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Post by Brittany & Elton on Aug 20, 2021 17:07:25 GMT -7
Brittany's Elton 8/20 Conservative-Libby; vet:Kalispell dodgerslist.boards.net/thread/7676/brittanys-elton-conservative-libby-kalispellElton hurt his back again 8/20. Just today. I’m assuming it’s his back. He was in the yard barking and was startled by something and yelped. Since then he’s been quiet and subdued. At dinner time he walked slow to his dish. When I let him out to potty I noticed he was a bit hunched. I went to pick him up and he was whining and shaking. [MED LIST/HISTORY- Moderator's Note. Please do not edit 8.8 lbs] I got his recovery crate ready. But Can’t remember if gabapentin needs to be spaced out from prednisone?
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PaulaM
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Post by PaulaM on Aug 20, 2021 18:56:35 GMT -7
Brittany, sorry to hear about Elton. For tonight, the single most important care is immediately crating to restrict movement of the back. A good review of tips, ideas and how to ensure STRICT rest: dodgerslist.com/2020/05/14/strict-rest-recovery-process/Food/water bowls should be attached inside the suite. Only out of the suite when carried to and from the potty place. Starting the anti-inflammatory prednisone can tie the vet's hands on his preferred anti-inflammatory drug (whether it would be more appropriate for the symptoms a steroid or a non-steroid NSAID.) It takes days for prednisone to leave the body. Refresh yourself on the two classes of anti-inflammatory drugs Gabapentin stays in the body for about 8 hrs. Time giving gabapentin now so that it will be close to being out of Elton's body when he visits the vet. This way the vet can best observe all the symptoms and give give a diagnosis and his choice of treatment. Suspect IVDD? Do these things NOW.A quick review. Look below the Banner of the brown doxie: dodgerslist.com POTTY TIME 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 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!
Do let us know if Elton still weighs 8.8 lbs and what the vet prescribes Sat morning (how many mgs dose, how often.) And for the anti-inflammatory its name, mgs, frequency and for how many days. Stomach protector Pepcid AC 5mgs 2x/day?
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Post by Brittany & Elton on Aug 20, 2021 21:04:55 GMT -7
Is there a danger in giving an almost year old compounded gabapentin?
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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 21, 2021 8:26:59 GMT -7
Just Googled and there are varying opinions mostly it is about strength deterioration. Anyway hope by now you've made contact with your vet. I'm in Columbia Falls and hoping to learn what your vet diagnosed and prescribed for little Elton.
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Post by Brittany & Elton on Aug 23, 2021 7:08:28 GMT -7
Made it to Flathead Pet Emergency on [8/21] Saturday with a 3 hour wait. They are curbside only. Elton is fairly reactive so I was very nervous. He went in with only leg weakness, when I stopped on the way home to for him to potty, he fell over trying to pass stool. (Left me wondering if he injured himself in the vets office).
The vet said back injury. Did not go into detail like vet I saw last year. Seemed to rely on medicines I asked for. He did reduce the ▼steroid dosage - said 5 mg was too high for his weight and the treating condition. Elton weights 9 pounds. Vet Prescribed prednisolone [taper dose] 3mg 1x a day 7 days, 1.5 1x a day for 7 days, 1.5mg every other day for 7 days. ▲Gabapentin up to 50mg every 12 hours.
[MED LIST/HISTORY- Moderator's Note. Please do not edit ▲9 lbs crated 8/20 with leg weakness After ER vet appt , fell over while pooping prednisone 10mgs tab: as of Fri 8/20: ?mg dose for 1 dose til vet appt Prednisolone liquid as of Sat 8/21: Rx written taper dose: 3mgs 1x/day for 7 days, then continued tapering as of 8/21 owner giving 1.5mg 2x/day of phn instruction as of 8/23 a.m.: started 3 mgs 1x/day gabapentin 50 mgs 2x/day Pepcid AC,5mgs 2x/day ]
I made a mistake and didn’t read the instructions close enough and have been giving [prednisolone] 1.5 mg 2x a day (every 12 hours) like I was told over the phone. (Phone instructions differed from written). I hope this is okay. I hope the Prednisolone works as well as the prednisone. Also, I gave Elton one dose of prednisone [10mgs tab, what was the dose in mgs?] Friday night. The vet assured me that there would be no interaction between the two. I hope it’s correct. I’ve called to ask follow-up questions and they are not very accommodating there.
