Vinnie Finally Has A Diagnosis-

[Guest bernadette]

We had Vinnie at North Star in NJ today to see a neurologist. Her diagnosis: Suspected cervical spinal pain /C1-T2 myelopathy - Dx: IVDD, stenosis, neoplasia, inflammatory (this is exactly how it is written on her report).

 

We are starting him on Gabapentin (300mg every 12 hours) in addition to the Rimadyl.

[Houndtime]

Which doctor did you see?

[tbhounds]

That's a heavy hit of gabapentin for a gh. There has been recent findings that Ghs do better with lower more frequent dosing. 300mgs is sure to show some lethargy. Usually you need to build up to that dose.

Not to be a Debbie downer but, I guess you still don't really have a diagnosis-the vet was able to isolate the pain but, did he/she recommend further diagnostic testing (MRI etc...)??

Hope Vinnie finds some relief with the new meds.

Edited July 4, 2012 by tbhounds

[Guest LindsaySF]

I'd do 200 mg Gabapentin every 8 hours instead of the 300 mg every 12 hours. He'd get the same amount each day, but not so much at once. Andy never had any lethargy from this dose, but some dogs do.

 

I'm curious if the vet recommended any further testing, or if you are just going the pain management route.

[Guest bernadette]

These are capsules, I'm not able to split them. We gave Vin his first last night, I've yet to see how he is reacting. I know G dosages have been discussed here, I welcome the info and thoughts.

 

We are starting with pain management and getting him comfortable. Unfortunately a $2000 MRI isn't in the cards, we simply can't afford that. I will have X-rays done by my vet, the views that North Star needs (I think Dr. Logan... I just woke up, I'm blanking on her name). Chest X-ray to rule out anything in that area and I believe views of the neck areas.

 

The vet was very comfortable with starting out with making him comfortable. She did walk him and noted his dragging but it wasn't enough of a walk to see everything, how he slows. She asked for video when we are able so that she could see it. She is quite confident that the back end issue is coming from the cervical area, which makes complete sense. He was inconsistently reactive when she was manipulating his hind end but definitely pain in his neck area. Correct me if I'm wrong.. But isn't myelopathy Wobblers? I did some reading last nite nite and Wobblers symptoms certainly sounds familiar.

 

We are to completely limit Vinnies activity for the next week or so and see the vet again in two weeks for a recheck. No walks, just take him out to 'go' and then back in... He is NOT going to appreciate that. I am heartbroken... I love walking my boy, I do hope that twist we are doing will help.

 

Maybe acupuncture now..? I forgot to ask the vet about that but we are able to email her.

I'm sure I'm leaving things out but it helps to discuss. I certainly

[dante2zoe]

I am sorry. My whippet has been diagnosed with myelopathy, based on his gait and symptoms. He is 15.5. He takes gabapentin twice a day. The 100 mg capsule is too much for him - it made him incredibly unstable (even moreso than where he is now, which isn't good) and woozy. I open the capsule and divide it into two doses. They are not exact, of course, but he gets what he needs over the course of the day. My vet is in agreement with this approach. I pour it on a piece of lunch meat and he gobbles it down with no problems. Costco sells it in their pharmacy and it is really cheap. He even has his own pharmacy card with them which gives him a discount since he doesn't have prescription benefits. The gabapentin won't slow his progression down, but it appears that he is more comfortable. I cannot ask for more than that.

 

As for acupuncture, Dante was receiving that for LS and it really did benefit him. He became more playful and eager for his walks again. I know it can be controversial, but it worked for us. It gave him relief and allowed him to participate in things more fully. I just unexpectedly lost him to osteo, but I know he was enjoying life to the end.

 

Good luck.

Edited July 4, 2012 by dante2zoe

[Houndtime]

Make a list of your questions, this way you won't forget anything. Don't worry if the list is long. That was an appointment with a specialist of for. Good luck and definitely ask about acupuncture.

[Guest LindsaySF]

What size are the Gabapentin capsules? Usually they are 100 mg each.

 

Limiting his activity is the best thing you can do for him right now. He needs time to heal, especially if there is any inflammation.

[Guest bernadette]

They are 300mg capsules. Thank you for the encouragement, it is very hard to turn him around to go bck inside when he wants to keep going. I know he doesn't know any better

[juliemac]

Since walking him is not an option, perhaps (if you can lift him), a car ride would make up for it?

[KF_in_Georgia]

Ask your vet to rewrite the script for Gabapentin. 100mg capsules are available at most drugstores (probably for much less than the vet's charge).

[tbhounds]

Ask your vet to rewrite the script for Gabapentin. 100mg capsules are available at most drugstores (probably for much less than the vet's charge).

Agreed-300mgs at once is going to make him wonky.

[Guest bernadette]

Thank you for all of your thoughts and information. I will bring the dosage of Gabapentin up to the vet. I have to make that list of questions...

So far, so good with the 300mg. No wonkiness, stumbling, etc. I know it takes a little while to do anything (positive), but so far nothing negative- thankfully.

