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Post by Tim & Ivan on Dec 24, 2023 17:10:47 GMT -7
[Original subject line:Tim's Ivan - 12/21 Conservative Cairn (mix?) ]
Hello all, I'm sitting here next to my 13 year old Cairn Terrier (possibly some mix, but not certain), Ivan. I am creating this thread just so I have it in case I have any specific questions later on, but right now we actually have some peace here and I think a steady plan to move forward. Thanks in no small part to the many threads I read on this site.
Name: Ivan Cairn Terrier (mix?) Age 13 24.03 lbs Walking: Toe-touching on front left paw. Wobbly legs from medication, but does have control
Pain: Very much so (more below) Other: Eating, drinking, pooping, and peeing are all perfectly on-schedule. Wags tail and still enjoys company
Diagnosis: None (just the Vet's suggestion that it's IVDD)
Timeline:
Dec 14th - Ivan was laying behind my office chair (he almost never does this). I rolled back and heard him yelp. He ran off but otherwise seemed fine. No limping or pain the rest of the day.
Dec 15th - Ivan showed a slight limp, but no yelping. I decided to wait and see if he heals on his own since it didn't seem bad.
Dec 16th - Ivan was heavily limping throughout the day and I kept a close eye on his paw, but otherwise didn't change anything about his day. By afternoon it hadn't gotten any better, so I checked it out more closely. He began screaming in pain (so scary). I took him to an emergency vet and told them about his paw. With his adrenaline pumping he didn't show any pain at the ER vet. He was walking around with no limp, no pain in their examination, and no toe-touching. They said there was nothing wrong with him and sent him home with Gabapentin 100mg every 12 hours.
Dec 17th - The limp was back. I scheduled an appointment with my general vet for the 20th (the earliest they could see him). Started carrying Ivan around the house (we have a lot of stairs)
Dec 18th - He was yelping more and laying around more, but I didn't want to make him scream again so I didn't closely examine his arm myself. I also didn't want to take him back to the ER vet just for them to send me home with another $250 bill for nothing. Dec 19th - Same as the previous day Dec 20th - Met with the general vet. She gave him a shot of ketamine (100mg injection) for the pain. Said she couldn't find anything wrong with him arm or paw at all. He didn't yelp much but she said he was in pain and wanted us to get him crate-bound right away. She wanted to take an x-ray, but the cost is high so we decided to try the Gabapentin (100mg every 12 hours) and Rimadyl (18.75mg every 8 hours) first. We took him home with the new prescription and set him up for crate resting for 2 weeks at her suggestion.
That night, [12/20]he had his worst episode of pain. He was screaming terribly. When the screaming stopped, he began panting heavily. I couldn't wait anymore, and I took him to a different ER vet. They weren't going to admit him, but then they saw his pain and immediately put him on an IV to put him at ease. He received methadone (0.3mg IV at 11pm and repeat at 3AM). They determined that his pain was due to a neck injury, and they suggested we do surgery immediately. The cost ($8,500) was too high, and it was 4am, so we decided not to make any decisions (they also suggested euthanasia). We received a prescription and took him home after they gave him the second methadone IV and a fentanyl patch (50 mcg/hr). They also gave a new prescription of Methocarbamol (250mg every 8 hours) which we started at home. He slept the rest of that night. Dec 21st - We called our general vet and she wanted to see him. He stayed there all day. She realized that the neck injury was possibly IVDD. Said we should do strict crate rest for a minimum for 3-4 weeks while we 1. Figure out if we want/can do surgery 2. See if he starts healing on his own. While he was worth her all day, we picked up a new pen to start the strict crate resting period. He slept that night.
Dec 22nd - Stable at home. Some occasional whimpers when he tried to move himself to get comfortable. He did not sleep at all that night, and I was jumping up every time he whimpered or yelped. Not a good night for either of us.
Dec 23rd - I called the vet because he still seemed so miserable. She suggested I give him a benadryl every 12 hours to help him sleep. I also called the ER vet and they told me to stop taking the Rimadyl 18.75mg/ 12 hours and they gave a new prescription for 25mg/ 12 hours [for ? days] Carprofen (same stuff from what I understand, just stronger dose). I also received the second fentanyl patch so I can replace it on Christmas Day, since the pharmacy will be closed. Dec 24th - Today. Best sleep and day he's had so far. He's stable and steady, sleeping here next to me while I write this. He was whimpering earlier, but I'm pretty sure that's cause he was lonely in his pen in the other room.
Medication: Gabapentin - Started Dec 16th. 100mg every 12 hours. On Dec 23rd we switched to 100mg every 8 hours.
