What a well-timed post!

Joella, my 8yr old Rottweiler Service Dog, just had arthroscopic surgery on her right ankle/hock. The surgeon had hoped to find a "pebble in the shoe" bit of cartilage but what he found was crab meat. All of the cartilage had been ground down and was now just fluffy sandpaper. He cleaned up the joint the best he could (I got cool photos!).

Jo has x-ray d'xed arthritis in both knees, hips, and the other ankle. (side benefit of these straight-legged genetic messes many Rottweilers have become) The surgeon has released Jo back to our regular vet and we meet with her in two weeks to discuss long-term care.

I'd much prefer she not be on a daily NSAID dose. Instead, I will ask our vet about the Adequan and Dasuquin. Jo already has cod liver oil and the "sea jerky" treats. I have osteoarthritis and connective tissue issues (side benefits of having Ehlers-Danlos Syndrome) so I can totally empathise with Jo's pain. I have gastric issues from being on NSAIDs for many years (I want my Vioxx back, dangit!) and I do not want Jo to experience that. She can't tell me her stomach is acidic, ya know?

PaulaO May 9th, 2009 01:14:32 PM

I like Adequan's results.  For my creaky arthritic dogs, it has made them much more mobile than daily Rimadyl, and even with lower and less frequent doses of Rimadyl, they're more comfortable than they used to be.  (Glucosamine helped at first, but over time it seemed less effective.)

We did the 2 shots/week for 4 weeks, but then followed it up with monthly injections for about a year.  At this point I'm giving them an injection every 2 months.  I give them Rimadyl occasionally, maybe a few times a month: if they aren't up to their usual antics, or if I see the one licking the joints in her forelegs.  Or if it's a really bad weather day and *my* arthritis is acting up...

Galadriel May 9th, 2009 01:15:49 PM

When we have broached this subject in the past, comments have ranged from life-saver experiences to cause of death. Shouldn't be surprising since the human counterparts are parallel.

IMO, key is to prescribed wisely, drill the unwanted side effects, taper down. I perceive the biggest problem being handing them out too freely for every situation requiring pain relief or ant-inflammatory properties; when perhaps other medications would be more appropriate. Dental? Send home with a few tramadols, Surgery? How about a fentanyl patch?

I know a companion dog that was administered Adequan for years & worked well, for a congenital disk problem.

As you have said above, and I'm echoing, dosages once considered routine, may be way too high for elderly arthritic patients with compromised organs.

todays update: NH vaccine local news coverage

Barbara "Pocket's Story from NH" May 9th, 2009 01:22:51 PM

My dog, who typically has an 'iron stomach', could not tolerate Rimadyl - she would throw up pretty quickly after she had some. Does this mean she would likely not be able to tolerate the other NSAIDs?

After the Rimadyl my vet went directly to Tramadol - which seems to work fine and not upset her stomach...but I'm not sure if it is appropriate is she needs something for more chronic pain as she gets older. Should I stick with the Tramadol, or try and find an NSAID that she can tolerate better?

Larry May 9th, 2009 01:58:00 PM

Thanks, Dr. Khuly, for raising this important topic.

Pain relief for dogs (and especially cats) requires careful prescribing and monitoring. But for those with pets who suffer from chronic arthritis pain, please balance concern for risks against your pet's (loss of) quality of life. Not managing their pain (in some way) is not an option.

Up until a few years ago, I had a manx cat with severe arthritis (spine, hips). I'm fortunate to have a vet who wouldn't give up on finding ways to improve my cat's quality of life  and persisted in trying different pain regimens before finally finding one that worked well for my cat (metacam + adequan for routine pain control; fentanyl patch once for an acute orthopedic injury). I confess, I was fearful of drug side effects, but with good communication and frequent monitoring, my vet found ways to ease my fears and improve my cat's quality of life. Thanks to our vet's efforts, my cat lived for 6 years with arthritis with a good quality of life.

karen May 9th, 2009 01:58:14 PM

My vet and I agree that my ~six yo rescued stray is relatively healthy, but he's not very lucky. In the year since he was picked up on the street he's had more prescription drugs than my previous dog had in the first five years we had him. He's had Rimadyl in short courses after his neuter, surgery to remove a perianal tumour, a cut paw and now a short stretch of mild arthritis. He was prescribed Clavamox for the kennel cough he came to us with, the wounded paw and mild colitis accompanied by blood in the stool. All of these minor complaints cleared up quickly after he saw the vet and presumably the rimadyl and clavamox supported his recovery but I wish there were another way. Just saying.

Ron May 9th, 2009 02:35:28 PM

I have a dog with OA in one elbow so bad that it is 'end stage'.  We work with a veterinarian who specializes in pain control and she's helped us get him down to low doses of metacam and tramadol because we also use Dasuquin, Adequan and fish oil.  In addition we do extra-corporeal shockwave therapy and iontophoresis with him.  Adding these therapies has taken us from feeling like his pain was barely managed to feeling like we have it well under control with a lot of leeway in the event that it gets worse.  If you have a clinic near you with shockwave capabilities it might be worth checking out for your chronic pain cases.

