Osteo Thread V

[NeylasMom]

Tamara3462, I am so sorry to hear about Dynamo's diagnosis.

 

we actually bit the bullet and gave Nube another Gabapentin last night (12 hours apart from 1st one) w/o talking to the vet. I did talk to him this morning, and he's ok with adding 1 but said to do it as 2 100mg pills at one time, not 12 hours apart, as it "peaks" and would be more effective that way, rather than spread out (smaller peaks I guess). I asked what the max would be for both meds (in case I can't get a hold of him) and he said that's the max of Gab he would like and we could go up 1 more Tramadol (so 4 pills 3 x day). I know a lot on here are on way more Gab than that, and hopefully the oncologist we see next Wednesday (argh it's so far away!!! ) will have better ideas, like you suggest he will.

I REALLY think you need to find a new primary vet to work with asap. What he is telling you about Gabapentin is just totally INCORRECT** and you aren't anywhere NEAR the max dosage (although you are with Tramadol),and 5 more days of improper pain mgt is a LONG time. This is not a dog who is suffering from some temporary minor pain due to injury or illness and will recover, this is a dog who has a terminal, and very painful disease. The primary concern needs to be managing pain, not worrying about side effects (within reason). I'm sorry to be so blunt and this will be the last comment I make because the last thing I want to do is offend you or in any way insinuate you're not doing the best for Nube. It's clear from your posts how difficult this is for you and how much you love him, but the advice you are receiving from your vet is just getting worse and it's really heartbreaking to watch you suffer watching Nube being in pain when you could potentially address it with proper direction from a vet.

 

**Published half life of Gabapentin in dogs (meaning the time it takes for half of the substance to have been removed) is 3-4 hours, meaning a dose of Gabapentin will be gone and no longer effective in ~6-8 hours. Additionally, research shows that half life is NOT affected by dose size (meaning a 200 mg dose will not take longer to leave the system than a 100 mg dose).

See a study published here

and straight from the Merck Veterinary Manual (also note recommended dosing is TID-QID, which is 3-4x/day)

Another reliable source that lists the half life as 2-4 hrs

Edited July 20, 2012 by NeylasMom

[45MPHK9]

It's clear from your posts how difficult this is for you and how much you love him, but the advice you are receiving from your vet is just getting worse and it's really heartbreaking to watch you suffer watching Nube being in pain when you could potentially address it with proper direction from a vet.

 

[Charlies_Dad]

Kim, I agree with Jen wholeheartedly. I don't believe your vet has a true understanding of Gabapentin. This is not surprising as some vets just are not familiar with it. I do think you need to either obtain a second opinion on the dosage or really just follow some of the dosages that have been suggested in this thread. I don't like anyone to do the latter without consenting a vet however in your case, Nube is likely suffering and in pain. If the meds can be increased and relieve some or all of that I believe you are all for it. Sorry to have to say this, no insult intended to you as I know you are suffering along with Nube right now.

[greysmom]

Kim, I agree with Jen wholeheartedly. I don't believe your vet has a true understanding of Gabapentin. This is not surprising as some vets just are not familiar with it. I do think you need to either obtain a second opinion on the dosage or really just follow some of the dosages that have been suggested in this thread. I don't like anyone to do the latter without consenting a vet however in your case, Nube is likely suffering and in pain. If the meds can be increased and relieve some or all of that I believe you are all for it. Sorry to have to say this, no insult intended to you as I know you are suffering along with Nube right now.

 

Yes.

 

Most vets don't know about or understand gabapentin, as it's use in dogs has only recently become more widespread. There is no need to be conservative when managing pain from osteo. My Toni is on gaba for a nerve issue, not osteo, but still extremely painful for her. She weighs 78 pounds and we can go up to 1600mgs per 24 hours. You have a LONG way to go to reach a maximum dosage of gabapentin for Nube.

