Just got back from the vet with Tia.  She has some pretty bad pain at the front of her abdomen.

I've had bloods taken for a general check up now, then depending the results there may be an ultrasound in the near future, so long as I can stay with her start to finish (she cannot be left at all for various reasons).  Vet was very understanding about that... then proceeded to insist that she took Tia out back to take the bloods, which totally stressed her out.  She's still anxious nearly an hour later, and when I've calmed down a bit I'll be having words with the vet for future reference (or changing vet if necessary, I know one of the others there is happy to take bloods in the room for a stressed/problem dog).

Anyhoo, my suspicions lie with cancer of some sort as she lost 2kg in the space of 3 weeks and her appetite has gone bananas, just wondering what other likely causes there would be?  The pain is worst just behind her rib cage, but because of her temperament/stress issues she totally tenses up when being examined (even with no pain, so you can imagine today she was like rock!) so the vet couldn't get a good feel.

Never mind - question answered, tumour(s).  :-(

It's an educated guess rather than a confirmed diagnosis, but it's enough.  Her bloods was all fine except a slightly low red blood cell count which suggests a small bleed from something, most likely a tumour.

The possibilities left for where her pain is are a stomach/gut problem or tumour(s) in the liver/spleen/pancreas, and as she's having no trouble with eating/digestion/defacation, that rules out the stomach/gut; and with the huge appetite and weight loss, tumours are pretty much the only suspect.

She was going to have an ultrasound but in view of the fact that she's at least 13, and gets very, *very* stressed with any kind of medical handling - even just, for example, me looking at her iffy leg if she's twisted it - I will not put her through any surgical; procedure, and it would take major invasive surgery to fix what's wrong now, if it even could be fixed.  The ultrasound would therefore be diagnostic only - purely to confirm what's wrong, it wouldn't actually be of any benefit to her so I'm not having her put through it (it would mean either full sedation or a horrendously stressful, bitey time conscious and neither is a good option for her unless it's 100% necessary).

So we are doing pain management.  She's already on tramadol, I've bumped the dose up a bit tonight as she's a little more sore, and I'm to assess in a week and update the vet, and maybe discuss other painkillers if necessary.

I'm gutted - I've had her only a year, it will be her first Gotcha Day on sunday :-(  But I am reminding myself that she's still happy and being a menace, and she's had a very good, pain free year with walks and happiness, not being ignored, and I've put work into her dog issues so she's not too worried about them any more.  So at least we won't have that stress for her, and I can get some good walks in - top of the list is the local manor house, I've not taken her before but it's a lovely place to potter around, and any dogs that are taken are on lead so minimal worry for her :-)

I also have a photoshoot booked for her next Thursday - she should be up to it, obviously I'll cancel if not, but it'll be just me, her and the photographer and lots of treats and fun, and hopefully a gorgeous portrait shot of her as I don't have any decent ones :-)

> <SPAN class=htt>In Response to</SPAN> Nikita Never mind - question answered, tumour(s).&nbsp; :-(

So sorry to hear the diagnosis. Wishing you both all the best, Lacy

Good luck with her pain management.  I hope that you can sort it so that she is with you for a while yet.

I'm so so sorry, really feel for you.

We are going through the same with my veteran only hers is a heart based tumour.
We had a guesstimate of a few days, couple of weeks or a month for the time we have left.
We are now in week 4. We've been told what to look for when we have to make the decision to let her go.
At the moment she's happy, eating, still dances for her meals and still happy to go for strolls etc.

At least in the year you've had your girl back, she's known love and affection and been spoilt and kept as stress free as possible.

Hugs

This is it, she's still lively and happy for the most part - first thing in a morning she does look fed up but it's the tramadol wearing off, she had her dose this morning at half 7 and has been for a walk since and been nice and bright.

Realistically I don't think it'll be long - considering she first needed one tramadol on Thursday evening and she's already up to two 3 times a day :-( but there's still a way to go with potential dose of that and of course other options for painkillers.

