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Post op agitation? re: Summer
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13 September 2023 - 12:22 pm
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As I posted in the ‘Share Your Story’ forum, Summer had an amputation for osteosarcoma this past Monday. She came home yesterday afternoon. She had a fairly decent night, slept until about 5 am, woke up, seemed like she was uncomfortable. Gave her one of her Tylenol w/codeine and it seemed to settle her down a bit. She ate a pretty good breakfast.

For the past half hour, she has been very restless, hopping around in the room, unsure of where she wants to go or what she wants to do. She did go outside to potty (urinate), had another Tylenol w/codeine, and I just gave her one of the Trazadone pills that vet said we could give her for agitation. She’s panting and pacing and I’m unsure what more to do. I’m starting to freak out on the inside, but staying calm on the outside.

She had her Carprofen and Gabapentin earlier this morning (8 & 11). Incision looks okay. 

Any advice would be so appreciated. Starting to question our decision to do this surgery.

Thanks,

Robin

Robin & Summer 

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13 September 2023 - 12:23 pm
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Summer’s Rx’s are: 

- Tylenol w/codeine 30/300, one every 8-12 hours.

- Carprofen 100 mg, 1/2 tab every 12 hrs.

- Gabapentin 100 mg, 2 capsules every 12 hours.

- Augmentin 500 mg, 1 tab every 12 hrs.

- Aminocaproic Acid 500 mg , 2 capsules every 8 hrs. (This is given because greyhounds- and other sighthounds, can be prone to delayed postop bleeding). 

Surgeon also gave us an Rx for Trazadone if needed for agitation. 

I am trying to stay ahead of the pain by giving her the pain meds a tad earlier than scheduled. 

Robin & Summer 

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Virginia



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13 September 2023 - 2:15 pm
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  Starting to question our decision to do this surgery.

We call this early part of recovery the, "What have I done TO my dog?" phase.  We understand completely! Most of us have experienc that exact same thpught process.

The better news is that it's almost always a matter of tweaking the pain meds.  Her hospital meds are   making their way put pf her system and this is when fine tun9 g the dose and frequency  kicks in.

Panting, seemingly  cant get comfortable, restless.......all pain signals

Of course,  not  a Vet and not giving Vet advice.  From what we've seen here, the Gabapentin dose and frequency definately  can be adjusted.  Ask your Vet about 300 mg every eight hours.   I've forgotten  how much Summer weighs,  but even 300 mg may be on the low side. FWIW,  no insight  Into the Tylenol  other than, from what I understand, the Codeine may cause some restlessness.   

Keep in.mind the Trazedone does NOTHING for the pain.

Okay....deep breaths.....this is MAJOR surgery that cuts through muscles, nerves, bone and she's not gonna feel like herself for a bit.  Talk to the Vet abput the med adjustments and see of that makes a difference .  

Hang onto us!  You've got this!!!  And so does Summer!!  Soon you'll be in the phase, "I'm so glad I did this FOR Summer!"

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 2023 - 2:19 pm
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Hi, I have a new amputee and wanted to let you know that for her, the Trazodone takes 1-2 hours to kick in.  She's 29 lbs.  It is obvious, for her, when it is taking effect.  Also my older dog takes Trazodone for vet visits and they want it taken 1.5 hours before the visit.  Just to give you an idea on the timing.

For what it's worth, Trazadone makes my older (non amputee) dog a little uneasy.  Like she's calm but is also unsure what is going on. Almost like it is physically calming, but mentally confusing for her.  Could you help your dog settle in her usual bed and try to keep her there with a treat or something to lick or chew? 

I wish I had other advice, I'm sure you are worried.

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13 September 2023 - 4:00 pm
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Thank you, Sally and Tara_2 for your replies. This is all so frustrating for me, I’ll admit. I’m a (retired) RN, but am used to dealing with people who can speak and tell me what is wrong. So much harder to watch an animal go through it.

I did speak to the surgeon since writing the above post and he told me to give her an extra codeine at 4 pm and to give the Trazodone along with it, so that’s what I did. I know that Trazodone doesn’t help the pain, but that particular combination did seem to pull her out of her agitated state. She’s lying quietly now, no longer panting, drifting off (probably quite high). Since I didn’t give the Trazodone until after her agitated state, I’m thinking either she didn’t get her codeine fast enough (original instructions were to give it every 8-12 hours, but we’ve now switched it to every 8), or the codeine is causing her some agitation. Tara, thanks for the timing info on the Trazodone. It did take about an hour for Summer to settle.

Sally, I didn’t read your response until after the surgeon called me back, so haven’t asked about increasing the gabapentin. If this combo/tweak doesn’t work, I will definitely inquire about that. To answer your question, Summer weighs 69 lbs. Oh, and she did lie on her incisional side this morning and yelped (loudly) when she got up. It just breaks your heart. She’s now lying on the other side, so hopefully that won’t happen too often.

We had such an excellent first postop day yesterday, I figured the other shoe would drop today. On the good news front, Summer is pottying outside consistently and had her first real poop this afternoon. Yay for poopiconicon_exclaim Poor thing did fall forward on her face while in the poop position, but didn’t hurt herself. She doesn’t really like us to help her with the sling, but we will have to support her a little better until she gets the hang of the new normal. She also uses the ramp like a champ even though we only received it the day before her surgery, and only got to practice it a couple of times Sunday night.

And absolutely, yes, this was a ‘what have I done TO my dog’ day. I know there are better days coming and I sure am looking forward to them. I need to be as brave as Summer and put my big girl panties on. smiley4 You know, Be More Dog . Thanks so much for being here.

