Long term use of painkillers [in dogs]

Family, Education, Health and Pets
1
Would be grateful for views and experience on the long term use of painkillers in dogs. Calling Mellancollie and Mrs Doolittle for starters.

Bella is now 13 and feeling her age a bit. She collapsed about 5 weeks ago and we thought initially it was her heart but after being seen by the cardiology team in Zurich that has been counted out. The conclusion was that she collapsed through pain from her back. Ashamed that I missed it .

She has been having acupuncture for a number of years, for stiffness and pain in her lower back, with the regularity getting closer, every 5 weeks at the moment. We have been giving her Metacam daily since the collapse, a lower dose than her weight would show on the advice of our vet and have had to resort to the Phen-Pred tablets instead twice over the last 2 weeks, each time for a couple of days.

We are assured that it is OK for her to have the drugs long term but I would value your experience of such use, what about her kidneys etc.?

I might worrying too much but she is very good at hiding pain. The first we knew of a bladder infection at Christmas was frank blood being pee'd on the day we were due to travel to the UK, needless to say we stayed home.

Oh and why might she be eating earth? she is scraping off the grass and eating the earth beneath.

Over to you and thanks in advance.

2
Life expectancy? At some point, long term side effects of medication become less important than pain management and 'quality of life' issues.

Do you trust your vet?

3
I know how worrying all this is. Yes, there is the potential for side effects in long term use of some of the pain medications. We cannot advise here, as only your vet knows your dog's history and prognosis. But perhaps our experiences might be of value as you are evaluating your options.

This exactly - I fully believe that quality of life trumps everything else, most especially when a dog has reached the senior years.

My very, very wise vet has a saying: "We treat the dog, not just the disease." And primary to 'treating the whole dog' is consideration of quality of life.

It's important to understand potential side effects, potential long term effects, of all medicines one gives one's dog, and to do what one can to mitigate them - but one must also balance those against the dog's day to day QoL.

Let's face it - if the dog is in pain to the point where he cannot enjoy life, whatever is happening with his liver is no longer relevant.

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While on pain meds, it may be advisable to monitor organ function. (Usually a blood panel will paint a clear enough picture to see trends.)

For instance, when each of my dogs was on put on a NSAID we monitored his liver values. First we did a base panel before starting, then one month later for a control, then at three months, then six - if we saw a problem come up, we went back to more frequent monitoring. When we saw worrying liver values, we took what steps we could to support his liver.

Dosage, how often the drug is given - these might be variables to play with. Some of my oldies got pain meds daily, some every other day or at a longer interval, some only on an 'as needed' basis. We tried to find the best regime for the individual, prioritizing pain control but keeping reduction of side effects in mind as well.

There may be supportive therapies to help mitigate long term effects. Some vets like to use SAMe, some milk thistle, to support liver function when using a NSAID - this is a discussion for your vet.

Some pain therapies might be better tolerated than others in individuals, or show better results than others - the key is to find what works best for your dog.

Among the NSAIDS, Psychocollie had good results with Rimadyl, but it caused Melon stomach upset. Melon tolerated Metacam well, though. Haifisch didn't improve on Metacam, but he did better on Onsior. Onsior didn't seem to help the Belltie, but Previcox does. A bit of trial and error is usually needed to see what is best for your dog.

Or, there may be delivery methods for particular problems that are less prone to long term issues.

For instance, the Belltie has chronic bronchitis and needs to take a steroid daily to try to reduce the inflammation, in order to keep his airways open. But long term systemic steriod use can cause organ damage. So rather than a systemic, he gets the steroid as an inhalant (Axotide) - the drug goes directly to his bronchia and lungs, targeting the diseased organ. There is little residue that makes it into his other organs.

But even if I had to resort to systemic steroid treatment I would do so, as his primary condition is respiratory. If his airways become inflammed to where he cannot breathe, it's all over anyway. So in his case - lungs/bronchia trump liver and kidneys.

When a dog is facing multiple conditions it is a good idea to have a frank discussion with your vet as to your goals and options if treatment of one condition might affect a secondary condition.

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Some dogs do well with accupuncture as a supportive therapy, either in place of or in addition to other measures.

There is a new-ish arthritis treatment, Anarthron (Cartrophen in other countries), a course of injections, that is not a NSAID - you might also discuss this with your vet as a possible option. Here's a thread on the subject:

Cartrophen for Dogs...

