Soul Is Limping

[Guest SoulsMom]

Well, we're back. Soul, as usual, charmed all the girls at the front desk

The vet tested for Lyme, Ehrlich, Anaplas, and heartworm. All negative. He put Soul on Rimydel (sp? on the bottle it's called Carprofen) for five days and Tramadol for three. Any experience with these meds? Ok, not ok? My vet is somewhat grey savvy, but I wanted to run it by the experts

 

He did say, and I noticed as well when he was examining Soul's leg, that Soul is in a lot more pain than he is letting on. He's being very stoic. They trimmed his nails, and he cried out when they tried to do that leg

 

So, Doc said if he's better in a day or two on these meds, then we'll treat it as a sprain and limit activity for two weeks. If he doesn't seem better he wants to do Xrays by Wednesday

He also told me that they just had a grey diagnosed with Osteo, and that in his experience the onset isn't as sudden as Soul's . . . . .

 

So that's where we are. I was seriously hoping for a firmer diagnosis. But, I need my expert peeps to let me know their opinions of these meds before I give him his first dose. Ok? Not Ok? One Ok and the other not?

 

Thanks in advance (Soul thanks you too )

 

Edited to add: and any good Mojo you can spare would be wonderful, too

Edited October 13, 2007 by SoulsMom

[Guest JenFallon]

Well, nothing wrong with the wait and see approach for a few days other than it stresses the owner out !

 

Both meds are fine. Tramadol is great for pain. Rhymidal works well but is usually not recommended long term as it's tough on the liver. Nothing wrong with using it for pain when things like this happen though. Some greys do fine on it long term but you need to watch the liver.

 

Hopefully he'll bounce back to his, well, bouncy self

[RobinM]

Truthfully, my vet (who owns greys and does all the medical on 2 local groups) prefers Deramaxx over Rimadyl. It causes less problems. BUT THAT'S LONG TERM. IF it comes to be that Soul needs to be on it for any extended amount of time, you can switch, no problem.

Give him the Rimadyl. He'll be fine.

 

Tramadol is for pain only (the other is anti inflamatory). It is a very benign pain killer, no worries.

 

GET BETTER SOUL.

[Guest BooMooandDoo]

I didn't think Rimidyl and Tramadol could be used together or even within days of one another. . . . you might want to do a GT search. It's been discussed several times. . .. I think

[RobinM]

I didn't think Rimidyl and Tramadol could be used together or even within days of one another. . . . you might want to do a GT search. It's been discussed several times. . .. I think

 

 

I don't think they can be used together either but days apart might be OK, check first.

 

BUT DERAMAXX and Tramadol CAN be used at the same time.

Edited October 13, 2007 by RobinM

[Batmom]

Rimadyl is just about the same thing as Deramaxx. Either can be used with Tramadol.

[Burpdog]

Assuming blood work was done before he dispensed the rimadyl? Did you get a product insert to tell you what to look for if he cannot tolerate the drug?

 

I am one of the few that does not like to use pain meds without knowing why. I would xray.

 

Yes, you can use a NSAID and tramadol. You cannot use pred and an NSAID. You can use tramadol & pred.

[Guest SoulsMom]

Assuming blood work was done before he dispensed the rimadyl? Did you get a product insert to tell you what to look for if he cannot tolerate the drug?

 

I am one of the few that does not like to use pain meds without knowing why. I would xray.

 

Yes, you can use a NSAID and tramadol. You cannot use pred and an NSAID. You can use tramadol & pred.

 

Well, not an insert, but we discussed it . . . . .and yes, the bloodwork was done prior. He originally thought it was a TBD, and seemed a bit more somber when it came back negative

 

 

 

 

[patricia]

Sending more prayers for just a sprain. Hug Soul for me.

[greyhndz]

Well, not an insert, but we discussed it . . . . .and yes, the bloodwork was done prior. He originally thought it was a TBD, and seemed a bit more somber when it came back negative

 

 

Amber, the tricky thing about tick borne diseases (esp. Lyme, given that it's endemic in our area) is that there can be false negatives when tested very early on in acute infection. The link below will take you to detailed info about the time parameter for tick bite, infection, mounting antibodies, etc. It can take 3 weeks for a dog to produce the antibodies that result in a positive SNAP test.

 

Most vets practicing in endemic areas will start treatment on a symptomatic dog immediately, whether the SNAP is positive or not. (symptomatic, meaning lameness, joint swelling, fever, lethargy, etc.) Usually, a dog with TBD will clinically improve 48 or so hours after being started on antibiotics. Nothing at all to lose by starting Soul on Doxycycline, amoxicillin or cefuroxime, but possibly everything to gain!

 

The dose for Doxy is 10mg/kg (or 5 mg/lb) given twice daily for a minimum of 3 weeks.

 

idexx snap 4

Consensus Opinion from ACVIM

 

Sorry for the medicalese. Let me know if you need me to translate.

