Spondylosis- looking for advice about meds schedule please

[LunaticPoodle]

Good morning,
Baldrick (skinny, 5 years 3 months old) has been diagnosed with spondylosis in his spine (on top of arthritis in his knees) and after being rather poorly for the last 3 weeks, he's finally showing improvement since adding Gabapentin two days ago. His weight has somewhat stabilized and we finally have normal looking poops, and more of them.

So he's been on Antepsin x3 daily, dog Loxicom x2, Gabapentin x2 (for two days now), Primperan x3, and probiotic + Critical Care. He also has the CBD cream a lot of people praise but it hasn't really done anything remarkable for him, so I don't know about that. Now he's clearly feeling better and I have a few questions:
1) should I alternate the painkillers or give them at the same time? I've been alternating them thinking it would give him more coverage, but I read that's wrong. The vet didn't say.
2) getting him off the Primperan once/if his digestion normalizes, how gradually is it safe to decrease it?
3) he's been taking Gabapentin twice a day, I'd like to see if he can manage on once a day- he's lost a lot of weight in the last 6 months, and I don't want to overload him with so many meds, but also want to be realistic about how much time he has left and make sure he's as comfortable as possible.
4)Antepsin is supposed to be given on an empty stomach and at least an hour away from the other meds, so I give it around his nap times, but he usually goes to eat right after, and how do you keep a piggy from eating for a whole hour or two? I'm just glad he eats on his own now to be honest, and I let him.

Since last year he has visibly aged, had chronic bloat on and off since last December, and gradually dropped a lot of weight even though I've been topping him up. Now he seems to be stabilizing and I'm hopeful he will stay with us longer. He hasn't been as gassy, poops look still a bit small but they're a normal shape and texture, finally, and he hasn't been visibly in pain anymore, and I'm so happy (sleep deprived given the last 3 months with first Eppu and then Pip, but finally something is going right!)

Thanks in advance to anyone who can share their experience and here's a few picture of our handsome boy through the years, mainly doing his favourite activity, which is "sleeping in odd places"

 

[Wiebke]

@Eriathwen @eileen : Do you have experience with the medication and treatment mentioned?

 

[Eriathwen]

OK so Primperan is what we would call Metocloperamide/Emeprid, I believe Primperan is just the human version. About 24 hours after poops completely return to normal I reduce from 3xs a day to twice daily for 2-3 days, then if poos continue to be normal, weight remains steady or increases and appetite remains normal, I reduce again to once a day again for 2-3 days and continue to monitor the above input and output. Once stopped continue to monitor weight, poops etc for any relapse.

I usually give pain meds at the same time if getting them twice a day, if I remember correctly they're not absorbed the same way so it doesn't strain the kidneys giving all at once, as long as they're well hydrated. However Gabapentin can be given 3xs daily so I've also done them at seperate times, metacam is twice a day maximum so 8 hourly and 12 hourly cant be given together logistically anyway, so technically I don't think it would matter either way. As long as you're seeing pain relief, I would stick to what works, both medications are metabolised very well. Personally I would prioritise the pain relief over seeing if he can manage on a lower dose just in case, spondylosis is very painful and it's easier to keep them out of pain once managed, than it is to get them back out of pain when it starts, if that makes sense.

Unfortunately I've never used antepsin so can't offer much help with that however a lot of directions for meds are aimed at cats and dogs and disregarded for guinea pigs, my labels for metacam for example always say "give with food" but that isn't relevant to piggies. I would assume that the directions to withhold food would also be disregarded unless the vet specifically told you to do so, as there are a very small, very specific set of circumstances food should be withheld from these guys.

My piggy with spondylosis also had hip dysplasia and was unable to walk for a bit, she was given a katamine injection which can apparently reset the pain receptors if pain relief stops working, the brain registers the same level of pain as increasing over and over, occasionally, and this reset can bring pain back under control if current pain relief doesn't seem enough, just something to bare in mind for the future if his pain seems to become less well managed.

Hope this helps a bit! Fingers crossed you get lots more good quality time with your boy

 

[LucyP]

Just to endorse the point about an empty stomach; I had a different med (vetmedin) but it was aimed at dogs not piggies, and the label had the instruction to give on an empty stomach. I queried this with the exotic vet who was very clear that this does not apply to piggies and was very much a printing oversight (which they apologised for and were going to remind pharmacy to watch out for)..so worth double checking that one.

All the best for your lovely piggy.

 

[LunaticPoodle]

Thank you

OK so Primperan is what we would call Metocloperamide/Emeprid, I believe Primperan is just the human version. About 24 hours after poops completely return to normal I reduce from 3xs a day to twice daily for 2-3 days, then if poos continue to be normal, weight remains steady or increases and appetite remains normal, I reduce again to once a day again for 2-3 days and continue to monitor the above input and output. Once stopped continue to monitor weight, poops etc for any relapse.

I usually give pain meds at the same time if getting them twice a day, if I remember correctly they're not absorbed the same way so it doesn't strain the kidneys giving all at once, as long as they're well hydrated. However Gabapentin can be given 3xs daily so I've also done them at seperate times, metacam is twice a day maximum so 8 hourly and 12 hourly cant be given together logistically anyway, so technically I don't think it would matter either way. As long as you're seeing pain relief, I would stick to what works, both medications are metabolised very well. Personally I would prioritise the pain relief over seeing if he can manage on a lower dose just in case, spondylosis is very painful and it's easier to keep them out of pain once managed, than it is to get them back out of pain when it starts, if that makes sense.

