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Post by Javier & Carter on Dec 9, 2023 17:54:27 GMT -7
this post is being marked. If there is extra information or a correction, please do so in a new post. Thanks bunches for understanding.
[Original subject line: Javier’s Carter ShihTzu conservative ]
Hello Dodgerslist,
Thank you so much for this forum, it is so helpful during these dark days of IVDD episodes. Carter is my 13 year old shihtzu, 23 pounds, and has had a couple of IVDD episodes in the past. It has been about 3 years since his last. Here is the series of events:
-12/6 carter started doing this odd ‘snorting’ noise and shivering. I thought maybe he had food stuck in his nose because this has been happening over the last few months… he coughs it up and is fine. However, this didn’t stop and it started to sound like he was in pain so I immediately went into IVDD episode mode.. I gave 100mg gabapentin, confined him and got him an appointment with vet for 10/7. However, carter didn’t improve with the gabapentin, was walking weird ( not as perky but tail still up for the most part) and just snorting constantly and I got worried and took him to the emergency vet. What a waste, they said it was reverse sneezing and he may have had a response to spine palpating. They said to just keep with the gabapentin and take him to his regular vet.
-12/7 carter still snorting all night and I started to notice he kept his back right leg a tad bit off the ground when standing. No limping or yelping, tail still up… not having the usual IVDD symptoms so I was just so stumped. Took him to the regular vet, he snorted when palpating the spine, no yelping during the exam. Keeping the hind right leg off the ground while standing but still no limping. Vet thought it was maybe an IVDD episode and impacting his ‘sciatica’ nerve down him leg. Gave the following meds:
Gabapentin 100mg every 12 hours (I gave it every 8)
Prednisone 10 Mg every 24 hours (I gave it every 12 bc pain was getting worse. Gave prednisone with Pepcid 10 mg each time)
[MED LIST/HISTORY- Moderator's Note. Please do not edit
23 lbs 13 y.o.
12/6 confined
12/7 diarrhea
prednisone as of 12/7: 20mgs 2/day for ? days, then abrupt stop 12/8 for diarrhea
gabapentin 100mgs 4x/day
Methocarbamol 125mg which every 6 or 8 hrs?; owner Rx'd as of 12/8
Tramadol: 25mgs 2x/day
Metronidazole 125 mg 2x/day
proviable-forte kit
Pepcid AC 10mgs 2x/day,]
That evening, Carter then started having terrible diarrhea and crying all night and not eating or drinking
12/8 not putting any weight on hind right leg, trembling, snorting during movement, really declining. Started giving him Methocarbamol 125mg every 8 hours (from my emergency stash for him) Took him back to the vet. Did all sorts of tests, bloodwork’s fine, not snorting as much (probably because the Methocarbamol is helping). Vet was more concerned with his severe diarrhea than his back/leg. Told me to stop the prednisone for 3 days or until he has normal bowel movements. Gave me a proviable-forte kit and gave 25-50mg of tramadol every 12 hours for emergencies since we were going into the weekend.
They didn’t think his back pain was that severe. I had to advocate for the tramadol because he was still trembling and acting like he was in pain with his leg by holding it up and snorting during movement. I gave 25mg of tramadol and Carter had a much better night, no diarrhea and slept through the night, started eating again at around midnight but still trembling at times. At this time, his med list is as follows:
Gabapentin 100 mg every 6 hours
Tramadol 25mg every 12 hours
Methocarbamol 125 mg [which?] every 6 to 8 hours
Metronidazole 125 mg every 12 hours (for stomach/diarrhea)
12/9 carter seems to be doing better, more comfortable but still showing signs of pain, trembling at times and moaning/snorting a lot when moving around in his recovery den. Still not wanting to put weight on his right hind leg, but will walk on it when going potty.
