NSAID blood testing

Re: NSAID blood testing

Hannah Wynne Richards — Sun, 28 Jun 2009 15:22:43 GMT

Iuse a lot of cartrophen in conjunction with Synoquin. Initial course of 4 then monthly injections, repeat course of 4 after about 18 months. I find this works very well. With the very old dogs, in whom it has stopped working, I try to push the owners along the quality not quantity of life route and advise NSAIDs I try to do regular biochem on these, as there is quite a lot I can do if hepatotoxicity. I have'nt been regularly doing haems-may be a good idea, and either switch NSAID or if evidence of gastric ulceration add antacid

Wynne

Re: NSAID blood testing

Emma Jarratt — Sun, 28 Jun 2009 11:37:32 GMT

Good idea with the FBC, I might add that to my own protocol.

Currently I'll do a PAP biochem profile before starting long-term nsaids, and then annual bloods, poss increasing to q6m in the really elderly patients. But I do also use a raft of other treatments eg cartrophen, tramadol/codeine, physio/hydro, acupuncture to minimise nsaid use.

Generally like Alex said I find cartrophen works better in the earlier stages.

Re: NSAID blood testing

Rudolph — Fri, 05 Jun 2009 18:23:17 GMT

Thanks Graham (and everyone else!) - they all seem like fair comments. I think maybe I'll try focusing more on the reticulocyte concentration now then worrying about the biochemistry, except for an initial test.

Because I'm working by myself a bit sooner than I would have like in my career, I worry sometimes that I'm not doing things as correctly as I could be. It's reassuring to get other opinions from time to time!

Re: NSAID blood testing

beldather — Fri, 05 Jun 2009 18:14:10 GMT

[quote user="Graham Bilbrough"]What about monitoring the reticulocyte concentration in the peripheral blood? [/quote]
Thats a b****y good idea.

Regards

Blair

Re: NSAID blood testing

Graham Bilbrough — Fri, 05 Jun 2009 17:30:47 GMT

What about monitoring the reticulocyte concentration in the peripheral blood?

To my experience, GI irritation with ulceration is a common side effect of NSAIDs and this may be seen as a patient with a normal/lowish red cell mass but increasing reticulocyte concentration. I have several anecdotal reports of dogs having an increasing absolute retic count on one type of NSAIDs with return to "normal" after gastroprotectants and/or switching to another NSAID. With my own dog, this was apparent after I switched from meloxicam to carprofen; but I have spoken to vets with dogs that report a similar finding when going in the other direction (carprofen to meloxicam).

Given that it only costs ~£3 in consumables or ~£4.50 to add a FBC it to a profile at a ref lab, and the significance of platelets, I think the cost:benefit is favourable.

There is a paper in there somewhere.... when I get a minute ;-)

[Commercial disclosure: I work for diagnostics company -- see my profile]

Re: NSAID blood testing

Alex Avery — Fri, 05 Jun 2009 15:48:07 GMT

[quote user="beldather"]

As you can tell I'm not a great fan of data sheets and legislation.

[/quote]

especially when it involves the licensing of generics resulting in a rather large increase in cost to the owner

I would also go along with the no licenced equivalent line and have used it a couple of times as such, just interested to hear other responses

To go back to the OP question, I tend to take a first initial blood test in any geriatric animals to check for pre-existing disease. If none is found and no clinical signs of any disease start during treatment then often that will be the only test that gets done. If they become PU/PD etc then investigation will be started straight away. For the more dedicated owner then routine screaning tests can be done. Obviously potential side-effects will always get discussed so the owner is warned and if anything starts to go wrong they are less likely to wait until they are very wrong before coming back.

Re: NSAID blood testing

Mark Frost — Thu, 04 Jun 2009 23:21:29 GMT

I use Cartrophen regularly and am mostly impressed with the results.. also use a lot of Tramadol but tends to be in cases where NSAIDs are not appropriate or not enough.

Re: NSAID blood testing

beldather — Thu, 04 Jun 2009 21:47:47 GMT

[quote user="sophia guymer"]Sorry, can't resist: Where have I heard that before?? Hmmmm, Homeopathy ring a bell?[/quote]

Not really, there is quite sound evidence that pentosan (cartrophen) has an effect that modifies the typical pathological processes involved in osteo-arthritis.

'The pathobiology of osteoarthritis and the rationale for the use of pentosan polysulfate for its treatment.'
Ghosh P.Department of Surgery, University of Sydney, The Institute of Bone and Joint Research, Royal North Shore Hospital of Sydney, St Leonards, NSW, Australia. pghosh@mail.usid.edu.au

As an example,
If you would like further studies I'm happy to get them. As I have stated earlier I do not believe its a failure in the medication, rather a failure in the accurate selection of appropriate patients.

Regards

Blair

Re: NSAID blood testing

Niall Taylor — Thu, 04 Jun 2009 21:27:44 GMT

[quote user="sophia guymer"]Sorry, can't resist: Where have I heard that before?? Hmmmm, Homeopathy ring a bell?[/quote]

Experience based medicine sure has its limitations!

