Osteo Thread Part Vi

[Guest FawnFan]

Thanks Kyle for asking about Gunner's feet. Yes he seemed to be ok shortly thereafter. He had gotten down off the couch and got in a dog bed and his feet were warm again. It comes and goes so not sure what the deal is.

 

And thanks regarding the morphine. I'll have to ask the vet about that.

 

Thanks again,

Jean

[4My2Greys]

A quick question because I'm on my phone and it will take too long trying to go back page by page to find the info. How much tramadol can be dosed at one time. Nadir just came back inside and is limping and panting very heavily like he is in a lot of pain. I just gave him 300mg of gabapentin and 50mg of tramadol. If I can get his pain under control I would prefer taking him in first thing in the morning and not having to make an e-vet visit tonight.

[krissn333]

Fritz takes 75mg every 8 hours. I know I could up it to 100 if needed...he weighs 57 lbs.

 

I'd wait though and see if the gabapentin cuts it before giving more tramadol. Sometimes more will just make them more anxious and they'll pant more.

[4My2Greys]

Thanks Kristin, I will give it a little more time then and see how he does.

[NeylasMom]

Neyla was up to 125 mg 3x/day at 60 lbs so you certainly have room to increase. How is he doing this morning?

[Guest urchin]

I haven't been here for awhile, but could use some advice from those of you who have been through osteo before. Our boy Jake was diagnosed with osteo last September, he is 11. He has done exceptionally well (to the point where I was thinking it was just arthritis) until the past month or so. The past week I have noticed a real decline. He is on a decent dose of Rimadyl, Gabapentin and Tramadol. He gets up twice a day to go outside and immediately comes back in after he does his business. He will not get up to eat, but will eat if we put the bowl next to his bed, which of course we do. Otherwise he just seems a bit lethargic. He still enjoys his scritches and treats but I am struggling with whether or not it's time to say goodbye. He had a bad night last week where he panted for hours and seemed extremely stressed. When we had to say goodbye to our boy Woody to old age last July, the decision was easier, you could see in his eyes that he was ready. It's been harder with Jake. He was always a big, goofy 85lb greyhound that we had nicknamed "Kramer" because of the crazy way he would come sliding or bounding into the room. He is extremely sweet and trusting and used to be constantly at my feet. I don't want him to suffer any more than is humane.

So after that long winded post, my question is "How did you know when it was time?".

Edited April 21, 2013 by urchin

[greysmom]

The lethargy and panting sound like a break through pain response. What dosage of tramadol and gabapentin is he on?? You may have room to significantly increase his dosages. The gaba can be as much as 300 mg 3 times a day. I forget what the max tramadol dose is.

 

Someone once told me to pick the three things your dog likes the very best - whatever those are, when your dog is no longer enjoying all three, then it's time to consider giving them the ultimate gift of freedom. But that decision is so personal - each dog and each person is different in their tolerances and strengths - no one can really make that for you. It's the hardest thing to do - ever.

[Guest urchin]

Thanks Greysmom. I know it's a personal decision, I was just curious how people ever know that it's time. Sadly, he has not been able to enjoy "the three things" in many months (he cannot go on a walk or to the park anymore). Dosages are as follows 100mg of Tramadol, 75mg of Rimadyl and 300mg of Gabapentin given three times a day for 300, 225 and 900mg respectively per day. The gabapentin seems to be helping slightly, he got up four or five times today to drink water, change beds, etc. which is a big improvement over two...but it's not like he is happy enough to play with toys, etc.

[NeylasMom]

I haven't been here for awhile, but could use some advice from those of you who have been through osteo before. Our boy Jake was diagnosed with osteo last September, he is 11. He has done exceptionally well (to the point where I was thinking it was just arthritis) until the past month or so. The past week I have noticed a real decline. He is on a decent dose of Rimadyl, Gabapentin and Tramadol. He gets up twice a day to go outside and immediately comes back in after he does his business. He will not get up to eat, but will eat if we put the bowl next to his bed, which of course we do. Otherwise he just seems a bit lethargic. He still enjoys his scritches and treats but I am struggling with whether or not it's time to say goodbye. He had a bad night last week where he panted for hours and seemed extremely stressed. When we had to say goodbye to our boy Woody to old age last July, the decision was easier, you could see in his eyes that he was ready. It's been harder with Jake. He was always a big, goofy 85lb greyhound that we had nicknamed "Kramer" because of the crazy way he would come sliding or bounding into the room. He is extremely sweet and trusting and used to be constantly at my feet. I don't want him to suffer any more than is humane.

So after that long winded post, my question is "How did you know when it was time?".

