PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on May 9, 2022 19:58:51 GMT -7
If pain would surface, your Plan B should provide enough meds to get thru til vet reopens to issue the quantity of pills needed to go with the anti-inflammatory level prednisone course.
Prednisone: The vet will likely go back to the original anti-inflammatory mg dose of pred and likely another 5-day course ending with another test taper.
Pain meds: The vet should ensure Henry will not be suffering any discomfort at all by addressing each of the 3 typical sources of pain with round the clock every 8 hour doses for the duration of the pred course. Pain meds are effective for only about 8 hrs. When the taper begins, pain meds would be backed off or full stopped to allow quick and accurate assessment of painful swelling.
Stomach protection: is for the duration of prednisone use til the final dose.
Below should give you the full picture on the why's behind the comments so you can make decisions, ask questions and if it were necessary speak up on behalf of Henry.
RULE OF THUMB
Prednisone tapering
Pain= another course of anti-inflammatory level prednisone + all pain meds back on board.
No Pain = complete the pred taper, finish the crate rest
Depending on the dosage, steroids can be used as low dose replacement steroid hormone in dogs not able to make sufficient hormone, can range in anti-inflammatory dose during a disc episode or a lower anti-inflammatory dose for skin problems. Doses can be higher for immunosuppressive effects for cancer and other diseases.
Typical is to use the higher end of the anti-inflammatory range for disc episodes.
24lbs dog x 0.3mgs prednisone = 7.20mgs prednisone 2x/day
A vet will typically round down or up to nearest size tablet.
Henry Rx's were at 5mgs 2x/day for his anti-inflammatory level course of prednisone
AS NEEDED
Pain meds are not used "as needed" with a disc episode. When dealing with a disease that is known to be painful, then IVDD knowledgeable vets act as if it is a painful thing. They cover each of the sources of pain that are typical to a disc episode. This multi-modal approach is to ensure the dog heals in comfort: traMADol for overall pain, GABApentin for nerve pain and methocarbamol for muscle contraction pain. 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 a dog is 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.pdfWhy not to use as needed.All pain is not alike…it can be complicated. Pain from a disc episode comes from nerves, from muscles, skeletal. Different pain receptors are blocked by different drugs….thus the usual need for several classes of pain meds. Getting dose to dose pain relief will happen in an hour when the meds are right for your dog. Working with your vet, giving prompt specific observational feedback about pain is how the meds are tweaked (change mix of pain meds, adjust the dose in mg and/or the frequency to give) to get it just right for your dog. Everything can just hurt more, pain is heighten when experienced under conditions of stress or anxiety. Dogs are stressed with the physical pain of a disc episode. All of their routines have been changed with crate rest..that is a stressful thing. So knowing a disc episode is a painful thing, it is prudent to act like it is painful and use an aggressive pain med approach. Michael Richards, DVM explains pain:
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Post by Paulette & Henry on May 10, 2022 5:15:40 GMT -7
At 3 AM this morning after I carried Henry out to potty I remembered that I have a Help ‘em Up harness that lifts his front end and back end with two handles. I used on a boat trip last year. I think this might be easier in my back and his. Any experience with a harness like this vs lifting and carrying? Day 2 of weaning.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 10, 2022 7:38:35 GMT -7
Paulette, the Help "Em Up IS a product we mention for heavy breed dogs in this tips with large dogs page: dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/ Note the strap that is available going over your own shoulder.... might be something you are interested in?? See the section "Lifting Aides." Use the same principals with the Help 'Em harness as you would when lifting him in your arms. The back should always be horizontal to the ground by supporting both ends of the dog. |
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Post by Romy & Frankie on May 10, 2022 13:07:41 GMT -7
If Henry experiences pain during the pred taper, there is still swelling in the spinal cord and Henry should go back on the full dose of pred and pain meds. If there is pain, there is inflammation, and the full dose of pred is what works on the inflammation.
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Post by Paulette & Henry on May 10, 2022 15:53:14 GMT -7
Thank you so very much. Today was a pain free day. 🤞Day2 of the weaning. And, I attached wheels to his crate! Awesome!!! He sat by the front door and looked out and tonight we are going to be in the family room together while I sit on the couch instead of the floor seat I made. Making progress. Thank you all for your experience.
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Post by Paulette & Henry on May 11, 2022 8:58:12 GMT -7
Day 3 of weaning and Day 2 without pain meds. Henry is resting comfortably and doing well with our new routine.
