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maneumann
11th December 2007, 11:55 PM
So poor little Jack is now suffering from internal bleeding as a side effect of the prednisone. They can give us medicine which will help heal his intestine, however, clearly he needs his medication changed or reduced. Waiting for his neurologist to make a recommendation.

Currently Jack is taking 2.50 mg every other day. Before this he was on 1.25 mg daily, but in attempts to reduce the side effects his vet wanted him to start pulsing (effectively doubling up one day and not taking nay the next).

We tried pulsing initially, but it caused Jack to have some very bad days, so we went back to daily dosage. This second effort has been OK, and he is mostly having good days. However, now internal bleeding. Jack also takes 75 mg Gabapentin twice daily and has weekly acupuncture (which seems to really be helping with energy levels and mood!).

What have others done with medication? And what dosages of Prednisone and frequency are most dogs on?

Thanks,
MA

Nancy
12th December 2007, 12:31 AM
what medicine are they giving him? I know sucralfate before meals is supposed to coat the stomach to avoid ulcers. I had a dog who also took tagamet or pepsid when taking steroids.

Cathy Moon
12th December 2007, 01:11 AM
I hope Jack feels better soon.:hug:

Charlie is taking:
80 mg Gabapentin 3 times a day
40 mg Amantadine once per day
10 mg Prilosec once per day

On his bad days we can also give him 25 mg Tramadol up to 2-3 times a day, if needed.

Charlie was on Prednisone for 2.5 weeks following decompression surgery, and he had diarrhea with a small amount of blood. It turned out that he had an overgrowth of Clostridium. He took liquid Flagyl and Benebac to heal from that. He's on his second 'syringe' of Benebac now and finally back to normal.

maneumann
12th December 2007, 04:50 AM
The vet gave us sucralfate and pepcid AC, because they don't want to reduce his Pred. So the same stuff.

Good to get some reference on the medication, so Charile does not take any pred?? Are the Prilosec and Amantadine easier on the body?

Kindest regards,
MA

Friday's Mommy
12th December 2007, 05:26 AM
Friday was on prednisone early on before and right after her surgery. I disliked it because she was so hungry all the time. She used to be a very picky eater and since then it changed her view on food.

Friday is on 100mg gabapentin 3x/day
25mg furosimide once a day (morning)
tramadol as needed (usually 1 or 2 per week)

Tried the prilosec and didn't see any difference.
Amantadine I've never heard of and I'll ask my doc about that. Cathy, is it a new drug to treat SM? It looks as if you and Cathy are having good results with acupucture and I may check more into that too. How often do you do it?

Cathy Moon
12th December 2007, 11:40 AM
The vet gave us sucralfate and pepcid AC, because they don't want to reduce his Pred. So the same stuff.

Good to get some reference on the medication, so Charile does not take any pred?? Are the Prilosec and Amantadine easier on the body?

Kindest regards,
MA
No, Charlie doesn't take Prednisone; only for that short while when he scratched his incision from the decompression surgery.

Prilosec is an over the counter acid-reducer drug which happens to have a side effect of reducing the amount of cerebral-spinal fluid the body produces.

Amantadine is an antiviral drug that has neurological side effects which are currently used to treat Parkinson's disease in humans.

I think the drugs that Friday is taking are the ones that are most often recommended by Clare Rusbridge.

I'm not sure why Charlie isn't taking those, except for the fact that he had severe neurological symptoms such as proprioceptive ataxia (dizziness, coordination problems), tetraparesis (weakness in all 4 legs), and a hypermetric gait (stepping high with front legs). The ataxia is gone - Dr. A. feels it was the high doses of Gabapentin which caused that, but Charlie has permanent neurological damage remaining.

We have to go to a compounding pharmacist to get the Amantadine and Gabapentin 80mg prescriptions, and it is costly! I don't know if these drugs are easier on the body. But they're working for Charlie, so we're staying with them.

