Osteo Thread V

[Batmom]

{{{{{{{{{{Nube & momma}}}}}}}}}}

[Guest cashie]

Poor Nube:( Hope he feels better. Cash started his Gabapentin today, no diarrhea but seems a little spacey. Maybe he is just a little out of it still from yesterdays vet visit. He definitely perked up when I made him his chicken dinner!

 

Just read about the Tramadol-I'm paying way too much! Definitely having my vet write a script from now on!!

Thanks:)

They can get wonky on the gabapentin until the body adjusts. Are you starting with 100mg capsules?

Yes, 100 mg twice a day for now. 75mg of Rimadyl twice a day, and the Tramadol, 1-2 every 8-12 hours depending on how he seems to feel.

[RaineysMom]

Poor Nube:( Hope he feels better. Cash started his Gabapentin today, no diarrhea but seems a little spacey. Maybe he is just a little out of it still from yesterdays vet visit. He definitely perked up when I made him his chicken dinner!

 

Just read about the Tramadol-I'm paying way too much! Definitely having my vet write a script from now on!!

Thanks:)

They can get wonky on the gabapentin until the body adjusts. Are you starting with 100mg capsules?

Yes, 100 mg twice a day for now. 75mg of Rimadyl twice a day, and the Tramadol, 1-2 every 8-12 hours depending on how he seems to feel.

 

Hope your Cashie is doing ok too!

 

weird (well, more like annoying) how vets can differ so. Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

[JJNg]

weird (well, more like annoying) how vets can differ so. Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

 

I suspect your vet is either being very conservative, or is not very experienced with pain management and is unfamiliar with these drugs. If it's the former, I disagree completely - there is no reason to be conservative about pain management with osteosarcoma. If it's the latter, I would suggest having a discussion with your vet, and if they are not willing to do more research or consult with experts about more appropriate and effective use of these drugs, then get a second opinion from another vet or specialist.

 

Hate to be blunt, but I'm very concerned about the amount of pain you describe Nube to be having. There's no need to even decrease tramadol when you start gabapentin. The only concern is sedation, which is why some choose to start gabapentin at a low dose, and why I suspect your vet suggested stopping tramadol. But when a dog is in serious pain, I don't mind if they're a bit sedated, and after a few days to a week, those sedative side effects will wear off as their system adjusts to the meds.

[Guest cashie]

I agree with JJNg, I would rather have Cash a little groggy than in pain. I'll admit, I was really concerned when earlier he just laid there with a dazed look in his eyes and considered skipping his second dose. But he bounced right up when he smelled his chicken cooking and continued to stare at me with his ears perked up so I knew he was OK. It also helps to have others confirm that its normal (thanks tbhounds! )

How much does Nube weigh? Maybe that was a factor? Cash is a big guy-he weighed 85 pounds until he lost a little weight with all this Osteo nonsense. Anyway, I hope you find a good combination for him and have a better night.

Hang in there!

[RaineysMom]

weird (well, more like annoying) how vets can differ so. Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

 

I suspect your vet is either being very conservative, or is not very experienced with pain management and is unfamiliar with these drugs. If it's the former, I disagree completely - there is no reason to be conservative about pain management with osteosarcoma. If it's the latter, I would suggest having a discussion with your vet, and if they are not willing to do more research or consult with experts about more appropriate and effective use of these drugs, then get a second opinion from another vet or specialist.

 

Hate to be blunt, but I'm very concerned about the amount of pain you describe Nube to be having. There's no need to even decrease tramadol when you start gabapentin. The only concern is sedation, which is why some choose to start gabapentin at a low dose, and why I suspect your vet suggested stopping tramadol. But when a dog is in serious pain, I don't mind if they're a bit sedated, and after a few days to a week, those sedative side effects will wear off as their system adjusts to the meds.

 

 

yeah, that's what I'm worried about but I'm not 100% comfortable with self-medicating my dogs against what my vet recommends. PLEASE don't get me wrong, I do NOT want him to be in pain -- any pain -- but if I do something that makes it worse somehow (like the diarrhea!!! ) I'd never forgive myself. Since so many of you (and other breeds, where I've researched) do both, and they're fine, I'm more confident to add more.