My concern is, he is still acting like he is in pain even when on all these medications. Is his dosing too conservative? Will the lack of steroid (he cannot have NSAIDs) severely delay his healing because the inflammation isn’t being treated? Is there any type of steroid that will help inflammation but not impact his stomach? He has developed quite the sensitive stomach in his old age. During his past IVDD episodes, I remember him not showing signs of pain (trembling and moaning) when he was fully medicated. I’m worried I’m not doing all I can. Any opinions would be much appreciated, thank you so much.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Dec 9, 2023 20:59:27 GMT -7
Welcome Javier. We are glad you joined us all. Your dog IS, indeed, still in pain. All pain meds should be given at the max. Confirm exactly what you had been DOSING and if you are now gonna give the max range vet's Rx indicated. -- traMADol 50mgs 3x/day (as the general analgesic) -- methocarbamol 125 mgs every 6 hrs (for muscle contraction pain) -- gabapentin 100mgs 4x/day (every 6 hrs) for nerve pain. PREDNISONE 1. Did the vet prescribe prednisone to be upped from 10mgs 2x/day to 20 mgs 2x/day?2. With diarrhea cleared up, Prednisone could well be resumed IF THE VET says so. Carter should have DOUBLE stomach protection of not just Pepcid AC (famotidine) but also Sucralfate. These two stomach protectors work in different ways to allow prednisone to be back on board. Discuss and advocate for getting Prednisone back on board Learn about how prednisone is used during a disc episode: ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/ ** Carter may have a neck disc issue called: ROOT SIGNATURE PAIN. Discuss what you learn from the Dodgerslist Neuro Corner with your vet: dodgerslist.com/2020/08/20/nerve-root-signature-pain/ NECK DISC CARE There are extra things you can do at home to help the neck heal, such as softening hard kibble, raising food/water dishes, etc. More info here: ==> dodgerslist.com/2020/05/05/cervical-care-tips/Look forward to hearing your answers to my questions so we know the whole story and to know Carter is out of pain as he should be when pain meds are used at aggressive dose. Hope if the double stomach protection is used, that he can get back on prednisone at the anti-inflammatory level of 10mgs 1x/day (or 5mgs 2x/day) 20mgs twice a day set Carter up for stomach lining damage of diarrhea!
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Post by Javier & Carter on Dec 9, 2023 22:05:05 GMT -7
Paula, thank you so much for your attention and quick response.
The prednisone as originally prescribed is 10mg 1x per day. This is because a couple months ago, the vet prescribed 10mg 2x per day for a tail injury. He had gastric upset but not too bad, cleared up with pepcid. So out of precaution the vet only prescribed 10mg 1x a day. However with his pain getting visibally worse through the night, I decided to go with 10mg 2x a day, every 12 hours, woth pepcid.
I increased the dose and frequency of tramadol to 50mg every 8 hours just now so hopefully I’ll see some relief from him soon. Can the Methocarbamol dose be increased to 250mg 3x a day? I just looked at my thread on here from 2020 and that is what he was on… I don’t think the vet is maximizing pain management. I’m her defense, he doesn’t act like he’s in terrible pain at the vets office, just at home so it is hard for me to prove he needs the maximum amount of pain medication.
I will ask about getting the sucralfate on Monday, 12/11 when they are open and talk about getting him back on the prednisone.
Thank you for the neck injury information. Definitely a possibility, he has had IVDD episodes in his neck before too.
Thank you so much for your response, this is so hard and it is so nice to have support.
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Post by Javier & Carter on Dec 10, 2023 3:15:47 GMT -7
Another update this morning, [12/10] he was great for about 5 hours and then now he whining and trembling. I’m not sure what else I can do, all his pain medicine is maxed out… I’m wondering if it’s his stomach pain? I just gave a 10 mg pepcid. * update- about 45 min after the pepcid he appeared to be comfortable enough to sleep. He’s been peacefully sleeping for the past two hours now, even after waking him up for another round of gabapentin and methocarbamol. ------- Paula, thank you so much for your attention and quick response. The prednisone as originally prescribed is 10mg 1x per day. This is because a couple months ago, the vet prescribed 10mg 2x per day for a tail injury. He had gastric upset but not too bad, cleared up with pepcid. So out of precaution the vet only prescribed 10mg 1x a day. However with his pain getting visibally worse through the night, I decided to go with 10mg 2x a day, every 12 hours, woth pepcid. I increased the dose and frequency of ▲ tramadol to 50mg every 8 hours just now so hopefully I’ll see some relief from him soon.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
23 lbs 13 y.o.
⚠️NOTE: 2020 Pred caused stomach issues, double protect.
