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Phantom Pain? Any input on dosages for meds?
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5 July 2017 - 6:39 pm
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Hey All,

I was wondering if any of you can give some advice on dosages for Gabapentin and Tramadol. 

Schlomo had his surgery 2 weeks ago and he initially came home with Clavamox and Rimadyl. He did fine for a couple of days before his knees gave out. When I took him back they told me to give Tramadol as well, which I did a bit less than the recommended dosage and he was really sedated. Fast forward a few days and it looks like he is experiencing phantom pain symptoms. I don't know why but the Vet world seems to be really divided on this subject with some saying it exists and others negating it, it went off into some philosophical territory. HOWEVER when I just called it residual nerve pain they all agreed. Ugh. 

After Jerry recommended Gabapentin in the chat, I called them to ask for it. They filled me a prescription for 100mg/twice a day. Schlomo is still yelping. I called them again today to ask if it should be taken in conjunction with something else and they said I could re-introduce Tramadol as well at 25mg/twice a day. Then another surgeon we have been to called me back (I left a message for him last week) and I talked to him about pain management. He said he would suggest 200mg Gabapentin/three times a day. That's 3 times more than he is getting now. He also said that with his weight (Schlo was about 46 pounds pre amputation) 200mg would be an average dosage for him. 

I'm a bit at a loss and am wondering if you have any input on how much your dogs got and if you noticed any side effects? If your pet experienced phantom pain how long did these symptoms continue and how long did you keep them on medication? Will the yelping continue even when on pain medication? Were you able to see what is caused by the meds versus than actual pain?

It is SO frustrating to constantly have to go after them for everything! They basically just took a huge chunk of money (again) and then turned their back (maybe dramatic but that is what it feels like).

Aaaaaaanyway. 

Thank you for any information you might have!

Mascha & Schlomo

Minneapolis, MN
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5 July 2017 - 10:25 pm
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We avoided phantom pain because our surgeon and other vets were very proactive about pain meds.  We were using Tramadol, Rimadyl and Gabapentin before and after surgery.  

NOT A VET, but ... I would not alter Tramadol dosage of 25 mg as that is an opiate, but it really can be given and is often prescribed for every 8 hours.  So that may be an option.  

But since this appears to be phantom pain, Gabapentin is the most effective and I would follow the second surgeon's advice.  Pofi weighed about 70 pounds and took 300 mg 3x daily and we were told we could go higher and did so later in his final days. This site shows 200 mg up to 3 x daily should be a safe dosage for Schlomo.

And if it were me, that is what I would do.  Rimadyl as precribed, 2 x day.  Gabapentin at 200 mg 3 x a day.  Tramadol you could try to stay with every 12 hours at that dosage (I might try this as Tramadol is probably least effective), but you can also try every eight hours.  But the very first thing I would do is increase Gabapentin dosage and frequency.  It takes about 2 days to really build to the therapeutic level that should provide steady relief.  And stay at that dosage for a while if it is working - maybe 2 weeks and then taper down.  Try every 12 hours at 200 mg and then 100 mg.  Taper down - don't stop suddenly unless there is a reason to do so (bad reaction).  

I don't know why some vets are so blase about phantom pain. I suspect they would be of a different mind if they had to lose a limb.

Best thoughts for Schlomo.

Lisa, Minneapolis

On October 27, 2016, nearly 6 months after amputation, and 18 months since his cancer likely started, we lost Pofi to a recurrence of Soft Tissue Sarcoma in his spine quite suddenly.  His Daddy and I miss him terribly along with his canine sister, Mia, and two feline siblings, Lucia and Cliff.

Blog: Pofi, Peripheral Nerve Sheath Tumor Amputation

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6 July 2017 - 6:09 am
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Hi Mascha,

We're still trying to pin down Zato's source of pain (could very well be phantom at times - his surgery was almost 2 weeks ago), but the vet also told me we could give him 200 mg. of Gaba three times a day.  Zato weighs about the same as Schlomo.  They also said we could increase his Tramadol to 50 mg/three times a day. We're trying twice a day today and see how it goes.  Poor boy is already backed up from the Tramadol dose he's been on!  Tomorrow we're going to the vet and try and get some answers and we will certainly discuss phantom pain with them.  If we come away with any useful info, I'll definitely share it.

