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I need suggestions on sedation

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I am taking Cocoa to the vet. It is usually an exercise in futility but she needs to have a good exam. Normally we muzzle, restrain, and try to get done what we can which is not much. The vet wants to give her Ace or Torbutrol. I know folks here have said Ace is horrible to use. What will Torbutrol do to her? Is it the same thing? Any suggestions. Our appointment is Saturday and I would really appreciate ideas on what to do for her. I know at the least we can get her shots updated but I really want to have her blood work done, teeth checked etc. I don't see that being possible without sedation. Thanks all.

 

Toni

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How about plain old Valium? If it's that big of a deal I would forego the annual "shots" (I don't do them anyhow but that's a personal decision). You're right about staying away from Ace and I'm not sure where Turbutrol comes into the picture.

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Valium probably isn't going to be strong enough if Cocoa is very stressed and difficult to handle at the vet. You would be amazed at how much benzodiazepines these guys can absorb and still override if they believe they are in a life or death situation, which is what the vet seems like to some dogs.

 

Solo just went to the vet and got a combo of Dexdomitor (dexmedetomidine) and Torbugesic (butorphanol, same as Torbutrol) and it worked like a charm. He was quiet enough to be handled without being unconscious, did not seem particularly stressed after the visit, and did not require a reversal shot. I did not give him any alprazolam ahead of time as, in my experience, it is just not high octane enough to make a difference. Solo needed an intramuscular injection because he was not cooperative enough for an IV injection. It took Solo about 15-20 minutes to be sedated enough to be examined, and he appeared calm and unworried (albeit with periodic growling), as opposed to immobilized but terrified which is how he looked on Ace. The vet and staff were able to do a basic exam (minus the teeth and the eyes, because he was muzzled, and because staring into his eyes would have been too freaky for him) and draw enough blood for a geriatric panel and heartworm test.

 

The vet warned me Solo may seem drowsy once we got home, because the adrenaline would wear off and the sedation would hit him harder, but he didn't. Actually, if I had not known he had been sedated I probably would not have noticed anything at all.

 

Good luck. I feel your pain.

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It is terrible to deal with animals who fear/hate the vet so intensely. My cat Mesto was like that, but obviously easier to control than a dog. He was usually muzzled and sometimes given a sedative. I never did find one that I thought made him less aggressive or fearful (just messed up and mean), but I wish you all luck, Toni!

 

Out of curiosity, what specifically is so bad about Ace? I didn't like it with Odin, but mainly because I thought it was ineffective. He was supposed to take it 3x a day for 10 days after the surgery, and we were encouraged to ask for more if we needed it. The tech, who has a young BC herself, told us we could/maybe should give a double dose because of how difficult a 8-mo is to keep down. We gave it to him, and even still high from the IV sedatives and Ace and painkillers, we were ushering him to his crate like a very fragile package when he immediately jumped up on the bed like nothing was wrong at all. He slept a bit more, but had also just had major surgery and we wouldn't let him do anything. Over that week, when we redosed him, he just seemed to get kind of uninhibited but clumsier, neither of which really helped post-surgery care in my eyes. But definitely no immobilization, even at the double dose. It just sounds like others here have had much worse experiences with it?

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Ace is awful for dogs with anxiety/fear/aggression issues because it is a paralytic with no anxiolytic properties, i.e. the dog can't react as quickly to stimuli but they are just as freaked out/anxious as they would be without meds so they often end up with worsening vet issues because of the now even more traumatic experience.

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Melanie,

The vet wanted me to pick up pills ahead of time to give to her. In your opinion would an injection work better? I just don't know about not having her sedated when I get there. No matter what I have done she is terrified. We went everyday for months the last time I had her shots. I did treats, companion pet... nothing made one bit of difference. Just getting her nails clipped is exhausting. The hair between her pads- forget about it. I would like to have something in our arsenal that would make these visits less stressful for her. I have worked with her since I rescued her touching her feet. While she finally adjusted to me brushing her (she has to be on a leash and isolated in the room with only me) , the feet have been another story. It takes 3 of us while she is on the grooming table to hold her.

 

Toni.

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Out of curiosity, what specifically is so bad about Ace?

The one time I used ace was on a dog who was on strict crate rest for a dislocated hip and who was also thunderphobic. The vet's soultion for keeping her "calm" during a storm was ace. It was soon clear to me after giving her the meds that all ace did was make her unable to move, even though she was clearly still terrified. That's not my idea of helping the dog. She had the same amount of fear/anxiety that she always had during storms, compounded by the fact that she couldn't move. Imagine how it would be to be so afraid of something you wanted to run away, only you couldn't move, and yet your brain was still reacting to that fear stimulus in the same way. ISTM the only result would be increased fear and stress from not being able to physically react to the fear stimulus. IMO, for cases like this, it would make sense to either knock the dog completely out with something so that it slept through the event or give it a mood-altering medication so that it felt "good" when normally it would feel fear.

 

Karen,

I don't think Toni was concerned about the shots so much as she was about getting blood drawn for a panel, checking teeth, etc. In other words, all the non-vaccine things she wanted done.

 

J.

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Thanks for that explanation, Julie and Maggiedog. It almost sounds like when they used to give human women ketamine (a dissasociative) during childbirth in the 50s. Apparently that caused a lot of psychological issues because the women still felt all the pain and even more terror, but couldn't move and often didn't consciously remember the experience later, but would have flashbacks etc. But it made it easier for the male doctors to just ignore the women and work in controlled conditions if they were essentially paralyzed.

