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Post by jw0068 on Sept 22, 2013 18:22:39 GMT -7
--What is your dog's name?
Oscar
--What breed is your dog and did you specifically get a diagnosis of IVDD?
Dachshund, bulged cervical disk
At the end of July, Oscar presented with severe pain in his neck area. We took him to the vet immediately and he was diagonsed with a neck strain or possible bulged disk. He was put on dexamethasone 2 times a day for 5 days, once a day for 6 days then every other day for 6 days. He was also put on Tramadol as needed for the pain.
The next day, Oscar started to have trouble walking, tripping over is front feet and falling as he walked. This (combined with a lower back disk bulge 2 years prior that completely healed with just a steroid treatment) confirmed that we were dealing with a disk in his neck.
We were happy with the results of this treatment. It worked with the back disk and seemed to work with the neck this time. Oscar returned to his normal self after the treatment...for about a week or 2.
This time, he wasn't in the screaming pain he was in at first and we only really noticed when he refused to step up on a step. It progressed some, and it became obvious he was in pain again. We called the vet and decided to put him on ▲another round of steroids. They cautioned us that if his neurological issues returned, they would likely recommend surgery.
Luckily for us, he never lost functionality and we proceeded with the steriod treatment. This time, when we tapered to 1 pill every other day, the pain returned. With the vet's agreement, we decided to give him half a pill every day instead so that he was getting the same dosage, but it was more constant.
This too failed to resolve the pain (mainly when picking him up to go outside, etc.)
It was at this time that I found this site and read about the 8 weeks of strict crate rest. At no point were we advised to really restrict Oscar. We were told to elevate his food and water bowls so he wouldn't bend down to eat, but that was it.
After reading this site, I wanted to try the conservative route and I called the vet again to see if we could restart a ▲ full round of steroid treatments in conjunction with the 24/7 crate rest. The vet agreed and is in complete agreement with trying the crate rest.
We began the strict crate rest on Thursday (9/19) and restarted the steroid treatment on Friday (9/20).
-- Is there still currently pain - shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, tight hard tummy?
Oscar was doing well, hadn't had tramadol since Thursday morning. He showed no signs of pain, just seemed stiff. Tonight, day 4 of strict crate rest he seems to have reinjured himself. He *hates* being in the crate and has episodes of prolonged barking and whining. We got a second crate to put in the living room so he could be near us but that doesn't seem to help. As for the pain today, this morning when carrying him out of his bedroom crate to go outside, he was fighting me and wanting to get down. I think he probably tweaked his neck since this evening he yelped out a few times and is favoring his right front paw.
I really do not know what to do about this. I can't keep him still enough when holding him (using the technique on this site) and this whole attempt seems like a lost cause since he reinjures himself so easily.
-- What are the exact names of meds currently given, their doses in mgs and frequencies?
Dexamethasone - .25mg 2 times a day for 5 days, 1 time a day for 6 days, 1 time every other day for 6 days
Tramadol - 12.5mg every 8 hours as needed
Pepcid AC - 5mg once a day
-- Currently can your dog wobbly walk? move the legs at all? or wag the tail when you do some happy talk?
Oscar can walk and was walking fairly normally until re-injuring his neck tonight. Now he holds his right front paw up in the air and limps on it when going potty.
He wags his tail like normal
-- Do you find wet bedding or leaks on you when lifted up?
No
-- Eating and drinking OK?
We originally were letting him eat outside his crate and he was eating normall. We bought bowls for the crate yesterday and today he ate his morning ration in his crate but did not eat dinner tonight. He has been drinking normally.
-- Poops OK - normal color no dark or bright red blood?
Yes
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This whole ordeal has been very disheartening and heartbreaking for me and my family. We are very stressed trying to care for him and feel that his nearly constant barking in the crate are not very helpful for the healing that is supposed to take place in there. Additionally, after carrying him properly and putting in the effort to crate him, it is even more disheartening that he has now apparently re-injured himself. I honestly don't know how we could prevent this as it seems as soon as he starts to feel better, he doesn't want to be held by me and fights me carrying him outside, re-injuring himself in the process.
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Post by kburnsey on Sept 22, 2013 18:46:25 GMT -7
This type of thing just happen with our Coton - and I just wanted to say I share your grief. Our whole family is so sad, at our bouncing young dog now laying there and when he is up, for a short time to pee, just standing there looking depressed. It is tough. Sounds like you are doing your best through, and that is all you can do. That and look after yourself too.
