Ls/cauda Equina And Depo Medrol

[DunesMom]

I'm new to board and have searched LS extensively. THANK YOU to all who have posted on this board in the past! My almost-14 y.o. boy has lumbosacral stenosis.

 

Background (you can skip to problems/questions if you want):

For 3 years it's progressed slowly, controlled by glucosamine/chondroitin/MSM/herbal supplements, fish oil and derramax, then metacam. Last six months it has progressed rapidly. Acupuncture helped a little but not much. Chiro didn't seem to help at all, though he liked going. Tramadol did not ever seem to make a difference at the dose prescribed previously (40mg 2x/day). Saw a neuro three weeks ago who said Dune's too old for surgery, so instead we went on prednisone oral 2x/day and 50mg tramadol 2x/day.

 

Some improvement on pred + tramadol but not much; tramadol at higher dose does seem to help though he's more unsteady and a bit dopey when I first give it. Breaking dose into 4x/day, 25mg each time, seems to keep him somewhat comfortable and still alert. Lots of panting on this regimen, which I understand is normal, though it worries me that it's pain and not normal steroid/tramadol panting, though he otherwise seems okay: eating, following me room to room although it's tough to get up and down.

 

 

The problem(s):

1. My boy is hard to pill. I and my vet are the only two who seem able to reliably put a pill down his throat. He is not food motivated and will refuse food that has had a pill snuck into it previously (for two years now he has refused to eat cottage cheese, hot dogs or lunch meat of any kind because a dogsitter tried to pill him that way). I have no choice but leave him in the care of his beloved dog-godparents for three weeks soon, and even though they can pill their own dogs, they've never been able to pill him. I need a non-pill way to give tramadol and steroids.

 

2. My neuro and vet both say the depo-medrol injections have no more effect than oral or other injectable steroids and it's not a magic pill. They are loathe to try it because it is a long-acting steroid and if he has a reaction, we can't undo it. They both said that the Depo-Medrol injection is "an old wives' tale" without any studies showing efficacy (beyond what you'd see with oral prednisone). They also say there are serious side effects and it's considered "quackery" now to use it in dogs. My regular vet is willing to try it for me if I insist, though. It's up to me on Monday afternoon. I am leaning toward trying it, mainly because of problem #1 -- this will reduce the number of pills the dogsitters must get in him.

 

My question:

Does anyone know of any validated research on both the efficacy of depo medrol for LS and the side effects?

Does anyone know of a way to give tramadol in a liquid form from a syringe, and is this easier for people than pilling?

Does anyone have other suggestions?

 

 

[Guest LynnM]

Yes, IMO, it does work, if the condition the dog has actually *is* LS/Cauda Equina. A lot of times, it becomes a generic term for any lower back condition and that's not the case. It is, as you probably already know, a specific condition. The injection is also given at a specific place in the lower back, rather than subcutaneously just about anywhere, as you would do when treating a dog for something like allergies.

 

I'm not sure why a depo shot would be considered "quackery". It's true, it is a drug that controls symptoms, rather than cures anything (be it allergies, LS, or what have you), but it is VERY GOOD at controlling symptoms and is useful when you cannot take away or cure the underlying cause (example: a flea-allergic dog in a kennel that, despite all efforts, will never truly be flea-free).

 

Lynn

Edited July 6, 2008 by LynnM

[Guest crazy4greys]

My boy Phoenix got Adequan injections for his LS instead of a depo shot. The Adequan injections along with chiropractic adjustments helped him a lot.

 

Have you tried peanutbutter with the pill inside?

[Burpdog]

At this point the goal is to make him comfortable. Do you have a certified chiropractor close?

 

None of my vets will do the shots in and around the spine, however, they would do a regular shot which would give him some comfort (although, not sure how long it would last). Have you ever done Adequan shots?

 

Is he eating well?

[DunesMom]

Yes, IMO, it does work, if the condition the dog has actually *is* LS/Cauda Equina. A lot of times, it becomes a generic term for any lower back condition and that's not the case. It is, as you probably already know, a specific condition. The injection is also given at a specific place in the lower back, rather than subcutaneously just about anywhere, as you would do when treating a dog for something like allergies.

 

I'm not sure why a depo shot would be considered "quackery". It's true, it is a drug that controls symptoms, rather than cures anything (be it allergies, LS, or what have you), but it is VERY GOOD at controlling symptoms and is useful when you cannot take away or cure the underlying cause (example: a flea-allergic dog in a kennel that, despite all efforts, will never truly be flea-free).

 

Lynn

 

I'm not sure why they called it "quackery" either, but your explanation makes sense. I just want to make him comfortable now; we have tried Adequan which worked for a while, but now even weekly shots haven't helped for the past four months.

