>
>Bodhi is over 10 years old now.
>He's also got arthritis in his elbows. They are just about fused solid.
>He's bright and cheerful, showing no signs of losing his interest in the
>world, but he's slowing down a lot. Stairs have been out for 6 months or
>more. Recently the arthritis has gotten bad enough that even a carpeted
>ramp has become a challenge. I've gotten used to his small sounds of
>pain when he gets up, but hearing them when he tries to come up the ramp
>or raise his front legs high enough to get through the dog doors is
>enough to drive me to search for more options.
>
>He is on a glucosamine-chondroitin supplement. He also gets cosequin.
>He's on a low bulk feed and his weight is under control (slight padding
>over ribs, but getting a bit bony).
good. the best thing for dogs with arthritis is to keep them skinny.
There
>seems to be anecdotal evidence of some breeds being more susceptible to
>the bad side effects of Rimadyl, so I want to check in here to see if
>there's any information that's BMD-specific.
see below.
>Last week Bodhi was at the vet and we did a blood panel. His lever
>enzymes are at 170, up from 140 9 months ago. The vet says that she
>starts to believe she's seeing a clear indication of a problem when it
>hits 200, twice the normal level.
depends on the enzyme; there are usually 3-4 values on the chemistry screen
than indicate liver function. some are more liver specific than others.
>
>I am considering the following: 1) Put him on 100 mg twice a day with
>food. 2) Continue for two weeks under close observation for all the side
>effects of Rimadyl. Stop immediately and get another blood panel if
>anything suspicious occurs. 3) If he shows clear improvement at the end
>of two weeks and he's tolerating the drug well then continue, else try
>something else. 4) If continuing, try reducing dosage and combining with
>cosequin to see what minimum dosage provides adequate relief. Get
>regular blood work to keep an eye on liver enzyme levels (vet will do a
>"short panel" to just check the liver issues for reduced cost).
that sounds extremely prudent and reasonable. side effects include vomiting
and diarrhea, and jaundice. I say jaundice because there was a report of 16
or so labrador retrievers who developed acute hepatic necrosis that may be
associated with them taking rimadyl. which raises the question: are labs more
sensitive? or are there just more labs in the world that have arthritis and
are thus put on rimadyl and so we see this adverse effect most prominently in
these guys. i think the jury's still out, although i haven't heard of reports
in other breeds.
you should also know that there is a new drug on the market called Deramaxx
(deracoxib) which is similar to vioxx and celebrex on the human market. it is
being marketed by novartis for perioperative pain, however based on uses in
humans, one might surmise that this could be another option for Bodhi or other
dogs with chronic arthritis pain. It's new, so we don't know of any adverse
effects of chronic use yet (the studies showed some GI problems, similar in
incidence to rimadyl and etogesic) but i thought i should mention it's
available, and in general i'm pretty excited about the possibilities because
it seems to be quite effective for pain control. i wouldn't use it in dogs
with renal insufficiency.
there are other medications that can be tried, usually in combination with
non-steroidal drugs (rimadyl, aspirin) that also don't have long histories of
use in dogs, but may be helpful in the future for dogs with refractory
arthritis pain.
>So, questions: 1) Is a two week trial long enough? 2) Opinions on
>likelihood of damage in a two week trial? How bad? Reversible? 3) If it
>seems to be working out, how often should blood work be repeated? Once a
>month? More often? Less OK?
1. yes. think of it as aspirin. some folks dose it like aspirin, instead of
a straight two times daily regime, they give it when they think their dog
needs it, or if they're going out on a long walk etc.
2. potentially. again, the liver damage hasn't been reported in berners, but
i think it was obvious relatively soon after starting the drug. potentially
reversible.
3. one month out, then every 3-6 months, sooner if you're worried or seeing
signs.
obviously, if you think your dog has a adverse reaction to rimadyl, the first
thing is to stop the drug and then run them by your vet. There are a number
of dogs who just experience some stomach upset with any drug, and so there may
be transient vomiting or diarrhea with the first two doses, but this should
resolve.
hope this helps,
...ben
Benjamin M. Brainard VMD
Resident, Anesthesia/Emergency/Critical Care
Veterinary Hospital of the University of Pennsylvania
3900 Delancy St.
Phila, PA 19104
(215) 573-7779
