What you say is so right Mel and thank you for saying it. I feel the same way, but after a lot of thought, I really want to keep Rebel happy for the time he has left, so I am trying again with a written presentation and will see what happens. If that doesn't work I will have to find another vet.
Also having an old dog with multiple problems (though less severe SM than Rebel), my attitude is like yours (and hospices), Flo - the no. 1 priority is to keep them pain free and comfortable and worries about possible addiction to morphine (in humans) or liver damage really don't apply.
I was surprised by what you said about the Willows. I haven't had to use them for Oliver's SM, but as he hasn't been near Chestergates since his last mini scan 5 years ago, I wouldn't dream of dragging him up there on trains and buses; our local vets have done their homework on SM and keep him pretty stable anyway. If the Willows refused to treat him for SM I think I would kick up a real fuss with them!
Best of luck with the literary composition!
Kate, Oliver and Aled
Hi Flo, this must have been devastating when your vet suggested euthanasia, any of us who have a dog with CM/SM issues know that the condition can fluctuate from day to day and our main aim is to keep them pain free. Kookie isn't 2 years old yet and he is normally on 500mg Gabapentin daily and increased to 600mg when there are sudden changes in air pressure also increasing his usual dose of tramadol (3x25mg) if necessary. We recently took part in the comfort study research (Clare Rusbridge) so it will be a good thing for all us owners when the results are published so we don't have to justify the need for increased meds with our vets. I can understand where you are coming from that Rebel has got used to this particular vet and any change might upset him. Hope the next visit goes well and they take on board that you know Rebel better than anyone.
I have found that twice a day isn't sufficient. Charlie gets his three times a day and he is always needing it by then.
I'm always puzzled as to why Clare Rusbridge's algorithm starts with gabapentin twice a day, because very few dogs seem to be able to go that length between doses. I find Oliver is better on 100mg four times a day, with an extra when air pressure is being difficult (though he seems to be affected by low pressure rather than high).
Kate, Oliver and Aled
I think because initially, it does suit many dogs, and can be upped as needed. Leo was on 2x for a couple of years before he went up to 3x, as I recall... she has said that it depends on the dog, how it metabolises gabapentin, what type of pain it is addressing... goal is always to start at the lowest dose of anything but the problem to my mind is that too many vets and neurologists never consider the overall algorithm and never increase dosage when it is clearly needed.
Flo, I agree with so many here on your main issue in the thread. I do think sometimes it helps to get words on paper. But also, I would expect more from a vet, especially one who knows a dog well. Maybe she was having an off day herself.
I am pretty picky on the vets I use long term, for the same kinds of reasons you note. I wouldn't hesitate to move if I was getting frustrated with a vet's approach. A good vet should realise that progressive conditions also have up and down days and the view should be a holistic one -- are bad days outnumbering good days, and is the pain manageable? There would seem many other options open yet. Not sure if you have tried Lyrica but had a great improvement in Leo with it, at a lower dose. But it is more costly. There are also a couple of different add-on painkillers that can be tried. Different dogs do better on different mixes.
Sorry to have taken so long to write this update, but I have been so busy with other things!
I took in my written appraisal of the situation, the disease being sometimes distressing and of course progressive, coupled with Rebel's condition and left it with the receptionist for the vet to read before our appointment on Tuesday.
It was all an anticlimax, because instead of being called in first as promised, we were kept waiting for half an hour in an overcrowded waiting room before being called in. When the clients who had arrived before us came out it was obvious their plight was more serious than ours, because they were in awful distress, with the man carrying a bloodstained cat carrier, so when we went in I chose the patient and diplomatic approach because I could see that the vet had been through the mill too!
Much to my surprise I was put very firmly in the driving seat, with the vet asking how Rebel has been and what drugs were needed. She listened to Rebel's heart for a long time, then said she could not hear a murmour and invited me to try to find one, but I couldn't hear it either. I explained that now the air pressure is more stable I had been happy to reduce the Gabapentin to 200 mgs a day and withdraw the Tramadol. Some notice must have been taken of what I had written because she then asked was I sure I had enough meds in stock to cope with another relapse if the weather changed again. Phew :rolleyes: Rebel got his usual cuddles and that was it - nothing more said on either side. Perhaps it's better that way.
So Rebel keeps his beloved vet and he does not need to go back there for another 3 months, so I'm sure the lady realises what a big mistake she made and has learned from it.
I am so grateful for all the support and advice; it really was helpful.
I'm so glad the situation has sorted itself out - which such things often do with a cooling off period and a chance to put your point of view in a less charged atmosphere. Well done for your literary endeavours! It's a sensible vet who realises that it's the responsible owner who lives with the dog 24/7 who is best able to assess pain levels and adjust medication accordingly, not the vet who sees the dog for a few minutes every few months. I hope you will be able to keep Rebel comfortable for a few more years yet.
Kate, Oliver and Aled