Unfortunately I've never used antepsin so can't offer much help with that however a lot of directions for meds are aimed at cats and dogs and disregarded for guinea pigs, my labels for metacam for example always say "give with food" but that isn't relevant to piggies. I would assume that the directions to withhold food would also be disregarded unless the vet specifically told you to do so, as there are a very small, very specific set of circumstances food should be withheld from these guys.

My piggy with spondylosis also had hip dysplasia and was unable to walk for a bit, she was given a katamine injection which can apparently reset the pain receptors if pain relief stops working, the brain registers the same level of pain as increasing over and over, occasionally, and this reset can bring pain back under control if current pain relief doesn't seem enough, just something to bare in mind for the future if his pain seems to become less well managed.

Hope this helps a bit! Fingers crossed you get lots more good quality time with your boy

Thank you so much, this was exactly what I needed to know.
I remembered what you said about resetting his pain receptors for Pip, but he was doing so poorly there wasn't even the time to try.

Baldrick is doing so well on Gabapentin and seems so much more comfortable. His back legs are quite stiff from arthritis but he still walks very fast when it's time to go out and play
Antepsin is a human medication to prevent heartburn, but it creates a coating and can interfere with absorption of food and other meds- I don't know it it applies to piggies, but our vet advised to keep it isolated.
Gabapentin in the dosage she gave me isn't sold here in liquid form, so we had to use capsules, open them, ehm... Process them in a very suspicious looking way (LOL) and give it with a little water in a syringe. But it's been working well, regardless. It hasn't made him drowsy and he's been eating more on his own rather than needing the syringe around the clock.

The one concerning thing is he is breathing heavily after a short run, his heart was checked a couple months ago and was ok- but at his age and with how much his health has declined lately I'm a bit paranoid about everything.

Thank you so much for the advice!

 

[LunaticPoodle]

Update:
He is doing very, very well on gabapentin. He is still struggling to put on weight as much as I'd like though, so we are still on Critical Care, but he eats it on his own. Because his poops aren't as solid as they should be, he's still off the veggies, so I give him a bit of that instead when the others get their veggies.
I'm anxious though, cos I will have to go visit family soon (my sister got into a bad car accident and they're going to need extra hands on deck) and I have to teach Mr Poodle to take care of piggy meds. He takes great care of the piggies in a normal situation, but this is a bit more than he is used to/comfortable with. Baldrick is stubborn and sometimes needs a firmer hand to start taking his meds, after that it's easy, but I'd prefer getting him to a point where he needs minimal grabbing/syringing and we aren't quite there yet. I'm terrified there's going to be an emergency when I'm not here and I know Mr Poodle cannot deal with hypothetically PTS. He does have a good eye for signs that something is wrong (he was the one to notice first when Eppu had the stroke and he has always noticed bloat very early with Baldrick). Baldrick is elderly and I don't think putting him in he care of strangers away from his familiar environment would benefit him. The one time I trusted a hospital with a piggy they left him to suffer alone for the whole day until there was nothing else to do, so that's an absolute no for us. Just thinking out loud to put my thoughts in order.

 

[Wheekallweek]

Could you take him with you?

 

[LunaticPoodle]

I'm going to another country... Flying is probably going to be horribly stressful for him, I'm afraid.
Did anyone fly regularly with pigs through the EU? Is it doable?

 

[Merab]

Sending hugs.
You have a lot to deal with at the moment.
Hope your sister recovers from her accident.
Holding you all in my thoughts

 

[Wheekallweek]

In that case I think it would be best for him to stay at home with Mr Poodle
Lots of practice before you go so he’s as confident as possible! I presume he will be able to contact you if he has concerns x

 

[LunaticPoodle]

Thank you Mr Poodle is being a trooper, bless his heart. Baldrick bullies him around a bit but he's really trying. Of course we'll be in touch all the time. For now I'm trying to get Baldrick off the gut stimulant and trying to fatten him up a bit, he's lost so much weight in the last few months. It's stable now but not really going up as much as I'd like (he was generally close to 1 kg and now he's hovering between 860-870g morning weight)
Family was in Scotland on vacation and crashed against a lorry, they are lucky to be alive and relatively unharmed, except for my sister who got the worst of it. They are back home now but we live in different countries so that's why :-/

 

[Merab]

I added a small piece of mashed banana to syringe food for mine if they needed a weight boost.
A dish in the cage also encourages eating.
Raw oats mixed with grated carrots or sweet potato is also helpful for weight gain.

The accident sounds awful.
So glad your family were relatively unharmed.
Praying for full recovery for your sister

 

[Wheekallweek]

Oh wow, hope they are all OK!

 

[Wiebke]

I'm going to another country... Flying is probably going to be horribly stressful for him, I'm afraid.
Did anyone fly regularly with pigs through the EU? Is it doable?

BIG HUGS

I am so very sorry for the very upsetting and difficult situation your family is finding itself in.

Practically, flying has become very difficult and expensive. Baldrick would have to travel in the hold and you would have to deal with the necessary red tape. So I don't think that is an option.

Could you train Mr Poodle while you still can by letting him do it but with practical tips and encouraging support so he is more confident and is being accepted as care giver?

Mr Poodle can use a mix of piggy body language and plenty of chivvying and praise to establish his dominance but also his support. The links below have practical tips on how deal with piggies in ways that they instinctively understand.
Understanding Prey Animal Instincts, Guinea Pig Whispering and Cuddling Tips

Who is the Boss - Your Guinea Pig or You?

All About Syringe Feeding and Medicating Guinea Pigs with Videos and Pictures

Mr Poodle is of course welcome to come on here for any questions, practical tips and moral support. He won't be the only man.