Cartrophen- your views.

Re: Cartrophen- your views.

Gareth C. — Fri, 15 Apr 2011 13:54:36 GMT

we use cartrophen quite regularly and whilst the natural waxing and waning does no doubt exist we find that cases predictably do not show improvemnt until 3-4weeks after the first injection and that individual cases represent for repeat course at fairly regular intervals (usually six months). So in the cases where it appears to work, it seems to work in a fairly predictable way. Which possibly suggests that it is working and not just co-incidence. But I am not suggesting that my, any of our individual observations, makes it a valid clinical trial. How many vet forum members would it take to run a statistically useful trial...

Re: Cartrophen- your views.

David Mills — Fri, 15 Apr 2011 00:56:53 GMT

Can anyone explain the mode of action thought to be at work for FLUTD?

Have used cartrophen with nsaids and many orthopods do - the contraindication is entirely theoretical. Found it very useful in early joint dz, e.g. elbow dysplasia where cost an issue.

Neutraceuticals are faddy, and nicely tune in with 'natural remedy' craze - owners who want them to work will report that they do. Horrendously expensive too. Absolutely no evidence for their efficacy. Be a great study to double blind with a placebo.

Shocked, like one poster above, that we are not using nsaids or painkillers more often. This is a painful disease, as any OA sufferer will tell you and not using nsaids severely negatively affects welfare. 'Looking stiff' and 'its old age' are comforting useless phrases we use as excuses for doing nothing for animals in pain. Not using nsaids adds to pain wind up, means animals don't use joints as much, which means more bouts of acute pain - vicious circle. Even paracetamol in dogs at 10mg/kg BID can help massively with no recorded adverse side effects (toxic doses 100mg/kg or more)

Re long-term use in cats everyone should read the ISFM Consensus paper on long-term NSAID use in cats, or at least Gunew et al in J Feline Med Surg 2008 - showed over a 6 month period no deterioration in renal disease even in IRIS-3 stage CKD on daily meloxicam at 0.01-0.03mg/kg for OA. Again, anecdote begets anecdote - we as vets are terrible at using evidence based medicine when we have one or a few negative anecdotes to the contrary - with regular monitoring, meloxicam should be de rigeur in most eldery cats. And, what you you rather have - a pain free 6 months or an uncomfortable wih acute painful bouts for 12 months?

ATE prognosis despite the odd success cannot be anything more than grim. Our hospital sees <30% leave, and survival rates of 100 days at most - and remember these cats often need multiple pills a day, and they will be euthanased because of recurrence, which means a death preceded (again) by intense pain). No evidence supports aspirin use. approx 60% of ours are in CHF too. Temp cut off is 35.8degC (96.5F). Aortic surgery above is heroic but unlikely to work in the vast vast majority of cases - it is the vasoactive amine release from the clot that causes the ischaemia NOT a total lack of blood flow - bilateral femoral artery ligation still produces ambulatory dogs fully ambulatory after 3-4 days - and do not EVER kid yourself that this is not a painful disease - it is excruciating, in every case (and far beyond the reaches of buprenorphine in the initial stages - what you see when a cat improves is a sedative effect only). Euthanasia, on any honest appraisal of a cat's welfare during the initial episode, hospitalisation, after care, and 3 months survival time before recurrence, has to be the only option until we can manage this disease with anything approaching success.

Re: Cartrophen- your views.

Laurence Webb — Thu, 14 Apr 2011 17:19:57 GMT

i use the standard dose rate and give it on days 1,3,5,10 then every 5-10 days thereafter if required

Re: Cartrophen- your views.

Claire Edgington — Thu, 14 Apr 2011 14:58:27 GMT

I can't seem to find doses for using it in cats with FLUTD. At what dose do people here use it? I presume it's still at a 5-7 day interval.

Re: Cartrophen- your views.

Daniel Furey — Wed, 13 Apr 2011 23:24:51 GMT

Like others I have had rather mixed results. I find the patients that respond best seem to be the ones in early stages of OA, especially ex agility collies. I tend to try it in younger animals with early signs or animals where NSAIDs are contraindicated- in such cases it is probably worth trying once.

Re: Cartrophen- your views.

Rob Loxley — Thu, 10 Mar 2011 08:47:08 GMT

[quote user="Martin Atkinson"]I have used Cartophen with (apparent) great succes in dogs and cats in the past but recent cases have not been too successful including my own cat with OA in the elbow.[/quote]

Are you more 'resistant' to the placebo effect than your clients?

Re: Cartrophen- your views.