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Post by Pauliana on Sept 22, 2013 20:34:03 GMT -7
Welcome to Dodgerslist. My name is Pauliana what is yours? It sounds like Oscar is indeed suffering from a neck disc episode and all of you are having a very rough time, understandably so. All of us here have been through it with our dogs so we understand totally what you are going through.. To help you, first things first.. Tramadol is not an as needed drug..It needs to be prescribed every 8 hours to be effective and the dosage he is on is not strong enough.. Have no patience with pain. That should be under control in one hour of getting the right combo of meds, the right doses in mg's and the right frequency to give them. So far that has not happened. Your vet needs immediate feedback so he knows there is still more tweaking to be done. These are the typical pain medications used to treat IVDD: Tramadol as the general pain reliever. It has a short half life of 1.7 hours and may need to be prescribed at a minimum of every 8 hours. Methocarbamol treats muscle spasms stemming from aggravated muscles due to nerve trauma related to the spinal cord inflammation. Gabapentin may be added to the mix for hard to control pain. Veterinarians are finding this medication works very well in combination with Tramadol. If you aren't already add water to his kibble to make it easier for him to eat. It is painful to chew with a neck disc episode.. With neck disks the front legs can be affected neurologically as the disc is pressuring the spinal cord. So glad you understand the need for 100% STRICT crate rest 24/7 only out to potty for 8 weeks. That is what allows the disc to heal. Here are the extra things you can do to help with neck disc plus the meds that Oscar needs, so you can strongly advocate for getting them on board right away please read about them here: www.dodgerslist.com/literature/cervical.htm As speedily as you can finish reading all the others on our "Phases of healing" pages so you can be up to speed on what you are dealing with: www.dodgerslist.com/healingindex.htmGlad to see you have Pepcid Ac as part of his medications.. Good for you!! Keep an eye on his eating, if he continues to reject food it would be wise to ask the Vet for Sucralfate to heal the GI tract.. It is given on an empty stomach 1 hour prior to Breakfast and his Dexamethasone. Pepcid AC can be given 30 minutes after the Sucralfate. Be sure to always give his Dex with food. We ask that all members read about each med their dog is on or may take as a safety measure. This directory is in alpha order: www.marvistavet.com/html/pharmacy_center.html Barking is annoying behavior. Using any oral calmer in combination with a Pheromone diffuser seems to work best. It takes several days for these to start working - it isn't immediate but they are a much better option if you can avoid heavy duty prescription sedatives. Of course always keep your vet in the loop on all things you give your dog. Farnum's Comfort Zone with D.A.P. www.petcomfortzone.com/dogs.html [pheromone diffuser] with one oral calmer from below: Oral calmers: 1) ANXITANE® S chewable tabs contain 50 mg L-Theanine, an amino acid that acts neurologically to help keep dogs calm, relaxed www.virbacvet.com/products/detail/anxitane-l-theanine-chewable-tablets/behavioral-health2) Composure Soft Chews are colostrum based like calming mother's milk and contain 21 mg of L-Theanine. www.vetriscience.com/composure-soft-dogs-MD-LD.php [Composure] 3) Rescue Remedy is a liquid herb combo to help with relaxation www.bachrescueremedypet.comOther brands may be available in your area… just shop by the active ingredient(s) on the label. Be aware you might be inadvertently training for unwanted behavior. To dogs rewards are: food, looking at them, talking to them, eye contact, approaching the crate, petting. So anytime you see unwanted behavior ignore it, turn your back, leave the room if you have to. Preferable is to start teaching what you do want before there is too much practice in doing the unwanted behavior. Anytime your dog is sitting or lying down quietly, give a reward. Soon your dog will see they get rewards for four feet on the floor, quietly sitting, etc. Here is a link that explains emergency crate training to help him become used to his crate. It is also helpful to put a towel or lightweight blanket over the top of the crate to create a den like feel for him and that helps to calm them.. www.dodgerslist.com/literature/EmergencyCrate%20Training.htmHang in there, once his pain is under control you will see him begin to heal and recover and that will make all the difference.. |
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Post by jw0068 on Sept 23, 2013 6:56:11 GMT -7
Thank you for this prompt and helpful reply. We will speak to our vet about the tramadol dosing immediately and begin giving that on a regular schedule in an attempt to keep Oscar's pain under control. We will also look into the other products you've suggested in hopes that we can minimize his stress/anxiety while he is in the crate.