The crate wheels are awesome! I am so very grateful for his comfort and his adjusting to this change in our lives. I am adjusting as well. I am so grateful for this group that I didn’t even know existed 10 days ago. I can’t begin to thank you for just knowing you all are out there. THANK YOU! We are now into a week and two days into strict crate rest and I couldn’t have done it this far without your support and creative ideas. I am taking it one day at a time. Tomorrow is acupuncture and laser. ❤️🙏
Henry has acupuncture and laser tomorrow morning at 8:45 AM. I understand every trip outside of his crate is a risk. The acupuncture and laser has been so helpful for him. I have read and reread everything about transporting him but I am scared. I checked with the acupuncture vet and she doesn’t do house calls. I am just talking out loud because I know you are listening out there.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 11, 2022 10:13:06 GMT -7
Paulette, just because there are so many services for sale, doesn't mean one needs to use 'em. Be a smart shopper, be a discerning shopper.
What IVDD owners need to do is give weight to the benefit of the service vs. potential for risk. Get out a piece of paper and make a benefit and a risk column.
Acupuncture and Laser light services
These services can:
-- be an adjunct to reducing pain.
-- can help to kick start nerves to self repair.
-- What benefit exactly did Henry have in the past with these services???
Pain meds
Using an aggressive use of pain med pills allows a dog to stay in their recovery suite.
Henry is in a test for pain taper. These two services are akin to being a blindfold about pain as are pain med pills.
Neuro status
I don't think you've reported nerve damage or if you did it is very mild. What is Henry's current neuro status?
Now assess your thoughts about the benefit to be gained with these two services: ???
Now assess what risk could be a potential to the healing disc with a vehicle transport, how Henry might accidentally be handled or something else unexpected in an environment outside of his normal at-home recovery suite.
I think you had a sense about going in for services. Now fill in with the details and compare risk to benefit.
Being an IVDD parent means being able to recognize advise or treatments that are well meaning but potential harm to Henry's healing disc.
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Post by Paulette & Henry on May 11, 2022 10:57:30 GMT -7
Neurologically Henry is as good as he was when he recovered from the back surgery in Oct. ambulatory, good CP, good bowel and bladder. He is resting comfortably. I agree that the acupuncture might not have a benefit for him right now but the laser will help with swelling. I am debating. Thanks.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 11, 2022 13:38:55 GMT -7
Jumping the gun?
Proof about painful inflammation comes when the taper ends.
Risk laser therapy transport during the prednisone taper?
Add a variable that would mask pain, and prevent doing an accurate test about painful inflammation?
So far, it is appearing that all inflammation is gone. No one knows for sure til the end of the prednisone test for painful inflammation concludes with last dose of pred.
In short best to stick with at home rest. Don't risk anything. Henry is on such a good path of healing, it would be tragic for him to be exposed to any potential set back. Anytime out of the recovery suite is a potential danger to the healing disc.
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Post by Paulette & Henry on May 13, 2022 5:41:21 GMT -7
Morning all. Henry is doing great. Day 5 of the wean. He is definitely feeling better because he is more whiny to be out of his crate. But, he remains confined. One day at a time…hope we have a quiet and healthy weekend and wishing the same to all of you.
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Post by Paulette & Henry on May 14, 2022 6:00:30 GMT -7
Morning all. Henry is doing great. Day 5 of the wean. He is definitely feeling better because he is more whiny to be out of his crate. But, he remains confined. One day at a time…hope we have a quiet and healthy weekend and wishing the same to all of you.
[Sat 5/14] Morning all. Henry is doing great during his Prednisone weaning. Today is a dose then every other day for 5 days. No pain meds for 4 days. He is still on strict crate rest except to go to the potty. I bought a very deep doggie stroller that he can walk right into and we can sit outside a little. If it is padded really well with blankets for him in the stroller is it safe to take small walks to break up the monotony for him? I hope you all have a great day.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 14, 2022 7:12:27 GMT -7
Paulette, the taper sounds very positive that all swelling might be gone. Won't take long now til you have the proof at the end of the EOD (every other day) doses. Before you know it graduation day will be arriving on June 28. To dogs sitting on the deck in a stroller gives them an opportunity to read the backyard newspaper. Their sense of smell is very keen and tells them a lot about what is going on. "The main goal during crate rest is healing and not entertainment. We need to be sure that we always provide the most conducive environment for healing to take place so that the dog is given the very best opportunity for recovery. Used wisely and with appropriate caution, a stroller can help us make the healing environment a little more convenient.....Waiting until crate rest is over for a stroll would be best." dodgerslist.com/2020/05/17/pet-stroller-conservatve-treatment/ |
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Post by Paulette & Henry on May 14, 2022 9:25:35 GMT -7
Ok gotcha! Thanks. What does EOD stand for? On the every other day off the Prednisone Henry still gets the Omperazole, correct?
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Post by Romy & Frankie on May 14, 2022 12:56:06 GMT -7
EOD on a prescription is usually every other day.