12/6 confined; 12/7 diarrhea
prednisone as of 12/7: 20mgs 2/day for 1 day, then abrupt stop 12/8 for diarrhea
gabapentin 100mgs 4x/day
Methocarbamol 125mg 3x/day
Tramadol: ▲50mgs ▲3x/day
Metronidazole 125 mg 2x/day
proviable-forte kit
Pepcid AC 10mgs 2x/day,] Can the Methocarbamol dose be increased to 250mg 3x a day? I just looked at my thread on here from 2020 [ dodgerslist.boards.net/thread/7660/javiers-carter-2020-conservative-shihtzu ] and that is what he was on… I don’t think the vet is maximizing pain management. I’m her defense, he doesn’t act like he’s in terrible pain at the vets office, just at home so it is hard for me to prove he needs the maximum amount of pain medication. I will ask about getting the sucralfate on Monday, 12/11 when they are open and talk about getting him back on the prednisone. Thank you for the neck injury information. Definitely a possibility, he has had IVDD episodes in his neck before too. Thank you so much for your response, this is so hard and it is so nice to have support. |
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Post by Ann Brittain on Dec 10, 2023 6:47:08 GMT -7
I'm glad to hear Carter is doing better after the Pepsid and was able to take his pain meds. Dogs can mask pain to avoid showing vulnerability. It's an instinct that protected them from predators in the wild and your vet is probably aware that Carter could be in more pain than he appears to be. Hopefully, your boy will have a restful day. Let us know what medication changes your vet recommends.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Dec 10, 2023 10:18:08 GMT -7
Javier, I'm also very relieved to hear pain is now in control with the increase of traMADol to 50mgs 3x/day! Yay!! Stopping pred on 12/8, would likely mean expect a need to also increase pain meds on 12/8. Sorry Carter did not get the expected pain med RX increase same time pred stopped. What are you now, 12/10, actually giving methocarbamol? mgs? x/day?METHOCARBAMOL Regarding methocarbamol increase...stick to the increase options the vet Rx'd for this episode rather than an Rx that was 3 years ago in 2020: -- Methocarbamol 125mgs 3x/day (every 8 hrs) -- Increase methocarbamol 125mgs to 4x/day (every 6 hrs) should 3x/day not be providing round the clock coverage of pain. -- A vet needs to take into consideration the dog's age and changing body processing time, etc. when Rxing meds. If you believe you would might need a further increase option of methocarbamol to more than 125mgs 4x/day (every 6 hrs), then get the ok first from the vet. PREDNISONE Since back in 2020 Carter already showed he had issues with prednisone, then from that day on IF, if, iF he ever would need to use prednisone again, then he ought to have his stomach always double protected by both Pepcid AC and Sucralfate. MED CHART Do you use a med chart to help see patterns, have dates and specific facts handy as you discuss things with the vet? D/l this sample and a blank form to use with Carter's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf |
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Post by Javier & Carter on Dec 10, 2023 13:37:20 GMT -7
Thank you Ann and Paula! Yes he seems to be having a better day today, still trembling sometimes but it is decreasing in frequency.
Thank you for the information about the
▲ methocarbamol. I gave him just a sliver more than 125mg, approximately 187 mg, and that seemed to have done the trick today. I am giving it to him every 8 hours if he seems comfortable, sometimes I’ll do 7 but mostly it has been 8 hours.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
23 lbs 13 y.o.
⚠️NOTE: 2020 Pred caused stomach issues, double protect.
12/6 confined; 12/7 diarrhea
prednisone as of 12/7: 20mgs 2/day for 1 day, then abrupt stop 12/8 for diarrhea
gabapentin 100mgs 4x/day
Methocarbamol ▲187mg 3x/day
Tramadol: 50mgs 3x/day
Metronidazole 125 mg 2x/day
proviable-forte kit
Pepcid AC 10mgs 2x/day,]
In regards to the prednisone, I have definitely learned my lesson here. Always going to pair it with surcralfate and pepcid. I wish surcralfate was sold OTC! In your experience, have you ever seen a full recovery of an IVDD episode without the use of a steroid or NSAID? Trying to see if I can avoid it or eventually put him back on it sometime in the next couple of days with sucralfat& pepcid.
That med chart looks so helpful! I will have to use it because it is hard keeping track of these 5 medications! 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 Dec 10, 2023 17:35:35 GMT -7
Javier, it is important to be consistent in promptly giving meds on time. You don't want to see pain surfacing because the meds had declined as they leave the body. The pain meds (gabapentin, methocarbamol and tramdol last about 8 hrs in the body. That is the reason they are normally Rx'd for 3x/day (every 8 hrs). The vet can prescribe every 6hrs (4x/day) if there is very serious pain. The body does make its own steroid hormone. However, the level is quite low for other uses in the body besides what the anti-inflammatory level dose of the synthetic steroid hormone prednisone can do! So pretty much a disc episode needs the big gun anti-inflammatory drugs + pain meds to get the painful swelling down so the dog does not have to go through a longer painful suffering period. Good reading for you on this topic: |
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Post by Javier & Carter on Dec 15, 2023 6:39:22 GMT -7
Hello Paula and Ann,
Carter is overall doing better, no more GI upset or in severe pain.
However, he is still acting like there is minor pain in his back leg, because I can tell he doesn’t like to put his full weight on it sometimes, especially in the morning.
I have sucralfate now and I am ready to put him back on the prednisone but I’m struggling with the timing. He is on gabapentin, methocarbamol, and pepcid. The prescription for sucralfate says to administer every 8 hours and no medication should be given within 2 hours and I read from the article you sent that no food should be given either.