Ingrid May 9th, 2009 03:42:08 PM

Ingrid: I should also have mentioned acupuncture and massage/hydrotherapy. I employ both, though the former through a trusted, certified veterinarian. Rehab underwater treadmills are also great--if you have the $$$. Don't know much about shockwave therapy. I'll ask my acupuncture and rehab locals. Thanks.

And your elbow dysplasia? So sad. There may be an elbow replacement out in the next couple of years. We're working hard on that since, currently, as soon as OA sets in anything surgical is contraindicated.

But yes, I agree with those of you who caution not to under-treat pain. I'd rather have a dead pet than one in serious chronic pain. Rough words, I know, but that's how strongly I feel about pain.

Dr. Patty Khuly May 9th, 2009 05:06:05 PM

I've seen wonderful results with Reiki in my older pet clients.  It helps them move better, and it helps with pain control (generally not as a standalone, but it can help reduce the dose of NSAIDs and other pain meds and it can also help with alleviating the side effects of those conventional treatments).  I've been working with a 12-year-old lab who is severely arthritic.  His owner has tried everything from conventional to acupuncture to shockwave, and she swears the Reiki is the only thing that really helps him.  He does move noticeable better after his treatment.

I offer a free report "How To Care For Your Arthritic Pet" on my website - nothing that Dr. Khuly hasn't already mentioned, but some of you might be interested. 

Ingrid King May 9th, 2009 06:13:02 PM

Adequan is awesome. Used it on my horse with great results. So much easier to inject a horse with the stuff than a dog though. I have 8 doses here that I probably should use, but I have trouble getting assistance (ahem) with holding the dog tight enough. (I can't do the injection and hold the dog.)

Neurontin (gabapentin) was prescribed for my dog by the oncologist when he was in so much pain from a tumor on his elbow — it worked where deramaxx and tramadol alone did not. But I haven't convinced my own vet that it can be used as a pain reliever. The cost of the drug is relatively low too.

Deanna May 9th, 2009 06:37:47 PM

Dr. K:"But yes, I agree with those of you who caution not to under-treat pain. I'd rather have a dead pet than one in serious chronic pain. Rough words, I know, but that's how strongly I feel about pain."

This is a seriously warranted topic, IMO. Animals are so very stoic & adept at hiding pain.

How do you assess pain, give it a 1-10 rating, and then how do you find the source of the pain?

 Some of you may think this is a stupid question, but more than once over the years, I've questioned the "what" is painful and how "bad" was it? Example: Elderly Dottie was clearly in moderate pain, but was it her eyes or joints? A dog reluctant to climb stairs can just as easily have bladder pain or limb, joint, or back pain. Having one squeal & pull away, when it happened so fast, you don't know if it was fright or touching near an area or what?

Barbara "Pocket's Story from NH" May 9th, 2009 07:59:55 PM

Hey Deanna, I give my dogs their Adequan injections without help.  I kneel with one knee on the ground and one knee in front of me.  I sort of hook the dog's abdomen over the knee in front of me, which lifts their hind end slightly off the ground and immobilizes them (along with a "stay" so they don't try to get down).  Not only is the thigh muscle right in front of me, at that point, but it's also relaxed since the hind feet are off the ground.

I do this with a couple of medium/large dogs and with a cocker...probably wouldn't work with a dog whose hind legs were longer than the distance from my knee to the ground :)

Galadriel May 9th, 2009 08:02:11 PM

We've found the best results from a three pronged approach.  First, a grain free diet.  If protein content is an issue for you personally, make your own at home.  Just get rid of that gluten and cut down on the starch.  Second, a joint supplement (I've had the best luck with Dr. Maggie's, but I know folks who have gotten great results on Costco bottles of Glucosamine/Chondroitin/MSM combos).  And third... DGP (Dog Gone Pain). 

Thanks for this post, Dr. K - I find that vets are FAR too willing to hand out NSAIDs.  Pulled muscle?  NSAID!  Cut pad?  NSAID!  Stiff from over-exertion?  NSAID! 

I prefer to treat the problem itself, and as a last resort mask the symptoms.  I will be taking a closer look at Adequan and Neurontin.

Around here all the vets try to push Cosequin as their glucosamine of choice... I've never had much luck with it myself.  Any others??

Kim May 9th, 2009 08:04:06 PM

I'm spitting blood from biting my lip while reading this one.  "I agree with those of you who caution not to under-treat pain. I'd rather have a dead pet than one in serious chronic pain"  Really?  I didn't see you mention one single SERIOUS pain reliever and they are certainly appropriate to be in the patients' tool box even if just for the occasional bout of sudden severe pain.  As one of the human counterparts, I can only say that none of you docs really know about pain and pain relief.  While I agree in part with you and with the pharm guy, I detest that you're following along the path of American human docs.  The result will be more pets suffering, just as the humans do.