In the meantime, our main concern continues to be how upset he is about being in his crate. Even before he was injured, if we put him in the crate when we were home, he barked as if he was on fire. We tried giving him a theanine pill at that time, but we noticed no improvement. We got a thundershirt for him, which seemed to help some, but we are apprehensive about putting it on him now that he's injured. We read all of the helpful links you've posted before we began the 24/7 crate training, and we have been following their recommendations very carefully. He continues to bark this furiously for about 15 minutes of every hour that we are home, and ignoring it does not seem to make it stop. He barks so insistently and is so visibly agitated that we don't see how he can be healing under these circumstances. We feel like he hasn't made any progress since we started crating him 24/7 because he is so upset about being crated all the time.
We understand that he will not heal if he is allowed out of the crate, but we are starting to feel like he will not heal if he is in the crate, either. It makes us feel like there is no humane option. Can anyone give us an idea of how long it might take with the "emergency" crate training before we start to see some positive improvements? We understand that it is different with every dog, but it would be comforting if anyone has been able to overcome a similar circumstance.
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StevieLuv
Helpful Member 
Conservative Treatment 3x. It really does work!
Posts: 1,335 
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Post by StevieLuv on Sept 23, 2013 10:23:56 GMT -7
Does he fret like that if he is confined at all?? Is your crate one of the solid sided ones or the wire crate?? some dogs will not tolerate the solid sided crates (airline type) because they are too isolating. Our Stevie was like that - but she tolerated the wire crate and an ex-pen recovery suite. www.dodgerslist.com/literature/CrateRRP.htm We just folded the sides of the expen up and used rolled towels to restrict the floor space. You can also ask your Vet for a mild tranquilizer if needed. You can get through these difficult first days - eventually dogs will give in and accept that they are stuck there for the duration. Make sure that you are not inadvertently rewarding the negative behaviour - even looking at them when they act up can be considered a reward. We have more than one member who had to hide out in another room for a bit to overcome this obstacle. Don't give up!!! We are here for you. Keeping you in thought and prayer. |
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Sept 23, 2013 15:06:36 GMT -7
My name is Paula, what is yours jw0068? First thing…. is pain now being fully controlled? 12.5mg of tramadol is a very mild dose. Because tramadol has such a short half life it is not likely to control pain unless given every 8 hours. How much does Oscar weigh? If pain is not under control, your vet needs to know about it to further tweak the pain meds. You can get the necessary handle on typical meds by reading pain management with IVDD: www.dodgerslist.com/literature/healingpain.htm Let us know what you are observing re: pain today. For Oscar it may be that the milder calmers are just not going to work. If he needs to be slightly drugged then so be it…discuss a sedative with your vet. The airline type plastic crate are not well tolerated by most dogs. As StevieLuv recommends look at a wire type recovery suite. What is the dose in mg's of Dex started on 9/20 weighs 17lbs.Dexamethasone as of 9/20 - .25mg 2 times a day for 5 days, 1 time a day for 6 days, 1 time every other day for 6 days Tramadol - 12.5mg every 8 hours as needed hadn't had tramadol since Thursday morning Pepcid AC - 5mg once a day |
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Post by jw0068 on Sept 24, 2013 5:27:47 GMT -7
[StevieLuv] thank you for your encouragement and suggestions. He has always had a wire crate, so we had purchased an extra one of those for the main level of our house. We had been covering it partially with a blanket to try to calm him, but after reading your post we decided to try taking the blanket off. We were out of the house most of the day yesterday, but he did do better and was less frantic when we were home and he was in there. We are hoping this is a sign that his pain is being managed better and that he is getting more comfortable in the crate. The diffuser was $50 at Petsmart but only $25 on amazon, so that should arrive tomorrow and we hope that will also help calm him down.
Hi Paula, my name is Billy.
My wife and I both work so we can't quite give Oscar the Tramadol every 8 hours. Starting yesterday, we gave him 12.5mg in the morning before work, 12.5mg again when we got home and then 12.5mg again before bed. This seemed to help him, but he still yelped once or twice so this morning I gave him 25mg since this is the longer stretch between pills. He weighs 17lbs.
We tried methocarbomal but he had a violent reaction to that with his back injury 2 years ago, so we do not want to use that again.
As for his crate issues, we are using wire crates. He actually tolerated it much better yesterday and this morning so that was encouraging. he certainly makes it known that he's not happy in there (who would be? :-)) but he only had one or two minor barking episodes.