Either way, he has progressed to where we were the first back injury. Knuckling over. He is able to walk with sling assistance. Still wagging his tail. Seems to be able to feel some with his feet. It’s harder to keep him calm this time around.
The gabapentin seems to help his pain. However, I need to build a better sling. This time around is much more difficult with an infant. I’m near my breaking point. Hoping he can recover. Trying to remember the early days before and how long it took for progress. I was pregnant last time.
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PaulaM
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Post by PaulaM on Aug 23, 2021 8:38:14 GMT -7
Brittony call your own vet today, right now. Prednisone/prednisolone anti-inflammatory level dose is 0.3mgs X 9lbs = 2.7mgs pred dose every 12 hours! Get permission from your own vet to dose Pred at rounded up to 3 mgs TWICE A DAY (every 12 hrs. Knuckling is due to Elton having NO ADEQUATE level of pred to work on swelling. Taper doses do not work on swelling Anything below Pred 3mgs Twice a day is a taper dose. ---------------------- After contact with vet about the emergency in my above post, here are other things to consider. Brittany, I'm so sorry the ER vet visit/phone were conflicting info. And yet still an anti-inflammatory level dose was NEVER prescribed by ER! Anything below 3mgs twice a day is a taper dose for a 9lbs dog and is not working on spinal cord swelling. Prednisone and prednisolone are basically same med. Things I'm concerned about is quickly (hours matter) getting prednisone adjusted upwards to an actual anti-inflammatory dose for a 9lbs dog to be Prednisolone 3 mgs every 12 hrs. Your vet may require a trip in for an exam before being able to Rx. ER is a mess but they have seen him and you can report diminishment of neuro functions to knuckling under paws. ER "should" be able to adjust pred to 3mgs every 12 hours (anti-inflammatory level dose during a disc episode). Fingers crossed you can quickly get pred corrected for Elton before nerve damage progresses to paralyzed legs. Hurry, please! Pepcid AC (famotidine) needs to be on board for the duration of pred. Pepcid AC 0.44mgs X 9lb dog could be rounded up to 1/2 of a 10 mg tablet. Thus 5mgs every 12 hours. Let your vet know you want Elton to be on an acid suppressor purchased at the grocery store. thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpgIf pain is not fully controlled then gabapentin every 12 hours is not yet right. ADVOCATE for --- gabapentin Rx for 50mgs promptly every 8 hrs (3x/day) -- traMADol Rx for promptly every 8 hrs. -- and possibly adding methocarbamol for muscle contraction pain promptly every 8 hrs. A figure 8 sling will be very helpful for Elton's male anatomy. dodgerslist.com/wp-content/uploads/2020/05/Figure8.jpgWhile this mix up in meds is a bad stumbling block, Elton can still recover. Monitor and report to vet any worsening pain or neuro: MONITOR As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.1. √8/20 Pain caused by the tearing disc & inflammation in the spinal cord 2. √8/21 Wobbly walking, legs cross 3. √8/22 Nails/toes scuffing floor 4. √8/22 Paws knuckle under 5. ___ Weak/little leg movement, can't move up into a stand 6. ___ Legs do not work at all (paralysis, dog is down) 7. ___ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. __ Tail wagging with joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option for your family (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. A quick overview of conservative treatment vs. a surgery: dodgerslist.com/2020/02/10/surgery-vs-conservative/So do not loose hope, just get the meds fixed. It can take 7-30 days on Pred 3mgs twice a day to get all the swelling eliminated. So that may mean more than one course of Prednisone. (The taper days do not work on swelling they serve another purpose). Please stay in touch as you can, we are anxious to know things have been corrected for Elton.
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Post by Brittany & Elton on Aug 23, 2021 11:39:27 GMT -7
He is on pepcid 5 mg 2x daily, never took him off. That doesn't need to be prescribed as I've learned my lesson with medications and dogs in the past.