Ketamine - Only Dec 20th morning. 100mg injection
Rimadyl - Started Dec 20th / Ended Dec 23rd. 18.75mg every 8 hours Methadone - Only on Dec 20th. Two doses of 0.3mg IV Methocarbomal - Started Dec 20th. 250mg every 8 hours Fentanyl Patch - Started Dec 20th. 50 mcg/hour Benadryl - Started Dec 23rd. 12.5mg every 12 hours Carprofen - Started Dec 23rd. 25mg every 8 hours
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24 lbs 13 y..o.
12/20 LF paw weakness, scuffs floor pain
Rimadyl® (carprofen) as of 12/20: 18.75mg 3x/day for 2 days,
as of 12/23 ▲25mgs ▼2x/day for 7 days, 12/30test StOP for __pain? __Neuro?
gabapentin 200mg 3x/day
fentanyl patch as of 12/20 expires on 12/24
methocarbamol 250mgs 3x/day
benadryl 12.5mg 2x/day
Ivan needs GI tract protector, Pepcid AC, on board for duration of Carprofen!]
At this point, I'm just wanting him to sleep through Christmas so that next week we can get back to the vet. We're scheduling an x-ray or MRI to see what's wrong with the poor guy. Until then, strict crate rest except for potty breaks (which are still normal and healthy). I don't even know if he actually has IVDD or if it's a general spine injury, but I figure I might as well use my time wisely right now and create this thread.
He is currently still in pain, as I can tell by his continued limping during potty breaks, occassional yelps if he turns too fast in his bed, and his awkward sleeping position extending his neck out. But he's not screaming like before or shaking/panting more than what might be considered normal.
I'll post back here if I have any updates or specific questions. Thanks for creating this site!
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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 24, 2023 19:02:04 GMT -7
Tim, I'm so glad you have written us. So sorry Ivan did not get a good diagnosis nor proper pain meds...oh dear. And he is still in pain.
Likely he has root signature pain from a neck disc, hence not wanting to bear weight on front left leg because it is painful!  Neuro surgeon, Dr. Isaacs, explains more about root signature pain, diagnosing, etc. at the Dodgerslist Neuro Corner Answers: dodgerslist.com/2020/08/20/nerve-root-signature-pain/AT HOME EXTRAS for neck discThese are the extra things you can do at home to help with a neck disc: 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/His pain meds ought to have been covering each of the three sources of pain and given promptly every 8 hrs (3x/day) Pain meds last about 8 hrs. √ Gabapentin for nerve pain √ Methocarbamol for muscle contractioin pain typical with neck discs √ Fentanyl patch (3-day) as the over all analgesic __ Amantadine Not a pain med per se. Please read up on so you can advocate for. 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. Often it will take 3 pain med for full control. Each pain med works on a different type of pain. Amantadine is something we are seeing neuros Rx as part of the pain med cocktail as it allows other analgesics to function more effectively . The Mar Vista vets explain the mysteries of amantadine www.marvistavet.com/amantadine.pml If pain meds can't contain the pain, then that would be a reason for a surgery. There are two class of anti-inflammatory drugs. The lessor NSAID class (Rimadyl®-carprofen) and the more powerful steroid class. Often the steroid prednisone for at home is an option to get the swelling around the neck disc down. Something worth discussing for Ivan. NOTE: It would likely be deemed an emergency to dispense with a normal 5-7 days of carprofen washout before starting a steroid. With a washout one would expect pain to increase...that CAN'T be allowed to happen, right? When not doing the washout, the stomach would need double protection with two protectors on board as carprofen stops and steroid is given. 1 Pepcid AC (famotidine) to suppress stomach acids (should be on board with carprofen!! 2. Add sucralfate to famotidine. Sucralfate works in a different way to bandaid any areas of the stomach lining that could be damaged and aid in healing. Learn more about why stomach protection when any anti-inflammatory is used: dodgerslist.com/2020/05/06/stomach-protection/Set up a med chart. You need a place to write notes, see patterns, etc. to have at hand when you speak with a 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.pdf**  Please do keep us posted tomorrow on what the vet does with the Fentanyl patch and any other med changes. If Ivan is to remain on the NSAID carprofen, for how many days is the Rx?
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Post by Tim & Ivan on Dec 25, 2023 15:06:04 GMT -7
Hi PaulaM, your comments are invaluable. Thank you. Today (Dec 25), Ivan has had some struggles. But, before I get into those, here are the medication answers you asked for: [MED LIST/HISTORY- Moderator's Note. Please do not edit
24 lbs 13 y..o.