 

Dune shows pain using the test from Dr. Stack's article, but according to the neuro, that still doesn't mean it's definitely LS, although all of his symptoms and the slow worsening over years seems to indicate that it is.

 

How fast will we see a difference?

[DunesMom]

At this point the goal is to make him comfortable. Do you have a certified chiropractor close?

 

None of my vets will do the shots in and around the spine, however, they would do a regular shot which would give him some comfort (although, not sure how long it would last). Have you ever done Adequan shots?

 

Is he eating well?

 

 

I think there is one certified animal chiropractor about 45 miles away; the one we tried before was a vet who became a chiro (don't know if that's a big difference or not). It didn't seem to help -- do you think a certified one would? If so, I'll make the drive. Dune travels well.

 

Adequan worked for a year and a half, with the shots increasingly close together as it lost efficacy. Now even weekly shots bring no relief.

 

He does still eat well, though he's lost a lot of muscle in the last six months and eats only soft foods now. He still begs for peanut-butter biscuits and we make fish or chicken and veggies for him every night when we cook for us, and he scarfs it up happily. But he won't touch regular kibble and even with top-quality canned food, eats about half a can at a shot, then comes back later for the rest. He's always been finicky and never overeaten even with free-choice kibble and can, so I don't consider this unusual for him.

[Hubcitypam]

The shots made my Rex a new man. He went from not being able to get off the couch to bounding up the stairs. His lasted longer than most -- about 6 months. Never had a side effect. Kennelmom will give you a similar testmonial. The shots do not go in the spine, despite common misconception. They go on either side and there is no danger of hitting the spine. Chiro did not help Rex at all. My vet suggested accupuncture instead and I should have listened.

 

As far as how long to see results, I'm not sure. Dr. Herron did Rex's first one when he did his corn surgery so I couldn't tell exactly when it worked, only that by the time his feet were well he was a new man. After that I could see the shots wearing off and took him before it got too bad. I -- a couple of days maybe?

[DunesMom]

My boy Phoenix got Adequan injections for his LS instead of a depo shot. The Adequan injections along with chiropractic adjustments helped him a lot.

 

Have you tried peanutbutter with the pill inside?

 

 

Oh, I wish peanut butter would work! I'm afraid to try it, because he won't swallow anything unless he chews it (I know, he's odd, even for a greyhound). He's never been food motivated, not even for liver treats or cookies.

 

When you place something in his mouth, he will lick and taste and spit it out to lick rather than swallowing. When he hits the pill, voluminous salivation and spitting ensues until he gets it out, no matter how sticky. Some of it must go in him as it dissolves, but not the whole amount.

 

I think it might work for poking it into his throat, but he fights so hard (even biting the vet tech) that I'm afraid it won't help our dogsitters.

 

If I could skip this trip I would, but it's not an option. I've cancelled everything I could for the last four months including a vacation, just to give him his medicine and try to make him comfortable until it's time. It's so hard when he's mentally fine but the pain is becoming an issue because we can't control it.

 

[Guest caiteag]

I don't have scientific studies for you.. what I can tell you is that depo-medrol injections gave my Quinnie two years of relief before they finally stopped working and we sent him with love to the bridge. He didn't have any side effects, but we knew there was the risk of some.. we were simply lucky that it didn't really happen to him. Every dog is different and what works for one hound might not work for another... however, your vet telling you that it is an old wives tale is completely irresponsible.

[Batmom]

Whereabouts are you located? Perhaps someone on the board knows a vet in your area who is familiar with the injections and has given them before?

[Guest Spiff]

The first depo-medrol shot that we gave Spiff made a remarkable difference. The improvement was obvious within a couple of days. He was able to walk without shuffling or tripping for several months. The second shot didn't work quite as well, but did help a little bit. One reason why we haven't tried it more than the twice is that our vet is VERY careful about giving the shots in exactly the right place, and so he likes to have Spiff sedated for it!

 

The trick with doing depo-medrol shots is that you would have to stop giving the regular pain meds about a week before the depo-medrol shots so that there are no bad interactions between the drugs.

 

Anyway, Spiff is back to taking Rimadyl, glucosamine/chondroitin, and Traumeel tablets. Thank goodness we discovered some vitamin paste that he LOVES, otherwise, I think we'd have trouble pilling him too. He also could pick out the pills from cheese, liverwurst, hotdogs, peanut butter, etc. Now we've been using this paste for YEARS and he hasn't gotten tired of it. Meanwhile, the pills can just have a faint hint of the paste and he STILL will swallow the pill! I don't know if you can get something like this in the US?

[Hubcitypam]

The trick with doing depo-medrol shots is that you would have to stop giving the regular pain meds about a week before the depo-medrol shots so that there are no bad interactions between the drugs.