PJBoosinger May 9th, 2009 08:09:22 PM

"Have veterinarians like me become too complacent in their willingness to hand out Rimadyl (or another NSAID)..."

Thank you for questioning yourself and the industry on this matter. We hear plenty of discussion about NSAIDs in the tripawd forums. Much of it is just fear, but some of it is is about pretty scary side effects. I can only say that all dogs must handle NSAIDs differently.

Jerry immediately showed signs of serious intestinal trouble on both Rimadyl and Previcox. But he handled Metacam quite well – even long term as part of his metronomic cancer therapy – while others have expressed concerns about their dogs adverse reactions to Metacam.

Thanks again, the more discussion about this topic the better.

tripawds.com May 9th, 2009 09:28:08 PM

Dr. K,

Great topic!

I still suspect, though it's far beyond proving, that Deramaxx played a part in my greyhound's rapid decline and ultimate death.

On the other hand, I am a huge fan of Adequan - I know many elderly dogs and horses of all ages who live full, happy lives because of it.

Also, while this is of course purely anectdotal - my own vet (not the one who rx'd Deramaxx!) prescribed a joint supplement for my older Border Collie mix that quite literally cured her lameness. My dog was hit by a car at one year old, and around age ten, was three-legged lame from the residual joint damage. Dr. Q got me to start her on Synovi g-3 chews and within a month Harley was on four legs again. More importantly, the repair has lasted - I haven't been able to keep her on the supplement consistently because of life/budget/etc, but she's remained sound on the leg ever since then. I give her the supplements as often as I can, and she stays pain-free and athletic and happy.

She'll be 13 in June, by the way.

I also credit weight management (she's on the thin side) and an active lifestyle - but the glucosamine and MSM get huge props from me!

Thanks, as always, for your informative and educational blog. Keep up the good work :)

StaceyV May 10th, 2009 12:11:01 AM

Barbara,

"A dog reluctant to climb stairs can just as easily have bladder pain or limb, joint, or back pain."

May I add "or Addison's disease. . ." My vet believed that my companion toy poodle had arthrites in his rear legs and prescribed METACAM. No warning, no possible side effects, no blood tests, NADA! METACAM. . .lethal. . .kills!

Asproolee's Story

Fotini May 10th, 2009 12:59:39 AM

Dr.Khuly,

Any experience with VetStem or any other company utilyzing an animal's own stem cells to help with arthritis? I know it's expensive, but if it works, it would beat having to constantly buy the expensive NSAIDS. There are testimonials, but not sure if I believe them.

Lynn May 10th, 2009 02:10:22 AM

If you're interested in the most up-to-date arthritis treatment, check out the equine literature, which is light-years ahead of human or small animal treatment. We've been using Adequan, Legend (IV HA), IA injections (HA + steroids), glucosamine, etc. for years, and have now progressed to stem cell therapy and are experimenting with gene therapy. Adequan is a terrific therapy--I'm surprised that it's taken so long to become popular with small animals, because I know a number of people who "borrow" their horses' prescriptions. Many sport horses begin Adequan when they're young, before they show signs of arthritis--normally we do a course of 7 injections, one every 4 days, twice a year, although some people also give it once or twice a month. Some people have had similar success using IM injections of cheaper substances like Chondroprotec, although that use is off-label and not backed by any clinical studies. With Legend, we usually give it 24-48 hours prior to each competition. The feeling of most equine sports medicine vets is that Adequan and Legend are so much more effective than the oral medications that you're better off spending your money on them (although recent studies have suggested that Cosequin + ASU shows some efficacy). Studies suggest that you need a minimum of 10 g glucosamine, 5 g chondroitin sulfate, 10 g MSM, and 50 mg HA/day if you deliver orally, and that can end up getting pretty expensive with no clear efficacy, whereas we know Adequan and Legend work. For more advanced cases, we inject HA plus a corticosteroid (usually depo-medrol or triamcinolone) into the affected joints every 4-6 months, or induce joint fusion surgically. More recently, we've been treating with stem cells derived from fat cells, IRAP (IL-1 receptor antagonist protein), or protein-rich plasma (PRP) for cases that have stopped responding to regular IA injections. Finally, there are several groups looking into incorporating IRAP into gene therapy--the main holdup with that is that the treatment doesn't last any longer than currently available treatments.

Sarah May 10th, 2009 03:37:24 AM

Someone mentioned shockwave therapy. We've used this for a while to treat soft tissue injuries in horses, and occasionally aim at an afflicted joint. Current consensus is that shockwave does NOT treat arthritis, but may provide temporary pain relief. Since international-level horses are required to compete under a No Foreign Substances rule, I know some people who will use shockwave  prior to a competition. However, we don't recommend it for regular use--if you're trying to avoid the normal, well-studied therapies, you're better off with something like acupuncture. Also look into heat therapy or magnetic blankets, both of which can provide some pain relief.