[kudzu]

Correct me if I'm wrong.. But isn't myelopathy Wobblers?

 

My understanding is that myelopathy is disease of the spinal cord. Just saying myelopathy doesn't explain the cause just as saying someone has a neuropathy doesn't indicate what nerves or what is causing it. This part, "Dx: IVDD, stenosis, neoplasia, inflammatory", is worrisome. Those sound like differential diagnosis not a specific diagnosis. Does she have any feel for which might be the actual cause? Basically any of those listed could cause spinal cord pressure & damage thus causing the symptoms you see. Totally understand the monetary constraints. To some degree the meds he does or does not respond to can be diagnostic but still in a general way, not really specific. MRIs can help shortcut the diagnostic process but conservative care could still yield results.

 

My concern about the 300 mg dose is less with wonkiness, though that is certainly possible, but more to do with effective, continuous pain control. Something to remember with gabapentin is that it takes a while before a dose kicks in & it beginning wearing off long before 12 hours. Depending on the patient, dosing every 12 hours could him in a cycle of highs & lows of pain control. Have seen it with my dog & experienced it myself. It's miserable. This doesn't mean it happens with everyone but for the degree of pain you are describing I would want that medicine to be working 24/7 & every 8 hour dosing has a much higher likelihood of doing that. With 12 hour dosing you could be leaving him to experience a high percentage of his pain for 2-6 hours/day. At a minimum you may be leaving him achy & uncomfortable for 4-6 hours/day. Remember that just because he may not be screaming in pain doesn't mean the level isn't still quite high. Sorry to sound so glum about it but I've been taking 2400 mg/day gabapentin for 5+ years. So I'm not just speaking in theoreticals here.

 

For my dogs I have taken my own 300 mg capsules & split them up to make 100-200 mg doses, depending on the dog in question. It isn't that hard but dose require some manual dexterity & fine motor control. Speak to your vet about this. As others have said, you can get 100 mg capsules also. For 600 mg/day that would only cost $15/mo at Walgreens with their prescription savings plan.

[Guest bernadette]

Kudzu, thank you. This makes sense, what you're saying about spreading it out not so much due to 'wonkiness' but more constant pain control. I am wondering what the vets reasoning is for the 300mg pills. At what point might I see an effect of the Ganepentin? What results might I see?

Vinnie is an amazingly good dog... throughout all of this (and I have expressed this to my vets) I have worried about how good he is. On top of greys being so stoic, he will not let on when it comes to pokes, prods, needles, etc. So, Iabsolutely cannot depend on him telling me he is in pain. I have really had to learn to 'speak dog' these last few weeks in order to look for signs.

[Guest bernadette]

We have wonkiness... I will be discontinuing the Gabapentin until next week when I am able to monitor the dosage myself and watch him (he won't be with me over the weekend as I'll be at a family members wedding and the closest pet friendly hotel is 20 miles away...

[kudzu]

I've got one very stoic girl. Makes it very hard for the vets to determine source of pain with her. This is just a note on the wonkiness. When starting gabapentin or increasing a dose it can take the body a little while to get used to it. For humans they suggest the first dose at bedtime. Certainly you don't want him hurting himself & to be honest Vinnie's dose sounded high but some temporary wonkiness wouldn't be a surprise or even a worry depending on severity.

 

Hope the wedding goes well as does the restart of the med. Good luck.

[Guest bernadette]

Without going into too much detail, the wedding was nice, dad ended up in the hospital during reception with a suspected stroke. Turned out to be stress and PTSD (forgot who we were for a day and a half) but he is doing well (despite no memory still of the wedding or reception).

 

SO... Vinnie ended up staying at pet hotel for an extra night before fiancé picked him up and took him back to NJ (I stayed in MI for another few days).

Judging by what was left of his pills, I believe the pet hotel confused the med instructions and was giving Vinnie one and a half Rimadyl in the morning (not just one pill). I believe they confused this with having to give him one and a half Pepcid in the morning...

We stopped the newly prescribed Gabapentin before leaving town for the wedding as it seemed that it made Vin wobbly. My infect was to restart it upon returning home.

Vinnie came home with an excellent appetite, before the hotel stay he had been down to one meal per day that he had to be fixed to eat. He is now wanting to eat ALL the time. He eats his breakfast and dinner immediately and begs for more. I believe he is also drinking more- he is definitely needing to go out more.

When we got home from wedding, we tried Vinnie on the Novox as a less expensive, Rimadyl substitute. This made his stomach upset so I stopped it. He has now been on nothing at all for about a week. I've been watching him closely (I have the time... Was laid off via a phone call while in the hospital states away with my dad who thought I was a nurse!) and he is doing well. His walks have been no worse.

My fiancé says that Vinnie is just hungry, leave him alone.

I just cant shake the feeling that I'm only seeing part of the big picture.

I just don't think it's normal for a dog to jump from 'never hungry' to seemingly ravenous so quickly...?