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Post by Doreen & Benjamin on Jun 4, 2024 19:58:03 GMT -7
This post is being marked for information. PLease do not edit. If there is additional info, please do so in a new post
[Multiple Courses of Pred & Pain Meds
Doreen's acct: dodgerslist.boards.net/user/8698]
Hello again. I am here about another pup unfortunately. Paula and Romy, you were incredibly helpful to me in late 2021 when my Nico had his first episode. I am forever grateful to you both for your help during that time. Nico died in Feb of 2022 from a brain tumor. Currently my Benjamin is experiencing IVDD symptoms.
Benjamin is an almost 13yo, doxie-jack mix who weighs around 15lbs. He does not look or act his age, is typically high-energy, active, fearless and comical. I adopted him 10 years ago. He has no other health problems. He has not yet seen a neurologist.
Our general vet suspects IVDD based on exam and spine xrays (most recent 1/13/24): "caudal-thoracic area. pain upon palpation with muscle-twitching in that area." He was also evaluated by our rehab vet (2/6/24): "suspected IVDD based upon signalment and presentation. Vertebral pain: hyperesthesia noted over caudal thoracic/cranial lumbar region."
Benjamin has never lost any function at any point; his signs of pain include changes in personality, tail tucked, walking very slowly, hesitancy to get up from lying down and struggling when repositioning himself.
He is currently on his 5th (!) course of pred and pain meds since January of this year. When he is on the meds he is himself and pain-free. Every time he was tapering off he would show clear signs of pain again. He is prescribed the following meds:
Prednisone 5mg: 1/2 tab every 12hrs (usually x7days, one course was x10days)
Pepcid AC 10mg: 1/2 tab every 12hrs (given 30 minutes before pred)
Gabapentin 100mg: every 8 to 12hrs
Tramadol 50mg: 1/2 tab every 12hrs
Methocarb 500mg: 1/4 tab every 12hrs
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 13y.o.
Crate rest STOPPED on5/20!
Prednisone as of 3/25 as of 5/5 ?mg ?x/day for ? days, then a taper test for _pain _neuro
as of 5/30 : ?mg ?x/day for ? days; then test taper: for _ pain and _neuro
gabapentin 100mg ?x/day actually given
traMADol 25mgs 2x/day
methocabamol 125mgs 2x/day
Pepcid AC 5mgs 2x/day ]
Benjamin has started and re-started pred and pain meds on the following dates:
February 18th
March 23rd
April 12th
May 4th
May 30th
He was on strict crate rest from March 25th to May 20th. (I deeply regret the delay in his being crated. It was an extremely emotional and stressful time with the illness and then death of my pup Pete as well as my mother being started on home hospice and then her death. Benjamin is also grieving as he was very attached to both of them.)
I am happy to provide more detail on each episode/course if needed. My concern of course is that he cannot be pain-free without the meds and he has been on them for a long time already. What does this mean for him and what can be done in a case such as this? Would surgery be recommended when he has no loss of function but cannot be without meds? (I had planned on getting a neuro consult but with everything that happened recently that was put on hold.)
Thank you so much in advance for your help
Hi Paula, Thanks so much! Benjamin is definitely not in pain currently. He was tapering again and at the point of pred 1x/day plus gaba 2x/day when he started showing signs of pain again on 5/30. So I [?] bumped him up on 5/30 to pred [?mgs] 2x/day and gaba 3x/day and tram 2x/day. Currently he is still getting pred 2x/day and gaba 3x/day. He appears to be completely comfortable throughout the day, no signs of pain.
Although his crate rest ended on 5/20 I am still very much restricting his activity because of all the times he needed to be restarted on his meds. So he is still being carried in and out each time to pee etc and he is always on leash when outside, not going on walks, not staying out there. Also he has no access to furniture, no ramps/steps, and there are yoga mats/runners in place around the house.
He gets to the every other day part of the pred taper and starts to show signs of pain again each time. If he is on 1x/day pred and gaba only 2x/day he will show signs of pain again. The longest time he has gone without pain on less meds was 7 days, during which he was on pred daily and gaba every 12hrs. At a minimum, he seems to need pred at least 1x/day along with gaba every 8hrs to be pain-free.
Would you think it best for him to start strict crate rest all over again? I thought there might be a concern about losing muscle tone etc if restricted to that extent again? Of course i will do whatever is best for him. Many thanks again! (I hope I answered all your questions/clarified things!)
