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Gabapentin dosing seems very high. Thoughts?
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12 September 2018 - 1:17 am
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Hi everyone 🙂 we are past the 9 day post amp mark yayyyy. It’s been a tough go but things seem to be getting better.

I’ll start by saying that the vet that did the amputation is not our regular vet and that the trust relationship is not there yet.

Our sweet boy Titan was sent home with antibiotics and that was it! It didn’t take long for a visit to the vet to get Tramadol, metacam and Gabapentin (thanks to everyon’s shared experiences in here).

Were on day 3 of Gabapentin and day 2 of no more phantom leg pain (hooray). Tonight when I was giving Titan his gaba I noticed the pills were 600 grams and he gets these twice a day. He is a 60 pound dog.

Based on what I found by googling, the pain management dose for gaba is 5-10 mg per kg so he would be 300 a day. I feel terrible that I was giving him 1200 a day! Can anyone giving gaba share what you are dosing at? 

I gave him 300mg of gaba before bed with 100 mg of Tramadol and we skipped his metacam for the first time today. 

Thanks in advance 🙂 

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12 September 2018 - 9:14 am
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Casey weighed 53 pounds post-surgery and took 200mg three times daily for 600 mg/day.  He was given a one week supply, which we refilled once and started tapering him off it.

The Rainbow Bridge

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12 September 2018 - 10:49 am
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Ok first, I am SO proud of you for advocating on Titan’s behalf for more pain medication. That is CRAZY that he only came home with antibiotics. Please consider a new vet clinic, as whoever treated him doesn’t seem to think animals need pain medication. If you want help locating one, let me know. I don’t say things like this lightly, but in this modern world of pain management for pets, there is no excuse for zero pain meds after amputation surgery. mad So now I will get off my soapbox and answer your question:

Were on day 3 of Gabapentin and day 2 of no more phantom leg pain (hooray). Tonight when I was giving Titan his gaba I noticed the pills were 600 grams and he gets these twice a day. He is a 60 pound dog.

Based on what I found by googling, the pain management dose for gaba is 5-10 mg per kg so he would be 300 a day. I feel terrible that I was giving him 1200 a day! Can anyone giving gaba share what you are dosing at? 

First, I don’t believe his is over-medicated. He just had amputation surgery. He has no more phantom pain , right? Is he acting lethargic at all? If not please don’t worry, it is likely very appropriate.

Second, remember two things: all dogs are different and take medication for different reasons, and Dr. Google is not always right so please don’t skip medication or dose your dog based on what you find on the internet — call your vet first, always.

But I will try to make you feel better so you don’t worry, and let you know that our Wyatt Ray , 82 pounds approx, has been taking 300 mg 2x daily for chronic pain. His veterinarian, an orthopedic surgeon at CSU, has just upped it to 300 mg 3x daily, so 900 mg total. He is taking gaba in addition to a small dose of Meloxicam and a muscle relaxer called Methocarbomol). 

Oh I want to add that his capsules are in 300 mg increments, which makes dosing much easier. You may want to get a new rx in this increment.

Please call the clinic that prescribed it if you are concerned and don’t stop anything, especially Gabapentin, before talking to a vet OK? Let us know what they tell you, we’ll be waiting! 

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12 September 2018 - 11:12 am
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Well, let me get on the soapbox you so politely vacated!  Yes, no pain meds is outrageous.  That said, our regular vet, who was so helpful with Jake and giving him Tramadol for his chronic pain from lumbosacral stenosis, pointed out a couple months ago that now even Gabapentin is being carefully monitored by the FDA and DEA.  Casey’s surgeon was unable to send him home with a fentanyl patch, either because her clinic is not licensed for Fentanyl or they simply don’t stock it for safety/risk of robbery reasons.

Damn opioid crisis is affecting our pets’ doctors too!

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12 September 2018 - 11:38 pm
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Thanks everyone <3 

We we’re far from impressed when we did not get pain meds on the day of surgery. We brought Titan home and then went right back to the vet to demand them. I think the reasoning is that the surgery included the cost of meds and aftercare and they were somehow hoping we wouldn’t notice that we didn’t have pain meds and that our dog was suffering. Fat chance there! 

We brought Titan in today to see if his stitches were ready to be taken out (they weren’t) and the vet admitted that the other vet at the clinic prescribed too high of a dose of the gaba. He is now on 300mg twice a day instead of 600mg twice a day.

The hardest part of this (and as you all know there are many)…but our regular trusted vet would not do the amputation. She felt that because of Titans age and diagnosis that it was not a good idea and refused, which broke our hearts. She told us he would die soon anyway and it was devastating. 

Time was of the essence before the cancer spread so we went with the closest vet we could find who had availability for the surgery. I now feel like I can’t trust either vet which is a crappy feeling to have but I’m hoping we are out of the woods for now. 