However, I got ahold of his regular vet (well a vet tech). I'm waiting to hear back from the vet on what to do about dosage. I gave the 1.5mg dose of prednisolone at 7:30 am. Regardless if I hear back or not, I'm giving at least 3 mg at 7:30 pm (I have quite a bit of unexpired prednisone 5 mg). What I don't know if what to do in the meantime since it was not an adequate dose.
Now, I also don't know if the 7 days starts over? Since it was a 7 day dose, then 7 day reduced, then 7 day further reduced.
[15 mins later update:] Just called back again. Still not available to talk to vet. I’m Starting to get nervous these hours are going to hurt him.
Is the 5 mg an immunosuppressive dose? That is what the emergency vet kept saying. (Which I knew 10 mg was way too high. That is what he was prescribed initially last year and was reduced.)
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PaulaM
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Post by PaulaM on Aug 23, 2021 12:27:38 GMT -7
Brittany, it may be that your vet would use 5mgs 2x/day since it could be hard to cut a 5mg pred tablet to get down to 3mgs dose size (how do you do that with any accuracy).
The tapering doses of 1.5 mgs is like not giving any predinsione. So the day pred starts at 3-5mgs 2x/day is the first day of the 7-day course.
Discuss with the vet about now giving the missing morning mg dose and then in the evening the 3-5 mgs 2nd dose of the day. Prednisone does not have be given with certain spacing of hours. The typical is to give the dose twice a day.
We are only familiar with IVDD, so not very familiar with immune suppressive doses. Do know for IVDD vets will often round up or down to fit the size of the whole pill or easily split pills of 1/4 or 1/2 of pill. Again you really need an IVDD knowledgeable vet supervising dosing for prednisone doses. That vet also would know your dog's health history to guide in dosing meds. We may not be aware of all of Elton's health and we are not vets either.
Dr. Ruben reflects the vet Rx's seen on this Forum who know IVDD are prescribing for prednisone specifically for a disc episode of using the upper range twice a day
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Post by Brittany & Elton on Aug 23, 2021 13:06:23 GMT -7
Elton has no other underlying conditions. An immune suppressant dose is just one that is too high - like the 10 mg. I don’t want to cause another issue by over prescribing.
I don’t know where I would find an IVDD familiar vet. Transferring him again in the car is way too dangerous. I just hope I haven’t lost precious time and permanently injured him by trusting a professional.
I gave the missed 1.5 mg dose. [MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs age? Prednisolone as of 8/20: owner taper dose: 1.5mgs 2x/day for 1.5 day as of of 8/21 Rx: taper dose: 3mgs 1x/day for 7 days, then continued tapering gabapentin 50 mgs 2x/day Pepcid AC 5mgs 2x/day ]
Waiting to hear direction on whether to continue 3mg of the prednisolone or switch to 5 mg of prednisone. I would not have enough prednisolone to make it through. Hopefully, his regular vet can review the records and write a script.
I hope there is still hope for him to recover & the swelling stops getting worse now.
Well, that’s ridiculous. The vet tech called back and said her “book” shows that 3 mg once a day is fine and what he should be on. I’m flabbergasted. Even though I told them he’s getting worse. She said that I can up the gabapentin. I’m not doing that.
Now I don’t know what to do. Run out of prednisolone. Or up it to the 5 mg prednisone. I’m really lost.
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PaulaM
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Post by PaulaM on Aug 23, 2021 14:02:01 GMT -7
Definately 10 mgs 2x/day is in the immune suppressive range for a 9 lbs dog. How many days left of 3mgs 2x/day pred pills do you have left? I can point you to specifically a very knowledgeable IVDD vet at Glacier Animal Clinic, Columbia Falls, Dr Mark Lawson. Here is Dr. Lawson's take on treating a disc episode. Stuff owners don't often get to hear or if it was said, in the emotion of it all some things are forgotten once home.
Any vet who has not examined Elton would very likely want/need to see Elton before Rxing meds. So if your vet has not yet see Elton for this disc episode, Elton would likely need to be transported in for a vet exam. If a vet transport is a must to get more pred pills when you are running out, then that is an urgent vet visit exam. Secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels/blankets snug around your dog to prevent movement or jarring the spine when braking or turning corners.