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Jun 4, 2024 22:22:20 GMT -7
Doreen, not having come in on the beginning of Benjamin's disc episode, there is a lot of missing information needed to clarify Benjamin's treatment to make sense to us. We are kinda starting from scratch in trying to establish a chain of events, use of meds to base comments on. You can help: • Use exact name of all meds. • Give the dose in mgs. • Give the frequency of dosing 1x/day, 2x/day, etc. • Use the date rather than Tuesday, last week, for events 🚩Did you or did the vet stop the crate rest on 5/30?
🚩Did you or did the vet prescribe an increase of prednisone (?mgs dose) 2x/day on 5/30?
🚩Prednsone is a steroid hormone that needs to be used under the direct supervision of a vet.
Do you have a vet who is Rxing and supervising the use of prednisone?
This is how the use of crate rest and Prednsone is used during a disc episode: --STRICT crate rest until off of all meds and no sign of pain or any sign of new or increased neuro diminishment is observed. -- On the schedule date of a pred taper, pain meds are also stopped to get a quick and accurate asssessment if all pain is really gone. March 25 to May 20th was 8 weeks of strict rest. Below are questions to help us understand what transpired with Benjamin's treatment (meds, crate rest, etc,) The important part of prednisone is the number days course prior to the taper (i.e. a 7-day course then taper, could be a 14-day course then taper) Typically a pred course is up at an anti-inflammatory level dosed every 12 hrs (2x/day) Taper doses are usually dosed at lower mg for 1x/day ending in an every other day dose. --- Taper days do not count in trying to get the swelling down. --- The date of stopping of STRICT rest nullifies prior days of prednisone use. With pain surfacing, it has to be assumed the disc had a set back, relapsed, re-tore causing pain. --- Stopping of crate rest means the need to start from square one of letting the disc heal again over the course of 8 weeks. Please provide the detail of prednisone use 3/25 to date of 6/4:
PREDNISONE missing information is highlighted in pink.
Please give us the mgs, times/day AND for ? days for each course:
3/25:
5/30:
Are there any missing pred courses that we don't know about between the 3/25 and the 5/30 courses? ++++++++++++++++++++++++++++++++++++++++++++++++ Prednisone as of 3/25: ?mg ?x/day for ? days, then date? of taper test for √5/30_pain as of 5/30 : ?mg ?x/day for ? days; then date? of test taper: for _ pain ++++++++++++++++++++++++++++++++++++++++++++++++
🚩 Were pain meds also stopped on the date of each pred taper ?🚩 Who directed stop of crate rest on 5/30 while prednisone was still in use?
🚩What was the reason to stop crate rest? |
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Post by Doreen & Benjamin on Jun 5, 2024 16:41:26 GMT -7
Hi Paula, thanks for all the information. I apparently got it very wrong about the crate rest part unfortunately. I will answer completely when I have all my notes in front of me later tonight, still currently at work. Just wanted you to know that I read your response and greatly appreciate all your help and the additional information.
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Post by Doreen & Benjamin on Jun 5, 2024 21:44:38 GMT -7
Hi Paula. Our general vet is prescribing all of Benjamin's meds and is aware of the situation with multiple courses of pred and pain meds. She never said to restrict his activities at any point;
I told her I started him on 8 weeks of crate rest based on my reading about IVDD (and I did the same with Nico). My understanding of the crate rest period was that 8 weeks was typically needed for the spinal cord swelling to decrease. (I screwed up, was depending on my memory for that piece, based on what I did with Nico).
The meds are dosed the same:
Pred 2.5mg **dose does not change with taper, only the frequency (2x/d x7d then 1x/d x7d then every other day x7d)
On 5/4 I asked our vet if this course should be longer than 7days and she told me to do a 10-day course.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 13y.o.
Crate rest STOPPED on5/20*!
Prednisone 3/24: 2.5mg 2x/day for 7 days; 5/1 test taper for: √4/12 pain _neuro
4/13: 2.5mgs 2x/day for 9 days; 4/22 test taper for √5/4 pain _neuro
5/4: 2.5mgs 2x/day for 10 days; 5/14 test taper for *√5/25, *√5/30 pain _neuro
5/30: 2.5mgs 2x/day for 7 days; 6/5 test taper for _ pain _neuro]
gabapentin 100mgs 3x/day
traMADol 25mgs ?x/day STOPPED
methocarbamol 125 mgs 2x/day STOPPED
Pepcid AC 5mgs 2x/day for duration of prednisone ]
Pepcid 5mg
Gaba 100mg
Tramadol 25mg
Methocarb 125mg
Regarding the courses of meds that coincided with the crate rest period:
He started a 7-day course on 3/24. Started crate rest on 3/25.
