Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 5, 2023 13:53:52 GMT -7
Hi - We took my 50lb border collie mix to the vet on 8/28 with signs of back pain (stiffness, reluctance to get up, tense muscles when touched, lethargic). The vet prescribed carprofen (50mg 2x daily), gabapentin (300mg 3x daily), & methocarbomol (500mg as needed), with NO activity restrictions. We reduced him to 2 short walks a day, and after a few weeks with only slight improvement on the meds but still showing symptoms, we took him back in (9/22) and they performed x-rays to check for bone cancer and nothing showed up on the x-rays. I started doing research and discovered IVDD and for the past 2weeks we've reduced his activity to just going outside 3x daily for potty breaks. He is 50lbs and does not tolerate being carried so he has to walk a short distance outside. I have a ramp setup to negotiate all but 2 small stairs, so we take it very slowly with a harness and leash. He is setup in a s mall gated recovery room inside where he mostly sleeps all day, only getting up to change sleeping position and eat/drink. We were seeing improvement and then had a few mistakes [date? 9/28] last week which set us back, once he jumped up and another he slipped off a ramp. Both times we saw him backslide in the following days. He is now 1 full week without any slip-ups and he's improved[?] somewhat but not drastically. I have a few questions: - What should the timeline for improvement look like for an dog with early stage IVDD and on conservative rest? Should he look mostly healed within a few weeks and then it's just a matter of continuing the rest the full 8wks? We are wondering how long we should wait for improvement before seeing a specialist.
- We are considering an appt with a neuro specialist for next week if we don't see improvement over the weekend. We're worried about setting him back further with a 1hr drive each way & exam at the specialist. Are MRI's common for dogs with the symptoms we're seeing? Or is that only used for later stages and when they expect surgery is required? Does the trip seem worth the risk?
- We are currently 4wks+ into taking a NSAID (carprofen) and gabapentin daily. At what point do we start to wean off meds and evaluate his pain level without meds?
Thanks in advance for your help, answer to the form questions below: ☆ 1 Some signs of discomfort & stiffness, mostly early in the morning when first waking up. I have to give him chicken and rice in the morning to get him to eat anything with his meds. Otherwise his pain level seems to be under control.★2 50lbs, 11-12yrs oldcarprofen (50mg 2x daily: 6:30am/6:30pm), gabapentin (300mg 3x daily: 6:30am/2:30pm/10:30pm), & methocarbomol (500mg as needed: not currently taking)[MED LIST/HISTORY- Moderator's Note. Please do not edit
50 lbs 11-12 y.0. Border Collie
8/28 pain, gait mostly(?) normal
8/28Vet Rx'd no crate rest
as of 10/5 no real crate rest due to lack of how to knowledge
9/22 x-ray
carprofen as of 8/28: 50mgs 2x/day for 28+ days
as of 10/5 (w/crate rest: 50ms 2x/day for ? days, then TEST STOP
gabapentin 300mgs 3x/day
methocarbamol 500mgs (not given)
Pepcid AC 20mgs once a day]
I have been giving 20mg Pepcid AC at 6:30pm with his nighttime carprofen...I will bump up 30mins based on what I learned here. I'd read it affects absorption of gabapentin so should be avoided within 2hrs of that, which is why we've been skipping the morning.☆ 4 border collie / cattle dog mix,Ollie. Mike☆ 5 Yes, but this was me suggesting this as a possibility to my regular vet. They did not seem to know much about it.Yes, regular vet, not a specialist☆ 6 Last vet visit was on 9/22 for X-rays and more guidance.