12/20 LF paw weakness, scuffs floor pain
Rimadyl® (carprofen) as of 12/20: 18.75mg 3x/day for 2 days,
as of 12/23 25mgs 2x/day for 7 days, 12/30 test STOP for √12/25pain __ Neuro?
gabapentin 200mg 3x/day
✙fentanyl 4-day patch as of 12/25 11a.m.; expires on 12/29 11a.m.
methocarbamol 250mgs 3x/day
benadryl 12.5mg 2x/day
Ivan needs GI tract protector, Pepcid AC, on board for duration of Carprofen!]
- Our Vet told us to swap out his fentanyl patch for the new one. I took off his old patch at 7:30 AM and put the new one on at 11:00 AM [12/25] (this was earlier than the recommended 6 hours, but the vet said that if he was showing signs of discomfort after 3-4 hours, it was safe to put the new one on early). Same type of patch as before - Ivan was prescribed Carprofen 25mg every 12 hours on Dec 23rd. There were 14 tablets, so that gives us 7 days. We also still have the other bottle of Rimadyl which they told us to discontinue using on the 23rd and replace with the Carprofen. However, the Rimadyl is 18.75mg and has 22 doses remaining. If the Carprofen runs out and he's still in pain, do you think it's OK to go back to the Rimadyl? The vet is closed for the rest of today, so unfortunately I won't have more answers until tomorrow. I have an appointment for Ivan at 11:30am tomorrow morning, but it is with a different vet. I am considering canceling that appointment so I don't need to transport him, especially when this is a new vet who doesn't know him. At this very moment, Ivan is sleeping. But, he's been whining and yelping more today than before. A timeline: 12:00 AM - Sleeping 12:30 AM - He began whining a bit 1:00 AM - He started turning around in his bed to get comfortable while whining about once every 15 minutes 2:30 AM - He began to ▲ constantly whine and ▲ turn in his bed, never able to get comfortable 3:00 AM - I took him outside to poop (with a harness and 6 foot leash), which he did right away. Brought him back in and he fell asleep. However, from that point on he would wake me up ▲ whimpering about once per hour. I would check on him and he would go quiet for another hour, then repeat. I'm exhausted  7:30 AM - I gave him his regular morning doses of Carprofen, Gabapentin, Methalcarbomal, and Benadryl (with a full bowl of food). I also took off the fentanyl patch as instructed. I didn't take him outside at that time because I've noticed a lot of squirrels in the mornings lately 9:30 AM - Ivan seemed very uncomfortable in his bed and was whining, but not frequently moving in his bed, he continued like this until I put the next fentanyl patch on 11:00 AM - I put the new ✙fentanyl patch on. By this point he was panting with discomfort, so I moved him gently out of his bed and onto a soft pillow so I could soothe him and change his bedding a bit. Then I put him back in his pen. 11:45 AM - My fiance took over watching him for me so I could sleep a couple hours. Twice he yelped loudly while he was trying to move in his pen. She said he kept sitting up for the first 30 minutes. It seems to me like he may have been acting uncomfortable because I wasn't in the room anymore, but I wasn't there so it's hard to say. 2:00 PM - She said he began panting at this time 3:00 PM - I woke up and came down to prepare his next dose of medicine and potty break. I carried him outside and he urinated totally fine, then he wanted to sniff around so I carried him back in to stop that. I gave him his second dose of Gabapentin and Methalcarbomal for the day after we got back in (with a spoon full of food). 3:45 PM - He was heavily panting (60-90 times per minute) and that really scares me. We couldn't soothe him in his bed, so I gently moved him out of his pen onto a pillow on the floor again to try soothing him. He calmed down after 15 minutes. He has now been resting for the past 1.5 hours, and even wagging his tail as he watches us nearby from his cushion that's outside of his pen. I am preparing my notes for the vet tomorrow (with your comments being a major help - thank you!), because we really need to figure out his pain. BUT, I also am wondering now if he's whining more because of other things, like a baby who needs food, water, bathroom, attention, etc... In order to not freak ourselves out, we want to create a checklist of things to try to help him before we make any decision to transport him to the ER Vet again because that's so hard to do safely. I also don't like moving him in and out of his bed to soothe him or potty him when he is whining, but it seems to do the trick. I have to admit that when he's heavily panting, part of me always jumps to wondering if I'm asking him to suffer more than he needs to, and if it's time to say goodbye. But I don't want to make rash decisions, especially right in the middle of a scary situation, so a checklist might help. What are some things that we could safely try to do with a checklist to help him before we jump to that conclusion? |