But the Gaba dose sounds right based on what I was told.  I hope he feels better soon.

Tracy & Zatoichiheart

Former neglect case/shelter dog, adopted in 2009.  Read my story here.

Elder statesman of Richard & Tracy's pack!  Nicknames: Little Bud, Master Ichi, The Anma.

Diagnosis of presumed osteosarcoma of the left proximal humerus on October 29, 2016 ~ Palliative Radiation & Zoledronate treatments November 2016 thru June 2017 ~ Left foreleg amputation on June 29, 2017 ~ Homeopathy with Dr. Loops starting July 2017.

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6 July 2017 - 6:44 am
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Lisa, thank you for getting back. That was my gut feeling. I just left them a message to give me a bigger prescription. It's also really helpful to know about the 2 days it takes to the therapeutic level. Thank you! I'll keep you updated. 

Hi Tracy, I'm sorry Zato is having a rough time too (I love his name by the way). It's so hard...Schlomo gets backed up from Tramadol too. I was reading about Amantadine last night. On this site it said: 

Amantadine helps prevent what is called pain “wind up”. Once the pain receptors are annoyed it takes more pain meds to calm them down. This drug blocks that response and can be used for 1-2 weeks postop. Lots of dogs with chronic arthritis also take this drug for flare-ups when the Rimadyl or other NSAIDs they are taking stop working.

I just left a message at the clinic and am waiting to hear back to get a better pain management assessment. 

When does Zato express pain and how does it happen? 

Thank you heart

Mascha & Schlomo

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6 July 2017 - 7:04 am
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He whimpers when he gets up to turn around on his bed, but once he's up he moves fine.  I've been sleeping beside him on the floor because I think the mattress is too soft for him to maneuver on right now...and a few times during the night, he would wake me up yelping, and then he would stand right beside me like he was coming to me for help... that's different than the moving around whimper...I think that's the phantom pain.  He almost looks confused, like he doesn't understand what just happened.

I'm definitely going to ask them about it.

Zatoichi is a character in some great old movies about a travelling swordsman! 

Tracy & Zatoichiheart

Former neglect case/shelter dog, adopted in 2009.  Read my story here.

Elder statesman of Richard & Tracy's pack!  Nicknames: Little Bud, Master Ichi, The Anma.

Diagnosis of presumed osteosarcoma of the left proximal humerus on October 29, 2016 ~ Palliative Radiation & Zoledronate treatments November 2016 thru June 2017 ~ Left foreleg amputation on June 29, 2017 ~ Homeopathy with Dr. Loops starting July 2017.

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6 July 2017 - 9:31 am
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Hi Mascha,

Our dog, Daisy, is also experiencing similar symptoms to phantom limb pain. She will be 2 weeks post op tomorrow (left front leg amputated due to osteosarcoma). She started with yelping episodes on day 3 post op and has continued since. Her episodes generally occur when she is trying to lie down but sometimes when she is getting up. She was taking gabapentin and rimadyl leading up to surgery but that unfortunately did not seem to have any positive effect on her outcome. She came home on gabapentin (200mg 3x day, she is 54 lbs post surgery), rimadyl and a fentanyl patch. We have tried different concoctions of meds with no noticeable difference. We tried removing the patch, adding tramadol, trying valerian root (per our own vet), tried an injection of buprenorphine and then the fentanyl patch again. Nothing has worked for her. We did videotape one of her episodes and emailed it to her surgeon per her request.The surgeon said she has done about 1000 amputations and hasn't experienced this before. Daisy went back in to the vet yesterday and they had her evaluated by the surgeon and neurologist. The surgeon was able to elicit a pain response near her incisional area where she cut the nerves. They applied a lidocaine patch to the area and kept her over night to watch her. They discussed doing a nerve block to see if that might offer relief. We are anxiously waiting to hear back this morning on how she's doing. It is so distressing to see them so uncomfortable! I hope you are able to find relief soon for Scholmo!

Tiffany

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6 July 2017 - 9:34 am
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As I mentioned, we aren't vets so we cannot give dosage advice. But, if I had to choose I would go with the higher dose that the surgeon recommended. You can always taper it down. And I agree that adding the Amantadine could be helpful.

