Tuesday, December 8, 2015

Cookie's Iliopsoas Injury Treatment: Other Medications

During the orthopedic specialist's exam it turned out there was more pain going on than Cookie was letting on. And we did go through iliopsoas injury with Jasmine as well.

Cookie can now enjoy short, low-key mouse hunting outings.

Besides strict rest, it was important to manage pain and inflammation as well.

Inflammation is a tricky thing. It is an important part of the healing process unless it gets out of hand or becomes chronic. You want just the right amount for specific period of time so damaged tissues can heal. But you don't want it getting out of hand. That's why, when we were discussing pain management for Cookie, I agreed to short-term NSAIDs.

We agreed to short-term NSAIDs to relief pain and calm down the inflammation.

Because Cookie had her blood work done shortly before all this happened, I knew her organs were functioning properly. And as much as I am not a fan of this medication, this was the time and place to use it.

We also discussed other pain relievers such as Gabapentin and Tramadol.

Such things are often used together because they attack pain in different ways. While NSAIDs reduce pain by reducing inflammation, drugs such as Gabapentin or Tramadol bring pain relief by altering the brain's perception of it.

I consider these two reasonably safe. Jasmine was on them.

Tramadol brings immediate relief and with Jasmine it was used on as needed bases. Gabapentin works long-term.

While I didn't rule out the possibility of using these, we decided not to start them at that point. 

For one thing, Gabapentin takes quite a while before it takes effect. And while we did have Jasmine on these, and many dogs do find relief on them, we haven't seen them doing anything for Jasmine at any point she was on them. That doesn't mean it wouldn't have worked for Cookie, it works for many dogs. However, we decided to keep them as a plan B.

For our plan A I wanted to focus on more integrative approach.

Armed with the results of the orthopedic specialist's consultation, I discussed our options with Cookie's primary vet. I wanted to have laser therapy and/or acupuncture, together with TCVM herbs as our primary weapons.

We also discussed the fact than it one of the few papers on iliopsoas muscles injuries out there, long-term NSAIDs actually interfere with the healing process.

After a short-course, we replaced the NSAIDs with a muscle relaxant and TCVM herbs, while we started physical therapy and laser therapy for Cookie.

The muscle relaxant does what you'd figure, relaxes the muscles. 

That helps in two ways. Injured muscles like to go into spasms which, of course, causes pain. And muscle tissue can only heal in a relaxed state. In people, muscle relaxants have been associated with better recovery.

So, beside Trazodone, that's what Cookie is on now.

From the TCVM herbs we considered two formulas, Body Sore which Jasmine used to get as well, and our new vet's favorite, DOK's Formula.

We got both but Cookie is getting the DOK's Formula and it seems to be working well for her.

Other than she hates the smell/taste. At first we got a jar with powder because that was the only one in stock and we didn't want to wait for a new order to come in. Jasmine had no issues having her herbs mixed directly into her food, in fact, I think she liked having her food "seasoned."

Cookie, however, figured her food was "contaminated" and didn't want to have anything to do with it. She was okay having it mixed with peanut butter but with the amount she was supposed to be getting she'd have to eat an enormous amounts of peanut butter. Which would be fine except she's already putting on some weight because of the drastic decrease in activity. Getting the weight out of control is the last thing we need.

I wanted Cookie start her herbs as soon as possible so while we were waiting for the capsules to arrive, we got creative.

We got gelatin capsules from our local pharmacy, emptied the gelatin and filled them with the herbs. Not fun but worked well in the bind.

It is a big difference for me, giving Cookie NSAIDs or giving her the herbs.

With NSAIDs I understand why she needs them and I hope that they won't do any harm. With the herbs I'm excited about all the good things they can do for her.

Cookie's favorite part of the treatment plan is the laser therapy but about that next time.


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 
Cookie's Iliopsoas Injury Treatment: Trazodone 


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!

62 comments

  1. I worked as a clinical laboratory scientist testing pain patients for Rx drugs. It amazes how pets use the same drugs as humans. Although the sized of the dose is different the purpose of the drug is the same.

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    1. In many ways human and dog bodies work the same. There are some differences but not really as many as one would think.

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  2. I'm so glad that you found something that works for Cookie! Sampson has been struggling with the Iliopsoas and we haven't been told to keep him quiet. In fact, we've been told to stretch his legs and walk him.

    ReplyDelete
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    1. The orthopedic specialist really stressed that rest is the main thing we have to do. Reading up on it, muscle tissue can only heal in relaxed state. So it makes sense.

      We do stretching exercises and hydrotherapy and she does go for short 10 minute walks to work the muscles a bit but not overwork them.