I'm hoping that with his pain more under control and him becoming more comfortable with it, he will continue to tolerate being in there.
Oscar is on .25mg of Dexamethasone twice a day but is supposed to switch to once a day tomorrow. I feel like we should continue with it twice a day though as I don't think he's ready to taper. How should we judge that?
Thanks for your help and encouragement :-)
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Sept 24, 2013 7:16:18 GMT -7
Hi, Billy
Since Billy is still showing signs of pain, you should notify your vet that you will not be starting to taper the Dexamethasone tomorrow. The tapering of the Dex is only done to test if there is still pain and it's already apparent that there is still pain. Sometimes it takes a week or two or even a month for the swelling to go down and still have a need for an anti-inflammatory. If Oscar had a reaction to Methocarbomal, please discuss with your vet increasing the Tramadol dose or adding Gabapentin to the mix. There should be no pain from one dose of pain meds to the next. So the pain meds still need to be adjusted.
I also notice that you're giving the Pepcid AC 5 mg once a day. Since you're giving him the Dexamethasone twice a day, the Pepcid should also be given twice a day - 5 mg 30 minutes before the Dexamethasone.
Please let us know how Oscar is doing today and what your vet says about adjusting the pain meds.
All the best to you.
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Post by jw0068 on Sept 25, 2013 4:27:26 GMT -7
I called the vet and she agreed that we could stay on the dexamethasone at 2 times a day for three more days and then taper. She said that it is a powerful drug and they don't like dogs to be on it at max dosage for more than 8 consecutive days. We will taper him down to 1 pill a day for 8 days starting on Saturday.
She also agreed to increase the tramadol dosage. Oscar is now taking 25mg every 8 hours and she said we could even go to every 6 if we felt he needed it.
We are also now giving the Pepcid twice a day as well.
Oscar seems to be mostly pain free and content in his crate now. Hopefully we are finally on the right track and he can heal.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Sept 25, 2013 8:27:10 GMT -7
Billy, kudos to you for strongly advocating what Oscar needed (upped Tramadol, pepcid AC and extention of Dex). We certainly hope that 3 more days of Dex at the anti-inflammatory dose would do the job. There is no way to tell until a taper is tried (back off pain meds and reduce dose of Dex). Often inflammation can be resolved in 1-2 weeks at the anti-inflammatory doses. However, there are many dogs than can take more like a month on a steroid. Each dog is individual. No doubt Dex is a strong and powerful drug with side effects. So no one want to have the dog on this med any longer than necessary. You might discuss going with a steroid that is not as notorious for GI tract problems as Dex is… prednisone if more time than 3 more days is needed to get swelling down. ![]() Pain being "mostly" in control is still not good enough. Again your vet has room to move with pain med dose and adding meds. Tramadol could go to 50 mgs every 8 hours. Methocarbamol and Gabapentin could be added to the tramadol. So what are the signs of pain you are observing (trembling, yelping, tight tense tummy, reluctant to move or change position, holds head in unnatural position)? |
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Post by jw0068 on Sept 25, 2013 8:38:32 GMT -7
By "mostly" in control, I mean for the most part there is no sign of pain, just that as we near the time for the next dose he doesn't seem as comfortable as he is when he is fully dosed (in the morning after sleeping longer than 8 hours, etc.) Once I give him the next dose, he seems pain free.
Oscar had a bad reaction to the methocarbamol with the first disc incident so we do not want to use that again. I think a consistent dosage of 25mg of tramadol seems to be working for him at this time.
We also started wetting his kibbles to help with the chewing and because he seemed to be getting constipated. He is still drinking normally and eating normally and he ate up all the kibble as soon as I put it in his crate this morning after wetting it so I think he liked this change in care ;-)
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Sept 25, 2013 8:47:25 GMT -7
OK, then clearly the pain meds are still not YET right, if pain is starting to arise nearing the next dose. Do report your observations to the vet.
Right, sorry, I did read about the methocarbamol. Then ask for a higher dose of Tamadol if giving 25mg every 6 hours is not keeping pain at bay fully dose to dose. Are you giving Tramadol every 6 or every 8? Gabapentin works synergistically with Tramadol and vets find good success in controlling pain.
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Post by jw0068 on Sept 25, 2013 9:14:58 GMT -7
We cannot give him the Tramadol every 8 hours since we both work. We give it to him in the morning and then about 10 hours later when we get home, then again about 6 hours later right before bed.