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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 25, 2023 17:30:24 GMT -7
Tim, the single most important care is making sure Ivan is always in his recovery suite to eat and rest. Only out for potty time. One unexpected dart could do more disc damage and set things back to square one. Think of safe ways to keep Ivan near you. --- Put his wire crate on wheels to roll it close to you. Your local pet store ought to have some of these easy to put on casters. --- Put his wire crate up on your sturdy coffee table so he can be near you, smell you and feel your warm feet near the wires of the crate. --- Have two recovery suites one where he sleeps at night and one where he stays during the day. Gives change in venue for Ivan. --- Consider a simple pet stroller to keep him by your side as you move room to room around your house. Features and other considerations about strollers: dodgerslist.com/2020/05/17/pet-stroller-conservatve-treatment/ PAINWith pain it is all about the meds. The important thing is to make notes of events and correlate with med times, what activity may have caused the pain, etc. You did that!!! Going through your notes times noted for med dose and correlations of signs of pain, it appears a combo of the patch wearing off AND the two pain meds also starting to wear off close to their 8 hr effectiveness, unfortunately caused Ivan a lot of pain. -- Once pain gets out of control it can take much longer to get back in control. Just as you reported. -- The quite rapid panting due to pain is also worrisome to avoid that happening again. 🚩 Discuss especially when the patch approaches its expiration date, to be to give gabapentin for nerve pain 4x/day. That's would be a bear for you and sleeping a 4x/day dose, but would just be for when the patch is soon to expire. 🚩 Do discuss adding Amantadine. 🚩 As mentioned the single most important care you can give is limited movement of the neck/back. All vet visits must be weighed for intended benefit vs. risk of disc and further nerve damage if there would be too much movement during a transport. Vets who know their IVDD, understand this principal and will do med adjustments over the phone and other updates. At ER, Ivan has established a file with his visit there, another ER vet on duty can look at the file and phone prescribe. And of course your own vet, can prescribe over the phone too. Disc disease is not a death sentence. There is no one size fits all meds. It might take keeping the vet updated for them to be able to tweak meds to get it just right for Ivan. If an aggressive med approach has been used and pain is not being contained round the clock, night and day, then a surgery is a consideration  **Dr. Isaacs, Neurology (ACVIM): "Some dogs respond well to medical management and it would be worth giving it a try. In the meantime, it is very important to keep your dog strictly inactive so as not to get any worse. Dodgerslist is a great resource for trying to manage intervertebral disk disease and helping improve your dog’s quality of life." dodgerslist.com/2020/08/14/conservative-treatment-medications-rest-and-time/Please keep us updated. What a very handsome boy you have! This is a stressful situation not only for you but also Ivan. Stress causes more stomach acids. Carprofen causes more stomach acid production. Ivan does not need another problem on top of what he already dealing with. Do make it a point to see if there is any health reason he may not take Pepcid AC (famotidine) 10mgs 2x/day to avoid a bleeding ulcer. Available at your local grocery store. "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. " --The dose of famotidine may require reduction in patients with liver or kidney disease. -- It may be prudent with heart murmurs to choose another class of acid reducer. |
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Post by Tim & Ivan on Dec 25, 2023 17:53:09 GMT -7
Thank you again, Paula. Tomorrow I will talk with our vet about:
- Amantadine
- Pepcid AC & sucralfate
- Gabapentin for fentanyl patch switch
- How the pain waxes and wanes with doses throughout the day
We will also get a wire crate as his primary recovery suite. Right now his pen is mesh, which might be difficult for him to see through to us and make him anxious. We are also going to get some potty pads and set him on those before we take him outside. He's never been trained on potty pads, so it might take a while to get him comfortable with these, but hopefully it can be done.
We just gave him his final dose of Carprofen for the day at 7:30 PM, took him to potty, and fed him a full bowl. From the time of my last post until now he has been still and comfortable in his bed. Right now he's just getting comfortable again after all the work he put into eating and going outside, but I am optimistic it won't take long.
We have one more set of medication at 11:30pm with Methalcarbomal, Gabapentin, and Benadryl. Then we'll see how the night goes. Fingers crossed!