      Delete
    2. With Eve, we first were told to stretch then another told us not to stretch. It is frustrating because the specialists give us conflicting advice.

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    3. That is very frustrating then :-(

      Delete
  3. It's always a challenge deciding the right plan of action for your pet. And it can make it difficult when you have to be creative in administering it.

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    1. Yes. Having options is great but it also makes it more difficult to choose the best one. With some things, one needs to act immediately and with sometimes decisions need to be made on the spot about what can bring relief right there and then.

      For long term, it is important to consider all options available and try to find the best one.

      Delete
  4. We have done laser, tramadol, muscle relaxers, and rimadyl with Eve's psoas pull. Only the Rimadyl worked.

    ReplyDelete
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    1. Rimadyl works to relieve pain and inflammation quite well, but I read that long term messes with healing. Cookie has been on NSAIDs for 10 days only. The laser really does seem to be working for her.

      Delete
    2. Note: the class of the laser might make a difference; since these muscles are deep within the body, deep-penetrating laser might be needed to actually get to where it needs to go. With class III or older lasers, it might not be penetrating far enough ... ? Cookie is getting treatment with class IV. Even the type of attachment used etc seems to make a difference.

      While the previous versions were referred to as "cold laser", class IV really isn't. Perhaps that's where the difference lies.

      Delete
  5. It's always hard to see your dog in pain, and then trying to decide the right course of treatment. I'm so glad you were able to come up with the right plan. I am looking forward to your next post.

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    1. It's hard to see them in pain and it's hard to "rob" them of things they love the most. But we need to go through this if we want Cookie to be as good as new again. And I know she wants that too, even know she doesn't realize she wants that. She just wants to run and play NOW ;-)

      Delete
  6. Well, I take Tramadol when my arthritis is really painful. It works okay but not as well as my twice a day Celebrex. Isn't it weird that our dogs can take the same medicines that we do? My Golden used to take the same thyroid meds as me. LOL!

    ReplyDelete
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    1. Some things indeed work the same in our otherwise different bodies.

      I never had Tramadol myself; it's supposed to be strong pain reliever. But hasn't done anything for Jasmine as far as we could observe.

      Delete
  7. They gave us Tramadol for Mr. N after his dental surgery. We just gave him one dose. He seemed fine without it.

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    1. Pain management after any surgery is important. Often dogs hide pain really well. I always gave pain meds as indicated after any surgery. Even when I wasn't sure whether they were doing anything or not.

      Delete
  8. Sorry to hear that Cookie has been in pain. Never fun at all, especially since we can't explain to dogs why they don't feel well.

    I'm glad to hear that you are figuring out a solution that will work for her.

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    1. Thank you, Mary. She hates being in pain and she hates not being able to do her running around and hunting. With the meds she's coping fairly well and the muscles are getting better.

      Delete
  9. I'm so glad you found a combination of drugs that is working well for Cookie! Pain management is so important! That's a good idea about the gelatin capsules! I would of never thought of that!

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    1. Yeah, making our own herbal capsules was pain in the backside but it did work.

      Delete
  10. I'm glad that you are helping Cookie and finding things that work. Pain is no fun at all!

    ReplyDelete
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    1. I think Cookie would rather take the pain than the house arrest. But hopefully soon she'll be able to have both no pain and freedom to have fun outside.

      Delete
  11. AH wow, so many hard decisions when it comes to our fur babies health isn't there?

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    1. Too many. Life should be much simpler.

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  12. It takes a lot of research, and experience helps, to feel as though you're doing the best you can for your dog. It's so tough when they're in pain. Hoping Cookie heals quickly!

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    1. Thank you, Mary. In most ways, experience helps. In other ways, created biases which may or may not be helpful. I always do my darnest to try to figure out what is the best thing to do.

      Delete
  13. It's great that your vet is so open to using alternative therapies! I'll be interested in seeing how the laser therapy works.

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    1. That was one of the important criteria when I was looking for a vet in our new location - being open to alternative and natural options. So far the laser seems to be working well.

      Delete
  14. Great to see you and your vet are working so hard on solutions. I have been researching for myself as I have had terrible arthritis and back and knee injuries. Yours sound like good plans - I found the laser and pulsing seemed to help and massage and physio. I hear a lot about other natural anti-inflammatories but there are few clinical trials. I am actually going in a trial for PRP in January (too expensive to pay myself).

    ReplyDelete
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    1. PRP is great for joints. It's awesome you're getting into a trial. It's actually not THAT expensive to get it done for dogs.

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  15. It sounds like once again you've been very thorough in your research and found a great treatment. My sister's vet recommends a lot of herbal supplements, acupuncture, etc and they have had a lot of good results.

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    1. When drugs have to be used I use them. But my preference are more natural and holistic options wherever possible.