I think the dosage is right, as he has no pain while he is on it, but we simply cannot give it to him soon enough. I don't think upping the dosage will help since it will still run out before we can give it to him again.
This is the first full day of the increased dosage so I am willing to see how he does today before calling the vet again and trying to change anything.
The Comfort Zone diffuser we ordered just arrived and we have that plugged in now to also try and help to keep him calm.
He is generally ok in the crate now but we figured this could help with those few times that he gets upset in there...like when the big mean UPS man comes to drop off a package containing a diffuser :-)
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Marjorie
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Post by Marjorie on Sept 25, 2013 10:11:32 GMT -7
Hi, Billy
I'm very glad to hear that your vet has made the necessary changes in medication. And that Oscar's feeling more content in the crate. Tramadol works best when given consistently. Is it possible for you or your wife to stop back to the house during the day or for a friend or relative to give the Tramadol to Billy? Or can he stay at someone else's house during the day where someone is home and can give him the meds? If your crate can fit in the car, it can be padded with blankets around the inside so Oscar would be secure during a car ride. He shouldn't be in pain before the next dose is given.
"Healing occurs faster when pain is under control. Pain affects blood pressure, heart rate, appetite, and general mood. Until all the swelling is resolved, there will still be a source of pain. Herniated discs, damaged spinal cord require a significant amount of time to heal. New tissue must be generated. Swelling must have time to subside. Pain is so important to the overall well-being of a patient that it has become the 5th cardinal sign of human assessment. (Philips DM. JCAHO pain management standards are unveiled. J.Am Med Association 284(4):428-429, 2000) Institutions can risk their federal funding if they do not routinely assess for pain."
Please let us know how he does today. Good job on wetting his kibble. Raising his food dishes helps, too, so he doesn't have to bend his neck down when eating. Hope he has a good day today.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Sept 25, 2013 10:24:10 GMT -7
I can see working is a problem if not possible to stop by at lunch time for meds.
Tramadol has a short half life of 1.7 hours. Imagine an element or a med has a half-life of five minutes, for example. If we start out with 20 ounces of it, five minutes later we will have 10 ounces remaining, and in another five minutes only 5 ounces remaining. The rate of decay has slowed from 2 ounces per minute to 1 ounce per minute, but the half-life is constant at five minutes. So I would discuss with your vet about moving the dose up to 50 mgs so that more Tramadol would remain in the system for a longer time, if you are seeing he is in pain during the longest stretch of the day or the pain starts to arise nearing the next dose of Tramadol. Let us know what you are observing today with the new dosing Rx. Hopefully the new Rx will do the trick. Just want you to know there ARE still options to get the pain fully under control.
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
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Post by StevieLuv on Sept 26, 2013 10:57:08 GMT -7
How did Oscar make out yesterday?? I was lucky enough to have someone I trusted, and who Stevie loves, come over in the middle of the day to give her medication and take her to potty so that she wouldn't have to wait. We all so the best that we can, and juggle things around to make it all work out. Please keep us posted on Oscar's progress. Keeping you in thought and prayer  |
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Post by jw0068 on Sept 26, 2013 16:09:09 GMT -7
Well, aside from one random yelp in his crate, Oscar seemed ok yesterday. It was bothersome to hear him yelp out. He did it as I reached to give him his pill in the crate. He reached for it with his head and yelped. Aside from that, he didn't show any signs of pain.
Today was more of the same. He seemed to be walking better and no signs of pain, even after going 10+ hours between tramadol doses. I got home from work, gave him his meds and then took him out to the bathroom.
When he came in from that, he began holding his right front paw up again and I just went to give him his evening steroid and he again yelped in pain when taking it. It has only been 2 hours since 25mg of tramadol.
He has now been on strict crate rest for a week and tomorrow is the final day of the twice a day dexamethasone and I feel like he is right back to square one.
I am quickly losing hope of him recovering from this without surgery and surgery is something we want to avoid at all costs. I really thought we were making progress and on the road to recovery but it seems like every time I think that, he has these set backs that take us right back to the beginning...limping and yelping.
I honestly don't know what to do. If keeping him in a crate for a week with max dosage of steroid isn't enough to keep him from re-aggravating it, how will he ever heal?
