Cartrophen.

RE: Cartrophen.

Chris Milligan — Sat, 14 Jan 2017 17:18:22 GMT

[quote user="Michael Woodhouse"]Do we know what the sensitivity and specificity is of ultrasound to rule in or out a HSA? Allowing for the fact these are going to be done by mostly GP vets without a special interest in ultrasonography often with less than ideal machines. [/quote]

Can't find any specific literature on sensitivity and specificity but identification of splenic masses on ultrasound is very straightforward and that should prompt a biopsy.

I've come to the conclusion that basic ultrasound assessment of the critical abdomen (AFAST + assessment of spleen and liver for gross masses) is now a basic skill we should be expecting of all vets - there's little excuse save for lack of postgraduate motivation for not knowing how to do this and the information gained is extremely useful.

What do you mean by ideal machines? A nice picture doesn't mean you have better diagnostic ability - you should see the stuff human sonographers were able to diagnose even back in the 80's.

RE: Cartrophen.

Chris Milligan — Sat, 14 Jan 2017 17:07:33 GMT

[quote]Something in excess of 20 years of using it in my practice is a fairly good clinical trial in my opinion!

[/quote]

This is a fairly bad clinical trial! We have a long way to go to catch up with our human counterparts.

RE: Cartrophen.

Rob Davis — Thu, 12 Jan 2017 17:08:44 GMT

[quote user="Aine Seavers"]I blame the 39C day cooking my Irish brain[/quote]

If only..... I'd swap for our current 3C and drizzle happily!

RE: Cartrophen.

Aine Seavers — Thu, 12 Jan 2017 10:31:53 GMT

I did, I blame the 39C day cooking my Irish brain.Glad we are on the same page now, whew!

RE: Cartrophen.

Martin Atkinson — Thu, 12 Jan 2017 09:22:21 GMT

[quote user="Aine Seavers"]Then Martin, we will have to agree to disagree on this one.[/quote]Did you not spot the wicked and wink emojis? Does being Irish and living in Australia deprive you of your ability to spot sarcasm? Have you not read my preceding posts? Do you not know that I am in a campaign to restrict the practice of homeopathy in Britain? Am I the one who's being slow and missed a double bluff devil's advocate post?

I have huge respect for you and your opinions Aine, our experiences with Cartrophen are similar.

RE: Cartrophen.

Aine Seavers — Wed, 11 Jan 2017 22:14:04 GMT

So would that be the highest level these non S4 authorised non-carthrophen medications would get? Bit of a contrast to the authorised medication data sheet of carthrophen. many tx,I rest my case.

RE: Cartrophen.

Beats — Wed, 11 Jan 2017 22:02:22 GMT

[quote user="Aine Seavers"] I am not sure what the registration in uk re medications now is but there is a difference bn a registered medication here like carthrophen and a homeopathic med.Here carthrophen is a registered S4 (POM) medication, same cant be said about any homeopathic med I have been shown but stand to be corrected on that if there is such a thing as a POM homeopathic med. [/quote]

In the UK if something is an authorised veterinary medicine then you can be sure it will do exactly what it says and is super-duper effective. Forget cartrophen and all those nasty contraindications and opt for something safer yet also uber-effective and licensed for arthritis such as:

https://www.vmd.defra.gov.uk/ProductInformationDatabase/SPC_Documents/SPC_139167.DOC

RE: Cartrophen.

Aine Seavers — Wed, 11 Jan 2017 21:48:22 GMT

Then Martin, we will have to agree to disagree on this one. I have zero time for homeopathy. I do however observe my patients very well and my own animals cynically and I do find improvements that allow me to continue to use this medication with a clear conscience. It seems very vetsurgeon list to call everything anyone disbelieves in as ''must be homeopathy". I could say thinking Tramadol works in dogs is homeopathy which is the last thing anyone using it would feel themselves to be a believer in/of. We need to move pass this concept of there being - it is homepathy if something doesnt work for me or , it isnt homeopathy if it does" and that way more knowledge gets shared both tacit and text sourced. I am not sure what the registration in uk re medications now is but there is a difference bn a registered medication here like carthrophen and a homeopathic med.Here carthrophen is a registered S4 (POM) medication, same cant be said about any homeopathic med I have been shown but stand to be corrected on that if there is such a thing as a POM homeopathic med.

RE: Cartrophen.

Martin Atkinson — Wed, 11 Jan 2017 14:19:25 GMT

Sorry Aine but you're deluded its all caregiver placebo effect, its no better than homeopathy.

RE: Cartrophen.

