Caring for a Three Legged Dog or Cat
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Hi everyone, sorry for starting a new topic without replying to the last I posted. Things have been a bit crazy and although Max's constipation was solved with incorporating pumpkin into his diet, his pain has increased.
Max was given the grim diagnosis of 'about' a month to live. It has been two months and for the last week his pain has progressively gotten worse. As of right now, he is on .5 mL of Gabapentin 3 times a day, and Prednisone two times a day.
However, this isn't enough. He had a bottle of Tramadol from before he got his Gabapentin, so we began giving him a 1/4 of a 50mg tablet twice a day to see if it would help his pain. The Tramadol seemed to help a small amount... but that's it. So we have stopped giving him that since it didn't seem to help much.
We called his vet to ask about finding a better pain medication (maybe to use with Gaba), and they said they have no idea about Gabapentin (we got it from Ohio State) and the best pain meds they offer for dogs are Tramadol, so they had no solution. They recommended we call Ohio State.
We called Ohio State, the neurologist told the assistant to tell us that they have to see him before recommending any increased dosage, new pain meds, etc. Their first available appointment is a week away.
His vet feels like he does not need to be seen, because it is terminal cancer and his only symptom is pain. I can't help but to agree. Unfortunately we're stuck, because the local vets (we called around) are basically useless when it comes to knowledge about better pain medication for cancer. Ohio State is our only hope, but they are apparently willing to let him suffer for another week.
My question is, what type of pain meds are recommended for when his current meds are not enough? And when is Prednisone supposed to stop? On the paperwork Ohio State gave us (when he got his diagnosis), it said Prednisone needs to be gradually decreased... but they never told us when, how, etc. So he is still on a tablet a day. I've heard a lot of dogs with cancer go on NSAID's, but with him being on Prednisone these are not an option...
The gabapentin .5 mL 3 times a day is clearly not enough and I hate to see him suffer. He has already outlived his expected time but is getting much weaker in his remaining leg... it doesn't seem like he has much more time and I don't understand why he has to be seen. He probably does not even have a month left and I'd hate to traumatize him for a vet visit that would be pointless. Not to mention a week is a long time when he only has a few left, if that. I want him to be pain-free as long as possible, not miserable. 
Thanks for any responses!
Ask Ohio State how much a emergency visit is. We found that when we asked Cornell about an appointment to see an a soft tissue specialist about amputation, the earliest appt was 10 days away and the cost was about $100 for the "consultation". When I said that we couldnt wait that long they suggested bringing her in on a emergency visit...$160.00. The attending vet was able to help her with her pain that night and they scheduled the amputation the next morning. I know you just are looking for pain management so chances are the attending ER vet will be able to help you immediately or at least speed things along.
Spirit Samson was Spirit Tripawd Daisys four legged "brother" and ruled as the self proclaimed head of the Monkeybutt Federations East Coast Division. Lady Chunky Monkey stayed from Oct 2011 and left for the bridge in Apr 2012. Miss Perdy is left and has some big pawprints to fill.
Do you have what it takes to be a Monkeybutt? Find out more at the Monkeybutt Federation
Thank you for your fast response! I do believe their emergency visits are about $150...
I just hate that he has to have a visit. I'm not sure why they need to see him… "Yep, he still has cancer. Looks like he's in pain. Here's medicine and a $200 bill." Sorry for the bitter joke, just a little upset! Unfortunately our experience at Ohio State wasn't the best and it really feels like they're just in it for the money. 
I was really hoping a local vet would be able to help because of the closeness, but looks like we have no other option.
Especially considering his time left is short… we just want to make it as trauma free as possible, because he is petrified of vets. But of course we also want it PAIN free… so if an emergency visit is needed we will have to do it!
Thank you again for your response!
Hi Max and family
So sorry to hear about the pain you are experiencing. That is the last thing a tripawd or a tripawd's family wants!
If I recall correctly (it has been nearly 2 yrs now), we went to a combination of Gabapentin and tramadol during the last week of two of my Tazzie's life. The Gab helped the pain a lot and this was a good combo. We only used tramadol at night, just because Tazzie was still romping at the park and would get rather uncoordinated on tramadol. In terms of pain, it probably would have been good to use it throughout the day. To be honest, we did not have a lot of time left when he got to the stage of pain that required Gab or the combo, but that was because his pain was due to a lump that was growing more than rapidly and starting to cause pain. That is a rather unusual form of metastasis.
My understanding is that these two drugs are safe together. I believe you have to worry about withdrawing slowly from Gab when a dog has been on the drug for a long time, but not for short (1-2 wk) periods.
I never used those with prednisone. Often prednisone can be a last-ditch wonder drug so I have no idea which would be more effective. Tazziedog (Pam the vet) would know this of course.