Sarah May 10th, 2009 03:45:34 AM

Gabapentin (Neurontin) has been used in human medicine with pretty good results for neuropathic pain for several years. Initially approved as an anticonvulsant (with variable results--most effective in partial seizures, also called petit-mal by some), it was used off-label for quite a while before it was finally approved for nerve-conduction related pain. It is now pretty much a mainstay by neurologists in treating chronic nerve pain.

I'm happy to see it being used in veterinary medicine because of my own personal experience. After a car accident in 2000, I developed chronic, excruciating left-sided headaches for which my PCP sent me to a neurologist. After CT, MRI, and MRA it was determined that I had developed an oculomotor nerve neuropathy from trauma to that side of my head. Many trials of different drugs followed (including several anticonvulsants) but the gabapentin was the one that finally gave me my normal life back. Though the dose was juggled for a while, to find a dose that worked with minimal side effects, once I got on a maintenance schedule, I have been pain-free for the past 6 years.

I also am somewhat resistant to long-term NSAID therapy due to the liver and kidney issues. I had a young GSD several years ago with joint issues (knee and shoulder) who was placed on Rimadyl. He quite rapidly developed jaundice, liver failure, and ultimately ended up being euthanized at the age of 3. I'm still willing to consider a short course if needed (after bloodwork, of course) but much interested in alternative therapy for long-term, chronic conditions such as OA.

Shellie May 10th, 2009 07:00:28 AM

Personally I'm just happy that there are drugs like NSAIDs available for my dog. She's got two bad knees, both repaired, but one still gives her a lot of grief. She takes glucosamine daily and I keep her trim and fit, and usually that's enough, but some days it's not and she gets a dose of Rimadyl. Or if we're planning on doing a lot, I'll give her a Rimadyl beforehand. Sometimes she's so bad she needs a tramadol as well, but mostly the Rimadyl will do it. She does well on it. She's never showed any side-effects, even when she was on it daily after surgery. She hasn't been required to get bloodwork as she's not on it regularly, but has had yearly bloodwork and there have been no changes. I figure she'll probably end up on it daily (or close to) when she gets older, and I'm ok with that, provided her bloodwork stays good.

Katie May 10th, 2009 10:06:02 AM

Excellent post.  We are using Cosequin with good results for my senior cat (12 yrs old).  If this wasn't working for his arthritis the vet wanted to prescribe Metacam or something similar.  Since his brother had a serious reaction to Metacam as a pain medication for cancer, I'm more than a little leary of using Metacam for him.  We tried Welactin, but he didn't like it.  Next time I'm in I will ask about Dasuquin for cats.

Raven's Mom May 10th, 2009 11:18:52 AM

@ Shellie: I took neurontin for nearly a year for neuropathy pain (and headaches similar to yours) and while it did wonders, I couldn't handle the twitching. I had to stop because the twitching became dangerous while driving. It wasn't just mild twitch, but like my arm would fly out or my leg would stomp on the gas pedal. However, as good as it worked, I'd not hesitate to use it on my dogs.

@ Dr Khuly: "But yes, I agree with those of you who caution not to under-treat pain. I'd rather have a dead pet than one in serious chronic pain. Rough words, I know, but that's how strongly I feel about pain." - to a point, I agree. I'd give them a few months pain free then let them go at the first sign of liver/kidney/whatever disease. This is, of course, after all other methods have been tried.

And good idea on the acupuncture! I'd forgotten about that. Our vet clinic offers that. No hydro-therapy in this area, however. I guess I could toss her in the river and pull her back out. (just kidding!)

PaulaO May 10th, 2009 01:00:37 PM

PJB: I don't want you to have to draw blood out of frustration. ;-) Tell me specifically what you're referring to when you're talking about our inadequate approach to pain relief.

Since this post is about chronic arthritis pain, these are the drugs and modalities we currently use. And it's the mainstay of human chronic OA pain, too. More heavy-duty opioids like oxycontin are too depressing and disorienting for long-term use in pets (and we can only use them in very big patients due to the dosing). Hydromorphone is always available but that's got its long-term issues, too, as you can imagine. It's generally reserved for severe pain in hospice settings or perioperatively. We do, however, use Fentanyl patches with great results. But that gets crazy expensive pretty quickly. And for long-term daily use, it has plenty of additional down-sides. Local nerve blocks and intra-articular injections are similarly available and are often employed (I love these), but they're not yet so common in small animal medicine. 

To my way of seeing things, veterinarians have lots in their arsenal for treating chronic pain and we don't approach it very differently from human docs. Their too-infrequent implementation is probably most of the problem. And that just depends on how aggressive/educated a veterinarian is about these issues.