Aine Seavers — Wed, 11 Jan 2017 06:23:09 GMT

have used it since 1996, must be in the many 1000s of injections by now and that would be the norm for most Australian vets experiences -Our 5 splenic tumours in that time since had not been on the drug-4 were related GSD and a Berneses Mt Dog.We stick to 2 days before and 2 days of NSAIDs clearance. we dont give with vaccines. significant improvement with injection, none of the oral versions seemed to work. About 10% failure rate with injection. We give one a week for 4 weeks, one a month for 4 months and one every 3-4mths thereafter as the dog dictates. The protocol came out in the 1990s here, no longer have the reference but found it to work superbly in the 20yrs so we have stuck with it given how the dogs responded (as opposed to very poor responses to Tramadol esp when there is such doubt about tramadol). We go through bottles of the stuff. Makes the owners watch the dog's wt as they are charged on wt each time and only for the injection-no consult charged unless the client asks anything -then its a consult. keeps the price down and affordable, increases client compliance and interaction with the clinic and its been a wonderful asset to arthritis case as part of a full program re wt, diet etc. There is interesting work on its effect on glycosaminoglycan layer hence its use in bladder conditions but now more broadly where there are manifestations of degenerative cartilage disease with reduced concentrations of glycosaminolglycan , glycoprotein and chondroitin sulphate in the hyaline cartilage of tracheal rings in tracheal ring collapse and myoxmatous valvular disease should we consider these conditions other indications for carthrophen use?

RE: Cartrophen.

Rob Loxley — Tue, 10 Jan 2017 20:22:42 GMT

[quote user="Anthony Dennison"]

[quote user="mariette asselbergs"]but the moment you see a bulge in a spleen I would say you need to back off carthrophen and/or operate.[/quote]

How about an FNA rather than straight to operating?

[/quote]

How good is FNA for focal (rather than diffuse) splenic disease?

RE: Cartrophen.

Anthony Dennison — Tue, 10 Jan 2017 12:55:20 GMT

[quote user="mariette asselbergs"]Michael I think you underestimate the popularity of ultrasound in first opinion practice and the skills of SA GPs. Checking out a spleen is not difficult, it is one of the first things you learn on a course.[/quote]

[quote user="Michael Woodhouse"]Benign splenic pathology is massively common. My concern is you are going to find a high rate of false positives for neoplasia in asymptomatic dogs.[/quote]

I agree with both of you, but Michael makes a good point about false positive rates.

[quote user="mariette asselbergs"]I don't know about the sensitivity and specificity of excluding[/quote]

There is the 'two-thirds rule' when it comes to splenic masses (two-thirds of splenic masses are neoplastic, two-thirds of the neoplastic masses are haemangiosarcomas), think I read it on here somewhere, so that would come in to play.

[quote user="mariette asselbergs"]but the moment you see a bulge in a spleen I would say you need to back off carthrophen and/or operate.[/quote]

How about an FNA rather than straight to operating? Guess the risk of seeding is high, and if it is something benign like a haematoma there is still a high risk of a bleed somewhere down the line.

RE: Cartrophen.

Michael Woodhouse — Tue, 10 Jan 2017 11:04:55 GMT

Benign splenic pathology is massively common. My concern is you are going to find a high rate of false positives for neoplasia in asymptomatic dogs. This needs careful consideration when looking at any kind of screening programme. You can put a lot of people through extensive cost and worry because we are seemingly inventing best practice by gold plating things.

I'm not knocking you personally, but I think we need to be very careful with such a blanket recommendation based on a best guess.

RE: Cartrophen.

mariette asselbergs — Tue, 10 Jan 2017 10:50:46 GMT

Michael I think you underestimate the popularity of ultrasound in first opinion practice and the skills of SA GPs. Checking out a spleen is not difficult, it is one of the first things you learn on a course. I don't know about the sensitivity and specificity of excluding, but the moment you see a bulge in a spleen I would say you need to back off carthrophen and/or operate. At least inform the owner and let them choose.

Mariette

RE: Cartrophen.

Iain Richards — Tue, 10 Jan 2017 10:45:16 GMT

Good thread. I looked at cartrophen when it first came out for use in some search and rescue dogs. As others have said the whole NSAID interaction is a coagulopathy - but, it's in vitro as far as I'm aware.

I love the "is this snake oil?" question. As others, my observation is improvement between 2 and 3, based on owner report. Own observation, first dog would refuse to jump a particular stile about 6 months post course, then clear it within a week of the "booster". No other changes, so an odds ratio of greater than one, but no control and only one case. To make the owner's observations correct, they'd need a comment from a friend (blinded observer).

First dog also died from splenic bleed with liver mets (more likely all secondaries to heart base) so perhaps the cartophen caused that....

I don't use it much now as metacam is good long term and the clients have to buy the whole bottle!

RE: Cartrophen.

Hannah Wynne Richards — Tue, 10 Jan 2017 09:50:08 GMT

Mariette. We're back to the maximum quality, or maximum length of life argument.

Wynne

RE: Cartrophen.

