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Post by Darlene & Stanley on Aug 10, 2022 18:55:00 GMT -7
[Original subject line:Could use a little advice]
Darlene's Stanley 6/13 conservative GRAD 8/8?
[Post is being read and marked. If there is additional info or a correction, make a new post. Thanks!]I have had dachshunds for more than 20 years. About 15 years ago, my first dachshund hurt her back. I didn’t have the funds to have surgery. And I can tell you only by your help did I learn about IVDD and how to help my dog recover. And she did with conservative crate rest. And she lived a wonderful life till the age of 16. Fast forward after she passed we got Stanley. He is 5 years old. 17 lbs dachshund.He always walked a little funny back legs kind of bow legged, but doctor was never concerned and said he was fine. [ MED LIST/HISTORY- Moderator's Note. Please do not edit
17 lbs 5 y.o.]
I always use ramps and absolutely no stairs. But on June 6th, he started acting funny. Not his happy self and won’t jump up when he greeted us. I thought maybe glands were bothering him. Took him on June 9th to the Vet he had glands cleaned . They said they were bad but not infected. But he still was acting funny. Kind of acting Gingerly. Doing a lot of just sitting. Took him back to the vet June 13th. I started crating him at this point because I suspect ed it was his back. They did X-rays and it showed calcification in his lower back. So started him on carprofen 1/2 tablet 75 mg every 24 hours. And then started him on ⚠️ Galliprant20 mg once a day. Well he just got worse. He had extreme pain. He would get spasms in his lowers back . He added tramadol as needed 1 tablet 50 mgs as needed to help with pain. Continued to get worse in pain. However never lost any use of his legs and never had any problems going to the bathroom. Just extreme pain. He was crated all along.Since the Galliprant was not helping, doctor had me stop it after 5 days cleaning out, Said he needed prednisone. But of course had to wait 5 days to start that. Well things got worse and had to take him to Akron metro hospital which was on the 24th. I thought they would do surgery or an MRI. But they wouldn’t because he walked fine and was not paralyzed. So they put a fentanyl patch on him started gabapentin solution 250mgs (0.16-0.32) every 8 . hours. Also started the prednisone 5mg once a day. Of course Pepcid was added on day one with the prednisone They instructed me to crate him for six weeks Well we kept him on the prednisone, slowly weaning him off and finally stopped it on August 3rdAlso stopped the gabapentin last week on the 3rd as well . He is of course still crated, but today [8/10] I noticed legs shaking. Which he never did. I think he might have a little pain, but no crying out. He is moving more in his crate, which is actually a playpen. I also have a stroller which he can sit in and look out the door. So now I feel defeated and need your advice and suggestions. I called to vet today asking about acupuncture and laser treatment. Do they help ? I never did that with our other dachshunds. If he needs surgery we are open to that too. Just want him to be healthy again, he’s so young I’m so this is so long. Appreciate your help.
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PaulaM
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Post by PaulaM on Aug 10, 2022 20:26:37 GMT -7
Welcome to the Forum! Hi, my name is Paula, what's yours? Aug 8 should have been the date of graduation from 8 weeks of disc healing with crate rest starting on 6/13. Did Stanley begun a slow and gradual introduction back to family life and activities upon the final dose of prednisone (Aug 3)? Or has he been allowed with supervision and gradual amt of activity prior to Aug 3? Please fill us in Right now he walks, so why the need for laser and accpuncture? PAIN
What are the circumstances where you see his back(?) legs shaking?
What is Stanley doing, lying down, taking some footsteps in his suite? Tell us what you see.
It helps to confirm pain if you also see more than one sign of pain. Some signs can be confused with being cold, anxiety, atrophied muscles shaking, etc.
