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Post by Lisa & Luca on Apr 15, 2023 11:26:29 GMT -7
Orig subject line: Lisa's Luca 3/30 conservative Chihuahua GRAD; 5/25
☆ 1currently pain?
Y☐ reluctant to move much in crate such as shift positions or slow, ginger movements
☐ Arched back Sometimes in the morning
Y☐Not their normal perky selves?
☆ 2 8lb Age? 6
A.. Predisolone 5mg given at 6am. Prednisolone 5mg was the start date & dose? Started 3/30. 4/14 started a new tapering from 1/2 tab once a day to 1/4 tab once a day for 5 days then every other day til gone.
Gabapentin 100mg/ml, 3x day, given at 6am, 1pm and 9pm
C.. NO PEPCID
[MED LIST/HISTORY- Moderator's Note. Please do not edit
8 lbs 8 y.0.
4/2 neuro consult, wobbly back legs
prednisolone as of 3/30: 5mgs 1?x/day for 15 days, then 4/14 test taper for: √4/15 pain / _neuro
gabapentin 100mgs/mL: ?mg (?mLdose) 3x/day, NOTE should be every 8 hrs.
Luca needs GI tract protector, Pepcid AC, on board for duration of Pred! ]
☆ 3 -- List any red flag signs of stomach damage.
☆ 4 Chihuahua, Luca. Lisa
☆ 5 Yes, IVDD diagnosed from ER with xray and his symptoms. He was walking slow and not wanting to jump or go up stairs. Took him to ER vet who diagnosed it and suggested 2 weeks rest and meds. A few days later, his pain seemed uncontrolled and we took him back to the ER. They suggested he see a neurologist at the University hospital which we did. They said he didn't have any neurological deficits and agreed with crate rest for 4 weeks. They gave him a shot of methadone and a few days of bupenorphine to get the pain under control. We are now roughly 2 weeks in from the onset and his pain seems controlled, but he i don't see any improvement in his personality or him wanting to move around. He seems especially stiff in the mornings. He goes into a crate at night and a small expen during the day. His bed is the base of a crate which we have nice and comfy. When he needs to go out, we put the top of the crate on and carry him outside to his tiny fenced potty area. This way, we don't have to pick him up. My worry is that he's not getting much better or am I expecting too much too fast. His dr. doesn't recommend an MRI at this time because of the small risk of getting anesthesia and he doesn't think it's necessary right now.
Neuro
☆ 6 Saw neurologist on 4/2
Super tried and true tips for setting up the recovery suite, the mattress and more! —> dodgerslist.com/2020/05/14/strict-rest-recovery-process/
☆ 7 specifically sniff and squat YES
☆ 8 He's a little wobbly in the back legs which the vet attributes to the gabopentin. He wags his tail a little.
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Post by Romy & Frankie on Apr 15, 2023 14:06:03 GMT -7
Welcome to Dodgerslist, Lucy. We are glad you’ve joined us all. We’ve got valuable information we’ve learned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you. Learn more about us and how we team up with veterinarians:
Dodgerslist work's with vets:
Luca is showing signs of pain, as he is reluctant to move and sometimes has an arched back. Pain in an IVDD episode is caused by inflammation of the spinal cord nerves. The Prednisolone is what works on the spinal cord swelling, but it can take up to 30 days on the full dose of Prednisolone for all the swelling to be gone. Luca is now on a taper dose and showing signs of pain. This means that there is still swelling in the spinal cord and a need for more time on the full dose of Prednisolone. It is not unusual for a dog to try a taper more than once before all the inflammation is gone
If the reluctance to move and arched back is seen mostly in the morning, it may be that the 9pm dose has worn off by then. Consider moving the last dose to 10pm. That way, there will be less time between the evening and morning dose. If this does not help, additional pain meds may be needed. You can speak to your vet about this. Are you giving 1 mL of the gabapentin?
