Marjorie
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Post by Marjorie on Oct 1, 2013 5:40:38 GMT -7
I'm so glad to hear that Oscar is doing better, Billy! Yes, flapping his head is a very good sign that his pain is under control. It sounds like he's feeling much more safe and secure in his crate now, too, which is great. What will the dosage of the Prednisone be?
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Post by jw0068 on Oct 1, 2013 6:00:53 GMT -7
Hi marjorie,
I believe the prednisone is 5mg. I will have to check when I get home.
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PaulaM
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Post by PaulaM on Oct 1, 2013 16:32:10 GMT -7
How good to hear pain IS now being controlled at last so Dex can do it's job and Oscar can be in comfort!!! ========= 10/1 -- weighs 17lbs tramadol 25mg 3x day, Gabapentin 1mL (40mg suspension) 3x a day Pepcid 5mg 1x day dexamethasone .25mg 1x a day We have another day or two on the dexamethasone and then we switch to prednisone (5mg's?) once a day for 2 weeks, tapered to every other day for a week. =========
It is important to have an understanding of how the meds work, what the switch to Prednisone 5mg 1x a day is, and what you need to be observing for so you know what action to take.
First let me share our observations of 1000's of vets confident in their knowledge of IVDD and the typical way they taper off of a steroid. A taper is a test, a test to see if all the pain is gone. Pain is a sign that swelling exists in the spinal cord. Pain meds (tramadol, gabapentin) are used to mask pain and give comfort during the time it takes a steroid to get all the swelling resolved.
So to get a clear picture if swelling still remains, both the pain meds and the steroid are tapered. If any hint of pain shows, you report that to the vet and she would likely call for another round of steroid for a bit longer and of course all the pain meds would be back on board asap. Often a course of steroid would be for a short time such as 5-7 days and then test. No one wants any of these high powered meds to be used any longer than necessary because they can carry adverse side effects. The fact is it can often take 14 day at an anti-inflammatory dose and for some dogs more like a month to get all the swelling down. Each dog is individual so the taper tells tells the story if steroid use needs to be for a longer time or not.
For a 17 lbs dog, such as my Clark, 5mg of Prednisone 2x a day was prescribed for a disc episode.
So in a day or two when there will be a switch from Dex to Prednisone at 5mg 1x a day, that will be a taper, a step down in dose from an anti-inflammtory level. It is possible in a couple of days all the swelling could be gone. Is your vet also calling for backing off pain meds to know for sure? If you are like me I want to know in advance what plan B will be if things do not go as expected… have you discussed with your vet so if at night or on the weekend you are prepared to know what action to take, extra meds, etc. until the vet opens again? Neck discs can be more of a challenge so do not be distressed if there is still more swelling to address in a couple of days when the taper down via Prednisone begins.
Please keep us apprised…we have our fingers crossed you will not see any of these signs of pain on the taper … no shivering, holding head unusually, not bearing weight or favoring a paw, tight tense tummy, yelps, no head shakes, not his usual perky self.
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Post by jw0068 on Oct 2, 2013 4:43:20 GMT -7
Hi Paula,
We had a minor setback yesterday, due to an inadvertent taper of the steroid. Oscar has been getting one .25mg dex a day and yesterday, we accidentally only gave him half a pill. When we got home from work (about 10 hours after the tramadol and gabapentin) Oscar was clearly uncomfortable. I gave him his dose of tramadol and gabapentin and it seemed to make him a bit more comfortable but he still had a quiet whimper while laying down in the crate.
We gave him his final dose of tramadol and gabapentin right before bed and after some more soft whimpering, he finally went to sleep.
He woke up around 3:30 this morning whimpering again. We made it to 5:30 and gave him his morning dose of tramadol and gabapentin along with the Pepcid. We then gave him his prednisone a half hour later and he is now sleeping comfortably in his crate.
We decided to switch to the prednisone a day early because we are going out of town this weekend and leaving Oscar in the care of my sister in law. We wanted to be sure that he would be okay with the new steroid before leaving him.
Here is my question about the prednisone. According to your chart, the dexamethasone has a 29 in "Relative anti-inflammatory potency" while prednisone is a 4. Is that per mg? If so, I believe the prednisone will actually be stronger since he was only getting .25mg of dex a day and will now be getting 5mg of prednisone.