Let us know if there are other SIGNS OF PAIN to help confirm: ⚙︎ 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 |
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Post by Darlene & Stanley on Aug 11, 2022 1:39:47 GMT -7
My name is Darlene. Stanley would alway look at his back when he had pain, almost like why does that hurt there. It is in his lower back. The trembling of his legs are when he is put down to go to the bathroom. I haven’t started letting him walk yet. I was going to start letting him walk this week end because he was moved to emergency on the 24th of June. And the pain was so intense. I am afraid. So I didn’t know if that would have been the official date. He started looking back again yesterday at his back area . And this may sound strange but some times I can notice that his fur the back leg is up a little, like they get when excited or upset about something. But it’s on the lower hip. His tummy is a little tight. Should I start to let him walk? Should I not start the meds again? Also when he was in pain, when he was taken outside to go to the bathroom, he would just sit down. Not walk at all since moving must have caused so much pain. Started doing that again yesterday. So worried for a new lapse. [MED LIST/HISTORY- Moderator's Note. Please do not edit 17 lbs 5 y.o.Prednisone as of 8/10: 5mgs 1x/day for 7 days, then 8/17 test taper for pain 8/9 pain/_neurogabapentin formula 250 mg/mL: 40mgs (0.16mL dose) 2x/day (range: 0.16 to 0.32ml 2x/day)Pepcid AC ?mgs 2x/day ] Stanley Prednisone 5mg once a day Gabapentin Solution.32 dose 250 mg every 12 hours He was off everything as of August 3rd. Started back yesterday August 9th because I thought he was in pain again Also started him on August 4th Dasuquin Advanced Supplement. I called the vet [8/10] yesterday he said to start the Pred and Gabapentin again. Vet said he will refer me to a surgeon. He is crated. I never stopped since June 13th. He's not showing any pain except legs shaking a bit. Could it be from not using them? |
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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 11, 2022 8:05:49 GMT -7
Darlene if you suspect another disc episode or re-damage to the same disc, then 100% STRICT rest immediately PLUS calling your vet to get permission or Rx to resume meds.
Please comfirm details so we have a clear understanding
Prednisone started 5mgs 1x/day by your vet's directive? For how many days will 5mgs 1x/day be given?
With one pain med gabapentin alone, is all pain now gone today Thurs 8/11--- round the clock, dose to dose?
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Post by Darlene & Stanley on Aug 11, 2022 8:11:52 GMT -7
Darlene's Stanley 8/10 conservative GRAD 10/5
I called the vet yesterday [8/10?] he said to start the ✙Pred and✙ Gabapentin again. Vet said he will refer me to a surgeon. He is crated. I never stopped since June 13th. He's not showing any pain except legs shaking a bit. Could it be from not using them? |
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PaulaM
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Post by PaulaM on Aug 11, 2022 8:21:06 GMT -7
Darlene, what date did you phone your vet to report this new 8/9 pain and get the meds adjusted?
Is there a heath reason why the typical pred dose was not used with Stanley? The typical with a disc episode is:
-- to use prednsone up at the anti-inflammatory dose for a 17 lbs dog.
Prednisone. 17lbs X 0.3mg pred = 5.1 mgs 2x/day
-- Gabapentin for nerve pain. What is the formula on the bottle.
• How many mgs of gabapentin are in on mL of liquid?
• What is the dose you give in mL 2x/day?
-- If all pain is not fully in control with gabapentin alone, advocate that all 3 sources of pain be covered promptly every 8 hrs (3x/day)
• methocarbamol for muscle contraction pain
• traMADol as the over all analgesic at the max analgesic dose for 17 lbs/ 7.71kg dog. The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours.
Pepcid AC (famotidine) is that back on board for the duration of Prednsone? ?mg ?x/day for Pepcid AC?
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PaulaM
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Post by PaulaM on Aug 11, 2022 8:23:25 GMT -7
Darlene could you use dates rather than yesterday, last week, etc.
