# NSAIDS-when to consider



## Nancy Jocoy (Apr 19, 2006)

My 9 year old went in today to have a tumor removed from her leg and dental x-rays for a possible cracked tooth (it was ok)

Anyway she has severe HD but actually does not seem to be bothered (she spins in the morning until I throw the ball, she chases the ball with speed and agility, and seems very active and bright and still wants to play when I end the game) -She cannot, however, jump very high and I don't ask her to jump at all. Her front musculature is starting to build to take more of the weight (You know how old dogs get heavier shoulder muscles)

I know when I go in to get her today the vet will be pushing those NSAIDS again (and her bloodwork is all good) but I am still hesitant because I know they reduce pain and inflammation but also impair healing.

If she was stiff or limping I would not hesitate but at what point do you decided to give them? She is getting a good fish oil and glucosamine MSM.

I bought a bottle of Dermaxx when she was first diagnosed in 2003 and they all went bad on us (well they got out of date and kind of funky looking so I quit using them.out of that bottle she maybe had a total of 20 pills)...

I am glad to give them to her if it will make her senior time *better* but I don't want to accelerate her joint degredation.


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## Connie Sutherland (Mar 27, 2006)

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"I know when I go in to get her today the vet will be pushing those NSAIDS again (and her bloodwork is all good) but I am still hesitant because I know they reduce pain and inflammation but also impair healing."_


I completely get it why you hesitate (and also why they can be such a magic bullet; I have a senior with HD/OA who is on Deramaxx, which allows him good quality of life). It sounds like the vet and you are on the same page about pre-protocol blood work (and, I'm sure, regular re-testing during). But I would ask for a discussion. Is the vet more concerned about post-surgical pain, or chronic OA pain, or inflammation? How long s/he is thinking that NSAIDs may be needed? If the concern is post-surgical pain, is Tramadol also something the vet would recommend? 


http://www.2ndchance.info/pain.htm

http://www.caberfeidh.com/Pain3.htm


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## Maren Bell Jones (Jun 7, 2006)

I had not heard they impede healing, so this is something I found in the human literature:

http://www.jfponline.com/pdf/6001/6001JFP_ClinInq1.pdf

But we do know now that pain itself decreases healing time, which is why it is no longer good advice to not give animals pain medications after surgery "so they won't move around as much." Even in sheep and goats in doing something like a castration, I use local blocks as well as general anesthesia plus an NSAID if indicated.

I like using fish oil and a good joint supplement, but there usually comes a time that NSAID use becomes necessary when it gets bad enough. When they start losing muscle mass as you describe, that would be a time I'd start them on NSAIDs. I'd do a trial for 10 days and see how he does. There are other pain meds besides NSAIDs your vet can prescribe as an adjunct or instead of NSAIDs. These include drugs like tramadol, gabapentin, and amantadine that can all be used together and they are not very expensive. For a joint supplement, I really prefer Dasuquin to some of the other stuff that's out there since it's the only veterinary product that has shown to be effective in the peer reviewed literature. There's also Adequan injections that you can do at home (some owners are comfortable giving subcutaneous injections, some aren't) as well as hyaluronic acid injections right into the hip joint that your vet will have to do. Good luck...

Edit: forgot to add...I don't personally have a "favorite" NSAID one way or the other. I have had some dogs do really well with some and not on others and then other dogs have the opposite experience. I have seen side effects on just about all of them as well. I usually try large dogs (40+ lbs dogs) on meloxicam first since it's the least expensive (it's a $4 prescription if you don't mind dealing with Walmart pharmacy, haha). Then if we have to go to a different one, we can. For smaller dogs, the human sized dosing tablets are way too big, so we have to use a veterinary specific product for them. So human meloxicam is about the only time that it pays to have a large dog for prescriptions.


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## Nancy Jocoy (Apr 19, 2006)

We are definitely giving metacam for the next 10 days. Not sure why she did not give tramadol. 

I had planned to check into adquan. I am confortable giving injections. I used to work at a vet school and did a lot of anesthesia and blood gases. (and I also had a job where I had to inject mice in the tail vein and not hit the nerve)

Human meloxicam = doggie metacam? She weighs 51lbs.


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## leslie cassian (Jun 3, 2007)

I started my old RottiX on metacam when it seemed like she had trouble getting up from lying down. Nothing major, she just seemed a little stiff and was a little off on one front leg. Didn't seem to do much for her, so after a couple of weeks, I took her off the meds. She got cranky and didn't settle as well - lying down and then getting up and grumbling off to lie down somewhere else. I put her back on the meds. It never made the limp go away, but clearly she was more comfortable.

With my severely dysplastic Labx, he suddenly seemed really uncomfortable one day - to the point of not wanting to do anything more than pee and go back to the car, instead of going for a walk like usual. Two weeks of Tramadol and Metacam and one day he just seemed to feel better and wanted to go for a walk again. I started to taper him off the Tramadol, but never stopped the metacam. He was only eight, and I wanted to hold off as long as I could before starting him on long term meds, but I had no choice. I kept him on metacam because it seemed to make him feel better, though I had hoped he wouldn't need it on a daily basis until he was older. He didn't make it to his ninth birthday before the pain from his hips caught up to him and the drugs stopped working.