 

I agree with JJNg, I would rather have Cash a little groggy than in pain. I'll admit, I was really concerned when earlier he just laid there with a dazed look in his eyes and considered skipping his second dose. But he bounced right up when he smelled his chicken cooking and continued to stare at me with his ears perked up so I knew he was OK. It also helps to have others confirm that its normal (thanks tbhounds! )

How much does Nube weigh? Maybe that was a factor? Cash is a big guy-he weighed 85 pounds until he lost a little weight with all this Osteo nonsense. Anyway, I hope you find a good combination for him and have a better night.

Hang in there!

 

thankfully, his appetite is super (he's a total food hound!). he is about 81 lbs, so a big boy.

[KF_in_Georgia]

Gabapentin still is unfamiliar to many vets. If I remember correctly, it started as a people-med to help control epilepsy. Then doctors realized that cancer patients who took gabapentin for epilepsy were in less pain from their cancer.

 

My vet was unfamiliar with Gabapentin. I told him what the people here on Greytalk were giving their dogs. He left the room, looked up dosages and side effects and interactions, and came back and wrote me a prescription for exactly what the people on here said their dogs were taking. He said Sam could have as much as 600mg a day; we conceivably could go to 900mg, but he wanted me to let him know if I thought that was necessary. Currently, Sam usually gets 400mg unless he's having a bad day (when I might give Sam 200mg extra). My vet is impressed by how Sam's doing.

[KF_in_Georgia]

Kim, is Nubie used to having vegetables in the quantities he's getting now? I have to be careful with my guys and raw veggies. And sometimes the problem doesn't start for a few days after they've eaten whatever it was.

 

Also, you might want to try Pepcid (or its generic) about 30 minutes before mealtime and pill time. (The generic is famotidine.) My vet said 10mg, but said I could go up if I needed to when Sam had a lot of trouble with meloxicam (an NSAID). We eventually cut out the meloxicam (too much gastric upset) and were able to cut back on the Pepcid.

[45MPHK9]

Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

 

Kim, Bee took 300mg of Gapapentin three times a day in addition to Deramaxx and Tramadol.

[vjgrey]

Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

 

Kim, Bee took 300mg of Gapapentin three times a day in addition to Deramaxx and Tramadol.

 

Gabe did, too.

[NeylasMom]

weird (well, more like annoying) how vets can differ so. Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

 

I suspect your vet is either being very conservative, or is not very experienced with pain management and is unfamiliar with these drugs. If it's the former, I disagree completely - there is no reason to be conservative about pain management with osteosarcoma. If it's the latter, I would suggest having a discussion with your vet, and if they are not willing to do more research or consult with experts about more appropriate and effective use of these drugs, then get a second opinion from another vet or specialist.

 

Hate to be blunt, but I'm very concerned about the amount of pain you describe Nube to be having. There's no need to even decrease tramadol when you start gabapentin. The only concern is sedation, which is why some choose to start gabapentin at a low dose, and why I suspect your vet suggested stopping tramadol. But when a dog is in serious pain, I don't mind if they're a bit sedated, and after a few days to a week, those sedative side effects will wear off as their system adjusts to the meds.

 

I feel like I say this all of the time, feel like I just said it yesterday (maybe I did? ) most "regular" vets don't seem to be well versed in working with owners who are dealing with pain with a terminal disease. They don't give owners advance notice on how to safely increase pain meds (in what increments and how often), nor do they prescribe enough so that owners have the supply they need when it comes time to. Unfortunately, added pain can often show up on the wkd when vets are not available so with a disease like this, you really do need to be prepared. This isn't a comment about anyone, just a general rant I like to go on.

 

What I have realized may be helpful is putting the max dosages per lb or kg of body weight for the various "usual" meds in the first post. I always post and post what Neyla was on, along with her weight, but having that info so each person can calculate for their own dog might be helpful. Maybe JJng and I can work with the OP for this particular thread to get that done.

 

In the meantime, to those of you struggling with this, Neyla (@60 lbs) was on:

 

300 mg Gabapentin 3x/day (she was allowed to go up to 500 mg 3x/day but at 400 she got woozy so we backed down)

125 mg Tramadol 3x/day (I believe we could have increased a tiny bit, but not much)

50 mg Deramaxx split 2x/day (we were at the max chronic dosage daily although safety info indicated the higher post-surgery doses (about 2x that) were okay short term (and frankly, for most dogs they probably would be long term, but I would go there last

 

I personally think it's better to overmedicate slightly to get ahead of the pain, then back down slowly to a maintenance level if possible, but if the dog were in minimal pain to start and gradually having more, I would start with Tramadol, 50 mg 1-2/day, Gabapentin 100 mg 2-3x/day and the lowest dose of NSAID possible. As pain increased, I would first add an additional dose of Tramadol (so a 2nd or 3rd) and/or Gabapentin (so a 3rd) and if that wasn't sufficient, then I would increase the amounts of either/both. If I had increased both to at least ~2/3 of the max dose and felt like it still wasn't sufficient, I would look at the NSAID.