Your encouragement and kindness is well received. I hope you have some time to enjoy your Holidays 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 Dec 25, 2023 20:27:23 GMT -7
Tim, don't think it will take long to train Ivan to use a potty pad adjacent to his crate. That will be a lot less lifting and setting him down and carrying him outside for you. Prepare for pad training. --- Store a piece of urine stained paper towel in a zip log bag in the fridge. If you could get another dog's urine all the better! --- When you believe Ivan would need to pee, place the urine stained paper towel on the pee pad. --- Place Ivan near the towel to let him take a sniff. When you see him do some usual things like sniff, circle, or begin to squat or lift a leg, give the command "go potty." When he does potty, lavish praise. Soon he will learn to go on command. STOP OF Carprofen and a Plan B The 7-day course of carprofen may not be realistic to fully resolve all the painful swelling on its expected stop on Sat 12/30. It can take carprofen 5-7 days to leave the body. So it might take a few days before seeing if pain would surface. (Fingers crossed with hope, though, that you would not see any pain!) All vets must guess on how long a course. The swelling usually resolves with the anti-inflammatory in 7 to 30 days of use. Your job at home is to be watchful for any sign of pain surfacing starting on the 12/30 Stop. Also normally to get a quick and accurate read, the pain meds are also stopped or backed down on 12/30 stop. If there would be pain being masked by pain meds that would defeat getting a prompt pain assessement to determine carprofen should be back on board. Naturally, if Ivan is showing any hint of pain close to day of 12/30, it would not be time to do any Carprofen stop on 12/30. Clearly then he would need another course (7-day or even a 14-day course) or with discussion choose to switch to a steroid.  *So you and your vet need a Plan B worked out ahead of time in advance of 12/30. A plan should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free! RULE OF THUMB on stop of carprofen Pain= another course of carprofen + all pain meds, GI protectors back on board.
No Pain= no meds at all are needed! Finish out the 8 weeks of crate rest for the disc to heal.
I hope to hear Ivan's pain will now remain in good control throughout the night. That would be the best present, right!
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Post by Tim & Ivan on Dec 26, 2023 18:13:33 GMT -7
Hi Paula,
An update for today. Here are the things I've checked off my list:
- Added a second recovery suite with wire fencing and a new orthopedic bed which we will use to move him when he's lonely or when we need to change his bedding. He will no longer be outside of his suite except to potty. (Wheels won't work for us with our apartment layout)
- The vet has ordered Amantadine and will have it this week
- She told me to swap Ivan's fentanyl patch on 12/29 instead of 12/28 (the first fentanyl patch was also a 4 day patch, apparently, not a 3 day). We will increase his Gabapentin through that period to add 1 more 100mg per day
- We will not test stopping Carprofen/Rimadyl on 12/30 and will instead keep it going at least one more week
- We will add Pepsid this week as needed, but she says he's doing fine right now based on his bowel movements and appetite being regular
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24 lbs 13 y..o.
12/20 LF paw weakness, scuffs floor pain
Rimadyl® (carprofen) as of 12/20: 18.75mg 3x/day for 2 days,
as of 12/23 25mgs 2x/day for 14 days, 1/5/24 test STOP for √12/25 pain __ Neuro?
gabapentin 200mg 3x/day
fentanyl 4-day patch as of 12/25 11a.m.; expires on 12/29 11a.m.
methocarbamol 250mgs 3x/day
benadryl 12.5mg 2x/day
Ivan needs GI tract protector, Pepcid AC, on board for duration of Carprofen!]
- I am waiting to hear back about an appointment for an MRI
- His next vet appointment is 12/30 and he will be there all day so they can monitor him
Today [12/26] was the best day he's had so far. It is clear to me now that some of his whines are because he needs to potty, and not out of pain necessarily. He slept the entire night with no wake-ups at all, and most of today has been quiet. He hasn't figured out the potty pads yet but we're working on it. Our only real issue was a single yelp when we took him outside right after he woke up at 7:30am.
The vet is most concerned about the way he is sleeping now, which is curled up with his head to the right (like the letter "C"). This seems comfortable to him, but she said this could cause him to feel stiff when he wakes up and also prevent proper healing. We will no longer have him potty first thing in the morning (that might be why he yelped today), and will instead give him some time to warm up and wake up.
I'm not sure how I can straighten his neck all night without having to manually maneuver his neck in place, which sounds unwise to me based on how he normally yelps when pressure is put there. I'm trying to learn some ways to do that now and will post back here if I find anything. Frankly, I'd prefer if the vet would show me how to do it, but I'm still concerned about transporting him too 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 26, 2023 19:30:26 GMT -7
Tim, wow! You obviously did a bang up job on advocating for Ivan for so many things. So glad to hear Ivan's pain is where it should be this Tues the 26th...no pain. I've been on this Forum since 2007, never heard an owner reporting their surgeon nor regular vet saying a dog can't sleep the position they find comfortable. Good luck in trying to position a dog from the sleep position they find comfortable. ------------------- Timing of morning meds 1. If need be, inch his pain meds (gabapentin & methocarbamol) back (or forwards) each day by an hr til you give them at his normal wake time at 7:30 am. Give the pain meds AND PEPCID AC upon awakening and then take him outside to potty or on the pee pad. Dogs don't speak up at first signs of GI tract trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach lining. Ask if your dog has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health issues” answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). 2. 30 mins later Give Rimadyl® (carprofen) with a meal. ------------------- Be prepared when Ivan wakes up with a fresh warm towel from the dryer. Drape it around his neck in case a bit if arthritis is troublesome until he can get moving around to ease stiffness. If you have some synthetic fleece from an old garment, you can fashion a lightweight neck gaiter that is easy to slide over his head from the sleeve part. Fleece doesn't ravel, so you just cut how high you want the neck warmer to be. The seam is already in the sleeve, so no sewing needed.  Do you have a something available inside his recovery suite so he can rest his neck/head on a small pillow or a rolled up bolster? 
