PDA

View Full Version : Spencer



Spencer'sMom
22nd March 2007, 04:47 PM
As you may remember Spencer was diagnosed with CM, though thankfully no SM, in mid-February. He’s been on Neurontin (gabapentin) for 32 days and is taking 200mg twice a day. He doesn’t scratch quite as often but definitely with the same intensity and for about the same duration (40-100 seconds- I've timed it!). I finally got to speak with our neurologist today. Gosh, was he hard to get in touch with! He was disappointed to hear that he’s still scratching though did say it was good that the episodes have decreased a little.

He wants us to try 300mg of Neurontin twice a day for two weeks and I need to watch him like a hawk for any signs that his scratching is decreasing. I mentioned adding Tagamet to the Neurontin. He said that we could try it though he’s not sure if will help since Spencer doesn’t have a lot of CSF production and Tagamet is usually good at reducing this. But I’m going to try it anyway! If after two weeks I don’t see improvements he wants us to consider surgery. He said the damage is ongoing and irreversible but surgery would help avoid continuing damage. He does decompression surgery and lamanectamy. I really hope we don’t have to go down this road now but if we do I’m going to research whether it would be better to have Dr. Dewey do it since he’s using the mesh plate.

Please send good thoughts our way. And to Molly and Bentley and all the other wonderful CM/SM furchildren on the board. :flwr:

Nicki
22nd March 2007, 05:21 PM
I'm sorry to hear this. that is quite a high dose of Gabapentin.

I was told that there can be residual nerve damage so the scratching may not go away completely anyway.

THe other effect of Tagamet {Cimetidine} is that it decreases that rate at which Gabapentin is processed by the body - as you may be aware, it's generally given every 8 hours as it passes through very quickly.

Once TedBear was on the Tagamet, we reduced his Gabapentin to every 12 hours, and he's doing fine. Previously he was on it every 8 hours, and for at least an hour before the next dose was due he would look very miserable and uncomfortable.

It might be worth mentioning that to your neurologist too.

I really hope Spencer will keep as well as possible - my personal decision was not to opt for surgery, but only you can decide that.

Spencer'sMom
22nd March 2007, 05:28 PM
Thank you, Nicki. Yes, Dr. McDonnell said to do the Tagamet 3 times per day. I asked about the 600mg of Gabapentin every day and he wasn't worried about. Spencer didn't expereience any of the groggy/out of it side affects when we started it and because of that Dr. McDonnell said he should be fine with the increased dosage.

Lindsay
22nd March 2007, 05:46 PM
TN Spencer to VA Spencer: Feel better soon buddy! :hug: :hug: :hug:

Karlin
22nd March 2007, 06:21 PM
Wow, the tagamet three times daily? Mind if I ask the dose and Spencer's size? (I know you told me the latter before, I just don't remember).

Frusemide works differently from tagamet so that might be a different option. Some find one works and the other doesn't. Many find frusemide is very effective.

Leo's level of scratching has gradually increased so I am looking at whether he needs increased gabapentin or at other options. He is on a fairly low dose -- 100mg twice a day.

PS I think often frusemide alone helps CM dogs that do not have SM... so maybe it is worth trying that rather than tagamet? I know I just read something on this in Clare Rusbridge's thesis so will see if I can find it.

Spencer'sMom
22nd March 2007, 06:46 PM
Karlin- Spencer is my loving Cavzilla at 23.5 lbs. :yikes We're supposed give 1/2 of a 200 mg tagamet tablet 3 times a day. And 300 mg of the gabapentin 2 times a day.

Karlin
22nd March 2007, 06:51 PM
That's interesting, that is a MUCH higher dosage of tagamet than I have seen suggested in one of the club bulletins. Makes me wonder if a higher dose would help Leo. The dose on the bulletin is to take a 200mg tablet, dissolve in three TBSP water, and give an amount just under 1/4th a teaspoon daily. So this is a very, very low dosage -- it would take me several weeks of a once a day dose to get thru that ONE tablet in other words.

I am really interested in this as I haven;t heard of other possible ways of approaching using tagamet.

Spencer'sMom
22nd March 2007, 07:23 PM
Do you think this high a dosage is dangerous? When I asked about it he put me on hold so he could check the dosage. And he didn't say anything about dissolving it in H2O.

Nicki
22nd March 2007, 09:03 PM
I have been told that Tagamet is a very safe drug.