Jordan up in NH

(Lyme's northern 'burbs)

[Guest SoulsMom]

Well, not an insert, but we discussed it . . . . .and yes, the bloodwork was done prior. He originally thought it was a TBD, and seemed a bit more somber when it came back negative

 

 

Amber, the tricky thing about tick borne diseases (esp. Lyme, given that it's endemic in our area) is that there can be false negatives when tested very early on in acute infection. The link below will take you to detailed info about the time parameter for tick bite, infection, mounting antibodies, etc. It can take 3 weeks for a dog to produce the antibodies that result in a positive SNAP test.

 

Most vets practicing in endemic areas will start treatment on a symptomatic dog immediately, whether the SNAP is positive or not. (symptomatic, meaning lameness, joint swelling, fever, lethargy, etc.) Usually, a dog with TBD will clinically improve 48 or so hours after being started on antibiotics. Nothing at all to lose by starting Soul on Doxycycline, amoxicillin or cefuroxime, but possibly everything to gain!

 

The dose for Doxy is 10mg/kg (or 5 mg/lb) given twice daily for a minimum of 3 weeks.

 

<a href="http://www.idexx.com/animalhealth/laboratory/c6/c6whitepaper.pdf" target="_blank">idexx snap 4

</a>Consensus Opinion from ACVIM

 

Sorry for the medicalese. Let me know if you need me to translate.

Jordan up in NH

(Lyme's northern 'burbs)

 

Wow, something to think about. Soul has been on antibiotics twice since May for a skin staph infection. Would this clear up a prior TBD? I've never found a tick on him (before or after) he's been on the meds for the staph, and his last round of antibiotics was stronger than the first round

 

[Guest SoulsMom]

Sending more prayers for just a sprain. Hug Soul for me.

 

Thank you. I'm hugging him a lot tonight.

 

[Batmom]

Usually, when a dog presents with an acute limp, the first thing that comes to mind is not TBD. Treating for a tick disease on the basis of an acute limp with no other symptoms or confirming bloodwork would be poor practice. There are lots of things that cause limping -- muscle strains, tendonitis, bursitis, bone problems, corns, sprung toes, etc. -- and most of them are not TBD.

 

[greyhndz]

Wow, something to think about. Soul has been on antibiotics twice since May for a skin staph infection. Would this clear up a prior TBD? I've never found a tick on him (before or after) he's been on the meds for the staph, and his last round of antibiotics was stronger than the first round

 

Depends on the antibiotics he was on and how long he was on them. It's also possible that he was just bitten very recently, which would account for an acute infection. There are a lot of deer ticks around this time of year, and the nymphs can be almost impossible to find, even on our short-haired hounds.

 

I've seen several (human) patients in the past couple of weeks who appear to have Lyme - it can be a bit easier to diagnose in humans because the majority of us will develop the classic erythema migrans rash. If I see a patient with this rash, they automatically get treated for Lyme, and we don't even bother drawing labwork because we know the test for the antibody will be negative so early in the course of the disease. With the pups, their classic presentation is often lameness and acting "sick". Starting them on antibiotics immediately also helps to nail the diagnosis: if they're better in 48 hrs, it's probably TBD; if not, look elsewhere for the problem.

 

I always keep doxycycline in the house - if I lived a bit closer, I'd get some to you tomorrow! (or, heck, if you feeling like heading north, I can certainly meet you)

 

BTW - I've used Rimadyl and Tramadol successfully in many of my hounds. OTOH, my sweet osteo girl Arielle took one dose of Deramaxx and bled out within 24 hrs (massive GI bleed). Never again. You can also give Soul a little Pepcid or tagamet with the Rimadyl and it will be less likely to bother his stomach.

 

Keeping healthy thoughts for Soul!

Jordan

[Batmom]

With the pups, their classic presentation is often lameness and acting "sick". Starting them on antibiotics immediately also helps to nail the diagnosis: if they're better in 48 hrs, it's probably TBD; if not, look elsewhere for the problem.

 

If it just started, I think first you would want to see if the anti-inflammatories help him, and if the problem recurs (or if anything funky shows up in his bloodwork). Doxycycline *is* a broad-spectrum antibiotic, and you'll get a favorable response to many types of infections from it.

Edited October 14, 2007 by Batmom

[Guest FrostyBottoms]

I hope Soul is walking better tomorrow and that it was just a muscle strain!

[Guest SoulsMom]

Usually, when a dog presents with an acute limp, the first thing that comes to mind is not TBD. Treating for a tick disease on the basis of an acute limp with no other symptoms or confirming bloodwork would be poor practice. There are lots of things that cause limping -- muscle strains, tendonitis, bursitis, bone problems, corns, sprung toes, etc. -- and most of them are not TBD.

 

After the physical exam, when we could both see how much pain he was REALLY in, he did the the blood test to check, then perscribed the anti inflammatory and pain meds. I'm actually glad he did it to rule it out . . . . . .Poor Soul. He's such a sweet, happy boy, and I had no idea he was in so much pain until I could see it in his eyes and feel it in the way he was leaning against me during the physical.

 

I've seen several (human) patients in the past couple of weeks who appear to have Lyme - it can be a bit easier to diagnose in humans because the majority of us will develop the classic erythema migrans rash.

