Tuesday, December 1, 2015

Cookie's Iliopsoas Injury Treatment: Trazodone

Poor Cookie is under house arrest to get her iliopsoas muscles to heal. Strict rest is the mainstay of her treatment.

The moment I heard strict rest, I knew it wasn't going to fly.

Not with Cookie. She needs minimum of three hours of activity a day to be content. After the last event we reduced it to two hours and she was already bouncing off the walls. Getting no exercise at all? That was not happening. Not without her jumping out of her skin and losing her mind. She'd be extremely wound up, frustrated and likely depressed.

Right there and then I voiced this concern.

Cookie on strict rest was not going to happen without some serious chemical help.

I know that mind games and training games are supposed to tire a dog out just as well as physical exercise. But I also know, from the few days last Winter when temperatures dropped so low that even Cookie couldn't spend more than 10 minutes outside, that no amount of those could cut it. And that was only one day at the time AND she was getting a few of the ten-minute runs outside.

As much as I hate drugs, this wasn't happening without some.

The orthopedic specialist wasn't overly surprised and suggested a drug she uses often in her patients as well as for her own dog - Trazodone. That sounded good. Of course, being a diligent mom, I asked about potential side effects to which I was told there weren't any.

When I came home, though, I looked it up and, of course, there are side effects listed. I was supposed to start Cookie on this right away but I wasn't going to do that until I had a chance to discuss the side effects issue. And I wasn't able to get hold off anybody.

I went and asked every vet I know.

Some of them never heard of it, some of them had another preference but most thought it was a good drug. Some of them directed me to an article which I have already found myself. They all tried really hard to help me out.

From all that digging I gathered that Trazodone for this purpose seems to be a drug of choice for most surgeons. It also seems to be a drug of choice for many veterinary behaviorists. Trazodone is an antidepressant but it has also been used to calm post-surgical dogs. From the three choices available for our purpose, I did like this one the most.

More importantly, I was able to get hold off Jasmine's vet and it turned out that he's been using it for many of his post-op patients for 11 months now. He discussed the potential side effects with me in detail and we covered every last one of them. From his own experience, he had only one complaint where the owners felt the dog was too sedated and instead of having the dose adjusted they opted to withdraw the use all together.

Sedation was the least of my worries.

I was finally comfortable enough to try giving one dose and see how it goes. We did that in the morning, just in case something did crop up, so it would be easy enough to see the vet.

Cookie was prescribed 75 mg every 12 hours.

About 40 minutes later it seemed to have kicked in. My concern was that Cookie seemed unsteady on her feet. I was worried that the dose might be too high for her and that being this wobbly she might further injure the muscles we were trying to treat.

Also, about 7 hours later the effect seemed to have worn off completely. And there were still 5 hours to go. I felt the dosage and distribution should be reconsidered.

There were some technical difficulties contacting Cookie's vet but Jasmine's vet, as always, was there for us again. He said that often it takes a couple of days to get things on an even keel and that'd he leave things as they are for now.

I didn't want to arbitrarily make any changes to how the drug was prescribed before talking to Cookie's vet about it.

We continued the Trazodone as prescribed while I was trying to get hold of her.

The second day the effect seemed about the same but by third day, instead of things leveling out, the effect of the drug seemed to have worn off after five hours instead of previous seven.

I was convinced we needed to make adjustments.

Finally I made it through the technical issues and got to talk to Cookie's vet. I explained my observations and concerns and we agreed on adjusting the administration to 3x daily while looking for minimum effective dose.

We started with 50 mg 3x daily. But that was not enough so we ended up giving 75 mg 3x daily which now seems to be the ideal dose and distribution for Cookie.

I have to say that I'm quite thankful for this drug.

Other than the unsteadiness the first two days, Cookie hasn't been having any side effects. And this drug helps her to remain at peace with the sudden lack of exercise and fun.

She isn't going crazy, isn't jumping out of her skin, isn't frustrated and isn't depressed. She still can get quite bouncy when she gets outside in the cold weather but knowing what things would have been like otherwise, the Trazodone seems to be doing exactly what we needed.

Cookie remains clear headed and can still enjoy her puzzles and training games.

She doesn't seem overly sedated. She's still curious, interested in things and excited about things. But she is able to cope with the activity restrictions.

Further reading:
Use of trazodone to facilitate postsurgical confinement in dogs

Related articles:
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot? 
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Incontinence? Cookie's Mysterious Leaks 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update
The Importance of Observation: Cookie's Chiropractic Adjustment
Sometimes You Don't Even Know What You're Looking at: Cookie's Scary "We Have No Idea What that Was" 
Living with an Incontinent Dog 
Summer Dangers: Cookie Gets Stung by a Bald-faced Hornet 
To Breathe or Not To Breathe: Cookie's Hind Legs Transiently Fail to Work (Again)
Figuring out What Might Be Going on with Cookie's Legs: The Process 
Figuring out What Might Be Going on with Cookie's Legs: The Diagnosis

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!


  1. I hope that Cookie is up and around soon. I hate giving drugs to my dog too, but sometimes it is just unavoidable.

    1. We hope so too, for her sake. Though with this medication she's coping quite well. Of course, that's not the only treatment we're doing; I'll write about the others in next post.

