How do you know it's atime to increase dosage/change medication? (SM)

Chloe was diagnosed with SM in September 2010. She was put on Prilosec and Gabapentin (100mg, 3X a day), a did a brief course of Prednisone. Because she had an obvious pain episode on this dosage, we upped her Gabapentin dosage in October to 200mg, 3X a day.

So she's been taking 600mg of Gabapentin a day since then. However, I've noticed that her scratching and face-rubbing has been increasing. She hasn't had a pain episode since, but she now scratches anytime she plays, is touched in certain areas, or gets excited. She digs at the ground and rubs her face more, as well.

My question is, is this just what is to be accepted when you have a dog with SM? Or is it a sign that we should be upping or changing her medication?

ChloeTheCavalier said:

Chloe was diagnosed with SM in September 2010. She was put on Prilosec and Gabapentin (100mg, 3X a day), a did a brief course of Prednisone. Because she had an obvious pain episode on this dosage, we upped her Gabapentin dosage in October to 200mg, 3X a day.

So she's been taking 600mg of Gabapentin a day since then. However, I've noticed that her scratching and face-rubbing has been increasing. She hasn't had a pain episode since, but she now scratches anytime she plays, is touched in certain areas, or gets excited. She digs at the ground and rubs her face more, as well.

My question is, is this just what is to be accepted when you have a dog with SM? Or is it a sign that we should be upping or changing her medication?

Click to expand...

I really don't think that it is fair on a dog with SM to just accept a measurable increase in symptoms.
It certainly sounds as if Chloe is experiencing increasing discomfort and if it was me I think I would be checking again with my neurologist.

Tommy was recently seen by Clare Rusbridge. She doubled his gabapentin and he is now on the same dose as Chloe, but in his case he is happier and more relaxed.
This is a progressive condition so I am keeping my fingers crossed that the improvement continues.

Clare did say that if the increased gabapentin did not help we should try pregablin ( Lyrica )

Agree here with Margaret. Any time you see a return of symptoms,it is time to talk to your neurologist as medications like;y need adjustment. Clare Rusbridge has noted that most SM dogs need a regularly adjusted 'cocktail' of meds. This typically means some kind of CSF inhibitor (fursemide, omepraozole etc), gabapentin or lyrica, and maybe pain meds on top of that. That is a typical example but all dogs are different and need individual care with their neurologist to find the best mix. Some drugs work better for one dog than another even if in the same class of drug so it can take some time to get things right. Some dogs need to be on prednisalone permanently if pain cannot be managed otherwise.

Hi, sorry for my late response but I've read your replies and appreciate all your help.

Margaret and Karlin- I too felt that these increasing symptoms must mean the pain/discomfort is returning. I called Dr. West (Chloe's neurologist at AMC in NYC) and he said that since she hasn't shown any actual pain episodes, that he would leave her gabapentin dosage the same and just increase the prilosec (from 10mg/day to 20mg/day). He basically said the scratching isn't caused by pain, but by an uncontrollable urge to scratch (not the exact wording, don't quote me).

I understand Dr. West is known to be more conservative for treatment (and I still am not considering surgery), but after reading Margaret and Karlin's responses saying that when correctly treated, there shouldn't be any symptoms, I'm thinking Lyrica might be the next option. I don't know what to do.

At what dosage is gabapentin usually "topped out" at before proceeding on to Lyrica? Since Chloe's on 600mg/day right now, is that pretty much the max?