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  16. We are wishing the best for Cookie, and hope she improves with her treatment. Love Dolly

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    1. Thank you, Dolly. She so wants to got out and run and play but we cannot allow that yet. At least she can go on short, low-key mouse hunts.

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  17. Oh, we is so happy dat you found something that works for Cookie! You is such a good pet-parent!

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    1. Thank you, Mattie. It's working, I just wish the process could be way shorter than it is.

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  18. This sounds like such a complicated situation. I'm sorry that the two of you have to go through it! It is a great thing that there are so many options available. I have been on Trazodone for years as a human and it isn't too bad of a drug. Just make sure if she ever comes off of it, that you take the time to wean her off. The withdrawls from it are icky. I will be keep you guys in my prayers!

    ReplyDelete
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    1. Thank you, Robin. Iliopsoas injuries are such a bugger to get to heal.

      Yes, the Trazodone seems to be a pretty good drug. Though today it seemed it wasn't working at all ;-)

      I was thinking she'd need to come off gradually, will have to figure out the exact approach once we get that far.

      Delete
  19. Pain is hard enough for humans when they can tell you what's happening. I can just imagine how difficult it is trying to help dogs. Best of luck with Cookie.

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    1. The hardest thing is convincing them that they need to take it easy. Little girly wants to go and do her things. Even in the midst of the event, when she must have been in a lot of pain, she still wanted to chase her squirrels.

      Delete
  20. Oh, poor Cookie! I hope she gets better.


    Christie from lifewithbeagle.com

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    1. Thank you, Christie, I wish it wasn't something that doesn't take this long to get better ... but, unfortunately, it is.

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  21. I'm so sorry you're going through this with Cookie. I think laser therapy is so effective - I wanted to comment on Gabapentin, as a tech this is one of the pain mgmt drugs I think works the best and I've seen big improvements in animals using this medication. Please continue to keep us posted.

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    1. I know a lot of vets love using Gabapentin. Perhaps worth of try. It's just that I've never seen it do anything for Jasmine.

      Delete
  22. Glad you're finding drug combinations that you and Cookie can live with, and that She's getting relief. I have no experience with this type of thing, so I'm making mental notes of your blog as a future resource.

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    1. Yes, it seems to be an effective combination. Hopefully you'll never have need for this information.

      Delete
  23. It is hard to see your pup in pain, so glad you found something that works!

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    1. Dogs should never get sick and they should never get hurt. If I was the queen of the universe, I'd made that a law. ;-)

      Delete
  24. Geeze I am sorry that you are going through so much - you are such a great dog mom.

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    1. Seems like I'm doomed to have heart dogs with problems. At least Cookie is in good hands, so that's the upside.

      Delete
  25. Awwww poor Cookie! As a animal massage practitioner, I see this type of injury all the time! Iliopsoas injuries are more common than most people realize. I wish Cookie a speedy recovery!

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    1. Yeah, apparently they're quite common and quite commonly undiagnosed too. I just wish it didn't take that long to get them healed up.

      Delete
  26. Gosh, I hadn't heard of this. An incredibly helpful article, thanks.

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  27. Glad to hear that you and your vet have come up with a plan of action for Cookie! I love that you all are trying alternative treatments too. I am interested to hear more about the laser therapy!

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    1. Next update is going to be about the laser therapy etc.

      Delete
  28. Poor Cookie has been through a lot lately! You've done such thorough research and worked up a great treatment plan, thanks for sharing your experience & knowledge.
    Love & biscuits,
    Dogs Luv Us and We Luv Them

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    1. Thank you, Cathy. Yeah, poor girly is walking in Jasmine's footsteps a bit too thoroughly. We're of course aiming for the muscles to heal completely and then hopefully being able to keep them happy in spite of her activity level.

      Delete
  29. THanks for sharing this. Maggie is on both Gaba and Tramadol and while I'm not crazy about pumping her full of meds, I thinks it's necessary for her. Jack has yet to display too many arthritic issues, but I'm glad to read about some of these holistic options.

    ReplyDelete
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    1. I agree that Maggie probably does need all those pain meds, at one point vet even gave us a prescription for a stronger narcotic for Jasmine. We also had this cool topical concoction with DMSO, lidocaine and morphine. With bone cancer, I believe you do need to throw big guns at it.

      For arthritis, I think more holistic options work just fine. You're working with Dr. Patrick, aren't you? (I'm so envious ;-) )

      TCVM has a number of great options for arthritis and other issues.

      Delete
  30. Sounds like a great recovery plan! I hope Cookie is feeling much better now!

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    1. She has improved a lot. Though a couple days back she might have set herself back some; waiting to see what her physical therapist says today.

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