Usually during a pred taper, pain meds are stopped and cut back. This way pain meds cannot mask pain which tells us spinal cord swelling is still there. In Luca's case, even with gabapentin on board, pain is still seen. Please call the vet as soon as you can and describe the pain you are seeing and advocate for additional time on the full dose of Prednisolone.
You can find information on meds typically used here: dodgerslist.com/meds-used-during-disc-episode
You are doing the best thing for Luca by putting him on Strict crate rest. The crate rest must be very strict. This is because the lack of movement allows the disc to heal. We often use the example of a broken arm. A cast on the arm limits movement and allows the bone to mend. The crate is a substitute for the cast, giving the disc time to heal. It takes 8 weeks of limited movement for the disc to heal.
I am not sure if you have had a chance to review the information on the crate rest process here: dodgerslist.com/2020/05/14/strict-rest-recovery-process
All anti-inflammatories, like Prednisolone, cause excess stomach acid, which can lead to serious stomach damage. To reduce the chances of damage, a stomach protector like Pepcid AC is used. Please ask the vet if there is any health reason Luca should not take Pepcid AC. Don't wait until signs of stomach problems, like nausea, diarrhea or reluctance to eat appear.
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory.
For dogs being treated conservatively with strict crate rest and anti-inflammatories, MRIs are not usually needed. This is because conservative treatment treats all the disc at the same time. An MRI is more commonly used before surgery, so the problematic disc can be identified, and the surgeon knows where to operate.
It is very scary when our dogs have IVDD. It becomes less so when we learn all we can about the disease. We have much more information on our main website: www.Dodgerslist.com |
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Post by Lisa & Luca on Apr 15, 2023 14:27:42 GMT -7
Thank you so much for your response. What you said makes a lot of sense. I will contact his neurologist on Monday. The frustrating thing is he is almost 2 hours away at a University Hospital and is either busy or not great at communicating back. I was hoping he'd take us under his wing and guide us through this, but that hasn't happened, so I'm trying to figure it out on my own.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Apr 15, 2023 15:07:56 GMT -7
Lucy, don't let Luca be in pain til Monday.
Luca has been seen by the ER as well as a Neuro. Both have a file on Luca and can adjust meds by phon or whoever is on duty can read the file and also adjust meds.. Report the pain via phone, that's what vets who know IVDD do avoid a risk to the disc with a vehicle transport.. Pain during the taper means you would expect Pred will go back up to the original dose (was that 5mgs 2x/day?) for another course. Maybe a 5-7 day course and maybe another 14-day course.
Gabapentin are you giving a 1 mL dose?
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Post by Romy & Frankie on Apr 15, 2023 15:12:48 GMT -7
A regular DVM familiar with IVDD or willing to consult with colleagues and learn about it, should be able to help you through this. This may or may not be your own vet. We have some information about what to look for in an IVDD vet here: dodgerslist.com/2020/05/10/find-ivdd-vet |
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Post by Lisa & Luca on Apr 16, 2023 5:07:18 GMT -7
Well, that's the problem I'm having with care. He was seen by a local ER 24/7 vet office then transferred to the University. The ER won't change his meds without approval from the University. The University doesn't have neurologists on call or available from Thursday - Sunday. I asked if the ER vets at the university would change his meds via phone and they wouldn't do so without talking to neuro first or seeing him. It's very frustrating.
I have extra prednisolone because prescriptions were given to us at both places. He was originally on [prednisolone] half of a 5mg pill twice per day. After your post yesterday, [4/15]I gave him another dose and today [4/16]I'm doing the half 2x again.
He's on 0.7 ml of gabopentin. It might be because his exact weight is 7.9lbs (not 8).
[MED LIST/HISTORY- Moderator's Note. Please do not edit
7.9 lbs 8 y.0.
4/2 neuro consult, wobbly back legs
prednisolone as of 3/30: 2.5mgs 2x/day for 15 days, then 4/14 test taper for: √4/15 pain / _neuro
as of 4/15: 2.5mgs 2x/day for ? days, then test taper for _pain/_neuro
gabapentin 100mgs/mL: 70mg (.7mL) 3x/day, NOTE should be every 8 hrs.