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Post by Brittany & Elton on Aug 23, 2021 14:21:48 GMT -7
[Pred] is in liquid form, and only exact dose of 3mg was prescribed - 7 days of 3 mg 1 per day, 7 days of 1.5 1 per day, and 1.5 1x every other day.
However, I have a lot of the 10 mg prednisone [pills]. Can’t get 3 mg, but can easily get 2.5.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o crated 8/20 with leg weakness After 8/21 ER vet appt , fell over while pooping no pain with gabapentin 8/23 8/23 back paws knuckle under with pred taper doses prednisone 10mgs tab: as of Fri 8/20: 5mg dose for 1 day til 8/21 vet appt Prednisolone liquid as of Sat 8/21: Rx written taper dose: 3mgs 1x/day for 7 days, then continued tapering as of 8/21 owner giving 1.5mg 1x/day of phn instruction as of 8/22 owner giving 1.5 mgs 2x/day as of 8/23 a.m.: started 3 mgs 1x/day gabapentin 50 mgs 2x/day Pepcid AC 5mgs 2x/day ]
Thank you, I will definitely look to his expertise should I need it.
The problem is that Elton is very reactive in vets offices and causes further damage.
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PaulaM
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Post by PaulaM on Aug 23, 2021 14:26:53 GMT -7
3:12 pm here. Checking on some information for you and will get back to you. Do you have the ability if an appt is avail to go today?
how old is Elton?
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Post by Brittany & Elton on Aug 23, 2021 15:36:50 GMT -7
Not likely. I highly doubt I will be able to go at all unless it was an absolute emergency. have an infant who is exclusively breastfed, no bottle, as such would need to have someone ride with me. There is further risk of injuries because of Elton thrashing at the vet appointment. Also, there are too many medical issues in my immediate family right now - people in the hospital, people needing to go to the flathead for their appointments etc etc.
I’m going to have to dose the 2.5 or 5 mg of prednisone. That’s just all there is to it. I will have to figure out which one I want to do by 7:30 pm.
If the dosing is .1 - .6 mg/kg, the range would be .418 to 2.508 - 2x per day. The 1.5 mg 2x per day was not working at all. I just need to decide if I want to reduce to 2.5 or increase to 5.
Elton is 3. The dose on 8/20/21 was 5 mg of prednisone at 7:30 pm. He had no additional doses that day. The next day [8/21] I didn’t dose in the morning after talking to flathead emergency. Then dosed 1.5 mg at 7:30 pm. Such a mess!
8/20/21 7:30 pm 5 mg predisone [1x/day]
8/21/21 7:30 am 1.5 mg prednisolone "[8/21] I didn’t dose in the morning" 7:30 pm 1.5 mg prednisolone "Then dosed 1.5 mg at 7:30 pm."
8/21/21 - 7:30 am NO PREDNISONE EN ROUTE TO ER VET - 7:30 pm 1.5 mg prednisolone
8/22/21 - 7:30 am 1.5 mg prednisolone [2x/day] - 7:30 pm 1.5 mg prednisolone
8/23/21 7:30 am 1.5 mg prednisolone [3 mgs a.m.] 1:00 pm 1.5 mg prednisolone [7:30pm dose to be determined] Also, 5 mg of Pepcid 2 times a day & 50 mg of gabapentin.
It’s incredibly frustrating that his regular vet wanted to increase the dosage of gabapentin to deal with this. Ridiculous. That’s the not the issue. His pain is controlled.
Also, thank you so much for commenting. Makes me feel less alone in this. Dealing with our senior chihuahua’s issues have been disheartening lately. I switched vets to Whitefish Animal Hospital, but Elton hasn’t been seen there yet. So I had to go to his old vet in Kalispell for follow up.
I will definitely look to the Columbia Falls vet for Elton from now on.