 

Yep, I got it myself when I lived in CT two years ago. But Soul has been vaccinated against Lyme (not by this vet, by the kennel)

 

I hope Soul is walking better tomorrow and that it was just a muscle strain!

Thank you. Me too. He's pretty wiped right now. Charming all the ladies at the vets office can wear a guy out

[greyhndz]

Usually, when a dog presents with an acute limp, the first thing that comes to mind is not TBD. Treating for a tick disease on the basis of an acute limp with no other symptoms or confirming bloodwork would be poor practice. There are lots of things that cause limping -- muscle strains, tendonitis, bursitis, bone problems, corns, sprung toes, etc. -- and most of them are not TBD.

 

 

I hear what you're saying Batmom - and an acute limp by itself is a different story. But an acute limp associated with lethargy (I thought I recalled Amber saying that Soul has been acting poopy) or depressed behavior, fever, a swollen joint, off their feed, when you live in an area endemic for Lyme, is a different kettle of fish. The prevelance of Lyme in NH alone has risen ~125% between 2005-2006. It's been estimated based upon surveillance that anywhere from 50-70% of black legged (deer) ticks in areas of NH test positive for borrelia. The Mass. numbers are even more impressive.

 

I believe the threshhold for treating empirically for TBDs is far lower here than it is away from the northeast and mid-atlantic seaboard. I can't seem to access any veterinary epidemiologic data, but anectdotally, several of the local vets have reported approx. 20% of their canine patients testing positive for Lyme on SNAP-3 or -4. That's not just dogs who are symptomatic - that also includes routine annual screening.

 

Scary.

[zimsmom]

I don't mean to worry you but I would insist on xrays.

[Guest KennelMom]

I hope it's nothing serious and he's feeling better soon...With a limp that came from "out of nowhere" I'd probably have wanted an x-ray on the first visit. We've had no problems giving tramadol and rimadyl together...if no improvement in a couple days, definitely get that x-ray.

[Guest SoulsMom]

I don't mean to worry you but I would insist on xrays.

 

That does worry me What is involved in Xrays? He'll need to be under? Unfortunately, I'm in my new job and I don't know if I can take any time off to do it before next Saturday. As it is, I had to miss the Sales Meeting yesterday. I hope I won't have to worry about it and that he'll be better soon. I haven't even celebrated his first Gotcha Day

 

But an acute limp associated with lethargy (I thought I recalled Amber saying that Soul has been acting poopy) or depressed behavior, fever, a swollen joint, off their feed

 

No fever, great appetite, no swelling. He was acting mopey Friday night, and some on Sat, but quickly perked up when he knew we were going for a RIDE, and was so happy to see the peeps at the vet.

 

Here's my Monkey Man, snoozing in his PJ's

Edited October 14, 2007 by SoulsMom

[Guest Honeysmom]

Awww ...Soul...feel better fast

[RobinM]

Souls mom, IF he si mellow and quiet they will be able to get x-rays of the leg without anethesia as we did with Polli.

 

When that comes back clear, you can sit and wait for another week. IF at that time there is no improvement, you should then bring him in for a series of pictures of his shoulder, neck etc that he would need to be under general for.

They are not out for long for this and bounce back relatively quickly.

 

We are going through the limp thing with you right now.

 

Get the x-rays done to start ruling things out. Knowing what you are dealing with makes it a bit easier.

Although, we STILL don't know why Polli is limping so we are treating it as soft tissue injury.

 

Chloe had a limp for 3 weeks and she is only just 3. She is fine now. Polli is a lot older so I will give it more time before the next step.

Edited October 14, 2007 by RobinM

[Batmom]

I've never had a dog sedated for x-rays. 'Course, Batman was calm and Zema is small (and easy to subdue ) , but at least at our vet, sedation is the exception rather than the rule.

 

Really depends on the symptoms, onset, etc. as to whether it's best to do x-rays first. Most things that cause pain and limping are NOT broken bones, osteo, etc. .... so in the absence of swelling, known injury (e.g., hit by car), extreme pain, etc. .... IMHO it is reasonable to give anti-inflammatory meds and a couple days rest first.

[Guest FrostyBottoms]

I don't mean to worry you but I would insist on xrays.

 

That does worry me What is involved in Xrays? He'll need to be under? Unfortunately, I'm in my new job and I don't know if I can take any time off to do it before next Saturday. As it is, I had to miss the Sales Meeting yesterday. I hope I won't have to worry about it and that he'll be better soon. I haven't even celebrated his first Gotcha Day

 

But an acute limp associated with lethargy (I thought I recalled Amber saying that Soul has been acting poopy) or depressed behavior, fever, a swollen joint, off their feed

 

No fever, great appetite, no swelling. He was acting mopey Friday night, and some on Sat, but quickly perked up when he knew we were going for a RIDE, and was so happy to see the peeps at the vet.

 

Here's my Monkey Man, snoozing in his PJ's

 

Oh Soul....how sweet are you with your head on a pillow!