Luca needs GI tract protector, Pepcid AC, on board for duration of Pred! ]
I'm really fed up with the care from the University, but don't know where to turn at this point. Starting over at another place with another neurologist would take too much time. It takes forever to get an appt. My local vet has been helpful, but she's not a specialist.
Also, have you ever heard of anyone trying red infrared LED light therapy for this disease?
Would you mind correcting Lucy to Lisa in the post subject. Thank you for all you do and your help.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Apr 16, 2023 7:23:28 GMT -7
Lisa, your Luca does not need a neuro, ACVIM, in order to continue on with conservative treatment. This treatment is not rocket science. The reason you do need a vet, often that would be your general DVM vet is to supervise and help you monitor when on prednisone. Prednisolone is not your regular med.... it is a hormone and needs to be used in a particular way. The dog stays on pred at the anti-inflammatory dose until all painful swellling is gone. Usually that would be in the range of 7 to 30 days. Exclude any pred taper days in that 7-30 day count as the dose is too low to work on inflammation. Read up on how pred works during a disc episode. Knowledge is how you work with the vet you have hired. How you know when and how to ask good questions. The link to read about prednisone, a steroid anti-inflammatory drug: dodgerslist.com/2020/04/18/steroids-vs-nsaids/Pain meds are typically PROMPTLY every 8 hrs because that is how long they are effective in managing pain. Ususally all three sources of pain would need to be addressed. The best pain medications control is using more than one approach to address pain from multiple fronts ( traMADol-general analgesic, methocarbamol- muscle spasm pain, gabapentin-nerve pain). All three pain meds need to be prescribed three times a day (every 8 hrs). Pepcid AC (Famotidine) is to suppress the acids caused by pred and stress.Dogs do not speak up at first signs like a person would, so best to be proactive in stomach protection. Keep your vet in the loop about things you give your dog! Today you can can also do something about that ONCE you understand why: dodgerslist.com/2020/05/06/stomach-protectionThere should be no sign of pain from one dose of meds to the next. Have no patience with pain as it does hinder healing. Look for your dog to be acting their normal, perky self when pain is fully under control round the clock. SIGNS OF PAIN:
⚙︎ 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 If Luca is still showing signs of pain, can you take him into a different ER? Not the best situation as car transports subject him to potential risk of too much movement of the spine. Weigh the risks vs. benefits. Pain is definately worth the risk to get the benefit of proper med adjustments.  **Secure the crate in your vehicle. Transport carefully using a crate padded out with rolled up towels on either side of the dog to prevent movement or jarring the spine when braking or turning corners. Let us know the result of upping pred to 2.5mgs 2x/day that you did... IS pain is now in control.Thank you for the detail about the dose in mL for gabapentin. For right now the priority is getting meds adjusted to be fully out of pain and the anti-inflammatory working on ridding the body of painful swellingn around the cord rather than concentrating on red light therapy. |
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Post by Lisa & Luca on Apr 17, 2023 8:47:40 GMT -7
Thank you for all the info. I’m so glad I found this site. As discussed, I put Luca on 2.5mg/2x day of Prednisolone [4/15] sunday and the improvement in his movement and personality was significant!
I’ve reached out to his local vet and am hoping to talk with her today about taking over his care. I had it in my head that it had to be a neurologist, but you’re right… at this point it’s managing meds.
Question: Does it matter when he gets the dose of Pepcid in relation to the Prednisolone? Same time, shortly before?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on Apr 17, 2023 8:59:23 GMT -7
Lisa, I'm so pleased to hear Luca is out of pain and his neuro (?) ability had improved. Please do provide details as we are not there to see what you see. Do you mean he is no longer reluctant to move due to pain being in control now? His pain is control round the clock, dose to dose of gabapentin (for nerve pain)? Did you change gabapentin to promptly every 8 hrs?Is his neuro diminishment of wobbly walking now less wobbly or not wobbly at all from what you can observe with the very few limited footsteps allowed at potty time? Communicating details to us as well as a vet, means being prescise in what you observe. The med list and your observations tells volumes of info. Do you have a med chart to tract doses as well as notable observations? MEDICATION CHART- Useful tool for quality communications with your vet. 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.pdfPlease do keep us posted on getting back to care by your local vet....that would make more sense at this point in time in managing meds.
