scrotal hernia in a lamb

Re: scrotal hernia in a lamb

james herriot lied — Thu, 09 Apr 2015 22:40:19 GMT

Sorry about the delay - been busy.

Blimey, that must have taken ages. If it's google Top Trumps we're playing, then how about:

http://www.ncbi.nlm.nih.gov/pubmed/12817781

"The treatment of calves with a combination of oxytetracycline and meloxicam (Group I) and especially with oxytetracycline and flunixin meglumine (Group II) caused a significantly faster, in comparison to the control group, normalization of body temperature."

Or even:

http://onlinelibrary.wiley.com/doi/10.1111/evj.12224/abstract

"Blinded pain score evaluation showed that more horses receiving meloxicam showed gross signs of pain than those treated with FM (P = 0.04)"

These are from the first page of Google, which speaks volumes on how easy it is to 'prove' a point - any point. However, what's really interesting about both of the above references is that both are from independent research (or, at least, there aren't clearly stated author interests within resources that I'm able to check). This is important, because:

[quote user="Michael Woodhouse"]

Carprofen provided better analgesia than flunixin here:

http://www.ncbi.nlm.nih.gov/pubmed/17359309

[/quote]

This is about mulesing. Hardly edifying, but it is at least by CSIRO, which is a public scientific body. Which takes over 30% of its funding from private industry. But that's ok, because it's aiming for 40%, and in order to gain more industry funding, it probably wouldn't have to compromise its scientific impartiality at all <sarcasm alert>

As a digression, but still taking your points in order:

[quote user="james herriot lied"]half-life is increased without noticeable decrease in pain relief through using a s/c or i/m route.[/quote]

It should be obvious by now that I can back this one up. Intramuscular or subcutaneous flunixin have significantly longer half-lives than flunixin by the intravenous route.

Moving on:

[quote user="Michael Woodhouse"]

[quote user="james herriot lied"]Second, what it isn't is an indiscretion, minor or otherwise: it's a reasoned approach based on published research, experience and peer opinions[/quote]

I agree to a point. Personal experience and that of peers remains the weakest form of evidence. When you look at the published evidence there is very little in support of your preposition.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Comparison+of+carprofen+and+flunixin+meglumine+as+adjunctive+therapy+in+bovine+respiratory+disease.

"a single dose of carprofen was equally effective as three daily doses of flunixin meglumine"

[/quote]

This research was conducted by Grampian Pharmaceuticals Ltd, a now-defunct company which manufactured - wait for it - zenecarp.

[quote user="Michael Woodhouse"]

http://www.ncbi.nlm.nih.gov/pubmed/15298058

"It is concluded that a single subcutaneous dose of meloxicam was as clinically effective as up to 3 consecutive daily intravenous doses of flunixin meglumine"

[/quote]

Boehringer. They make a brand of meloxicam called Metacam.

To go back to a point you made above, when we open ourselves to EBVM - a no-brainer - we need to resist the temptation to throw the baby out with the bathwater: anecdotal evidence isn't necessarily the weakest form of evidence. It has the potential to be weak, and often is, but it can also be extremely useful, informative and guiding. We are professionals, and our experiences should speak volumes. Otherwise, we're bound to follow the contents of a slip of paper inserted into the packaging, rather than our own observations. Sometimes these bits of paper can be immensely useful - look at the strides we've made in monitoring hyperthyroidism in cats, enforced through the data sheet recommendations. But sometimes these restrictions - placed entirely by commercial outfits which have an entirely vested interest in selling and which are protected from us by the VMD - can be quite damaging; if you want expansion on this, or the problems inherent in buying into drug company research, then I'd suggest reading Bad Pharma by Ben Goldacre.

It's this point that's worth discussing: how can we objectively include our clinical observations into our decision-making process and still retain protection from the VMD and its cascade system? You and I disagreeing on where to put the needle with flunixin is small potatoes in relation to the potential misinformation from selectively-declared pharmaceutical company research.