Cathy Moon
12th December 2007, 12:08 PM
Amantadine I've never heard of and I'll ask my doc about that. Cathy, is it a new drug to treat SM? It looks as if you and Cathy are having good results with acupucture and I may check more into that too. How often do you do it?

I don't know if Amantadine is new.

We're going once a week for acupuncture. I'm not sure how many appointments will be needed as we've only gone one time so far.

Barbara Nixon
12th December 2007, 12:40 PM
Perhaps your vet will prescribe a different steroid. When Teddy had them, for his skin, the vets swapped between Prednisolone and Medrone, saying they had slightly different effects.

maneumann
12th December 2007, 05:20 PM
We're going for a second opnion in two weeks, so I'll be sure to bring up some of these other medications.

Regarding the accupuncture, Jack has been going for 4 weeks. I think his holositc vet, whom I like very well, would like to keep seeing him weekly indefinitely. But it is $90 a session, so my plan is is go for 3 months (which I've read is the time needed to "rebalance" weekly and then every 10-14 days for maintaince.

Karlin
13th December 2007, 04:29 PM
Hmmm -- I'd really rethink this with the vets as they are starting the usual treatment protocol in reverse. Have they considered pulling him off steroids entirely and just putting him on a higher dose of gabapentin? What he's on now is extremely low as a dose -- the very minimum Dr Rusbridge recommends for example. My Leo, who only weighs 15 lbs, takes 100mg twice daily and he only has moderate scratching symptoms and no clear pain. Clare Rusbridge only puts them on preds when *nothing else works* or to bring immediate relief for a seriously affected cavalier. You'll note her treatment protocol says to begin with a low gabapentin dose but to increase if there's no relief. Steroids are her last recommendations before moving to surgery or for seriously affected dogs for whom surgery isn't a consideration.

Also, gabepentin clears the system after 8 hours for many dogs and he is probably being left with no relief at all from it for two four-hour periods daily. I'd talk to a neurologist about changing this regime as a matter of urgency if he is having internal bleeding, and/or maybe go through the Rusbridge recommendations with your vet?

maneumann
13th December 2007, 05:41 PM
I'm actually starting to rethink his vets altogether. I was promised that they would contact Dr. Kortz and Dr. Rusbridge and neither has happened. Jack has an apt. Jan. 2 with Dr. Kortz because I can't wait any longer for the 2nd opinion on the surgery.

They do think Jack is seriously affected, before he started taking his Predisone and Gabapentin he was only walking with one leg in the air and screaming. His MIR also showed his brain to be very far back. Now he is close to normal.

Do you think I should try giving him his Gabapentine 3 times a day and ween him off the pred now? Or, does he need somethign in addition to the Gabapentine? He is not even 11 lbs yet and 8 months (a side effect I think from the pred), so 75 mg may be becuase of his weight? I'm sure his reg, vet woudl give me a prescription until I see Dr. Kortz.

Thanks!

natalieandmike
13th December 2007, 11:02 PM
I don't like the side effect profile of prednisone in humans much, either. I've seen too many GI bleeds on it, and over the long term, bad Cushinoid symptoms...

Immediately post-op Bianca was on Gabapentin tid 100 mg. She was NEVER on prednisone before or after surgery. For awhile, she scratched a bit at her sutures, so we put her in a cone. No prednisone, though. Now she is 4 weeks post-op, and off all meds including gabapentin (fingers crossed!). I don't think of prednisone as a long-term solution for anything. It basically suppresses your immune system, which will give you bigger problems in the long run. I'd up the Gabapentin frequency to tid as Karlin said --again, you may want to consult another neurologist here as I'm no expert!

Karlin
13th December 2007, 11:03 PM
You really need a neurologist's advice on this as these are serious medications. I'd contact Kendall for a vet that is familiar with SM as I know you have been in touch before, who might be able to change his meds. I'm afraid I don't know any vets in your region who know about SM though. I don't want to give advice on self-medicating for something this important -- I am really giving suggestions on what the usual approach would be by many neurologists and am suggesting finding someone (or sit down with your vets) who would go through Clare's document.