Tim, is the vet appointment on 12/30 to change the 12/25 4-day patch applied on 12/25? The 4-day patch that expires 12/29? Is there a reason you can't monitor him at home to avoid trips into the vet. Hopefully carprofen will show its ability to resolve all pain in the usual range of 7 to 30 days of use. Pulling for the now extended to 14-day carprofen course will be the lucky guess! Is there a very high suspicion that Ivan has a different disease than IVDD that warrants further looking into things right away? |
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Post by Tim & Ivan on Dec 27, 2023 11:33:57 GMT -7
Hi Paula,
I'm sharing an update earlier today since things are going so positively. A few things to check off the list:
- He does have some rolled up blankets in both of his suites to rest his head on, and he uses them a lot
- Luckily, we had already gotten his meds scheduled to start at 7:30 AM each morning, so that part was easy to continue. Moving his Carprofen back by 30 minutes worked well so he doesn't have everything happening so fast. He gets a little rest after potty and before eating (with Carprofen) for the pain meds to kick in, which went very smoothly this morning
- I will get his Pepcid today when I have the car again. Also picking up a refill on the methocarbomal 500mg (1/2 tablet every 8 hours) since that runs out today
- I'm taking your advice and letting him sleep in the position he's comfortable, but I'm certain this will come up again with the Vet about getting him a neck brace (or making one). Will keep you posted
The 12/30 vet appointment was scheduled to do xrays and all that, plus for the vet to checkup on his pain. She does believe it's IVDD, but there's a concern at his age about possible cancer. So MRI and all is advised, which we want to get done soon, but not so soon to disturb his rest right now. My original plan was to try pain mediation at home to see how that goes, since he's still "got that dog in him" and has been using the bathroom regularly, good appetite, wagging, etc...
Today, I feel much more confident in that decision (thanks in no small part to you). He has had no problems today other than a bit of panting and whimpering (which I solved by taking him potty). He's sleeping peacefully right now. We will continue to monitor him at home, but I do think the 12/30 visit and internal scans will be necessary.
I thought I would share a fun little note since we're in a positive moment. The vet didn't actually believe me (jokingly) when I said he was 13. When she first saw him she thought he was 8 or 9. My profile photo is of him just 4 weeks ago! Ivan has a lot of life left in him and I'm glad we got away from the euthenasia talks with the ER vets.
I've been reading a bit about cold laser therapy. Is this something to think about for long-term healing after he gets through these next weeks of crate rest? Almost sounds a bit gimmicky to me, but I'll try it if it's legitimate.
Thanks for everything.
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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 28, 2023 17:51:11 GMT -7
Tim, I'm so psyched to hear how well Ivan is continuing to do. Nice work you do in monitoring and attending to the little things that count. Have an in depth discussion with your vet, then make your decisions. These are things I think about. The single most important care for Ivan is the STRICT rest (limited movement) of the spine (neck) while it is trying to heal over the course of 8 weeks time. Be watchful of any calls for things, devices that require transports. See if Ivan can maintain good progress in keeping pain at bay with his meds til the test date on 1/5. The testing point is on 1/5/24 when pain meds ought to be backed off or full stopped along with the carprofen stop. Then you will have a quick and accurate answer if another course of carprofen is needed or not. It can take carprofen 7-30 days to get all swelling resolved. Again, my fingers are crossed the 14-day course will be long enough and 1/4 will be enough days of carprofen. "What if" there would have been no pain on 1/5, but for having done a 12/30 transport. Xray, MRI, laser therapy require transports and risk re-injuring the disc with too much movement. Let the current therapy playout. Adding other things could muddy the water on the effectiveness of the current treatment. 1. ⚠️BracesMostly ads one sees are for those back braces. I imagine, similar comments would go for a neck brace. Dodgerslist has consulted with several neuro and rehab specialists. " Orthotics, such as a back brace, should require a prescription from a board certified neurologist (ACVIM) who is well educated in disc disease. An ill-fitting product that is not custom made can do more harm, and the prescription would be for a specific reason. The overriding concern is that owners may buy a brace on their own, thinking it will substitute for strict crate rest" Please do read the rest of the points: dodgerslist.com/2020/02/24/devices-supplements2. ⚠️ X-rays and other imaging that require sedation to get a clean, quality image. Verify there was is a HIGHER suspicion of cancer over the diagnosis given of IVDD. Tim, a vet often suspicions a disc episode by knowing your dog is a breed prone to IVDD, his history plus the signs shown with a hands on neuro examination. If your dog improves with the prescribed medication and rest, then likely the diagnosis was correct.Laser therapy CAN help with pain as an adjunct to an aggressive max use of pain meds. It seems, now with meds adjusted, there is not a need to risk transport for a therapy not needed. If at some future time, laser therapy is considered, look for a mobile vet who would come to your home. |
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Post by Tim & Ivan on Dec 28, 2023 18:46:34 GMT -7
Heard loud and clear, Paula. Thanks, as always.