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Post by Brittany & Elton on Aug 23, 2021 19:45:48 GMT -7
Gave 2.5 mg of prednisone and 50 mg of gabapentin at 7:30 pm. Going to continue with 2.5 mg. If it doesn’t work out will seek the advice of the vet in Columbia Falls.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o FYI: 2020 traMADol caused barking day/night; had to stop crated 8/20 with leg weakness After 8/21 ER vet appt , fell over while pooping no pain with gabapentin 8/23 8/23 back paws knuckle under with pred taper doses 8/24 can no longer right knuckled paw or move up to stand, pain in control 8/31 slipped out of sling and fell over prednisone 10mgs tab: as of Fri 8/20: 5mg dose for 1 day til 8/21 vet appt Prednisolone formula: 3mgs/1 mL as of Sat 8/21: ER Rx : 3mgs (1mL) 1x/day for 7 days, as of 8/21 owner giving 1.5mg 1x/day followed phn instruction by mistake as of 8/22 owner giving 1.5 mgs 2x/day as of 8/23: 'solone 3 mgs am; 'sone 2.5 mgs pm as of 8/24: 5mgs 1x/day am for 2 days as of 8/26: 5mgs 2x/day for 5-7 days as of 8/31: 5mgs 1x/day for 5-7 days as of 9/1: 2.5mgs 1x/day for 7 days as of 9/1: 2.5 mgs EOD for 7 days gabapentin 50 mgs 2x/day Pepcid AC 5mgs 2x/day ]
The Prednisolone I have is liquid, the prednisone is tablets.
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PaulaM
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Post by PaulaM on Aug 24, 2021 7:38:13 GMT -7
Thanks Brittany. Could you look on the bottle of liquid Prednisolone to find its formula. The formula for the liquid solution might look like this or have different numbers: 5 mg/ 5 mL
What mark on the syringe is corresponds to a 3mg dose? Usually with liquids the markings are in mL. So then how many mL are what you are referring to as a "3mg" dose?
Do you still live in Libby (1.5 hrs from Kalispell)?
If it comes to a point where a surgery could be a consideration, is that an option for your family?
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Post by Brittany & Elton on Aug 24, 2021 9:38:43 GMT -7
Prednisolone formula. 3mg/ML
Nothing was marked by vet. But 3mg dose is 1ML. Dosage says 1ML per day for 7 days. 0.5ML per day for 7 days. 0.5ML every other day for 7 days.
"3mg" dose? 1ML
Yes [Libby]. a 1.5 hour trip with an infant is often 2 hrs.
[Surgery?] Unfortunately, no. Last year yes. This year, no. Kills me to say that.
I wonder if Elton's vet would consult with the vet in C Falls for dosage, or if she would find that incredibly offensive.
I called Glacier Animal Clinic to see if they do any med consults with other vets since he is knowledgeable with IVDD. Not even a remote possibility. Even if I could get him in, he’s booked out. It’s very frustrating that vets don’t do consults with each other in IVDD cases. They certainly do in congestive heart failure - specialists and cardiologists consult with general practitioners for meds. I get having to see the dog, but with records, grading of IVDD plus video consult. It’s wild to me that no one offers this. In many other illnesses for dogs they do. Especially on how dangerous it is to transport an IVDD dog.
Anyway, just venting. Hopefully, he makes progress soon.
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Post by Brittany & Elton on Aug 31, 2021 9:17:14 GMT -7
I was able to see a new vet that is familiar with IVDD. He adjusted the prednisone dosing to 5 mg 2x a day for 5-7 days, then 5 mg 1x a day for 5-7 days, then 2.5 mg a day for 7 days, then 2.5 mg every other day for 7 days.
We did 5 mg 2x a day for 7 days ending [last dose on Sun 8/29?] Monday. We are now [8/31] on day 2 of 5 mg once a day for 7 days. He’s still on the gabapentin and Pepcid 2x a day.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o 8/23 back paws knuckle under with pred taper doses 8/24 can no longer right knuckled paw or move up to stand, pain in control 8/31 slipped out of sling and fell over Prednisone 10mgs tab: as of 8/23: 5 mgs 1x/day am for 3 days as of 8/26: 5 mgs 2x/day for 4 days as of 8/30: 5 mgs 1x/day for 7 days as of 9/6: 2.5mgs 1x/day for 7 days as of 9/13: 2.5 mgs EOD for 7 days gabapentin 50 mgs 2x/day Pepcid AC 5mgs 2x/day ]
Last night I took Elton out and the homemade sling I have slipped off one of his legs. He fell. I’m hoping he wasn’t injured. I feel horrible. I need recommendations for a sling to purchase. It’s not enough.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Aug 31, 2021 9:43:31 GMT -7
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Post by Brittany & Elton on Sept 15, 2021 7:03:21 GMT -7
[Aug 31, 2021 at 11:00am via mobile ]: Whoops just realized I don’t even know what day of the week it is. Today is day 2 of 5 mg once a day (8/31). Yesterday was day 1. 5 mg 2x a day ended 8/29.