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Marjorie
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Post by Marjorie on Sept 26, 2013 16:30:56 GMT -7
Dear Billy,
I know it seems like it's been a long time but it's only been one week. It can take two weeks or sometimes even a month for the steroid to get the swelling in the back down. Meanwhile, the swelling is pressing on the spine and causing the pain. Thus the need to get the pain under control until the steroid gets the swelling down.
As Paula recommended, you need to speak to your vet about increasing the Tramadol to 50 mgs. Explain to the vet the difficulty you have in giving Oscar meds at regular times. Neck injuries are more painful than back injuries and can take longer to resolve. It's tricky sometimes getting the meds right and then you have the added difficulty of not being able to give the meds at close enough periods of time.
You mentioned that his last yelp of pain happened after being taken out to do his business. Are you carrying him in and out to the place where he does his business and limiting the amount of steps he takes as he goes? He shouldn't be taking more than a few steps to do his business and shouldn't be allowed to sniff and walk around before or after he goes. If that's what he's doing, you can get some push in the ground type of fencing and section off a small section for him to do his business in. That will limit his walking around.
Of course, since he still is having episodes of pain, the taper of the dexamethasone will have to wait. Please contact the vet as soon as possible to discuss increasing the Tramadol to 50 mgs. And discuss holding off on the taper of the Dexamethasone. And of course let him know that Oscar's once again holding up his paw.
Please don't lose hope. Neck injuries can be difficult but they can heal. The meds need to be adjusted again, that's all. Please let us know how Oscar does tomorrow and how you make out with the vet when you speak to him.
Keeping you and Oscar in my thoughts and prayers.
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Post by jw0068 on Sept 26, 2013 16:38:42 GMT -7
Hi marjorie,
Thanks for the reply. Unfortunately, our vet will not let us go beyond 8 days on the dexamethasone before tapering. We have to taper after tomorrow.
He doesn't really sniff or walk around much after going to the bathroom. He did pee and poop this trip which required him to be out there for a bit longer and he did seem to still be a little constipated so that didn't help matters either.
I really feel like the vet has been more than on board with trying to get Oscar to heal without surgery and with the strict crate rest, but each time I talk to them, I get the feeling that they think we are getting closer and closer to that since we keep trying to get him comfortable and don't seem to be making progress.
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Post by tugandbucket on Sept 26, 2013 16:59:53 GMT -7
Hello Billy, the ladies here have given you a load of great information. I read earlier on that Oscar was not enjoying his crate time, but has now settled down a bit. I, too, went through the first days of my little man Rusty being absolutely obnoxious about being crated. At times I thought, the heck with his nerves, I need something for my nerves! I'm glad to hear that he has seemingly settled in. I'd just like to say that I finally spoke with our personal doc about Rusty's behavior in crate - I was so worried he would hurt himself further. He didn't hesitate to give us a sedative (of course, Rusty was way beyond just barking and such while in crate) to settle him down. It worked wonders and wasn't so much that it knocked him out - just more mellowed him enough to rest. Just something to keep in mind if Oscar starts back up again while in crate. I don't normally like meds like sedatives, whether for a person or a pup. However, with the operative word in our cases.... crate REST - it is something to keep in mind if needed. Here's to hoping Oscar keeps moving forward to success! |
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Sept 26, 2013 17:08:45 GMT -7
As Paula mentioned yesterday, there are still things your vet can do to give Oscar the time to heal. Dexamethasone is a very strong medication and is hard on the GI tract. If more time is needed on a steroid, your vet can switch to Prednisone. Please see the steroid chart that Paula posted above. Plus the Tramadol can be increased to 50 mgs. It has a short shelf life and the extra dosage will help Oscar's pain for a longer period. You had mentioned yesterday that you were willing to see how Oscar did today before calling the vet for more changes. But today you seem reluctant to do that. I know this is all discouraging but please hang in there. There is still room to adjust medications. Each dog is different and sometimes it takes awhile to get the medication right. But once that happens, Oscar can then heal in comfort.
Also, you mentioned that Oscar is a bit constipated. Pumpkin can help firm up stools OR it can help to loosen stools. The amount of water in the diet makes all the difference. To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. To firm up the stool add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives for constipation: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.
I wish I could give you a hug but all I can do is to try to send you some encouragement. Talk to your vet again and let's see if we can get Oscar to a good place.
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Post by jw0068 on Sept 27, 2013 10:57:11 GMT -7
I just got off the phone with the vet. She is willing to switch Oscar to prednisone, starting tomorrow morning. She said he is at the max dosage for tramadol but was willing to try gabapentin so we will switch to that as well.
