Ozzi is gone... August 15, 2010

[peggy0]

Re: Starting Over With Ozzi...Need Advice

Hi kevin

Sorry that poor Ozzi is in pain!! They are amazing what they tolerate aren't they? I knew of one young dog that had a compressed vertebrae and was operated on very succesfully. In a week she was running around. It was amazing. Now to humans. My sister in law has one and tried the drugs first. She said you get use to them and the pain feels like it is increasing. She was on some pretty heavy duty drugs as well. She just started accupuncture and is really pleased so far. She cut back on the drugs and is taking just one pill with the accupunture. i know they use it on horses very successfully. Hope this helps.

[k9diabetes]

Re: Starting Over With Ozzi...Need Advice

http://veterinarymedicine.dvm360.com...ate=&pageID=10

http://www.peteducation.com/article....2+2084&aid=456

http://petsurgery.com/caudeaquinasyndrome.html

The links all make consistent references to significant pain as a result of the pressure on the nerve.

Big surgeries come inherently with risk.

I'm probably biased since Chris never had his cataracts removed but if I was going to do one surgery I would do the back surgery.

Mainly because the cataracts can generally be managed relatively easily and should cause no discomfort as long as any inflammation they cause is controlled. The spine apparently is painful and it could take a lot of medical management to control the pain without surgery.

So if I had to choose between surgeries, I'd do the back.

Especially given intermittent incontinence. It sounds like there is at least a possibility that could be resolved with surgery and that's one that's extremely difficult for the dog and his people to live with.

On the other hand, it's a big invasive surgery and there are risks inherent to any surgery like that. There's an extended recovery time...

No easy answers. I would want to make sure the surgeon doing either surgery is board certified and has a great reputation.

Natalie

[CarolW]

Re: Starting Over With Ozzi...Need Advice

Kevin - I've been thinking about you and Ozzi all day, and I reviewed your entire thread. Your choice, undoubtedly, is difficult. If you do decide on the surgery, I agree with Natalie; don't worry about the cataracts; Ozzi can cope with those.

I really don't know how successful pain management with the drugs would be.

And surgery does have big risks associated with it. I just don't know what to suggest. I think you have in your favor that you're doing well with the glucose control.

Sorry not to be more help.

Thu, 25 Mar 2010 00:31:44 (PDT)

[CoolGram]

Re: Starting Over With Ozzi...Need Advice

Kevin,

I too would be at a loss as to what path to take, but I did want you to know you and Ozzi are in my thoughts. If only surgeries came with guarantees, but since they don't, it makes decisions like these even harder. I guess if I were to be honest, if it were Gretel, I'd probably lean toward taking care of the cataracts - that is, if pain meds would work to control her pain. It's my main fear right now for her, that she will eventually lose her sight and I don't know how I would deal with that, even though from what everyone else here says, she would probably deal with it just fine.

Anyway Kevin, keep your chin up, do as much research as you can, observe Ozzi, and the answer will come to you. I really admire you, because you're doing everything humanly possible to take the best care of Ozzi, and that's the best any of us can do. Good luck to you both.

Carolyn

[ozzi]

Re: Starting Over With Ozzi...Need Advice

Thank you all for your advice and support! I really do appreciate it. I realize that ultimately I need to make a decision for Ozzi myself, and I wanted to gather the thoughts of others whom I trust. Despite not knowing any of you, there is an inherent trust in this forum that I appreciate. I think it stems from the simple fact that the people here understand, care, and love our animals as family members. And there is a comfort in that. Thank you!

I just got off the phone with my local vet. I just love her. She helped me think this through in a way that I hadn't been thinking. She framed the discussion by asking me "Is Ozzi's quality of life suffering by his decreased vision?" and "Is Ozzi's quality of life suffering with the spinal stenosis?"

Aside from bumping into things occasionally, Ozzi really isn't suffering from the cataracts, and it is not impairing his quality of life from what I can tell. I realized today that I have unknowingly compensated for his decreased vision by announcing that "Daddy's home" when I come home from being out, so he can hear me. I noticed that the first thing he does is "sniff me"...I guess to make sure it's me. I have been "leading" him down the six stairs in the house to get him outside, because he has become more hesitant. So, without knowing, he and I have inherently made some adaptations to his lifestyle to maintain his quality of life, and I had not thought about this until today.

Regarding his back, everything I have read about cauda equina, which was confirmed by the neurologist yesterday is that it is a progressive burning pain. Despite the hind weakness, struggling to get up and the obvious neuro symptoms, Ozzi honestly does not appear to be in pain or unhappy on a daily basis. The neurologist believes all of those things are indicators of pain, and I'm sure he's right. I'm just saying, if you met Ozzi, you would have no idea. I have no doubt he is having pain, I'm just not convinced it's horrific since he goes on with his day as usual. My vet pointed out that owners are in the best position to judge given that we are with them 24/7. So, when she asked if the stenosis symptoms were causing an adverse affect on his quality of life, I could not answer in the affirmative.