 

As for the Ace, I didn't see anything resembling immobilization, so I guess we weren't dosing Odin strongly enough. In any case, not impressed, and again, thanks for the info.

 

Toni, good luck on Saturday, hope things go well.

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Just wanted to give everyone an update. I faxed the Vet Melanie's suggestion and received the response that if I wanted to give Coca IM I would have to reschedule as she had onlly scheduled 15 mins as she planned on doing an IV. In what world did she think she would be able to do an IV without sedation? I was so frustrated. So now I am searching for a new vet.

 

Toni

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Just wanted to give everyone an update. I faxed the Vet Melanie's suggestion and received the response that if I wanted to give Coca IM I would have to reschedule as she had onlly scheduled 15 mins as she planned on doing an IV. In what world did she think she would be able to do an IV without sedation? I was so frustrated. So now I am searching for a new vet.

 

Toni

 

 

I don't understand that. How hard would it be for a vet tech to come out and give the IM injection 20 minutes before the appointment? You wouldn't necessarily need to be in the exam room while waiting for the sedation to take effect.

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I agree Toni. If the whole issue is the dog's behavior, I don't get the idea that she was going to be able to give an IV. Mary's right, you could wait in the car and let a tech do the injection. When you find a new vet and move your business, I hope you tell the former vet why (in a nice way, of course), so maybe she won't lose future clients for something similar.

 

J.

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Thank you for the support everyone. I thought that maybe I was being too demanding, but I worked hard for Cocoa's trust. The fluff butt deserves to have someone fighting for her. Thanks guys.

 

Toni

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Thank you for the support everyone. I thought that maybe I was being too demanding, but I worked hard for Cocoa's trust. The fluff butt deserves to have someone fighting for her. Thanks guys.

 

Toni

The fluff butt certainly does need someone fighting for her! Good for you, and don't stop being her voice!

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Well, my vet had also hoped to do an IV injection (because it takes effect so much more quickly) but gave up immediately when she saw how uncooperative Solo was going to be. It is possible that if the vet has not worked with Cocoa before, she may have underestimated Cocoa's distress. Often, owners will describe their dogs as more difficult than they actually are.

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It almost sounds like when they used to give human women ketamine (a dissasociative) during childbirth in the 50s. Apparently that caused a lot of psychological issues because the women still felt all the pain and even more terror, but couldn't move and often didn't consciously remember the experience later, but would have flashbacks etc. But it made it easier for the male doctors to just ignore the women and work in controlled conditions if they were essentially paralyzed.

 

Ketamine works in a very different way than ace. And we use quite a bit of ketamine in human medicine today- it's a dissociative drug, and is primarily used in children because grownups tend to have weird freaky emergence dreams. I've used it on the occasional grownup without problems, though. (the lady who burst into "The Star Spangled Banner" notwithstanding.) And it's certainly not a paralytic - when I knock kids out with it *(usually for facial laceration repairs), someone still has to hold them. But they do very well and don't remember the scary stuff.

 

FWIW, Ketamine has street value now.

 

I don't like ace, and don't use it on my dogs or my human patients. I used it a couple of times on the dogs early on, but I don't like it. They get googly-eyed and act drunk.

 

Unless they have intractable hiccups. Then it works. In humans, I mean.

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Ketamine works in a very different way than ace. And we use quite a bit of ketamine in human medicine today- it's a dissociative drug, and is primarily used in children because grownups tend to have weird freaky emergence dreams. I've used it on the occasional grownup without problems, though. (the lady who burst into "The Star Spangled Banner" notwithstanding.) And it's certainly not a paralytic - when I knock kids out with it *(usually for facial laceration repairs), someone still has to hold them. But they do very well and don't remember the scary stuff.

 

Sorry - not saying they work the same way, I know ketamine is a dissociative. Just pointing out it seems like in both uses, the drug is apparently immobilizing a being (or essentially attempting to render them inert) as a way to make things easier for the practitioner and not the patient. Obviously the mode of immobilization is different - the way I heard it described in my psychopharmacology class at high enough doses a person is sort of "frozen" and not very responsive. The prof I heard this from (an MD herself) found the practice of giving ketamine during childbirth (don't know about other applications) an extremely sexist practice based in the roots of the concept that women can't handle childbirth and need a (male) doctor to enact it while they are helpless/out of it. AFAIK it is not used this way anymore? That lecture was ca. 1997. But also forgive me if I misunderstand the true difference between the drugs as I gave my dog a lot of Ace and he wasn't immobilized at all.

 

Anyway, I clearly digress. Toni, I also applaud your fighting for your girl. I *hated* switching vets with Mesto because I found almost no one would take me at my word about how freaky he was. That is, until they saw it firsthand when it was already too late and we were both bleeding and the cat further traumatized.

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Ketamine works in a very different way than ace. And we use quite a bit of ketamine in human medicine today- it's a dissociative drug, and is primarily used in children because grownups tend to have weird freaky emergence dreams. And it's certainly not a paralytic - when I knock kids out with it *(usually for facial laceration repairs), someone still has to hold them. But they do very well and don't remember the scary stuff.

How young are these children and how do you know they're not remembering the scary stuff? Would they be able to communicate that to you? Would this be an immediate reaction or delayed? Just wondering.

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