 

This is me, on wine, rambling a bit, so I reserve the right to edit myself later.

Edited July 16, 2012 by NeylasMom

[KF_in_Georgia]

I posted earlier about Sam's dosage, but here's what he takes:

 

Tramadol: one 50mg, 2 or 3 times a day (so 150mg/24 hours; vet prescribed a max of 300mg/24 hours)

Gabapentin: two 100mg, 2 or 3 times a day (so 600mg/24 hours; vet authorized a max of 900mg/24 hours)

Methocarbamol: one 500mg, 2 or 3 times day (so 1500mg/24 hours)

No NSAIDS, an occasional pepcid. Also, thyroxine (.8mg twice a day), and metronidazole (half of a 500mg pill, every other day; he contracts diarrhea out of thin air).

 

Sam was diagnosed with lung cancer based on some nasty-looking spots on x-rays. But that was November and he's still here--still sporadically coughing (despite various antihistamines or antibiotics back in the fall) and often short of breath--so the diagnosis probably was wrong, but something's going on there. But because he has back pain (and fought the x-ray even in November), we're not going to repeat the x-rays. He coughs--and that's it. He also has spinal arthritis, a slightly herniated disk at L5, and very wobbly back legs. He's 12 years old. He's a small boy: 65 pounds.

 

Uncontrolled arthritis pain makes him tense his muscles, and it hurts him to stand or lie down (hurts him to the point of making him scream). The tramadol and gabapentin are managing his pain, and the methocarbamol is a muscle relaxer.

Edited July 16, 2012 by KF_in_Georgia

[Guest GenetJen]

Wanted to say Hi. Just started delving into this thread tonight and am nearly cross-eyed reading all the information. My 11 year old grey, Maya, was diagnosed last Monday and we've decided to take the palliative care route after talking to two different vets. I had a hard time accepting it the first time around, I suppose. Link to pic and her story: http://forum.greytalk.com/index.php/topic/287917-fce-fibrocartilaginous-embolism/ This is horrible. I'm up tonight browsing threads because I can't sleep and Maya was sick of me bawling over her, I think. Osteo is awful and it does help to read about others' experiences (although sad).

 

I mentioned this in my thread and in Nube's, but we tried this Saturday for pain management: http://www.litecure.com/companion/ Maya was more energetic that night than she'd been in a month, but we had also started Rimadyl in addition to Tramadol that day, so who knows? I still think we might go back, though. It doesn't cause her stress, so it certainly doesn't hurt.

 

It made me happy (and jealous!) to learn that Nube is a chow-hound. Maya has never been a great eater, and since all this crap started a month ago she's lost about 13 lbs. She's down to 45 and I'm feeding her anything she'll eat. However, her appetite has been better since laser/rimadyl/gabapentin.

 

There are so many things I'd like to comment on and say, but I'm brain-dead tonight. Just wanted to share my bad news and offer support to everyone else dealing with this.

[Guest patterpaws]

I'm so sorry, GenetJen. I feel heartbroken for you and Maya, and all the hounds here. I'm glad Maya responded to the drugs and laser therapy! At least that will give her some relief.

 

Reading about specific drugs is helping me, especially since my hound's current medication dose is not taking care of the pain (just upped the frequency, hoping that helps, and will talk to the vet tomorrow). I'm worried about the likelihood of pathological breaks though, and my suspicion that even upping the pain medication will not be enough to really mask the hurt.

[Guest amberj002]

Ours just has 100mg 1 x day and told us to completely stop the Tramadol (which we did not but reduced).

 

Kim, Bee took 300mg of Gapapentin three times a day in addition to Deramaxx and Tramadol.

 

Gabe did, too.

 

Kim, this is what Nadia was on as well...although her NSAID was Previcox. When we first started the Gabapentin she was pretty sleepy, but I was ok with that because she was comfortable...and if I remember correctly, it took a few days to really see any improvement, but after a couple of days she was like her old self again. That side effect didn't seem to last long before her body adjusted. Same with the Tramadol, at first it made her a little anxious and off, but that didn't last long either. The other thing that I learned early on was to give doses of meds together so they could "knock out" pain...our vet wasn't really clear so I was trying to space things out, it worked much better when I gave all 3 at the same time. Hoping Nube is having a better day.