The symptoms you describe, if due to CM or SM, would be considered serious, I'm afraid. Different neurologists will see different things in an MRI -- I'd only want it read by someone very familiar with SM in the breed.

Kendall would be a very good source of advice. :thmbsup:

maneumann
13th December 2007, 11:34 PM
Kendel is a good call, I'll email her tonight. Is Clare's document on the cavalierhealth.org? I've saw a list of meidcations on there to be used.

That is great news on Bianca!!!! How long was the recovery? Is she showing less symptoms post surgery?

Cathy Moon
14th December 2007, 03:47 AM
Clare's documents are on this site:
http://sm.cavaliertalk.com/
I'll be thinking of you and Jack :hug::hug::xfngr::xfngr:

natalieandmike
14th December 2007, 04:29 AM
Thanks for asking...but I don't want to hijack your thread! (Bianca is now 4 weeks post op and seriously she is doing so well I 'm kind of holding my breath if that makes any sense...she isn't doing ANY bunny hopping or phantom scratching like she did before surgery, but I have read that it takes up to 3 months for the healing process, and then when the scar tissue forms you may see a return of symptoms so I can't be too premature here). But she is back up to nearly normal activity (no strenuous runs yet) and to look at her, you'd never know she had surgery. Granted, her symptoms were not as severe as many with SM who opt for surgery, as for example, Charlie.

Anyway, back to the thread at hand--I'm keeping my fingers crossed for you and Jack , so let us know what Kendall/another neuro says. :dogwlk:

maneumann
14th December 2007, 05:53 AM
Thanks Cathy-- I'll take the medication diagram in on my next visit and report back!!! I just hate him being on predinsone.

Such great news on Bianca! That gives me hope for Jack Sprat. :)

maneumann
9th January 2008, 05:59 PM
We saw Dr. Kortz in Roseville, CA last week and really liked him. In part because he is very optimistic, but also because he is the first neurologist we have come across that treats multiple Cavaliers with SM and has preformed the decompression surgery several times. Dr. Kortz used to fall into the decompression surgery camp, but now feels that the techniques that exist today will only relieve symptoms for a period of time (6-12 months). Although, he did agree that if we were to do the surgery, that the sooner the better. In his experience, dogs that are medically managed do as well as the dogs that get surgery in the long run. Since this is technically Jack Sprat’s fourth opinion (one was an informal opinion over the phone with a neurologist in OR), we are going to continue on this path. Particularly since Jack is doing so well presently.

He also suggested that acupuncture remain part of Jack’s treatment as it helps to manage pain. Best of all, Dr. Kortz feels that we can wean Jack off prednisone and instead Jack will take omeprazole in conjunction with his gabapentin! That makes me extremely happy due to the internal GI bleeding, although I guess this medication carries the long term risk of stomach cancer. He did indicate that Jack would likely get worse at times and then need to go back on the predisone. And then when the symptoms subsided, we could take him off again. It reminded me of the progression of multiple scoliosis. I have a good friend and a aunt that have MS and the symptoms flare up and then go away, although with every flare up something remains… a left foot that drags just bit, slurred words, etc. and in this way the disease progresses.

Karlin
11th January 2008, 03:38 AM
This is a highly personal decision. The only comment I'd make is that his opinion would differ from many and probably most other neurologists that have done many surgeries in this area. With a young dog with very apparent symptoms personally I'd be thinking of surgery as one of the only options for medium to long term lifespan (and I have a moderately affected dog where I am not considering surgery, weighing up the available options). I know of surgery dogs still doing well with no medications 6 years after surgery. Few dogs post surgery decline enough that they need to be euthenised. Clare Rusbridge has actually tracked the surgery vs non-surgery dogs and there's a higher rate of euthenising with non-surgery dogs. Having spoken directly with her on this issue, she feels that IF a dog has mild to moderate symptoms, medications are a viable option to consider for longer term treatment but she would feel symptomatic young dogs probably have very few options excepts surgery for anything more than a short term prognosis and short term palliative care.