It used to be used for dogs as an antacid - I actually give half a 200mg tablet when they have colic or colitis, it's very effective.

This is the original dosage as appeared in the Cavalier bulletin:

200mg tablet Tagamet dissolved with 1 1/2 oz (3 Tablespoons) water, keep in dark bottle in the refrigerator and give 0.9cc {0.9ML} per day.

I make this up about every 5 days, keep it in a glass bottle in the fridge and give my boys 1ml daily as they are quite big – 21 and 23lb - I have a Cavzilla too :lol: . I find it works best given in the morning about 1 hour after breakfast.

It does sound like he checked the dosage though - I really hope it helps Spencer, please keep us posted.

The severely affected dogs I was aware of from the support group were generally on 200mg of Gabapentin 3 times daily - every 8 hours.

Karlin
22nd March 2007, 10:22 PM
I'd just check the tagamet dosage -- but I am quite interested to know if he feels a larger dose is more likely to be helpful. That .9ml is a tiny, tiny amount daily.

As with humans gabapentin can be variable in how effective it is at certain doses for certain types of pain. Some dogs can be on quite high doses. For some it also may not help very much.

Jen
22nd March 2007, 10:25 PM
Wow, the tagamet three times daily? Mind if I ask the dose and Spencer's size? (I know you told me the latter before, I just don't remember).

Frusemide works differently from tagamet so that might be a different option. Some find one works and the other doesn't. Many find frusemide is very effective.

Leo's level of scratching has gradually increased so I am looking at whether he needs increased gabapentin or at other options. He is on a fairly low dose -- 100mg twice a day.

PS I think often frusemide alone helps CM dogs that do not have SM... so maybe it is worth trying that rather than tagamet? I know I just read something on this in Clare Rusbridge's thesis so will see if I can find it.

Frusemide worked very well in Abbey's case (COSM), but then she started having accidents in her sleep so we took her off it. She's on Gabopentin now, and it seems to be working the same as Frusemide only without the accidents.

Alison_Leighfield
23rd March 2007, 06:34 AM
The severely affected dogs I was aware of from the support group were generally on 200mg of Gabapentin 3 times daily - every 8 hours.

We use 400mg daily (evenly spaced throughout 24hrs), 2mg steroid (2 x 1mg daily) and the tagamet in the above dose. This is just about keeping her at comfortable as a house/garden dog only.
Surgery was not my choice either.

Alison.

Alison_Leighfield
23rd March 2007, 06:36 AM
OOoops...would like to say that isn't for Whitmey (left) she is scanned clear. ;)

Alison.

Molly's mom
24th March 2007, 02:56 AM
Molly is currently taking 100mg 3X a day. They actually prescribed 75mg but liquid form is $65 a bottle here and the pills are only 11.40 for 90 days worth, so the Dr. didn't think it would be harmful to do 100mg.

Nicki
24th March 2007, 10:35 AM
Bev do you mean the liquid form of Gabapentin {Neurontin} or Tagamet {Cimetidine}?

It isn't possible to obtain liquid Gabapentin in the UK, the vets and neurologists don't recommend it, as it is extremely irritating to the gut lining...hence the powder is given in capsules which only dissolve in the stomach.

***note to everyone giving Gabapentin, please do not remove the powder from the capsules to give it to your dog***

Karlin
24th March 2007, 11:40 AM
Hmmm, I did remove it initially when Leo was on 50mg twice a day. I just mixed it in his food and Clare Rusbridge thought that was fine as did my dad (retired doctor). Obviously not ideal as the dosage is not as exact. I wouldn;t think it would matter if given in a regular meal as the capsules dissolve very fast anyway in the gut; a meal would also delay absorption. I can see not giving it in just a small amount of food. Anyway most people don't have the worry of handling small dose, I suppose, which is good -- most dogs start on the 100mg capsules; I've hardly heard of anyone giving smaller doses. Some get smaller amounts made up in capsules but that costs a lot more.

Nicki
24th March 2007, 09:24 PM
It's interesting to hear different views - I remember from the A-C group that quite a few people used to empty the capusle onto a small food item to give it to their dog, and we were telling them not to...

