Mar 232013
 
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Sasha's faceWhen Sasha came home from her visit to NC State Friday of last week, she was clearly uncomfortable and in pain.  During a previous visit to the vet school, Dr. Hauck had suggested that we increase the amount of Tramadol that we were giving Sasha in an effort to better manage her pain.  At that time, we did not feel that increasing Sasha’s dosage of Tramadol was necessary, but after this last visit, we decided to give it a try.  We started giving Sasha two Tramadol Pills with each meal, and then increased the dosage again to three pills.  Sasha’s discomfort seemed to be getting worse and quickly.  Carlos and I were so scared because Sasha’s health seemed to be deteriorating, and we feared that we were going to need to say goodbye to Sasha soon.  We did everything that we could to comfort our girl, but nothing seemed to work.  When things were really bad, Carlos called a 24hr emergency vet and asked if we could give Sasha four pills every six hours.  The veterinarian told us, given Sasha’s condition and prognosis, “give your baby anything she needs to be comfortable”.  This advice was echoed by another veterinarian that we had been in contact with.  Giving so much Tramadol to a dog would usually never be recommended, but since Sasha’s condition was terminal, and the end seemed to be very near, there really wasn’t any concern about the damage that the Tramadol might cause.  We understood that possible adverse side effects of Tramadol, especially at high dosages, but we agreed with the advice that we were given, and gave Sasha the four pills every six hours.

Sad SashaWhen even this extremely high dosage of Tramadol was ineffective at helping Sasha, we knew it was time.  Carlos called a mobile vet who provided in-home services, including euthanasia, in case Dr. Neuenschwander would not be available to come to our home when Sasha was ready.  I took the day off from work to spend as much time with my baby as I could before saying goodbye to her.

Just as we were coming to terms with the inevitable, Carlos told me that he had an idea.  He wanted to talk to me about an idea that he had that he felt might help Sasha, but there was some risk involved.  His idea was to stop giving Sasha Tramadol altogether.  The obvious risk was that Sasha would possibly be in severe pain as the last dosage of Tramadol wore off, but Carlos had noticed something.  Almost like clockwork, Sasha seemed to feel the worst about 30-45 minutes after giving her Tramadol.  It suddenly seemed clear that the Tamadol was the culprit in Sasha’s recent and ever worse suffering.  Also, once he made that connection, Carlos also realized that Sasha’s suffering seemed more like anxiety and extreme restlessness rather than the effects of pain.  After taking a high dose of Tramadol, Sasha would become very agitated and unable to find a comfortable position.  She didn’t seem able to stay in one position for more than thirty seconds at a time.  Her eyes were opened so wide that it seemed they would pop out of her head.  We were mistaking this dysphoria as pain.  It came on so quickly and seemed so bad that we were about to put Sasha ‘out of her misery’.

Sasha is doing much better now that we have decreased the amount of Tramadol we are giving her.  No more dysphoria mistaken for pain, and no more tears being shed in our home for now.  It looks like Sasha will be sticking around for a while.  Now we need to figure out the best dosage of Tramadol for Sasha, and the best frequency to administer it.  We are also inquiring about alternative pain meds that may not affect Sasha in the same way as Tramadol.  Needless to say, Carlos and I are happy beyond words that we will have Sasha in our lives for more time.

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  4 Responses to “Sometimes More Medication is not the Answer”

Comments (4)
  1.  

    Yay, great job Carlos!!! Lots of love and positive energy as well as prayers on the way to Sasha. You hang in there baby girl!

    •  

      Thanks Barbara! I’m having a difficult time getting over the fact that we almost decided that it was Sasha’s time to go because of a problem that we were causing, but I am also very happy that we figured out what was causing Sasha so much discomfort. Unfortunately, Sasha is still suffering from pain, and we do need to find a way of making her more comfortable. We will be writing a post in the near future that discusses the alternatives we are looking at, and which direction we ultimately decide to go.

  2.  

    I’ve been catching up on your blog. I’m so sorry that Sasha has reached this part of the journey. It is the toughest and yet can also be the most bonding.
    I’m so glad you realised about the Tramadol. It has taken me many many months to stop torturing myself about the decisions we made at this point and advice that we were given (in our case I don’t think we were getting enough pain relief in the last week).
    I don’t need to tell you to treasure each new day. Even though you know it is approaching that final day can still sneak up and catch you unawares.

    Many hugs
    Karen (Spirit Magnum’s mom from Tripawds)

    •  

      Hi Karen,

      Thank you for writing. When we learned that Sasha’s cancer had returned, we were devastated. After all that Sasha had been through – after all the treatments, trips and time invested, Sasha was supposed to be healthy. We really believed that our girl had beaten the disease, and that she would be taken by old age, rather than by cancer, many months, and perhaps, years down the road. I always thought that Sasha and I were close and that our bond was as strong as it could be, but with each new chapter in our journey with her, our bond grows stronger.

      I already question myself about decisions that we’ve made concerning Sasha, and I know that I will continue to do so on into the future. I think self doubt in a situation like the one we are in is inevitable. We can only do what we feel is best for our girl.

      Carlos and I watched a video and looked at some pictures of your sweet Magnum. Such a beautiful dog.

      Thanks again for writing. I’ll give Sasha a special hug from you.

      ~ Liliana

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