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 ๐Ÿ™‚
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?ย ๐Ÿ™‚

Deborah-ย 

sounds good!ย 

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 ๐Ÿ™‚

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 ๐Ÿ™‚

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

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Hi Deborah!

I’ve enjoyed following the stories you post on FB about the dogs you heal, and who’d’ve thunk I might one day need your services?

My dog, K, has been gimpy for about a month or so (back right leg)… took her to our vet a couple of weeks ago. By poking and prodding, they figured it’s her knee. Gave us some anti-inflammatories and said to keep her from running, going up stairs, etc. It showed improvement during the first week, but then we let her back on the stairs and it’s back to the same.

My former vet friend, P, looked at it a couple of days ago… She strongly suspected an ACL tear.

I poked around a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought I’d ping you and ask you a few questions:

– What would our next step be? (we haven’t had x-rays or the “drawer-test” that Pam described to me)

– If we wanted to do any rehab through you, how would that work and what would the fees be?

K seems very happy and it doesn’t really slow her down too much (unfortunately! She wants to continue being the family dog that she is, around us all the time). Yesterday, we decided to confine her (like crate rest), but the problem is, the gimpiness seems worse after she’s been lying down for a while, then it seems to warm up and work itself out once she walks around a bit. So by keeping her confined, she’s lying on it a lot more and not moving as much, so it actually seems worse. (making me wonder if the confinement is the right thing to do…)

Thanks!!
T

My Answer Today:
Hey Gurl…
Goody…I happen to be home and able to give you a better answer via the pc keyboard!
The best option, imho, is to have me come out and do a consult regarding how you should proceed. It usually takes an hour for something like this. I prefer to see animals for the first visit in the home environment so I may discuss potential pitfalls and see home items we may use for drills, among other reasons. I am also able to do phone consults at $1/minute, but I prefer to see the pet in person…

The second best option is for you to go onto my rehab site and look under notes for the homework for post cruciate ligament rupture rehab.
I also have a video posted on YouTube and my WordPress site regarding a massage technique that is beneficial. The Pittie featured in the video is 3 years out from a cruciate ligament tear and never had surgery. He is doing great because the owner did the homework as I recommended. The YouTube link is on my WordPress and is under RehabDeb if you search it.

I do not think I would ever have surgery on one of my own dogs for this issue again. My little Grace had two TPLO’s, the major surgery where the bone is cut and replaced at a different angle, and both didn’t work out. One wouldn’t have worked out because she had a congenital joint disorder on that knee and the surgery wasn’t ever going to be solid, and on the other knee she ended up getting a raging infection at the time of surgery that eventually ate up the whole joint. The Grace had a poor immune system, and she was open too long on the table, due to unforeseen circumstances, among other things.

She was bone on bone in both knees for the last 3 years of her life, yet she was definitely full of life! She ended up tearing all three ligaments in the second knee, so far as I/we can tell, and it was muscle support of the joint that enabled her to function as well as she did. None of the available braces were of a good enough design for her, and I’m not a fan of what is currently available for most dogs, especially not without working on my walking and exercise drill protocol first.
I deal with many dogs whose owners don’t want surgery for a variety of reasons, and the feedback I receive is that they have done great without surgery.
Of course, I also do rehab with many pets that have had surgery also, from both boarded surgeons and regular vets, using all types of modifications.
I’d be glad to discuss the differences.

We don’t do surgery on every human athlete, much less every human, yet most of the dogs are immediately referred to surgery as if there isn’t another answer the vet knows to suggest. This is because the vets are trained to react in that manner, and they usually don’t have any foundation in muscle-building and joint support protocol. Most of the reasons I’ve heard given in favor of surgery aren’t necessarily scientifically correct, according to available research and anecdotal evidence. I’m trying to make my functional rehab protocol using principles of exercise physiology more readily available.

My background in sport science definitely gives me a huge edge in developing protocol for recovery, and it is just taking slow time, getting the word out and getting people to think more wholly about the situation, and to see/know therapies that exist in other areas of physical science and apply them here. The angle of a dog’s knee, or any quad-ped knee, is definitely different than that of a human/bi-ped, however many principles of physiology and of the relationship between soft and hard body tissue apply and are useful to improve function and quality of life.

Blessings!!

(10-17-13 and now you may purchase the guide book for rehab of this condition atย http://wp.me/p1wSDA-cUย )