Re: scrotal hernia in a lamb

Michael Woodhouse — Wed, 08 Apr 2015 01:04:21 GMT

[quote user="james herriot lied"]For one, yes I can justify the use of flunixin - it's a better anti-endotoxic and analgesic[/quote]

My understanding was the 'anti-endotoxic' effect wasn't really true - the drug just masks some of the effects. If you look at people with endotoxamia they don't use NSAIDs - they use more steroids.

http://www.ncbi.nlm.nih.gov/pubmed/8239142 (flunixin versus ketoprofen)

"Each NSAID modified the response to LPS, but none was clearly superior to the others in modulating the clinical signs or physiologic alterations induced by infusion of LPS in neonatal calves"

Better analgesic isn't really supported (example directly related to the OP):

http://www.ncbi.nlm.nih.gov/pubmed/22524300

Carprofen provided better analgesia than flunixin here:

http://www.ncbi.nlm.nih.gov/pubmed/17359309

[quote user="james herriot lied"]half-life is increased without noticeable decrease in pain relief through using a s/c or i/m route.[/quote]

Hexasol LA's datasheet says (after IM use):

"to provide initial antiinflammatory activity for 24-36 hours"

Flunixin can be repeated every 24 hours up to 5 times.

hardly a big difference in duration of action.

[quote user="james herriot lied"]Second, what it isn't is an indiscretion, minor or otherwise: it's a reasoned approach based on published research, experience and peer opinions[/quote]

I agree to a point. Personal experience and that of peers remains the weakest form of evidence. When you look at the published evidence there is very little in support of your preposition.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Comparison+of+carprofen+and+flunixin+meglumine+as+adjunctive+therapy+in+bovine+respiratory+disease.

"a single dose of carprofen was equally effective as three daily doses of flunixin meglumine"

http://www.ncbi.nlm.nih.gov/pubmed/15298058

"It is concluded that a single subcutaneous dose of meloxicam was as clinically effective as up to 3 consecutive daily intravenous doses of flunixin meglumine"

Re: scrotal hernia in a lamb

Hannah Wynne Richards — Tue, 07 Apr 2015 19:27:00 GMT

Fair enough. I'm obviously a bit old-fashioned, as I regarded "Don't give flunixin unless you're absolutely sure it's not a surgical, in case it disguises symptoms" as 1 of the 10 Commandments.

Wynne

Re: scrotal hernia in a lamb

Wren — Tue, 07 Apr 2015 19:17:21 GMT

[quote user="Hannah Wynne Richards"]

I've got nothing against giving it (together with xylazine ) for transport, but how does that 3/4 hour delay affect the outcome of colic surgery? Genuine question, I'm not trying to be awkward.

Wynne

[/quote]

The delay when I'm waiting to see whether or not it responds to the flunixin?

I don't think it does. If, on first rectal I can feel a large colon torsion, or distended SI, or similar, it gets referred straight off. If I'm not sure (eg. HR 60, but NAD rectal) then it would rarely be referred on those findings anyway. So it either gets referred in an hour if there is no response, or in 3-4hrs if it responds initially then subsequently deteriorates. I don't think in either scenario that I am delaying the horse reaching the table, as it wouldn't have gone there on the strength of the initial exam anyway.

Re: scrotal hernia in a lamb

james herriot lied — Tue, 07 Apr 2015 18:18:25 GMT

T[quote user="Michael Woodhouse"]

The cascade doesn't allow me to use flunixin because it is cheaper. I have to be able to clinically justify the use to prevent unnecessary suffering. I honestly can't over the other NSAIDs. I suspect hand on heart you can't either. It maybe sounds like a 'minor' indiscretion but its a slippery slope.

[/quote]

For one, yes I can justify the use of flunixin - it's a better anti-endotoxic and analgesic and half-life is increased without noticeable decrease in pain relief through using a s/c or i/m route.

Second, what it isn't is an indiscretion, minor or otherwise: it's a reasoned approach based on published research, experience and peer opinions.

Re: scrotal hernia in a lamb

Hannah Wynne Richards — Tue, 07 Apr 2015 18:03:53 GMT

We desperately need much much higher farm gate prices.

Wynne

Re: scrotal hernia in a lamb

Michael Woodhouse — Tue, 07 Apr 2015 17:26:12 GMT

[quote user="james herriot lied"]

Do you dispense Resflor?