3/24 thru 3/30:
Pred 2x/d [Prednisone 3/24: 2.5mg 2x/day for 7 days May 1 test taper for: √4/12 pain _neuro]
Tram 3x/d
Gaba 2x/d
Methocarb 2x/d
3/31Taper started
Pred 1x/d x7d
Tram 2x/d (then 1x/d on 4/3 4/4, discontinued on 4/5)
Gaba 2x/d (then 1x/d on 4/5 4/6, then discontinued on 4/7)
Pred every other day: 4/8 4/10 4/12
4/12 Pain Again
Gave him Gaba and Tram in evening on 4/12
4/13 Pred 2x/d again
Gaba 3x/d
Tram 1x (needed another script, pharmacy issue)
4/13 thru 4/21 [for 9 days]
Pred 2x/d
Gaba 3x/d
4/22 thru 4/30
Pred ▼1x/d
Gaba 3x/d
5/1 5/2
Pred 1x
Gaba 2x
5/3
No Pred (every other day)
Gaba 2x
5/4 Pain Again
Pred ▲2x/d for 10d
Gaba 3x/d
Tram 2x/d
Methocarb 2x/d
5/6 5/7 5/8
Pred 2x/d
Gaba 3x/d
Tram 2x/d
Methocarb 1x/d
5/9 thru 5/14
Pred 2x/d
Gaba 3x/d
Tram 2x/d
Methocarb none
5/15 Taper started
Pred 1x for 10d
Gaba 3x
Tram 2x
5/16
Pred 1x
Gaba 3x
5/17 thru 5/24
Pred 1x/d
Gaba 2x/d
5/25 Pain Again
Pred 1x
Gaba 3x
Tram 1x
5/26 thru 5/29
Pred 1x/d
Gaba 3x/d
Tram 2x/d
5/30 Pain Again
[Prednisone 3/24: 2.5mg 2x/day for 7 days; 5/1 test taper for: √4/12 pain _neuro
4/13: 2.5mgs 2x/day for 9 days; 4/22 test taper for √5/4 pain _neuro
Crate rest stopped 5/20
5/4: 2.5mgs 2x/day for 10 days; 5/14 test taper for *√5/25, *√5/30 pain _neuro
5/30: 2.5mgs 2x/day for 7 days; 6/5 test taper for _ pain _neuro
Gabapentin mg 3/day
traMADol stopped
methocarbamol stopped]
Pred ▲2x
Gaba 3x
Tram 2x
Methocarb 1x
5/31 6/1
Pred 2x/d
Gaba 3x/d
Tram 2x/d
6/2 thru 6/5
Pred 2x/d
Gaba 3x/d
So today (wed 6/5) is the 7th day of this course (Pred 2x/d) I'm not sure if I should do total of 10d again this time.
I was trying to find the sweet spot for Benjamin, where he would be pain free with the least amount of meds so I was adjusting his pain meds with each taper. Our vet did not give me specific instructions for that part, just prescribed the meds knowing I would use them based on my observations of his comfort level.
I hope I provided the clarity needed this time, Paula. I unfortunately can only write these posts late at night which is part of the problem! I so appreciate all your time and help!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Jun 6, 2024 11:59:14 GMT -7
Doreen, the med list we keep for each member is organized in a manner that patterns can be seen and related to events (tapers, stopping crate rest, transporting to a vet, etc.) Home use of a med chart is another way owners can monitor for patterns and have at hand dates and details when working with a vet. If you don't have a med chart, here is one plus a sample to see how one can fill it out D/l a sample and a blank form to use with your dog's meds www.dodgerslist.com/wp-content/uploads/2023/12/med-chart-printable.pdfThank you for compiling all the missing data!!!! I have pieced and organized together the different items you have reported. Truthfully, I may have gotten the day-course end with the taper date start off a day or two. For what we are trying it to understand, that may not matter. However, from now on, you will report as things as they happen giving us the most accurate of dates, mgs, etc. data. This is Benjamin's med list for you to look at and see the same patterns we see. The more knowledge owners have, the better care they give their furry friends. Not all vets know IVDD. A disc episode ALWAYS DEMANDS giving 100% STRICT rest for 8 weeks to allow the disc to heal. MED LIST/HISTORY
15 lbs 13y.o.
Crate rest STOPPED on 5/20★!
