Results 1 to 9 of 9

Thread: When to move on to stronger medication?

  1. #1
    Join Date
    Oct 2006
    Location
    Hartlepool UK
    Posts
    653
    Post Thanks / Like

    Default When to move on to stronger medication?

    One of my dogs is on 3 gabapentin and an onsior per day , she is starting to scratch a bit ( she didn't scratch before) & occasionally has sensitive spots on her sides & rubs her head , we then give her her medication and she is ok.
    she doesn't scream and is quite cheerful when we go out but at what point should we consider putting her on something stronger , like steroids ? She does seem to be getting worse but obviously steroids have side effects so i'd rather keep them for when she really needs them.
    my vet is not great so its a case of I tell them what I need and when .

  2. #2
    Join Date
    Mar 2005
    Location
    Dublin, Ireland
    Posts
    24,011
    Post Thanks / Like
    Blog Entries
    15

    Default

    You should have many, many options before steroids.

    Are you using Clare Rusbridge's treatment algorithm with your vet, to decide on dosage and meds? That would likely be very helpful, if not.

    What dosage of gabapentin are you on?

    Also not sure what an onsior is -- ? Is she on a CSF inhibitor?

    I would say, given your description, that yes, it is time to adjust medications. Those are clear signs of increased pain and the goal is for the meds not to wear off and pain occur before the next dose, if at all possible.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

  3. #3
    Join Date
    Oct 2006
    Location
    Hartlepool UK
    Posts
    653
    Post Thanks / Like

    Default

    Quote Originally Posted by Karlin View Post
    You should have many, many options before steroids.

    Are you using Clare Rusbridge's treatment algorithm with your vet, to decide on dosage and meds? That would likely be very helpful, if not.

    What dosage of gabapentin are you on?

    Also not sure what an onsior is -- ? Is she on a CSF inhibitor?

    I would say, given your description, that yes, it is time to adjust medications. Those are clear signs of increased pain and the goal is for the meds not to wear off and pain occur before the next dose, if at all possible.

    she's on 100 mg gabapentin 3 times a day ( she weighs 5 kg) csf inhibitor 2 times a day . and one onsior ( rymadil but another brand)

    the mri referral centre put her on the first two & I asked my vet to put her on the onsior ( after a 40 minute consultation of him saying oh this is odd & wouldn't believe it was Sm causing her to flinch on her side , he thought i'd kicked her)

    i'll have a look at the treatment algorithm as I think its changed since I printed it out

  4. #4
    Join Date
    Mar 2005
    Location
    Dublin, Ireland
    Posts
    24,011
    Post Thanks / Like
    Blog Entries
    15

    Default

    Wow -- are you sure you wouldn't want to change vets? I'd kick a vet who made such a suggestion! But seriously -- would look perhaps for a more sympathetic and proactive vet. Sensitivity to touch is one of the most common signs of SM.

    Might be time to increase the gabapentin (eg to 150) or add in a daily painkiller from Clare's list. Leo is about 5kg as well and went up to 200mg, but that would have really been borderline as to what he could take. Lyrica really improved his breakthrough symptoms and only needs to be given 2x but is a lot more expensive.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

  5. #5
    Join Date
    Oct 2006
    Location
    Hartlepool UK
    Posts
    653
    Post Thanks / Like

    Default

    Quote Originally Posted by Karlin View Post
    Wow -- are you sure you wouldn't want to change vets? I'd kick a vet who made such a suggestion! But seriously -- would look perhaps for a more sympathetic and proactive vet. Sensitivity to touch is one of the most common signs of SM.

    Might be time to increase the gabapentin (eg to 150) or add in a daily painkiller from Clare's list. Leo is about 5kg as well and went up to 200mg, but that would have really been borderline as to what he could take. Lyrica really improved his breakthrough symptoms and only needs to be given 2x but is a lot more expensive.

    That is the owner of the practice , when i've mentioned SM he says " oh that skull thing" ( he also thinks mvd does not cause early death ) it took me 40 minutes and eventually convincing him to search google for the symptoms on your site , then he said oh this does not match her symptoms .So I had to point out the paragraph on sensitivity and sleeping with the head raised.

    I only went there because I liked his employee who I thankfully asked to give me an mri referral for my dog the week before he left for another practice , She had no obvious symptoms when he examined her but he referred her on my say so. If i'd gone a few weeks later i'd have had no joy from his boss.

