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Timing pain medications
Neuro Corner Answers
Dr. Jared Galle
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, spinal trauma, wobbler syndrome, inflammatory brain disease, and developmental brain abnormalities (hydrocephalus and Chiari malformation).
Question
BARBARA WONDERS:
If gabapentin given at the same time as tramadol and robaxin would pain relief increase as opposed to giving the gabapentin a few hours after the tramadol and robaxin? I am giving my dog tramadol and robaxin 2 times daily as well as gabapentin 2 times daily. I have been giving the tramadol and robaxin together and then giving the gabapentin about 5-6 hours later as to try to keep some kind of pain medication in his system working toward pain relief. What is your opinion on this?
ANSWER
Hello Barbara and thanks for the question. First, if you feel that your pet’s pain is not being adequately controlled, contact your veterinarian. The medication doses or dosing frequency may need to be changed.
Research studies have found that when when given together gabapentin and tramadol can enhance the effect of each other; therefore, giving the two drugs together may have an advantage for treating inflammatory pain.
You need to keep in mind that not all dogs respond the same way to pain medications. I have had some patients that respond better when staggering pain medications. You should consult you veterinarian if you want to change the tramadol and gabapentin dosing instructions that are on the prescription.
Dr. Jared Galle, DVM
Diplomate ACVIM (Neurology)
Tense during expressing
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
ANGELA ASKS:
My little doxie, tenses up when I express him. He won’t let me do it and he also cries.
When the vet does it he gets lots of urine out, but I can’t. I squeeze a lot and nothing comes out. He’s tensing up. I heard there is a medication to help relax his muscles in the bladder. Do you know what it’s called. And how much to take? He weighs 18 lbs. Thanks.
ANSWER
I would talk to your veterinarian about trying a course of diazepam (Valium). Typically, I use a dose of 0.5 to 1 mg/kg every 8 hours – giving the dose and then trying to express 30 minutes later.
Andrew Isaacs, DVM
Diplomate ACVIM (Neurology)
Rear sway and discomfort
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
WENDY ASKS:
My 8 year old French bulldog has been diagnosed with IVDD about 6 months ago. He has always loved to walk around the block but these days by the end of the walk his backend is swaying from side to side like crazy and then he shows signs of discomfort later in evening.
My question is: Would a backend cart be something I should consider that would allow him to take daily walks around the block or does the small dose of exercise (we live on a small block) do him good? Thank you for your help-
ANSWER
This is a good question. How was your Frenchie diagnosed with IVDD, were any medical or surgical treatments prescribed, and are there other times that you appreciate a sway and discomfort?
In general, I would be leaning towards trying to limit the walks to a length that does not lead to the sway and discomfort. This would help with maintaining muscle tone and strength in his rear legs. If this is not possible then a cart would be something to consider to help with his quality of life. Either way it would be worth getting set up with a physical therapist to give you low impact activities to help with maintaining muscle strength.
Andrew Isaacs, DVM
Diplomate ACVIM (Neurology)
Surgery indicators
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
NANCY ASKS:
My dog has been diagnosed with IVDD about three years ago. I am terrified to take him to surgery, he is a small Chihuahua. I am unsure of success rates, recovery times etc. Could you tell me at which point surgery is indicated?
ANSWER
Hi there,
The decision to do surgery is dependent on a variety of variables. The ones that I typically take into account in deciding if surgery is indicated are
- 1) neurological status
- 2) degree of compression noted on imaging
- 3) history (medications and doses of medications, flair ups, etc)
- 4) expectations of owner
So, unfortunately this is a difficult question not knowing the specifics pertaining to your dog. Ideally, if you are able to take him to see a neurologist these are questions that they could answer for you.
You should not be afraid to ask questions.
Also, you should never feel pressured into surgery.
Hope this is somewhat helpful.
Andrew Isaacs, DVM
Diplomate ACVIM (Neurology)
Anti-inflammatories warrant stomach protection
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
G ASKS:
Knowing a dog’s body is stressed during a herniation, and stress can cause gastric problems (vomit, diarrhea, ulcers, etc), and knowing NSAIDs and steroids can also cause gastric problems, Should gastric protectors always be used during a dog’s medical treatment for a herniation, to prevent complications, such as an ulcer?
ANSWER
The use of a GI tract protectant in cases that are receiving NSAID’s or steroids would definitely be warranted under the supervision of the patient’s veterinarian
Andrew Isaacs, DVM
Diplomate ACVIM (Neurology)
Expectation for spinal cord healing
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
CIARA WORRIES ABOUT THE FUTURE AFTER SURGERY:
My dog is currently in recovery, he had deep pain sensation before surgery as far as I was aware. He had been wagging his tail on Sunday. The herniation occurred on Saturday at 1.30am (so Sunday really) I phoned the vet straight away but she said to take him out in morning.