She did say that we have been trying to heal this and keep him comfortable for a while now and that while she is willing to give this 8 weeks a try, she thinks we should begin to look at the surgical route.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Sept 27, 2013 11:03:44 GMT -7
Billy, if Oscar is still showing any signs of pain, then you have two choices at this point. 1. Go ahead with surgery. These two pages are highly recommended to read now in getting prepared: www.dodgerslist.com/literature/healingsurgery.htm and www.dodgerslist.com/literature/surgery.htm2. Today, get on the phone and hire a vet who is comfortable in treating a disc episode. Your current vet is loudly telling you he is not comfortable with the aggressive pain relief meds nor the need to stay the course with a steroid to get the swelling down. It can take 1-2 weeks or even more than a month on steroids to get all the swelling down. These tips can give you insight in to approaching hiring the right vet to support you through this disc episode and for future years ahead: www.dodgerslist.com/literature/VetchkList.htmWhen time permits, please let us know how Oscar is today…re: pain. We are here to support you with either continued conservative treatment or with surgery. |
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StevieLuv
Helpful Member
Conservative Treatment 3x. It really does work!
Posts: 1,335
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Post by StevieLuv on Sept 27, 2013 11:06:23 GMT -7
That is great news about the prednisone! You have done a great job in advocating for Oscar, and helping your Vet learn about the treatments for IVDD at the same time. Gabapentin and Tramadol work very well together to help with that difficult to control pain. I hope that this does the trick and that Oscar starts to fell better soon. I wish I could express how very pleased I am that you are getting Oscar the help he needed!!! Hang in there ! |
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Sept 27, 2013 11:17:52 GMT -7
Great job, Billy, on convincing the vet to switch to Prednisone. Now Oscar will continue to have a steroid working to bring that swelling down. As for the Gabapentin, are you switching to that from the Tramadol or is the Gabapentin in addition to the Tramadol? Both of those pain meds work together on hard to control pain and should be prescribed together. When you get a chance, it would be helpful if you listed all of the meds Oscar is now on, including the dosage in mgs and the frequency given. I know you had included Pepcid awhile back.
You had mentioned how you were trying to avoid surgery at all costs, so I truly hope that this change in meds will be the working combination so Oscar can heal in comfort. Please let us know how Oscar does today. I'm keeping my fingers crossed for the boy!
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Post by jw0068 on Sept 27, 2013 11:37:37 GMT -7
The vet just called back and wants to do the Gabapentin *with* the Tramadol so that makes me feel better.
The Gabapentin will be delivered to our house Monday or Tuesday, we start the prednisone tomorrow morning.
He will be on:
40 mg of gabapentin every 8 hours
25mg of tramadol every 8 hours
prednisone once a day for 14 days then taper (I will find out the dosage when I pick up the prescription)
5mg of pepcid 30 mins before the prednisone
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Sept 27, 2013 14:16:46 GMT -7
Kudos to you Billy, for advocating for the meds Oscar needs to get pain fully under control. You just became the captain of this health care team, a real driving force to get things right for Oscar! Sounds like you might be shipped a liquid form of Gabapentin? I would go ahead today and double check on that, so as not to waste time having to remix. If it has been compounded into a liquid form you want verification from the pharmacist that toxic-to-dogs xylitol has not been used as a sweetner. This ingredient won't be listed on the bottle, you will have to specifically ask. If the compounder is a veterinary pharmacy, very likely they will know not to use xylitol. I so hope to hear that the addition of gabapentin to the Tramadol will be doing the trick to fully control pain. We anxiously await your observations. Do know, though, Tramadol is not maxed out should Oscar need a higher dose: e) Dosage Information
i) Dog
(1) 3 to 5 mg/kg (0.5 to 2.5 mg/lb) TID to QID (up to 6 times daily at lower dose)1
(b) Anecdotal reports include 10 mg/kg QID for more severe pain" Veterinary Anesthesia & Analgesia Support Group vasg.org/t_drugs.htm |
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Post by jw0068 on Sept 30, 2013 10:36:41 GMT -7
I just wanted to update everyone after a roller coaster weekend.
I picked up Oscar's Prednisone and more Tramadol on Friday and after consulting with the vet, the plan was changed to allow him to finish his dose of 1 a day Dex instead of switching to 1 a day Prednisone and give him 1/2 pill of tramadol every 8 hours. The idea is that the Dex is stronger and it would be an easier taper instead of switching straight from Dex twice a day to Pred once a day.