☆ 7 sniff and squat and then release urine Yes - no mobility issues
☆ 8 Yes he can walk, his gait is mostly[?] normal. |
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Post by Romy & Frankie on Oct 5, 2023 14:57:37 GMT -7
Welcome to Dodgerslist. 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.com/about-team-dodgerslist/
Dodgerslist work's with vets:
The most important thing you can do for Ollie right now is to have him on Strict crate rest. The crate rest must be Very Strict. We always use the example of a broken arm. A broken arm is put in a cast to immobilize the arm, so the bone can heal. The crate is similar to the cast. Its purpose is to limit movement of the back, which allows the disc to heal. The crate should only be large enough for the dog to stand up, turn around and fully stretch out when lying down. STRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times
Some more information about crate rest is here:
During potty time, keep footsteps to an absolute minimum. Limit Ollie's walking severely.
I am glad that you have been giving Ollie the Pepcid AC. The Pepcid is only effective for 12 hours, so it should be given twice a day as long as Ollie is on the carprofen.
You mention that Ollie is showing signs of pain in the morning. He should not be in any pain. Is there a reason he's not taking the Methocarbamol? Pain meds work best when given on a regular schedule. This is because it is much easier to keep pain under control than to get it under control once it has emerged.
Generally, a dog with IVDD would not be on the NSAID for four straight weeks without stopping the NSAIDs and stopping or cutting back the pain meds to see if they are still needed. If stopping the meds causes pain, more time on the anti-inflammatory and pain meds wil be needed. But Ollie is still showing signs of pain even with the carprofen.
It can take up to 30 days on the full dose of the anti-inflammatory before the spinal cord swelling, which causes the pain is gone. But Ollie has had several setbacks so more time might be needed.
You can read more about these meds here: dodgerslist.com/meds-used-during-disc-episode
Aluminum hydroxide and magnesium hydroxide antacids can interfere with the effectiveness of gabapentin. Pepcid AC is an Anti Histamine based acid reducer, and will not interfere with gabapentin.
MRIs are usually done before surgery, so the surgeon will know exactly where to operate. MRI's can also be of use if the vet suspects something besides IVDD.
It is best to limit transport during an IVDD episode. Many regular vets can treat IVDD, but if you do not have confidence with your vets IVDD experience, you can visit the neurologist to confirm.
It is scary when our dogs are diagnosed with IVDD. It becomes less so when we learn all we can about the disease. More information can be found at our main website: www.dodgerslist.com |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 5, 2023 16:53:08 GMT -7
Mike, welcome. Please do read the important information Romy has provided in her post above Would you provide these specific details: 1) --- exact date last week slipped off of ramp
--- What specifically did you observe a week later on date? " he's improved somewhat" What exactly improved, paint us a word picture of what you saw. Were back legs less wobbly? Could he move back legs with more ease??? 2) Let us know when you have Pepcid AC 20mgs on board 2x/day due to the early warning GI tract issues of not wanting to eat. Learn more about this acid suppressor and why: dodgerslist.com/2020/05/06/stomach-protection/3) Describe specificallywhat you observe as of 10/5 for: " He can walk, his gait is mostly [??] normal" --- do his nails graze the floor, do rear legs wobbly, cross or???  **Learn the timeline for each phase of healing. One can simple not rush mother nature nor short cut crate rest time when providing every chance possible for good disc healing. Nerves repair is another phase with another time line. Inflammation is also another healing phase with its time line. It is very helpful to have the Conservative Roadmap taped on the fridge as you begin to sort out the parts of healing and what it takes. Avoid dangerous detours with the Conservative Roadmap for your fridge. VIEW, DOWNLOAD and print: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdfWhile you likely cannot safely carry a 50 lbs dog to and from the potty place, there are plenty of options for giving the same safe healing disc care we do for small dogs including using a recovery suite (a room is too big!). Check out this page to adjust your potty time procedure and more: dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/ |
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 6, 2023 7:38:49 GMT -7
Thank you for all the information! I started him on the morning dose of ▲pepcid 30mins before carprofen and will continue to do so 2x a day from now on [Pepcid].
