aug 17, 2021 11:56:50 GMT -7
Hi Rocky had no issue with Tramadol but he can't tolerate anti Inflammatories at all. Black poos after Carprieve [carprofen] previously. The steroid injection is effective for a few days I was told. Should be wearing off now. Sorry I didn't get the name. So much to process. Today vet has given me ✙Gabapentin 100mg morning and evening and upped his ▲Tranadol to twice a day too alongside the Valium.
Moderator's Note. Please do not edit 16lbs 4 y.o. JRT no anti-inflammatory Rx'd on 8/10 name of steroid injection on 8/15 Valium for muscle contraction pain 2mg 2x/day (also may be anti-anxiety) traMADol over all analagesic 50mgs ▲2x/day ✙Gabapentin 100mg 2x/day ]
He had his first dose of all 3 meds about an hour ago and is resting comfortably.
When he greeted me thIs evening his head was very low and he yelped when he lifted it up so I'm thinking he has neck damage done. Also I am to start him on Amantadine tomorrow too. Don't know dosage yet. I gave him all 3 meds in one go this evening. Is that OK or should I space them out? I'm thinking 8am and 7pm for all meds?. He is still able to walk but sits with his front shoulders very forward and spaced out. Also how many potty breaks are recommended daily? I'm finding this harder than after his surgery as his pain was managed by the time he came home to us then😔. Thank you
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Post by Romy & Frankie on Aug 17, 2021 13:30:43 GMT -7
I hope the change in meds will help Rocky's pain. Pain slows the healing process. Since you gave him the meds is he showing any signs of pain? Pain should be relieved in about an hour after taking the meds . If not, let the vet know so the pain meds can be adjusted. Sometimes it takes a little trial and error to get the pain meds right.
When you said he could not tolerate anti-inflammatories did you mean all anti-inflamatories or only NSAIDs like Carprieve? I am asking this because the steroid shot did not cause him stomach problems. Some dogs that cannot tolerate NSAIDs may be able to tolerate steroid type anti-inflammatories. Also, a stomach protector makes it less likely that stomach issues will occur. Dogs are often given prednisone or another type of steroid in pill form to take at home after a steroid shot.
If no anti-inflammatories at all can be tolerated, Rocky can still heal, but it will take a lot longer. The body makes its own steroid hormone to regulate the body. It is at a much lower level than the synthetic prednisone vets use during a disc episode. So it may be that a vet will rely on the body's cortisol hormone. It may take longer to do the job of taking care or inflammation. Conventional pain meds would be needed to provide comfort during the time it takes to get spinal cord swelling resolved.
Rocky's symptoms do seem to indicate a neck disc issue. Neck issues are typically very painful. We have some tips about caring for a dog with neck disc problems here:
The three meds you mentioned can be taken at the same time . When a dog is on steroids they will want to drink more and therefore need to pee more. Since Rocky had a steroid shot, even though it is wearing off, he may need to go out more often. Sometimes as frequently as every two or three hours.
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Post by Siobhan & Rocky on Aug 17, 2021 13:47:37 GMT -7
[ Dublin, IreLAND time Tues AUG 17, 10 pm ]He slept for about 2 hours after the meds then woke up and vomited. I took him out to potty and he pooed but he was shaking and panting very heavily when he came back in. He has settled a bit now but it's very very hard for us to watch him like this.
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Post by Romy & Frankie on Aug 17, 2021 14:17:15 GMT -7
Rocky is still in pain even with the adjustment to medication. Please speak to the vet right away about adjusting Rocky's meds. He should not be in pain. Gabapentin and tramadol do not last long in the body and often must be given 3x a day to be effective. The dose of tramadol may need adjusting. As mentioned previously, For a 16lbs /7.26 kg Rocky expect the tramadol dose to be promptly every 8 hrs AND to be at minimum a full 50 mgs tramadol tablet each dose.
Also mention the vomiting and ask about a stomach protector.
Please advocate politely but firmly for the meds that Rocky needs. He should not have to suffer.