Cheers,

Niall

Re: NSAID blood testing

sophia guymer — Thu, 04 Jun 2009 21:18:22 GMT

[quote user="beldather"] It appears to be a hit and miss type of drug. Some respond very well, others ok, others none at all. [/quote]

Sorry, can't resist: Where have I heard that before?? Hmmmm, Homeopathy ring a bell?

(Not starting a conversation/argument/discussion here, just couldn't resist a dig)

Re: NSAID blood testing

beldather — Thu, 04 Jun 2009 19:20:12 GMT

Sorry, and to actually answer the question, as I read the wording of the cascade, I'm still within the rules as there is no licensed equivalent of tramadol.

Niall, similar results as with Alex re: cartrophen. It appears to be a hit and miss type of drug. Some respond very well, others ok, others none at all. Saying that I get a good response I will use it repitively. So they would get the initial 4 courses then I will repeat monthly, bimonthly, trimonthly as required.
I'm pretty much convinced of its effect as I have had multiple dogs that have improved drastically on it, and will deterioarte 2-3 months later with a re-injection improving lameness noticably, this is repeatable.
I personally feel that if we worked lameness/arthritis problems up further, eg MRI, arthoscope etc we would better be able to target animals that would benefit. (Convinced it is strongly associated (personal opinon of course) with degree of cartilage damage, synovial fluid changes, osteophyte levels etc), but due to its high safety threshold its easier and cheaper just to do a trial run with initial four weeks and assess response.

Much easier in Australia as would typically use the horse product and supply the first four injections to owner to be given at home, so also very cheap. This is obviously not an option in the UK.

As you can tell I'm not a great fan of data sheets and legislation.

Regards

Blair

Re: NSAID blood testing

beldather — Thu, 04 Jun 2009 19:08:50 GMT

[quote user="Alex Avery"]how does that stand up to (dare I say it) the cascade wrt the use of licensed products for a licensed condition compaired to a product with no animal licence? [/quote]

I've had this discussion with the VMD after my bosses were uncomfortable with my using it routinely. They basically said ummmmm.
I work on a simple principle, metacam is an NSAID, tramadol is not. they are not an equivalent product, they have different modes of action, different side effects. I would rather be up in front of the board for breaking the cascade system (for which I have an abject hatred of) then live with using a drug (NSAID) on a patient I consider it contraindicated in (renal disease).

Regards

Blair

Re: NSAID blood testing

Alex Avery — Thu, 04 Jun 2009 18:20:13 GMT

I use cartrophen a fair amount with hugely varying effects. A significant number of animals, I have found, do tend to improve to some degree though not always sufficiently to warrant cartrophen being the only treatment used. Having said that I do find a combination of cartrophen and seraquin works very well in younger/less severely affected dogs and so it is these I tend to target rather than the ancient, completely seized-up lab which tend not to show any improvement. How much of this improvement is due to the waxing/waning nature of mild OA and my wishful thinking though I'm not sure . we do have a number of more severely affected patients on monthly injections and their owners do notice a significant deterioration if timings are allowed to slip.

With regards Tramadol use before NSAIDs, how does that stand up to (dare I say it) the cascade wrt the use of licensed products for a licensed condition compaired to a product with no animal licence? I have only just really started using tramadol but tend to reserve it once all else has failed/stopped working. Also, has anyone had any problems with its use?

Re: NSAID blood testing

Niall Taylor — Thu, 04 Jun 2009 17:01:40 GMT

[quote user="beldather"]I will routinely exhaust cartrophen, tramadol and physio options prior to kicking into long term NSAIDS[/quote]

How do you find Cartrophen as a matter of interest. I never feel it has much of an effect?

Cheers,

Niall

Re: NSAID blood testing

beldather — Thu, 04 Jun 2009 16:55:39 GMT

[quote user="Rudolph"]I can't justify to myself prolonging an animal's life by keeping its kidneys healthy if it is in chronic pain. [/quote]

That pretty much answers the question. I will routinely do a baseline measurement with Urinalysis before starting long term NSAIDS. This to be honest is more a 'cover my backside' as well as a 'lets me sleep at night 'kind of thing. If cost is an issue or owner really have no interest in treating anything bar quality of life then will usually just treat without bloods.
I will routinely exhaust cartrophen, tramadol and physio options prior to kicking into long term NSAIDS. Will usually just monitor SG if dog otherwise looking BAR.
The more neurotic the owner, the more tests I will do to keep them relaxed about using drugs with known side effects.
Definitely a moving target.

Regards

Blair

Re: NSAID blood testing

Niall Taylor — Thu, 04 Jun 2009 16:42:04 GMT

Hi Rudolph,

I don't routinely test animals on NSAIDs unless I know there's a pre-existing problem. Not long ago I put one of my patients, a black labrador with marked azotemia and concurrent arthritis, on previcox as well as kidney treatment and it did extremely well for about 18 months. Whether the final deterioration had anything to do with the NSAID's I couldn't say but there was no deterioration at the time treatment was started (and we were doing monthly serologies).

Cheers,

Niall