[RaineysMom]

Kim, I agree with Jen wholeheartedly. I don't believe your vet has a true understanding of Gabapentin. This is not surprising as some vets just are not familiar with it. I do think you need to either obtain a second opinion on the dosage or really just follow some of the dosages that have been suggested in this thread. I don't like anyone to do the latter without consenting a vet however in your case, Nube is likely suffering and in pain. If the meds can be increased and relieve some or all of that I believe you are all for it. Sorry to have to say this, no insult intended to you as I know you are suffering along with Nube right now.

 

yeah it sure seems like so many here have/are using a much higher dose. I actually emailed Dr. Kellogg at OSU (who did the confirmation of the OS diagnosis) to see what her opinion is. I did read that the dose for seizures is usually a lot higher, and it's somewhat lower for pain.

 

he seems to be having some back-end issues this afternoon now, it's giving out on him and that just started. Maybe it's from the Gab. He also was "twitching" a lot this past hour, just his 2 front legs and his head/neck (not the sleeping kind, I know how that is). He was restless again after lunch he just now finally fell asleep.

 

for the gabapentin, is the general consensus that dosing 3 x per day is preferrable? I'd be willing to try 100mg 3 x a day to start (afraid to go high right off the bat, especially if his back end issues are from the 2nd one at 10am this morning). He didn't seem to have any problem last night after we gave him the 2nd one 12 hours after the first.

[NeylasMom]

 

for the gabapentin, is the general consensus that dosing 3 x per day is preferrable?

Yes.

[RaineysMom]

for the gabapentin, is the general consensus that dosing 3 x per day is preferrable?

Yes.

 

would it be better to give it in between the Tramadol doses then? in other words, if he get the Tram at 5:30am, 1:30pm and 9:30pm, give the Gab at 9:30am, 5:30pm and 1:30am? I don't know that this would make a difference but I thought I'd ask.

[NeylasMom]

I think if you can manage that sort of schedule then it wouldn't hurt to try it. It would mean both meds weren't wearing off at the same time. But sleep (your own) is also important to surviving this so weigh that too.

[RaineysMom]

I think if you can manage that sort of schedule then it wouldn't hurt to try it. It would mean both meds weren't wearing off at the same time. But sleep (your own) is also important to surviving this so weigh that too.

 

yeah, and he's sleeping well through the night so I'd hate to wake him up for a pill and have him get restless. maybe it would be better to get both at the same time so there's more relief at one time, I don't know.

 

I'm just so depressed and frustrated, NOTHING seems to be helping. Again, he doesn't yelp when he walks but the limp is SO bad, it HAS to be hurting him. And the restlessness and panting to me is a sure sign (although the panting may mostly be from sunning himself for a couple minutes outside, he gets pretty hot but he seems to pant a LOT longer after he's been in when he's like this).

 

I know we had to get the x-rays done to find out for sure what was wrong, but I wish I could turn back time. He was bad before (limping pretty badly) but since the x-rays (done Tues July 10th) he's been SO much worse, and then he's worse again after what he did Wednesday night .

[NeylasMom]

I'm so sorry, I can really feel your pain. The only thing I can say is that your recourse is to get him on an appropriate dose of pain medication so that his pain is managed well (or consider radiation or IV pamidronate, which may provide greater pain relief - you can discuss those options with OSU and/or the oncologist) or unfortunately let him go. I hate to even say those words and I really hope you're not there yet (you certainly haven't maxed out on meds), but the reality is that he's not going to get better, he's only going to at best stay the same or get worse without further intervention from you.

 

And I do not say these things lightly - I know how incredibly painful it is to deal with this disease. You have no time to process it, suddenly it's just what it is and you're incredibly emotional and stressed dealing with the shock, the early stages of grieving, the lack of sleep and all the while trying to figure out what's best for your dog. It's horrible and no one should have to go through it.