Saturday morning started out okay, but around mid morning, we decided to give him some Benadryl to help keep him calm. Shortly after, Oscar turned in his crate and began yelping in severe pain. We decided to increase his Tramadol dosage since we are still waiting on the Gabapentin and gave him 3/4 pill.
He was very clearly agitated and in pain after that dose with several episodes of barking/yelping. We decided at that point that surgery was likely the only option for him because his pain was just too much but we would try as best as we could to keep him comfortable through the weekend. We stopped the Benadryl after 2 doses since it didn't help him and then we began to wonder if it somehow made things worse since he had such a bad day.
Oscar got another dose of 3/4 tramadol before bed and then slept well, really well, through the night. Yesterday morning, he awoke with no signs of pain and we gave him another 3/4 tramadol with his dex.
I took him out to go to the bathroom without incident and put him back into the crate. He did give a small little whimper when going into the crate but he quickly got comfortable and slept...and slept...and slept.
He laid down, calm in his crate and slept most of the day yesterday without any further signs of pain. He got up a few times from laying down and gave a few whimpers to indicate he needed to go out to potty and went back in (almost willingly) and relaxed with no issues.
He had an event free evening, again, mostly resting/sleeping in the crate and then slept through the night.
He did great again this morning and has done well today as well. It is very obvious to us that the tramadol is really affecting him and keeping him comfortable. I am slightly concerned about the amount of drowsiness. Is it okay for him to be pretty drowsy and want to sleep most of the time? He is currently getting 37.5mg every 8 hours. I'm also wondering if he is just exhausted from being in pain and can finally rest.
The Gabapentin comes either today or tomorrow so the plan is to introduce that and cut the tramadol back to the vet recommended dose of 1/2 pill every 8 hours and see how he does.
I did call the pharmacy and verified that they made it [gabapentin] chicken flavored and used no xylitol.
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Sabrina
Helpful Member
My Charley-dog, a Dodger'sList grad enjoying life!
Posts: 471
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Post by Sabrina on Sept 30, 2013 12:29:43 GMT -7
Hi Billy, I'm Sabrina. Sorry to hear of the roller coaster IVDD episode, but you are doing fantastic in being Oscar's advocate! I am so glad to hear that his pain is being controlled - that is wonderful news. Sedation is a side-effect of Tramadol: "The dose can be increased up to 5 to 10 mg/kg QID for more difficult to manage canine cases. At these higher doses some sedation may be evident" page 4: www.vasg.org/pdfs/NEWER%20OPTIONS%20FOR%20CHRONIC%20PAIN%20MANAGEMENT.pdfBeing pain free and resting/sleeping are good things. For my own dog, he slept through most of his crate rest, even after he was off all the meds. But I know how nerve-wracking a disc episode is! You are doing well to educate yourself - caring for my dog, I found by learning all I could that I got better at distinguishing between worry because I didn't know something, and worry because my "gut" was saying something's wrong. You know Oscar best so of course don't ignore your "educated gut" if you think something's wrong. Is Oscar eating ok/eager for his food? (I know for my Charley-dog, if he's not eating eagerly something's wrong!) ))Hugs!(( - Sabrina |
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Post by jw0068 on Oct 1, 2013 5:02:55 GMT -7
Hi Sabrina, thanks for the reply. Yes, Oscar is eating normally. He eats his wet kibble and a bit of pumpkin twice a day with no reservation :-)
He continues to do pretty well. My wife was home with him yesterday and she said he only let out one little yelp when she was closing his crate door, but I think he does that when he *thinks* it is going to hurt because when he actually has pain, it is more than one yelp. He hasn't had any more pain episodes since Saturday and he has resumed shaking his head to flap his ears which is encouraging as well.
We received the Gabapentin yesterday evening and gave him a dose of that. We then gave him one last dose of 3/4 pill of Tramadol before bed last night and gave our first combination of Gabapentin and 1/2 pill of Tramadol this morning.
His current meds:
AM: 1/2 tramadol (25mg), 1mL Gabapentin (40mg suspension), 1/2 Pepcid (5mg) and then a half hour later, 1 dexamethasone (.25mg)
PM: 1/2 tramadol, Gabapentin
Bed: 1/2 tramadol, Gabapentin
We have another day or two on the dexamethasone and then we switch to prednisone once a day for 2 weeks, tapered to every other day for a week.
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