What country are you in "Yesterday" in the USA would be Wed Aug 10 not Tues Aug 9
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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 11, 2022 8:30:29 GMT -7
6 hrs ago (8/11) you reported a tight tummy and you reported shaking legs. Now you report only shaking legs. Sorry but this is a bit confusing reading and not being there with you and Stanley to see what is going on. If there is pain, that signals spinal cord inflammation. What needs to be determined if at all possible is: are shaking legs actually pain or muscle atrophy weakness. Seeing two or more signs of pain helps to confirm actual pain. If in doubt best to assume pain and treat accordingly as if a new disc or same disc had a relapse. --- 100% sTRICT rest --- 3 pain meds to provide round the clock comfort from pain. --- anti-inflammatory to work on the swelling over the course of 7 to 30 days. Taper days DO NOT count as they go below the effective level to fight inflammation. -- IF there is any concern this may be something else other than a disc episode, then a consult with a neuro or ortho would be in order. Important info for YOU to discuss things regarding conservative vs. a surgery, etc. ** dodgerslist.com/wp-content/uploads/2020/05/dr-isaacs-surgery-interview-1.pngDr. Isaacs answered alot of questions we've all had about surgery.You will find it worthwhile to read his answers: dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/More excellent info to help with conservative vs. surgery decisions: dodgerslist.com/2020/02/10/surgery-vs-conservative/ |
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Post by Darlene & Stanley on Aug 11, 2022 8:50:42 GMT -7
His tummy did not feel tight [Thur 8/11] this morning. Thank you for the information. I will keep him on meds.And follow up with an Ortho, waiting for referral from the Vet.
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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 11, 2022 8:58:20 GMT -7
Is pepcid AC on board to suppress the acids prednsone causes? If not tight tummy could be due to GI upset or damage from prednisone.
Is med list correct? please advise re questions in pink
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Post by Darlene & Stanley on Aug 11, 2022 10:21:37 GMT -7
Stanley is always on Pepcid 10mgs two times a day every 12 hours and always 30 mins before taking Prednisone. Doctor said as long as needed for the Prednisone/ slowly reducing dosage. Once a day
Gabapentin in 250 mg , the dosage was higher when pain was bad . I gave him .01 yesterday. He also said to use it as needed. Every 12 hours or if pain is bad every 8 . He was on max dosage in June.03 ml .I did not give him any today. Yesterday at 3:30 pm I gave him dosage .01
He doesn’t seem like he is in pain this afternoon. Tummy is not tight. Just shakey legs .
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Post by Romy & Frankie on Aug 11, 2022 14:07:16 GMT -7
I am glad to hear that Stanley does not seem to be in pain this afternoon.
Pain meds work best when given on a regular schedule. It is much harder to stop pain once it is started than to keep it from starting. Gabapentin does not last long in the body and often has to be given every 8 hours to prevent pain.
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PaulaM
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Post by PaulaM on Aug 11, 2022 15:26:39 GMT -7
Darlene, we can not understand the dose of gabapentin Stanley gets. Would you look on the gabapentin bottle for the formula. It could be written something like 100mg/1mL or 25mg/1 mL, etc.What is is the gabapentin formula as written on the bottle?what is is the unit of measure for "0.01" dose? mgs, mL, cc?Pain meds are never given as needed. Assume a painful disease is painful! Give promptly so that pain never has the chance to surface. Stick with 2x/day or 3x/day. If pain on 2x/day you would know he needs 3x/day. UP and down dosing and frequency is not good. MED CHART You may find a med chart help you to note cause and reactions with meds, especially when the pred taper begins. A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdfOn the taper of predsnone where it goes less then 5mg once a day, then is the time to reduce pain meds. The pred taper is for YOU to monitor for any pain surfacing. Rule of thumb on the taper of prednisone Pain= another course of anti-inflammatory + all pain meds back on board + Pepcid AC. No Pain= go to conclusion of pred taper... finish out the 8 weeks of crate rest for the disc to heal. The full details on how Prednisone, an anti-inflammatory works with a disc episode. Good reading to be able to ask the right questions and discuss treatment: dodgerslist.com/2020/04/18/steroids-vs-nsaids/It is not clear from what you write, if prednisone has started to taper lower than 5mgs 1x/day. We track the important information of how many days on Prednisone 5mgs 1x/day. What date is the taper to start or has started already? |
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Post by Darlene & Stanley on Aug 11, 2022 16:21:25 GMT -7
Stanley never took more than 1 5mg steroid for the 4 weeks he was on it. Vet never said that wasn’t enough. That is disappointing.