Am I reading that correctly?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 2, 2013 8:17:42 GMT -7
I do not know that the potency is relatable to mgs between dex and pred. The level of prednisone that is at the anti-inflammatory rate is 5mg 2x a day for a 17 pound dog. So giving less Pred is a taper down from the anti-inflammatory dose.
Dex stays in the body for a far longer time than Prednisone, that is the half life column.
Clearly Oscar has pain and this is not the time for a taper as there is still inflammation going on in the spinal cord a steroid needs to work on. Your vet needs to be updated on your observations of pain with the inadvertant Dex taper. Since you will not be able to observe over the weekend, can your sister in law join the Forum if she needs support? Do you have plenty of meds remaining should things not go as expected and only ER will be open? Do you have a plan B with your vet if there is pain and she is doing 5mg Pred only 1x a day?
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Post by jw0068 on Oct 2, 2013 8:48:53 GMT -7
Hi Paula, I just found this converter online: www.globalrph.com/steroid.cgi According to that, a .25mg dose of dexamethasone is equivalent to a 1.67mg dose of prednisone. Several other sites have converters that agree with this one. The results are roughly the difference shown on your chart. So it seems to me that the 5mg of prednisone a day will indeed be a stronger steroid than Oscar has been getting. He seems a lot more comfortable today and back to how he was on Sunday and Monday. I'm cautiously optimistic that we are back on track now.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 2, 2013 20:34:10 GMT -7
Nice converter, thank you for sharing. Let us know what you continue to observe if all pain is under control fully dose to dose of tramadol and gabapentin now that he is on Prednisone.
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Marjorie
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Post by Marjorie on Oct 8, 2013 18:02:38 GMT -7
I've been thinking of Oscar and wondering how he's doing, Billy. How has he been on the Prednisone?
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Post by jw0068 on Oct 9, 2013 7:27:54 GMT -7
Oscar had another pain episode on Friday morning as his prednisone and pain meds were wearing off. We decided at that point to pursue surgery as his pain was too much. We called two different places and were quoted totals north of $7k. We simply cannot spend that much money so we decided to call our vet to increase Oscar's prednisone dose.
The vet basically said that Oscar is at the top end of the prednisone dose and did not agree with increasing the dosage. She recommended splitting the 5mg into half a pill in the morning and half at night. We explained that our only other option if we cannot get his pain under control is to put him down.
We were out of town so we instructed my sister in law to just go ahead and give him half a pill at night but a full pill each morning, even though this was more than the vet instructed. At this point, I was willing to take my chances at a higher dose since the only other option was putting him down.
Oscar had a really good weekend and was basically a different dog when we returned home on Sunday. He showed no signs of pain or discomfort and was holding his head higher, back straight, etc. He even reached up to give me kisses when I carried him out to potty.
We spent Monday calling other vets to see if we could find one that would agree to the higher dose of prednisone since he seemed to be responding well to it. We found one that was able to see him Monday evening so we took him in.
This vet was very nice, listened to all of our questions and concerns and put Oscar through some tests. She did the knuckle test and found that Oscar had some deficiencies in both right legs.
She agreed with the previous vet that Oscar was just about maxed out on the prednisone dosage but encouraged us to increase the tramadol to a full pill each time if needed and was ok with the half pill of pred in the evening, full pill in the morning that we were giving him.
She did an xray and it showed no calcification of any discs in his neck so she said that this is an acute injury and not chronic, which was encouraging. Oscar had a cold laser treatment while we were there and that seemed to help him calm down. She said she believes most if not all of his pain is the muscles in his neck around the slip.
We left there with a plan to taper the prednisone back to a half pill twice a day and then taper again to a half pill once a day on Friday. In the mean time, they are making a house call today to do another laser treatment and then another on Friday. Oscar simply gets too worked up going to the vet to have it done there. We will have 3 more treatments next week as well.
So in a nutshell, since the pain incident on Friday, this was the longest stretch of no pain and the happiest he's seemed in a long time.
We had been giving him 3/4 pill of tramadol at night since that was his longest time dose-to-dose but last night I forgot and only gave him half a pill and this morning was his first 1/2 dose of prednisone. He seems a bit more uncomfortable today so I gave him another 1/4 pill of tramadol and hope that combined with the laser treatment this afternoon, he will feel better again.