[/quote]

Yep. And Hexasol, but they are licensed for the IM route. Flunixin is even licensed IM in pigs. IV only in cattle.I know it works - that fact is not in doubt.

If I want an IM NSAID then we have Ketofen. If I want to go sub cut we have meloxicam and carprofen products.

I even use Hexasol routinely after lambing sheep as I believe I can justify that under the cascade (wanting long acting antibiotic and NSAID).

Re: scrotal hernia in a lamb

james herriot lied — Tue, 07 Apr 2015 17:19:42 GMT

Do you dispense Resflor?

Re: scrotal hernia in a lamb

Hannah Wynne Richards — Tue, 07 Apr 2015 17:09:32 GMT

I've got nothing against giving it (together with xylazine ) for transport, but how does that 3/4 hour delay affect the outcome of colic surgery? Genuine question, I'm not trying to be awkward.

Wynne

Re: scrotal hernia in a lamb

Michael Woodhouse — Tue, 07 Apr 2015 17:00:08 GMT

[quote user="james herriot lied"]

[quote user="Michael Woodhouse"]

JHL - would you dispense a bottle of Flunixin to a farmer?

[/quote]

There are a couple, yes.

[/quote]

This is my absolute frustration with the cascade. We flatly don't because we can't come up with a clinical justification for doing so and believe it is 'illegal' under the cascade. In the same way we don't dispense 1000's of Oxytet tablets for watery mouth prevention in lambs and force people to use Spectam instead. This is the unlevel playing-field I talk about in the cascade thread - farmers talk at the auction mart and neighbouring farms vet lets them have the cheap painkiller or yellow pills and can't understand why I won't give them. It reflects badly on us all.

This is why I think we need rigid enforcement of the cascade or complete abandonment. We go to a lot of trouble to do things 'right' whether we always agree with the rules or not. Frustrating.

Re: scrotal hernia in a lamb

james herriot lied — Tue, 07 Apr 2015 16:53:31 GMT

[quote user="Michael Woodhouse"]

JHL - would you dispense a bottle of Flunixin to a farmer?

[/quote]

There are a couple, yes.

Re: scrotal hernia in a lamb

james herriot lied — Tue, 07 Apr 2015 16:52:33 GMT

[quote user="Wren"]

[/quote]

Ditto, although as we live over 150 miles from the nearest useful colic surgeon, referral isn't an option in the vast majority of cases anyway.

But I also love a bit of torb, as an adjunct.

Re: scrotal hernia in a lamb

Michael Woodhouse — Tue, 07 Apr 2015 16:49:09 GMT

JHL - would you dispense a bottle of Flunixin to a farmer?

Re: scrotal hernia in a lamb

james herriot lied — Tue, 07 Apr 2015 16:47:18 GMT

[quote user="Michael Woodhouse"]

[quote user="james herriot lied"]Flunixin in the muscle is a great option in calves. The cascade can whistle.[/quote]

We used to hand out a lit of flunixin to farmers who had been using it since the Finadyne days, but we no longer do so. I know perfectly well it works (Hexasol anyone?) but it's not licensed and I won't use it that way. I'm not sure how the hell I can expect farmers to follow route of administration instructions if we can't as vets.

[/quote]

Now I know you're being disingenuous. We can expect farmers to follow advice on route of administration (not, I confess, a major concern with our clients) because of things like this, not in spite of it. We have knowledge, understanding and experience which allow us to give differentiated advice and farmers respect this more than a 'my hands are tied by the bit of paper that comes with the bottle, plus I might get into trouble with the pencil necks'.

Re: scrotal hernia in a lamb

Michael Woodhouse — Tue, 07 Apr 2015 16:30:17 GMT

[quote user="Wren"]I firmly believe that a) flunixin is pretty much the best analgesic for use in colic and therefore what we should be giving as a painkiller, and b) that we are good enough diagnosticians to detect a deterioration in clinical parameters even after it has been administered.[/quote]

I'm glad you said it, because otherwise I was going too! For transporting colics for surgery or further treatment I will always give flunixin and sometimes a little xylazine - it is not fair on the horse transporting it in agony.

Re: scrotal hernia in a lamb

Wren — Tue, 07 Apr 2015 16:21:09 GMT

[quote user="Hannah Wynne Richards"]

It's so good for visceral pain in horses that it's actually contra-indicated unless you're 100% certain that it's merely a medical and not a surgical colic.

Wynne

[/quote]

I'm giong to dispute this! It was a commonly held viewpoint 15 years ago when I graduated, but I think we know far more about the diagnosis and treatment options now than we did then.

Whilst I believe flunixin is a great painkiller for colic, I don't believe it works miracles. I often use it as a diagnostic tool, along with hyoscine, in the abscence of definitive rectal findings indicating a surgical cause. I give it to pretty much every colic I see. Most horses will look an awful lot better an hour after flunixin. Those that don't get referred (not necessarily for surgery, but for further investigation, medical and fluid therapy). Some look hugely better, then get worse again, often around the 3-4hr mark. Those also get referred. I do not believe in flunixin completely masking a surgical colic. It is a good drug, but not perfect. I have used it routinely (several times a week) for many years and if they're going to get worse, you'll still see it. And despite the dire warnings given at vet school I have yet to find a surgeon who is even mildly disgruntled that the horse has been given flunixin before admission. So long as they know, they're happy.

I firmly believe that a) flunixin is pretty much the best analgesic for use in colic and therefore what we should be giving as a painkiller, and b) that we are good enough diagnosticians to detect a deterioration in clinical parameters even after it has been administered.

Re: scrotal hernia in a lamb

Hannah Wynne Richards — Tue, 07 Apr 2015 09:18:36 GMT

My large animal knowledge is a bit hazy by now, but I think the usefulness of flunixin in cases of E coli nastitis isn't just anti-inflammatory/analgesic, but also anti-toxic.

Wynne

Re: scrotal hernia in a lamb

Hannah Wynne Richards — Tue, 07 Apr 2015 09:02:40 GMT

It's so good for visceral pain in horses that it's actually contra-indicated unless you're 100% certain that it's merely a medical and not a surgical colic.

Wynne

Re: scrotal hernia in a lamb

Michael Woodhouse — Mon, 06 Apr 2015 22:18:11 GMT

[quote user="james herriot lied"]Flunixin in the muscle is a great option in calves. The cascade can whistle.[/quote]

[quote user="John Flynn"]I'm not arguing against it, but i do reckon that there's a modern tendency to over-estimate the analgesic effects of an NSAID for something like this?[/quote]

Do you do any large animal work? Give a colicing horse 10ml of flunixin IV and then tell me its not a great painkiller.

Re: scrotal hernia in a lamb

John Flynn — Mon, 06 Apr 2015 19:47:09 GMT

[quote user="Sammy82"]Back to the original topic, for this wee lamb a shot of metacam does not cost that much, so why not use it? [/quote]

I'm not arguing against it, but i do reckon that there's a modern tendency to over-estimate the analgesic effects of an NSAID for something like this?

Potential adverse effects in a young lamb? I'm not sure they'd put me off if just "reduced kidney function" or something clinically irrelevant to a short-lived lamb, but if gi ulceration was a significant risk i'd think a bit more about it,..

Re: scrotal hernia in a lamb

james herriot lied — Mon, 06 Apr 2015 19:29:11 GMT

[quote user="Michael Woodhouse"]

[quote user="james herriot lied"]Flunixin £22 a bottle from the same place, at about 4ml/100kg[/quote]

Maybe so, but I'm not injecting them all IV and it is only licensed by that route.

[/quote]

Get on, I'm not sure your poker face can withstand the strain.

That was all to do with guff about meat blemishes in the States - it works very well in the muscle and, I feel, has a longer effect.

Meloxicam is a superb drug and I use it wall-to-wall in small animals as a first-line NSAID; the preferential Cox-2 inhibition really makes a difference in long term use. But it's way too expensive in cattle. As I say, we use it routinely in high-cost procedures like DAs and caesars, probably because the price doesn't stand out, but much less in other situations and I still prefer flunixin in E Colis; flunixin definitely gives better pain relief, albeit of less duration, and I prefer it personally for minor procedures with an expected shorter duration of inflammation. For larger ops, where inflammation and pain are likely to be extended, the pharmacology of meloxicam makes it a better choice overall.