1) For how many days will Luca be on 2.5mgs TWICE a day?
2) When will Pepcid AC (famotidine) be on board to suppress extra stomach acids from stress and pred? |
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Post by Lisa & Luca on May 8, 2023 15:17:24 GMT -7
Hi, We did everything suggested for Luca and met with his local vet who suggested he stay on the 5mg of prednisolone (2x day) for 14 days. We did that and on the 7th day of getting the tapered dose of 2.5 mg day, he had a pain relapse.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
7.9 lbs 8 y.0.
4/2 neuro consult, wobbly back legs
prednisolone as of 3/30: 2.5mgs 2x/day for 15 days, then 4/14 test taper for: √4/15 pain / _neuro
as of 4/15: 5mgs 2x/day for 14 days, 4/29 TEST TAPER for: √5/6pain/_neuro
gabapentin 100mgs/mL: 70mg (.7mL) 3x/day, NOTE should be every 8 hrs.
Luca needs GI tract protector, Pepcid AC, on board for duration of Pred! ]
I’m wondering if it’s normal for a relapse to take 7 days after decreasing the prednisolone dose. I thought it would happen sooner if the inflammation wasn’t gone. Also, he was off all pain meds during the decrease so there was no chance pain could be masked. Thank you
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on May 8, 2023 15:42:53 GMT -7
Lisa, we are only able to comment when details are shared. What were the signs of pain you observed on what date of the pred taper.
If your dog has a slower metabolism, meaning is takes longer for pred to leave the body, that could explain things why it took 7 days after the taper started to show signs Did the pain meds stop on the same date (4/29) as the begin of the taper? Or were pain meds backed off gradually?
What you are looking for is to get all swelling down with the expectation it may take several "anti-inflammatory level" pred courses adding up to the range of 7 to 30 days before all swelling is gone. Taper days are not included in the 7-30 days. Some dogs just may take longer than 30 days. If a surgery is an option for your family, you may wish to investigate if that is the route to go OR to try again with another 5mgs 2x/day pred course. Was strict rest maintained? If there was too much movement to the spine that could be a reason for a relapse to the early healing disc causing more pain. KNOW YOUR OPTIONS to consider conservative or surgeryDr. Isaacs answered alot of questions we've had about surgery: "Surgery needs to be a decision an owner enters into recognizing the risk, but also recognizes the benefit. This way if something unforeseen occurs an owner can be comforted and at peace with the fact that surgery was the right decision and they did all they could for their dog." You will find it worthwhile to read the rest of his answers about surgery: 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/PEPCID AC. I see you edited a post after it was marked--- sorry, I did not see your question. It is best to just make a new post once your posts have words marked in bold so we do not miss important information. Pepcid AC takes 30 mins to be fully active. Thus give it 30 mins before prednisone. Pepcid AC lasts for 12 hours. Thus give it every 12 hrs (2x/day) for the duration of prednisone. |
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Post by Lisa & Luca on May 9, 2023 13:32:23 GMT -7
[May 7th relapse of early healing disc with too much movement OR May 7th taper revealed prednisone still needs more time to work on swelling] Thank you for your response. The pain med ( gabopentin) was backed off slowly and he was completely off of it [4/27ish?] for 2-3 days prior to decreasing the prednisolone dose. He was doing really well until day 7 [May 7] of the taper. He went to stand up and let out a squeal. [MED LIST/HISTORY- Moderator's Note. Please do not edit
7.9 lbs 8 y.0.