The vet said she has "high hopes" he can recover from this, so that was encouraging. I also feel a little better that he doesn't seem to have any calcified discs that could cause him trouble in the near future.
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Post by Jean & Mimi on Oct 9, 2013 7:38:44 GMT -7
Hoping this goes well. I am in the same boat with my Mimi. The cost of surgery for us is $7000 that we cannot afford. I am hoping that the next two weeks are fruitful.
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Sabrina
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Post by Sabrina on Oct 9, 2013 11:57:22 GMT -7
Hi Billy! Well done for taking the initiative to find another vet to help Oscar. Did your new vet give you a reason that she did not want Oscar on 5mg pred 2x/day? There aren't any "safe" medications, and treatment is always a risk/benefit analysis. What risks did she say would outweigh the benefit of an anti-inflammatory dose of pred? If the risks are related to GI problems, I would discuss if it is ok for Oscar to take Sucralfate in addition to the Pepcid to protect his stomach: www.dodgerslist.com/literature/drugs.htm#intestinaldrugsThe Dodger's List main site has a good article on what x-rays can show: www.dodgerslist.com/literature/CalcifiedDiscs.htm I hope that the laser treatments help Oscar! I think it's wonderful they will treat him at home so that he doesn't have the stress of going to the clinic. ))Hugs!(( - Sabrina
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Post by jw0068 on Oct 9, 2013 12:29:38 GMT -7
Hi Sabrina,
Oscar just received his second laser treatment and he seemed to enjoy it. It had him wagging his tail, although it may have also been that he was allowed out of his crate for it ;-)
He seems to be fine today even on the decreased prednisone dose. More of the same as the past few days now. He got his usual afternoon dose of pain meds and he is sleeping comfortably in the crate.
He went out this morning and after going potty he gave a good full body shake and has done several of those since. I find this encouraging since he is now on a lesser dose of prednisone.
I think the vet wants to begin the taper of the prednisone since he will be having the laser treatments and he seems to be doing well. She seemed open to bumping them back up if pain returned after the treatments and the decrease on Friday. But she seems to want to taper the prednisone while doing the laser and bumping the pain meds if needed. The plan is to have the 3 laser treatments this week, taper down to one half pill of prednisone on Friday, have 3 more laser treatments next week and then go back for an evaluation to see what we should do at that point.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Oct 9, 2013 12:51:37 GMT -7
Billy, first of all Kudos to you for hiring another vet. While this vet is not fully comfortable in treating a disc episode she is much more comfortable than the old vet. With your ability to strongly advocate for Oscar's needs you and the new vet might be a good team for Oscar's disc episode.
------------------ Let us know if this is the correct med information Oscar is now getting: weighs 17lbs Tramadol 50mg 3x a day? Prednisone 5mg/am, 2.5mg pm as of 10/7; taper to start 10/11: 2.5 2x a day, 2.5 1x/day Pepcid AC 5mg 2x a day Gabapentin 1mL (40mg suspension) 3x a day ------------------
You did not mention giving Gabapentin, is this not on board now, why?
I agree with the new vet, that it is typical that much of the pain stems from muscle spasms with a neck disc. Hope Oscar finds as much good help with laser as many dogs do since he can't tolerate methocarbamol.
I would not mess around with Tramadol with 3/4 or 1/2 pill. Give it at the max prescribed 50mg every 8 hours and promptly on time. Michael Richards, DVM gives a very good explaination of pain control:
Your new vet has prescribed Prednisone almost approaching the anti-inflammatory dose for 4 days and then calls for way less than the anti-inflammtory dose with a taper this Friday 10/11…. did I read your post correctly? If that is correct on, then on Friday you need to be especially watchful for any signs of pain and if you see them strongly advocate for maintaining an anti-inflammatory level of pred for a bit longer. NOrmally the pain meds would also be backed off to get a correct read on pain.
Are you giving Pepcid AC 5mg 2x a day 30 mins before Pred. And giving Pred with a meal?