Let us know what the vet says when you speak to him. We will be wanting to hear.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 17, 2021 15:11:10 GMT -7
Siobhan, chiming in too about what Romy wrote. When the meds are correctly adjusted, it will be like the difference between night and day. Rocky's suffering is too awful and is not necessary. It would make no sense at all safety wise to move from the steroid shot to the other class of NSAID such as Loxicam®(Meloxicam), Carprieve® (Carprofen). It would be a risk to the stomach of too much acids causing bleeding ulcers, black or red stool, vomit. Stay the course with a steroid pill for at home called Prednisone. The 8/15 steroid shot long ago wore off and nothing was provided for at home to deal with swelling. Why? It appears the disc is in the neck and those are more painful than a back disc. QUESTION: Could you find out the exact name the 8/15 steroid injection. May be on your receipt or the receptioninst can look in the file to find out for you.This would be my strategy if Rocky were my dog to act quickly when the vet opens in Ireland first thing in the morning by phone. -- Call the vet Wed 8/18 morning asap and report all signs of pain including head lifting issues. This lets vet know his Rx's are not yet right. Strongly advocate for getting Rocky out of pain in the TWO ways it takes to accomplish: -- #1 ADVOCATE for pain to be in control in one hours and thereafter round the clock with doses to be given PROMPTLY every 8 hrs. Pain meds wear off at about 8 hrs. Pain meds are doing NOTHING to get rid of swelling. Valium does not work for many dogs for muscle contraction pain VERY typical with a neck disc episode . It is METHOCARBAMOL that is more effective, ask for an Rx to this med.-- #2 ADVOCATE for the necessary steroid prednisone at-home pills (no non-steroids -NSAIDs at all -- too risky). It will take steroid prednisone pills 7 to 30 days (excluding taper days) to rid the body of painful swelling. -- Give all meds ( pain and anti-inflammatory steroid prednisone) with a snack or a meal since Rocky stomach is not settled. Especially give a steroid prednisone pill with a meal-- Rocky could well be vomiting due to all the stress he is under. Stress causes the body to produce more stomach acids. Change in routine can cause stress. Then add a steroid EVEN MORE ACIDS. --- ADVOCATE STRONGLY BUT POLITELY for one of these three below. FYI : The steroid shot should have been followed up at the same time with stomach protection!! #1 choice is Pepcid AC (famotidine) to suppress stomach acids. 5mgs every 12 hours. Works immediately and lasts for 12 hours. In Ireland you can get it over the counter at a Chemist or the grocery store. Verify with vet Rocky has no liver, kidney or heart issues to keep him from use of Pepcid AC (famotidine) #2 choice is Losec® or Losamel® (Omeprazole) can take 3-5 days to reach peak efficiency to suppress production of stomach acids. #3 If one of the the above two do not sit well with Rocky, then ask vet for a prescription to Sucralfate. SUCRALFATE works in a very different way. It does not suppress acids. It works by forming a gel coating over any damaged areas of the stomach lining due to excess acids. Sucralfate also acts like a bandaid to promote healing of the damaged area. BONE UP On WHY stomach protection is a must so you are in position to present your case and discuss: dodgerslist.com/2020/05/06/stomach-protection/We will be anxiously watching the Forum to find out the names and doses (?mg ?x/day) adjusted/prescribed. There is no reason Rocky should be in pain if the typical truly aggressive mediation approach is being used.
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Post by Siobhan & Rocky on Aug 18, 2021 13:32:12 GMT -7
Thank you both very much. I gave him Tramadol and Gabapentin 3 hrs ago but he is still in pain when he moves although resting quietly. Very sleepy today. I will give both every 8 hours from tonight.
Started him on ✙Amantadine 4ml twice a day also. So far he has had only one dose. This is a liquid and its a struggle to get him to take it!. (50mg/5ml).