Michael Woodhouse — Tue, 10 Jan 2017 01:21:38 GMT

[quote user="mariette asselbergs"]Exactly, so should we be more careful to use carthrophen in haemangiosarcoma prone dogs like older GSDs etc without offering at least an abdominal ultrasound to assess the spleen?[/quote]

Do we know what the sensitivity and specificity is of ultrasound to rule in or out a HSA? Allowing for the fact these are going to be done by mostly GP vets without a special interest in ultrasonography often with less than ideal machines. In a drug with a pretty satisfactory safety record:

https://www.ncbi.nlm.nih.gov/pubmed/12779171

Does the manufacturer of cartrophen not have any data used to get the product to market? We have 1 dog in the practice who would have been PTS without the product, conventional NSAIDs did very little. They come in for the 4 week booster on Saturday mornings so I occasionally see them. When I did more smallies I never gave it much credit, but some dogs it did seem to anecdotally help.

That said I used to get owners to reduce NSAID dose and more recent evidence suggests that's not a good idea:

https://bestbetsforvets.org/bet/335

RE: Cartrophen.

mariette asselbergs — Mon, 09 Jan 2017 21:32:36 GMT

[quote user="Robin Grimmer"]

From the datasheet:

Do not use in dogs with blood disorders, coagulation disorders, bleeding or malignancy (especially haemangiosarcoma). Pentosan polysulfate has an anticoagulant effect.

[/quote]

Exactly, so should we be more careful to use carthrophen in haemangiosarcoma prone dogs like older GSDs etc without offering at least an abdominal ultrasound to assess the spleen?

Mariette

RE: Cartrophen.

Robin Grimmer — Mon, 09 Jan 2017 17:18:48 GMT

From the datasheet:

Do not use in dogs with blood disorders, coagulation disorders, bleeding or malignancy (especially haemangiosarcoma). Pentosan polysulfate has an anticoagulant effect.

RE: Cartrophen.

Martin Atkinson — Mon, 09 Jan 2017 14:18:26 GMT

[quote user="robloxley"]

[quote user="mariette asselbergs"]from heart base tumour. Just coincidence? Could carthophen have had an influence? Sadly put to sleep, no other option[/quote]

I think the heart base and splenic tumors were just waiting to bleed. You might have more luck linking the dog's exercise to the onset of the bleed, though I'm not sure I'd suggest not taking 9yo GSDs for walks

[/quote]+1. This is why I would not put anything on Cartrophen, any more than I would on long term NSAID, without a full clinical examination and if concerned a blood profile - dogs with OA are nearly always older patients which are likely to have co-morbities. Cartrophen can also exacerbate existing renal disease and has in one of my patients but it was reversible.

RE: Cartrophen.

Rob Loxley — Sun, 08 Jan 2017 10:20:09 GMT

[quote user="mariette asselbergs"]from heart base tumour. Just coincidence? Could carthophen have had an influence? Sadly put to sleep, no other option[/quote]

RE: Cartrophen.

Hannah Wynne Richards — Sun, 08 Jan 2017 10:16:04 GMT

I doubt if cartrophen caused the tumours. Splenic tumours in GSDs are common. It may have contributed to the bleeding, but, again these tumours do tend to bleed.

Wynne

RE: Cartrophen.

mariette asselbergs — Sat, 07 Jan 2017 19:25:12 GMT

Interesting, not though of carthrophen for years since we don't use it in the emergency clinic. Then got a 9 year old GSD in, had regular carthrophen, last was lasrt week, and was now put on tramadol, then keeled over on his walk, owner thought it was the tramadol. Brought in white as a sheet, in shock, I could notv feel femoral pulses or hear the heart at all, ultrasiound showed moderate abdominal bleed of splenic tumour and massive pericardial and pleural bleed from heart base tumour. Just coincidence? Could carthophen have had an influence? Sadly put to sleep, no other option.

Mariette

RE: Cartrophen.

Rob Loxley — Sat, 07 Jan 2017 17:18:53 GMT

[quote user="Rob Davis"]it amused me to see him employing a favourite homeopath argument to justify his use of cartrophen....[/quote]

A critical appraisal of Martin's experience might be that it is a non-blinded, non-controlled (versus placebo or, say, NSAID), subjectively-appraised (by someone who has a financial interest in the success of the intervention being studied, and by a pet owner who has invested in the intervention) case series at best.
That's not to say that good research evidence couldn't come out of in-practice study data, but you have to be able to critically appraise such data

One of my main issues with neutraceuticals for arthritis is that by using such drugs we are often not using NSAIDs for our patients, which have well proven efficacy and safety.

RE: Cartrophen.

Martin Atkinson — Sat, 07 Jan 2017 10:04:25 GMT

[quote user="Rob Davis"]So say the homeopaths.[/quote]I know hope that was tongue in cheek Rob but at least Cartrophen has an active ingredient in it whether it works or not.