Prednisone 3/24: 2.5mg 2x/day for 7 days; 5/1 test taper for: √4/12 pain
4/13: 2.5mgs 2x/day for 9 days; 4/22 test taper for √5/4 pain
5/4: 2.5mgs 2x/day for 10 days; 5/14 test taper for ★√5/25, ★√5/30 pain
5/30: 2.5mgs 2x/day for 7 days; 6/5 test taper for _ pain _neuro
gabapentin 100mgs 3x/day
traMADol 25mgs ?x/day STOPPED
methocarbamol 125 mgs 2x/day STOPPED
Pepcid AC 5mgs 2x/day for duration of prednisone
How prednisone is used during a disc episode: --- Crate rest serves the purpose of allowing the disc to heal and not have setback of a redamaged or increased damage to the cord.--- Prednisone's only purpose is to resolve painful swelling over the course of 7-30 days (Taper days are not counted as the dose 1x/day is too low) It may, then, take 2 or 3 courses of pred to eventually get the swelling resolved. --- During a course of pred, assume a painful disease IS PAINFUL. Be aggressive in sticking to prompt dosing 3x/day pain meds at the right mgs dose for the dog. The time to stop pain meds is on the scheduled taper day. --- ALL vets must guess on the days-course, then taper. It is prudent to try a 7-day course and then taper. Prednisone does have side effects. No one wants a dog on pred any bit past having achieved the benefit (all painful swelling resolved). --- Pain meds are used to provide comfort for the duration of the Rx'd days-course.
---The date the pred taper starts is the date to stop the pain meds, not before.
---The pred taper IS the time to assess for pain. Pain meds on board block your ability to quickly and properly observe for painful swelling. --- IF pain surfaces on the taper, then another pred course, all pain meds back on board --- If NO PAIN surfaces on the taper, then go to conclusion of taper. Complete the remainder of the 8 weeks for disc healing. I've not had time to try and coordinate if there were any stops of crate rest with the 3/24 nor 4/13 pred courses to see if Ben just had not had enough time on pred. Or if true STRICT rest had been suspended and a disc relapse was the cause of pain. So it is not known the reason for pain reported on 4/12 and 5/4. If STRICT rest had been given and pain surfaced on the taper, that would mean simply not enough time on pred....and would expect another course of pred., all pain meds BACK on board, then try another "test for pain" pred taper. Technically, if STRICT rest HAD NOT been given and pain surfaced on the taper, it would mean to start at square one of 8 weeks of rest to enable strong, secure scar tissue to re-form on the disc. If your vet aggress to extend his 7-day course that was supposed to taper on 6/6 and extend for a 10/day course, I would do the 10-day course. You reported pain just a short 7 days ago (details of pain never reported). -- Maintain ALL pain meds at 3x/day at the Rx'd dose in mgs Let us know the details of EACH pain med you give as of today til taper date:
? Mgs dose 3x/day (promtly every 8 hrs).If you would be on the new 10-day course
-- with taper day on SUNDAY 6/9, stop the pain meds on 6/9.
-- Be ready to observe if any surfacing hints of pain which could take some days to surface.
-- Maintain STRICT rest until new graduation day if you have chosen the 10-day course.
What date did you resume 100% STRICT rest?
-- Carried to potty place and back.
-- ONLY a very few FOOTSTEPS allowed to take care of business.-- Report pain with specific details of what you observed
•Always avoid using any general terms (a month ago, pain, better, worse). You are our eyes and ears to understand what is going on. Paint us a picture with your words. •Specific pain observances could be:
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Post by Doreen & Benjamin on Jun 6, 2024 21:03:44 GMT -7
Paula, I am really upset with myself for missing something so critical in caring for Benjamin. I did not realize that each time pain resurfaced, not only did he need to restart all meds but he also needed to restart another 8 wks of crate rest. (Granted the last few months have been a nightmare in general for me but I still should have realized this.)
So Friday/tomorrow [FRI, June 7] will be the 9th day of a ▲10d course of pred.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 13y.o.
Crate rest STOPPED on 5/20★!
Crate rest resumed date?: ______
Prednisone as of 5/4: 2.5mgs 2x/day for 10 days; 5/14 test taper for ★√5/25, ★√5/30 pain
as of 5/30: 2.5mgs 2x/day for ▲10 days; Sunday 6/9 test taper for _ pain _neuro
gabapentin 100mgs 3x/day
Pepcid AC 5mgs 2x/day for duration of prednisone ]
B is getting pred 2x/d and gaba 3x/d currently. That's it. He has not been crated since May 20th (just limited activities,and still carried in & out). He had only the 8wks of crate rest from March 25th until May 20th. So 8wks total. I did NOT restart crate rest at any point when pain resurfaced on the taper schedules. I did not realize that he needed to start crate rest all over again, for an additional 8wks each time when pain resurfaced.
