Changing Pain Relievers for Pepper-Torn Ligament

Changing Pain Relievers for Pepper-Torn Ligament

Deborah-

Dr. L prescribed 2 weeks worth of Gabapentin and wants to have a check up with her on Feb 11th. He said that it is definitely a torn cruciate but will reassess for the meniscus at her check up.

Pepper is willing to put weight on her leg without any ice with the additional pain meds, and almost doesn’t ‘cheat’ at all on her walks! So far she may only miss 3 or 4 steps by cheating now, where before we were lucky to get her to get several good strides in a walk. She’s already even starting to use it a little on her own in the house. K said that he had good results with her walks when he sat and iced her knee for 30 minutes.

Her pill regimen now is 1.5 tramadol 3x/day, and 1 gabapentin 2x/day with the rimadyl at 0.5 2x/day.

I think that is all for now!
Jan 29

to B-

That is great!
So, do the five minute walks this week, getting success at weight-bearing, and then next weekend start her on the ten minute walks.
I think we can make some headway now 🙂
What milligram dose is the Gabapentin? 100 or 300?
Blessings-

D-

Its 100 mg. It’s still amazing to me the difference in her walks!

Jan 29

to B-
Good… That’s even a pretty low dose for her size, It’s just a better drug for her body chemistry, evidently, and it often works really well along with Tramadol.
I am very happy about this!

Hi Deborah,

Pepper is not getting any sleepier than normal with the added pill, but I’m not sure that I have seen much decrease in her limping. I forgot to mention that she has been out of glucosamine for about 1.5 weeks, so that may have a little effect. It finally came in the mail tonight so she will be back on track with that.

She is taking the new walk time well.

B

Hi B-

Overall, great info.

So, you gave one more Gabapentin along with the other pills? Twice a day or just once? Also, the Glucosamine could make a substantial difference. In the near future, maybe we can switch her to a natural anti-inflammaroty, Xyflamend, instead of the nsaid she is taking, after she is pretty stable for a while and not any additional lameness…

Deborah

Deborah-

We are giving her the additional gabapepentin with all the same pain meds.

I would definitely like to get her on a safer antinflammitory. Do you have any experience with bromelein? B

B-

B-

good…

yes, I have experience with it, and let’s talk about transitioning at my next visit. I feel it’s too soon right now because we just got to a better place, so let’s give her the stronger tools to keep getting better muscularly, and then we’ll transition her to biologically kinder interventions for longer term.

good? 🙂

Deborah- 

sounds good! 

Pepper will need refills on everything by the end of next week. I didn’t realize that he changed her dose of the Rimadyl. He changed it to 1/2 tab per day and she was taking two 1/2 tabs per day.

B

Feb 24

B-

Good-

That’s a step in downsizing, and what you need to look for is more lameness with less drugs. I realize you are now giving more Gabapentin…has there been less lameness with that? And then look to see if there is more lameness with less Rimadyl.

She won’t need the same drugs/doses “forever”, but once we get on the upside of the pain, there is no sense in removing the drugs before the rehab work is done, so I do it in increments, looking for more muscle and function production and less lameness.

I’m sure that makes sense 🙂

Blessings-

And, as for switching to a natural anti-inflammatory,

Remember that Omega 3’s are anti-inflammatory (whereas the other Omegas are pro-inflammatory), and you also mentioned that you were going to get more of the Glucosamine/Chondroitin/MSM joint formula Pepper was using before you ran out. Both of those are good to implement now and for the duration of her life, as you probably know.

Like I said in the email I just wrote, the vet reducing the amount of the nsaid is a step in downsizing, and what you need to look for is more lameness with less drugs. I realize you are now giving more Gabapentin, too, than you previously were…has there been less lameness with that? And then look to see if there is more lameness with less Rimadyl. In the older dogs with torn ligament and torn meniscus, we have consistently gotten better pain relief with an nsaid, Tramadol, and Gabapentin all together in moderate doses. This always seems to work better than trying to eradicate pain with high levels of just one or even two drugs. She won’t need the same drugs/doses “forever”, but once we get on the upside of the pain, there is no sense in removing the drugs before the rehab work is done, so I do it in increments, looking for more muscle and function production and less lameness.

I often remind people that once we get to the good pain relief with the least lameness we are thoughtfully able to accomplish, then we need to stay there while the functional drills progress (so long as blood work supports that). Often then along the way less lameness is realized, less pain, because the muscles build and the joint settles down and other positive things are taking place. It is only after good, consistent success with exercises and drills that we want to play with reducing the pharmaceutical medications. Often, then, if there are no conflicts, I encourage some of the older dogs to get on Xyflamend, which I have found beneficial and have been using more and more recently in conjunction with a local vet who is well-versed in herbs and knows there are no conflicts. I have personally used the product for a couple of years now as part of an anti-inflammatory regimen for my body as well as for some joint and muscle pains.

You asked about bromelain as a natural anti-inflammatory, and I’m aware that the internet is full of testimony toward Wobenzym N, a popular supplement that contains bromelain and other protease enzymes and that it has been around for quite a while. I tried it for a bit in the 1990’s. The approach is different in Wobenzym N than Xyflamend, and maybe both would eventually be good for her, but they are also not cheap (neither one), so I usually start now with Xyflamend due to the advance of research into some of its components and because I really, really like tumeric/curcumin 🙂

My finding is that (unfortunately?) there is not any one natural remedy that has the impact on greater pain, like Pepper has and like most of my patients have, that pharmaceuticals have, and I have found that a combination of natural substances, like Xyflamend and/or Wobenzym N and Omega 3’s and Glucosamine/Chondroitin/MSM at the forefront, works best for long-term maintenance.

There definitely isn’t one natural compilation along with interventions from us, like massage/ice/heat/laser, that will take over in a situation like this, with torn meniscus and with her ongoing pain that we’ve had a difficult time finding the right combo of pharmaceuticals to address. I have found this out over time and through very many cases, even in thinking of allowing for every being having slightly differing biochemistry. In time, though, and with thoughtful progress, we should be able to transition to more natural aids without also putting a huge dent in your schedule for the day!

I had a client at one time with a quite elderly mid-sized dog, and he did not want to use any pharmaceutical interventions. This dog appeared quite painful and was very, very stiff from arthritis. I had him doing a regimen of massage and ice and I did laser therapy. He also used several neutraceuticals (Omega 3’s, joint formulas), and I also recommended Epsom salt baths (rinsing very well after). These interventions, along with some others, did little to quell the pain, yet the time investment was around 3 hours daily. I finally talked him into dosing the trial of Rimadyl the vet had given him, and his pet was notably substantially better by later the first day. Unfortunately for the dog, I don’t think he continued with that medication and he fell off of pursuing rehab interventions.

I won’t take time here to get into windup pain or concepts of getting on top, over the top, of substantial pain and minimizing the reactivity. I think we are on a good path with Pepper so long as she continues to show improvement. Keep me posted!

Blessings-Deborah