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Post by Mollie & Minnie on Jan 22, 2023 11:17:20 GMT -7
Meds:
Gabapentin (0.3ml/8 hrs), Methocarbamol 500 mg tablets (1/4 tablet every 8hrs), Metronidazole 250mg (1/4 tablet every 8hrs)
WAS taking Carprofen 25mg (1/2 tablet every 12 hrs) but no longer due to bad GI reaction (hence the Metronidazole).
[MED LIST/HISTORY- Moderator's Note. Please do not edit
11 lbs 7 y.o.
Carprofen shot 1/17
carprofen as of 1/18: 12.5mgs 2x/xday for 2 days, 1/19 TEST STOP:1/20 -1/21pain/_neuro STOPPED 1/21
on laxatives prior w/GI diagnosis. STOPPED 1/17
1/21 diarrhea
Gabapentin 100mg/mL as of 1/18: 30mgs (0.3ml dose) 3x/day
Methocarbamol as of 1/21: 125 mg 3x/day
Metronidazole as of 1/21: 62.5mg 3x/day
needs GI tract protector, Pepcid AC, on board for duration of carprofen!
Breed: Chihuahua/Dachshund Dogs name: Minnie
Weight: 11lbs Age: 7
My name: Mollie
Diagnosis: IVDD. Been in and out of vets for 2 weeks as originally was thought to be a GI issue. Vet who diagnosed was a general DCM but specialises in orthopaedic surgery.
Date for conservative treatment: The night of 01/17/23
My pup has been diagnosed with IVDD on Tuesday [1/17]. She can walk still but was obviously in pain and if she did not have to move, wouldn’t. Since then she’s been on strict rest and meds. The Carprofen was causing crazy diarrhoea so the
[1/21] vet told me to stop and prescribed anti-diarrhoea medication and some muscle relaxers after I noted she still seemed in pain.
She’s been on the muscle relaxers and anti-diarreahls since yesterday afternoon. Since then the shakiness she had has gone but she’s pretty out of it. Nights are usually the worst as she becomes a bit restless and starts scratching to get out and moving around. The days she just seems like a shell of the dog she was.
I want to do everything right for her. She is still walking which I am so thankful for. I am so thankful I trusted my gut when I knew something still wasn’t right and took her back to the vet. I don’t know if it’s the drugs or just the pain making her like this but her personality has just gone. I miss how excited she used to get when I came in the door, her putting her paws on me to beg for table scraps, how her whole body would wiggle when she wagged her tail really hard.
I know it’s early days but how long till they should start feeling better? The diarreah seems to have stopped thank god. It caused her to somehow escape from her fenced off area 2x.
Friday night [1/20] was the worst night. I stayed up with her the whole night. (This was when she was cut back to just the Gabapentin) she was shaking and obviously in so much pain but also needed to use the bathroom. If I tried to pick her up to take her out she’d scream and Yelp in pain which broke my heart. Now I can pick her up very very slowly but I’m scared to. I don’t want to hurt her.
She’s also gone off her food (she’s on bland chicken and rice right now for her stomach) and has become an expert at finding ways to get the pills out of anything I give her. She doesn’t seem to trust any food I give her anymore which is making it difficult for me to get her to eat and for her to take her medicine.
I know recovery is a process and before Tuesday I had never even heard of IVDD. I didn’t even know she was dachshund! The rescue told us she had pug in her! I’m just scared I’ve lost my little happy girl forever and that this is the new normal.
To answer the other required questions:
Eating/drinking: not much right now. She will not go to her water bowl by herself, will drink a small amount if I bring it to her. Doesn’t seem to enjoy or trust the food I bring her anymore. Thinks everything has medicine hiding it it.
Bathroom: Still peeing and no bowl movement since yesterday afternoon (pre anti diarrhea meds) which was diarreah. No blood seen in pee or poop.
