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jacies
30th October 2009, 04:47 PM
After taking Chaos to the vet because her SM was not being controlled enough with the Gabapentin she decided to put her on Preds as well and Tramadol. She gave me a supply of the Preds and she is now having 1 x 5mg per day. She ordered a supply of Tramadol but when I went to collect these they were 50mg capsules and she wanted her to have 1mg-5mg per kilo of weight, twice a day. The vet on duty would not give them to me as said they were too strong as Chaos weighed 8.7kg. I managed to speak to the orginal vet again and she said they could not supply the tablets but I could collect a prescription and get them myself.
I have now collected the prescription but which is for 50mg tablets and says to give 1/2 a tablet BID (not sure what this means) I have checked with the online chemist I use and the local chemist. They do not think they can be cut in half because they are sustained release.
I was wondering if any other SM dogs were on Tramadol and if so what type of tablets/capsules and what dosage and where you get them from? The vet I am seeing does not seem to be very clued up about this medication, she was researching it online I think and also it a 35mile round trip to see her.
I should say that the improvement in Chaos since being on the Preds is amazing, she walks so much better and I am pushing her stroller round with us but she really does not need it much and she is much happier all round. I think the idea of the Tramadol was to give that as well and try to slowly wean her off the Preds.

*Pauline*
30th October 2009, 04:59 PM
I've never heard of Preds but, if it is working well, does she need this Tramadol tablet (I've never heard of this either) which is impossible to split so small? The less pills the better is what I say but you best ask your neurologist.

jacies
30th October 2009, 05:07 PM
Sorry Pauline, Preds was short for prednisolone or steroids. I guess she wants to cut these out eventually or at least cut them down because of long term damage caused by them. The Tramadol tablets can't be split because they say they are sustained release, I think this means that the drug is released slowly in the stomach over 12 hours.

*Pauline*
30th October 2009, 05:10 PM
Yes, my neuro and i don't like steroids especially giving them to such a young dog as mine is but Chaos is nearly 6, even I would consider steroids at that age.

Murphy
30th October 2009, 06:51 PM
Sorry Pauline, Preds was short for prednisolone or steroids. I guess she wants to cut these out eventually or at least cut them down because of long term damage caused by them. The Tramadol tablets can't be split because they say they are sustained release, I think this means that the drug is released slowly in the stomach over 12 hours.


Might be an idea to get your Vet to e-mail C Rusbridge or whoever your testing Neuro was? I know Clare is very helpful about Meds. and has done much research into their administration.
Just an idea?
Elspeth Glen

Love my Cavaliers
30th October 2009, 06:55 PM
First of all, BID means twice a day. It is just medical shorthand. Riley was on Tramadol only after her SM decompression surgery. I was given 50 mg tablets and she was to have 1/4 tablet as needed. They even divided them into 1/4s for me. The ones you received must be different. The prescription on her bottle reads Tramadol Hcl 50 mg. Does yours actually say "timed-release"? Riley weighs about 12 pounds or 5.4 kg. She is also on the same daily dose of prednisone as Chaos and it is a wonder drug for her. She has been on it for about 6 months now and is a different dog on it than off it. Her balance is much better and she seems more like a normal dog - happier like Chaos. Because she is on it long-term she also takes Denamarin - a supplement to protect her liver. So far the only side effect I have noticed is that her chest hair is starting to thin out. Other than that, she pees longer when she goes out, but doesn't need to pee more and has not gained weight. Hope you get it figured out.

jacies
30th October 2009, 08:12 PM
Thanks for reply Bev. I havn't got the tablets yet because the online pharmacy told me on the phone that they could not be cut in half because of being sustained release. My local chemist told me the same thing. I think I will have to do a bit more research on the internet about Tramadol, maybe a different supplier might have normal ones. I will also look into Denamarin supplement, my vet did not mention this.

Karlin
30th October 2009, 08:50 PM
If your is basically vet guessing about putting her on preds, I would really talk to a neurologist or have the vet talk to a neurologist. Often you would simply raise the dosage level of gabapentin or introduce something like tramadol or metacam. Often you'd use a CSF inhibitor before something like metacam -- that is typically the starting point for medications, and often it is enough on its own or working with gabapentin. Preds generally would be the last resort drug to give long term, if nothing else is working (NB it is the very last option to go with on Clare Rusbridge's treatment diagram (http://www.veterinary-neurologist.co.uk/syringomyelia/docs/treatalgo.pdf)). Generally with SM it doesn't seem to work to put the dog on prednisalone then wean them off -- the results don't last as they do with some other illnesses. Is your vet working from/familiar with the treatment diagram? That might increase options. There are several other NSAIDS that can be used besides tramadol, for example. The diagram also shows tests that should be done once dogs are taking these drugs.

meljoy
30th October 2009, 09:31 PM
Hi,

I presume that Tramadol for dogs is the same as Tramadol for people? If that is the case then they are actually powder inside a capsule which is why you cant split them.
Tramadol is a very strong pain killer, one step down on the WHO pain ladder in people from Morphine based meds.

The adult dose in a human is 300mg a day so 50mg BD seem quite a bit to me for a little dog.

Good luck and keep us posted.