[RaineysMom]

I'm so sorry, I can really feel your pain. The only thing I can say is that your recourse is to get him on an appropriate dose of pain medication so that his pain is managed well (or consider radiation or IV pamidronate, which may provide greater pain relief - you can discuss those options with OSU and/or the oncologist) or unfortunately let him go. I hate to even say those words and I really hope you're not there yet (you certainly haven't maxed out on meds), but the reality is that he's not going to get better, he's only going to at best stay the same or get worse without further intervention from you.

 

And I do not say these things lightly - I know how incredibly painful it is to deal with this disease. You have no time to process it, suddenly it's just what it is and you're incredibly emotional and stressed dealing with the shock, the early stages of grieving, the lack of sleep and all the while trying to figure out what's best for your dog. It's horrible and no one should have to go through it.

 

we're hoping the oncologist will suggest radiation (or possibly chemo, if they'd do it w/o a biopsy) and that's why we haven't started the artemisinin yet.

 

I agree we have not maxed out the meds but there's only up some with the Gab as he's pretty close to maxed out on Tram, and I don't want to go too fast with upping the Gab as I don't want him wonky or stumbly, but I also don't want him in this kind of pain for many more days. And I had hoped he'd be feeling a LOT better (or ANY better ) already. That's my greatest fear, that we will not be able to get his pain under control and we'll have to let him go. I just can't do that yet but it's killing me to see him like this.

[45MPHK9]

We were only able to get Bee's pain under control once we increased the Gabapentin dose. Per our vet's recommendation we stopped giving her the 100mg capsules and started with the 300mg capsules. That worked for a while. It really did stop the limp.

 

She was never wonky or stumbly. She slept peacefully for hours and was able to rise up off her bed without wincing in pain. That drug was a miracle for her for a while.

 

I hope you get to experience those same results with Nube soon.

Edited July 20, 2012 by 45MPHK9

[joejoesmom]

I agree with the opinions stated here. It sounds like your vet is not well educated regarding gabapentin, and perhaps also not up to date on pain management for bone cancer.

 

Dr. Couto at OSU told me late last winter that a vet in Boston was doing research on gabapentin efficacy in greyhounds. He determined that the best pain control was gained by giving smaller doses, more frequently. Dr. Couto suggested that I dose with gabapentin every 4 hours and tramadol every 8 hours. He did say that it would be okay if I didn't get up in the middle of the night and just double up the dose at bedtime.

 

If I remember correctly, we started with 100 mg of gabapentin every 8 hours. He did fine with no side affects so we increased it to 100 mg every 4 hours. He got 1 or 2 50 mg tramadol every 8 hours, depending on his pain level. The last few days, I increased this. He also got deramaxx every day.

 

Jane

[tamara3462]

Thanks for the support everyone and I am so sorry to everyone else who is going through this.

[NeylasMom]

 

we're hoping the oncologist will suggest radiation (or possibly chemo, if they'd do it w/o a biopsy) and that's why we haven't started the artemisinin yet.

 

I could be wrong as chemo for non-amputees wasn't being recommended when Neyla was diagnosed, but I don't believe that will give Nube any pain relief. You would need to do the radiation or IV pamidronate. If you are considering either of those, you may want to consider calling and talking with the hospital ahead of time about the possibility of leaving him for treatment the day of your appointment. The radiation requires anesthesia so you would want to not give breakfast or treats, etc. in case. The pamidronate is done while the dog is awake, but takes several hours as they give IV fluids before, during and after the treatment. If I remember correctly you said this oncologist is far for you - just thinking it could save you a trip and get Nube more immediate relief if you choose to pursue it.

[tbhounds]

I agree with the opinions stated here. It sounds like your vet is not well educated regarding gabapentin, and perhaps also not up to date on pain management for bone cancer.

 

Dr. Couto at OSU told me late last winter that a vet in Boston was doing research on gabapentin efficacy in greyhounds. He determined that the best pain control was gained by giving smaller doses, more frequently. Dr. Couto suggested that I dose with gabapentin every 4 hours and tramadol every 8 hours. He did say that it would be okay if I didn't get up in the middle of the night and just double up the dose at bedtime.