Dr. Patty Khuly May 10th, 2009 01:07:43 PM

I wish I'd known about the 'other' non-NSAIDs you've mentioned.  My oldest sweetheart dog, who passed away 6 weeks ago, was on Zubrin for a bit more than a year.  While it did have a great good impact on her arthritis pain, and there was no kidney or liver damage (I had 6 month panels done), I didn't know that it could affect her heart as much as I believe it did.  She was slowing down (which made sense to me, as she was 14), but was eating, drinking, barking, tailwagging, and eliminating just as well as ever, so her decreased mobility being related to increased arthritis pain lead to increasing her dosage of Zubrin from 1 every 2-3 days to 1 daily.  In her last 3 months she sometimes appeared disoriented and her walking speed slowed down - a lot - but I didn't know that it was an issue with her heart.

The afternoon I came home to find her unresponsive and panting heavily, I tried rushing her to the vet, but she died in the car.  I insisted on an x-ray (thinking maybe she'd had a splenic tumor that had burst or something), and as I slid the film onto the lightbox, even I could see her heart was much bigger than it should have been.  My vet doesn't often tell people about side effects of NSAIDs, but after I'd refused Rimadyl and Derramax because of my knowledge of liver/kidney issues, he'd suggested the Zubrin because it was supposed to be less damaging on those organs, with a smaller likelihood of gastric bleeding.  Her blood tests were great, but I didn't know to also get a EKG and/or ultrsound (or at least baseline and 6 month x-rays) of her heart.

Now, my 11 yr. old Shep-Rottie, after a 'sleeping' x-ray of his hips showed deterioration/dysplasia, especially in the left joint, is taking Tramadol, which I've taken with good results for 10 years.  The vet said I could use the Zubrin (I've got 22 left), but I think I'll such up the $ lost, and ask about Adequan and the other things.  He's also getting Glyco-Flex 3 soft chews and milled flax seed (fish oil stinks and then so does his gas), but I wonder if the Dasuquin would be better/more economical?

(And I know that humans and dogs/cats react differently to NSAIDs, but after taking Excedrin - at one point, 8 a day for almost a year - I never had any gastric bleeding issues.  I've been almost completely off them for 2 years, and had a horrible neck nerve issue recently.  The doctor prescribed etodolac, and withing three days I was bleeding.  Not cool, and I certainly won't try it on my dogs, no matter what.  That was unpleasant.) 

KateH May 10th, 2009 03:46:09 PM

Shellie, Glad the Gaba works for you and I hope it keeps doing so.  It is what the neurologists are currently pushing, in lieu of all else it seems.  However, it doesn't work for many of us and it is new with a rather long list of potential, partially or completely incapacitating, side effects.

Dr. K, I'll try not to write a thesis.  Docs tend not to recognize pain in its early stages so see the relief in the patient as being pain free when it is only taking the edge off.  Yes, that's better but IMO not best.  Get the patient completely out of pain and then work backards until you see pain then back up just a touch.  Opiods like oxycodone don't work for all but do for some, even very long term, and should be at their ready disposal, especially for "rescue" situations.  (BTW, pain itself can be quite depressing and disorienting.  In addition, the early depression and disorientation on heavy drugs is often the body/brain "taking a break" now that it's not in pain.  If one has been in pain a long time, that could take a while but then the world clears again.)  Pain is a primary stressor and, when the body is focused on it, then the body gives up doing some of its other work, leading to overall deterioration.  There are many things that can't be treated or fixed but we know how to get rid of pain and intervention should be early and complete and ongoing.  Pain also contributes to weight issues as one in pain simply doesn't want to move because it hurts.  I think it's cruel to tell a patient to "work through it"; more cruel to expect that of a pet.  Besides that, why?  This type of pain is simply not the "good pain" of a normal body doing normal exercise as anyone with arthritis can tell you.

Oxycontin is supposed to last 12 hours but it doesn't in most patients.  It can last as little as 6 hours and doses should be adjusted accordingly.

One of the things I've personally experienced and I wonder if vets do this too.  If you give codeine, do you know what form it is, what else is in it?  For example, if I take codeine sulfate, it has zero effect; however, codeine phosphate works just fine.  Do you know exactly what the patient is or isn't reacting to?  Does the file say "codeine sulfate" or "codeine"?  Do you use colored pills?  If so, do you note the color ingredients?  I'm guessing pets are allergic to some of those just like humans.

All docs point to "long term" consequences.  And long term chronic pain doesn't have consequences?  There's a balancing act to be done but that's no excuse to exclude a tool from the box.  When my mother was lying in a hospital bed with less than 36 hours to live, her doc gave me a lecture on the long term consequences to the morphine she was receiving.  It is much too easy to go on auto pilot and spout what one learned in med/vet school than to think each situation through, each patient's needs considered.

