Kookie in so much pain from CM

[cavie3]

This is so hard to get things right, Kookie was doing so well that I thought we had this under control. Following Claire's report our vet prescribed Gabapentin 100mg x 3 daily, loxicom 1mg per kg once daily and 1mg -1.4mg Cimitidine x 3 daily. Kookie was like a different dog since starting the medication and his symptoms seemed so well controlled. I noticed yesterday he seemed more highly strung, more vocal ie barking excessively at next doors cat, slightly irritable, difficult to distract and less responsive to commands. This morning he was sensitive around face and eyes again when grooming. His eyes were squinting and he had that confused look about him, he took himself into his crate and he was cowering in the corner, he was just sitting there, yawning excessively, his body was shaking and he was drooling alot, the latter I haven't seen before. This is just so heartbreaking to see him in so much pain and I feel so helpless. I have just given him some (tramadol) as he was on this before to manage the pain and he is asleep now and I am awaiting a call back from the vet.

[Tania]

I am sorry Kookie is not doing so well.

My Dougall is a cm dog. His pain has to be managed much more closely than Molly who is a sm dog.

Approx three months ago, I switched Dougall from Gabapentin (300mgs per day) to Lyrica. I assumed he would be much better on the Lyrica. His symptoms became worse even to the point he started screaming. I had him mri'd to be sure he had not developed sm or there was nothing going on with his spine. Everything remained the same. I switched him back to Gabapentin but I increased the dose to 400mgs per day for ten days and introduced a low dose of Tramadol at bedtime (25mgms). I have now dropped the Gabapentin back to 300mgms per day. Dougall is a completely different dog, he is sleeping through the night, even though his back is sensitive, for the first time in a long time I am able to touch it. I intend to keep him on the Tramadol. I should also mention he is on the once per month drug Trocoxil.

All of my other dogs are on Lyrica and are doing much better than they were on the Gabapentin.

As you are a Client of Clare's, I would e mail her and let her know what is happening with Kookie. Sometimes it takes a bit of playing around with the drugs to get it right and every dog seems to react differently.

[cavie3]

Thanks Tania and it is great to read that Dougall is doing so much better now, I haven't heard of Trocoxil before, is this an additional medication to help with CM? I got Kookie referred to Clare so that she could view his MRI scan and give the local vets advice regarding a treatment plan. Whilst awaiting Clare's report I requested Gabapentin for Kookie from the vets 100mg x 2 daily, he was already on Tramadol for the pain 50mg twice a day. We started Kookie on the medication as described in my first post just over one week ago after receiving Clare's report. Kookie responded so well and I really thought we had cracked it so today I am feeling somewhat lost in all this again seeing him suffer like this at only 10 months old. I emailed Sandy (neurology nurse) at Stone Lion only 2 days ago telling her how much Kookie had improved since starting this treatment programme so today it has hit me hard seeing him in such discomfort again. Clare did mention in her report that Lyrica could be a consideration if Kookie doesn't respond well on Gabapentin, she stated that this is more expensive however there may be a generic available soon. It is worrying to hear though that Dougall was worse on the Lyrica. I am wondering if the Loxicom isn't managing Kookie's pain as well as the tramadol did and he was on quite a high dose before starting this new regime.

[Charlifarley]

I'm so sorry to read that Kookie is in pain again. It's a roller coaster ride getting the meds right for our cm/sm dogs. About the price of Lyrica -I give this to Bosco -and here in Ireland the price has come down dramatically in the last couple of months -so maybe before you decide to change it would be a good idea to enquire about the cost at your local pharmacy first. Best of luck I hope he starts to feel better soon.

[Karlin]

Trocoxil is an NSAID that only needs to be given monthly I think? Then the dog needs a break for a month then can start again. Clare feels it works better for many SM dogs than other NSAIDS.

Interesting detail on Lyrica etc -- thanks for the posts. Am going to trial Leo again on a higher does -- we tried the starting dose and he was much worse. So it is useful to know your experience Tania as perhaps it won;t suit him and an NSAID would be better,

[Tania]

Troxocil is a once per month drug, it stops the lows on a daily basis and keeps the pain relief at a consistent level. It blocks pain (an enzyme), so in layman’s language "it shut's the pain gate".
I believe Trocoxil is normally used treat dogs for chronic osteoarthritis or degenerative joint disease. http://www.trocoxil.co.uk/

I can't advice you how much to give Kookie but 100mgms of Gabapentin 2 x per day is a low dose.


Have you thought about keeping a daily record of the atmospheric pressure.
One of my dogs is affected weather changes such as storms or a cold front seem to bring on pain episodes (some neurologists believe this may be due to shifts in atmospheric pressure which affect the CSF fluid pressure). If the air pressure has gone very high, this can affect dogs with SM/CM (low pressure as well - it seems to be sudden changes in pressure that affect them). Human CM sufferers regulary report they are affected by this.

