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Medication not working for Maggie

3cavies

Well-known member
Recheck at the vet yesterday didn't go to well for Maggie. The medication has had no effect at all. If anything, she seems worse. We have an appt. with the Neurologist at Auburn University on Tuesday do discuss surgery:(
 
Hi Stacy

Sorry things don't seem to be going well with Maggie, but many people with SM dogs find that their medication needs adjusting over the first few weeks and months, so the neurologist may be able to suggest a different combination/dosage. For example, Gabapentin is metabolised (sent through the system) at different rates by different dogs; the average is about 8 hours, but averages mean that there are dogs who need the same dose but much more often and others that need it only twice a day. It's a bit of trial and error. So your neurologist may be able to make Maggie more comfortable by adjusting her medication while you weigh up the pros and cons of surgery.

Let us know what he says,

Kate, Oliver and Aled
 
I'm so sorry Maggie hasn't responded to her medication. Riley didn't respond to any medication (Gabapentin or Prednisone) either which is why I decided to go the surgical route with her. For Riley, it was the right decision. Three years post op, she is a like a miracle dog. I didn't think she'd still be alive, but she is alive and doing beautifully.

Good luck at your neuro appointment. Maybe they'll decide to try a different cocktail of meds or different dosages before they recommend surgery, or like Kate said, to at least make her more comfortable. Let us know how Tuesday goes.
 
To review - Maggie has been on gabapentin and prilosec for about a month now, right? What dosages? And she was on prednisone but for ten days only. Did she seem improved during those ten days? Would you consider another trial with adding prednisone or an NSAID assuming that her symptoms have increased? Is it worthwhile to try a switch to Lyrica to see if that makes a difference? Those are things that you could discuss at your neurologist appointment.

You indicated before that Maggie's only symptom was some scratching but she evidenced no pain. Do you think that has changed and she is now exhibiting pain?

The AL neurologist seemed to favor no surgery but meds only, while the MS neurologist was pro-surgery. Do you think that the AL neuro will change his mind and now decide that surgery is the best option? If that is the case, I'd really think seriously about having the MS neuro do the FMD. He has pretty extensive experience, and his swine tissue duroplasty seems to be superior in many respects as far as helping to prevent scar tissue formation. Do you have info on the track record and surgical techniques for the AL neurologist? I can't even find him listed on the ACVIM list of neurologists, so I'd want to do some major research on him to understand the pros and cons of using him for surgery. The pros and cons of the MS neurologist are pretty well documented, and I can share my personal notes and his speaker notes from the CE session of his that I attended.

Sorry for the 20 questions game - you don't have to answer them all; I'm just trying to give you some food for thought as you consider all of the aspects and options. I like to make an outline on paper to help me think through all of the ramifications when I have a big decision to make!

Pat
 
Stacy,
I'm so sorry that the medication is not going so well for Maggie. I totally agree with Pat's suggestion. Dr. Shores did surgery on Corey when he was still in AL and when he left we decided not to go to AL for the follow up check up because I couldn't find the neuro name that's replacing him on the ACVIM list of neurologists. So far Corey is doing great, a lot better than before the surgery. Hope this help and keep us posted.
 
Thank you all for your comments and such great information. It gives me alot to think about. I have a list of questions started for the Neurologist. I do hate the thought of surgery but am leaning toward it due to reading that since it is a progressive disorder results are usually better when it is done earlier. I don't want to wait until it worsens and possibly limits the results. Hopefully we'll have a clearer picture of her condition and what steps we need to take next after our visit. If anyone has found that not to be the case or has different information, please share. I want all the information possible, even thought I'm already pretty overwhelmed. So much is out there, I just want to make the best decision I can for her. Pat, she is still not in pain, but her scratching has increased and she only walks a short distance without scratching. Before it was only caused when she was on lead or you touched the side of her neck. Now she does it without anything provoking it.
 
Aw. Sorry to read meds have been ineffective. Personally i would also pursue surgery if meds didnt help and u see progression. Though the thought of the actual surgery is unbearable to me...
 
Sorry to hear that Maggie is not responding to the medication mix she is on. We had to play around with Minnie's medication quite a bit until we got the right mix.

She did not do well on gabapentin but when change to Lyrica(pregabalin) 50 x 2 a day it made an immense difference.

I certainly think it is worth while speaking to your Neuro about the medication options available.

It is such a big operation that personally I would not want to consider that as an option until all other routes have been tried.:l*v:
 
Just got back from Auburn with Maggie. Dr. Sorjonen changed meds to Gabapentin (100mg. once a day), Prednisone (5mg. twice a day), Omeprazole (10mg. twice a day), and Sucralfate (1g. twice a day). We go back in 2 weeks. If we don't begin to see an improvement by then, we will most likely move toward surgery.:xfngr:
 
No Pat, that's correct. Her symptoms are still very mild compared to some. She shows no obvious signs of pain just the scratching. He did increase the Gabapentin from 25mg. to 100mg. Do you see that as a problem? This is my first experience with this, so any help is appreciated. Thanks.
 