She and I decided that it probably does not make sense to do anything about the cataracts right now. She feels that given Ozzi's level of functioning at present, we should treat the back and leg pain, and keep spinal surgery in our back pockets. She felt it would be a very tough surgery for Ozzi to have, and to recover from. She is open to acupuncture, but said she does not have enough experience to comment on it. She's going to look further into it for me. In the meantime, she said neurontin (gabapentin) is today's fashionable drug for neuropathic pain, but does not want to give that to Ozzi because she has had cases where the blood glucose increases from the drug. Rather, she wants to start him on tramadol and see if there is any improvement with that. I think that is a reasonable route to go. If Ozzi can rise more easily, then it will be clear that he is having pain, and that it is relieved with meds. Then I can determine if the longer term solution of surgery might be appropriate.

I wanted to update people on Ozzi's situation, and more importantly wanted to share the approach that my vet took. I think whenever we face difficult decisions about our animals, the question probably should be: "Is it adversely impacting his/her quality of life." Personally, I found it very helpful to think about in that way, and I hope it might help others faced with their own struggles.

In the meantime, Ozzi had a rough night last night. He definitely WAS in pain after having taken the long trip and being "roughed up" by the neurologist. I did not want to give him more deramaxx for obvious reasons, so it was a difficult night. He kept moving from place to place, and I knew he was having pain. That actually made me feel better to think that I at least have some sense of when he really is having problematic pain versus "dealing with it." He got to sleep, and this morning he looks bright eyed, happy and doing very well. I'm going to pick up the tramadol and start that today.

Sorry for writing so much, but I wanted to let you know how I came to this conclusion. It's funny, my vet started the conversation by saying "Hi, how is Ozzi doing?" I said, he's doing well, it's me who is tormented!! It really is nice to have a vet who you can trust and can talk to. She spent more than 20 minutes on the phone with me today, and that was great!

Thank you all again for your thoughts and support, and I'll keep you updated on the kid!
Kevin

[Patty]

Re: Starting Over With Ozzi...Need Advice

Kevin,
Peggy is using Tramadol with Forbin right now. You might read the thread she posted in Everything Else with the effect she's getting on his bgs.
http://k9diabetes.com/forum/showthread.php?t=1744

Here's some general info on it: http://en.wikipedia.org/wiki/Tramadol
http://www.marvistavet.com/html/body_tramadol.html
Patty

[ozzi]

Re: Starting Over With Ozzi...Need Advice

Thank you Peggy. I actually had read Peggy's post several days ago...little did I know that I would be faced with giving it to Ozzi! Because I had read it, I did ask the vet this morning about it, and she said that she has not seen tramadol increase blood sugar. However, I know Peggy has, so I will be monitoring Ozzi's BG to see if it has any effect on him. Yet another good reason to home test!! I have limited choices since he is already on a non-steroidal anti-inflammatory and will continue that, and neurontin is a known offender according to my vet. So, I'm willing to try it and hope for the best. I appreciate your vigilance!
Kevin

[Noodle]

Re: Starting Over With Ozzi...Need Advice

Thank you Peggy. I actually had read Peggy's post several days ago...little did I know that I would be faced with giving it to Ozzi! Because I had read it, I did ask the vet this morning about it, and she said that she has not seen tramadol increase blood sugar. However, I know Peggy has, so I will be monitoring Ozzi's BG to see if it has any effect on him.

Just a reminder that it dropped Forbin significantly (70 at 3 hours pre-meal) - not increased. Increased BG wouldn't be the end of the world since his vision has already been decreased. But sudden lows could be a big problem. Maybe that was just a typo and you meant decrease - just wanted to make sure since I'm sure you'll want to test more frequently until you see how it effects Ozzi. I'm SO happy you home test.

I don't have any knowledge about the back procedure on dogs. But I've had some significant back issues myself for the last 13 years, so I thought I'd toss in another perspective. I think your regular vet is on the right track. In my own experience, doctors have a difficult time determining pain in someone else. There were times my scans had the doctors questioning why I wasn't crumpled up in a ball screaming. Other times, they seemed to raise an eyebrow as to why I was complaining of significant pain when their scans didn't seem to indicate a reason for it.

If you have chronic pain, you learn to adapt your body moments to accommodate that pain. There were times that my way of moving made family and friends think I was in tremendous pain, even though I wasn't - you just learn to move in a way that avoids the worst pain.