Do you mean other steroids? Rex came home after his first Depro shot wearing a fentanyl patch from his surgery.

 

Edited July 6, 2008 by Hubcitypam

[greyhndz]

As far as pilling, have you tried having his meds compounded? There are many veterinary compounding pharmacies around the country, and they will compound almost any med into a liquid, or a transdermal gel, or a chewable treat that can be easily administered.

 

They can flavor the liquids almost anything imaginable. I used a pharmacy I found online called Center Pet Pharmacy in Washington DC (I live in NH). They'll take the prescription order by phone or fax, and work with you to compound the meds into a formulation that will work. (The transdermal gel, which you apply to the skin on his ear, might work well for Dune.)

 

There might be a compounding pharmacy near you, or you can google veterinary pharmacies to find other accredited pharmacies in the area. I used compounding for my iggie's methylprednisolone and enalapril. You can either shoot it into his mouth, or put it on his food, and he won't taste anything bitter.

 

ETA: Have any imaging studies been done? I ask because that degree of pain and debilitation makes me wonder about tumor, having gone this route with my 12 yo Mini who developed wasting of her R hind leg, and was diagnosed with spinal osteo.

Edited July 6, 2008 by houndznigz

[DunesMom]

As far as pilling, have you tried having his meds compounded? There are many veterinary compounding pharmacies around the country, and they will compound almost any med into a liquid, or a transdermal gel, or a chewable treat that can be easily administered.

 

They can flavor the liquids almost anything imaginable. I used a pharmacy I found online called Center Pet Pharmacy in Washington DC (I live in NH). They'll take the prescription order by phone or fax, and work with you to compound the meds into a formulation that will work. (The transdermal gel, which you apply to the skin on his ear, might work well for Dune.)

 

There might be a compounding pharmacy near you, or you can google veterinary pharmacies to find other accredited pharmacies in the area. I used compounding for my iggie's methylprednisolone and enalapril. You can either shoot it into his mouth, or put it on his food, and he won't taste anything bitter.

 

ETA: Have any imaging studies been done? I ask because that degree of pain and debilitation makes me wonder about tumor, having gone this route with my 12 yo Mini who developed wasting of her R hind leg, and was diagnosed with spinal osteo.

 

 

GREAT idea on the compounding -- that hadn't even occurred to me. I will investigate this immediately.

 

We didn't do the MRI b/c of cost and that it wouldn't change our treatment, in the neurosurgeon's opinion. We have had numerous x-rays, and they show nothing but maybe a slight narrowing of the lumbosacral joint where you'd expect the stenosis to be. No other abnormalities.

 

The first depo-medrol shot that we gave Spiff made a remarkable difference. The improvement was obvious within a couple of days. He was able to walk without shuffling or tripping for several months. The second shot didn't work quite as well, but did help a little bit. One reason why we haven't tried it more than the twice is that our vet is VERY careful about giving the shots in exactly the right place, and so he likes to have Spiff sedated for it!

 

The trick with doing depo-medrol shots is that you would have to stop giving the regular pain meds about a week before the depo-medrol shots so that there are no bad interactions between the drugs.

 

Anyway, Spiff is back to taking Rimadyl, glucosamine/chondroitin, and Traumeel tablets. Thank goodness we discovered some vitamin paste that he LOVES, otherwise, I think we'd have trouble pilling him too. He also could pick out the pills from cheese, liverwurst, hotdogs, peanut butter, etc. Now we've been using this paste for YEARS and he hasn't gotten tired of it. Meanwhile, the pills can just have a faint hint of the paste and he STILL will swallow the pill! I don't know if you can get something like this in the US?

 

I wonder what the paste is that makes it so delicious? I'll look for something similar. Dune has exactly one thing that is guaranteed to be eaten immediately, and it's a chicken-flavor "Ripples" soft dental chew. I have no idea why -- he'll turn up his nose at real chicken and peanut butter and steak some days, but the Ripples he begs for nonstop. Wonder if I could turn it into paste....

[Batmom]

The other thing you can try, if you're willing to work on it every day, is making the "down your throat" pilling a more rewarding experience so he doesn't fight so (and an easier experience for the people). Put a blob of peanutbutter or cream cheese on one finger, open his mouth, "Good boy!" let him go and let him have the peanutbutter. Repeat repeat repeat. Do that for 2-3 days. Next day, do the same but stick your hand in his mouth before letting him have the pb. Do that for 2-3 days. Next day, stick your hand far enough back that you could dump a pill down his throat if you had one. Etc.