[MachosMom]

I just wanted to send everyone a quick bunch of hugs! I have only minimally been able to follow this over the weekend. I hope all pups who had a rough weekend are doing better!

 

Macho had a party yesterday and a bunch o greyhounds came to the house to see him! I will try to get some photos finally to this forum of him . His face just lit up when they all started arriving. It made my day to know he was so happy. Making moments while I can.

[Guest cashie]

So glad Macho had fun at his party! What a great idea, I bet he loved it!

 

I hope Nube is having a better day and that Tristan's new medicine dosage is helping him!

 

I'm sorry to hear about our new member:( Even though its nice to have support the reason for it is terrible. I hope you have many happy, pain free days with Maya.

 

We are just hanging out here getting used to the new meds. Haven't noticed a huge difference yet but he seems a lot more perky today and that glazed look in his eyes is gone.

[Guest snakes]

HI all, sorry to hear Nube is still in pain, i hoep today was better. welcome, but sorry you had to join, to maya and family.

 

Just a quick note to everyone based on earlier threads that gabapentin as well as tramadol are available at human pharmacies for MUCH cheaper, especially if you buy a bunch at once. I think I buy 300 of 100mg gabapentin capsules for just under $20. I forget how many tramadol i get at once but its quite a few (~50-75) for $15-18.

 

Hang in there everyone!

I may not be on as frequently as i have started a new job, but feel free to PM me for any questions, i'll still check in every couple of days

[Guest patterpaws]

Congrats on your new job, snakes!

 

Thinking of everyone and hoping the hounds and humans are all hanging in there! Tristan gave me a scare with overdoing his leg and letting out a huge yelp, but from advice on the forum here I think it was breakthrough pain and not a fracture. We're reaching a turning point where our amputation is scheduled for tomorrow, and if we don't go through with it we will have to put him down since the xrays show imminent pathological fracture. I think we are going to do it. Tristan is just so full of life and energy, I can't bring myself to extinguish it. Of course I have my fears and doubts since the odds are not super great, but we'll hope for the best and do all we can to help him recover as fast as possible. Keep your fingers crossed for Mr T tomorrow.

[krissn333]

Thinking of you and Tristan this morning

 

Pinky had her first Amicar dose BEFORE her surgery, not the evening the day of the surgery. I gave it to her about 30 minutes before I loaded her into the car to head to the vet.

 

Steel your nerves and give him a big hug. I was a bawling mess when we were doing her intake paperwork. As the tech took her leash from me, she grabbed my hand and said "try not to worry...we already love her like she's our own dog, we'll take very good care of her and we'll call you right before she heads into surgery and right after she wakes up." That small moment of reassurance meant the world to me. You'll need to switch yourself from fear and anxiety mode to fight mode now. Time to be tough for Tristan and kick that cancer's ass!

[Charlies_Dad]

 

You'll need to switch yourself from fear and anxiety mode to fight mode now. Time to be tough for Tristan and kick that cancer's ass!

 

Indeed. Now that you have chosen your path, it's time to get angry and tough. Tristan will need you more over the coming days and weeks to get back to his normal self. It will take some days to recover from the initial operation and then once he is up and about (he'll be up and walking by tomorrow most likely), you'll just need to help guide him (having a harness is really nice to have or at least a sling) and make sure he does not fall or lick his stitches. Hopefully within 2-3 weeks you'll see your boy coming back to his happy self, it can be sooner or could be later, each pup is different. Just remember, time to get tough with cancer, you're fighting along with Tristan, don't look back and don't have second thoughts, he will his happy self again.

[Guest patterpaws]

Time to be tough for Tristan and kick that cancer's ass!

 

Yes, switching to fight mode now. I'm thinking of it kind of like how when I first adopted him, he was in a weak state and he needed me to make up for it and be super strong for him. I couldn't coddle or be weak around him, he needed me to be self assured so he could feed off that energy. Switching to that mode now, big time.

 

The vet was going to give T the Amicar first thing this morning.

 

Must be strong!!!! We're going to smash that cancer!

[greysmom]

 

Tristan!

[RaineysMom]

:hope Tristan :hope :hope

[joejoesmom]

Adding my good thoughts for the handsome Tristan.

 

Jane