-------- [9/15/2021]: Elton is on day 3 of the 2.5 mg prednisone every other day (Monday 2.5 mg 1x a day, Tuesday no prednisone, Wednesday 2.5 mg 1x a day). He has shown no improvement. Monday night [9/13] he started showing more signs of pain (hunched back, whining, shaking). I thought perhaps I decreased his pain medication too much. Tuesday morning he was back to normal. Tuesday evening he was showing signs again, hunched pack, whining, shaking, but was almost unable to straighten out to put his legs into the sling. Also wasn’t going pee enough. I started to think UTI.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o 8/23 back paws knuckle under with pred taper doses 8/24 can no longer right knuckled paw or move up to stand, pain in control 8/31 slipped out of sling and fell over Prednisone 10mgs tab: as of 8/23: 5 mgs 1x/day am for 3 days as of 8/26: 5 mgs 2x/day for 4 days as of 8/30: 5 mgs 1x/day for 7 days as of 9/6 taper: 2.5mgs 1x/day 9/12 pain! as of 9/13: 2.5 mgs EOD for 7 days 9/13; 9/14 pain gabapentin 50 mgs 2x/day owner decreased dose? Pepcid AC 5mgs 2x/day ]
[Date? Sep 15?] I called his vet in Columbia Falls. Soonest appointment with his Dr. was in October. Soonest appointment with any vet there is the end of September. I’ve been to 4 different vet offices for my two dogs in the past couple years, and I’ve noticed they’ve all stopped holding appointments for their clients when urgent things come up. Hoping his Vet will have a solution. Flathead Pet Emergency was horrible last time. Long wait, you can’t go in.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Sept 15, 2021 9:57:27 GMT -7
Britanny, so sorry to hear the 14 cumulated days at the anti-inflammatory level was not long enough. With the tapering beginning on 9/6, it was not until there was also a decrease in pain masking pain meds (gabapentin) that Elton showed not all painful swelling was actually gone.
Quite typically it can take in the range of 7 up to 30 days at the anti-inflammatory prednisone level. Taper days do not count. Low dose taper days are for another reason. For IVDD it happens to be a perfect window to assess for possibly still existing pain.
Make it clear Elton is in pain and you are asking the receptionists to help you.
Rather than asking for an appointment which is not avail til Oct, tell the receptionist you want to get a message to the vet that on the every other day dose PLUS decrease of pain meds, Elton is in pain (hunched back, shaking) again. Give your telephone # and your email address too. A vet has jam packed full days of appointments. You may not get a response til end of the work day. Or ask if, possible can the vet relay a response via the receptionist. It may be that another course of prednisone would be Rx'd to a specified pharmacy near you and any pain meds needed to accompany.
Have dates handy with when things happened in case the vet needs specifics. We are kinda lost and out of the loop since you last wrote end of Aug and are not able to see the pattern of date/med dose/observation of pain.
Pred taper 2.5 mgs 1x/day started on 9/6. Since 9/6 taper what date(s) did you see any sign of pain surfacing other than 9/13 night and 9/14 night? Pain med gabapentin (50 mgs 2x/day). What date(s) did you decrease mgs or frequency? What was the change in mgs or frequency?
NEURO FUNCTION With the begin of the pred taper on 9/6 (2.5mgs 1x/day) have you observed any decrease or worsening in neuro function from 8/24 of can longer correct knuckled paw nor move up to stand?
Since 8/24 did you observe any improvement of neuro function abilities?