Need feedback on medication dosage from experts please

No Pat, that's correct. Her symptoms are still very mild compared to some. She shows no obvious signs of pain just the scratching. He did increase the Gabapentin from 25mg. to 100mg. Do you see that as a problem? This is my first experience with this, so any help is appreciated. Thanks.

Stacy, I'm an SM novice as I've not lived with an SM Cavalier, and I hope that Karlin and others will chime in.........but my understanding is that Gabapentin is effective for about 8 hours, and it is usually given twice or even three times per day for effective symptom relief. 25 mg once a day is kind of laughable, and I think that once a day dosage in general is just not going to give a good demonstration of whether or not the drug is going to be effective. I know that Maggie's symptoms are mild, BUT you are actually considering surgery because you have seen no improvement and perhaps even worse scratching. From my novice perspective, the neurologist has prescribed a high dose of pred (and has hopefully told you about side effects including throwing a dog into Cushings) and has moved from a "nonexistent" dose of Gabapentin to a low dose of Gabapentin.

Did he say why he added sucralfate? Also, PLEASE tell me that he instructed you to give sucralfate either two hours before or two hours after any food or medication. It coats the stomach and greatly interferes with the absorption of medications. And it should be given away from food also in order for it to work effectively.

Pat

P.S. My personal belief is that Gabapentin (and Lyrica) are much "safer" drugs than steroids or NSAIDs, so I know that if I personally had a dog with SM, I'd want to give a higher dose of Gab or Lyr in order to try to avoid pred and NSAIDS. But that's just me, I know too many horror stories from steroids and NSAIDs (and even some from diuretics), esp. because of my years in the canine kidney diet group and the CHF group and reading thousands of stories. And, on that subject, I'd also be monitoring much more aggressively than the recommended blood chem screenings if my dogs were taking pred, NSAIDs or diuretics on a long term basis.
 
I agree about the Gabapentin. My Jade has fairly severe symptoms and what works best for her is Gabapentin 100mg 3x a day and she has to have Pred ( only 2.5 mg per day). The pred is a miracle drug for her and when we tried to wean her off it, her pain was much worse. I have the option of increasing the Gabapentin, but so far she is having a lot of good days. Jade is also on Puresis 10 mg twice a day. She can't take Omeprazole as it gives her bad diarrhoea. Hope this helps....
 
It's so hard when you get so much conflicting information, but the dosing of gabapentin is really most effective when given every 8 hours. I actually was on it myself for migraine prevention and took 300 mg every 8 hours. I've also been on Sucralfate and what Pat says about timing it around food is the same information I was given.

You probably will notice a difference though with the huge dose of prednisone. Riley was on that dosage for a while and she was like a puppy. She had so much energy and her symptoms almost disappeared. Her neurologist only kept her on that dosage though for about a month and then decreased it to her current dosage of 5 mg a day which she has been on for about 2 and a half years. She also is on Denamarin to protect her liver and Pepcid to protect against stomach upset. She has her blood checked every 4 months. Like Jade, Riley needs the prednisone. It is a miracle drug for her also and I will take any and all side effects at this point, which luckily have been minor.

Good luck through this confusing time. Remember, you know your dog best. But you also have to have faith and trust in your neurologist. We're here to help and give our opinions, but mostly we are here to give you our support. There's no one magic prescription for every dog. Wishing you and Maggie the best.......
 
My understanding is that gabapentin is a pain preventive rather than a pain killer, so it needs to be in the body 24 hours a day. Dogs metabolise it at different rates, but the average is 8.5 hours. One dose almost certainly won't last 24 hours. 100g twice a day didn't really control Oliver's mild headaches; he does much better now he's gone up to 3 times a day. Perhaps your vet will up the gabapentin dosage when Maggie is eased off the prednisone? 'Among the skills required by vets is the ability to juggle' :badgrin:

Kate, Oliver and Aled
 
Just an update: The increased medication has again had no effect. Surgery is scheduled for Tuesday morning :( I didnt want to risk waiting and it progressing to a point that she was in pain. I hope and pray this is the right thing to do for Maggie.
 
We'll be thinking of her on Tuesday Stacy.
She's a young fit and otherwise healthy cavalier and perhaps going down the surgical route now,may give her the best chance of a normal life.
I guess there's no right or wrong decision regarding surgery...it depends on the patient and the surgical facility/resources available to you.
Just to echo what Pat has said about NSAIDs.
Daisy didn't cope well with Rimadyl...she's been vomiting twice daily over the last ten days and we've now stopped it.
Looks like Gabapentin from now on.
Sins
 
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