I struggle with this for myself. NSAIDS make me feel a lot better, but I know there are side effects and I question whether I want to start taking them daily now, or try to hold off as long as I can.

I worry about the downward cycle I saw in my old rotti... as she did less and less activity, her muscle mass decreased and she was capable of less and less. In the end, I figured a more comfortable existence on metacam was worth the price of the possible side effects, but that's just my personal take on it.


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## Gina Pasieka (Apr 25, 2010)

I do agree with Maren. If you are noticing that she is changing muscle mass because of altering how she is bearing weight, it may be worth trying a course of metacam. The fish oils are a great add and it would not hurt to try the Adequan other than the expense. Another important thing to remember is to avoid the weekend warrior syndrome. Mild to moderate activity is great to keep her joints lubricated and moving well, however intermittent intensive exercise is going to result in more significant pain 24 hours later.


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## Maren Bell Jones (Jun 7, 2006)

I like tramadol because about the only major side effect is sedation. It's a very good add on an NSAID or by itself. A downside is that it doesn't do a ton for some dogs (or people). It is also not an anti-inflammatory either. With NSAIDs and really any pain medication, it's best to hit it earlier rather than later and target multiple spots on the pain pathway via different drug classes (NSAIDs, steroids, opoids, and so on all can have their place). Also, "holistic" treatments like acupuncture, nutritional support, massage, laser, and so on need to likewise get started sooner than later. As I said recently on another thread, I really would like to see working/performance people being more proactive with their dogs in the 5-8 year range instead of letting them coast into the 10-15 year range and the results may be less than ideal. I want them as comfortable and working as long as possible. Hmmm...I feel the need to do a blog post on this.


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## Nancy Jocoy (Apr 19, 2006)

I will further explore the metacam with the veterinarian, particularly if given a less expensive option. I take good care of my pets (and Cyra gets short sessions of ball play twice a day and is active-and showing no visible signs of discomfort and this is a dog who is vocal when she does hurt)

I think like many I am willing to do what is reasonable but some vets expect us to pull out all the stops with infinitely deep pockets, and striking a balance between what is reasonable and what is overkill can be hard. 

I don't want my dog to suffer but when we start talking thousands of dollars I will be looking at the green needle. So I want to know is that really the reality or is it really all that bad? I am not a cheapskate but having spent about $4000 on vet care for my dogs this past year, but I also don't intend to go into debt for veterinary care and much more will put me at that point.

ust yesterday she suggested I look at capping all her worn down teeth....I don't have thousands of dollars to put into a dogs mouth.... You know if the dogs teeth are hurting would she still be carrying stuff in her mouth all the time and chewing on things?


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## Maren Bell Jones (Jun 7, 2006)

That's understandable. My very first client as a house call vet actually called me a few weeks before I officially opened because her elderly dog was not doing well. She was on the fence about euthanasia and to be honest, it would not have been a poor choice as the dog appeared to have multiple problems and she had no money for any further diagnostics. She could barely afford the exam and the house call and could not afford the euthanasia right then. She said she wanted to wait and think about it as she had a little money coming in a few weeks. I said I was not comfortable leaving the dog in considerable discomfort from arthritis and what I suspect was bone cancer for a few weeks, so I said I'd write her a $4 prescription for meloxicam until she had enough for euthanasia, in which she'd call me in a week or two to schedule it. Fast forward three whole months later, she calls me yesterday and said the dog had been doing much better on the meloxicam and a diet change (I got her to switch off Kibble n Bits), but it was finally time. So we're euthanizing tomorrow at home. Do I wish we could have tried a few more things? Yes, but at least she got an extra 3 months with her dog who was more comfortable than the dog would have been otherwise.

I guess that's one reason one of my special interests is in end of life care. They may not need to be euthanized the exact same day that the poor diagnosis comes, but most owners want to see their pet pretty comfortable, able to sleep at night, and have a good appetite for their last few days or weeks until they get things in order, so there's a few things we can do. Something to keep in mind though is we are ethically obligated (IMO) to offer the best medical plan as we are the advocates for the patient, not the owner's pocketbook. That doesn't mean the gold standard plan A is going to always be feasible, but it should always be offered. If that's not possible, then there are always options (euthanasia being one of them). I've had numerous clients that mentally thought that euthanasia was simply not EVER on the table (which was distressing to me seeing their animal not doing well with a poor prognosis). It's a hard balance. I just don't want someone to take a very sick animal home to die without any palliative care that might have simply cost as much as a couple coffees from Starbucks. :???:

On the teeth thing, I always recommend to working dog people when they have dogs that use their mouths to go see a specialist if possible. Dogs hide pain tremendously well, even though dental pain is one of the worst out there. My old Rottie had a slab fracture on her upper left fourth premolar (the big one) which didn't seem to bother her (always the classic phrase) since she was still eating fine. But when I got her teeth cleaned last winter, pus actually came out around the gums while we were inspecting it







under anesthesia and the dental radiographs looked really bad. So I know it was likely causing a lot of pain even though it didn't look too bad from the surface, so that had to come out.


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