He is on Gabapentin Solution 250 mg:/ml
His dose says give 0.16 to 0.32ml as needed every 12 hours. I also have Tramadol but never gave it to him because the pain was controlled well I thought with the max dose of Gabapentin. I feel like I am starting all over again. He really doesn’t seem like he is in pain. Again just shakey legs when he go to the bathroom. I am so overwhelmed.
I had the prednisone completely stopped on August 3rd and the Gabapentin. He was fine.Just started shaky legs yesterday August 10th. I’m so sorry I do think I put the 9th of August. I called the Vet immediately on August 10th to ask about starting the meds again And he said to do that. I asked for a orthopedic referral.
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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 11, 2022 20:41:07 GMT -7
Darlene, glad to hear you reporting Stanely this afternoon was not in pain! Sorry this is difficult to find the important details about the medications. Could you look at the gabapentin bottle again and copy exactly as written? This formula does not note the number of mL: Gabapentin Solution 250 mg:/ml 2) What gabapentin dose are you promptly giving every 12 hours 0.16mL or 0.32mL? Vet gave a range of mL doses so you could adjust to provide perfect pain relief. It is does not mean to bounce up an down in mL doses every day.
3) Have you described shakey legs to the vet. What did he determine: a slight neuro diminishement or was that a sign of pain? Is the current mL dose you give providing round the clock comfort day and night? That is then dose in mL to stick with if he is fully in comfort from pain. Avoid bouncing up an down in mL doses. If you find he is not pain free round the clock, then increase the Gabapentin mL dose. Then stick with that dose as the new dose. Again avoiding bouncing up an down in mL doses. Does that make sense? 4) For how many days is prednisone to stay at 5mgs 1x/day before lowered in mgs/frequency? It is a 5-day prednisone course, a 7-day course, then taper? Taper days do not work on swelling. This is why we are particularly interested in the number of days. Most vets take a guess at a 5-7 day course and then taper to find out if all swelling is really gone.
5) Pepcid AC? What is the stumbling block to protecting Stanley's stomach for the duration of prednisone? |
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Post by Darlene & Stanley on Aug 12, 2022 3:34:44 GMT -7
It does say exactly on the Gabapentin
Give 0.16ml to 0.32ml by mouth every 12 hours for relief of pain
Compound drug product
Gabapentin solution 250 mg/ml. (20cc)
I did adjust the dosage every week to a lower amount until stopping on August 3rd.
I did start again on the 10th lower dosage.
Isn’t it better to go with a lower dosage if no pain is indicated??
The Pepcid is given every 12 hours , 30 mins prior to Prednisone.
The steroid was prescribed for 7 days 1 5mg tablets
It was given for almost 14 days. He adjusted it after the fentanyl patch was removed. Then every other day for 10 days and then 1/2 every other day. Then 1/2 every two days until stopping on
August 3rd.
Doctor didn’t say what he thought to issue was. I will call again today. He was supposed to call was referral for an orthopedic doctor yesterday, didn’t.
This morning again no indication of pain and legs are not as shaky. But he’s on prednisone again and pain med.
It’s been over 2 months since this happened and well over 8 weeks of strict crate rest. Would you think I would have to do this for another 8 weeks??
I will do whatever is best for him.
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PaulaM
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Post by PaulaM on Aug 12, 2022 7:08:27 GMT -7
Darlene, thanks for sharing many of the important details asked for.
This 8/10 is a new disc episode. It is confusing when you mix in things about the last 6/13 disc episode. Stanley's history is available for us to review your previous posts if we need to.
From now on let's just stick to details of this new 8/10 episode.
GABAPENTIN
Thank you for the clear information about the formula!
What is the dose in mL you currently are giving gabapentin every 12 hours?