I'm so sorry for you ((((hug))))
I went through the same two weeks before christmas with Ben, I'd only had him 2 years, he went pretty quickly, which was best for him I think, he'd gone off his food and was wheezy as the cancer had spread to his lungs.

He was on Tramadol and steroids, I up'd his meds too to keep him comfortable on the last couple of days.

Here's hoping she has a wee while yet

We're now up to 2 tramadol 4 times a day :-(  I have left a message for the vet to call me back tomorrow, to look at other options or maybe steroids alongside the tramadol.  Tia's okay most of the time, and had a very good day yesterday but otherwise she's in too much pain too soon - i.e. the tramadol is not lasting long enough between doses.  She yelped getting up first thing this morning and has been hurty-panting and groaning a bit today too, which is new.  And she hasn't had a walk today to have caused any extra soreness (something to do with Raine stealing and eating an entire very large portion of chips off the side and me needing to keep an eye, the little sod!).

Seems to have kicked in for now though anyway, will see what the vet says tomorrow.  I think she just needs something to complement the tramadol - to help with the period between one dose wearing off and the next kicking in, which is taking a while to happen properly.

I hope the vet can help by introducing an anti inflammatory as well to deal with pain in a different way as you have reached the max. dose of Tramadol I would give to an adult human patient.

Keep us posted.

Perhaps.  She's already on turmeric for her arthritis - that is anti-inflammatory and does a better job for her joints than any of the conventional stuff!  Things like rimadyl, previcox etc did nothing for that - but they maybe will for this.  I've got a bit of both and some metacam in the cupboard all in date, just want to check with the vet first.

According to the literature there's still room for more tramadol - max dose is 5mg/kg, up to four times a day so she could have another 4 a day yet.  But personally, I'm not at all comfortable giving her that much and it'd still take a while to kick in.

Maximum for a human is 100mgs four times a day, I am presuming your capsules are 50mgs each, when I reached the maximum dose and it wasn't working I was started on Morphine and then later Fentanyl patches when the Morphine tabs didn't work with my shift patterns.

What form does the turmeric come in?

Yep, 50mg capsules.  Mine, actually :-P

The turmeric is just shop-bought powder for cooking, nothing fancy - I was going to look at refined capsules for the higher curcumin content but as she's done so well on the powder I've left it at that.

Annoyingly I missed the callback from the vet - not that it would have helped, she didn't call til the place was shut at half 1 anyway.  And typically she called in the 30 seconds I left the phone to nip to the loo!

Thankfully Tia's doing okay today, she'll be ok til I can get to the vet on Monday I think.

> The turmeric is just shop-bought powder for cooking, nothing fancy - I was going to look at refined capsules for the higher curcumin content but as she's done so well on the powder I've left it at that.

You might want to research Asian grocers. Fresh turmeric in root form - although uncommon - can be bought sometimes. I first spotted it about 15 years ago in a grocery store in London's Chinatown. I'd guess that would have the highest curcumin content of all.

Glad Tia is more settled, may have taken longer to get the full effects of the increase in the Tramadol dose,long may it continue.

Yes I realised it is an Indian spice[called herb in places] probably have some in my spice rack but can't remember if it is strong or not as I don't want fire coming out of my tail end.

Don't you hate it when you are by the phone for hours and the minute you go to the loo or out to the garden with the dogs it rings and you can't get back to the person.

> Yep, 50mg capsules.&nbsp; Mine, actually :-p

Supplied by the NHS!?

Yes, why?  I got given them when I was having horrendous rib pain which nothing else would touch - as that's gone I don't need them so she may as well make use of them.

> Yes, why?

Because it is stealing from the NHS, paid for by us all.  In effect we are paying for your dogs health care.
You may not need them just now but if your pain returns you will get another prescription from your doctor.
You are also giving a prescription medicine to your dog without prescription from a vet.