Ivan has now added [?mg ?x/day ] ✙Amantadine and ✙Pepcid AC to his daily lineup.
Tomorrow (12/29) is when we replace his fentanyl patch and I will see how he does with the extra dose of Gabapentin.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24 lbs 13 y..o.
12/20 LF paw weakness, scuffs floor pain
Rimadyl® (carprofen) as of 12/20: 18.75mg 3x/day for 2 days,
as of 12/23 25mgs 2x/day for 14 days, 1/5/24 test STOP for √12/25 pain __ Neuro?
as of 1/2/24: 18.75mgs 2x/day
as of 1/10 18.75 1x/day
gabapentin 200mg 3x/day, 1/7 2x/day
fentanyl 4-day patch as of 12/29 ; expires on 1/2
methocarbamol 250mgs 3x/day, 1/8 2x/day
✙Amantadine ?mg/mL?: ?mg (3mL dose) 2x/day ; 1/9 1x/day
✙Pepcid AC 10mgs 2x/day
benadryl 12.5mg 2x/day]
All activities today went perfectly with no hiccoughs and no signs of pain, save for one period of extra panting around 4:00 PM after a potty break.
Will keep going as suggested. Have a great night!
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Post by Tim & Ivan on Dec 31, 2023 9:40:47 GMT -7
Hi Paula! Final update of the year today, and things are looking good. Ivan's biggest issue now is that he wants to get out of his pen and is trying to climb out, so we got him a new fully enclosed crate for the night.
Amantadine [formula ?mg/mL?] is 3ml every 12 hours with food
Pepcid AC is 10mg given [2x/day] 30 minutes before the Rimadyl
We did replace the fentanyl patch on Dec 29th. After 12 hours, Ivan was starting to pant heavily and yelped twice while moving in his bed. Even though it wasn't as bad as Dec 25th, I decided one more patch should be good to keep him calm. We'll try to remove this third patch on Jan 2nd
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24 lbs 13 y..o.
12/20 LF paw weakness, scuffs floor pain
Rimadyl® (carprofen) as of 12/20: 18.75mg 3x/day for 2 days,
as of 12/23 25mgs 2x/day for 14 days, 1/5/24 test STOP for √12/25 pain
as of 1/2/24: 18.75mgs 2x/day
as of 1/10 18.75 1x/day
gabapentin 200mg 3x/day, 1/7 2x/day
fentanyl 4-day patch as of 12/29 ; expires on 1/2
methocarbamol 250mgs 3x/day, 1/8 2x/day
Amantadine ?mg/mL?: ?mg (3mL dose) 2x/day ; 1/9 1x/day
Pepcid AC 10mgs 2x/day
benadryl 12.5mg 2x/day]
We have a plan to start tapering the drugs on Jan 7th. One drug will be tapered each day and we'll watch to see what happens. Tapering in our case means reducing the frequency of dosages first, and then reducing the strength of the dosages. We'll see how he reacts each day before making the next changes.
The vet told us to taper in this order:
- Rimadyl/Carprofen (Down from 25mg twice daily to 18.75mg twice daily on Jan 2)
- Gabapentin (Down from 3 to 2 a day on Jan 7)
- Methocarbomal (Down from 3 to 2 a day on Jan 8)
- Amantadine (Down from 2 to 1 a day on Jan 9)
- Rimadyl/Carprofen (Down from 2 to 1 a day on Jan 10)
On Jan 11th we'll see how he's doing and will discuss with Vet about next steps over the phone.