Anxiously await what med adjustments are to get Elton back in comfort from pain. Hope also to hear it was pain that was not allowing Elton to want to make the effort to pee and is not a UTI. Which sling did you opt to purchase?
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Post by Brittany & Elton on Sept 15, 2021 11:27:10 GMT -7
The receptionist knows all the details, I did not just ask for an appointment. She just informed me there’s no way to see him, but was going to put a note in to him. I definitely want to know if it’s an UTI. I explained very thoroughly where we were in the wean to the receptionist so she knows.
[Dates are preferable and accurate] Week 1 [date?] was 10 mg week 2 [date?] was 5 mg week 3 [date?] was 2.5 mg week 4 [Sep 12???] is 2.5 mg every other day.
We are in week 4, day 3. Pain presented [Sep 12??? DATES are BEST!] at week 4, day 1. (So it wouldn’t have been any different than the week before since week 4 is Monday - 2.5, Tuesday no prednisone, Wednesday 2.5).
I did not decrease frequency of pain meds, but the amount [dose in mg decreased to what?]. And really only very slightly, to taper his dose. That started at the beginning of week 3. He wasn’t even this amount of pain when he was first injured.
No improvement whatsoever in neuro function. No changes though either.
Maybe it is just too early to wean. I still have more prednisone. But would still need to know if it’s was a UTI. Not sure how to rule that out without going there.
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Post by Romy & Frankie on Sept 15, 2021 13:37:18 GMT -7
It definitely sounds like it is too early to taper. It can take up to 30 days at the full dose before all the inflammation is gone. The taper, in addition to the decrease in pain meds resulted in Elton being in pain. Pred does not leave the body immediately, so the fact that there had been no change in the amount of pred on day 1 of week 4 when pain manifested may simply be because at that point the amount of pred in the body became too low.
There are no meds that can heal the nerves already damaged. Time alone can do that, and nerves are slow to heal. It would not be unusual to see no improvement in neuro functions at this point.
Please let us know what adjustments the vet makes in Elton's medication when you hear from him. We will be wanting to know.
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Post by Brittany & Elton on Sept 15, 2021 16:57:17 GMT -7
I didn’t hear back from the vet today. It worries me since tomorrow would be no prednisone. I will call again in the morning.
I was able to collect a urine sample, and a local vet is willing to test it tomorrow to see if it’s a UTI.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Sept 15, 2021 17:12:33 GMT -7
Hope you will hear something back this evening. IF not right you are to call tomorrow morning.
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Post by Brittany & Elton on Sept 15, 2021 20:49:59 GMT -7
Spoke to the vet [9/15] after hours. He advised to go up to [▲prednisone] 5 mg and see if the symptoms persist. If symptoms persist, go up to 10 mg. Then we will evaluate a wean plan. This may include a wash out period and switch to less damaging NSAIDs. We will approach this as we get there.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o 8/23 back paws knuckle under with pred taper doses 8/24 can no longer right knuckled paw or move up to stand, pain in control 8/31 slipped out of sling and fell over Prednisone 10mgs tab: as of 8/23: 5 mgs 1x/day am for 3 days as of 8/26: 5 mgs 2x/day for 4 days as of 8/30: 5 mgs 1x/day for 7 days as of 9/6 taper: 2.5mgs 1x/day 9/12 pain! as of 9/13: 2.5 mgs EOD for 7 days 9/13; 9/14 pain as of 9/15: ▲2.5 mgs 2x/day for TBA days ( if pain, then 10 mgs 1x/day ) gabapentin 50 mgs 2x/day owner decreased dose? Pepcid AC 5mgs 2x/day ]
We also talked about looking for a wheelchair. Talked about surgery. Talked about the unfortunate choice to make should his pain not be able to be controlled and quality of life declines.
I gave him 2.5 mg as soon as we were off the phone. Good news - at his next potty, he was no longer shaking or whining. He wasn’t as stiff. He even moved his back legs a little rather than just dangling on the sling.