Have they ever been prescribed by your vet? They can have side-effects when combined with other medication, so your vet needs to know exactly what you're giving.

>According to the literature there's still room for more tramadol - max dose is 5mg/kg, up to four times a day so she could have another 4 a day yet.

Was this for humans or for canine use?  The tolerance levels could be very different.

Could be wrong, but thought anti anti inflammatories should not be given with steroids?

Do you lot really think I'd just randomly medicate my dog without knowing it was safe?  Good grief.

My vet knows I'm using my leftover tramadol, she's perfectly happy with that and it was her who advised me of the dose according to the veterinary literature, she checked in her book so we'd both know how much Tia could have.  Why on earth would I use a human dose rate on a dog?  So many are different - look at Remy's thyroid meds.  Dose rate for humans is typically around 20mcg a day - for dogs it starts at 240mcg a day.  I know there can be huge differences so I look at the relevant lit.

As for dog vs human use - as I understand it, tramadol is a human drug anyway (wasn't there a discussion on its use by vets on here recently mentioning that?) so the dose will have been defined based on that.

Stooge - I pay my prescription costs, and Tia hasn't had the whole lot - just what I had left over.  I see no sense in it just sitting in the cupboard where it won't be used, when it's been approved by the vet and can do some good.

Edit: oh and yes, they have been prescribed for her before - she was on trocoxil and tramadol is the only other option for pain with that.  My vet is also fully aware that Tia is no longer on trocoxil so is able to have other options for the pain.

> Stooge - I pay my prescription costs

That is just the prescription charge, subsidised by the NHS, the cost of the drug is a very different thing.  I would be very surprised if the vet understood you were using your own drugs and approved as it is illegal. 

I would be very surprised if the vet understood you were using your own drugs and approved as it is illegal.

Last summer my dog needed Tramodol. when I asked the vet hospital if it was ok to give her mine they said yes....did i feel guilty? not at all. you just have to take a walk in the street to see the real theif's in todays society. cant believe someone is actually nit-picking this. unless they are whiter than white that is, and if so there arent many of these around.

She is well aware it's my tramadol and she is fine with it - I asked specifically if it was ok to use.  I think she would have noticed if I hadn't mentioned it anyway - it'll not be on Tia's notes as a prescription.

As for cost - I had two boxes on my prescription, she's used one.  It's generic tramadol, which costs the NHS 8p per capsule; 30 capsules per box, so £4.80 worth altogether.  I paid £7.40 for my prescription.  You aren't paying for it - I am.

Now as this is going OT, I think we should leave it there - I could rant about what the NHS has cost me in tests and treatment lately, but it's got nothing to do with Tia and certainly won't help her.

> unless they are whiter than white that is, and if so there arent many of these around.

I think there are lots of people that have never stolen anything.  Maybe if you worked in the NHS, working harder and harder to deliver a service within an ever deminishing budget you might consider how you would feel about people helping themselves to treat their dogs!

> It's generic tramadol, which costs the NHS 8p per capsule; 30 capsules per box, so £4.80 worth altogether.&nbsp;

Actually the price of the capsules is rather less than that but the cost of delivering them to the patient, via the GPs and Pharmacists time, adminstration costs etc will be more than the BNF price.  All of which is besides the point, drugs issued to humans by the NHS are not intended for their pets.

Maybe if you worked in the NHS, working harder and harder to deliver a service within an ever deminishing budget you might consider how you would feel about people helping themselves to treat their dogs!

You have no idea where I work and to be honest I have seen so much waste in the NHS, I certainly would not be flying their flag. waste is waste, whether is is NHS or supermarket/where ever. As the OP said this has gone OTT and obviously rattle a cage that isnt going to be settled here.

You are right, there is a lot of the wastage that goes on but I do not feel that makes it right to justify it when you see it but you are also right she does seem unlikely to see it.

> All of which is besides the point, drugs issued to humans by the NHS are not intended for their pets.