I don't think the NSAIDS would be more effective than Gab or pred at this stage.
Aren't there any vets in your area who have Gabapentin or can't your vet get it in? Sometimes they can write a script that you can take to a human pharmacy. We did that for a few drugs.
Susan
It depends on the concentration of the liquid gabapentin. The dose can be increased as high as 10-20 mg/kg 3 or 4 times daily and your local vet should be able to look at the bottle and make the calculation for you. Is this med specially compounded? I usually use the 100 mg capsules for small dogs since the prescription liquid contains xylitol which at high doses can cause problems such as low blood sugar or increased liver enzymes. OSU may have specially compounded it so you need to check the concentration with your vet.
Tramadol can also be safely increased up to 3 to 4 times daily and your vet should be able to calculate that dose for you. I have also added amantadine for nerve pain relief and some dogs can tolerate higher prednisone doses.
I think it is worth your time and money to revisit OSU since they seem to know your dog best. Some vets do specialize in pain management so there could be a lot that they can do for him.
Pam
No need to apologize, you have Max to tend to, we understand.
Oh guys, we are so sorry. Is there any chance that you have a hospice service nearby? This is an incredible service run by pros who understand pain meds. They can help you deal with where you are at with this disease. Here is an article we wrote about it:
And some of these posts about hospice (skip the first one, the others are more relevant) and end of life care might help bring you some comfort.
Many hugs coming your way, we are thinking of you.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Max's Family,
I don't have personal experience with this, but I think it might be worth a call to one of the "housecall" vets. Around here, there are a few who come to your home, and we all know (don't we) that they do a ton of in-home euthanasia. I would imagine that, since they deal with end-of-life stuff so much, they might be the most willing to treat Max's pain. Not with euthanasia, mind you, but with something that doesn't require a trek to OSU. If you told them when you called (provided you have one around you) that this was for crisis pain management , that the dog is terminal and doesn't need an evaluation, then maybe you'll get some help. Second choice might be a local emergency vet clinic. They get so much trauma that they should be experts in immediate pain management . Good luck.
Shari
From abandoned puppy to Tripawd Warrior Dude, Dakota became one of the 2011 February Furballs due to STS. Our incredibly sweet friend lived with grace and dignity till he impulsively raced over the Bridge on 12-15-12.
Dakota's thoughtful and erudite blog is at http://shari.tr.....pawds.com/
Thank you all so much for your caring responses!
THANKFULLY, a local vet we had left a message for on Tuesday called us back yesterday and squeezed us in at the end of their day. This is an office that specializes in pain management
, acupuncture, natural remedies, etc. and sounded very promising. The vet was extremely knowledgeable with pain medication and very familiar with Gabapentin. She said the fact that our liquid form had any xylitol wasn't good, and she recommended the 100mg tablets (double his dose from before). She also doubled our Tramadol dosage (when needed) and said to keep him on his Prednisone. So right now, he is on 100mg of Gaba every 12 hours for pain and Tramadol whenever needed. And I am so happy to report that after getting his dose last night, he was back to normal! He had been in such agonizing pain I thought the end was surely near... now he is almost completely pain free and happy again. A little drowsy when he first gets his dose, but very alert if "Bye bye" or "Walk" are mentioned! (Or Mcdonalds chicken nuggets.... every since his cancer diagnosis he has been "Americanized!" haha.)
Pam - when we first got the Gabapentin from OSU (when he was first diagnosed) it was their own specially compounded liquid form. Unfortunately when we ran out we didn't have a chance to go to OSU, so we only had his local vet to turn to (which were completely clueless, they know nothing about Gabapentin or pain management .) They called in a liquid form into our Walmart pharmacy... when we asked if it had xylitol in it, the vet and Walmart said it'd be so minute it "shouldn't hurt him"... that didn't sound too promising.
Shari - We had actually been looking into those type of vets, because we wanted to be prepared when the time comes... Max gets rather distraught when we take him to the vet and I did not want him to endure that stress during his final moments. Unfortunately, we did some searching and it doesn't seem like there are any in this area... we live in Ohio and my mom said she had difficulty finding any in the state. Our best offer was from his local vet, they said they would come in before opening hours so it was empty and more relaxed. I still wish he could go peacefully at home.
Needless to say, we are now going to this new vet permanently. A little pricier for a visit, but absolutely worth it. We haven't had a good experience with vets around here (either insensitive, rushed, rude, or just completely clueless) and I am SO glad to say I think we've found the perfect one. So now Max is on 100mg of Gaba every 12 hours and 5mg of Prednisone a day. And 25mg of Tramadol as needed... and he's doing good again! Yay! Now our only battle is his remaining rear leg weakness... need to invest in the leash that supports the rear-end!
