Vets tomorrow re pain management. Any advice?

[Ephedra]

We have a 5 year old border collie who has something wrong with him. The numerous vets we have seen don't know what the problem is despite many tests.

Pain is an issue for him but he hides it really well (so I have no idea how much pain he is in). He is not normally on painkillers we just give them when we think he needs them. He has been on them for a week now and on Wednesday I called the vet about increasing the dose for that day as he was really restless and clingy. I've never had to do that before and I am not 100% sure that the pain was dealt with.

Dog is currently on pardale v and has had tramodol before, he cannot take NSAIDs at all.

Tomorrow we are going to discuss options* with the vet but I don't feel like I know enough for the discussion to really useful, so does anyone have any advice?

*I am aware that options include if and when to pts.

I think he needs to be assess by either internal medicine or ortho but go so where with neuro as well so all confer. That is what we do with difficult cases. It sounds like polyarthritis but I accept it has been excluded by the taps. Has he had a CSF sample taken (fluid from around brain)? Does he ever have a temperature?

Ps any abnormalities on bloods? B12 deficiency produces abnormalities on haematology

Thank Cats. The last ortho we saw didn't think the dog needed pain relief all the time, so the plan was to give it as and when needed. The major problem we had with the ortho vet was communication, he was really hard to get hold of and clearly kept poor notes as he kept saying different things each time.

No CSF, no temp ever, all blood tests have come back normal but I'm not sure what tests he has had. In fact all tests have come back normal much to everyones surprise. I thought polyarthritis too.

I think the reason we have just been left to get on with it is that the dog dooesn't seem that bad. No vet has ever seen him at his worst and many don't seem to see the issue with his walking.

Cats I have sent you a pm.

I spoke to the vets yesterday and my poor dog is now on enough drugs to sink a ship!

He now has Pardale V twice a day, PLT (Prednisolone/Cinchophen?) three times a day and 2 omeprazole capcules once a day to hopefully help with the PLT side effects.

Vet implied that this was the last lot of drugs we could give the dog for pain as he is allergic to NSAIDs (and lots of other things). We have a weeks supply and then have to call the vet back.

She said she could refer us to liverpool but wasn't sure that finding the cause would stop the pain and/or she would discuss putting him to sleep if the drugs don't work.

A quick update.

My dog played today and yesterday. He enjoyed his walk today. He even found the energy to destroy a toy!

I am so very pleased and pissed off that he wasn't given this drug before.

So pleased he's a bit better! Really hope you get to the bottom of it, there's nothing worse than seeing your much loved dog in pain

Bloody brilliant!!!!

long may it last

Thank you!

We are only on day 2 of the PLT so it is very early days but I'm like this:

Another update, dog spent 1 week on 3 plt a day and did really well except for the side effects, so the dose was halved for the last 2 weeks. Unfortunately half the dose had half the effect with the same side effects.

This morning when I spoke to the vet we had 3 choices: pts, risk the side effects and keep at the same dose, or risk the side effects and increase the dose.

We decided on option 3 and will increase the dose by half a tablet tomorrow. It is now a case of balancing the effectiveness of the drug with the side effects and deciding when to pts.

It is the hardest decision I have ever had to make and I have no idea if I made the right choice.

I have had a couple of patients with similar symptoms both had hyperaesthesia. I sent them to our local neurologist (which seems the only speciality you haven't) both were prescribe gabapentin that brought their pain under control. One was drug free in under 6 months and one has intermittent drugs.
I suspect if you saw a neurologist you would get an MRI.

Thanks Lonecat I just had a very quick look at hyperaesthesia but couldn't find much info. Is it always due to distemper in dogs?

My dog has had the symptoms he has now to varying degrees since we got him at 11 weeks old so whatever caused it happened before then.

We have a new vet who will sort any referral we want when if the dogs pain is under control.

In neither of the patient so have had has it related so distemper. One was triggered by a bout of pancreatitis and the other from muscular back pain.

Interesting. Do you know where I can find more info? Nearly everything I found related to cats.

All my cases were seen by Colin Driver at Anderson Moores in Winchester.
There is not a lot published on this syndrome and is an area of interest for Colin. It is a diagnosis of exclusion, so you rule everything else out to diagnose it. An MRI would be pretty high up the list to rule out other things, though sometimes they do CT instead.