"and we can only use them in very big patients due to the dosing"  Why?  Isn't that exactly what compounding pharmacists are for?  When my Shiba was having such severe allergies and asthma, I considered trying Singulair for her but it only came in (human) adult doses at the time.  However, a compounding pharmacist was readily able to formulate it and change the dosage for me.  Although Purdue no longer makes Oxycontin in less than a 10 mg, there are plenty of the generics of oxycodone in smaller dosages.  How about just good old fashioned morphine?

There are what, about a hundred?, different opiods alone plus the lesser drugs for pain treatment.  How many do vets know enough about to prescribe?  How much pain out there because they don't know?  Well, there's my extraordinarily short rant.  The long one really would be a thesis with a list of all the drugs I've researched.  Maybe I really should write it and post it somewhere.

PJBoosinger May 10th, 2009 04:05:42 PM

KateH, I take 20-24 Ibuprofen and 4 full strength aspirin a day, every day; have for the better part of a decade (excluding "drug holidays" so they don't lose effectiveness).  It kills my doc that I have no stomach issues, no kidney damage, etc., etc.  Doesn't do all that much for the pain but it takes the edge off and does keep my blood from being so thick it clots in my brain again (and they can actually take blood samples without have to suck it out with a large needle and syringe).  And it does beat the dickens out of arguing with docs influenced by drug company reps to the point they've become completely irrational on the subject due to their lack of knowledge.

I think there needs to ba a new profession that directly advises patients on drugs and interactions; like pharmacists used to do.

PJBoosinger May 10th, 2009 04:18:03 PM

PJB - I was just remarking onthe difference in dogs/cats versus humangastric bleeding issues, because Dr. K. had written "In the veterinary world we use plenty of these, too. But we can’t usually use the human versions as they tend to elicit extreme gastrointestinal problems in our dogs and major kidney and liver trouble in our cats. That’s why we’ve devised great new NSAIDs for pets that are far safer than the human kind.  Meloxicam (Metacam), etodolac (Etogesic), deracoxib (Derramax), and carprofen (Rimadyl) are some commonly prescribed NSAIDs in veterinary medicine."

While I am glad that etodolac is considered to safer for pets than 'human' NSAIDs, my personal experience with it was pretty disturbing.  Again, I realize there are differences in reactions (especially on an individual basis), but it was such a fast and noticable reaction in me (the gastric bleeding after 3 days of etodolac), after no such reaction after years of high dose Excedrin, that I just would be extremely leery of giving etodolac to my pets.  I was also given amytriptoline (in case the problem was more nerve-based, as opposed to inflammation), but that didn't do much, except give me the most horrible dry mouth.  I was glad my pain decreased, but it hasn't gone away completely, and I dread another flare-up, as while the etodolac made the pain decrease 90%, I don't want to get a bleeding ulcer instead.

KateH May 10th, 2009 05:00:06 PM

PJB & KateH: I think we are dreaming if we think true pain is going to be alleviated in companion animals for long-term chronic care.

As it is, you would be hard-pressed to obtain anything resembling a narcotic for more than a few days therapy. Even painful post-op pain of spinal disk disease (with my Pearl) was only a short acting fentanyl patch, then either a NASID or what she was on previously ---"prednisone". Her human counterpart was on heavy-duty narcotics for weeks---tapering down to NASIDS.

Hospice? Not too many clinics are addressing that either. The answer to that, is euthanasia, pure & simple.

Obviously, IMO, the reason being, that vets are concerned that these drugs will be diverted or used by the owner! Which is completely ridiculous in my mind, because most can be obtained for a fraction of the price thru their own health care provider (with of course, a legitimate diagnosis)

Barb A./NH May 10th, 2009 06:05:29 PM

On VetStem: I've heard good things directly from pet owners who swore by the treatments. But most surgeons out there still consider it "voodoo" medicine. Here's a past post on it.

Dr. Patty Khuly May 10th, 2009 06:58:32 PM

As a (retired)  medical doctor for people ,who DID deal with chronic pain patients,please avoid generalizations about ALL doctors, ALL vets,ALL cases of monkeypox. Yes,there are many MD's who don't know how to treat pain,don't take irt seiously and are scared to death of using narcotics and think it's better for people to live with disabling pain.

It is quite difficult to come up with any drug that is completely harmless,including OTC drugs,herbs,supplements etc.The KEY to success is having a vet like Dr Khuly who takes the time to explain pros and cons and precautions. Just handing a client a sheet of warnings is not enough. Every time I wrote a prescription , I was aware that this week's "must prescibe drug", eg estrogen could be next month's lawsuit . I also tried to saty away from new drugs but wvwn those out for years and "used widely in Europe" ( Is topped falling for that one) might be found to have serious side effects years later.

What galls me is when a USEFUL drug,used carefully,like Vioxx,is taken off the market. Why take this tool away from us?

Chemo therapy is pretty toxic too,but when used correctly and with patient education ...AND (hopefully) the patient's ability to make their own informed decision ,it can be life-saving.

