Air scratching between doses of pain killer

[rubles]

Charlie was diagnosed with SM two months ago and was put on 0.62 mils of Gabapentln every 12 hours. So I try for 6 a.m. and 6 p.m.
Sometimes he air scratches mid-day. Does excitement cause this--he was getting his harness on for a walk and it (air scratching was very noticeable) so I gave him 1/2 his usual dose at that time and his full, regular dose at 9 p.m.. Air scratching sometimes occurs without his being excited. So I'm wondering if he needs more meds.
When I get up in the morning he greets me and leads the way to where his meds are kept. I'm not sure if he's in pain or looking for the treat he's given following his dose.

[Sabby]

I can’t figure out what 0.62 mils of Gabapentin are. I don’t know how sever your dogs SM is but I know Gabapentin only lasts a maximum of 8 hours. That’s why most dogs including my Ebony take it 3 times a day. My Ebony is on 100mg 3x a day. She starts scratching if I don’t give her tablet by 6am, I assume that’s because the big cap between the evening and morning dose. During the day she is ok. Talk to you neurologist. It does sound that Charlie needs more medication if he scratches in between. It's all trial and error untill you get the medication right. With my Ebony it took 4 month to get it right.

[Kate H]

The base line for starting gabapentin is 100mg x 2, but as Sabby says, most dogs need to take it 3 times a day and the more usual dose is 100mg x 3. Is you Cavalier taking a liquid version of gabapentin, as you speak of mils? I think most of us find the capsules easier to administer - well wrapped in cheese, pate, sausage or whatever your dog likes best! There is a very useful information sheet (called an Algorithm) on Dr Clare Rusbridge's websit (www.Veterinary-neurologist.co.uk), designed for vets, which provides treatment outlines. You might find it helpful to print it off and show it to your vet (if he is the one prescribing for Charlie - or is it a neurologist?) - many vets in general practice aren't 100% familiar with SM and its treatment.

As Sabby says, it can take several months to get the dosages right for a particular dog. It's not a good idea to add a 'bit extra' if Charlie seems uncomfortable at midday - the important thing with gabapentin is to build up a regular flow, so to speak - it's a pain preventive (ie blocking pain from coming into consciousness), not a pain killer (dealing with pain episodes). sometimes a dog does need an extra boost of gabapentin, if obviously uncomfortable, but when Oliver is like this, I give him one off his next regular dose (ie divide the dose). But if Charlie is getting uncomfortable at midday, it sounds as if he might be better going to three times a day; talk to your neurologist or vet about it. Is Charlie also on a diuretic such as frusemide or Zitac? This too is standard treatment for a dog with SM as it helps to reduce the pressure caused by the cerebral-spinal fluid.

Sorry you're having to cope with SM, but once the medication is right it can usually make a huge difference to the dog's comfort and enable him to lead a virtually normal life. My Oliver is nearly 11 and is still active and happy in spite of SM.

Kate, Oliver and Aled

PS Knowing Cavaliers, I'd bet that Charlie is interested in his 6am treat!

[Karlin]

The liquid version is harder I think for the rest of us to compare doses with. Very few of us have dogs on liquid gabapentin, so am not really sure what that matches in mg tablets/capsules.

If you are seeing air scratching, then the daily dose and probably, frequency isn't high enough. So you will want to either have your vet work with your neurologist, or return to your neurologist to ask what to do next. Twice daily is actually the recommended starting dose for gabapentn as this does work for some dogs -- but the majority seem to move to needing it three times daily as most of us find it wears off pretty close to every 8 hours.

Also, the initial prescribed dose is really just an experimental starting point. I think the majority of us also find it either isn't enough right away or need to up the dose over time or try Lyrica (breakthrough scratching like you are seeing is a typical sign that the meds are not yet right and discomfort isn;t adequately addressed yet).

Dr Clare Rusbridge says most dogs really need a 'cocktail' of pain meds -- usually a CSF inhibitor, gabapentin or Lyrica, and then often something for pain on top of that -- and that cocktail usually needs a lot of adjustment for dose and best mix (as several different meds can fill those roles and not all work for all dogs), and then again, needs to be altered and adjusted over time as well.

You def don't want to split half the dose midday -- as others note, you want a consistent level at regular intervals.

The correct step though is to get your neurologist's advice on what to try next.

[rubles]

Thank you Sabby, Kate and Karlin for your excellent, common sense advice.
Yes, Charlie takes gabapentin in liquid form, a syrup, administered by syringe.
Pharmacist (chemist) advised drug not available in tablet form in that dose.
I'll contact his vet for advice. This seems to be a learning curve for owners. Breeder advised she'd never seen it so wasn't able to help with advice something I don't believer for half a second.

[Karlin]

A lot of us divide tablets or capsules -- capsules are probably more of a pain as then you generally need to buy empty capsules (whch you can do!).

I would certainly recommend using one of the CSF drugs (eg cimetidine, omaprazole) as well as adjusting the gabapentin, if you aren't doing that. There is some evidence that they help slow progression and do seem to help relieve pain. Neurologists seem to be moving away from prescribing frusimide -- see some previous discussions on why (to do with potential adverse affect on hearts).

My most affected dog is on cimetidine, gabapentin and trocoxil (an NSAID given once a month).

[rubles]

Charlie's dose of gabapentin has been increased to .7, .4 and .7 a dose every 8 hours. Air scratching still happening following this increase.
Maybe it's time to include the prednisone twice daily.

[murphy's mum]

Misty too scratches between doses of Gabapentin. When she was having a bad spell last month we spoke to Jacques Penderis at our neurology department in Glasgow. He advised that the scratching can be very hard to control, he said in many ways the pain episodes were much easier to keep under control. He said that humans suffering SM often speak of "odd sensations" and "pins and needles", he believes that the scratching, without pain episodes, are likely to be these sensations.

Misty has Gabapentin, and Cimetidine three times a day, and until last month she also had Rymadol(NSAID), twice a day. Due to her bad spell she's currently on one Prednisolone a day, instead of the Rymadol, she steps down to 1/2 a tablet a day on Saturday, to see if how she copes. The scratching hasn't got better, but neither has i got worse, and it's always as her next does is due. She's perked back up again on the steroids, and is back to her happy little self

[Karlin]

Maybe it's time to include the prednisone twice daily.

Prednisone isn't generally given twice a day, but the dose could be increased. However I sure wouldn't increase or add prednisone just for scratching unless there's some real distress with the scratching, and of course only on vet/neurologist advice. You only ever want the lowest possible dose. I'd want to try adding other things like cimetidine (and/or try Lyrica rather than gabapentin) and keep off preds if at all possible.

[rubles]

The neurologist recommended a very low dose of prednisone 2.5 mils every 12 hours totalling 5 mils a day and gave me enough for 3 weeks. My vet preferred to increase the gabapentin saying it's too soon for the steroid. All his breeder said was give him prednisone and hasn't experienced SM herself. Such a confusing disease, diagnosis and treatment that I'm trying to find my way through.
Usually Charlie follows me to the second floor. To-day he came half way up, wouldn't come further, turned around and went back down. He seems to want me to lift him to my lap as well rather than jumping up as he used to.
I want what's best for Charlie and consider all opinions.

Thanks again for your help.
Sandra