[MED LIST/HISTORY- Moderator's Note. Please do not edit
50 lbs 11-12 y.0. Border Collie
8/28 pain, gait mostly(?) normal
8/28Vet Rx'd no crate rest
as of 10/5 no real crate rest due to lack of how to knowledge
9/13 ramp slip, pain lethargic
9/21 jumped on chair pain: lethargic mornings, did not lift head.
10/6 current status, neuro diminishment rear legs slip out & wobbly
9/22 x-ray
carprofen as of 8/28: 50mgs 2x/day for 29 days
as of 10/5 (w/crate rest: 50ms 2x/day for 1.5 days, then 10/7 TEST STOP
✙methocarbamol 500mgs ?x/day
gabapentin 300mgs 3x/day
Pepcid AC 20mgs ▲2x/day]
[Date? ]Yesterday afternoon / evening & now into this morning, he's been more picky with food (not finishing his dry food & not offering at his wet food). He will still eat chicken & rice though even that takes some coaxing. I have a call in to my regular vet to ask they're suggestions. I'm not sure if it's NSAID related, pain related, etc. Any thoughts? I'm considering skipping the NSAID tonight, after getting approval from my vet.
**UPDATE [Oct 5?]: I talked to my vet this morning and she was concerned about his waning appetite. She agreed we should skip the NSAID (carprofen) tonight and see how he looks tomorrow morning.
If the pain is manageable with just the gabapentin and ✙methocarbomol [?x/day]
we will continue skipping the NSAID and then be in a position to start a steroid soon if needed. She also recommended doing bloodwork again (we did full bloodwork panels for another issue earlier this summer) if his appetite doesn't improve or if we see any other decline.
We are setting him up in a recovery pen: 4X4 in the corner of the room with a bed and his food and water it should be just enough room to turn around and stretch out comfortably. I've tried modifying his potty time to reduce the walking even further, but he's always been slow to go, so he's taking his time. A work in progress.
Regarding your questions,
The methocarbamol was prescribed as-needed and my vet told me to avoid it if necessary so as not to dope him up too much.
For his setbacks, he slipped off the ramp on 9/13 and that evening and the next couple of days he looked more sore than usual, and lethargic. Within 2-3 days he started looking a little more like his normal self.
Simililarly he jumped up on a chair on 9/21 and for the next 3-4 days he looked sore and lethargic, especially in the mornings. Specifically, he wouldn't pick his head up when I came down in the morning, wouldn't stand to eat right away, and looked stiff when finally rising. His gait still looked normal once he was up and moving.
When I say his gait looks "mostly" normal, I've noticed what looks like some rear leg weakness a few times. He has had a few small slips where it looks like his back legs are sliding out [neuro]. These are rare occurrences and otherwise he looks normal, wants to walk, etc. I would say I've noticed a slight wobbliness [neuro] a few times but it would be so subtle it's hard to say for sure.
We're really struggling with the decision to take him to see a specialist and risk the car ride setting him back further. I think if his appetite doesn't improve over the weekend we will end up taking him in for the Tuesday appointment. I'm still hung up on the idea that we're basically guessing at whether this is IVDD....we're somewhat confident of the diagnosis based on what we're seeing, but our regular vet was pretty unfamiliar with IVDD so this is mostly a self-diagnosis.
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Post by Romy & Frankie on Oct 6, 2023 13:47:43 GMT -7
I am glad that you are moved Ollie to the smaller pen which will help keep him from moving too much. It is the immobility enforced by crate rest that allows the disc to heal. Please excuse my confusion. I am not sure if Ollie is the dog's name or yours, and I want to get it right.
I understand that you are temporarily stopping the carprofen because of concerns over stomach damage. The reluctance to eat is definitely an indicator of stomach damage. However, when there is no anti-inflammatory on board, there is nothing working on the spinal cord swelling. which causes the pain and any neuro deficits. The gabapentin and methocarbamol can control pain but they do not work on the root cause of it. Getting bloodwork done seems prudent.