But if this medication was no longer required why not? if it was returned to the pharmacist they would throw it away so why not put it to good use.

> But if this medication was no longer required why not?

It could be used again by the same patient as long as it was in date.

But it won't be - I've already said that.  And before you say 'it might be' - my rib pain was caused by a simple vitamin D deficiency, the deficiency is addressed and the remaining aches have gone.  So I won't be needing the tramadol again, simple as.

So therefore, it could either sit under the counter until it went out of date and was no good to anybody; I could return it to the NHS, where it would be destroyed and of no use to anybody; or I can use it to keep my old dog comfortable.

> Do you lot really think I'd just randomly medicate my dog without knowing it was safe?&nbsp; Good grief.

Nikita.
I was in no way suggesting or inferring that you randomly medicate your dog. I have to use rimiadyl occasionally for one of ours, but when put on steroids a couple of months ago was told very definitely not to use it for the duration. Just hope that something can be done to assist Tia, a horrible time for you both, all the very best.

Unless you have a crystal ball I cannot see how you can say they are ready to be discarded.

It wasn't aimed at you Lacy, sorry if it seemd that way :-)

Stooge - the problem they were prescribed for is resolved.  Therefore they are not needed - I don't need a crystal ball, it's pretty straightforward.

What I can also say with confidence is that we are not going to agree on this and arguing about it isn't helping Tia, so I am leaving it there and won't respond re. the use of my tramadol again.

> we are not going to agree on this

So it seems if you cannot imagine that you can ever have a different requirement for analgesia but perhaps enough has been said to consider its use in the future :). 

Seeing as you can't return medications what is the problem in this?  She was prescribed that amount and didn't need to use it all.... 

> Seeing as you can't return medications what is the problem in this?&nbsp;

I have explained why.  They could be used by the same patient as long as they are in date. One problem may have resolved but if another occurs it would be back to the doctor.  This is all in the thread already.

> One problem may have resolved but if another occurs it would be back to the doctor.

Stop making assumptions about me - you do not know me.

Firstly, if another problem was to occur, I have other strong painkillers I can use, left over from the same problem; the tramadol was prescribed because those did not work for THIS condition.  Secondly, if I ever need tramadol again, I will order it - legally - from the same place I get mine and Remy's thyroid medication overseas - which I pay for myself, because the NHS refuse to do anything about it.

Third, if the doctors had listened to me in the first place 3 years ago when the pain started, I would never have needed the tramadol in the first place - I told them what was wrong and they ignored me for 3 years (and even laughed at me on one occasion).  It took multiple appointments, four GPs, changing surgery and a referral to an endocrinologist to finally get a test, result and treatment recommendation; and my GP would not then follow the endo's recommendation so I ended up doing that myself, successfully, too.  Likewise treating several other deficiencies successfully which they would not even acknowledge.  And, the referral was actually for my thyroid - which as I said, they will not treat.

As a result, I now do not go to the doctor unless I have no other choice - and I mean literally no other choice.  I'm also looking at health insurance so I can avoid the NHS in future if at all possible.

How horrible that a thread about a gravely ill dog has turned into owner bashing for using NHS drugs. Some people should really get down from their high horse and refrain from commenting if they havent got anything constructive to add to this thread on a DOG forum.

How horrible that a thread about a gravely ill dog has turned into owner bashing for using NHS drugs.

Agree giving un-used medication where it will do some good is better than throwing them away no matter  who paid for them.

BACK TO THE ORIGINAL

My dog is on NSAID and Tramadol - nothing like the amount you are giving but giving together is not a problem.

Oh yes, tramadol and NSAIDs is fine - as I said she was on trocoxil before and tramadol is the only other option for pain for dogs on that.

Just need the vet's go ahead for it, I'm waiting for a call at the moment - the idiot receptionist I got on Friday passed my message of 'the tramadol isn't enough, she needs something else to complement it' as 'the owner is running out of tramadol' to the vet, whose called I missed on saturday, so the only note on the system is to put me more tramadol out :-(

She is on holiday this week so the actual message has been emailed to the other vets for them to have a quick look at the notes, chat to me and prescribe something else.