So, as of now [9/15], it is Day 1 - 5 mg for an indefinite term. He is back in the office Monday and we will discuss.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Sept 16, 2021 9:32:41 GMT -7
Brittany, so glad your vet, got back to you after his long day and called for another prednisone course. And the good thing is already you are seeing pain back in control with no more shaking. Would you update the complete med list with the prednisone Rx with a bit more information so we know exactly what Elton is currently taking. Brittany, fingers crossed another course of Prednisone will be able to fully resolve the painful inflamed tissued around the spinal cord.
The goal with conservative treatment is over time if any escaped disc material lodged in the spinal cord canal it would be reabsorbed by the body enough to allow nerves to again be able to function properly. The nerves might then become accustomed and less aggravated and painful.
The goal right now, besides having full round the clock pain control, is to heal the disc with the 8 weeks of rest. As your vet mentioned down the line to try perhaps the smallest dose of a NSAID for long term to keep pain at bay since surgery is not on option. Same principal as humans use the miracles of modern drugs to carry on with comfort in life for some diseases.
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Post by Brittany & Elton on Sept 17, 2021 20:33:14 GMT -7
Dosing for Elton: 5 mg of prednisone in the AM 5 mg of Pepcid AC 2x a day 40 mg of ▲gabapentin every 8 hours
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o 8/23 back paws knuckle under with pred taper doses 8/24 can no longer right knuckled paw or move up to stand, pain in control 8/31 slipped out of sling and fell over Prednisone 10mgs tab: as of 8/23: 5 mgs 1x/day am for 3 days as of 8/26: 5 mgs 2x/day for 4 days as of 8/30: 5 mgs 1x/day for 7 days as of 9/6 taper: 2.5mgs 1x/day √9/12 pain! as of 9/13: 2.5 mgs EOD for 7 days √9/13; √9/14 pain as of 9/15: 5 mgs 1x/day for TBA days ( if pain, then 10 mgs ?1x/day ) gabapentin ▼40 mgs ▲3x/day owner decreased dose? TopCare famotidine 5mgs 2x/day ]
Question - is Top Care Famotidine ok to use in place of Pepcid AC?
Our grocery store was out of Pepcid AC. (Shelves are getting bare here) Pharmacist gave me TopCare Acid Reducer Famotidine 10 mg. The inactive ingredients are different than Pepcid AC. Nothing else opens until 9 am. 3 hours past his dosage.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,611
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Post by PaulaM on Sept 18, 2021 6:53:45 GMT -7
Top Care Acid Reducer with one single active ingredient of famotidine is perfect and less expensive too!
Any signs of pain since the gabapentin at 40mgs 3x/day and the prednisone increased to 5mgs 1x/day on Wed, Sep 15?
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Post by Brittany & Elton on Sept 18, 2021 8:47:09 GMT -7
No signs of pain. But now I’m late for dosing. Called around to everywhere to get Pepcid-AC. Going to give it to him now.
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Post by Brittany & Elton on Oct 9, 2021 8:18:18 GMT -7
We’ve been on 5 mg for 25 days as of today. He is finally showing progress!
[MED LIST/HISTORY- Moderator's Note. Please do not edit 9 lbs 3 y.o 8/23 back paws knuckle under with pred taper doses 8/24 can no longer right knuckled paw or move up to stand, pain in control 8/31 slipped out of sling and fell over 10/4 week: correcting knuckling, using legs Prednisone 10mgs tab: as of 8/23: 5 mgs 1x/day am for 3 days as of 8/26: 5 mgs 2x/day for 4 days as of 8/30: 5 mgs 1x/day for 7 days as of 9/6 taper: 2.5mgs 1x/day √9/12 pain! as of 9/13: 2.5 mgs EOD for 7 days √9/13; √9/14 pain as of 9/15: 5 mgs 1x/day for TBA days ( if pain, then 10 mgs ?1x/day ) gabapentin 40 mgs 3x/day owner decreased dose? TopCare famotidine 5mgs 2x/day ]
This week he started correcting his paws, and using he legs. He still has leg weakness, but he’s came so far. I have a call into his vet, because the instructions were unclear on taper and when to start. I’m not sure when to go down to 2.5 mg, or how long to do that. His vet won’t be in on Monday either. I’m not sure if it’s more harmful to stay on 5 mg, or start taper it’s it not time.
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