Unfortunately she misdiagnosed a torn ACL and referred me to a specialist on Monday. At 10 am on Monday I saw the specialist and she said it was spinal and referred me on to another specialist. By 6pm on Monday he had his Myelogram but they couldn’t perform surgery that night as he had been under too long already. Surgery was performed on Tuesday later than expected as I think they wanted to ensure he had recovered properly from the anesthetic from Monday and he was awake and looking around him by 8pm on Tuesday night. I know it wasn’t in the ideal time frame unfortunately, if I had known earlier he would’ve been seen earlier but hopefully it doesn’t affect his chances. Would they have given medication to prevent deterioration in this time?
The vet said they are happy with him and the surgery but he hasn’t regained motion in his legs yet but it has only been 29 hours. I need to ring to find out more tomorrow as I haven’t been thinking clearly when on phone to ask right questions. He is about 150 miles away or something as it is only place does this surgery and I am going to visit on Friday now. I am obviously very worried and I’m hoping to see signs of improvement.
If he does walk again can I still take him on walks when he is better?
And is he more likely to re-learn that he needs to pee than to walk?
I just want him to be ok and pain free and if that means wheels that is ok too. It’s not ideal but which comes first, bladder control or walking?
This is just a horrible time I don’t have insurance of course (hindsight!) but I will get help to pay his bills off for now. I am very worried about future incidences but I will do what I can to prevent this. It’s all so horrible and worrying I hope he is ok. If he wags his tail on Friday I will be elated. Thank you for taking the time to read this I just need some answers I hope I have provided enough information.
ANSWER
Ciara, hope all is going well with your dog. I know it is hard, but the time that sets the tone for his recovery is the first 2 to 4 weeks after surgery. Not that there is not continued improvement after 2-4 weeks, but I would not want you to get discouraged until at least 2-4 weeks have gone by without any signs of improvement – the spinal cord takes time to heal.
You definitely can take him on walks when your vet lifts the post-operative restrictions. The key is to make sure your dog is on a leash with harness to help prevent higher impact movements on the walk.
Typically, we will see dogs start to voluntarily urinate when they start to get movement in their legs. It does not have to be enough movement to walk though. So, urination usually precedes walking.
Please let me know if you have any other questions.
Andrew Isaacs, DVM
Diplomate ACVIM (Neurology)
Sling for a wobbly dog
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
MAGGIE ASKS:
My 6 year old female miniature dachshund was having pain, and I took her to the Vet, she is on crate rest now since Wednesday. When I take her out to pee. She has trouble standing, it seems to be her rear legs, and she will flop and fall over. The vet thought it was a cervical disc, and we are treating conservatively with Prednisone and pain meds.
I saw that you used a leash to hold up the back end of a dachshund, is that recommended? I don’t want her to hurt herself more with the falling.
ANSWER
Using a leash, towel, or other cloth item in front of the rear legs under the abdomen as a sling is OK. There are slings that you can purchase, but the hope is your dog gets better and there is not a need for a sling long term.
Ideally, if your dog is that wobbly it would be best to be seen by a specialist that can talk to you about advanced imaging +/- surgery. It is understandable if this would be cost prohibitive, but just wanted to make you aware that at this stage more than medication may be required.
Andrew
Seizures and IVDD linked?
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LINDA ASKS:
Have you seen a link between seizures and IVDD disc episodes?
ANSWER
Dogs that have idiopathic [cause is unknown] epilepsy could have a flare up of seizures due to the stress of having IVDD. Visa versa we see dogs develop IVDD after having had seizures.
Andrew
Do anti-inflammatory drugs prevent disc episodes?
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
JILL ASKS:
- 1- For a Staffy breed, would that mean she has Hansen type 2?
- 2- Can a neck pull on a leash rupture an IVDD disc in lower lumbar-sacral?
- 3- Can anti–inflammatories prevent a bulging disc from fully rupturing?
My Vet and Chiro had conflicting answers on some of these questions….thanks for any information!
ANSWER
Larger breeds typically have Hansens type 2, but will sometimes see Type 1.
Pulling on a dog’s collar with neck lead could potentially cause L/S disk rupture, but more likely to cause cervical disk issues.
Anti-inflammatory medications help address inflammation, but do not prevent a disk from rupturing.
Andrew
[Editor’s note: See harness information for the IVDD dog (selecting and fitting) https://dodgerslist.com/harness-with-leash/
Pulling on leash-collar disc stress
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
JILL ASKS:
With a collar, is pulling backward more stress on the neck than pulling forward? Meaning, your dog pulling you, or you standing in front pulling him forward? Can neck pulling affect a disc in the lower lumbosacral area?
ANSWER
Both can be stressful on the disks in the neck. If the pull was hard enough it could cause issues with any disk.
Andrew
[Editor’s note: See harness information for the IVDD dog (selecting and fitting) https://dodgerslist.com/harness-with-leash/
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