 

If I remember correctly, we started with 100 mg of gabapentin every 8 hours. He did fine with no side affects so we increased it to 100 mg every 4 hours. He got 1 or 2 50 mg tramadol every 8 hours, depending on his pain level. The last few days, I increased this. He also got deramaxx every day.

 

Jane

LIKE :-)

[Guest snakes]

I know almost everyone has already chimed in, but DEFINATLY talk to another vet about gabapentin. Even when FedX was going through a rough patch and I had him up to 300mg three times a day the vet said we still had room to go up on the dose.

 

When I increase FedX's dose when he is having more pain i generally increase the frequency then the doses. For example, if he is currently on 200mg twice a day and somethign happens, i would add in 200mg as a third dose and if that didn't help i would increase the mronign dose to 300mg the next day, then if no improvement i would then increase the midday dose to 300mg, then if no improvement i would change the evening dose to 300mg.

Luckily we haven't had to go any hgiher, but we could if need be.

 

Gabapentin is one drug that i wouldn't be shy with, especially as the only possible side effect is being a bit wobbly.

 

I feel everyone's pain and frustration, hang in there and get yourself some good food to spoil yourselves as well and the pups!

[Guest cashie]

More panting=more pain or more anxiety from Tramadol? Does melatonin help?

 

Dynamo:( I don't like to see new members of this club:(

Edited July 21, 2012 by cashie

[NeylasMom]

More panting=more pain or more anxiety from Tramadol? Does melatonin help?

 

Dynamo:( I don't like to see new members of this club:(

Is the panting accompanied by any other signs of anxiety? Restlessness, pacing, just general weirdness? Did it coincide with an increase in the Tramadol dosage?

[Guest patterpaws]

Hmmm all this talk of medicine has me curious. Tristan is doing ok, though he isn't eating at all today and is pretty lethargic. I expect him to be taking it easy tonight since he's just been through a lot, but he's supposed to eat when he takes the rimadyl and I can't even get him interested in fresh cooked chicken... or any of his treats...

 

Here's the meds he's on:

 

Aminocapric Acid 1 500mg tablet 3 times daily

Tramadol 2 50mg tablets 3 times daily (I could up this to 3 at a time)

Gabapentin 1 300mg tablet twice daily

Cerenia 80 mg tablet once daily

Rimadyl 90mg tablet twice daily with food

 

Dang it, when I was writing this out I realized I didn't have the Rimadyl included in his pills this morning, I accidently left it off the chart I made. Maybe thats why he's not eating? I need to give him his evening dose now but he should take it with food...

 

For the gabapentin, it seems from what you're saying, I should be giving it more than twice daily? But the pills are 300mg each so I can't space them out. Hrm.

 

Here he is... "Mom, I don't feel like eating chicken soup "

 

 

 

I'm so sorry for the diagnosis, Dynamo.

 

Hoping Nube feels better soon!

 

*edited since it was accidentally posted before I was ready.

Edited July 21, 2012 by patterpaws

[Guest cashie]

More panting=more pain or more anxiety from Tramadol? Does melatonin help?

 

Dynamo:( I don't like to see new members of this club:(

Is the panting accompanied by any other signs of anxiety? Restlessness, pacing, just general weirdness? Did it coincide with an increase in the Tramadol dosage?

 

Yes to both. I gave him an extra Tramadol since he seemed to be in more pain (limping more). He was restless, agitated and panting. When I snuggled and pet him he seemed to calm down a little. He's OK this morning but I'm just wondering about future doses.

[krissn333]

I think I'd dose the gabapentin more like every 4 hours at a lower dose than 300mg at a time. From what I'm seeing from others here, that seems to be most efficient, both for effective pain management and to keep him from feeling woozy.

 

(null)

 

Ok I just tried to quote the post about Tristan in the above post, but, it didn't work (I'm on my phone and the newest IPBoard app doesn't seem to do quotes or new posts very well), do ignore the (null) at the bottom.

