Not happy with Misty

[murphy's mum]

Over the last two weeks I've not really been happy with how Misty is acting. It started when we had taken both of them out on a walk at Hoddem Castle, which ment they were both on a harness and lead for an hour. Now normally becasue of where we live, neither are on a lead for more than 10 minutes. The harnesses are the same harnesses they use to travel in the car too. They were both super excited as we'd never been there with them before, so both were singing as soon as we stopped the car. The problem was Misty was scratching so much, she could hardly walk. She has never ever done this before, but like I said they are never on the leads for long. It got so bad I actually tried puting the leash on her collar to see if it made any difference at all, but it didn't.

Her scratching continued all that week, I spoke to a Neuro(not our normal one as she is on study leave) and we increased her Pred up to a half everyday. She said to call back in if she wasn't better by the Monday. So I did as I was still seing scratching, especially when excited or if she'd jump up beside me. I got a different Neuro, who just told me that scracthing was the hardest thing to control and that he didn't like the fact Misty was on Pred permenently now. I was told to leave it for a fortnight and reduce the Pred back to half alternating days. I'll be honest I wasn't very happy after the phone call, as I felt he dismissed her scratching as nothing.

I don't think it is "nothing" though. I feel she's in discomfort while she's scratching, and while I do distract her and she stops, she is constantly seeking me out to rub her head for her. She come to me and shoves her head in my hands and I rub all over her head, and she does this little groaning noise. She's also taken to jumping onto my lap and her rolling over onto her back with her head in the crook of my arm. This seems to be her most comfortable position in the evening for her. She still bugs me for head rubs in this position too though. I also feel her back legs aren't as stable as the were, she "leaves" a leg sometimes when stepping over things, and can't always jump up on things first go either.

She's on Gabapenting 100 x 3. Cimetidine x 3 and currently half a Pred a day too. I asked about increasing the Gabapentin, but the male Neuro said it would make her too drowsy. I've to call back in today, but what do I do? What do I say? I really feel she is having headaches or sore sensations around her head, but feel it's all being dismissed.

[murphy's mum]

What level of head rubbing and/or scratching do you all see with your dogs? Am I over reacting? My gut tells me no. I hate to think she in pain, and just because she's not yelping, doesn't convince my she isn't. I think her face shows it, but I'm not sure. Do you ever worry your looking for symptoms that aren't there?


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[MomObvious]

As a mother,when my kids where young, I have taken them in to the doctor and just said I don't know he's not acting normal and his eyes look weak. I was right most of the time and the doctor found an ear infection or strep coming on. I think it helped get them better faster. I would go with that Mommy gut feeling, and keep calling maybe she needs to be seen. Too bad your normal Neuro cannot be reached. Personally, I'm a big fan of my kids or dogs seeing the same vets or doctors all the time, that way they are more aware of your dogs or kids issues. I'm telling you the Mommy gut feels are there for a reason......


Good luck I hope you get it sorted out soon so your baby can get back to feeling better.
Melissa

[murphy's mum]

I spoke to a really nice Nuero today called Maria, I've spoken to her in the past about Misty, and she's always very helpful. She listened to all my concerns, and worries about Misty, and has prescribed Tramadol for her. The leg weakness is a sign that there has been progression, and the increased head rubbing is a definite sign of her added discomfort as far as she is concerned.

My head is buzzing. Maria has advised me that some dogs on Tramadol become very drowsy and listless, to the point where she feels their quality of life is affected. Many can be sick on it, while others are completely fine and it does wonders for them. She feels our other option would be amitriptyline. I hate to think we're at the stage where we're running out of options, and don't really want to dwell on it. I've to call her back on Friday to let her know how she's doing, and discuss our options and Misty's quality of life. That's the hard part for me. How is Misty's quality of life? If Misty has something to do, or there is something going on about the house that she's watching, she's great, you wouldn't think there was anything wrong with her. She eats well, she loves her walks. she doesn't often scratch when out walking, unless I need to pop her on her lead, that walk around Hoddom really opened our eyes to how bad she is when she has to have a lead on though. It's when she's in the house her symptoms are the worst, or if she's over excited about getting ready for a walk.

As I type she's laying beside me, every now and then she's grinding her teeth a little, or licking her lips, and then she'll get up and move across to the footstool and then back to the sofa. She's wanted her cuddles less over this last week, she seems happier to lie on the floor or the dog bed, although she still seeks me out later in the evening most nights. How do you decide if she's happy when she's can't tell you herself? We know that dogs hide their pain, but to what extent. We've never had a sick or old pet, and had to assess their quality of life. I think she's mainly happy, but is it simply because she's distracted from the chronic pain while she's busy.

[Karlin]

I would tend to agree that it's better not to be on prednisalone unless absoutely necessary and other things don't work well for her. She is still on a pretty low dose of gabapentin I would sure try raising that, or trying Lyrica instead, before I'd even consider adding tramadol daily. I'd also try trocoxil (given once monthly) before I'd do tramadol daily.

You need to wait a couple of weeks really to see how a medication works. Often a dog (or person for taht matter) will have side effects the first wdays/week or two on a new medication then it will stop.

My Leo would scratch all the time on a harness if he were only on 100mg 3x.

Finding a good mix takes time and you do need to try different things.