[Moderator's Note. Please do not edit 16lbs 4 y.o. JRT no anti-inflammatory Rx'd on 8/10! name of steroid injection on 8/15 traMADol over all analagesic 50mgs 2x/day Gabapentin 100mg 2x/day Valium for muscle contraction pain 2mg 2x/day (also may be anti-anxiety) ✙Amantadine formula 50mg/5mL: 6mgs (4mL dose) 2x/day]
He is resting all day. Very reluctant to move at all. I brought the toilet inside to him ie bucket and peepads right outside his crate rather than take him outside but he has only peed once today so far. Is that OK? I will speak to vet about Steroids and Valium. He is not in as much pain as last night thankfully but far from ok yet.
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Post by Romy & Frankie on Aug 18, 2021 14:24:50 GMT -7
If your Rocky is still in pain three hours after you gave him the pain meds the meds are not yet right. Pain relief should be within an hour of taking the meds. For some dogs, Valium does not work well for painful muscle spasms often seen with neck disc issues, and methocarbamol will work better. Some tips about giving medications to a dog can be found on this video. Liquid medication is about halfway through the video.
Good idea putting the pee pads next to the crate. If he does not pee fairly soon, it could be a cause for concern. Stale urine in the bladder can cause UTI's. If he is not used to pee pads he may be reluctant to use them. In that case, see if you can get a paper towel or something with another dog's urine on it. This will help him understand what to do. I had to use the paper towel to get my dog to use the pee pad during his IVDD episode.
If he has use pee pads before, he may just be reluctant to move outside his crate to pee. In that case, when the pain meds are right, and he is pain free, he should be able to urinate more frequently.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 18, 2021 16:23:08 GMT -7
Siobhan, picture may help to know where exactly to stick the syringe:
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Post by Siobhan & Rocky on Aug 19, 2021 8:44:38 GMT -7
[Thursday 8/19 5pm Ireland time ]Just spoken to vet. He had a cortisone shot Sunday and he dosnt recommend any more steroids for him. Meds are all upped to 3 times a day and I do see his pain lessening a bit. Still very reluctant to move but he did walk outside and peed for Ireland this morning. Nothing since though. I know it's a long road but when he peed that gave me such hope. Vet will review him on Monday.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 19, 2021 10:44:07 GMT -7
Siobhan, what explanation for why no more steroids did the vet give when YOU asked why. It is your job to understand the treatment a vet prescribes and thus to ask why when you do not know things. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated so we can team up to work with the vet you have hired. . I've read back through your surgery posts and could not find a mention of the use of a non-steroid given to Rocky having had a stomach protector on board at the start of either Carprieve® (carprofen) or Loxicom® (Meloxicam). There is just the dealing with red flag signs only AFTER seeing vomiting, black poop from bleeding ulcers. Closing the barn door after the horses had escaped is too late!
Stomach protection at the start of any anti-inflammatory drug (steroids or non-steroids) is prudent! Rocky is darned lucky with the steroid cortisone shot since no stomach protection was provided at the time of the shot! In addition the Cortisone (Hydrocortisone) shot lasted for a short life of 8-12 hours in effectiveness as it had begun to decrease by half the amount thereafter. No wonder Rocky has been needlessly suffering pain. If your current vet has no health reason particular to Rocky why either a NSAID or a steroid can't be used when accompanied with stomach protectors such as Losamel® (Omeprazole), Pepcid AC® (famotidine), then may be time to fire and then hire a more IVDD knowledgeable vet. Rocky just can not be allowed to suffer needlessly with pain. A consult with a specialist surgeon is not just for the purpose of a surgery. When a local family vet is just not comfortable with their knowledge of IVDD and the meds used, a surgeon can be an excellent resource about pain meds they use every day and the use of an anti-inflammatory to work at the root cause of the painful inflammation. There may also be another vet in your town or next town who knows their IVDD.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Aug 19, 2021 17:31:47 GMT -7
Just wanted to emphasize the vital need to limit Rocky’s steps. You mentioned that he walked outside and peed. Rocky must be carried out to potty, allowed only a very few steps to potty and then carried back to his crate. Too much movement while on conservative care and the damaged disc can tear more, even rupture, resulting in more pain and possible nerve damage. Limit his steps by using a harness and 6 foot leash and stand in one spot. The less movement, the better.
Hope the correct meds are on board very soon. Healing prayers for Rocky.
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