PEPCID AC
Are you dosing for a 17 lbs dog: Pepcid AC 5mgs every 12 hours?
PREDNISONE
Is the current Rx of prednisone for this 8/10 disc episode also for 7 days, then a taper?
CONSERVATIVE TREATMENT
It takes a disc 8 weeks to heal from the date of disc damage. You reported another disc issue (maybe the same disc, maybe a different disc.) on 8/10. Your vet acted as if this were a disc episode with his diagnosis/treatment for prednisone Rx and one pain med on 8/10.
Until you have a different diagnosis that this is not a disc episode, then it is prudent to act like you are dealing with a disc episode.
MEDICATIONS
Prednisone MUST be tapered to signal the body to again make its own steroid hormone. During the taper is a perfect window to assess if pred has rid the body of all painfully inflamed tissue around the spinal cord.
During the pred taper, since it is YOUR job to monitor and observe if any hint of pain still exists, you do not want to be wearing a blindfold, right? Pain meds mask pain. So when pred tapers after the 7-day course on 8/17 the pain med is either:
1. full stop of gabapentin
2. a vet depending on factors he knows about Stanley may prefer to back down in times per day and in mgs of gabapentin
FIND OUT what your vet wants: full stop or backing down pain med on Wed. 8/17.
PAIN
A disc episode is a painful thing. You never want to see a dog in pain. It hinders healing. Consistent and prompt dosing makes sure the dog is not in pain. Stopping, restarting, changing doses up and down defeats control of pain. The time to reduce/stop pain meds is at the end of the 7-day course of prednisone when the taper starts. That is a kind of test to see if pred had fully resolved pain or if another course is needed.
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Post by Darlene & Stanley on Aug 12, 2022 11:29:13 GMT -7
Giving Stanley 0.2 ml of ▲Gabapentin every12 hours
Pepcid 10mg every 12 hours
Doctor said 7 days and taper on Prednisone
Have an appointment with Orthopedic vet Sept 2
[MED LIST/HISTORY- Moderator's Note. Please do not edit
17 lbs 5 y.o.
Prednisone as of 8/10: 5mgs 1x/day for 7 days, then 8/17 test taper for pain 8/9 pain/_neuro
gabapentin formula 250 mg/mL: ▲50mgs (0.2mL dose) 2x/day (range: 0.16 to 0.32ml 2x/day) 8/17 reduce 40 mgs (0.16) mL; full stop on last dose of Prednisone
Pepcid AC 10 mgs 2x/day ]
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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 13, 2022 8:18:02 GMT -7
FIND OUT what your vet wants: full stop or backing down pain med on Wed. 8/17 when prednisone begin tapering down. Your job is to monitor for any hint of pain re-surfacing during the pred taper.
Well before Sept 2 ortho appt, you likely will know if prednisone has been successful in resolving all pain or not. You will then have facts to make a decision if you need to go ahead with ortho appt.
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Post by Darlene & Stanley on Aug 13, 2022 13:15:16 GMT -7
He said he wanted me to taper after the 7 days so that by the orthopedic appointment we will know how he is doing. At that point we will have to get an MRI if he still in pain. He is not showing any symptoms of pain and the shaky legs have stopped. The meds clearly working. And of course still crated. I’m starting to feel really bad , it over 9 weeks crated. Thank for all your help.
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Post by Romy & Frankie on Aug 13, 2022 13:36:10 GMT -7
Glad that Stanley's legs are not shaking and he is showing no signs of pain.
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PaulaM
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Post by PaulaM on Aug 13, 2022 14:27:36 GMT -7
Darlene, to get clarification:
Your vet DOES WANT you to back off the PAIN MEDs on 8/17.
What is the method: to reduce gabapentin by mL dose (what mL dose)?
to reduce the gabapentin frequency down to 1x/day?
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Post by Darlene & Stanley on Aug 13, 2022 14:48:49 GMT -7
He wants me to stop pain meds on 08/17 to minimum (0.16 is the minimum) and then stop when the prednisone is done. I am currently at 0.2 minimum is 0.1.
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