Arthritic dogs with liver disease

RE: Arthritic dogs with liver disease

Anthony Todd — Sat, 25 Aug 2018 15:47:36 GMT

[quote user="David Mills"]logical disassociation of raised liver enzymes with "liver disease". It very rarely is.[/quote]

Don't you mean "association" 'cos I do?

RE: Arthritic dogs with liver disease

Anthony Todd — Sat, 25 Aug 2018 15:45:23 GMT

[quote user="Richard Carter"]o I suppose the take home message is - choose your cases (heading for serious QOL issues), beware of limitations of the medications and side effects, have the owner on board[/quote]

I used bute in may cases with or without Csteroids and never had a problem.

What sort of levels was this dogma based on and from whom?

RE: Arthritic dogs with liver disease

Richard Carter — Sat, 25 Aug 2018 12:43:02 GMT

Re PLT which is pred/ nsaid combination - some of our European colleagues treat low dose preds/ depomed with daily nsaids in combination without too many issues - this from advice of the sister (in UK) of a German orthopod in a case where really the dog needs hips to be cut out if it was more healthy/ younger. Seems to be fine at present, using hindquarters quite well. Similar rx in a cat with depomed at low dose 0.2ml ev 4-6 weeks, loxicom cat normal dose.

When I graduated there was a dex/phenylbutazone injection combination that could be given i/v - used to revive parvo rotties and RTAs very well when used as shock rx but obviously will have been reasons for being discontinued (prob bute effect on kidneys?)

so I suppose the take home message is - choose your cases (heading for serious QOL issues), beware of limitations of the medications and side effects, have the owner on board

RE: Arthritic dogs with liver disease

Bob Russell — Sat, 25 Aug 2018 10:01:47 GMT

PLT's were supposed to be returning but not had any recent news about them. If they do return please just not in tubs of 1000!

I did use them very successfully in some of these cases.

RE: Arthritic dogs with liver disease

Clare Tapsfield-Wright — Fri, 24 Aug 2018 23:55:39 GMT

I agree too , their quality of life and the relief of pain enabling them to move around more and keep mobile is more important. I hate seeing old dogs in pain because their owners “don’t believe in taking tablets” . Heat and physio or hydrotherapy ,weight loss , regular gentle exercise etc makes a big difference too and is often overlooked by clients. I believe a major benefit of pain relief is that I really helps them to stay active and prolongs their life rather than worrying about slightly raised liver enzymes. Shame PLTs are not available anymore , they seemed to work really well when metacam was no longer sufficient.

RE: Arthritic dogs with liver disease

David Mills — Fri, 24 Aug 2018 21:38:50 GMT

One of my pet hates is the logical disassociation of raised liver enzymes with "liver disease". It very rarely is.

There was a great talk on this and testing for liver disease at bsava this year.

Give the dogs NSAIDs. Their liver enzymes may even be raised because of the OA

RE: Arthritic dogs with liver disease

rachaelyost — Fri, 24 Aug 2018 15:35:14 GMT

The history is a bit vague with both of them-liver enzymes have been raised but in 1 dog are back to normal and the other dog have been elevated but no further testing done..she has been told no nsaids and is really wobbly on low dose gaba so may have to persuade her to try nsaids.

RE: Arthritic dogs with liver disease

Richard Carter — Fri, 24 Aug 2018 09:44:24 GMT

one of the London Vet show talks on NSAIDs couple of years back (think from RVC?) advised the half dose or alternate day dosing if persisting with NSAIDS when organ failure setting in. We usually switch to preds/ tramadol when reaching end stage as the euphoric effect of preds is sometimes more important than the side effects by this stage.

RE: Arthritic dogs with liver disease

Clive Ansell — Fri, 24 Aug 2018 09:34:47 GMT

+1 for using Metacam at the lowest effective dose, maybe a multimodal approach in combination with low dose pred, pardale V or even Tramadol.

All off label of course, so prescribed on the basis the client understands and accepts the risks. Welfare and being as pain free as possible has to trump all else.

RE: Arthritic dogs with liver disease

Phil Fox-Manning — Fri, 24 Aug 2018 08:18:46 GMT

Yep I agree with this, if it’s a QOL issue then the owner will just have to acknowledge the unknown risks to the liver to prioritise the dog’s welfare.

Meloxicam is the least hepatotoxic of the modern NSAIDs available in the UK according to my BSAVA cert, and lowest effective doses can be used to reduce this risk further.

Obviously you can try some of the other OA management alternatives first, but ultimately an NSAID is likely to be required at some point if the dog is only relatively young. And I’d probably avoid paracetamol if possible due to largely hepatic metabolism and excretion.

RE: Arthritic dogs with liver disease

Michael Woodhouse — Thu, 23 Aug 2018 23:16:09 GMT

Most dogs with liver disease tolerate modern NSAIDs very well in my experience.......

RE: Arthritic dogs with liver disease

Jill Butterworth — Thu, 23 Aug 2018 22:22:37 GMT

Intra-articular ketamine? Never tried it bu there have been good reports.

RE: Arthritic dogs with liver disease

Robert FalconerTaylor — Thu, 23 Aug 2018 17:10:49 GMT

Matthew Gurney gave a useful and relevant talk at BSAVA 2017, this from the proceedings. The presentation is on BSAVA website.

RE: Arthritic dogs with liver disease

Martin Atkinson — Thu, 23 Aug 2018 16:53:37 GMT

In cases like this we need to prioritise and if the dogs are in intractable pain/have poor quality of life then needs must and although you may mess up their livers more with NSAIDs at least they will be comfortable. I had just this issue with a old Doberman a few years ago and that was the compromise the owner accepted. However, have you tried Pardale even Tramadol albeit I'm not a fan of the latter.

The Nutravet rep came in yesterday eulogising the benefits of Boswellia in Nutramed which is targeted as an anti-inflammatory for dogs that can't tolerate NSAIDs. I'm rather sceptical but it may be worth consideration except you have order a minimum of 6 units of their products at time.

RE: Arthritic dogs with liver disease

Anthony Todd — Thu, 23 Aug 2018 16:38:55 GMT

When you say "hepatitis" do you just mean, actually, just raised liver enzymes or bilirubin etc.

Back in the day when I sent weird skins or feet to the RVC [and they'd always had steroids prior to the second opinion] "liver disease" was the diagnosis and the cause??

RE: Arthritic dogs with liver disease

Joyce Whitehead — Thu, 23 Aug 2018 16:29:02 GMT

Steroids? Might just help the liver. In what way doesn’t it tolerate the gaba? Is it just woozy, as that would be my suggestion too.