All anti-inflammatories cause excess stomach acid which can lead to serious stomach damage. The Pepcid AC helps to prevent this damage. For some dogs, Pepcid AC is not enough. There is a second medication, Sucralfate that can be used in addition to Pepcid AC for dogs that are starting to show signs of stomach damage. Sucralfate is a prescription medicine which works as a sort of bandage for any damaged parts of the stomach and aids in the healing process.
Generally, moving from an NSAID type of medication to a steroid should be done with a 5-7 day washout where neither type of medication is used. But if the vet thinks it is a medical necessity to switch from the carprofen to a steroid, the stomach should have double protection with both Pepcid AC and Sucralfate. Sucralfate requires timing with other meds, and must be given on an empty stomach to form the protective gel coat wherever any damage to the stomach lining starts to develop.
Did the vet say the neck discs may be involved? I ask this because reluctant to lift the head is more common during a neck disc episode. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 6, 2023 20:35:26 GMT -7
Mike, I'm chiming in to add to pertinent info Romy has for you in her above post. Please consider discussing with your vet the idea to find out first if any anti-inflammatory at all (steroid or NSAID) is needed. Especially in light of Mike's concerning stomach issues you report for " Yesterday afternoon / evening & now" Please use dates rather than Tuesday, last week, yesterday, etc Here are the points you mentioned: --- 9/13 slip off of ramp, Mike showed signs of pain, no report of any neuro diminishment. Pain resolved in 2-3 days. --- 9/21 chair jump caused pain. --- 10/5 it appears you report currently, he does have a small degree of neuro diminshment (back legs slide out AND wobbliness). It would fill in missing info, to have the date neuro diminishment first happened. It is only time that will see how much neuro dimishment will self repair. Since it is mild diminishment, could well be at some point you won't see any diminishment. No meds will heal nerves. Think in terms of months rather than days/weeks for this slowest part of the body to self heal (nerves). So based on the three things you reported, why not then get proof spinal cord swelling is actually gone and no need to be on any anti-inflammatory (steroid or NSAID)? Pain meds on board will blindfold you to the true situation if pain exists or is now gone. 1. Stop carprofen as scheduled it appears on Sat 10/7? 2. Stop methocarbamol (500 mgs ?x/day added 10/6) on same date 3. Stop gabapetin 300mgs 3x/day on same date Find out why there would be a need to even switch to the most powerful anti-inflammatory class, the steroids) for such a mild case Mike has. Steroids can adversely affect the GI tract. As Romy mentioned with the problem Mike already has, use of a steroid would very likley need TWO stomach protectors Pepcid AC plus Sucralfate A steroid will not heal neuro dimishement A steroid will not likely heal spinal cord swelling any faster than the NSAID for such a mild case that Mike has. With "stop proof," one might find no need of any meds at all!Mike, below is the short story when the NSAID is stopped. Do re-read the full article here dodgerslist.com/2020/04/18/steroids-vs-nsaids/ so you are in position to speak up for, bring things to the table and advocate for Otto. You will be the one assessing for surfacing pain and any NEW or INCREASED neuro issues on the STOP of carprofen Sat 10/7 (please provide dates, corrected dates, -- so helpful for us to have accuracy. Thanks.)
Short Story on NSAID STOP for Sat 10/7 pain = swelling = another course of nonsteroidal (NSAID) + pain meds, Pepcid AC back on board.
no pain surfaces = no meds at all needed! Finish out the balance of crate rest time to allow the disc to heal.
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 7, 2023 6:34:40 GMT -7
Hi Paula & Romy -
This is Mike with an update on how Ollie is doing. We skipped the NSAID (10/6) last night as advised by my vet,
and this morning (10/7) when we woke up he was in bad shape: He wouldn't get up from bed & wouldn't lift his head or wag his tail to greet us. He was reluctant to eat anything, I think because of the pain.
[MED LIST/HISTORY-
50 lbs 11-12 y.0.