I tried to get the liquid for TedBear, as sometimes it's difficult to get him to take the capsules - but was strongly advised against it, even if we could get hold of it {thought it would also be useful for when we are out to save carrying something to wrap the capsule in - we used to use peanut butter, but he went off that. He finds it in anything like ham or cheese or even chicken, even if you give him several pieces first...the only thing that works at the moment is covering it in a small amount of butter, and giving it to him, then giving him some more butter on your finger to lick. He's so busy licking that he doesn't notice the capsule and just swallows it. Fortunately he's always been on the skinny side so the butter isn't doing him any harm!}

Molly's mom
24th March 2007, 10:15 PM
Yes I meant gabapentin. When Molly was originally diagnosed, the neurologist from Virginia prescribed 63mg. and the vet on duty from my local vet clinic said just to give her 50mg by opening up the capsule and doing my best to split it. :yikes

Spencer'sMom
24th March 2007, 11:51 PM
Spencer's been on Tagamet (well the generic kind from Walmart!) for three days and call me crazy but I really think he's scratching less. He still does it a couple of times in the morning and then again about an hour before his nightime does of gabapentin. But I haven't seen him do it during the day, which was a problem before. Please keep your fingers crossed that I'll continue to see improvements.

Here's what he's getting.

6am- 1/2 of a 200mg Tagamet tablet
7:30 am- 200mg of Gabapentin
2:00 pm- 1/2 of a 200mg Tagamet tablet
7:30 pm- 200mg of Gabapentin
10pm- 1/2 of a 200mg Tagamet tablet

Bev- where did you find gabapentin for so cheap? I called around and found that Walmart would be the least expensive for our month supply of 120 capsules- $55.

Karlin
25th March 2007, 02:23 AM
I bought generaic cimetidine in 200mg tablets over the counter at Walgreen's in the US on a visit, at $10 for 50. Bet you could get even cheaper generic cimetidine at someplace like Costco.

That's interesting though that the dose of tagamet/cimetidine is so high. I wonder if other neurologists are prescribing at that level. I'd be really interested in seeing some other recommended dosages as the liquid solution from dissolving a tablet is so much smaller a dose and does little for Leo. I'd like to increase the dose if there are other recommended doses of this. Must ask Clare what she thinks -- her treatment diagram for example offers the usual starting dose and how to increase, for a number of drugs. It would be helpful to have a similar diagram for tagamet.

Molly's mom
25th March 2007, 04:40 AM
I stand corrected, it is 90 pills for 11.40 not 90 days. icon_whistling
That being said, we called around and oddly enough it was a locally owned pharmacy that had the cheapest price. The other chain pharmacies ranged from $25-$50.

When the Dr. suggested lyrica, it would have been $180 a month :yikes a whopping $2 per pill x3 a day. I asked if we could try it for 10 days, and it ended up not helping anyways.

Janine
25th March 2007, 07:32 PM
Nicki/Alison

Do you get tagamet/cimetedine from your vet? I don't think you can buy it over the counter in the UK, can you? We'd like to try Emma on it as she's not doing brilliantly at the moment.
Best wishes
Janine

Karlin
25th March 2007, 08:55 PM
You can't get tagamet/cimetidine over the counter in the UK or Ireland. Hence when I was in the US I grabbed the chance to pick it up over the counter and cheaply. :) Thinking back I think I actually got the 50 pills for 6-7 -- the brand tagamet was more like $10 for 50. IT sure is worth calling around because independent pharmacists do often have drugs cheaper.

Lyrica is a stronger variation of gabapentin -- it may be less to give one of those rather than several of the gabapentin doses. My mom used Lyrica for a while and found it knocked her out. Some say the same with dogs -- but others have good reports (for dogs needing really strong pain relief).

Caraline
26th March 2007, 01:04 AM
Big hugs for Spencer. :hug:

Nicki
26th March 2007, 08:33 PM
Janine, I get a prescription from my vet for Tagamet {Cimetidine}, and then take it to my local pharmacy - there is a standard prescription charge which is currently £6.65 - I get 120 tablets for that. Obviously this will go up slightly in April...

The Gabapentin comes directly from my vet - it varies considerably in price even from month to month - I've paid from as little as just over £15 to as much as £50 for 100 tablets...

Alison_Leighfield
28th March 2007, 10:04 PM
Hi Janine, :flwr:

I get the Steroids, Gabapentin and Tagamet from the vet and they bill the insurance normally monthly for me. I just pick it up around the 1st of the month when she has a little check up.
I like to have her weighed and her heart checked and also a quick chat about any concerns with the SM etc.
I will find the invoice and see how much they charge.

Alison.