Walking: she can walk! And I wouldn’t say it’s even wobbly. She can bend down to sniff a spot as well. She is still squatting to pee as well.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jan 22, 2023 14:22:25 GMT -7
Welcome Mollie! Very goods news your STRICT crating has kept symptoms mild of pain only and nearly no back leg neuro function decline! It would be helpful to use specific dates that we don't miscalculate them. Please correct if any are wrong. UNFORTUNATE, her stomach was not protected during use of anti-inflammatory carprofen and very likely caused the GI track damage of diarrhea and potential for bleeding ulcer. Hard to discern where Minnie is with disc healing. Let us know what you think. --- Usually the anti-inflammatory carprofen would be stopped after a 5-7 day course. Pain meds would be stopped also. This provides owner opportunity to observe for pain. Pain surfacing indicates carprofen had not completed its job. Indicates another course plus pain meds back on board plus Pepcid AC. --- Currently she is still on pain meds blocking your ability to know if painful swelling around the spinal cord still exists. You reported 1/20 pain existing before the stop of carprofen 1/21. Seems to indicate she "might" need more days on carprofen two days later 1/22 ?!? --- If pain still would exist, then carprofen is needed back on board to complete its job of resolving all inflammation/swelling. --- If Carprofen is brought back on board, would be prudent to use not just acid suppressor Pepcid AC (famotidine) but also SUCRAFATE to aid in repair of any spots on the stomach lining that need repair. Two GI protectors allows the use of carprofen to resume if needed. Carprofen Rule of thumb is:
on its stop: pain = swelling =
back up at anti-inflammatory dose,
pain meds and Pepcid ACReading to help you understand the use of anti-inflammatory drugs: 🚩 How anti-inflammatory drugs are used during a disc episode. dodgerslist.com/2020/04/18/steroids-vs-nsaids/🚩 why GI protection is a must: dodgerslist.com/2020/05/06/stomach-protection/🚩 How to carry out STRICT rest. Lots of tips to make the 8 weeks go smoother: dodgerslist.com/2020/05/14/strict-rest-recovery-process/ 🚩 Get a good overview of the disease your dog has in 10 mins: dodgerslist.com/2020/06/26/time-and-ivdd/What is the gabapentin formula on the bottle? How many mgs gabapentin are in one mL of liquid? NOTE gabapentin is very bitter. If compounded by a veterinary pharmacy it should have stuff that makes it not taste bad. IF the taste doesn't suit Minnie, that is why she is suspioucious of your tainted treats, food, etc. Also pain can be a reason to not feel good and not want to eat. Do you observe any signs of pain currently (1/22) or just maybe over medicated that she is out of it? PILLING Put the pill into the well of a small mashed banana ball, a cream cheese ball, liverwurst ball, Gerber Lil' meat sticks, or inside of a sticky small marshmallow and sealed completely so no taste is on the exterior. Use the three treat method. Prepare 2 treats with no meds inside PLUS the med ball. Give plain treat while holding med ball in front of eyes. The idea is your dog will be greedy after the first treat to get the 2nd. Immediately hold the 3rd plain treat so she will hurry to swallow the med ball to get to treat #3. You made need to retrain her by giving fake tiny treats til she trusts you again for treat balls with med in them. ALTERNATE PILLING METHOD
LIQUID MED Place the tip of the Syrine in the mouth, just behind one of the canine teeth. Angle the syringe slightly to the side and deposit the medications onto the tongue Dosing liquid meds vcahospitals.com/-/media/vca/images/lifelearn-images-foldered/423/dog_administering_liquid_meds_2020.jpg |
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Post by Mollie & Minnie on Jan 22, 2023 14:46:16 GMT -7
Hi Paula,
Thank you for your quick response!
To clear some things up I maybe forgot to include:
01/17: Initial diagnosis of IVDD. Given Carprofen shot that night at vets 50mg/ml 0.22ml. Prescribed Carprofen:25mg 1/2 tablet every 12hrs
01/18: Called vet back that evening after seeing she was still in pain/shaking. Prescribed Gabapentin (100mg/ml, 0.3ml every 8 hours) to go with the Carpforen. Also noted diarreah however she was taking laxatives till 01/17 due to initial diagnosis of GI issues. Was told by vet to monitor and call back if diarreah was still an issue.