Did you talk to the acupuncturist about it?

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6 July 2017 - 9:52 am
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TIFFANY...we have a member. named Charlie. While his symptoms were .much more severe, the problem FINALLY was diagnosed as a nerve issue at the incision site. After all the pain meds and everything else
, they FINALLY did an "exploration surgery to find if it was a nerve. They actually jad ro go back in and find the exposed nerve and "fix" it...whatever that entaiked, cant remember exactly. Like your Daisy, it was a rare, rare fluke thing that happened but it was causing Charley excruciating pain off and on for weeks before they found the true cause. I'll try and find the post. It really does spund like this couod be a possibility...And it IS fixable!!

Wishing everyone best of luck.

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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6 July 2017 - 11:21 am
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Thanks Sally! I did a quick search but couldn't find the post you were referring to. Do you know if the spelling is "Charley" or "Charlie"? I will try to do a little more digging. And you mentioned he had an "exposed nerve"- what does this mean exactly? What typically happens to the nerves that are cut during amputation (I should probably know!)? I am still waiting to hear back but will certainly mention this to the surgeon when she calls. Thanks again!

Tiffany

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6 July 2017 - 11:32 am
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It sounds like Daisy, Zato and Schlomo have very similar symptoms. I am still waiting for the clinic to call me back but I'll let you know what they say re:Amantadine. Have you heard back about Daisy yet?

Hey Jerry, of course I understand that! Worry not. I was curious about other people's experience with their dosages and because all these different opinions are really confusing. 

As for Schlomo, he was definitely in a better mood before. He is hesitant to lay down now, does extra turns to find the least painful angle. He was on both his sides after surgery and now he tries not being on any one side. The acupuncturist said it takes time and that I need to give him time to heal, which I understand, but he is in real pain. I don't believe mine does dry needling but I sent him an email to double check. 

Please let me know how Daisy and Zato progress. 

Sending loads of light your ways. 

Mascha & Schlomo 

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6 July 2017 - 2:02 pm
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Hi Mascha,

I did hear back and they want to do an MRI to rule out any issues relating to her spine/neck or to possibly detect an inflamed nerve (I think this may be what Sally was referring to with the dog, Charlie?). If they don't find anything, the vet will go in and do a nerve block while she is still sedated. She also just ordered her amantadine which I have noticed is regularly mentioned here for nerve pain. MRI will be done tomorrow morning so I will update on their findings afterwards.

You mentioned that Schlomo is hesitant to lie down. Daisy has been the same way- as if she's afraid. She will circle one way and then the other and then switch again. Often this is when her yelping occurs (which is very distressing and lasts for about 30 seconds) so I do think this is why she is so hesitant. We did try acupuncture as well a few days ago which worked wonders at relaxing her and slowing her breathing. She was pretty good for the remainder of that day but early the next morning was back to yelping. Does Scholmo yelp out just once or longer? Is there anything you've found that helps to comfort him during this time?

Tracy- I'd love to hear what your vet recommends tomorrow for Zato as well. Keep us updated!

Tiffany heart

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6 July 2017 - 3:37 pm
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Hey Tiffany,

I'm glad you are able to get all those tests done with Daisy and I understand how helpless it makes you feel. 

Schlomo is very hesitant to lie down, I think he's afraid too. He's yelped consistently for a few days. Before that his back knees gave out and were an issue but now the main concern is the yelping (not that the knees aren't, I'm just trying to prioritize). He will give out a shrieking yelp, usually one and not multiple. I also put my mattress on the floor and have been sleeping on the mattress or the floor with him. When he yelps in the middle of the night he is so startled that he comes up to me as if he is looking for help like Tracy was saying too. He has yelped walking as well, which started yesterday. Again, not continuously but after he yelped walking he didn't want to walk anymore. 

I have been massaging Schlomo when he yelps. I try to calm him like that. I started massaging around the incision with Vitamin E oil yesterday and I ordered hot and cold compresses to start using with him. Have you looked into the farabloc yet?

I can imagine how distressing a 30 second episode must be. It must be gut wrenching. How do you deal with it when it happens? 

The clinic finally called me back and I updated them and asked for Amantadine. I am going in tomorrow morning so they can look at him again as well. Last time we were there was Sunday. 