How do I proceed now, on day 9 of this 10d course? Does he restart crate rest again before he even starts the taper on June 9th?
My poor little guy! All these episodes of pain because I missed a key piece of his recovery. Paula, I am so grateful for you and this forum! Thank you SO much for your help! He needs to go back in the crate for another 8wks, doesn't he?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Jun 7, 2024 9:03:43 GMT -7
Doreen, non-surgical conservative treatment REST works like this: Conservative treatment REST is ONLY for 8 weeks to allow the disc to form secure scar tissue. Most all of our conservative dogs do graduate on time at the end of 8 weeks. --- Prednisone is used to get the painful swelling down. A pred taper allows owner to observe for pain. If pain would surface during the STRICT REST, it only means the pred course was not long enough. Expect another pred course and another pred taper to find out when all swelling is gone RULE OF THUMB on a prednisone taper with STRICT rest pain = swelling = another course of pred back at the anti-inflammatory dose + pain meds and Pepcid AC no pain = go to conclusion of pred taper. No pain meds, just Pepcid AC for duration of pred finish out the 8 weeks of crate rest for the disc to heal LACK OF employing actual real STRICT REST --- There are a small number dogs where STRICT rest was suspended or never Rx'd by the vet. Those dogs had to start the 8-week count from the date real STRICT crate rest started to allow the disc to heal. --- Lack of STRICT rest most often will cause the weak and still healing disc to re-tear. The pain whether new or increased, whether on a taper, relates to lack of rest and the disruption to the disc formation of scar tissue. --- When a disc's healing has been disrupted, it will take re-starting from day one with the 8 weeks of STRICT rest to ensure the dog has time to form secure scar tissue on the disc. RULE OF THUMB with pain due to lack of STRICT REST
pain = swelling from disruption of disc healing = A new course of pred + pain meds and Pepcid AC
(All previous pred was for naught All previous crate rest was for naught)
8 weeks of crate to heal the disc restarts at square one
What is the date you resumed doing actual real STRICT crate rest for B?
Confirm as of the date you started STRICT crate rest again that you are on the same page as we are:
◼︎No laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎Eats in recovery suite, only out for potty time
◼︎Carry to and from the potty place w/harness and leash to control speed and darting off. No meandering at potty times. Only but a few limited footsteps during potty time.
◼︎No PT for conservative dogs during 8 weeks to heal disc |
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Post by Doreen & Benjamin on Jun 7, 2024 15:48:47 GMT -7
Hi Paula, I finally get it. So as of today 6/7 Benjamin has started a new 8 week course of strict crate rest.
He is currently not in pain.
He is on the 9th day of his 10 day course of pred (2.5mg 2x/d) and getting gaba 100mg 3x/d as well.
Because I totally screwed up the crate rest piece, I am expecting he will show signs of pain again once the taper starts on 6/9. So is it not in his best interest to even attempt the taper on 6/9? I would ask our vet but unfortunately like most vets she misses the whole piece about the need for 8 weeks of crate rest. Thanks so much again for all your time and help with Benjamin!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on Jun 7, 2024 19:41:00 GMT -7
Doreen, I appreciate your way of communicating...so full of details about his meds, crate rest restart date, too. Prednisone is one medication you MUST use under the direction of a vet. You must communicate with the vet! With the pred taper date to begin on Sunday, 6/9, you will be at home to monitor and as well on 6/10 Mon morning. -- Are you prepared with enough meds on hand or an Rx to quickly get more should pain arise on Sunday 6/9? -- No one knows how long it will take for Pred to resolve his root cause of pain. EVERY vet has to make a guess for how many day pred course to give. Even you are even guessing/expecting what you don't know for sure. The pred taper is the proof
of whether or not B needs another course or not. |
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Post by Doreen & Benjamin on Jun 7, 2024 20:42:23 GMT -7
Paula, thank you! Yes I am letting our vet know the recent events and the plan with Benjamin. I will definitely be with him to monitor for pain as the taper starts. And I do have all the meds available as our vet made sure to give me refills so I would have them for any future episodes. But thank you for the reminder--I have run into pharmacy issues before over the weekends!
Many thanks again! What a blessing you are! Enjoy a peaceful weekend!
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