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Post by ladyfrank on Oct 9, 2013 10:36:03 GMT -7
Frank is 6 years 9 months old, a bit on the chubby side and has had a history of jumping. I took my little Frank to the vet last Friday (9/11) because he just wasn't acting right. We thought he might be constipated or have tummy troubles because he would skip a meal, but would take a treat. His bowel movements were sporadic, but he was urinating as usual. Our vet diagnosed Frank with a mild vertebrae injury. He gave me
▼presnisone (5mg)
tramadol.
I have followed the dosage instructions of both medications exactly as I was told. It has now been 5 days since Frank's vet visit and he seems very lethargic. His symptoms have not worsened, but they don't seem like they have improved that much either. I have read stories of Dachshunds taking steroids for back injuries and being back to normal within a day or so - this has not been the case with Frank. Frank is being crated, except for potty breaks. He has not lost any mobility in his legs (no dragging or limping), he walks, but it is slow. He is eating normally, normal bowel movements and urination (a little more drinking and urinating because of the steroids, but that's improving now that his dosage is▼tapering off), he lifts his leg to urinate and is wagging his tail. I spoke with the vet this morning and he said he'd like to see him on Friday. I'm wondering what others have experienced with their Doxies when taking steroids and tramadol. He seems so sad, it just breaks my heart to look at his little face. I would appreciate any advice, information, stories - anything to help me through this difficult time.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 9, 2013 10:54:43 GMT -7
Lady, welcome to Dodgerslist. It is clear on the taper if Frank is not his normal perky self, walking slowly that he is in pain. Your vet needs this information today, so that Pred can go back up to the original dose for a bit longer to get all the swelling in the spinal cord addressed. Do not be distressed. Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. When the vet guesses swelling might be gone there will be a taper. Your vet guessed the swelling might be gone in about 3-4 days and then called for the taper. The dose is lowered to less than the anti-flammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too. Rule of thumb is: pain = swelling = more time on Pred needed. STOMACH PROTECTION Cortisteroids (Prednisone, Prednisolone, Dexamethasone, etc.) are involved with stimulating gastric acid secretion causing GI upset to the more threatening bleeding ulcers or holes in the stomach or intestine. Phrase the question to your vet in this particular way: "is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5MG Pepcid AC (generic name is Famotidine) 30 mins prior to steroid. 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 and the one I use for my dogs: www.marvistavet.com/html/pharmacy_center.htmlAfter you have Frank's meds back on board via a phone discussion, please update us on some details. What is the dose in mg's initially prescribed for Pred and what is the current taper dose? What is the dose in mgs and how often you give Tramadol? Before the taper started was that dose/frequency fully controlling pain? |
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Post by ladyfrank on Oct 9, 2013 11:07:30 GMT -7
THANK YOU so much for your quick response. Frank received 2 5mg Pred Friday after vet visit (around 1 pm), 2 5mg Pred Saturday AM, 1 5mg Sunday & Monday in the AM and now we are on every other day for the Pred. He also gets one 20mg tramadol in the AM which I have done everyday even when he is not getting his Pred pill. Thanks again for the quick response.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 9, 2013 11:51:11 GMT -7
how much does Frank weigh?
Basically your vet gave Frank Prednisone for 2 days, a very, very tentative use of this med. So it is not at all unusual that his swelling is not yet gone. Many vets will call for a 5 day use of Pred and then call for a taper test. The taper test is only clear when there are no pain meds to mask pain…so pain meds are either stopped or backed off.
If 20 mgs of tramadol 1x a day was controlling pain when he was also on Pred 5mg 2x a day (the anti-inflammatory level of dosing), that is good. However, if you saw signs of pain still on Fri and Saturday, do know that Tramadol is not likely to control pain unless given 3x a day as it has a very short half life of 1.7 hours.
Let us know what your has prescribed today to help Frank and that Pepcid AC is on board as a stomach protector.