I have nothing but trouble with 3 of the receptionists there, they are total planks and just as dense!  Never get a message right, even if they actually understand what I'm saying to start with.  Thankfully today when I called back to see what the vet had written I got one of the 3 original ones with brain cells who knows me :-P

>Stop making assumptions about me - you do not know me.

They are not personal assumptions about you just the nature of health generally.  None of us know what is in the future.

> How horrible that a thread about a gravely ill dog has turned into owner bashing for using NHS drugs.

I agree,   I am sure I have made my thoughts very clear so I do not understand why it continues to be resurrected.

How is she doing today?

> I agree,   I am sure I have made my thoughts very clear so I do not understand why it continues to be resurrected.

Because you continued to comment on it.  I did not want to continue, however your comment about going back to the doctor does read to me as an assumption about me, given that we have been discussing my individual situation and choices - I felt I needed to defend myself.

Rhodach - she's been doing well today, at least up until the walk this afternoon - fine on it, but then once her then-dose had worn off she was hellish grumpy with Remy - he laid down on the bed next to her and she was doing a lot of growling.  No news from the vet though, but they were awfully busy today.  Will be chasing them up first thing tomorrow.

Edit - not so good :-(  She's just stood up to go and greet my lodger on her way out to the shop, got stood up then just stood there hunched :-( That is not Tia - Tia's greetings are constantly mobile and wiggly and noisy, usually with a bone in her mouth :-P  She just stood there, tail dropped :-(  She's due some more now, only just time for the next one.  That's the problem, these inbetweeny bits.

Thanks for the update. Can you arrange her walk to midway between Tramadol doses where the painrelief should be at its optimum?

> Because you continued to comment on it.&nbsp;

I hadn't commented since last night! since then three people had dug it out again covering the same ground :)

> I did not want to continue, however your comment about going back to the doctor does read to me as an assumption about me

I can't see it but sorry if you thought that, of course I don't know anything about you and your health, any of us could require painkillers at some point.

> Thanks for the update. Can you arrange her walk to midway between Tramadol doses where the painrelief should be at its optimum?

I do normally - just got mucked up today thanks to my idiot lodger.  Going to be a hard couple of days as she moves out, because Tia will want to be greeting everyone and will be trying to be up and about even if no-one comes into the room with her :-( But at least after that it'll be total peace and total control over visitors (or lack thereof) so from that POV, it'll be better for her.

We were going to have a pootle in the grounds of the local country house tomorrow - it was her 1 year gotcha day yesterday, and it's a lovely, peaceful mooch there - I will wait till she has something else for the pain though, she'll not enjoy it otherwise.

Well, moving day went pretty smoothly - bit too sore to bother I think, and of course the safety gate was up.

We're seeing a different vet tomorrow - understandably, he won't prescribe anything new without seeing her.

He's either not read the notes or the original vet skipped some bits though - he said he'd do the ultrasound if I wanted, but I'd already explained why I didn't want to to the other one.  Doesn't matter though, I'll just explain to him tomorrow :-)

So hopefully she'll be back on track properly by lunchtime - she's not too bad tonight having said that though.  But she hasn't had a walk this afternoon - that seems to help generally, not just when my timing's out.  But then it gets tricky, because if I take everyone else out she tries to come with us because she really wants to come!

Still, we shall manage :-) I think she's going to be fine for the photoshoot, and we'll try again for the country house on friday :-)

She's on cortisone now.  She was at full cover with the tramadol when we saw the vet today - that helped him as she wasn't tensing up much so he got a good feel.  He said he can feel something not-good in there but couldn't tell what exactly - but I've explained to him about not doing the ultrasound.

Between what he felt and her symptoms, he does agree that it's looking like a tumour or tumours as the original vet said so we're continuing with palliative care as planned.