PS To me it makes no sense that they are giving you the sense that you are running out of options -- you are still on a relatively low dose of gabapentin, as I said, and Lyrica often works like a miracle drug when gabapentin isn;t working well, but you could ask to try 150 mg gabapentin 3x for example (Leo was on that level a long time -- now on 200mg 3x and he's a small cavalier). There are a whole range of CSF inhibitors, as well as pain relievers too.

Clare's protocol gives all the options, pretty much.

Some SM/CM dogs really cannot tolerate leads with harnesses or collars and you need to find off-lead safe ways of having those ones get their daily exercise instead and avoid the lead walks. Clare nots some cavaliers are better on collar/lead than harness/lead. Maybe a different style harness would work as well. The excitement probably didn't help as that often triggers Leo too. You could increase meds if you are off for a day and could give a rimadyl or metacam or tramadol an hour before going to boost pain help? I only ever use those painkillers as needed. You sound unsure if you are really seeing any real shifts. Weather changes also trigger difficulties and then I just give something for that period. Could symtpoms be connected to the warm weather? But I'd just try raising the gabapentin level first off rather than add in extra stuff...? Why does the neuro think more gabapentin would make her drowsy? 200mg 3 x has never made Leo sleepy.

[murphy's mum]

I did ask again about increasing the Gabapentin, but Maria said that the 100mg was right for a 10kg dog, and that increasing it wouldn't make a difference. The Pred was only supposed to be a short dose to get her back on track, and then switch back to Rimadyl, but every time we reduced it her symptoms got worse again.

I discussed Trocoxil with our usual Neuro at the start of the year, and she was set against it because if it didn't work, we would need to wait a month for it to come out of Misty's blood.

[Karlin]

Well, she is wrong -- maybe discuss Clare's protocol as those are starting guideline amounts -- those levels are adjustable and that's a low dose for a 10kg dog. Leo only weighs about 7.5kg and is on double Misty's dose -- I have gradually had to increase gabapentin over time (and every time t DOES make a difference! It has stopped/limited scratching) but it manages about 90% of symptoms. Some scratching towards end of an 8 hour period, rarely some occasional body sensitivity.

I'd try trocoxil rather than prednisalone. Clare feels it works better than many other NSAIDS for neuropathic pain.

All doctors are going to have different opinions -- but your neuro is at significant variance from Clare Rusbridge's approach to pain. And the advice she is giving you certainly doesn't match what probably most of us managing SM longer term have found... you might ask Nicki who has managed several dogs now. You could do tramadol but there are other drugs like amantidine etc.

[Sydneys Mom]

I'm so sorry your little one is in pain and you are so worried about her. I understand how hard it is to figure out just what they are trying to tell you, but I always found my instincts were correct. No one knows your dog better than you.

Sydney took tramadol a few years ago with no ill effects. Of course, his issues were different than Misty's and it was short term use. When Sydney's MVD got worse and his health started to decline, I do believe he told me in little ways that he was tired. I saw it in his eyes and looking back some of the little things I thought to be just quirky behaviour, were really signs from him. In the end though, he did save me from the decision.

Only you can decide what is right and any decision you make will be the right one because you are making it informed and with love. I hope you can find some relief for Misty and that she has more happy years ahead.

Sending hugs to you and Misty.

[murphy's mum]

Don't get me wrong Karlin, I thought increasing the Gabapentin would have been the first thing to do, but I've had two of them over the last week tell me "no". How do I politely tell them I think they are wrong, and that I think a higher dose of Gabapentin would be better. I don't want to try and tell them what's best by saying the should treat the same way Claire does, yet at the same time I want whats best of my Misty in the long run. I feel caught between a rock and a hard place.

Joyce it's good to hear Sydney had done well on Tramadol. Misty seems ok with her first dose, she's giving me the eye while I'm grating cheese for an omelette here, so hopefully it will agree with her.

Regards
Paula

[Margaret C]

That's the hard part for me. How is Misty's quality of life? If Misty has something to do, or there is something going on about the house that she's watching, she's great, you wouldn't think there was anything wrong with her. She eats well, she loves her walks. she doesn't often scratch when out walking, unless I need to pop her on her lead, that walk around Hoddom really opened our eyes to how bad she is when she has to have a lead on though. It's when she's in the house her symptoms are the worst, or if she's over excited about getting ready for a walk.

As I type she's laying beside me, every now and then she's grinding her teeth a little, or licking her lips, and then she'll get up and move across to the footstool and then back to the sofa. She's wanted her cuddles less over this last week, she seems happier to lie on the floor or the dog bed, although she still seeks me out later in the evening most nights. How do you decide if she's happy when she's can't tell you herself? We know that dogs hide their pain, but to what extent. We've never had a sick or old pet, and had to assess their quality of life. I think she's mainly happy, but is it simply because she's distracted from the chronic pain while she's busy.

"How do you decide if she's happy when she's can't tell you herself?" This is why SM is such a horrible condition. So much is guess work.

We have to be advocates for our dogs because they have no one else, but it is very difficult when we cannot know for sure just what they are feeling.

I have spent so much time trying to decide whether I am being paranoid and imagining ordinary behaviour is abnormal or whether I am being neglectful for not acting on the vague uneasiness I feel.
I think we know our dogs so well that if we think they are uncomfortable then we are usually right..........as Melissa says that "Mommy gut" feeling.

With Tommy restlessness in the evening and pawing at my legs for attention tells me he is not comfortable. He head rubs a little, seldom scratches. When he lies behind chairs or under tables I suspect he is especially touch sensitive and guarding his body from being jostled by the fluffies.

I believe that I can see in his eyes when he is in pain.