Just wanted to thank you all very much for your kind responses, I truly appreciate every one!!
maxthejackrussell said:
...the fact that our liquid form had any xylitol wasn't good...
Indeed! We linked to an article by Dr. Khuly about the dangers of Xylitol in this topic:
Beware of Xylitol in vet drugs
We're surprised whenever any vet prescribes medicine without concern for the ingredients, and are happy to hear you found a vet who can help Max. Please feel free to share your veterinary specialist referrals with others.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
I'm late to this thread but just wanted to say that I am glad you were able to find a vet to work with you. Good for you for advocating for Max!
I hope the new doses keep him comfortable for a long time to come.
Karen
I'm so sorry you're having such trouble finding a good vet who fits Max's needs. You might want to ask this new one what they would do in your shoes when his time is done. Can they refer you to someone who could help Max cross the bridge at home when the time comes? Would one of their techs come to the house? Personally, I feel this is the companion animal version of a human right. But I'm opinionated and stubborn and tactless. Oh well. Too bad!
Shari
From abandoned puppy to Tripawd Warrior Dude, Dakota became one of the 2011 February Furballs due to STS. Our incredibly sweet friend lived with grace and dignity till he impulsively raced over the Bridge on 12-15-12.
Dakota's thoughtful and erudite blog is at http://shari.tr.....pawds.com/
I'm so glad you found a vet who you feel comfortable with and who is professional and caring. I'm not sure where you are in Ohio, and this may be information you no longer have a need for, but we're in Dayton and when our local vet diagnosed Sylvia's osteosarcoma, he recommended the Medvet folks in Cincinnati or in Columbus, as well as OSU. (I'm now glad we chose Medvet and not OSU!!) We went to Cincinnati where Sylvie was in the care of the oncologist there, Dr. Karina Valerius. Medvet's focus is on cancer and eye issues and they also see emergency cases. The staff there is the best group of caring professionals involved in veterinary service that I've ever dealt with. If things don't work out with your new vet (altho he/she sounds great!), you might want to consider the Medvet folks.
- Karen and Angel Sylvia
Sweet Silly Sylvie, the Old English Sheepdog
Diagnosed with osteosarcoma 11/04/2010 at almost 7 years of age * Left hind leg amputated 11/09/2010 * Chemo on 12/10, 12/17, 01/10, 01/31
Sweet Sylvie's earthly journey ended on Nov. 3, 2011, one day short of a year since her diagnosis and 6 days short of her one-year ampuversary. Her family celebrates her life as a sheepdog – ever the puppy, ever silly, ever sweet – and are grateful for our 7 years together.
So sorry late to this discussion but we are in the same boat with the same meds and the same length of prognoses time!!
I was reading your posts and realized the dosage was way off for Max to control pain,but he's smaller than Trina so wasn't sure what the dosage would be.So glad they came thru for you on that!!
Gabapentin works on nerve pain,normally works better at night, but can be every 12 hrs along with the tramadol.The thing about tramadol is it can interfere with deep sleep patterns, yet I give it to Trina and she sleeps fine with it.Knocks her out pretty well,always has.Trina is 83 lbs,an american bulldog with OS and 2 tennis ball size lung mets,back left leg amputated 3/8/11. She was given a "few weeks" a month ago.I have taken both of these meds and still do so know how it feels even if I am not a dog.
I have been playing with both meds to see what works best, but both combined together seems to work best for a good nights rest for her.She's been on 50mg tramadol and I have upped it to 1 1/2 pills or 2 pills depending how much panting she has.It settles her breathing pattern.Little cough, yet the vet said that would progress.She did vomit blood a few weeks back,once,gets gaggy but not vomiting, so put pepcid in with her food.She loves pumpkin and yogurt on top to settle her tummy and lately soup too.She hates the taste of the tramadol so have had such a fun time trying to hide it in cheese or bread and butter,cat food.Right now i just make doggie meatballs of regular mushy dog food and sneak them in and she gobbles them down.She's smart,if I hand something to her she gets real suspicious,if i toss it in her bowl no problem.I think she is way smarter than me.She grumbles when she's due for meds,so i know if it's 4 or 5 hrs and her panting is increasing and she's grumbling then it's time for another pill.She still exhibits wanting to interact with everyone and going outside for short walks or lying on the grass and watching the air and sniffing the grass.So we may have a little time left yet.She's getting some loose stools but not sure if that's from a change in the wet dog food ( she's always had a sensitive tummy to food changes) or if it's from the pain meds,but haven't upped them that much,just increased frequency as needed.It still varies day to day.Some days/nights she can go longer than others.
My heart goes out to you and Max and hope we do the best we can,we sure are trying hard enough!
Karen,Trina's mom
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