Of course, if you,your family member or your pet YOUR dog is the one that has an idiosyncratic reaction to a drug,of course, you will never go near it again. Thank goodness for alternatives and adjunctive therapies ,and for medical and veterinary professionals that practice their craft carefully.

Lastly,it IS up to the consumer to be educated and ask questions. Always ask if there are other options and always ask if you should watch for anything in particular.. Even I made a mistake in that vein. There is a human drug called Ultram. It is non-narcotic pain med. My dogs have  used Tramadol for post op pain many times,and until the other day ,I just assumed the drugs were the same!

Marsha in VA May 10th, 2009 09:04:34 PM

My Shepherd-Chow mix of 85 lb. initially took Metacam at a low dose for about two years, subsequently needing higher doses accompanied by Tramadol before bedtime and Joint Support Plus daily.  This routine kept her pain-free from arthritis during that time period but eventually became ineffective.  She received Adequan injections as well but there was not noticeable improvement with that.

She also had advancing degenerative myelopathy so mobility became an issue.  Since the Metacam became ineffective, she was switched to a steroid, Azium 0.25 mg every day, recognizing she would be on this for life (started age 13 1/2), along with Tramadol 50 mg, up to three times a day.

The Azium helped greatly, though she had expected side effects of increased thirst and appetite.  However, Tramadol, even a half a tablet at her weight of 85 lb., made her so drowsy that she could hardly function.  Eventually, she declined and the Tramadol was recommended to be given two tablets three times a day, which I tried but it made her unable to walk at all.  Very difficult decision but she was euthanized five weeks ago, having turned 14 the day previous, due to advanced degenerative myelopathy which caused complete rear limb paralysis; she was unable to stand, her front legs were trembling, shivering, significant decline.  So very sad.  She was relatively healthy in a body that failed her from a disease that is so sad.

Though I know Metacam and other NSAIDS have risks, I am thankful that my vet prescribed it - I was made aware of what to look for, had the insert from the drug company and fortunately it kept my dog pain-free for a long time. 

Tramadol was great for bedtime; it helped my dog sleep through the night comfortably.  However, it was too sedating for daytime use, though I do believe this is not the norm. 

Having just discovered this site, I am "catching up" on previous posts and wanted to mention my vet came to my home and did the two-injection euthanasia.   Tore at my heartstrings to lose her, but it could not have been more peaceful and in death she looked the most comfortable as I had seen her in so long.  I am so grateful.

Deb May 10th, 2009 10:51:54 PM

Marsha in VA, you wrote "There is a human drug called Ultram. It is non-narcotic pain med. My dogs have used Tramadol for post op pain many times,and until the other day ,I just assumed the drugs were the same!"  I wonder if you meant to say that "...I just [realized] the drugs were the same" because Ultram and Tramadol are the same drug.

KateH May 10th, 2009 11:14:49 PM

 Tramadol = Ultram. http://www.drugs.com/ultram.html  IMO, barely souped up aspirin but about the best most vets will send home post op.

Marsha, why do you say "DID deal with chronic pain patients" rather than "treat"?  Why should patients ask questions rather than demand relief?

Barb, I'm past dreaming on this one and up to being quite demanding for my pets.  I've given up on human docs but still harboring some hope for vets.

PJBoosinger May 10th, 2009 11:57:44 PM

"be diverted or used by the owner! Which is completely ridiculous"  I agree.  Just FYI to the docs on here.  If any of us "want" drugs, they're far cheaper and more easily obtained through alternative sources.  We come to you for a reason but, if you don't take care of us...  I remember a story a while back about an attorney who suffered from chronic pain, was cut off by his docs from effective treatment, finally resorted to street drugs, arrested and serving a sentence for the street drugs but the kicker is that the jail doc had to treat his chronic pain (and using more potent drugs than his former docs OR what he was getting on the street).  Wouldn't it have been nice if some doc had just done that in the first place?

Jail docs not an option for my pets so I'll keep pushing the vets to properly treat their pain.  I've got my own zero tolerance position on any medical professional who chooses to leave a living creature in pain.  It was a doctor who first advised me to find some "alternative" sources for pain meds.  I've opted not to do that for myself but, if I'm ever arrested for illegal drugs, it will probably be for getting them for one of my critters.  I won't risk going to jail for me (mostly because that would leave my critters without a caretaker) but I'd risk it for them.

PJBoosinger May 11th, 2009 12:23:09 AM

Marsha: I'm right there with you on Vioxx. Obfuscations on the part of the drug manufacturer notwithstanding, this was an excellent drug no longer in our [human] arsenal because of the kind of knee-jerk reactions human beings are predisposed to. Every drug has the power to harm. Every supplement does, too. Foods are not exempt, either, as we all know. 

Careful decision-making is the answer. Transparency on the part of drug makers. And some degree of patient responsibility. Not yank-em-off-the-shelf reactionary behavior when a drug proves it can do more than what it says it's meant to. 