I’m disappointed in both clinics and trust me I have been fighting the urge to email our first vet to say “look at how well he is doing, you were wrong” but in times like this I just want to focus on the positive and snuggle Titan every chance I get. 

Thanks again for the quick responses. I hope all your fur baby pawds are doing great 🙂

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12 September 2018 - 11:52 pm
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why did you skip the metcam?  many dogs are on it foreve.. it does have some anti cancer properties in additon to the pain relief

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13 September 2018 - 12:41 am
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He is so doped up all the time, it just feels like we’re over doing it. He is essentially on all the same drugs that he was getting to fight the tretourous pain of the tumor in his tibia pre amp plus we’ve now added on the gaba. 

The metacam has the worse side effects so we skipped it yesterday and again today. He has not shown us any signs of discomfort. To be honest I’m not sure if it’s the right thing to do but I feel like there has got to be an end insight to the constant pain meds and seeing him so drowsy all day and night.

Virginia
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13 September 2018 - 9:50 am
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christine82 said
but in times like this I just want to focus on the positive and snuggle Titan every chance I get. 

EXACTLY!!!   And make no mistake  about  it, Titan is loving  all the attention  and spoiling!! 😎  

As things settle down, you can formulate  an email to both Vets expressing  your disappointment.  We had a special member here named Atlas.  A large beautiful  Great Dane who has osteo, as well as Wobblers (a condition  that affects mobility).  She was told my two, maybe three, different  Vets that euthanasia was rhe only  option, not amputation.  She found a Surgeon  who felt Atlas would do just fine with amputation.   And Atlas thrived and enjoyed life to the fullest after amputation  for around two years!!!!😁

Glad the Gaba dosage got reduced to one 300 twice a day.  That’s still ample for a dog in his weight range.  Gaba can definitely  cause drowsiness!!!   It may take a day or so to see him perk up as he still has a lot in his system,.

You’re  doing a great job.  Titan should start getting his sparkle back, slowly but surely!  It took me three weeks before  I could finally say I did this FOR my Happy Hannah and not TO her!!!

Keep us updated.

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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13 September 2018 - 10:33 am
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What are the metacam side effects you see? There are orher nsaids you can change to.  I add omperazole etc to meals to help with nsaid side effects.  Milk thistle also

The Rainbow Bridge

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13 September 2018 - 10:33 am
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Yay for getting a new dosage of meds for him. You are such a great advocate!

As you both get your bearings back and you feel strong enough to tackle the vet clinic issue, let me know if you’d like help locating a good one near you. I can’t blame you for being disappointed in both, how frustrating! No pain meds is nuts. And any vet who immediately dismisses a dog due to size, age or even a diagnosis, rings an alarm bell to me that they are not staying current in modern protocols. It’s an old-school way of thinking, which undoubtedly is reflected in how they practice.

But you know, we don’t learn this stuff as pet parents until we go through a situation like this, so don’t be hard on yourself. Most of us have been there! You’ve learned how to advocate through the school of hard knocks (I did too!) and now you have some knowledge to get Titan the kind of care he deserves.

If you’d like to read more about advocating for our pets by finding a good clinic, here are two places to get started whenever you have time:

Dr. Kay’s 12 Things to Expect from Your Vet

Thinking of a New Vet Hospital? Explore AAHA-Accredited Clinics on #AAHADay 2018

One more thing to consider (as if you don’t have enough going on in your head!)….once his system gets used to the Gabapentin (about 1-2 weeks), it should not be causing any more drowsiness. And don’t be shy about pain meds, that’s why they exist. Some dogs are on them for the long term, some are not, but each case is different. Properly managed pain medications provide more benefit than harm in the long run, and as long as you choose a good vet who will monitor him while he’s on them, Titan can feel good indefinitely.

Oh, finally…please consider getting him to a rehab therapist. Yeah, one more thing I know, but hey the Tripawds Foundation may even pay for your first rehab visit , so you can’t lose! And Titan will certainly gain from it as well. Even one visit is so educational for us and helpful for our Tripawd. Let me know if you have any questions about the program.

It's better to hop on three legs than to limp on four.™
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13 September 2018 - 3:42 pm
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I think that 600 mg of gabapentin is a high starting dose but FYI you can go as high as 20 mg/kg so maybe that vet just wanted to make sure there was no pain.  I would strongly agree that your dog probably needs an NSAID such as Metacam for up to 14 days post op even if you don’t think he is painful because there is a large amount of muscle trauma and inflammation secondary to an amputation.  Metacam is fairly benign and unless you have GI side effects I would continue it or at least discuss it with your vet. Even ACL surgeries get 10-14 days of NSAID post op and that is a less traumatic surgery…..

Pam

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13 September 2018 - 5:41 pm
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Dr. Pam you ROCK! Thank you for the feedback.

It's better to hop on three legs than to limp on four.™
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