Robin

Robin & Summer 

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13 September 2023 - 4:11 pm
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Robin, I'm in the Tripawds chat for a little bit if you want to talk. More in a sec.

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The Rainbow Bridge



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13 September 2023 - 4:14 pm
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Glad you were able to talk to the surgeon. pain management is an art and during these first few days, usually needs adjusting. 

FWIW that dosage of Gabapentin is VERY low. Most dogs over 50 pounds get 300 mg 2-3x daily, and we find that 3x daily gives more consistent pain control. Another example: our Nellie is 60 pounds and she gets 100 mg 3x daily for maintenance (she has a wonky limb issue). Upping the Gabapentin could really help, with your vets approval of course. 

Also, Tylenol with Codeine (which works differently than Gaba to control other pain pathways) is an opioid, which will make many dogs dysphoric. You could see more agitation when that Traz wears off so just a head's up.

Everyone second guesses themselves at this point. Rest assured she is giving some really good signs (toileting!) that her recovery is on track! 

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13 September 2023 - 6:43 pm
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 Thank you! The vet did mention the possibility of the opioid causing some agitation. It’s so hard to know exactly, but I think it might be NOT helping. I’m going to talk to him tomorrow about upping the Gabapentin because that med does seem to help her. It’s 8:40 pm here now. Summer slept for several hours, then woke and I took her out for a short potty break. She came back in, ate a little, but seems somewhat agitated again - not as much as before. We’ll see how the night goes.

I’m sorry I missed you in the chat room . I was offline when you posted.

Robin & Summer 

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14 September 2023 - 6:16 am
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Summer update: Summer had a good night. She slept until 6:30 am and even then, we woke her up because we were worried about her being too zonked. Still trying to find that happy medium. But she went out to potty, ate a good breakfast (almost her normal amount), took her meds, and is lying quietly by my feet. We did increase her Gabapentin dosage and are giving it 3 times a day now. Going to try cutting back on the Codeine today and see how it goes.

It’s nice to see my girl calm today. That agitation was awful - for her AND us!

Robin & Summer 

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14 September 2023 - 7:37 am
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sounds great!  I'm so glad she's not agitated any more!

Along Bizkit's recovery we made a call in to the vet about "being too zonked." This was after I requested Trazadone because Bizkit was too active during her recovery.  Their guideline was along the lines of, if she seems too sleepy to eat or use the bathroom, let's bring the dose down. And when dinner time came, she didn't eat, so I did ease back on the dose and we found our sweet spot.

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14 September 2023 - 7:48 am
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Thanks, Tara! Finding that sweet spot isn’t the easiest, is it? Summer was definitely zonked this morning upon awakening. She did potty and eat, so that made me feel better. I just took her out again and noticed that she tends to hurt more (and gets a little agitated) after going outside to potty. I’m guessing she's still quite sore and this seems to really be a workout for her at this point (we are now on postop day 3, not counting surgery day). I can’t wait until we are further along in her recovery, though I’m sure everyone feels that way.

I’m so glad Bizkit is doing well. It’s hard to watch them find a new normal. Hope your day goes well!

Robin & Summer 

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Virginia



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14 September 2023 - 7:55 am
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Glad everyone got some rest!

Regarding the gabapentin, so the increase is how many milligrams a day.....200 mg 3Xday?   

In my non vet opinion, there's still a little wiggle room for more Gabapentin. I wish you could try that without the Trazodone and without the Codeine just to see if that is the best way to curb the pain and the restlessness.

, great news about getting some sleep, and she's eating and drinking and partying! Celebrate that!

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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14 September 2023 - 8:03 am
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Gabapentin 200 mg three times a day. We only gave half dosage of Codeine this morning and no Trazodone, so will see how it goes.

And, yes, definitely celebrating the small things!

Robin & Summer 

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The Rainbow Bridge



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14 September 2023 - 10:41 am
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Yay! You two are getting there, it takes some doing and 72 hours out is reallllly early as you know. Moving is hard work, so that explains why she's a little agitated coming back inside. That's one reason why we just tell folks not to force more bathroom breaks than usual. By the end of this week you'll have it down pat. 

200 mg is a good bump up, with room to increase if needed and your vet agrees. It's nice getting the meds in 100 mg dose, even when 300 mg is prescribed at first, because the 100 mg lets you fine tune it better.

You are both doing GREYT! Thanks for the pupdate!

Something to put a smile on your face: we've had quite a few interactions with Greyhounds over the years, such a fun bunch of people and dogs!

https://tripawd.....greyhounds

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14 September 2023 - 2:52 pm
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Wow, thanks for the greyhound link! Greyhounds really are special - I’m not sure they’re really dogs. icon_lol It’s unfortunate that this disease is so prevalent in them. As soon as Summer started limping, I knew.

Summer’s having a quiet, restful day. She’s a little subdued today (but not zonked), which I think is better than the agitated state she was in yesterday, so I’ll take it. Rest = healing. She’s eating pretty well and we’re taking her out for potty breaks only when she asks. She hasn’t had a single accident in the house since she came home. My little rockstar. 

As a side note, that aminocaproic acid is so important in greys. They gave it to Summer as an injection during surgery and she’s still on it 3 times a day in pill form for now. Something other greyhound owners whose dogs need surgery should know and ask about.

Hope everyone is having a good evening. Will update on Summer tomorrow.

Robin & Summer 

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