You still have room to increase a bit on both the Tramadol and Gabapentin. You should check with your vet on the max amt you can give of each based on Jake's body weight, but Neyla's maxes at 60 lbs were 125 mg Tramadol 3x/day and 500 mg Gabapentin 3x/day. However, I will caution you that above 300 mg per dose of Gabapentin she got woozy, which is something you don't really want in a dog with osteo so if you're going ot try increasing that further, I would suggest doing it incrementally.

 

Having said all of that, as Chris said, obviously no one can tell you when the right time is so I will just tell you my experience. When Neyla was diagnosed in May of 2010 there weren't many dogs who were living more than a few weeks to a month or two with palliative care. There were a few seeming anomalies, but not many people had gone down our path, at least that I knew of. At that time, everyone thought of osteo as a very fast progressing disease, but as things progressed with Neyla and I started to pay attention to other people whose dogs were diagnosed because of this thread I started to speculate that it was in fact very slow progressing for a period of time (at least 6 mo to a year, possibly longer) and that it only progressed very quickly (exponentially) at the end stage of the disease, but that people weren't realizing their dogs had it until they had already gotten to that stage. Now, with better education and possibly better diagnostics people are realizing sooner and dogs are surviving much longer. There are also better palliative treatments which of course affect that. I'm saying all of this to say, I strongly believe this is the true progression of the disease and when you start to see faster progression, it will only go downhill. For us, we went 5 months with virtually no change, then over the next month or two things moved more quickly and then suddenly we couldn't stay ahead of it. Despite everything I knew, I wasn't prepared for how quickly things would get worse at the end.

 

You may not be there, or I could be totally wrong. Like Chris said, it could be breakthrough pain that you can try to get ahead of and then things may go back to "normal" for a period of time. What I do know though is that the disease is fatal and Jake is not going to be cured. In my mind, the most important question now is are you sure his pain is managed (or if not, can you get it managed quickly) and is his quality of life overall otherwise still good? The latter is a value judgment and we each seem to define quality of life differently. Some people are comfortable iwth the idea of hospice care while others choose to let their dogs go at the first sign that they cannot enjoy everything they have in the past. It's really what you're comfortable with, but it's worth keeping in mind that if he's panting, having trouble sleeping, or having difficulty getting up or down, his pain is probably not managed.

 

I hope I don't sound like I'm pushing you toward one decision or sound cold. I know how gut wrenching dealing with this disease and making this decision can be and I'm very sorry you're in this position. I wish I could do more to help you.

[Guest FawnFan]

Hi Everyone - just a quick update on Gunney. I'm thinking we're getting close to the end unfortunately. His pain increased last Tue/Wed; I increased his gabapentin to 200 mg 3x's/day per Vet's order. His pain increased again this week and the Vet increased his gab to 300 mg 3x's/day - this was yesterday. He's still eating OK yet just a little while ago - right when it was time for the 75 mg of Rimadyl - he was panting and clingy. Panting and clingy are his clues to me that he's in pain. It has happened every time now. The Rimadyl has been in his system for about 35 minutes now and he's calmer and not panting now. I just have this feeling though. We may have to make a decision by the end of the week as my husband is going away for a week and a half this coming Monday. Ugh...

 

The Vet told me yesterday that next we'll increase the tramadol (he takes 2 pills 3x's/day right now) and then I could also add in one of the Tylenol 4 with codeine (that she Rx'd) to the mix too. This scares me a little for some reason.

 

Anyway... will keep everyone posted.

 

Please keep us in your thoughts over the next week or so. Thank you. - Jean

[KF_in_Georgia]

Jean, it sometimes takes 48 hours for gabapentin to get up to full speed, so achy today doesn't necessarily mean that current gabapentin is insufficient.

 

We'll be thinking of you guys...

[Guest FawnFan]

Thanks Kathy for that info about the gabapentin. And thanks for the thoughts too. He was just lying down with his head up panting so I know he's in a little pain right now. He also doesn't look "happy" at the moment.

[KF_in_Georgia]

Jean, if you go up on the tramadol, consider going up by adding a 4th dose in the day rather than just an extra pill 3x/day. See if a shorter time between doses is more helpful than larger doses, especially if he seems to be okay for a while after his meds, then not as good as it gets close to time for the next round.

[Guest FawnFan]

Thanks Kathy. On the bottle it says the max is 2.5 pills every 8 or 12 hours. So I'll see what I can do with the 1/4 dose. He's panting again now. I may have to call the ER just to make sure about the dosages even though they really weren't helpful the last time I called. The vet closed at 7:45 tonight. Thanks again!

[KF_in_Georgia]

One thing with tramadol is that larger doses sometimes cause panting and symptoms that look like pain--but may be an anxiety-like reaction to the drug. (This doesn't happen all the time or with all dogs, but it happens sometimes with some dogs and seriously worries the owners.)

