Just giving her the gabapentin and tramadol now... Holding off on prednisone and omaprazole until Pat weighs in. I can tell that gabapentin is wearing off by morning. Not sure why he has her on it just twice a day. Other folks seem to be giving it every 8 hours. But just these 2 meds alone gave us a great day ... Best in weeks. She was actuaaly playful last night for a long time. That has been gone for a few weeks. And her eyes are happier. Was afraid these would make her dopey but not bad. Giving her full dose of tramadol at night only...half dose in morning.
I'll do a series of posts instead of one long one......This first post may sound like a lecture, but it is directed at all of us not just to you! It's just an opportunity to make an important point.
First of all - the comment that you were waiting for me to weigh in scared the you-know-what out of me! No one should make medical decisions based only on what someone says on an internet message board. Here is a good approach, especially when dealing with a clinician with whom you don't have an established relationship. This is what I do to establish credibility and get to a relationship where the clinician and I are part of a treatment "team":
1. Print out any and all valid veterinary resources to read, highlight, and use for a discussion. In this case, I'd print Clare's treatment algorithm for vets and also pages from Plumb's Veterinary Drug Handbook on all of the various drugs that you want to discuss - prednisone, gabapentin, tramadol, any NSAIDs, omeprazole, etc.
2. If there are questions that you have from reading message board input/feedback, I'd list them on paper to ask the clinician. But be very careful - when you start a sentence with "I read this on the internet" you almost immediately "turn off" a medical professional and put him/her on the defensive. So you want the clinician to understand that your main sources are valid veterinary references but that you also have feedback from folks with dogs with the same problem. That 360 vet website is an excellent source for material by the way. There is crap on the internet and there is valid information on the internet - you want to immediately establish that you are smart enough to know the difference!
3. IF you do not follow discharge instructions you MUST inform the clinician what you are doing and why and give feedback on the results. The fastest way to destroy a relationship is to not follow instructions and not inform the clinician until later. If you aren't able to have a phone discussion or in person discussion with the clinician, I've found it useful to send a carefully written fax or email, being careful to cite sources. My cardiologist has commented to me how helpful it is when I do that in between appointments, because he can ponder the situation and then phone me for a discussion. He says that this is a very efficient use of time.
4. If you establish a relationship of respect and partnership, with full disclosure of what you are doing and why, there should not be a problem if you choose to not exactly follow the clinician's recommendations. This (deciding a treatment course other than what was recommended) very rarely happens with me and any of my vet team, but if it does, the clinician knows that I have made an informed decision and that I accept responsibility for the consequences. I am a member of the treatment team, but I'm also the coordinator and I am the final decision-maker.
I'll do a second post with feedback.
Pat