The first patent for Lyrica/Pregabalin expires 2013. This is the earliest possible date that a generic version can become available, so in theory the price should drop. I am not sure if this is going to happen because I have found this:-

"There are other circumstances that could come up to extend the exclusivity period of Lyrica beyond 2013. These circumstances could include things such as lawsuits or other patents for specific Lyrica uses. For instance, a court ruling has upheld a December 2018 Lyrica patent, which means that Lyrica will likely not "go generic" until then even though the first patent expires in 2013.

[cavie3]

I'm so sorry to read that Kookie is in pain again. It's a roller coaster ride getting the meds right for our cm/sm dogs. About the price of Lyrica -I give this to Bosco -and here in Ireland the price has come down dramatically in the last couple of months -so maybe before you decide to change it would be a good idea to enquire about the cost at your local pharmacy first. Best of luck I hope he starts to feel better soon.

Thanks Shirley for that info, it certainly is a bit of a rough road trying to get things right. I will see how it goes on the Gabapentin as it is early days and I guess i need to be patient and hope that this is just a blip.

[cavie3]

Trocoxil is an NSAID that only needs to be given monthly I think? Then the dog needs a break for a month then can start again. Clare feels it works better for many SM dogs than other NSAIDS.

Interesting detail on Lyrica etc -- thanks for the posts. Am going to trial Leo again on a higher does -- we tried the starting dose and he was much worse. So it is useful to know your experience Tania as perhaps it won;t suit him and an NSAID would be better,

That's interesting about the Trocoxil, seems there are many other options available so i shouldn't despair until I find the right concoction for Kookie. The vet rang me back and they said I was right to add the tramadol, to use it over the next few days and intermittently if I feel he needs this. If there isn't any improvement then they will contact neurologist. Seems to be an improvement this morning, I increased the cimitidine to the higher dose so perhaps this is helping.

[cavie3]

Troxocil is a once per month drug, it stops the lows on a daily basis and keeps the pain relief at a consistent level. It blocks pain (an enzyme), so in layman’s language "it shut's the pain gate".
I believe Trocoxil is normally used treat dogs for chronic osteoarthritis or degenerative joint disease. http://www.trocoxil.co.uk/

I can't advice you how much to give Kookie but 100mgms of Gabapentin 2 x per day is a low dose.


Have you thought about keeping a daily record of the atmospheric pressure.
One of my dogs is affected weather changes such as storms or a cold front seem to bring on pain episodes (some neurologists believe this may be due to shifts in atmospheric pressure which affect the CSF fluid pressure). If the air pressure has gone very high, this can affect dogs with SM/CM (low pressure as well - it seems to be sudden changes in pressure that affect them). Human CM sufferers regulary report they are affected by this.

The first patent for Lyrica/Pregabalin expires 2013. This is the earliest possible date that a generic version can become available, so in theory the price should drop. I am not sure if this is going to happen because I have found this:-

"There are other circumstances that could come up to extend the exclusivity period of Lyrica beyond 2013. These circumstances could include things such as lawsuits or other patents for specific Lyrica uses. For instance, a court ruling has upheld a December 2018 Lyrica patent, which means that Lyrica will likely not "go generic" until then even though the first patent expires in 2013.

Thanks for all the above Tania, the trocoxil sound great if it shuts the pain route and this may well be worth trying if Kookie continues to have these episodes. He may well be affected by atmospheric pressure as we certainly have been hit hard by the cold front so keeping a record will certainly be a good idea. Kookie seems much more comfortable today, vet said it is ok to add tramadol for a few days and I have increased cimitidine to the maximum he can have. Kookie is on 3 x 100 mg Gabapentin per day, he was started on 2 and Clare increased this to 3.

I do hope they allow a generic Lyrica, but I guess the big pharmaceuticals will not want this.

[Sabby]

Hi Cathrine

I have just seen your post. All 3 of my Cavaliers are with Clare Rusbridge. It’s been nearly 2 years that they have been diagnosed. SM/CM is so different in every dog. My Ebony has symptomatic CM no SM. She started off at 3x100mg Gabbapentin & Zitac. On a bad day she has to take a fourth tablet. She was also on Trocoxil but the effect wore off after 3 weeks.
My Harley has SM and dilated ventricles that give him headaches. He is on Lyrica & Zitac.

With Ebony I can tell that the gabapentin is helping as if she scratches because the tablet is late or she is having a bad day about 30 min after she had the tablet she is ok again. With Harley he could be scratching 2 hours after he had Lyrica or he could be going 10 hours without scratching without having another tablet. So I am never sure if Lyrica does anything for him.
Also what Tania mentioned about air pressure is correct. When my 3 have bad days I just look at the air pressure and it always without fail has dropped or risen a lot.