[NeylasMom]

More panting=more pain or more anxiety from Tramadol? Does melatonin help?

 

Dynamo:( I don't like to see new members of this club:(

Is the panting accompanied by any other signs of anxiety? Restlessness, pacing, just general weirdness? Did it coincide with an increase in the Tramadol dosage?

 

Yes to both. I gave him an extra Tramadol since he seemed to be in more pain (limping more). He was restless, agitated and panting. When I snuggled and pet him he seemed to calm down a little. He's OK this morning but I'm just wondering about future doses.

I'm sorry, there are so many new pups diagnosed in here - I can't remember what his other medications and dosages are. I would say if you have room to increase the Gabapentin and he's still limping, maybe try that instead of the Tramadol then and see what happens. From what you're saying, it sounds like it could very well have been the increased Tramadol that caused the panting and restlessness.

 

 

For Tristan, I am not really sure how post-op meds might differ so I'd check iwth your vet. In theory I don't see why dosing would be different in this scenario, but what do I know. The Cerenia is to help his appetite so I would try feeding him about 20 minutes after you've given him that. If chicken doesn't interest him, try baby food (the pure meat formulas seem to go over best). It's hard to say whether the lack of appetite in his case is pain from the surgery or just general lethargy as the surgery meds wear off, etc. but if you can get him eating little bits then his appetite should come back.

[greysmom]

Tristan! He looks prety good! Probably feels really crappy though. Cerenia 20-30 mins before food, then the rest of his pills after he eats.

 

After his surgery and after each chemo treatment, the only thing that would spark Dude's appetite was a McDonald's cheeseburger! Rotisserie chicken from the store was also popular. Not sure why that chicken was better than chicken *I* made at home, but he definitely liked it more.

 

Throughout his treatment I found I would have to rotate his food - he became much more picky and got tired of things faster. This from a hound who never met a meal he didn't like. We bought a couple cans of a lot of different kinds of dog food, and we rotated through the Canidae carb-free flavors of kibble. The cheaper the canned food the better he seemed to like it.

 

For our current picky eater we've had good success with the little Beneful Prepared Meals in the little plastic cartons.

 

Back to tramadol vs gabapentin - I would say the increase in restlessness was caused by the Tramadol. It's an opioid pain med and ome greyhounds don't do well with them. I've never seen that reaction from gaba - usually it's the opposite. The gabapentin will give good pain relief but only at a high enough dosage.

[Guest cashie]

More panting=more pain or more anxiety from Tramadol? Does melatonin help?

 

Dynamo:( I don't like to see new members of this club:(

Is the panting accompanied by any other signs of anxiety? Restlessness, pacing, just general weirdness? Did it coincide with an increase in the Tramadol dosage?

 

Yes to both. I gave him an extra Tramadol since he seemed to be in more pain (limping more). He was restless, agitated and panting. When I snuggled and pet him he seemed to calm down a little. He's OK this morning but I'm just wondering about future doses.

I'm sorry, there are so many new pups diagnosed in here - I can't remember what his other medications and dosages are. I would say if you have room to increase the Gabapentin and he's still limping, maybe try that instead of the Tramadol then and see what happens. From what you're saying, it sounds like it could very well have been the increased Tramadol that caused the panting and restlessness.

 

 

For Tristan, I am not really sure how post-op meds might differ so I'd check iwth your vet. In theory I don't see why dosing would be different in this scenario, but what do I know. The Cerenia is to help his appetite so I would try feeding him about 20 minutes after you've given him that. If chicken doesn't interest him, try baby food (the pure meat formulas seem to go over best). It's hard to say whether the lack of appetite in his case is pain from the surgery or just general lethargy as the surgery meds wear off, etc. but if you can get him eating little bits then his appetite should come back.

 

Thanks! I will try the extra doses of Gabapentin. It seems like less more often might be the trick.