Hugs to Oscar
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Post by jw0068 on Oct 10, 2013 5:36:27 GMT -7
Hi Paula,
Here is a listing of Oscar's current doses (his weight is down to 15lbs):
------------------ weighs 15lbs Tramadol 37.5mg 3x a day (we want to be able to move to 50mg if we need to) Prednisone was 5mg AM, 2.5mg PM...now: 2.5mg AM, 2.5mg PM...tapering to 2.5mg AM tomorrow Pepcid AC 5mg 2x a day 30 min before Pred, tapering to 1x a day tomorrow Gabapentin 1mL (40mg suspension) 3x a day ------------------
Oscar gets all of his meds wrapped in a hunk of bread and gets his pred right near breakfast and dinner. He continues to scarf down his wet kibbles and pumpkin and going to the bathroom normally.
He did pretty well yesterday. Lots of full body shakes, stretching both front and back legs when coming out of crate for potty breaks, etc. These are things that he didn't do when he was feeling crummy.
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Marjorie
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Post by Marjorie on Oct 10, 2013 7:17:05 GMT -7
Hi, Billy
It sounds like Oscar is at a good place now and I'm so glad you were able to find a new vet, one who I hope will work with you better to help Oscar heal. I'll be thinking of you both and praying that Oscar will have a pain-free taper tomorrow. If not, you'll know what to do. Please keep us in the loop, too, as we're all here to help you and Oscar get through this.
Blessings to you both.
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Post by jw0068 on Oct 11, 2013 9:33:45 GMT -7
After a few days on his new, lower dose of prednisone, Oscar seems to be more uncomfortable. He hasn't had any episodes of severe pain but he definitely isn't feeling as well as he was at the higher dosage.
I called the vet and she agreed that we won't taper again (we will remain at 1/2 pill in the AM, 1/2 pill in the PM) but she said we should increase the tramadol up to a full pill in the AM and at the bedtime dose, leaving the middle dose at a half or 3/4 pill.
She wants us to try that over the weekend and see how he does with it, and then if needed she wants to try a very low dose of methocarbamol on Monday to help relax his neck muscles.
He is due for another laser treatment this afternoon, so hopefully that gets him feeling better at least temporarily.
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StevieLuv
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Conservative Treatment 3x. It really does work!
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Post by StevieLuv on Oct 11, 2013 9:42:31 GMT -7
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Post by jw0068 on Oct 11, 2013 12:13:52 GMT -7
Oscar had another laser treatment this afternoon. He seems to be feeling better too.
After we talked this morning, the vet did more research and then while they were here for the laser treatment, we decided to switch the methocarbomal for diazepam since he had the reaction to it before.
Oscar will start that on Monday if the increased dose of tramadol doesn't help this weekend.
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Post by jw0068 on Oct 16, 2013 9:29:40 GMT -7
Oscar had another laser treatment on Monday and went in today for a follow up vet visit and another laser treatment.
She said his walking and right side deficits have improved but he still has "considerable" pain on the left side of his neck. We are discontinuing the gabapentin and starting the diazapam in hopes that it helps relax his neck muscles.
His meds, starting this evening are:
2.5mg of Diazapam every 12 hours (3-4 hours apart from Tramadol) 2.5mg of Prednisone every 12 hours (Pepcid 1/2 hr before) 50mg of Tramadol in AM and PM 37.5mg Tramadol midday
He will have another laser therapy treatment on Friday and two more next week.
She is going to contact a neurologist this week to see what they suggest regarding the long term steroid use and other ideas as well. We are to give her an update on how he is doing on Friday and she will let us know what the neurologist said.
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Post by Jean & Mimi on Oct 16, 2013 10:08:50 GMT -7
Just wanted to say my Mimi will be on steroids for a month total, having failed two tapers and is now on an increase of steroid. My vet said it was totally ok for her to be on the steroids for a month. Just wanted to let you know you aren't alone in dealing with this for a long time. Hang in there
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Post by jw0068 on Oct 16, 2013 10:36:44 GMT -7
Thanks. Oscar has been on steroids off and on since the beginning of August, with two failed treatments without crate rest prior to this attempt. He had blood work done about a month ago and everything was fine but we want to be able to get him off as soon as we can due to this long term usage.
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Post by Jean & Mimi on Oct 16, 2013 10:40:39 GMT -7
I hear you....next week we are trying a taper for Mimi too. I know our vet wants us off as well.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Oct 16, 2013 15:39:44 GMT -7
That's very good news on the neuro improvements that your vet observed, Billy! Please keep us updated on the new med mix. Prayers that all goes well. You and Oscar certainly have been through the mill the past month.
All the best to you both.
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