This is a very personal choice but just be aware that his view would not be a common one. Kendall I know would be more than willing to discuss this further as she also met with Dr Kortz in the process of making a decision. I would recommend getting a bit more context before accepting this viewpoint. Also keep in mind that various surgeons do this surgery in different ways and may all get different results with their approach. I've certainly never heard of *most* dogs declining after only 6-12 months and know of many who are several years beyond surgery and leading normal lives, albeit often continuing on gabapentin for scratching.

Paper 9 here might be of interest: http://sm.cavaliertalk.com/research/london/london06.html

maneumann
15th January 2008, 05:16 PM
Trust me, we did not reach this decision lightly and we continue to question it everyday. But, we have talked to 4 neurologists, and 2 of those doctors are very familiar with SM. One of them was also Rory’s (Kendall’s dog) neurologist, Dr. Harrington. His advice was to wait until Jack was a year and he is becoming more in favor of acupuncture as a means of treatment instead of surgery. There is a lot of concern that in such a young dog his bones are not fully formed and scar tissue or regrowth of the skull would be much more likely. The study (#9) also suggests that the average relief is .2 to 2 years and then there is decline again. Dr. Kortz feels that the dogs that show relief for longer periods are dogs with less severe symptoms to begin with and poor Jack was having very apparent symptoms at 5 months.

Dee Dee
3rd March 2008, 12:36 AM
I am new at this, my longhaired dachshund was just diagnosed with a dilated spinal cord this week (we have yet to do the MRI). I am planning to take her to Dr. Harrington this time, so I am glad to see him mentioned and that it sounds as though he is pretty good with this kind of thing. Did you really like him? I hear as of last Friday he has moved up to the Lynnwood area (unfortunately). I wish you the best with Jack, I had never heard of this horrible thing before and I am pretty devastated at the news as I'm sure you all were when you first heard it. I still don't know much about it and am wondering if I'll ever see my little girl like she was a week ago, again! Happy and no pain...

Dee Dee
3rd March 2008, 10:35 PM
I am desperately trying to locate Dr. Harrington but his office is closed and he appears to not be practicing at the moment. I hear he may be moving out of stae. I am so upset, I think I missed being able to see him by just a few days. Does ANYONE still have a contact for him?? I tried sending an email but it keeps coming back. If I could contact him and just ask him for a phone consult...so he can answer some questions for me would be such a help. Please if anyone knows how to contact him can you let me know? Thanks!

maneumann
4th March 2008, 01:33 AM
I got his contact information from Cavalierhealth.org. I did like him, but it was a phone consultation and he ultimately referred me to a neurologist we are now seeing in CA, so i do not have a very strong opnion. I was referred to him by a UC Davis vet student who really likes him, so that is a good sign if you can locate him. Best of luck with your baby!

Cathy Moon
4th March 2008, 01:46 AM
I am desperately trying to locate Dr. Harrington but his office is closed and he appears to not be practicing at the moment. I hear he may be moving out of stae. I am so upset, I think I missed being able to see him by just a few days. Does ANYONE still have a contact for him?? I tried sending an email but it keeps coming back. If I could contact him and just ask him for a phone consult...so he can answer some questions for me would be such a help. Please if anyone knows how to contact him can you let me know? Thanks!

I have sent you a private message with contact information for several neurologists in WA state. The information I sent came from CavalierHealth.org

Karlin
4th March 2008, 02:06 AM
I don;t know what his current status is; I'd be really glad to get current info when anyone has it! The other neuro you mentioned in another post is also listed on Cavalierhealth as having SM experience. :thmbsup: