Deramax question

[diane allen]

AK doc: Do you feel like you're being abused here, for all the free advice you're asked for?! (We surely do appreciate it - we certainly all have our own vets, but sometimes they're pressed for time, and we don't get all our questions asked and/or answered in the office!) Anyone else with experience or knowledge is welcome to reply too!

 

This is NOT a border collie question - but my 9+ year old, otherwise very healthy, German Malamutant mix (you get the picture?!) had an intermittent limp, diagnosed (x-ray) as tendonitis this winter; basic blood work was done, with no indications of any liver or kidney problem; his orthoped recommended 3 weeks of regular Deramax, some rest, some gradually working back up, etc..

 

He seems fine now, but the vet said I might consider giving him Deramax a day before any known "extra" activity (an extra long hike, snow play, agility runs). So - he's NOT on a continuing dosage, only on "special" occasions.

 

I recently read something indicating a larger than normal incidence of bleeding ulcers and other abdominal problems seemingly related to the drug. I've also done a Google search for deracoxib, and read lots of articles...but none seem to really address the long-term effects...maybe because its so new?!

 

I'm inclined to not use it for some slightly elevated activity, and see what happens. I just hate using drugs that might alleviate an immediate problem, but cause much more severe long-term problems.

 

Any input, ideas, thoughts?

diane

[Betsy]

I'm not AK Doc Doc (or even close!) but I have used Deramaxx. Riley had OCD surgery a year ago May 1. He was on Deramaxx for 4 months leading up to the surgery and about a week afterwards. He was fine.

 

But that was before the recent results of internal bleeding / ulcers that you have heard about. One of the volunteers with our local BC rescue is a vet tech at a local Emergency Vet clinic here. She recently told us she has been seeing a LOT of dogs come in with the internal bleeding / ulcers that are (or were recently) on Deramaxx. Some of them haven't made it.

 

Personally, if I had to go through the OCD stuff again, I would stay away from the Deramaxx. I believe it is a very new drug and the after-affects are just now seeming to come to light. It wouldn't be worth it to lose your dog over it!

 

Perhaps AK Dog Doc could suggest an alternative?

 

Betsy

[AK dog doc]

Hi gang

I'll be a bit limited in answering Deramaxx Q's since I've never used it; we don't carry it at our clinic, so I can't even go in and read the drug insert. So I'll answer based on principles of analgesia and physiology and hope that'll do. The short answer to the question is that intermittent use has a lower potential for side effects IN GENERAL than more sustained use. Now to the mechanisms, which might make this make more sense. Sorry if TMI.

 

It's easier to prevent pain from rising above the pain threshold than it is to push it back down below that threshold once it's already broken loose. Studies in humans have shown that (in non-addicted persons, presumably) if the patient is allowed to control their pain medication by means of a voluntarily activated medication pump, they actually use LESS medication than if they're given meds on a set schedule. Beacuse they use the meds when they *begin* to feel painful instead of having to wait until the pain is in full sway, they supress it before it gets very far, which takes less medication than hammering it back into the box after it has already escaped. What your vet is suggesting is that you do the same for your dog - a pre-emptive strike. He can't anticipate his pain, but YOU can, and if you pre-medicate, he'll have better pain control than if you post-medicate.

 

This is not something we can ask dogs about, but 1) we can extrapolate from human data, and 2) studies that use restlessness, heart rate, respiratory rate and blood pressure as indicies of pain in postsurgical animals show that better analgesia is obtained by pre-medicating than post-medicating with the same amount of medication. So, for humane reasons, for healing reasons (dogs heal faster if they're not painful) and also for reasons of using the least amount of medication to control the signs, premedication is a good idea.

 

The one caveat is that you use good sense about the amount of work you allow the animal to do while medicated. He won't be so aware of his pain and if his pain is keepng him from re-injuring himself, you can worsen an injury by masking his limitations from himself. So it is YOUR job to make sure that doesn't happen. I'd be cautious therefore in using this technique with an animal still recovering from an injury - medicate to control pain, by all means, but don't go work the animal while he's on meds. You probably already know this, but I have to say it so I know I didn't mislead you about it.

 

Chronic pain or situations where re-injury is not the issue (as in arthritis, where the problem is the changes already in the joint, which are not going to go away short of surgery) is a different story. That's an appropriate time to use this technique - you're not talking about doping the dog so he can't feel his pain and then competing him in a trial, you're talking about "I want to take my dog out on his favorite hike but I know he'll be sore afterward, so I'll give meds before we go." Or, I'm working my eight year old sheepdog on the farm, I know we have an extra-long day ahead of us, and I know she'll be sore tonight after the extra hours, so I'll give the medications before we go the extra miles. That sort of thing.

 

As far as gastric ulceration, the way that works is that there are some substances, prostaglandins (PGs), that are involved in different functions in the body. Some are pro-inflammatory (will produce inflammation and the accompanying pain), some are gastric-protective. What you want ideally is a pain killer that spares the gastric-protective ones (so the stomach is protected) and only inhibits the pro-inflammatory ones (which promote pain). Some analgesics inhibit both, so you have some risk of ulceration. Other analgesics are partially sparing of the "good" PGs and mainly inhibit the "bad" PGs, and some are pure inhibitors of one or the other. The more you spare the good ones and inhibit the bad ones, the more likely you are to have good pain control without dinging up the stomach. Different pain killers have different abilities this way. That's only part of the potential for toxicity, though; there's also the liver and kidneys to consider, since they may be affected in metabolising the drugs. Since I don't use Deramaxx, I have no idea what the potential side effects in that regard are.

 

As a GENERAL thing, the metabolism (liver/kidney) side effects are minimal if the medication is used intermittently. A sensitive animal can stil have a problem, but in my expereince, they're more likely to have a gastric problem with this type of use than to have a liver or kidney problem - not to say that either couldn't happen. However, they also have problems if you don't control pain, and dogs can and DO ulcerate just on stress alone - and pain causes stress. So there are very good reasons to use pain control.

 

I feel like this little dissertation is starting to get away from me - I'm a bit punchy tonight, having been up late every night since Iditarod started - so I hope this made sense and wasn't completely out in left field about the explanations. Ping me if it is and I'll try to neaten it up a bit.

 

As for feeling abused about being the free advice person - well, whose fault is it now, if I log on? Until someone starts pointing a gun at my head, I'd say it's pretty much my own doing, so no one to "blame" but myself! But I AM going to bed now...

[jrid]

Whenever any of my dogs have to be on medication for pain or inflammation, I always try to give them a Pepcid or Zantac at the same time to keep their stomach from getting irritated.

 

When I gave Deramaxx to an old dog, he lost his balance and could not even lift his leg to urinate without falling down. When trying to come to you he would weave all over the place. After I discontinued giving him the drug he regained his balance.

[juliepoudrier]

What about Metacam as an alternative? I've used only in a very limited sense, as I tend to be very conservative about painkillers/antiinflammatories (mainly because I don't want them feeling so good that they exacerbate an injury while on the meds), but it has worked wll the few times I've used it. I don't think it's widely used in the US, so problems could arise I suppose, but it is used in Europe....

 

J.

[Tassie]

You could check Australian sites for Metacam effects. It seems to be the pain control drug of first choice here in Oz over the last few years. My two had it as post-op prophylactic pain control when they were de-sexed year before last. And it was the first choice for my previous old bitch to help with arthritis - although we did end up going to Rimadyl as the Metacam didn't seem to be helping enough after a while.

 

BTW thanks for that explanation of the mechanisms AK Dog Doc.

[AK dog doc]

You're welcome, and thanks for you patience in reading it all!

 

I like Metacam, and will switch to it from Rimadyl if the patient has trouble or insufficient pain control on Rimadyl. But as Tassie points out, sometimes you end up switching the other way - every dog is different. I certainly have had many patients on Rimadyl as well, and even some on aspirin, though it has more drawbacks. Some dogs seem to do fine on any of them. OTOH, we have dogs the owner has given a single dose of Ibuprofin (DON'T do this!) and it dies of massive GI hemmorhage the next day. Others get five doses and have no ill effects, by some miracle. This is why medicine is never boring...