4/2 neuro consult, wobbly back legs
prednisolone as of 3/30: 2.5mgs 2x/day for 15 days, then 4/14 test taper for: √4/15 pain / _neuro
as of 4/15: 5mgs 2x/day for 14 days, 4/30 TEST TAPER for: √5/7pain/_neuro
as of 5/7: 2.5mg 2x/day for 7 days, Sun 5/14 TEST TAPER for _ pain/ _ neuro
gabapentin 200 mg/mL: 36mgs (0.18 mL dose) 3x/day.
traMADol 25mgs 3x/day
Pepcid AC (famotidine) 3.5mgs 2x/day ]
Our vet had told us it was okay for him to start moving a bit more [he could go for short walks which we did in our yard with a harness.] if he was still doing well a few days after the taper. Maybe that was the problem. She said to [5/7] keep him on the full dose [2.5mg 2x/day] of prednisolone for 7 days and try a taper again. We will definitely keep him confined until he’s completely done tapering this time. Right now, he’s not a candidate for surgery. He doesn’t have any neurological deficits. His neurological exam is normal except for the disc pain. |
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Post by Romy & Frankie on May 9, 2023 13:59:40 GMT -7
I am sorry that Luca's taper was not successful. This is disappointing, but many dogs have had to taper a few times before all the swelling in the spinal cord has been eliminated.
You are doing the absolute best thing for him by keeping him strictly confined, since immobility is what allows the disc to heal.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on May 9, 2023 16:20:55 GMT -7
Lisa, ugh and double ugh! Now two variables have been introduced to the taper period not allowing for a clear assessment as to why pain and what action to take. So we know not what to make of the sign of pain on the DATE: May 7th. It would be very helpful if you would use dates. Again, we do not want to make a wrong calculation. (1) Either the pain was revealed by being allowed a dangerous to the disc of " start moving a bit more" causing a re-tear to early healing disc! If this, then it would mean starting back at square 1 for 8wk count on crate rest. If that be the case, then graduation day of giving 8 weeks for a disc to re-heal would now be on June 30 (not May 25). (2) OR pain was revealed by lowering prednisone to see if it has completed its job to reduce swelling. If pain surfaced, then another pred course & continue to finish STRICT rest til graduation on May 25. STRICT crate rest lasts until graduation day where 8 weeks have allowed the disc to heal. Sorry, but length of crate rest is not related to a prednisone taper! Lisa, I would like you to have at your fingertips a means to help train your brain to recognize when things just do not feel right. Think about how much Luca is depending on you. Not all vets know IVDD. Luca needs you to be able to recognize when well-intentioned but harmful advise is offered and to be able to politely but firmly avoid bad advise. Recommend you tape the "Conservative ROADMAP" to your fridge. Be able to refresh your mind quickly what it takes to heal each of the 4 phases of a disc episode. The Roadmap will help to prevent dangerous detours in Luca's healing.  ***VIEW, DOWNLOAD and print the MAP for your fridge: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf **This is how you can help prevent a possible delay in getting timely and correct information to you for Luca. Each time you mention a change or new med, give the accurate details. An accurate and up to date med list from you saves time and possible errors on our part. It is simply a dangerous idea for us to guess, have to calculate dates for what Luca is taking. 1. Provide the date started 2. Name the med 3. Tell what changes in mgs and times per day 4. With prednisone give the all-important detail: for how many days til the taper QUESTIONS1. Date the new 7-day pred course started?2. The 7-day dose in mgs and times per day?3. Is gabapentin back on board? ?mg ?x/day 4. Is Pepcid AC (famotidine) on board for the duration of prednisone? ?mg ?x/day 0.44mg X 7.9 lbs = 3.5mgs famotidine. Often the dose will be rounded up to Pepcid AC (famotidine) 5mgs given every12 hours.You were there with Luca to know how much more movement he was doing (on what date?) of the pred taper. Your guess is as good as ours as to whether he re-tore his heaing disc and should re-start 8 weeks of crate rest. OR was it mearly decreasing dose of prednisone that proved not all painful swelling had been fully resolved and the need for another course of pred. What do you think graduation day should now be on June 30 (just to be safe strong secure disc scar tissue developed) OR stick with original graduation day of May 25? |