It would be best to continue using the Omperazole every day until Henry is completely off the pred
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Post by Paulette & Henry on May 14, 2022 13:08:56 GMT -7
That’s what I thought. Just double checking. Thanks
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Post by Paulette & Henry on May 15, 2022 13:05:13 GMT -7
Henry whimpered out in pain tonight and is shaking just a little. Guess the prednisone wean isn't working yet and he still has inflammation.
So I gave him a ✙ [gabapentin] pain med and back to the ▲pred for 5 days straight and start the wean again after the 5 days straight. I need to get more pred. And let the neurosurgeon know tomorrow.
Today was the first of the every other day pred guess it failed. So basically I know he still has swelling.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24lbs 3 1/2 y.o.
Feb 10 disc episode
MRI 5/3
5/3 true crate rest started
Prednisone as of 5/3: 5mgs 2x/day for 5 days, 5/8 test taper: √5/16 pain/ _ neuro
✙Gabapentin 100 mg 2x/day SToPPED 5/9
Omeprazole 10 mgs 1x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 15, 2022 14:29:48 GMT -7
Dang, was so hopeful the taper was going in a good direction indicating all the swelling might be gone.
Did he whimper after moving or ??.... Fill us in on the details.
Coud the shivering be due to being chilled or anxiety about something?
Yes, do keep the neuro in the loop.
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Post by Paulette & Henry on May 15, 2022 15:37:55 GMT -7
He couldn’t have been chilled. We live in Florida! He just came back in from going potty and was back in his crate He just came back in from going potty made a tiny sound out there but not much. Wen he got back in his crate he let out a cry and I reached in to pet him and he whimpered and was shivering.
I immediately gave him a Gabopentin 100 mg and the Prednisone [5mgs dose?] that he didn’t get today. I also gave him his CBD oil 1/4 dropper. I had to leave for about an hour. When I got back he wasn’t shivering and no evidence of pain symptoms. He seems happy and content. So, we start again. Walking, peeing,pooping all ok. Tail pinch responsive.
I don’t know if the Prednisone will be once a day or twice a day until I talk with the neurosurgeon. I don’t know if he will want to start completely over with 5 mg twice a day x 5 days then once a day x 5 days then the every other day. I will call in the morning.
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[5/15] I don’t know if the Prednisone will be once a day or twice a day until I talk with the neurosurgeon. I don’t know if he will want to start completely over with 5 mg twice a day x 5 days then once a day x 5 days then the every other day. I will call in the morning.
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[5/16] Henry is very comfortable today.
Neurosurgeon said go back to the every other day prednisone 5 mg until the bottle is done and to use the gabopentin 100 mg as needed. He hasn’t needed any today but he did have a prednisone yesterday and today. He us refilling the Rx just in case but if so finish the pred and use the gabopentin and he us still uncomfortable I am to call back.
[5/17 6:23am] Ok let’s try this again. Today [5/17] is a no prednisone day. Fingers crossed that he does well. I have mixed feelings of continuing with the EOD Pred instead of starting over with daily dose and wean again. But, I don’t have the vet degree and I also have little experience with all of this so, here we go.
two weeks in the crate today. Feels like months.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 17, 2022 8:22:29 GMT -7
Our fingers are crossed with yours, too!
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Post by Paulette & Henry on May 18, 2022 10:53:05 GMT -7
I just found out about the procedure laser disc ablation. There is a surgeon five hours for me that performs it. I understand that they can’t be done during a clinical event like Henry’s in now and that they have to be off meds for at least two weeks before they would even be a candidate. I found a very old post on Dodgers list from many years ago but I was wondering if anyone had any recent experience with this procedure. I have been researching it and understand the risks and benefits. My surgeon said that when is. Off meds and not in a clinical state, off his crate confinement that it would be something to discuss and maybe consider. Any experience from the group?
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Post by Romy & Frankie on May 18, 2022 13:56:17 GMT -7
Dodgerslist has been asked many times about the Laser Disc Ablation procedure (PLDA). We asked Dr. Danielle Dugat, DVM, MS, ACVS at Oklahoma State, where most of the research has been done, about her latest follow-up research. She was kind enough to send us the following information:
"We looked at 303 cases. 19.8% of the dogs (n = 60/303) had an episode of SUSPECTED or CONFIRMED disk herniation after having the PLDA, but only 3.6% had a CONFIRMED disk herniation (via CT, MRI, surgery). 19 of the 60 dogs had a suspected episode of pain that resolved on its own in less than 3 days (this is probably not a true recurrence, but we had to include them based on the clinical signs that owners were reporting). 94.4% of owners reported that their dog was the same or better immediately after the PLDA (we want them to come in and leave our hospital the same - normal). "
Laser disc ablation is not a guarantee that a dog will not have another IVDD episode. Every single disc in the spine has the potential to be effected by the ongoing IVDD disease process. During LDA, the surgeon usually selects only 7 discs to zap (those that seem to herniate most often). Any of the other discs can become problematic, resulting in an IVDD episode.