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Post by ladyfrank on Oct 9, 2013 13:41:52 GMT -7
Frank is 23 lbs. - we are working on getting his weight down, but with his recent injury our main focus is to make him comfortable. Friday and Saturday he seemed to be more alert and engaged. When we would enter the room or open the refrigerator he would look up, wag his tail, look around at us while we were talking, but now he really has to be coaxed to get mildly excited. He has quite a few Pred pills left so I'm assuming the vet wanted us to do the every other day dosing for awhile. He also has a lot of the Tramadol pills left, too. The vet said to bring him in Friday if he doesn't improve. In the meantime, should I give him another Tramadol to make him more comfortable? Thanks again
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 9, 2013 14:55:54 GMT -7
You have clear indication that Frank is in pain. Pain means there is still swelling to address. Pred addresses swelling when it is at the anti-inflammatory dose, not the taper dose. Have you gotten on the phone to tell the vet of your observance that Frank is not his normal perky self and to strongly make the case that he needs help… he needs prednisone back on the orginal dose. You play the roll of nurse at home, watching and reporting back to the vet. The vet depends on your feedback. The fact of the matter is you are not just the nurse but YOU are the captain of the health care team. To be effective in that roll, takes reading. Lucky you, the treasure trove of information is available for you to access any time. Frank is depending on your reading this information. I recommend to start with this page and then read all the rest of the Index. www.dodgerslist.com/literature/healingpage.htmDo you now have Pepcid AC on board? Did you discuss the full range of Tramadol. Tramadol 1x a day is not likely to control pain. Do you know what to do if at night or weekend if you can go to 3x a day if needed. It is good as team captain to know all your options. Here is how the use of Pred work with a disc problem: During the time on the anti-inflammatory the pain meds do need to be adjusted so that there is no pain surfacing dose to dose of pain relief medications as pain deters healing. Often it takes being at the anti-inflammatory dose of prednisone (5mg 2x/day) for 1-2 weeks or even for some dogs more like a month before all the swelling is gone. When the vet guesses swelling might be gone he calls for a taper. The dose is lowered to less than the anti-flammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too. Rule of thumb is: pain = swelling = more time on Pred needed. If there is no pain on the taper then it goes to completion. Then no meds at all are needed. Disc healing will continue for the remainder of the 8 weeks. Let us know you have made contact with the vet and have pred back to the original dose and know all your options about Tramadol. Pepcid AC is needed to be proactive in protecting the stomach while on Pred…. Frank does not need another problem (vomit, diareah then moving to bleeding ulcers) on top of his disc problem. We anxiously await hearing back from you on what the vet says. |
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Post by ladyfrank on Oct 14, 2013 7:30:24 GMT -7
I'm it took so long for an update on Frank, but our main focus has been getting him on the road to recovery. My husband took Frank to our vet on Friday and they prescribed 5 days of steroids and to continue the Tramadol. However, instead of 2 5 mg steroid tabs and one Tram in the morning they told us to give him 1 steroid and 1/2 a Tram with breakfast, 1 steroid and the other 1/2 Tram with dinner, then maybe another 1/2 Tram before bed - if he needs it. We will continue this regime for 5 days. Our vet asked that we call this morning with an update, at which time we will talk about when to begin to taper him off. I am VERY, VERY happy to say Frank is feeling like his old self again!! I never thought I would be so happy to hear him bark, but it has been music to my ears! He is of course still being crated and watched very carefully. This has been a wake up call for us, Frank is no longer allowed to jump from the furniture, we are cutting his food back to help him shed a couple of pounds and when he is up to it an exercise program with start. Thank you for all your help and advice!
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Oct 14, 2013 7:46:56 GMT -7
It would be very helpful if you could give us the exact dose in mgs and frequency of each medication now being given. It sounds like the steroid has been tapered, is that correct? If so, I'm very glad to hear that Frank is doing so well. If there are no signs of pain during a taper of the steroid, then the steroid is doing its job of getting the swelling down. Is he also taking Pepcid AC to protect him from side effects of the steroid?
Now is not the best time to cut back on Frank's food. It is important not to give him extra treats during crate rest, but you should continue with his regular diet. Frank's body has a lot of repair work to do right now so he needs his regular nutrition. Once crate rest has finished, then a diet can be implemented.
Please keep us updated as Frank continues with his eight weeks of crate rest. All the best to you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,598
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Post by PaulaM on Oct 14, 2013 10:18:22 GMT -7
Please correct this list of meds for us, if we have not understood what you wrote:
23 lbs
Prednisone 5mg 2x a day as of 10/11 extended for 5 days, taper to be discussed 10/14
Tramadol 25mg 2-3x a day
Do you have Pepcid AC on board to protect the GI tract from Pred?
Now is not the time to start a diet, Frank needs nutrients for all the repair jobs his body is performing. Cut out treats, and sub for small pieces of low cal apple, carrot or frozen green beans.
When the vet guesses swelling might be gone he calls for a taper. The dose is lowered to less than the anti-flammatory dose your job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. To have a clear picture on a taper, pain meds are also stopped or backed off too. Do discuss whether Frank will have his Tramadol backed off or stopped for the test taper.
We look forward to hearing how the phone call went with your vet.
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