01/19: Called vet back as diarrhea still issue. He said stop with the Carprofen immediately (so that evening) and continue with Gabapentin.
01/20: Minnie's worst day/night yet. No sleep through the night, in a lot of pain, shaking. She needed to go out as she had the urge to pass stool but was in too much pain to let me pick her up. Escaped her confinment and had diarreah on floor inside. Still obviously in pain shaking after.
01/21: Morning after, I call the vet let them know what happened (more pain, more diarreah). She is prescribed Metronidazole 250mg (1/4 tablet every 12 hours) for diarreah, and Methocarbamol 500 mg (1/4 tablet every 8 hours) and told to remain on Gabapentin (100mg/ml, 0.3ml every 8 hours). Starts her first dose of Meronidazole and Methocarbamol that afternoon followed by another dose in evening.
01/22: Minnie is not moving much at all [pain?], did a little in the night, was pawing at the gate to get out but eventually lay back down. She hasn't really moved positions all day. Took her out to pee but she did not (could still walk but a little wobbly I'm thinking from the muscle relaxers). She has pretty much slept the whole day so hard to assess if this is because she is in pain or because of the drugs.
So in total she was on the Carprofen for only 2 days before the vet told me to stop giving it to her. I asked if this would slow down recovery and he said it may but she still should manage with the other drugs.
Thank you for the tips on giving her the pills! I am going to try that when she gets her next dose. The liquid gabapentin she is managing to do ok although I'm sure she isn't loving the taste.
The hardest part about keeping her still is taking her outside to use the bathroom. She still wants to sniff everywhere and is very fussy about where she goes. If I stand still in one spot she would rather hold it in then go somewhere she doesn't want to! At the moment I am relenting and letting her sniff a little but not very far.
Do you recommend sticking with the course of meds we have now and assessing in another week or so? Is it normal for dogs to loose their personality when they are in pain or on meds like this? When should I expect to see some recovery signs?
Thank you again for your response! It is a lot to learn after receiving this diagnosis and I'm trying my best so she can have a good recovery.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jan 22, 2023 17:41:27 GMT -7
Mollie, thank you for the easy to follow chain of events with dates!
-- Reluctant to move or not moving much is a sign of pain.
-- Too high a dose on the methocarbamol will over relax muscles.
-- Are you aware of any people you visited in the hospital that were chipper and interested in life around them, if their pain was not being controlled? Ditto with pets. Pain deters healing.
With a disease known to be painful, it would be prudent assume pain exits based on:
1. One day ago 1/21 she displayed pain.
-- Pain meds do not work on pain, they only block pain from you and Minnie.
-- There is NOTHING on board to work on the cause of painfully inflamed spinal cord. Carprofen is not on board. Hardly likely in one day all pain would be gone.
-- It usually takes 7-30 days on an anti-inflammatory to resolve all pain. She has had 3 days of carprofen (1/17 shot, 2 days on at home pills)
2. It is well known in the vet world, a multi modal approach to pain meds which covers each of the three sources of pain works best. Bring to the table to discuss with your vet:
-- 1. Methocarbamol targets muscle contraction pain may be able to be lowered a bit IF, if all three sources of pain were to be covered.
-- 2. Gabapentin at 30mgs 3x/day targets nerve pain
-- 3. traMADol targets over all pain 3x/day. Something to discuss with your vet.
Seriously discuss use of TWO GI tract protectors (Pepcid AC® -famotidine and SUCRALFATE.) 2 protectors is how vets are able to continue on with carprofen, to address the painful inflammation root cause.
Seriously, arrange a potty place that lets Minnie know there will be no sniff festing going on. For me that solution was an ex-pen in the grass or winter to build a high snow berm around a 6 foot potty area. These types of fenced in potty places provide a physical and visual barrier to let Minnie know to take care of business. Won't hurt if can spike the potty place wth some of her own old urine or even better another dogs. Save old urine on a piece of paper towel in a zip lock bag in a cool place. Place the piece of paper towel in her potty place and command "go potty" when you see her sniff. Praise her when she pees. Soon she will be able to potty on command.