    I am considering moving practice but don't know where to go.

    we have her litter sister who is technically worse but has reacted quite well to the medication. i'll have a look at the options and then maybe take her in to see the new vet there. who is nice but newly qualified

  6. #6
    Join Date
    Aug 2008
    Location
    Coventry UK
    Posts
    1,857
    Post Thanks / Like

    Default

    Sorry you are having problems. A 'nice but newly qualified vet' may actually know more about SM, as the veterinary profession is slowly catching up with what Cavalier owners have known for some time - that CM/SM is a widespread and devastating problem in the breed. They may even teach it in vet school now! Ideally, you should also take your dog to see a neurologist with experience of SM (some of them are specialists in other things) - I think there is one in County Durham, which wouldn't be too far from you, or perhaps go where you had the MRI done. The initial consultation can be quite expensive (I hope you're insured!), but then they are at the end of the phone in the future, when anything new crops up or medication needs tweaking. And your new vet will then be able to ask your neurologist for advice on medication and treatment. My vet and I now work as a team (after a slightly rocky start!), with Clare Rusbridge's website to hand and occasional consultations between the professionals. We need to do this to give our dogs the best chance of living as free of pain as possible - as Karlin says, there are a number of options before steroids, which are a last resort. Hope you can find the right vet.

    Kate, and Oliver and Aled, both with CM/SM

  7. #7
    Join Date
    Oct 2006
    Location
    Hartlepool UK
    Posts
    653
    Post Thanks / Like

    Default

    Quote Originally Posted by Kate H View Post
    Sorry you are having problems. A 'nice but newly qualified vet' may actually know more about SM, as the veterinary profession is slowly catching up with what Cavalier owners have known for some time - that CM/SM is a widespread and devastating problem in the breed. They may even teach it in vet school now! Ideally, you should also take your dog to see a neurologist with experience of SM (some of them are specialists in other things) - I think there is one in County Durham, which wouldn't be too far from you, or perhaps go where you had the MRI done. The initial consultation can be quite expensive (I hope you're insured!), but then they are at the end of the phone in the future, when anything new crops up or medication needs tweaking. And your new vet will then be able to ask your neurologist for advice on medication and treatment. My vet and I now work as a team (after a slightly rocky start!), with Clare Rusbridge's website to hand and occasional consultations between the professionals. We need to do this to give our dogs the best chance of living as free of pain as possible - as Karlin says, there are a number of options before steroids, which are a last resort. Hope you can find the right vet.

    Kate, and Oliver and Aled, both with CM/SM

    I was at wear last week with my sisters dog and he just mentioned steroids.
    think i'll ask my own vet if maybe she should have tramadol or similar.

    They didn't send my vet any information at all after their scans , is that usual ?
    I had to tell them the diagnosis and the medications she is on. My vet where trying to give her ranitadine at one point saying the zitac was just for her stomach and it was the same .

    This one is insured , Her sister was insured but they refused to pay out due to her coverage being changed half way through the year to the higher rate ( same company) & the third dog is not insured so yes it gets very expensive.

    She's been laying on her front with her legs splayed out and her head up tonight.

  8. #8
    Join Date
    Mar 2012
    Location
    Northern California, USA
    Posts
    385
    Post Thanks / Like

    Default

    I would definitely vote for a new vet, one who is knowledgeable and with whom you can work as partners.

  9. #9
    Join Date
    Mar 2005
    Location
    Dublin, Ireland
    Posts
    24,011
    Post Thanks / Like
    Blog Entries
    15

    Default

    Your vet should request a summary report.

    Steroids are the easy first choice for (in my opinion) lazy vets and neurologists. They have far more potential side effects some of which can be serious, and some, difficult for the owner to manage (increased hunger and constant begging for food, and weight gain, not great for a breed with endemic heart disease). They will almost always also bring swift results, making the client happy and the patient easier to manage.

    Steroids have their place for short term and long term use but far too many opt for them first and never adequately explain the potential issues.

    I would feel steroids are only needed for SM 1) when no other option is available (eg a dog that doesn't respond well to other alternatives or where they give significant additional relief); or 2) for fast pain relief while a longer term care plan is put in place; or 3) when owners are giving the max they can give of gabapentin or Lyrica and the dog is still in pain and needs additional help.

    I don't have time for vets who don't listen to my concerns or won;t take time to learn about a condition as serious as SM.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •