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Struggling one week post amputation - Gabapentin side effects?
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Member Since:
8 September 2023
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22 September 2023 - 4:28 pm
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Hi

Our Cocker Spaniel, Aura, is 10 and on 15 September she had her right front leg amputated and has been generally struggling since.

A lump appeared on her elbow about 18 months ago, which was diagnosed as a bony growth as a result of a fragmented coronoid process and was initially benign on biopsy. She became more and more lame and deteriorated 3 weeks ago to the point that a further scan was carried out and revealed the lump was now almost certainly a malignant chondrosarcoma and the only option was amputation of her whole right front leg to save her life. After much deliberation and upset she had the op on Friday 15 Sept and came home on Sunday 17 Sept.

She has gone downhill since Sunday. Initially we were pleased and surprised by how well she seemed - she seemed happy to move around on her remaining front leg and even ran towards the car to come home, but since then Aura has been shaky, stumbling and so miserable and flat along with being un-coordinated and uninterested in anything and basically in a stupor.  Her back legs have been shaking and her body trembling and her existing front left paw is swollen.  She pants and is restless at times and it seems that her existing legs can hardly support her.  She is on strict rest for another 9 days. Her neck is sore and she cries out in pain.

Her medication since Sunday as been - 2 x 100mg gabapentin 3 times a day.  0.5 x 500mg paracetamol 3 times a day and Onsior once a day.

When she is sleeping she often breathes fast and whines.

We spoke to the vet hospital yesterday and they said it sounds like side effects of gabapentin and that we should stop giving it to her immediately. She has now been off gabapentin for around 32 hours and though she is perhaps slightly brighter, there are no significant improvements yet.

We took her to our own vet tonight and she said it was almost certain that she is suffering from side effects of the gabapentin and she was unsure why the hospital prescribed it post op, as it can take something like 5 days to start to work effectively as a painkiller.  She is now only on Onsior and Paracetamol. Her temperature is normal and there are no signs of infection and her incision site is healing well. Our vet said this dosage of Gabapentin was the right at the top of the range for Aura's weight and could take a few days to work its way out of her system.

Aura is usually a 10/10 happy dog and she is around 1/10 at the moment.

We are so worried about her and just wondered if anyone else has experienced anything like this, especially with Gabapentin side effects?

Thank you so much for listening.

New England
Member Since:
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22 September 2023 - 5:56 pm
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Welcome, Mark. Your future posts will not require approval.

I'm so sorry to hear that Aura is struggling after her amputation! It's not uncommon for there to be a bit of a regression a few days after they come home. The really good hospital meds are out of their system and their new gait is making their body sore.

Hopefully our resident vet expert will be able to shed some light on your situation.

Pennsylvania


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23 September 2023 - 2:22 pm
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Hi Mark, So sorry your Aura’s had a setback! sp_hearticon2 Is she doing any better today?

Like you, my pup Juno (37lbs pre-amp) was prescribed up to 2x100mg gabapentin - though only twice a day - as needed (plus carprofen and codeine) when she was first diagnosed by an ER vet with osteosarcoma.

When I later had a consult with the surgical department they were very disturbed by how much gabapentin (and carprofen) had been prescribed and dropped her dose down to 100mg every 8 hours. They felt the original level was quite dangerous for her size - as you seem to be finding for Aura. (I can only imagine the ER vet might have been prescribing what she felt was a palliative dose just in case I didn’t follow up for treatment?!?) We never saw the symptoms you’re seeing but that might be by chance as we only gave her 2 gaba at night, and one during the day.

Hopefully, like @mischief said, Tripawd's resident vet expert Dr. Pam can weigh in with her professional opinion when she gets a chance. You could also try posting a version of this in the Ask A Vet! section of the forums, which is where she’s easiest to reach.

Natalie & Juno (aka June)

The Rainbow Bridge



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23 September 2023 - 3:19 pm
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Mark, I'm sorry you and Aura are struggling with this situation. It does sound like a pain control issue and Aura is either getting too much or not enough medication. It's hard to tell at this point but rest assured her situation is not unusual and it does get better once you get the med dosage and timing dialed in.

What country are you located in? 

From what we have learned through vet pain management experts, gabapentin is a standard post-amp prescription here in many countries, and while it does take a day or two to kick in, it doesn't take more than that. Human amputees start taking it immediately after amputation as well.

Many times what happens is a dog comes home from surgery and appears to be doing really well. So they do too much too soon and have a setback like this. We see it all the time. Once the pain is managed and brought down, and they get the rest they need, things get better.

I'd like to point you to a canine rehab/physiotherapist if you're willing. Tripawds Foundation will pay for your first rehab visit , because these experts can make such a huge difference in a dog's recovery, especially older ones. If you're willing to go, message me your location and I'll find a therapist for you. About 9 times out of 10 I can find one for members.

How is she doing today?

Member Since:
8 September 2023
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24 September 2023 - 12:33 pm
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Thank you so much for the replies, it really helps to know that there are people like all of you out there who understand and know how difficult it is to go through this.

Aura had to go back into the vet hospital yesterday. When we called them to update them on how she was doing they were a little bit concerned about her neck pain, and also about whether the pain management plan was working out for her. They examined her and said she does seem to have neck pain and also her back legs were a little slow to respond when they tested how quickly she recovered when they bent her toes back. They are increasing her pain medication while she is in there (methadone initially, then reintroducing gabapentin but a lower dose) to make sure she is comfortable. They called this morning to say she is doing well and already seems less tense around her neck and is getting up without pain, so they are going to start reducing the meds again and get the neurology team to check her out tomorrow morning. We are hoping she can come home tomorrow night. 

Thank you so much for the offer regarding physiotherapy, Aura has actually been visiting a physio locally for over a year, since she first started limping due to the mass on her elbow. She's quite local to us (we live near Liverpool, in the UK) and we have an appointment scheduled for Saturday, though this may be a little to early so could be rescheduled. We'd love to hear if there are any other rehab /physio's in our area that you could recommend too though - again, thank you so much for all of your help. We didn't realise how hard this would be and reading the advice and stories from others on Tripawds has really helped. We are so worried about her and just want her to be as happy as she can be when she comes home, so she can start her recovery properly.

The Rainbow Bridge



Member Since:
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24 September 2023 - 2:25 pm
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Hey Mark, I'm so glad she is getting some TLC and a new pain control plan from her team. Sounds like they have things as good as can be right now, and hopefully she will come through the next few days without any additional issues. You are all doing everything possible for her, which is awesome.

One thing you might want to mention is the new pain medication called Librela, which is a canine arthritis treatment, monoclonal antibody therapy. This injectable is giving some really good pain relief to many dogs now and it's relatively new so just making it into practices. It was a UK member who introduced us to it, and we just got it here in the states. Vets are calling it a game changer for managing pain. See Clare's post about her sweet angel doggie Meg and the treatment she received in addition to the LIbrela.

How Meg Enjoys a Pain Free Tripawd Life

 

That's great Aura is already seeing a physio! I would keep that appointment with your existing one. Can I ask who it is? I searched both directories and only found a couple of credentialed CCRT or CCRP physios somewhat near you (about 1.5 hrs!).

https://www.phy.....vet.co.uk/

https://www.fac.....siocorner/

It was tougher than I thought finding practitioners in Liverpool! If anything, you could call Meg's vet physio Philippa and ask if she knows any near you that I might have missed.

Member Since:
8 September 2023
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24 September 2023 - 3:09 pm
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This is our physio, she is about 30 minutes away from us - https://wirralv.....sio.co.uk/

Aura started on Librela in June! She had 3 treatments in total, her last one was in August and she was due another this month but events overtook us - we will ask whether this should continue to be part of her pain management plan going forward. We found that the first 2 treatments really made a huge difference, but that the third didn't seem to be as effective - though that may have been because the mass was growing and having more of an impact on her mobility and pain levels.

We'll check out those links, again thank you so much for your help.

The Rainbow Bridge



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26 September 2023 - 11:08 am
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Hey there thanks for the link to your physio. She looks fantastic and has great credentials, I would stick with her practice if it's convenient to you and you like the team.

That's super cool that Aura started Librela. I also wonder if the treatment was colliding with the pain of the mass, I'm guessing that's what happened with the third treatment and going forward.

I hope your girl is home now! Please keep us posted.

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30 September 2023 - 4:24 pm
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Hi there. Just wanted to say thank you again for all of the amazing resources on this site, we have been browsing through forums and blog posts and looking at the store ever since we knew that Aura had to have an amputation.

It's been an up and down few days since we last updated. She came home on Tuesday after 3 nights in the vet hospital where they put her back on higher strength opioids. She was comfortable in there and they gradually started to reduce the meds before she came back home so that she was back on Gabapentin (a slightly lower dosage), paracetamol, Onsior and Memantine. 

She was initially great when we got home, really active and almost bouncy - looking much more like her old self and seeming happy. This lasted for about 2 hours. Then she gradually started to lapse back into lethargy, fast breathing and panting, tremors in her rear legs, whining and crying out. I watched her get worse and worse until I called the out of hours service at around midnight. After a couple of calls with the vet I took her back to the hospital so they could take a look at her - it seemed pretty clear to me that her pain wasn't being managed well enough. She had brightened up by the time I got her to the vet (obviously) and they were reluctant to readmit her but gave her trazodone to calm her and that helped her to settle when I got her home again. 

Since then she has been making steady progress - we spoke to the vet on Wednesday and agreed an adjustment to her meds schedule - spreading out the pain relief more evenly though the day and evening. This seems to have worked and she is now less agitated and settled for longer periods. There is still some panting and restlessness but it's definitely reducing. I even managed to sleep a few hours the last couple of nights! The main issue now is how uncoordinated her back legs are which is making her unsteady on her feet. 

She was back in the vets on Friday to have her staples removed (one had turned itself round and was extremely painful to remove) - whilst checking her over the vet said that her rear leg unsteadiness could be due to having to re-learn proprioception . I'm hoping this is something that our physio will be able to help out with - is this a common issue for front leg tripawds?

Thanks for listening and for all the support x

New England
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30 September 2023 - 4:45 pm
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the vet said that her rear leg unsteadiness could be due to having to re-learn proprioception . I'm hoping this is something that our physio will be able to help out with - is this a common issue for front leg tripawds?

The physio should be able to help with this. I can't speak to if it's a common problem, though. 

The Rainbow Bridge



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25 April 2007
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30 September 2023 - 11:06 pm
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You are being such a great advocate for her! Many times pain medication needs adjusting so that's not unusual. Is the pain relief plan still working? 

She was back in the vets on Friday to have her staples removed (one had turned itself round and was extremely painful to remove) - whilst checking her over the vet said that her rear leg unsteadiness could be due to having to re-learn proprioception . I'm hoping this is something that our physio will be able to help out with - is this a common issue for front leg tripawds?

Not all dogs will pick it up right away, every dog is different. Yes, your physio can absolutely help with that. If you can take video of her walking around at home that will be really helpful for them to see. Animals are so good at hiding symptoms once they are home. 

Keep us posted!

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8 September 2023
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27 December 2023 - 3:46 pm
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Hi there, it's been a while since we last updated on Aura's progress. The first 6 weeks post op were really rough. Getting the pain meds right took several attempts, literally sleepless nights and lots of return visits to the vet hospital. On top of that it seems like a disc was damaged in her neck during the operation and that added to the pain. Then finally when she went to get her staples removed one had inverted and had to be pulled out manually which was agonising for her. She also became really depressed during the weeks when she was restricted to one room in the house. It's been so much to deal with for both of us, but mainly for her of course.

However, from the moment she was able to start going outside she has made brilliant progress. She's now 14 weeks post op and happily running along the beach chasing her toy, playing with other dogs and chasing squirrels in the park. She can handle going upstairs pretty easily (not down, apart from some small steps in the garden) and is gradually working out what she can and can't do. We have to drive her to her walks now and she gets tired much more quickly than she used to, but a couple of weeks ago she came on a short overnight trip to the Lake District for some gentle walks and loved it.

I know everyone's experience is different and there were times in those first few weeks when we were at our wits end and wondered how we could ever get through it, but it feels like we are over the worst now. Even better news is that she returned to the vet hospital for a scan on her chest, as they had initially thought there might have been some spread to the lungs, and was given the all clear. 

I just wanted to thank you for providing this incredible resource - it was invaluable in the lead up to her op, while we were deliberating about the decision, in deciding what harness to buy her and in giving advice through the hardest of times. 

Thank you so much

Mark & Michele & Aura xxxx

Virginia







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27 December 2023 - 4:33 pm
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Oh gosh, this is such an impor update f0r so many reasons!

First of all, CONGRATULATIONS on clear scans!!  Spectacular  news!!👏👏👏   Running along the beach, chasing squirrels, enjoying  her toys.....BFAVO! !😎

The other important  thing about  your update is how you laid out how hard the first many weeks were.  As you said, every dog is different.  Often times the expectations  are that, after the two week recovery,  there  will be smooth sailing.  Nope, not always the case at all!!.  So sharing what rough a start you had with Auroa, tweaking meds   to her specific needs, overcoming the disc issue, the painful inverted stitch, etc....all this helps newbies who aren't having a "smooth" recovery.  They will get there!  .  You stayed the course, you stayed optimistic and you got through the hardest times!  👏 

Thanks so much for taking  the time to Chronicle where she was and where she is now.  HAPPY FOURTEEN WEEK AMPUVERSARY  AURA♥️  Keep on keeping on sweet girl👍

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!

The Rainbow Bridge



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27 December 2023 - 6:02 pm
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Awww you guys this made my day! I was getting worried when I started reading your news but by the end you had me smiling from ear to ear and doing a hoppy dance! smiley_clap

What a relief for all of us and especially you. Every day is icing on the cake now. Be More Dog ! Make the most of every day like Aura is doing and you can't go wrong. 

Thanks for this terrific news. Remember we are always here for you so don't be a stranger. sp_hearticon2

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