I had the Belltie on Anarthron for some time, as this was the safest option given that he also was on a steroid. But his arthritis has progressed to the point where we needed to do something more, hence the Previcox.

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(Alert readers will note that I am using a daily steroid and an occasional NSAID with the Belltie. Usually concurrent use of steroids and NSAIDs is contraindicated - but again getting back to the QoL issue, we treat the dog, not just the internal organs. We minimize the risk of organ damage by using an inhalant rather than a systemic, and we only use the Previcox on an 'as needed' basis. But when he needs a pain killer he gets one - I will not allow an elderly dog to suffer. My vet and I have discussed this at length, and I understand the ramifications.)

These are the kinds of discussions one needs to have with one's vet. There is no one size fits all - a pain management program needs to be tailored to your dog's individual needs.

Key to keeping our elderly dogs happy is a good partnership with your vet. Is your vet open to discussion, to exploration?

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As said, I know how worrying this is. Paws crossed, thumbs pressed that you can find a good pain management program, and that you and your doglet have many more good times ahead.

4
I'm so sorry about your dog, and I hope you and the doctors can find a way to ease all of its pain safely.

Eating earth... that does seem really strange. My first thought was an iron deficiency, since I've heard of people craving dirt when they have severe anemia. So then I Googled "dog iron deficiency" and, sure enough, I guess dogs, too, can have iron deficiencies, especially if they've lost blood. Of course, I have no idea if this is why your dog is eating dirt -- could just be a weird side-effect of the pain meds. But it sounds like something you should definitely talk to your doctor about.

Warm wishes...

5
Re: Eating dirt

There could be either a physical reason - that is, the dog might be seeking some nutritional element currently lacking, the dog might be seeking to calm stomach irritation, etc - or there could be a behavioral reason.

This needs to be discussed with your vet in the first instance, even if only to rule out medical grounds.

If the dog is seeking something lacking in his diet, this could be something so simple as changing foods. But it could also point to a malabsorption issue. Either way, your vet can best advise.

If your dog is eating dirt due to an upset stomach, this needs further veterinary exploration, especially in light of the meds she is on.

It will be helpful if you can pinpoint when the behavior started, and whether there is any correlation to her meds. (Length of time on the meds, change in meds. When does this happen - time of day, relation to meals/meds. How often does this happen, etc.)

Even if after examination it is decided that eating dirt is behavioral, this too could be a sign of pain. Dogs often resort to compulsive behaviors as a distraction from pain.

But if all that is ruled out - a program of behavior modification would be the next step.

Always seek veterinary counsel first.

Poor pup - really hoping you and your vet can find a solution.

6
Thank you all. We have already had "the" chat with our vet who I do trust implicitly, he knows we only do what is good and right for Bella and when the time comes he may have to remind us of that fact if we are emotionally unable to make the decision our selves.

Rimadyl is not good for her hence Metacam, and she is due another blood test when we return home at the end of the month. The earth eating started the last time we were here in France, early July so just before her collapse, she has access to a garden here which she doesn't have at home and the resident moles are being helpful in pushing up plenty at the moment

She is half Labrador so we initially put it down to that thinking she was eating p** as she does others and anything else she can find. I was suspecting a mineral or vitamin deficiency so will discuss with our vet when we get back.

Thank you again, my mind is a little more settled and we take each day as it comes and give thanks every day we all wake up in the morning. I don't even mind the snoring now, from Bella that is, at least I know she is breathing.

7
I will share with you what our vet said to us recently (our dogs are 13, 11 and 9). Referring mainly to the eldest dog, she said that "at this age, each day is a gift."

Not much more I can add here as MC, our resident expert, has said it all, in her usual eloquent fashion. Except that our dogs eat grass when their stomachs are upset, this seems to cause them to puke and they feel better afterwards. But it is just grass, not dirt. Occasionally one dog will dig in the dirt if there is something very interesting under it. (once she found a bone buried in the garden.)

Our eldest dog is almost 14, and she is taking Karsivan. She had back surgery a few years ago, and her problem now is the one of back legs is weak, so she is a bit wobbly. But she is not in pain. Karsivan is supposed to improve the circulation and improve the quality of life. (I have been wondering if humans can take it. )

Our youngest dog, who is almost 10, has severe arthritis in one of her back legs. The vet has prescribed Cosequin capsules but this dog has such a sensitive stomach that we are not sure if this is the right treatment. Arthri dog might then be an option.

I think you have to trust you vet and your own instincts. Last week I met someone who has a dog going on 19!