You know Ozzi and you'll know when his pain is causing him a level of difficulty that compromises his quality of life and when it reaches a point of being unmanageable without unreasonable levels of pain meds. Time is on your side since you will always have the option of having the surgery when you feel the time has come. I'd be inclined to pass on the cataract surgery since so many dogs adapt incredibly well and Ozzi appears to be doing so. Then I'd set aside some funds for possible back surgery when the time comes and delve into research on the best available surgeon for the job, so I didn't have to worry about that later if I was under the gun, so to speak.

I hope the Tramadol works for Ozzi and doesn't drop his BG too far or cause any other significant side effects. Looking forward to updates on "the kid".

[peggy0]

Re: Starting Over With Ozzi...Need Advice

kevin

tramadol LOWERED forbins BGs significantly. He was at 70 2 hours prior to his meal and he is typically about 120, so please be careful with it!!

[ozzi]

Re: Starting Over With Ozzi...Need Advice

I'm so sorry...that WAS a typo! My head is all over the place since yesterday! Thank goodness you guys are alert and oriented!! I must have been thinking about the neurontin (which my vet said can increase the glucose) when I wrote that about tramadol as well. Thanks so much for the reminder, and I will keep an eye on his sugar. I just picked up his tramadol and gave him one, so we'll see how he does with it, both pain-wise and glucose-wise. It really is comforting to be here with all of you!!!!!!!! Thank you!!
Kevin

[peggy0]

Re: Starting Over With Ozzi...Need Advice

Kevin,

great news! wanted to make sure you knew the right info. Just an fyi, if tramadol zones ozzie out too much, i gave forbin 1/2 of one and had a much better affect. he has 50mg and they wanted me to give him 1 and 1/2 every 12 hours. i gave him 1 and he slept all day. i gave him 1/2 this afternoon as he seemed edgy and he was running in the yard. we went for a walk tonight !!

[peggy0]

Re: Starting Over With Ozzi...Need Advice

THANKS patti for the info on tramadol. I couldn't find much on google.

[Patty]

Re: Starting Over With Ozzi...Need Advice

Glad it helped

[CarolW]

Re: Starting Over With Ozzi...Need Advice

Hi again Kevin,

As always, I'm following all of your thread. Lots of great posts for you!

Neurontin scares me; looks as though Tramadol is a good bet, and with the information you're being offered on that, I expect you could work out what dose is best for Ozzi.

As I've been sleeping on the idea of surgery, I finally realized that if it were my dog, I would bypass the idea of back surgery entirely. Largely because first, of course, it's very invasive, and second, it's a long recovery time, with large stress on the body, which is also a stress on the mind. And it's painful, too.

If Ozzi were a lot younger, THEN I'd consider the surgery and maybe go for it. But at his age, it's an awful lot to ask of a dog. I thought again about my Kwali, for whom I'd decided, nothing invasive. And now Kumbi, and again, he's 13, and if he had these problems, I'd go for the pain management rather than for the surgery.

I see others have also mentioned they think Ozzi would cope fine with blindness, and I agree with that, as he's a delightfully spirited dog, like Kumbi! Kumbi has been blind for more than three years now, and does just fine with it.

I'm watching, and cheering you on.

Thu, 25 Mar 2010 21:15:35 (PDT)

[ozzi]

Re: Starting Over With Ozzi...Need Advice

Thank you Carol for your thoughts! I have come to the same conclusion as you. It's tough because I really want to do the surgery since it is pretty much a guarantee that he will be pain-free by releasing the pressure on the spinal nerve root. BUT, the process of getting to pain-free has its toll as you mention. If this were 5 years ago, I wouldn't even question surgery and would have gone for it. Now, it's different. He is a big dog (66.4 pounds at the neurologist, so he gained weight!), and he'll be 14 this year. Like everyone here, I want to do the best thing for my dog. I know the surgery is huge, he'd be at Angell Animal Hospital for three days which would kill both of us, (although I know we'd both get through it!), and the recovery would be difficult. So, at least for now, I'm comfortable trying pain management, and I'm thinking it's working!!

I picked up the tramadol yesterday. It is 50 mg, and the instructions are 1/2 to 1 pill twice/day. I gave him 1 pill last night, and I think it was too much for him. As you mention Peggy, and I would be hard pressed to find a better word, Ozzi was "zoned"!!!!!!!! I will say, he did rise more easily, but he was groggy, which I didn't like. Today, I am giving him 1/2 pill and so far he seems fine. I do think this is helping him, and I'm really happy about it! So we'll see how it goes.

I'm still mixing his food (3 cans BB with 1 can Alpo) now and no more diarrhea! I'll have him back on BB only in a week or so, and look forward to doing a curve. All in all, I think he's doing pretty good and I'm much more at ease.