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Post by Lisa & Luca on May 10, 2023 8:35:07 GMT -7
1. new 7-day pred course started MAY 72. Prednisone: TOTAL 5mg - 2.5mg 2x DAY GIVEN AT 6AM and 6PM 3. gabapentin YES, 200mg, 0.18mg 3x DAY. ALSO ADDED TRAMADOL 50mg 25mg 3x DAY. BOTH STARTED ON MAY 7 4. Pepcid AC (famotidine) YES, 3.5mg 2x DAYTHE TAPER FROM 5mg to 2.5/mg PER DAY STARTED ON APRIL 30. THE PAIN FLARED UP ON MAY 7. What do you think graduation day should now be? he is bouncing back to being himself much quicker after the pain on may 7 than after the original onset. could that mean the set back wasn’t a complete reinjury? i’d rather be safe than have him go through a relapse again. that means he should be on a full dose of pred for 2 weeks again right? thanks
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on May 10, 2023 11:14:47 GMT -7
Lisa, the details you provided have cleared up many things in our understanding of Luca's treatment. Thank you! Heartened to hear Luca is bouncing back with the aid of meds back on board. What does that mean, what are the details? Is his pain now fully in control round the clock dose to dose of the two pain meds (gabapentin & traMADol)? What is the forumula for the liquid gabapentin written on the bottle? How many mgs are in one mL of liquid?
What is the mL dose amount you give 3x/day? With liquids often the measure mark would be in mL not mgsWHAT WE MIGHT KNOW 1. The pain meds are able to control pain, if you observe no pain round the clock, night and day. 2. Prednisone is again working on getting swelling down. It can take a range of 7-30 days for that to happen. It is the taper the gives the answer. WHAT WE CAN'T KNOW 1. How long to use the anti-inflammatory level of pred (2.5mgs 2x/day)? A vet must guess if a 7-day or a 14-day course would be needed. It is prudent of your vet to try a 7-day course, taper and see if his guess is correct. Using prednisone when it is no longer needed just means Luca is exposed to all the bad side effects when the benefit had already been achieved. 2. It is not possible to have an accurate, clear and fast way to assess for pain when the pred taper starts on Sunday, May 14 unless both pain meds are also stopped on May 14. Pain meds would block you from seeing pain, right? Let us know if pain meds will be stopped 5/14.
Do you have a medication plan worked out with the vet in advance should pain surface when he is closed Sunday? What is your Plan B?
 * 3. Impossible to know if the 5/7 pain was due to the re-tearing of the disc OR the test for pain taper revealing prednisone did not finish its work. 4. If Luca was allowed to move too much and did re-damage his early healing disc, this would be the textbook order of deterioration going from the mild to very severe loss of neuro function. 1. 5/7 Pain with re-tear of disc itself and ensuing painful re-swelling around the cord
2. __ Wobbly walking
__ legs cross
3. __ Nails/toes scuffing floor
4. __ Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all
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 (DPS), the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.Help us to understand what was involved with the implementing " start moving a bit more." Did Luca walk around at potty time rather than being strictly limited to a very few minimal footstep? You are our eyes and ears and we depend on your descriptive details we can not get from this side of the computer screen. |
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Post by Lisa & Luca on May 10, 2023 16:04:55 GMT -7
Hi, Yes, his pain is controlled around the clock.
Sorry, the Gabapentin is 200 ml [200mL one part of the forumula; how many mgs gabapetin in the 200mL?] and we give him 0.18 ml every 8 hours.
Our plan B is the same as May 7th. If pain reoccurs, back to 2.5 mg of Pred 2x day and back to the two pain meds and call the vet on the next business day. We do have a 24/7 emergency vet in the area if pain is not controlled with what we have. Yes, the pain meds will be stopped on 5/14 when the Pred taper starts.
Luca does not have any of the “deterioration” signs listed in your message. The [5/7] relapse was basically a squeal when he stood up and looking like he was in pain. He has not had neurological issues with his legs. Unfortunately, our vet told us if he was doing well, he could go for short walks which we did in our yard with a harness. His personality and movement were very normal and it seemed reasonable. Now I know better.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on May 10, 2023 16:51:13 GMT -7
The gabapentin formula shows how many gabapentin mgs in 200mL of liquid. The formula could be written in many ways. 25mg/200mL or maybe stronger at 50mgs/200mL, etc. What does your bottle say?
[Orig subject line: Lisa's Luca 3/30 conservative Chihuahua; GRAD 5/25]
Since the yelp happened seemingly in conjunction with the introduction of short walks, my best guess is that the weak disc scar tissue may well have suffered a painful tear. IF that were to be the actual case, then you would want to ensure that disc is fully healed 8 weeks from date of suspicion of a new disc injury. Pain showing 7 days after starting the taper, then could explain why all was going well (no signs of pain) til May 7.
The new graduation date would then be on June 30. The new grad day, ensures that disc will have by the end of 8 weeks strong secure scar tissue. That is what I would want if it were my dog.
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Post by Lisa & Luca on May 10, 2023 17:06:37 GMT -7
I agree. That’s what we will do - 8 weeks of confined rest starting 5/7. The Gabapentin bottle says “Gabapentin suspension 200 mg/ml” which means there is 200 mg in 1 ml. Doseage is 0.18 ml. Does that makes sense? I appreciate all of your help so much. Thank you
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on May 11, 2023 8:12:09 GMT -7
LIsa, we have an accurate picture now, thanks to your detailed reporting. Thanks for double checking the med bottle. We now have a good basis of understanding how the pain med dose is fully controlling pain with every 8 hrs schedule.
gabapentin 200 mg/mL: 36mgs (0.18 mL dose) 3x/day.
traMADol 25mgs 3x/day
If pain does surface with your keen attention to keeping his spine with limited movement, then that pain would mean pred still needs more time to finish the job of no more painful swelling. With the 5/7 disc relapse all the previous pred doses have been negated. Unfortunately, he is at square one of his first 7-day pred course in the count towards 7-30 day range to resolve swelling.
I've got my fingers crossed that Sun May 14 and forward you will not be seeing any surfacing of pain. Meaning pred had done its job and you go to conclusion of the taper. The disc will continue to form stronger scar tissue for a graduation date of June 30.
We will be watching for your update observations as the 5/14 taper date approaches. If you were to see signs of pain surface, then alert the vet as it would not be time to begin the test for pain taper. Instead you'd expect another course of pred.
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Post by Lisa & Luca on May 16, 2023 7:52:35 GMT -7
So far so good. We stopped Luca’s pain meds on 5/13 with no problems and started the Pred taper on 5/14 (2.5mg once daily) He isn’t in any pain and is doing well. What is the taper you recommend? Our vet said half dose for 7-10 days then every other day (but for how long?).
[MED LIST/HISTORY- Moderator's Note. Please do not edit
7.9 lbs 8 y.0.
4/2 neuro consult, wobbly back legs
prednisolone as of 5/7 rlps: 2.5mg 2x/day for 7 days, Sun 5/14 TEST TAPER for _ pain/ _ neuro
gabapentin 200 mg/mL: 36mgs (0.18 mL dose) 3x/day. STOPPED 5/13
traMADol 25mgs 3x/day STOPPED 5/13
Pepcid AC (famotidine) 3.5mgs 2x/day ]
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,567
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Post by PaulaM on May 16, 2023 9:48:00 GMT -7
Lisa, so far so good on the pred taper of no surfacing pain! Fingers crossed that Luca can proceed to the final taper dose with no signs of pain.
Prednisone requires the use of it to be supervised by the vet. The taper is actually to signal the adrenals to start making its own steroid again. The taper schedule varies according to how long it was used, etc. This is the vet's job to design the taper to meet Luca's needs. The taper does end in an every other day dose. The number of times for the every other day info should be on the pred bottle. If not, do call in to get that info.
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