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Post by Mollie & Minnie on Jan 30, 2023 13:50:54 GMT -7
Hi there,
Thank you again for your response! Since you replied, I took her back to the vet. She is now on [Date?] ✙Prednisone (2.5mg 2x per day) [for ? days prior to a taper?] along with the ✙Methocarbamol and ✙Gabapentin. Initially this seemed to really help! She was on in 2x a day and definitely has had more energy and has moved around her confinement more.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
11 lbs 7 y.o.
Carprofen shot 1/17
carprofen as of 1/18: 12.5mgs 2x/xday for 2 days, 1/19 TEST STOP:1/20 -1/21pain/_neuro STOPPED 1/21
on laxatives prior w/GI diagnosis. STOPPED 1/17
1/21 diarrhea
✙prednisone as of 1/24: 2.5mgs 2x/day for 5 days, 1/29 a test taper for: _pain / _neuro
Gabapentin 100mg/mL as of 1/18: 30mgs (0.3ml dose) 3x/day
Methocarbamol 125 mg 3x/day
Metronidazole as of 1/21: 62.5mg 3x/day STOPPED?
needs GI tract protector, Pepcid AC, on board for duration of prednison! ]
Now [DATE?] we are in the "tapering off" phase of the Prednisone. She is down from 2 pills/day to 1 pill/day. She has started yelping again after a few days of not doing it when i go to pick her up to go outside. I really cannot tell if this is pain or fear of pain at this point. She has always been a fearful, timid dog. Yesterday before I even touched her, she yelped [1/29] and ran away which definitely seemed like a fear of pain response. The difference now with the steroid than before is she does not have these shaking episodes after being picked up. She yelps but when I can put her in her bed again she calms down, or when I take her outside she will still go pee even after yelping.
I'm not sure what to do in this situation. She will have been on crate rest for nearly 2 weeks now and has had 5.5 days on the steroids. I'm scared I'm hurting her but also I feel it could equally be fear making her cry out.
Is it possible dogs can plateau after being on steroids? She is definitely more active than before, eating well, getting up to drink by herself, playing with her snuffle toy, wagging her tail, etc. But I fear she now is stuck.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jan 30, 2023 16:42:09 GMT -7
Mollie, it is impossible to answer when we lack specifics. I would feel very badly to make a wrong comment based on an incorrect assumption. We really do depend on you, You are our eyes and ears. I can't see the medication bottles to read them for myself.
-- what is the start date of prednisone 2.5mg 2x per ?
-- What date did the pred taper start of ?mg once a day start?
-- gabapentin ?mg ?x/day is actually given?
-- methocarbamol ?mg ?x/day is actually given
-- Pepcid AC (famotidine) for the duration of prednisone 5mgs 2x/day?
The only days at are counted with prednisone are the days before the taper. The taper serves a different purpose. Often it will take somewhere in the range of up to 30 days before prednisone fully resolves all painful swelling.
On the taper is the time to assess for pain. NO ONE (not you nor the vet) will have an accurate picture about pain UNTIL all pain meds (gabapentin and methocarbamol) are stopped. Normally these pain meds are stopped on the date of the pred taper.
WHY? Because the job of a pain med is to block pain, hiding it from your eyes.
-- You should want to accurately and QUICKLY know if another course of pred is needed. Pain meds at the start of the taper would not be on board.
-- Did you stop the pain meds on the date of the pred taper?
Oh dear! Very concerning she was able to run away from you on 1/29. Do you always use a leash ad harness to control escaping when out to potty? What is your pottty time setup and procedure? Since escaping have you noticed any backsliding with pain, with less neuro function??
I'll be watching for your answers so we can be updated with the important details about the meds, escape, etc. to make our best comment.
If you have concerrns, of course, contact your vet immedately.