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Post by Paulette & Henry on May 19, 2022 19:15:57 GMT -7
Just checking in. Henry is on the taper EOD prednisone with 3 pills left. So getting down to the wire to see how he is really doing. No pain meds since that weird episode last Sunday when I gave him one Gabopentin. He and I are taking it one day at a time. On Tuesday we started into week 3 weeks of tge recovery crate restriction period. Slow and steady. Fingers crossed every day. So tomorrow is a new day.
[May 23, 2022 at 7:31am]
Today is the last day of week 3 and one more day of the prednisone 5 mg taper. No pain meds for a while and appears to have no pain. I wake up everyday thankful that he is peeing, pooping and walking. I feel like I am always waiting for the other shoe to drop. We are both happy and have settled in. His stroller opening is the height as his crate and the opening to the stroller is exactly the same size as the opening to the crate. So I can lock the wheels when. i am home and give Him a bit of extended space. So, again, 🤞 as we continue the path. Thank you all for being out there,It definitely helps. ❤️🐶
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 23, 2022 10:25:01 GMT -7
Paulette, this is good news off all pain meds and one final dose of the every other day pred.
Not sure what extending the size of the stroller area means.
The area of limited movement where the disc has the best opportunity to heal, should only be large enough to easily turn around in. When lying down to fully stretch out the legs.
Giving access to another space such as into wire crate, that would mean Henry needing to take footsteps to get there. Not a good idea because limited movement is the key to getting the disc to heal.
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Post by Paulette & Henry on May 23, 2022 11:20:49 GMT -7
The stroller butts up against the crate so he can go between the two.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 23, 2022 12:17:16 GMT -7
Paulette, so the limited area for STRICT rest has been enlarged to enable more than the required:
-- ONLY enough room to be able to turn around in.
-- ONLY enough room to fully stretch out the legs when lying down.
Now the suite room has been expanded to allow taking footsteps from one recovery area to another.
Help us to understand the thinking behind adding space to his recovery area:
--- What are your reasons to not follow the true principals of STRICT limited movement?
--- What are your reasons to want to decrease Henry's potential to heal his disc by expansion of his suite area?
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Post by Paulette & Henry on May 23, 2022 12:22:50 GMT -7
I guess I wasn’t thinking. It is not expanded all the time. I use it for when it’s time to go into the stroller and I don’t want to bribe him w food. It is open to him and he can go in at his leisure. When he does I zip it up and he us then in the stroller confined.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 23, 2022 12:40:00 GMT -7
Paulette, your details complete the story. We read every single word you write and take them literally.
If it is a matter of only one suite at the time WHEN you want him in the stroller or back in the crate, that is ok to open the passage door for him to take a footstep or two to cross over.
It is not ok to have both the stroller suite and the crate suite open so Henry can go back and forth between the two suites at his own will. Both suites open to Henry would double his recovery suite area. Not good for the healing disc.
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Post by Paulette & Henry on May 25, 2022 17:24:36 GMT -7
Henry has one more day of prednisone. How many days once he is off of it should he stay on the omperazole?
So far Henry is doing very well. I am very hopeful that all progresses well w my little man.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 25, 2022 18:21:54 GMT -7
No changes since my 5/9 post re omeprezole suppressing the acids prednisone causes.
“Stomach protection: is for the duration of prednisone use til the final dose.”
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Post by Paulette & Henry on May 27, 2022 8:25:33 GMT -7
[This post has been read and marked by moderator. Please add in any new information/correction in a new post. Thank you]
Well Henry has been off the Prednisone for two days. Still breathing one day at a time. No other meds except Chinese herbs and CBD. Still on crate rest or in the stroller and outside to use the potty. We are at 4 1/2 weeks - halfway until the next phase. The stroller and wheels in the crate are lifesavers.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24lbs 3 1/2 y.o.
Feb 10 disc episode
MRI 5/3
5/3 true crate rest started
Double P II with prednisone, stopped 5/20(?)
Prednisone as of 5/3: 5mgs 2x/day for 5 days, Sun 5/8 test taper: _ pain/ _ neuro
✙Supple Spine on 5/20
Omeprazole 10 mgs 1x/day ]
Edited May 27, 2022 at 12:59pm by Paulette & Henry
He was on Double P for 3 weeks and last week [5/20?] they changed him to ✙Supple Spine twice a day. His acupuncture vet prescribes them.
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