I remember flunixin coming out, as a student, and it was a WONDER drug. (Do many people, on the other hand, remember stegentox?).

Flunixin in the muscle is a great option in calves. The cascade can whistle.

As an aside to those who just instinctively feel that local into the scrotum is automatically a better option, I'd ask: would you do it to a dog? Why not? It may just be that there are better, more humane ways to manage the situation in calves, too. And anybody else who wishes to propagate lazy and unfair stereotypes about farm vets will get equally short shrift: that kind of nonsense went out with the ark and such comments fall short of our expected professional conduct.

Peace and love all round.

Re: scrotal hernia in a lamb

Sammy82 — Mon, 06 Apr 2015 12:22:36 GMT

[quote user="Michael Woodhouse"]

I'd be amazed if any practice policy specifically said NOT to use post operative analgesia.

The biggest barrier is cost.

I don't routinely use NASIDs for dehorning or castrating, but I will always recommend its use. If they leave it up to me then they get it. I recommend the use with calf dehorning during HHP reviews, BUT there is a very poor uptake.

With the farm side if you add an obligatory £10/calf for analgesia then that could be the final straw that makes them decide to do them themselves next year.

£77/bottle Metacam from Farmacy. 2.5ml/100kg. If you do a batch of 50 250kg calves then that is £240 of NSAID. That would be more than the professional fee and more than double the cost of the procedure. We are a bit more expensive than that for the drug anyway....

[/quote]

Of course no written practice prototol (if there even is one) stops the use of anaestesia or analgesia. It's how it has always be done and maybe "practice culture" might be a better word for it. As you have pointed out Michael, the prohibitive factor is cost and losing the work or even the client over it is not in our interest. You said you offer analgesia and the uptake is low. So even though your (and my) personal choice is to give it, most calves don't get any. So in the end it is costs vs. welfare.

Back to the original topic, for this wee lamb a shot of metacam does not cost that much, so why not use it?

Re: scrotal hernia in a lamb

Hannah Wynne Richards — Mon, 06 Apr 2015 10:30:53 GMT

As I keep saying, we desperately need farm gate prices to be multiplied by at least 5 in order to get acceptable standards of animalwelfare.

Wynne

Re: scrotal hernia in a lamb

Anthony Todd — Mon, 06 Apr 2015 10:11:55 GMT

[quote user="Michael Woodhouse"]there is the danger of anthropomorphising too greatly and overusing products[/quote]

Sure, and I can't say there seemed to be any sign of post-op pain in routine desexing of dogs and cats after GA, depending on the surgeon though......

Scrotal hernias in lambs seems like a different case, numbers are small, post op pain with rings guaranteed for some time, and an easy and cheapish solution.

Re: scrotal hernia in a lamb

Michael Woodhouse — Mon, 06 Apr 2015 00:53:33 GMT

[quote user="james herriot lied"]Flunixin £22 a bottle from the same place, at about 4ml/100kg[/quote]

Maybe so, but I'm not injecting them all IV and it is only licensed by that route. Our old friend the cascade rears its ugly head. I can see no clinical justification for going off licence when there are other NSAIDs licensed to go under the skin or into the muscle.

[quote user="james herriot lied"]I'm yet to be convinced of metacam's duration in ruminants as well[/quote]

Agreed. The data they have seems to be based on half life rather than anything else. They word their data-sheet with bugger all claims for duration of activity. Clinically I see an effect for 2 days

[quote user="james herriot lied"] I think flunixin is better for initial inhibition of the inflammatory cascade.[/quote]

Possibly if you are giving it IV? Over time I am coming to the conclusion that there is little to chose between the products. I always used flunixin for 'endotoxaemic' cows, but I've used meloxicam and had similar results.

I carry a meloxicam, a carprofen and a flunixin and use them interchangeably! It gets more complicated when I need to inject a horse or pig etc.