  2. I hope Cookie feels better soon! Trazadone seems like a great, safer alternative to ace!

    1. Yes, as far as I can tell it's way better than ace.

  3. Poor baby, I hope Cookie is feeling better soon!

    1. She thinks she's all better and can't wait to get out there again. But she still has some ways to go.

  4. Really want to thank you for sharing your exploration of this drug - we doggies really count on you humans to help us out, and boy you sure did! Cookie is a lucky pup and you is a pawesome momma!

    1. Thank you, Mattie. It seems to be a pretty good drug for this kind of use. Cookie is subdued (as subdued as she gets) and not unhappy.

  5. Sounds like you got it adjusted perfectly! I'm glad that nowadays vets and doctors seem more likely to tweak medication suggestions instead of just saying one dose fits all.

    1. Theory and real life are not the same thing. Jasmine's vet always included a note with all his reports and prescriptions that if for any reason the treatment is not working right or it's not possible to go through with it to contact him and he'd always come up with an adjustment or different plan.

      Of course, not all medications can be easily adjusted, antibiotics, for example, need to be given as calculated.

      Our new vet though, kept insisting that the initial was a correct dose and took a lot of convincing to get her to consider talking about it.

  6. We have been battling a iliopsoas strain with our corgi Eve for a year now. Rest will get it nearly healed but never fully and then it returns or flares up again with even just a little activity. She has done 20 PT sessions with class 4 laser, been on Rimadyl (not a fan of that), takes tons of supplements etc. It is a very frustrating injury and we have resigned ourselves to just dealing with flare ups. I hope yours heals up much better than Eve's has!

    1. Oh no! Poor Even and not something I like to hear. Often, though, this injury is secondary to another problem ... was Eve checked for underlying cause?

  7. I would have done the same. It's a 'catch 22' as you don't want to have to medicate them but as a pet parent, you have to decide which is the best option. This gives her the chance to heal and less chance of making her injury worse. Thanks for sharing.

    1. Yes, it's about finding a balance. After all, stress "medicates" with cortisol and that's not a good thing either. This drug seems as safe as they come and more importantly it's keeping Cookie where she needs to be - lowered activity level and the peace to cope with it.

  8. So sorry about Cookie's injury, bu good to know about Trazadone. I hope she feels better soon.

    1. It's going to be a process but she's getting better. The Trazadone is godsent.

  9. Replies
    1. Thank you, Amy. Iliopsoas are a bear to treat.

  10. Get well soon Cookie. Glad you have meds and toys to help your recovery along.

    1. Thank you, Val. Unfortunately there are no quick fixes for this. But working hard on making the recovery as fast as possible.

  11. In a past life I was involved on the human medical side of things in an office and we would transcribe this a lot - paw prayers for recovery and a speedy one at that

    1. It's also used for behavioral issues, as it is anti-depressant. But it seems to be doing what we need it to be doing.

      Thank you for the prayers, I'm hoping the girly gets all well soon too. But it's reasonable to expect it a long process.

  12. I hope Cookie is up and playing again. It's so hard to keep a active dog quiet but your doing a great job.

    1. Unfortunately, this type of injury takes weeks or even months to get it fully healed. She does get to go out for short, low-key mouse hunts now, though. So that makes her happy.

  13. We hope Cookie heals quickly and will no longer need the drugs!

    1. Thank you! As soon as she can go back to her normal activity level she won't need them. That might be a while, though.

  14. Oh I hope the healing process is quick and easy for Cookie! It's gotta be difficult for both of you.

    1. Thank you, Rosa. Thanks to the drug it's not overly difficult for Cookie. Which is good because getting this healed is a long process.

  15. It's so hard keeping an active dog still. I'm glad the drug is helping and I hope her recovery goes smoothly!

    1. Thank you; yes, we couldn't do it without some chemical help.

  16. As a technician, I knew of trazodone as an option, but i never knew an actual patient who was taking it. Thanks for sharing your research and Cookie's experiences.

    1. It's interesting with this one. Some vets use it a lot and some have never tried it. When I was agonizing over this I was so happy to find out that Jasmine's vet has been using it for his surgical patients for 11 months now and had good clinical experience with it.

  17. I am really sorry that Cookie has to rest but *thank you* for telling us about this drug. Our intense black lab will need a major elbow surgery before too long. Last time, the surgeon sent us home with "ace" as the calming drug. It didn't work. Now I know another option to discuss with the surgeon!

    1. I'm so glad this might be helpful to you. That's why I blog. Please do let me know if this works for your dog also.

  18. This is a common injury in agility. I hope Cookie makes a full recovery!

    1. Yes, it is. We never thought of Cookie as a sporting dog but we should have. While her activity is voluntary, her body works at least as much as any sporting dog. We do need to look at it that way now.

  19. Thanks for post. We have a post surgical Labrador (Thymoma removal) this weekend and we are using it. She was really wobbly first two days - we were worried it was over medicating her - but seems to work well with her pain patch to keep her calm and comfortable. She doesn't do well with tramadol - makes her agitated - and they used it first day to counter that. Have us continuing it with pain patch and she seems to be comfortable. We discussed using just at night - but we could tell the difference without it.

    1. I'm glad it's working for your girl. Yeah, Cookie was quite wobbly the first days too, I was concerned and we played with the dose distribution a bit. Over time the effect evens out.

      Since this is not a sedative per se but antidepressant used for sedation effects, we distribute the amount evenly. In our case, we'd actually use it during the day and skip at night. But I think that a "level" amounts are best.