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Post by Jack & Coco on Nov 7, 2022 12:17:39 GMT -7
Paula, thanks again.
Coco is being brought back up to the higher ends of the dose range (as last discussed)for all the meds. I likely will go even higher on Tramadol, shooting for around 500mg (125mg x 4X day) to see how she does on that. She had a "good day" yesterday on 11/6, but pain/discomfort/restlessness struck back between midnight last night and 4am this morning (11/7). Her next dosing wasn't due to 5:30 am. She wasn't doing well, so I supplemented her with another 100mg of Tramadol and 100mg of Gabapentin at 4am.
MED LIST/HISTORY- Moderator's Note. Please do not edit
55 lbs/24.95 kg 9 y.o.
70 miles away ER Neuro MRI 9/25 for head plant. Surgery too difficult. Crate rest RX
10/13 5 min slow walks
10/14 disc relapse, returned to orig state of pain
11/4 pain surfaced at lowering of sedation pain meds
11/14 2nd opinion nearby Neuro appt
dexamethasone 0.75mg tab , ER vet
as of 9/27: 0.75 mgs 2x/day for 2 days; 9/29 taper doses due to diarrhea
as of 10/14: 0.75 mgs 2x/day for 21+? days; then a test taper for _pain/ _neuro
traMADol 100mgs 4x/day
gabapentin 200 mgs 4x/day
Methocarbamol 500mg tab: 500 mgs 3x/day
Amantidine 100mgs 1x/day
Pepcid AC 20mgs 2x/day]
As an interesting observation, coco seems to have her biggest struggles "in the middle" of a dosing timeframe (when meds should be at their highest efficacy). For example, with her 11:30 pm dosing last night on 11/6, most of her discomfort is around 2am to 3am (when all meds should have kicked in the most). *******And, as I'm writing this now at 1:50pm on Monday 11/7, 2 hours and 15 minutes after her 11:30am dosing, she got up restless, circled 4 times, sat and yelped on the way down).
********A theory of mine is as follows. At this "midpoint" between doses, she clearly looks/is the most sedated, not wanting to get out of the crate. But, she does get up a few times to reposition herself, whether it be for pain and/or fact she sensed she urinated on herself. So, when she stands up to reposition, she doesn't have a whole lot of strength (due to sedation) and, when you combine this with an already completely atrophied front left leg and atrophied left leg shoulder (and chest) muscle (it's basically a shell now), the weight of her body isn't supported well (on the left front side). That's when it appears she seems to yelp most often.
Interestingly, this morning [11/7] at 11am (near the end of her 6 hour dosing schedule), she had decent energy to get up to relieve herself and was showing very good range of motion in her neck when eating and from a sitting position (turning her head both left and right easily when sitting). With the range of motion looking so good, I'm hopeful the disc has started to heal. And maybe (RELATED TO MY "DOSING MIDPOINT" OBSERVATION), most pain is really coming as a by-product from the weakness in her front left atrophied leg (described above)...and how that interacts with what painful inflammation still remains in her neck.
A note on the Neurologist. As a reminder, the ER vet neurologist is a full 70 miles away and I've only been doing quick (and perhaps not so effective) phone calls with the vet tech and occasionally I get the doctor.
It took a long time, but my appointment with a neurologist closer to my home (it was a month wait) is coming up [11/14] 1 week from today. I do plan on going there for their opinion (on her current status and treatment options) and to work closer with me to manage the meds protocol (as it has admittedly been tough).
On the FORUM, we have 10/14 as Coco's beginning date. I'd like to think of that date as "the true date" for reasons of conservatism (with GRAD date of 12/9). On the other hand, if there was truly no further damage done to the disc/nerves prior to 10/14 (when I noticed the relapse in pain), then perhaps the 8 week period ends in late November (since she has been on restricted movement since the release from the ER vet on 10/1).
That's why I'm hopeful the neurologist can give sound advice on when we should officially try a taper based on coco's history.
Thanks again for all your support. It has been invaluable!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 7, 2022 13:22:55 GMT -7
Jack, if we could only know for sure. It is an advanced imaging comparison of disc prior to 10/11 to compare with 10/14 disc. Since we don't know, prudent to give the disc time to heal.
It will be good to have a 2nd opinion on 11/14. And comments about the head plant on 9/25 with MRI showing compressed C6-7 nerve root but a surgery would be difficult at that spot. What would be the 2nd opinion's vet on meds, rest, and your "midpoint dosing observation, etc.
Do ask the 2nd opinion Neuro his thoughts about length of crate rest in particular for a senior 9 y.o. large breed dog.
--- With C6-7 disc damage cause by a physical trauma head plant.
--- The amount of muscle atrophy— it is more likely from disuse or due to nerve damage?
Let us know if your Midpoint dosing observation pain still happens or if she continues since this morning 11/7 to now be able to move and have head range of motion in comfort. The disc material that had escaped to "pinch" the C6-7 nerve root may have shifted/shrunk back a bit or maybe the nerve root is learning to live with the intrusion and not be so aggravated as hoped with conservative treatment. The disc is only painful on the initial tear back on 9/25 with the head plant.
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Post by Jack & Coco on Nov 7, 2022 23:08:54 GMT -7
yes, so many unknowns here. I'd hate to make a hasty decision. The atrophy happened very fast, so perhaps the neurogenic cause.