Mel

jacies
30th October 2009, 09:44 PM
Karlin, when Chaos was first diagnosed at the RVC she was just started on Gabapentin. Whenever she had a really bad episode the vet I used then put on her a short course of metacam or rimadyl but these always upset her stomach. After doing my own research I decided to give her the omeprazole and this really helped with her stomach problems if nothing else. Since her insurance would no longer pay for SM I now have to go to the PDSA. They also gave her Carprofen which also upset her and did not make much difference to the SM.
When I went there a couple of weeks ago I once again took the treatment chart from Clare Rusbridge with me but she did not want to look at it. She said to me "I read a new article yesterday about SM treatment but it is at home, I will read it tonight and ring you tomorrow with what I will prescribe". I asked about the tests of their liver etc. that they should have but she said that although a regular vet would do these the PDSA did not do them.
She then phoned me and said she wanted to start Chaos on prednisalone and tramadol, I went back and collected the preds and she said she would order the tramadol as they did not have it in stock.
I do not have a copy of Chaos's scan but I do know that it looked quite bad and the notes from RVC say "neurological lesion present; spinal cord lesion present C1C5 lesion; ataxic in all four limbs; cervical hyperaesthesia in caudal and mid cervical spine.
I am not sure if I would be able to talk to a neurologist but could try to phone the RVC and see what they suggest. I know she is 100 percent better on the prednisalone and did not really understand why she needed the tramadol as well.

Karlin
31st October 2009, 01:20 AM
Prednisalone is always a bit of a miracle drug -- the issue is the long term effects. However neurologists definitely say it may be the drug of choice in many situations and the goal is to find the lowest maintenance dose. If you see a big improvement maybe that is your best option.

But that is a bit strange that a vet, who is not a specialist, would not care to look at a treatment protocol from one of the leading specialists which is widely used by other specialists. :confused:

I'd ask the vet why she thinks Chaos should be on both Tramadol and preds. In your shoes I'd feel a lot more comfortable if the vet was willing to talk to the RVC neurologist rather than making guesses about how to treat -- generally neurologists are very wiling to advise the primary care vet. If you wanted to make that intervention yourself you could definitely try ringing the RVC and explain the situation.

It is so hard to know what to do. Many of us are not in the ideal care situation and live far away from our neurologist or need to switch to dealing with our vets instead. You are doing the best in the situation I think. I'd politely hold your ground to get the explanations you need to understand this vet's choices. She is clearly reading up etc which is great but the rejection of the established treatment protocol seems a bit odd.

*Pauline*
31st October 2009, 10:12 AM
I am not sure if I would be able to talk to a neurologist but could try to phone the RVC and see what they suggest.

I went to the RVC and saw Victoria Penning who is happy to phone me back when she is free and I never have to wait more than a couple of hours. She invites me to phone whenever I like and I would never let a vet decide what to give Dylan.

On the scan issue, the software to print off our scan was down at the RVC when Dylan had his MRI. After claiming my insurance, the scan on film was available from the RVC, but the insurance would only have paid had it been included in the original claim. So I could pay about 50 for two films (he has two syrinx) or have a disc with 193 images for FREE! I chose that. Ask your neuro, who did you have?

harleyfarley
31st October 2009, 10:26 AM
Harley was in awful pain yesterday so i took him to the vets, he was given tramadol too but only a few days supply, also he now has a plastic hood to stop him aggrevating his wound which he hates. The vet which was a lo-cum
was dubious about precribing him anything else until she speaks to the neuroloigist at the animal health trust to see what they recommend.

jacies
31st October 2009, 01:44 PM
Pauline, at the RVC I saw a German chap called Holger Volk but am not sure if he is there all the time or was just running the drug trial that Chaos was on to find a new drug for SM. That is probably the reason that they kept the scan and all I have are copies of the notes which they sent to my previous vet. Don't know what is happening re the drug they were testing now but am pretty sure that Chaos got the dummy pill as it did not make any difference to her at all. Dr Volk obviously did not know which dog got which but he did tell me that some dogs had improved a lot.
Anyway, hopefully they will still have the details on Chaos and might be able to help me.

Karlin
31st October 2009, 11:54 PM
Judy let us know how it goes. You can't lose by calling and asking. :) Vets are right to be cautious but generally the neurologists everywhere have been good about giving some basic advice to the treating vets for dogs they have seen and scanned.

A lot of vets would not know too much about using gabapentin as it is not licensed or has not been for animal use.

antigone
1st November 2009, 01:31 AM
FYI, Levi is on Tramadol (among other things). You can order it (with a Rx from your vet---which they will call and fax for) from Drs Foster and Smith Vet pharmacy. There is no postage on meds sent from there in the US but I don't know their policy for outside the US. They sell it in a generic for $.30 (which would be .2 Euros). If it is legal to send rx drugs from country to country, this might be a solution. The tablets come in 50 mg so I split them in half for Levi. He gets 25 mg three times a day: at 7 am. 3 pm, and 11 pm. Every eight hours. Sometimes he has been on Tramadol every six hours but never more frequently than that and never at stronger doses. The tablets are not sustained release and are the same tablets he got at LIVS (they also split them in half). You don't usually give the proton pump inhibitor (Prilosec, famotidine, or medicam or ?---CSF reducers) at the same time as you give the Neurontin (gabapentin) because they interact in some way. That is NOT a hard and fast rule, I guess, and the interaction, if any, isn't dangerous.

Kathy

patg
2nd November 2009, 03:50 AM
Hi Judy,
Riley was just diagnosed 4 1/2 weeks ago. He was on prednisone 5mg twice/day and tramadol 50mg twice/day. The Neuro reduced his meds during the past few weeks and he is now on 1/2 prednison 1 x/day and tramadol as needed. Unfortunately some of Riley's symptoms started to come back last week. I phoned the Neuro and he put him back on the tramadol 2x/day. We are going back on Tues as the Dr. wants to see him. The prednisone was like a miracle drug but it seems now like the dosage is too low or he is having breakthrough pain. We have not been put on gabapentin as of yet.
Hope Chaos is doing better. Riley has been on tramadol before for post surgical pain and it is a really good pain reliever. Hope this helps in some way.