I am hoping you can offer advice on a schedule for his medications as to where I can sleep through the night, somewhat. I am 8 months pregnant and exhausted.
His med list:
✙Prednisone: 10mg every 24 hours for 5 days then every other day until complete. Correction: prednisone is 5mg 1x a day. So sorry, the pill is 10mg, but prescribed as 1/2 pill.
▼Gabapentin: 100mg every 8 hours
Methocarbamol: 187mg every 8 hours
Pepcid: 10mg every 12 hours
✙Sucralfate: .5gm every 8 hours separated from other medications by 2 hours
[MED LIST/HISTORY- Moderator's Note. Please do not edit
23 lbs 13 y.o.
⚠️NOTE: 2020 Pred caused stomach issues, double protect.
12/6 confined; 12/7 diarrhea
prednisone as of 12/7: 20mgs 2/day for 1 day, then abrupt stop 12/8 for diarrhea
as of 12/15? taper dose: ✙5mgs 1x/day for 5 days, 12/20? test taper: _Pain? _ Neuro?
gabapentin 100mgs ▼3x/day
Methocarbamol 187mg 3x/day
Tramadol: 50mgs 3x/day
Metronidazole 125 mg 2x/day
proviable-forte kit
Pepcid AC 10mgs 2x/day
✙Sucralfate 1g tab: 500mgs 3x/day.]
Thank you in advance for any advice!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Dec 15, 2023 10:26:40 GMT -7
Javier, pain just can't be tolerated. Not wanting to bear weight on leg is not acceptable. Advocate for 23lb/ 10.43kg Carter about these two things: 1--- That prednisone be given at the "anti-inflammatory level dose". Pred 5mgs ONCE/day is a tapering dose that is not efficiently working on the painful swelling. Call and advocate for 5mgs TWICE/day. Let us know what the vet re-prescribes for pred dose.For a disc episode, the higher ranges PLUS twice a day dosing is commonly seen on this Forum for a prednisone course. Does Carter have a health issue that keeps him from the "anti-inflammatory level dose?"2--- traMADol to be increased in mgs every 8 hrs. Plumb's is considered the "drug bible" of the veterinary world. It is the vet's job to Rx/prescribe, not the dog owner. The dog owner's job is to advocate for their dog. Call the vet about existing pain and let us know what the vet prescribes for Tramadol. FYI math: 10mgs (traMADol) X 10.43kg (Carter) = 104.3mg 3x/day AMANTADINE When meds are properly used at the aggressive dose and 3x/day but pain is still not fully controlled, then bring to the discussion with your vet the addition of amantadine for further control of that tough pain. Pain is a complicated issue. Amantadine is something we are seeing neuros Rx as part of the pain med cocktail as it allows other analgesics to function more effectively. Amantadine alone is not an effective analgesic but when combined with the other IVDD pain relievers (methocarbamol for muscle spasms, gabapentin for nerve pain and tramadol as the general analgesic), it adds an extra dimension of pain relief. As always be fully knowledgeable about each med your dog takes by reading the full med info: www.marvistavet.com/amantadine.pml . PREDNISONE What is the start date of Prednisone 5 10 mg 1x/day? This is important to know as it makes you aware of the date of the taper. The taper also often calls for a stop of all pain meds. You do not want to have a blindfold on about pain, when the taper starts. If pain were to surface, then you'd know he may need another 5-day course. IT is all guess work for any vet. Getting accurate and prompt information about pain on the taper is important info to share with the vet. SUCRALFATE If this schedule is not your current schedule, you can inch up by an hour each day until you reach a more suitable time for dosing that gives you very important sleep for you as the care giver. Confirm your newly worked out schedule with the vet. Sucralfate reacts with stomach acids to form a protective paste at the site of any ulcerations. ~Ideally give Sucralfate on an empty tummy at least 1 hour before feeding or 2 hours after feeding ~If possible, it should be given 30+ minutes prior to the administration of Pepcid AC. ~Give Pepcid AC 30minutes before Prednisone ~Give prednisone with a meal. Pred could be given along with pain meds IF also due at that time. Resource: www.marvistavet.com/sucralfate.pmlYou did not mention the time you currently give meds. So below is a possible dosing schedule for first dose of the day. Again you can "inch" up or back an hour a day til you achieve a schedule that works for you. 5:00am sucralfate 6:30am Pepcid AC 10mg 7:00am prednisone, tramadol, methocarbamol & gabapentin 7:00am breakfast NOTE the "Example" med chart, does have this same dosing time which may easier to visualize: dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf |
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