 

2.5 pills every 8 hours would be 7.5 pills a day. That could work out to 2 pills every six hours for three doses, then 1.5 pill on one dose (maybe the one closest to when he gets the Rimadyl on board or maybe the bedtime dose, if he's most likely to sleep all the way through until morning).

 

I just looked up tramadol dosing for people. The drug is prescribed for "every four to six hours" for people, so I'm thinking it really wears off by 8 hours--at least in humans. Dogs might not process it as fast as humans--so that a dose lasts longer in dogs. See what the ER says.

[krissn333]

Agree totally with the above. More frequent, smaller doses have always worked better for us.

 

Fritz takes 75 mg (1.5 pills) every 8 hours and he's good. If he starts having pain I'll likely add the gabapentin in first (we have it on hand but havent needed it yet) before I add another dose of tramadol, but, if it comes to that, we'll just move to dosing every 5-6 hours rather than giving him more at one time.

[joejoesmom]

With OSU's okay, I gave Joe tramadol every 4 hours (I don't work so this was possible for me). 50 mg every 4 hours worked better than 100 mg every 8 hours.

 

Edited to add:

 

Just saw Kristin's similar post that she posted same time as me.

 

Also, I was allowed to give Joe 100 mg just before bed so I didn't have to get up in the middle of the night. This was at the end. We started at 50 mg every 8 hours.

Edited April 25, 2013 by joejoesmom

[krissn333]

Right now Fritz gets his Deramaxx and tramadol at 6:30am. Mom comes up to my place at 2:30pm to give him more tramadol, and then he gets his last dose at 10:30pm.

 

I've found that giving the Deramaxx first thing in the morning has been the best time for him. Then it's most active in his system during the day and when it's wearing off overnight he's got the tramadol fresh in his system.

 

So far no limping and no panting from him. I hope it continues for a long time. I'm still so angry that this craptastic evil disease is going to rob me of the best dog ever Don't get me wrong, I love all of my babies, but Fritz is the most well behaved, tolerant, friendly, ambassadog our group has ever had. And he's MY baby boy

[Guest FawnFan]

Thanks for all of the advice. I upped his gabapentin this week so he's getting 300 mg 3x's a day now. And I upped his tramadol to 2.5 pills at night time... he gets 2 pills the other two doses during the day. He has been panting more this week than in the past few weeks. He also started limping yesterday; last night he was really limping. Today his limp is less visible yet still there. He's still eating yet it takes a few times of enticing to get him to eat.

 

I will be filling the Tylenol Rx today too just in case I need it this weekend. We don't want him to be in pain and yet we don't want a zombie either. So that's where we are right now...

Edited April 26, 2013 by FawnFan

[NeylasMom]

If he's limping he is definitely in pain.

[krissn333]

Fritz's osteo has progressed He is still not limping, but, the films show some progression.

 

His initial from Good Friday:

 

Today:

[Charlies_Dad]

Jean, I am sorry you are having trouble controlling Gunner's pain. I have no advice that has not already been given and our thoughts are with you and your boy.

 

Kristin, I don't know what to say. You've experienced too much of this disease and sorry your are travelling this path again. Every time I read of an Ace update, I am hoping for status quo but unfortunately this disease is purely evil. Our thoughts are with you both.

 

 

Please give both your boys a hug from me from afar.

[Guest FawnFan]

Thanks Kyle. I'm fighting the pain the best I can and also trying to mentally be OK with giving him so much. I spoke with another Vet in the practice and we upped his Gabapentin again. He's now on 400 mg 3x's/day. He also is at 3 tramadol (150 mg I believe - don't have the bottle here) at night; 2.5 tramadol during the day (for three times a day). And then his rimadyl. There's a little limp if one watches closely. Yet he did run from the back corner of the yard into the house this morning after his first outing so it must not be too, too bad as he seemed happy to be doing this.

 

I'm watching him closely. My husband and I discussed it again and we want him to be comfortable yet not drugged up and wobbly.

 

I also figured out alternative dosages given the above advice. My concern is the number of pill feedings during the day. He isn't a chow hound. The last time I tried to space out the three pain pills to start within an hour of each, say at 6 AM, 7 AM and 8 AM, by time I got to the third dosage, it was a fight to get him to eat. He kept looking at me and appeared to be saying, "Aah Momma, I ate already. I don't want any more. I'm not hungry. Did you forget I'm a greyhound? I should be sleeping now that my belly is full... sleeping not eating more." Then I had to pill him... not fun.

 

So I'm doing my best and trying to space them out a little at least.

 

And Kristin, like Kyle said I can't believe you're dealing with this again. I think of everyone going through awful cancer thing often.

 

Have a great Sunday everyone!

Jean

[RaineysMom]

to everyone fighting this

[EllenEveBaz]

Adding our hugs, too.