8/28 pain, gait mostly(?) normal
8/28 Vet Rx'd no crate rest
as of 10/5 no real crate rest due to lack of how to knowledge
9/13 ramp slip, pain lethargic
9/21 jumped on chair pain: lethargic mornings, did not lift head.
10/6 current status, neuro diminishment rear legs slip out & wobbly
9/22 x-ray
carprofen as of 8/28: 50mgs 2x/day for 29 days without crate rest
as of 10/5 (w/crate rest: 50ms 2x/day for 1.5 days, 10/7 test STOP: √10/7 pain/ _ neuro
methocarbamol 500mgs ?x/day
gabapentin 300mgs 3x/day
Pepcid AC 20mgs 2x/day]
I was able to hand feed him enough chicken and rice to give him his gabapentin (300mg) and Pepcid (20mg) at 6am and then we gave him his NSAID at 6:30am and I was able to feed him a small meal of chicken w/ rice and pumpkin. I took him outside and for a quick potty (pee only) at 8am, and he ate some more chicken and rice at 8:30am.
I have a call in to the vet again this morning (10/7) to talk about about options for protecting his stomach (possibly Sucralfate?) until we see the neuro specialist on Tues morning (10/10). With his pain level being so bad using only gabapentin and methocarbomol, I don't see how we can continue to skip the NSAID until our appointment.
Addressing your questions:
Romy - our regular vet did a test of his neck pain & mobility at our appointment on 9/22 and she did not find any issues. She believes the issue is in his lower back.
Paula - The neuro symptoms we've seen recently have been so subtle and sporadic that I can't pinpoint dates or say for sure they occurred because of IVDD.
For the past 6mos or so, even when he was feeling better, he would occasionally trip with his back legs while going up stairs / over curbs...especially when rushing. So I'm not sure the occasional recent slip is a new issue or not.
Thank you both so much for the thorough answers and help! I will read through the new links and continue to educate myself as we wait for the next appointment.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 7, 2023 8:22:21 GMT -7
Mike, so sorry to hear Ollie in such pain 10/7 morning with the withdrawal of the night carprofen dose 10/6. You have your answer, painful inflammation still exists. I'm very glad you do have an appt with a neuro to get a confirmation of a disc episode or anther disease on Tues 10/10. Using carprofen for 29 days w/o crate rest does muddy the waters. You need a specialist to quickly get to a confirmed diagnosis taking into consideration his age, breed, etc. No doubt about it, the anti-inflammatory Carprofen + pain meds need to be back on board to provide Ollie comfort from pain til the neuro appt. Pain meds last for 8 hrs. It gives the neuro the best opportunity to diagnose things when signs are not covered up by pain meds. Confirm with the neuro's office if you should time pain meds to be pretty much out of his system at appt time. Carprofen takes 5-7 days to be out of the system. Also it is a good plan of yours to make sure Ollie's stomach is not further damaged by not only acid suppressor Pepicd AC (famtotidine) 20mgs 2x/day is on board but also: Sucralfate to work in a different way of a bandaid to any areas of stomach damage and aid in healing. If your vet has not had much experience in using sucralfate with IVDD, reading up can help you advocate for it and how to time it with food and Pepcid AC: marvistavet.com/sucralfate.pml A neck disc could affect not just the front legs but also could affect the back legs. The identifier this may well be a neck disc is your reporting of not wanting to lift head. The neuro will be able to confirm for you where the likely bad disc is. Doing these exra things now won't hurt and can really help Ollie even if it ends up being a back disc: ==> dodgerslist.com/2020/05/05/cervical-care-tips/Please confirm the meds. Pain meds last for 8 hrs and thus 3x/day is usual: Methocarbamol 500mgs ? x/day |
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 7, 2023 11:52:36 GMT -7
Hi again -
I spoke to a different doctor at my vet today and she prescribed Ollie 1/2 gram of Carafate (Sucralfate) 3x daily (every 8 hours). She also recommended I switch from the 20mg Pepcid 2x daily to 20mg of Prilosec 1x daily. She said she's had better success using Prilosec (omeprazole). Do you have any experience with Prilosec? I'm not sure the reason for giving it only 1x a day except it does say it's an extended release? I'm told the Carafate should be given 1hr before the Prilosec, and the Prilosec 30mins before the Carprofen. I'm trying to figure out Ollie's new med schedule if you can double-check this looks OK...I hope this changes after our neuro appointment to make it easier on everyone:
Daily:
5:30am: 20mg Carafate
6:30am: 20mg Prilosec + 300mg Gabapentin
7am: 50mg Carprofen w/ meal
1:30pm: 20mg Carafate
2:30pm: 300mg Gabapentin
7pm: 50mg Carprofen w/ meal
9:30pm: 20mg Carafate
10:30pm: 300mg Gabapentin
The 500mg Methocarbamol was prescribed to him for as needed use 1x daily in the evenings. I have been giving him that in the evening on days when he looks particularly sore. He is very doped up by it when he's on that and the gabapentin, so I would be hesitant to use it during the day when he has to navigate the ramp.
I was able to confirm with the neuro vet that he should have no food after midnight the day before his appointment, and that he can take all of his normal prescribed meds that morning (including small amounts of food to take pills).
Thanks again for your help!
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Post by Romy & Frankie on Oct 7, 2023 13:37:30 GMT -7
There should be two hours between the carafate and other meds. The antacid, Prilosec should be given at least 30 minutes after the carafate. So something like the below would work. You can shift this around a bit if you like, keeping the above timing in mind.
5:30 carafate 6:30 prilosec a
7:30 gabapentin
8:00 carprofen and food 1:30 pm carafate 3:30 gabapentin 7:00 carprofen w food this could be earlier if it works for you 9:00 carfate 11:00 gabapentin Prilosec is a good acid reducer once it reaches peak efficiency in 3-5 days. Pepcid is effective in 30 minutes. |
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 8, 2023 6:20:55 GMT -7
Thank you for the help with the med schedule, I wasn't told about the 2hr separation between carafate and other meds. That clears things up for me! Ollie looked MUCH better this morning (10/8) compared to yesterday, with the NSAID back in the mix. He also seems to have a better appetite today...I'm not sure if the carafate/sulcrufate could be helping his stomach feel better already? We started the prilosec this morning...I was hesitant because of your note about it taking a few days before reaching peak effectiveness, but I'm hopeful the carafate will help protect his stomach while it kicks in.
I will report back after our neuro vet visit on Tuesday - thank you again for the help, all of the advice has been invaluable! I wish I discovered this forum sooner.
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Post by Ann Brittain on Oct 8, 2023 6:57:54 GMT -7
I'm glad to hear Ollie is feeling better and regaining his appetite. It takes time for a dog to heal, but you're doing the right things to help him recover. Dodgerslist is a great resource and, like you, I'm grateful I found this site when our Buster went down. Fingers crossed for Ollie. Please do post on how the neuro exam goes.
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 11, 2023 4:49:54 GMT -7
We took Ollie in for his neuro appt yesterday and they performed a MRI and found no signs of disc injury, but they did find a tonsillar mass extending into his throat area, as well as a mass on his thyroid. They suspect this is an aggressive form of cancer but we won't know for sure until the biopsy results come back. The vet's best guess is this cancer is driving immune-mediated disease in his joints.
We were told to stop the carprofen and do a minimum 48hr washout period before starting ✙prednisone. He was told to continue the gabapentin 3x daily (400mg), and they replaced the methocarbamol with Amantadine (100mg, 1x daily). He had the gabapentin and Amantadine last night before bed and this morning he looks terrible, won't take any food or water and I can tell he's in a lot of pain.
[MED LIST/HISTORY-
50 lbs 11-12 y.0.