Tonight, on 11/7, we did the 5:30 PM dosing of
gaba [gabapentin 200 mgs 4x/day] and
tram [traMADol 100mgs 4x/day]
and she started to whine a bit and get a little restless around 8pm. So, this midpoint dosing trend is continuing at least for today.
I was wondering if the timing of the metho doses. Hard to tell. Or, can it be a negative side effect to higher doses of the meds (i.e. they probably kick in after 2 to 3 hours and would that be the most likely time a negative effect shows up). She is whining non-stop now and I'm worried. Keep you posted.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 8, 2022 8:40:28 GMT -7
Jack, Coco's pain and pain meds is a complicated thing.
Is it possible to communicate by speaking to any vet you can speak with. What about your local DVM, to see what he would say about if you can't speak with the ER neuro vet, or another ER DVM vet who can look at Coco's folder and speak with knowledge of her background to advise about methocarbamol timing.
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Post by Jack & Coco on Nov 8, 2022 10:32:46 GMT -7
Hi, I was on phone with ER vet office vet tech early this am, who relayed message to Neurologist. While not definitive (since nothing ever is, they think (based on my "midpoint" pain observation) that it's possible coco is demonstrating side effects from pain killers (they called it dysphoria, -- whining, unease, can't get comfortable). We will keep a close eye on it. They suggested keeping the dexamethasone, Metho and Amantadine as is. But, suggested to me to lower the ▼Tramadol and ▼gabapentin [specifics?]. I also plan on getting the opinion of the new Neurologist, for which I have an appointment on 11/14.
Totally random, but related, have you ever heard of people getting stem cell therapy as an option to treat a herniated disc. I see literature online about it, but the new neurologist (who I will meet next week) indicated it wasn't an option for coco's situation. And this place does stem cell therapy. Thanks
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Post by Romy & Frankie on Nov 8, 2022 14:29:19 GMT -7
Drugs like tramadol can sometimes, not very often, cause dysphoria, so it is possible that is what is causing her whining and unease. Definitely keep an eye out for signs of pain as you lower the dosage of her pain meds. These are the signs of pain we look for:
SIGNS OF PAIN:
- shivering-trembling - yelping when picked up or moved
- tight tense tummy -arched back, ears pinned back
- 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
If you start to see any of these signs besides the restlessness and whining, it is likely pain.
Stem cell therapy is not a proven therapy for repair of nerves. At this point in time, there is a need for more research using stem cells for IVDD before we can determine how helpful this would be. |
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Post by Jack & Coco on Nov 9, 2022 16:45:21 GMT -7
So far, with meds reductions [▼Tramadol and ▼gabapentin], Coco [dysphoria] appears to be improving. Certainly, the restlessness/unease has now been minimal. This unease still will come 2 to 3 hours after the dosing (what I referred to as the "midpoint"), but now is a more mild unease.
Her biggest outward issue, is not wanting to put weight on the front leg. Now though, my intuition (as supported by today's in-home doc visit) is that there is just so little strength left in that atrophied leg and shoulder. So, naturally it would seem hard to support her body weight on that leg (especially when she is sedated). When she does go out to pee, she is able to walk on the leg in a mostly normal fashion (no knuckling and paw facing straight forward). As good news, her front paw test by the doc today passed the procioreception test!
Meds now: These recs came from the ER Neurologist doc. ▼Tramadol (weaning off, current 2X-3x day @50mg each); ▼Gabapentin (weaning off, current 3X-4X day @100mg each), Dexamethasone (stays the same at .75mg @ 2X day), ➖Methocarbamol (cut out for now), Amantadine (remains at 1X day at 100mg). Continued with Acupuncture yesterday (which included cold laser).
Thanks all.
MED LIST/HISTORY- Moderator's Note. Please do not edit
55 lbs/24.95 kg 9 y.o.
70 miles away ER Neuro MRI 9/25 for head plant. Surgery too difficult. Crate rest RX
10/13 5 min slow walks
10/14 disc relapse, returned to orig state of pain
11/4 pain surfaced at lowering of sedation pain meds
11/14 2nd opinion nearby Neuro appt
dexamethasone 0.75mg tab , ER vet
as of 9/27: 0.75 mgs 2x/day for 2 days; 9/29 taper doses due to diarrhea
as of 10/14: 0.75 mgs 2x/day for 56+? days; then a test taper for _pain/ _neuro
traMADol ▼50mgs ▼2-3x/day due to dysphoria tramadol/gabapentin combos)
gabapentin ▼100 mgs 3-4x/day
Methocarbamol 500mg tab: 500 mgs 3x/day STOPPED 11/9
Amantidine 100mgs 1x/day
Pepcid AC 20mgs 2x/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 Nov 9, 2022 18:05:43 GMT -7
Jack, whew, good to hear the uneasyness is now subsiding to mild. Good news on the nerve healing to now being able to place her paw correctly on the ground, and assuming there was no delay in placing the paw correctly.
I sure hope the both of you can now rest easy and have a good night of sleep with today's good news from the in-home vet visit.
Appreciate your taking time to keep us updated to know how she is doing.
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Post by Jack & Coco on Nov 10, 2022 10:24:07 GMT -7
Thanks Paula. A note on the "paw test." In-home doc indicated reflex action was instant, but as I witnessed and he pointed out, the [11/9] paw itself returned to its normal position in a slower fashion (barely 1/2 the speed of the other paws). But, we'll take it for now, as a few weeks ago the paw didn't do anything.
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