Dr. Patty Khuly May 11th, 2009 08:37:24 AM

excerpt from Physician's First Watch for May 11, 2009

"Older patients with moderate-to-severe pain are candidates for opioid therapy and should only "rarely" receive nonselective NSAIDs and COX-2 selective inhibitors, according to a revision of the American Geriatrics Society's pain management guidelines."

 Geriatrics Society Changes Its Pain Management Guidelines http://www.americangeriatrics.org/education/final_recommendations.pdf

Barbara A. Albright/NH May 11th, 2009 07:11:19 PM

The only reason I spent the time and money to take the IVAS acupuncture course was because the head of the anesthesiology department at Davis was a true believer. Since I've started using that in conjunction with some good multi-modal management like Dasuquin and Adequan I've managed to cut out a lot of NSAID use for my patients. I'm still a little bit amazed each time I see a new patient and how well they respond to it.

JV at pawcurious May 12th, 2009 12:27:29 AM

Can someone justify or explain to me why a vet (no longer used) would prescribe rimadyl after "routine" spays and or neuters? For puppies? For rescue dogs? I understand using it for chronic pain, but something that is so short term? Anybody?

I admit, I didn't feel comfortable giving rimadyl to a rescue dog - and usually didn't My problem has never been a dog that acted at all in pain after spay/neuter - but the ones that feel so good it is nearly impossible to keep them quiet for 7-10 days so the little critters heal up.

robinsdogs May 12th, 2009 02:58:58 PM

I noticed a comment on May 9th regarding a product called DGP.  I have used it with my Heinz 57, Alias, for years (along with Adequin) and it has been great.  BUT, finding something that worked -- without side effects -- was ultimately my responsibility!

I am a true believer in listening to what the doctor has to say but I refuse to become a "bobble head doll" -- I will not just sit there, nod my head up and down and do whatever they suggest.  It is my responsibility to research their suggestions and also look at alternatives including natural products.  That is how I came across DGP.  The Whole Dog Journal had an article about a trial conducted and the results.  AGAIN, my responsibility to do more research so I called the manufacturer (American BioSciences) to ask questions and I looked into the ingredients.  Based on my own research I decided to try it and it has worked wonders.  BUT, here is the KEY...it is up to you to decide.  I know it is hard and time consuming but it is necessary!  There are LOTS of informational sources out there -- use them!

Stacey May 12th, 2009 04:56:34 PM

My Bulldog took Rimadyl for most of her life with no ill effects. She had her first two orthopedic surgeries before her first birthday. I fail to understand why a useful drug like Rimadyl is demonized, especially for short term use and for moderate to severe post-op pain. Rimadyl is, as has repeatedly been stated here, an NSAID. It's pharmaceutical name is carprofen. It was originally developed for humans. Humans use NSAIDs in appropriate doses all the time for short term, moderate pain, and NSAIDs are freely sold over the counter. So why, if my dog is suffering from short-term pain, would I want to put him on an opiate? Assuming he is healthy and normal and the vet keeps me informed, this seems entirely appropriate to me.

A few months ago my dog bruised his chest or his ribs pulling on his soft harness. I took him to the E-vet, where they said he was fine, but he clearly was still sore. I gave him rimadyl I had in the house. It helped. I was happy I had it.

Many dogs -- and it varies by breed -- are stoic and do not show that they are in pain until they are suffering terribly. Just because surgery is "routine" does not mean there is no post-surgical pain. Just because they aren't crying, does that mean they should be allowed to suffer?

Dogs are individuals. Metacam made my Bulldog bleed. Other people praised it as a wonder drug. I'm glad my two current dogs are healthy enough that they do not currently need any long term medication. But if I see that one is in pain, and I can't get a vet appointment within a couple of hours, I will not hesitate to give a proper dosage of Rimadyl (unless it is a gastrointestinal problem, of course).

Susan Rosenau May 12th, 2009 08:48:01 PM

Acupuncture, homeopathy, diet, and specific massage can help a lot of arthritis patients, too. And meds like Pepcid can be given with NSAIDS to reduce some of the side-effects. A lot depends on the dog owners budget, time, understanding, and willingness to work with healers for their pet. Also, remember that the earlier pain problems are treated, the better the results.

K Levin DVM May 13th, 2009 12:40:49 AM

Stacey,

Thank God for the Internet!  In any event, what would you have done without it?  Unless one has a personal BAD experience, she/he will depend on what the doctor or the vet prescribes, diagnoses, and gives prognoses bc everyone trusts them.  After all, they are the experts, the professionals who attended medical or veterinary schools.  If I, the layperson, were to do their job, I might as well be my own doctor or vet (which I do now simply because I have had a terrible and heartbreaking experience with my companion animal). 

Asproolee's Story

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i use them as sparingly as possible. most of the therapy is physio and restricted activity and diet. acupunctue and homeo is not recommended. also meds should be purchased at a local hospital.

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