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Post by Mollie & Minnie on Jan 30, 2023 17:02:40 GMT -7
Hi there,
Apologies if my previous post wasn't very clear! Let me clarify a few things:
Start date of prednisone 2.5mg 2x per day (1x every 12 hrs) = 01/25
Pred taper start 2.5mg 1x per day (1x 24 hrs) = 01/29
Gabapentin Suspension 100mg/ml, 0.3ml given 3x per day (1x every 8 hrs)
Methocarbamol 500mg tablets, 1/4 tablet given 3x per day (1x every 8 hrs)
No pepcid AC given as was not recommended by vet
My vet told me to taper the prednisone but to continue with the other pain meds. While she is still better than she was before the prednisone, since the taper she has been yelping more when I pick her up. (Like i said, sometimes it is before I even touch her so I can't be 100% sure if this is pain or fear related).
She is always on leash to go potty. Sorry should have specified when I say "ran away" she will move away as far as the leash will take her or go quickly to the back of her bed to "hide". Current potty setup is leash/harness taking her outside to lawn (she will only go on real grass), I do not let her wander far, she usually goes pretty quickly but the last couple of days has yelped when I go to place her down no matter how I do it.
I have not noticed any less neuro function. She can still walk, will get up to drink, stands up to play with her snuffle toy and will dig at it, eating well too.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jan 30, 2023 17:48:59 GMT -7
Sorry I can't follow your med list. Please just answer the questions asked. Including extra info not asked for is confusing.
-- what is the start date of prednisone 2.5mg twice a day ?
-- What date did the pred taper start of ?mg once a day?
-- gabapentin ?mg ?x/day is actually given?
-- methocarbamol ?mg ?x/day is actually given
-- Pepcid AC (famotidine) for the duration of prednisone 5mgs 2x/day?
1. Did the vet say there was a health reason Minni could not take?
2. Did vet say we wait until there are signs of a bleeding ulcer?
3. if no health reason, then prudent to use Pepcid AC while on prednisone
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Post by Mollie & Minnie on Jan 30, 2023 18:17:00 GMT -7
-- what is the start date of ✙prednisone 2.5mg twice a day ?
01/24
-- What date did the pred taper start of ?mg once a day?
01/29
-- gabapentin ?mg ?x/day is actually given?
0.3mg 3x/day
-- methocarbamol ?mg ?x/day is actually given
125mg 3x/day
-- Pepcid AC (famotidine) for the duration of prednisone 5mgs 2x/day?
1. Did the vet say there was a health reason Minni could not take?
No, he just did not offer it to us, and as it was late at night it slipped my mind to ask. She has had no GI issues since.
2. Did vet say we wait until there are signs of a bleeding ulcer?
No.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jan 30, 2023 21:12:42 GMT -7
Mollie, thank you for using dates, giving the details of mg/times per day. Very clear, concise communication from you! Makes my job so much easier. Minnie has already shown signs of GI damage starting with the 1/21 diarrhea likely caused by anti-inflammatory carprofen. Minnie doesn't need another problem of a bleeding ulcer to deal with on top of this disc episode with now the use of prednisone. Really taking chances using anti-inflammatory prednisone and not getting Pepcid AC on board. IF there are no health issues, you buy it at the grocery store. Give 30 mins before prednisone and thereafter every 12 hours for as long as your dog is on prednisone.  Seeing more than one sign of pain, helps you to confirm pain. Especially when signs can have two causes. Here are two examples to explain what I mean: 1. there is anticipated learned pain (she has learned to expect pain just thinking you might lift her when you hadn't even touched her yet. 2. shivering can be from being cold or it can be due to pain -- So observe if you are seeing any other of those many listed signs of pain to help you confirm if pain or not. IF you are confirming pain, then clearly she should NOT be continuing the taper of prednisone! The pred taper is to test for pain. Your reporting the pain signs would mean expectiation the vet promptly Rx's going back up to the anti-inflammatory level 2.5mgs 2x/day for another 5-day course or so and then another test taper for pain. If you believe you are not seeing pain, because the yelping sign is related to anticipation of learned pain or shivers not due to pain but being cold, THEN you are in the dark. You have a gabapentin/methocarbamol blindfold on. No one not even the vet knows if all pain is really gone, til the pain meds are stopped during the taper. |
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