I believe all 3 of us are at the Vet tomorrow. Let's keep each other updated. They seem to be in such similar states. 

Mascha & Schlomo heart

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6 July 2017 - 4:04 pm
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Hi Mascha & Tiffany,

I'm going to ask about Amantadine, too tomorrow while we're there.  He's actually been doing a little better today with the increased meds but nowhere near where I want him to be!  He yelps only once, usually the middle of the night thing, but did once getting up earlier...he had been lying on his good side.  I'm sure it's very painful to try and sit up after something like that.  I am hoping that having the sutures out will help a little, too.

I'll let you know what we find out!  Oh, and I also totally agree with the afraid to lie down look.   Hoping for the best for these 3 sweet souls.  And fast relief!

Tracy & Zatoichiheart

Former neglect case/shelter dog, adopted in 2009.  Read my story here.

Elder statesman of Richard & Tracy's pack!  Nicknames: Little Bud, Master Ichi, The Anma.

Diagnosis of presumed osteosarcoma of the left proximal humerus on October 29, 2016 ~ Palliative Radiation & Zoledronate treatments November 2016 thru June 2017 ~ Left foreleg amputation on June 29, 2017 ~ Homeopathy with Dr. Loops starting July 2017.

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7 July 2017 - 12:39 pm
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Ok, we're back!

Zato got a great report and he has really rallied the last 12 hours, for which I am so grateful.

We didn't discuss the Amantadine since he's doing better, but we did discuss phantom pain.  The vet said ABSOLUTELY that could be the cause of the sudden yelping.  She said it usually passes in a few weeks and that Gabapentin is really good for that. I noticed Zato did not yelp last night, and it's about the third day on his increased dose.  And she also said that there could be some fear to lie down if it is painful and that can make them vocalize, too.  As well as the Tramadol.  It apparently affects dogs mentally more than it does people as far as side effects go.

She said to continue on the Tramadol every 8 hours for another week and then see if he will tolerate going back to twice a day, and to continue the Gaba 3x a day for the next few weeks to give the nerve/phantom pain a chance to settle down.  She checked all of his joints and said the whimpering (which has almost stopped, too) and the funny stance he has sometimes with his butt low are a combination of inflammation/post-surgical pain (nerves trying to reboot)/and learning how to move with 3 legs. She said while he was used to carrying his front leg from the tumor and getting around fine, that leg still had weight that he used to pivot, so now that the leg is gone, he still has to learn and it fatigues his other muscles.  I felt really good after the visit.  She said basically he's where he needs to be at this point in the recovery process.

Oh, and after going on about suture removal, I found out they'll dissolve. whatever

I hope your visits went as well.

Tracy & Zatoichiheart

Former neglect case/shelter dog, adopted in 2009.  Read my story here.

Elder statesman of Richard & Tracy's pack!  Nicknames: Little Bud, Master Ichi, The Anma.

Diagnosis of presumed osteosarcoma of the left proximal humerus on October 29, 2016 ~ Palliative Radiation & Zoledronate treatments November 2016 thru June 2017 ~ Left foreleg amputation on June 29, 2017 ~ Homeopathy with Dr. Loops starting July 2017.

Virginia
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7 July 2017 - 2:36 pm
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Great feedback goi g on among everybody!! Knowing you aren't alone and being able to share your experiences and give and receive firsthand nformation is what makes this such an invaluable community!!heart

TIFFANY...sorry to throw the info about Charley out there and then not be able to find it! UGH! And I'm not sure of the speng either! Think my typose are bad...ya' should see how bad my "seach" skills are. His situation involved loud screaming and yelling with almost every movement sometimes. She posted a video and it was really hard to watch. Daisy could, indeed, be feeling some form of that from an inflamed nerve, just, thankfully, not as painful.

TRACY thanks for the great feedback from Zato's visit roday! The Vet explained what was going on with Zato, and probably Sch@omo and Daisy too very well. Thank you for taking the time to share that. Meds and patience will get everyone through this!

One other thing that happe s with dogs sometimes too. They are used to circling one way more than the other when getting ready to lay down. And sometimes they often are used to sleeping on one side more than the other. So this makes it upsetting for them too initially as they work through these little breaks in habitx.

Sending love and hugs ro all!

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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