8/28 pain, gait mostly(?) normal
8/28 Vet Rx'd no crate rest
as of 10/5 no real crate rest due to lack of how to knowledge
9/13 ramp slip, pain lethargic
9/21 jumped on chair pain: lethargic mornings, did not lift head.
10/6 current status, neuro diminishment rear legs slip out & wobbly
9/22 x-ray
10/11 MRI and new diagnosis: neck & thyroid cancer
✙prednisone as of 10/12: ?mgs ?x/day, for cancer
gabapentin 400mgs 3x/day
✙amantadiine 100mgs 1x/day
carafate (sucralfate 500mgs 3x/day
Prilosec 20mg 1x/day as of 10/7
Pepcid AC 20mgs 2x/day STOPPED]
From what I'm reading about Amantadine it's not a fast-acting pain medicine. I'm frustrated that after we explained how much pain he was in last time we tried stopping the carprofen, the vet didn't prescribe us a better short-term solution to get him through the pain during the washout period. I have a call in to the specialist and will call my regular vet as soon as they open this morning to see what other options we have to get him through today & tonight. If we can't get any additional meds on board, the neuro vet said we could start the prednisone tonight if his condition was deteriorating rapidly.
We are completely heartbroken. He feels awful right now but we know that if we can get him through this washout period and transitioned to prednisone safely, then we have a chance at having some good days with him. We're looking forward to doing some of his favorite activities together.
Even though this wasn't IVDD, I want to thank Paula and Romy/Frankie for all of their help over the past week. Starting the Carafate and antacid put us in a much better position to try this switch to a steroid. Thank you again!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 11, 2023 7:50:05 GMT -7
Mike, my heart breaks to hear this news.
Clearly Oliver is under medicated for a stop of NSAID and days of waiting for a washout!
When deemed an emergency such as treating cancer, no washout can be done IF two (2) stomach protectors are on board. You DO have the two protectors on board.
Highly advocate with vet(s) that:
--- prednisone start asap today.
--- Amantadine alone is not an effective analgesic but when combined with the other IVDD pain relievers, it could add an extra dimension of pain relief. Example gabapentin for nerve pain.
--- Advocate for yet another pain reliever in addition to gabapention to get the pain back in control. Even if it takes intially a strong shot to quickly give relieve, then followed with at home pills.
Please let us know Oliver has been helped to get the pain back under control. I know you are doing all you can. Just love on him and take it a day at a time. That is all I could do when my dog had cancer.
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 11, 2023 8:55:24 GMT -7
Thank you Paula! We rushed Ollie to our local vet this morning and they gave him a shot of Torbugesic (butorphanol), which has seemed to mostly control his pain for now. Our plan is to ride that through the day and then start the steroid tonight. He is currently not eating or drinking anything, and is very difficult to pill, so hopefully we can get all his meds in him. I was also given 2 extra doses of Torbugesic if he needs them.
He looks so bad right now it's hard to remember he was wagging his tail and was happy as ever as he trotted out for a car ride yesterday morning. I'm trying to keep that in mind and hope we can get him back to that point or better, even if only for a short time. Thank you again!
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Post by Romy & Frankie on Oct 11, 2023 13:01:43 GMT -7
So sorry to hear this, Mike.
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 11, 2023 13:35:09 GMT -7
One quick question if anyone can confirm the answer: We've been giving the carafate (1/2 gram, every 8hrs) on an empty stomach as advised by the vet. But I'm reading some places online that it should be crushed and/or dissolved in water to be most effective. Can anyone confirm?
Ollie's pain has been managed most of the day with the butorphanol shot. We were even able to get him to eat some chicken + rice and a few spoons of yogurt. He is still not doing well but we're hopeful for more improvement after starting the prednisone tonight.
Thanks
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Post by Romy & Frankie on Oct 11, 2023 13:42:37 GMT -7
I am glad that Ollie is pain free today.