Finally, I'm looking into finding a mobile vet who can do the cold laser therapy starting Jan 7
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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 31, 2023 11:03:04 GMT -7
Tim, with Ivan's mix of health issues, the backing off of meds does sound like the right way to go. I'm heartened by your continued efforts to find solutions the moment you observe a safety issue to Ivan's healing disc. Your devotion and love for Ivan are abundant! Pepcid AC for the duration of carprofen would continue to be 10mgs twice a day even when carprofen goes to once a day dose 1/10 If you can see the Amantadine formula printed on the bottle, could you share how many mgs amantadine are in 1mL of liquid? The formula could vary and be something like: ? mgs per 5mL. Here are couple of these tips from our members to help make crate rest go smoothly. Check out the rest of the tips here: dodgerslist.com/2020/05/14/strict-rest-recovery-process/Consider some of these ideas for Ivan: -- Make the crate or ex-pen more cozy by draping a blanket over part of the top. Should Ivan jump against side of recovery suite, he'd not see anything. Trying to get out or hopping upwards types of behaviors should extinquish quickly **-- Put a garment you have been wearing and have not washed in his suite as a comfort thing to smell you. -- Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when he wants something. Dogs are generally much calmer when they are focused and aware of how to act to get what they want. To achieve this, reward your dog with a high-value food treat the moment he looks at you. You can also say "yes" or use a clicker to mark the exact moment your dog looks at you. Then quickly follow up with a treat NOTE: for crate resting dogs, shift your body a bit] Wait for your dog to look up at you once more., Say, “Yes,” before giving treat. After about ten repetitions, say, "All done," and put the treats away. Come back later and repeat the exercise until you notice that your dog is genuinely beginning to make eye contact automatically in anticipation of hearing "Yes" once more and receiving his reward. NOTE: treats should be deducted from the normal daily kibble intake to prevent weight gain gain weight during crate rest. The size of the treat is irrelevant to dogs. Speak in your dog's language! Be aware that you could unintentionally be training for undesirable behavior. Dogs see food, attention, eye contact, talking to them, approaching the crate, and petting as rewards. Therefore, whenever you notice undesirable behavior, try speaking to your dog in his language to get him to calm down. Until he calms down and settles, keep your body turned to the side and avoid making eye contact just the same as one dog would communicate to another. Start teaching what you do want before there is too much practice in doing the unwanted behavior. Give your dog a reward of a loving, relaxed "good sit/lie" whenever they are sitting or lying quietly. Your dog will quickly realize that sitting quietly, etc. is rewarded. |
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Post by Tim & Ivan on Jan 6, 2024 15:44:24 GMT -7
Hi Paula,
Just sending an update after a few days of progress. Ivan is doing better every day, with no signs of pain recently. He's trying to get out of his pen more so we are starting to put him in an enclosed crate for some time each day.
Amantadine is 30mg per 3ml, twice daily
Ivan's fentanyl patch expired and his Rimadyl was reduced on the 2nd and he's doing well. Tomorrow (Jan 7th) we will begin tapering his Gabapentin, and every couple of days after that (depending on his pain) we will reduce the other drugs as shared previously.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
24 lbs 13 y..o.
12/20 LF paw weakness, scuffs floor pain
Rimadyl® (carprofen) as of 12/20: 18.75mg 3x/day for 2 days,
as of 12/23 25mgs 2x/day for 14 days, 1/5/24 test back off for: pain!? _Neuro?
√ as of 1/2/24: 18.75mgs 2x/day
as of 1/10 18.75 1x/day
gabapentin 200mg 3x/day, 1/7 2x/day
methocarbamol 250mgs 3x/day, 1/8 2x/day
Amantadine 30mg/3mL: 30mg (3mL dose) 2x/day ; 1/9 1x/day
Pepcid AC 10mgs 2x/day
benadryl 12.5mg 2x/day]
Will let you know if anything happens!
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Post by Romy & Frankie on Jan 6, 2024 16:07:27 GMT -7
Very good news that Ivan is doing so well with the end of the Rimadyl and the expiration of the fentanyl patch. When our dogs start feeling better, they often try to get more active. They think they are fine. We know it is 8 weeks of strict crate rest that allows the disc to heal.
i.postimg.cc/3rLH7g7X/320still-healing-disc.jpgOne thing I did with my dog to keep him engaged was having him choose which hand had a treat. I also tried teaching him the name of objects and had him try to touch the right one with his nose. He did all this lying down because at that point he could not stand. This could be modified for a dog having a neck disc episode by using a paw to indicate the object. If this causes too much neck movement, it should be stopped. |
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