 

When you get around to real pilling, always have the extra fingerful of peanutbutter or cheese or braunschweiger for them to lick -- keeps them swallowing and working at something rather than spitting the pill out, AND serves as a reward. When Joseph hears the peanutbutter jar being opened, he comes running fast enough that I start to think, heck, the boy could've had a better career if only the lure had sounded different!

 

Best luck.

[DunesMom]

The other thing you can try, if you're willing to work on it every day, is making the "down your throat" pilling a more rewarding experience so he doesn't fight so (and an easier experience for the people).

 

 

Good idea. I'd been giving him a treat immediately after each pill, and he now looks for the special reward after the pilling, but he still runs from me when he suspects a pill is in the offing and fights the actual process. I didn't think about using the peanut butter/treat BEFORE the pill. Smart!

[Batmom]

I actually don't give it to them till after I shove the pill down the hatch, but I've got it ready. They know they're going to get it and can put up with momentary annoyance for that reward.

 

None of mine are dreadful fighters tho.

[greyhndz]

GREAT idea on the compounding -- that hadn't even occurred to me. I will investigate this immediately.

 

The guy who owns Center Vet Pharmacy was really great about getting right on Lexi's prescriptions, as I'd told him her story and the urgency of getting the meds. He's kind of an odd bird ( ) who apparently invented the whole flavoring system and admits to tasting the flavoring before using it. But he had the compounding done immediately and the meds arrived in 2 days.

 

We didn't do the MRI b/c of cost and that it wouldn't change our treatment, in the neurosurgeon's opinion. We have had numerous x-rays, and they show nothing but maybe a slight narrowing of the lumbosacral joint where you'd expect the stenosis to be. No other abnormalities.

 

Ah, I'm relieved to hear that. I feel the same way about the MRI, or myelography, or anything else invasive; if you're not planning to proceed with surgery, there's no reason to do any of those studies.

 

The other thing suggested to me about disguising pills in yummy treats: never put medication in their supper, or they'll start avoiding eating their meals. Also, if you hide the pills in a treat, give him a couple of treats without the pills both before and after the "spiked" one, and he'll be less likely to avoid taking the treats in the future. Will Duke eat a little canned food? When I got the compounded meds, I'd squirt them into a large tbs of canned food, cover it up with a little more canned food (something stinky - strained baby meats also works), and Lexi would chow right down.

 

Desperate times call for desperate measures!!

[Guest KennelMom]

Our boy went from a growling, snapping, miserable boy who barely wanted to get up to a dog who was running in the yard the yard. It did eventually lose efficacy, but I treasure the extra year+ of happy, pain free life it gave him.

[Guest Spiff]

Do you mean other steroids? Rex came home after his first Depro shot wearing a fentanyl patch from his surgery.

 

We were giving Spiff Rimadyl for a while before his second depo-medrol shot, and the vet wanted that out of his system before the depo-medrol steroids went in. I don't know if this is typical? Our vet is VERY careful about everything he does. We did start the Rimadyl back up about 6 weeks after the depo-medrol shot though.

[packmom]

DM shots did not help old Jake. He did not get any relief from accupuncture either.

[sweetdogs]

Your boy is 14 & in discomfort. You have tried numerous things. My understanding is that the shot either works or it doesn't. If it works, yeah! If it doesn't, you can continue to try other things to help manage his pain. While I wouldn't be comfortable twisting a vet's arm to give a shot they don't want to, I think I would want to give it a try. (Just wondering if your vets think chiropractic & acupuncture is quackery too.) This is a quality of life issue & I know I'd try everything to give my dog freedom from pain.

 

Maybe you could contact Dr. Stack & she could help alieviate your vet's concerns?

 

I know it's not at all funny, but these pups can be so stubborn! He must be a champion pill-spitter-outter!

[DunesMom]

Maybe you could contact Dr. Stack & she could help alieviate your vet's concerns?

 

I know it's not at all funny, but these pups can be so stubborn! He must be a champion pill-spitter-outter!

 

 

My vet is going to do the shots for me this afternoon! She's still concerned about side effects, but she understands that we're to the quality-of-life decision, so she's bending. Let's hope Dune is one of the lucky ones and gets some relief. She said we can continue the tramadol with the shots, if we can get them down. I'm calling the compounding pharmacy next.

 

He is a champion pill spitter-outer, and despite his greyhound sweetness, if you're not fast, he'll clamp down on your hand to keep the pill out. Last night he somehow managed to get a pill up that I'd poked down a full finger's length, and it came up with enough saliva to fill a juice glass.

 

DH stood nearby in horror: "That's just disgusting." No Mastiff could have out-drooled him last night!

 

Dune happily went to his bowl to see what treat followed the pill.

[sweetdogs]

Dune happily went to his bowl to see what treat followed the pill.

Atta boy!

 

I certainly hope the shot helps him - best of luck!