While a slurry of sucralfate may be optimal, it can also be given in pill form. For Ollie, if it is easier to give it as a pill, that should be fine.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 11, 2023 14:58:31 GMT -7
Mike, you've been good at reading up on Ollie's meds. Butorphanol seems to have lots of different length of effectiveness until you read closely and read a couple of different sources to get the full picture. For at home butorphanol, are the doses shot or pill form?
Butorphanol can control three kinds of pain but for very different length of time (cough, sedation, analgesia). It is the analgesic length that is troubling. Read and ask vet questions.
---- While the sedative effects of butorphanol may last for 2 or more hours, the effect of analgesia is only about 40 minutes, an important consideration when managing pain of any greater duration. World Small Animal Veterinary Association World Congress Proceedings, 2013 www.vin.com/apputil/content/defaultadv1.aspx?id=5709883&pid=11372&print=1
---- Duration of effect is 30 minutes to 1 hour in dogs. Veterinary Anesthesia & Analgesia Support Group www.vasg.org/b_drugs.htm
---- The first-pass effect typically removes 85 to 95% of opioids absorbed from the gastrointestinal tract. This explains why buprenorphine and butorphanol are such ineffective analgesics when swallowed. Perioperative Pain Management Moving Beyond Butorphanol. www.vasg.org/newer_options_for_chronic_pain_management.htm
--- Verify border COLLIE breed: Butorphanol should be used carefully in dogs with MDR1 (ABCB-1) mutations. Dog breeds most commonly found to have the MDR1 mutation include Australian shepherds, Shetland sheepdogs, collies, long-haired whippets, and silken windhounds. Your veterinarian will weigh the pros and cons of using this drug in these breeds and will decrease the dosage by 25-50% if it is used. vcahospitals.com/know-your-pet/butorphanol#:~:text=Butorphanol%20is%20a%20short%2Dacting,decreased%20liver%20or%20kidney%20function and also www.marvistavet.com/butorphanol-tartrate.pml |
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Mike & Ollie
New Member
MALE - Border Collie/Cattle dog. . 10/10 Cancer Diagnosis
Posts: 9
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Post by Mike & Ollie on Oct 11, 2023 15:27:53 GMT -7
Hi Paula - I did not have a chance to do any research on the butorphanol this morning when we took Ollie in for the emergency pain relief. I asked about Tramadol and the vet told me that it's not very effective in dogs (counter to what I've read). We were told by the vet that the butorphanol injection was the best option they had, and that it would control his pain for 6-12hrs after dosing...it sounds like that was a stretch. They gave me 2 syringes (0.43ml per syringe) to administer at-home if needed. I'm trying to avoid using it if possible given how intense the sedation is - he actually fell over on his side in the grass while leaving the vet.
We've started the prednisone (10mg to be given 2x daily for 2wks, then adjusted) as of 5pm tonight (10/11). How quickly should we expect to see the effects? Should we expect a gradual improvement over the course of days, or more of an overnight effect like we saw on the NSAID?
Thank you again,
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 11, 2023 17:05:30 GMT -7
Mike, the only disease we know a lot about is IVDD. For a disc episode prednisone's role is just for the purposes of getting painful spinal cord swelling down over the course of 7-30 days. There are a number of reasons prednisone is a part cancer treatment, something you'll want to delve into with your vet plus your own readings. The dose for prednisone used with cancer is a different dose than for a disc episode.
Sounds as if possibly border collie is part of the breeds where Butorphal should be used with caution with COLLIES?? "Butorphanol is one of these drugs involved in this scenario, making dogs with this mutation (the "MDR1 mutation") sensitive to the sedation side effect of butorphanol. Dose reduction is recommended. " Verify with your vet about the extreme sedation you reported of falling over in the grass already when leaving vet. Sedation does not provide analgesia (relieve from pain). Have your local vet confer with neuro on what other opioid could help Ollie with pain.
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