Peter Ding — Thu, 10 Mar 2011 08:41:03 GMT

The recent huge all encompassing review of all studies related to the use of Glucosamine supplements in human OA seemed to come to the conclusion that such products are only demonstrably of benefit in erosive arthritis of the stifle.

This certainly goes against my own anecdotal "evidence", but as with cartrophen with any condition showing very variable symptoms from day to day or week to week it is virtually impossible to prove any benefit unless it's equivalent in magnitude to NSAIDS

I use both however as adjunctive treatment allowing the owner to decide to continue using them if they seem to work for their pet.

Using evidence based medicine in OA is very difficult: cod liver oil, acupuncture, magnets, holistic therapy, swimming etc etc etc all SEEM to work well in some patients and fail abysmally in others. Not always related to severity.

Crazily PLT is the only thing that seems to work reasonably reliably in the most severe OA cases....significantly better than modern NSAIDS like Previcox.

Re: Cartrophen- your views.

Martin Atkinson — Wed, 09 Mar 2011 19:47:54 GMT

I have used Cartophen with (apparent) great succes in dogs and cats in the past but recent cases have not been too successful including my own cat with OA in the elbow. He's had Cartophen, glucosamine/chondroitin, EFAs and Mobility support with little benefit. Meloxican works but I'm very reluctant to keep him on that as I've seen too many cats get renal failure from long term treatment. I just leave him be now, massage his joints when he has a fuss and give him a dot of Metacam on odd days when he's really bad. My good friend Mike Guillard has told me that its the osteophytes in his extensor tendons that are causing the pain and I should wip them out but I'm too much of an orthopaedic coward to do that. Like Malcolm, I've become very cynical of the whole nutricutical scene and now begining to believe the natural resolution of acute pain cycles is attributed too much to them. Pity as they're good money spinners!

Re: Cartrophen- your views.

Kate Richardson — Wed, 09 Mar 2011 09:41:19 GMT

I remember reading an article about prognostic indicators in ATE and low rectal temperature was a poor prognostic indicator- I can't remember the cut off point though, so I'll try and look it up

Re: Cartrophen- your views.

Alex Gough — Wed, 09 Mar 2011 09:38:35 GMT

Probably should have a different thread, but I think you need to assess thromboembolic cases as individuals. Some of them have heart disease but aren't in heart failure, and cats that haven't got to the heart failure stage can live for a long time with heart disease. Yes they can be in pain, but there are some pretty good pain relief options around now, so again you need to tailor the analgesic to the individual. Some cats that you treat for ATE can have good responses and durable survival times. There is a 2003 paper in JVIM that showed a 45% survival to discharge, with a median survival time of discharged cats of 117 days, but those in CHF (which comprised 44% of cases) the survival was 77 days, and those without 223 days.

Re: Cartrophen- your views.

Hannah Wynne Richards — Wed, 09 Mar 2011 08:59:54 GMT

Not NSAID and cartrophen as contraindicated, but can use codeine while cartrophen is kicking in-legal as no veterinary alternative Also can use synoquin-I use it on my own dog-or j/d diet

Wynne

Re: Cartrophen- your views.

Malcolm Ness — Wed, 09 Mar 2011 08:47:33 GMT

Despite some outrageous claims having been made over the years about the efficacy of various medicines, nutraceuticals and other remedies, there remains (to the best of my knowledge) absolutely no known chemical that will beneficially modify the disease process of OA.

Most arthritic patients (human and veterinary) present because of an acute flare of the ongoing chronic OA. Pain and disability are the major signs and consequently medical pain control is an effective first line of treatment. We can refer to these drugs as NSAIDs which makes us sound cleverer than perhaps we are and it also allows us to charge more. Other useful interventions include weight control and physiotherapy. The opportunity to pursue and identify the primary diagnosis should not be missed as many of the primary diseases are amenable to effective surgical treatment.(assume that all OA in dogs is secondary and you won't go far wrong).

Bear in mind that most lameness due to acute flare of chronic OA will return to pre-flare levels (perceived by most owners as "normal") within a month or thereabouts so if you do nothing other than dispense a few kind words, most patients will get better anyway - therein lies the source of the apparrent efficacy of many of the remedies (conventional and otherwise) that wash in and out of fashion for the treatment of OA.

Re: Cartrophen- your views.

Vikki Halliday LLB — Tue, 08 Mar 2011 23:19:34 GMT

[quote user="Busybee"]Or a combination ie. NSAID while the Cartophen is taking effect?[/quote]

NSAID use is specifically contraindicated with Cartrophen.

Re: Cartrophen- your views.

Busybee — Tue, 08 Mar 2011 22:24:05 GMT

Sorry to dig an old post up again!

What is the general opinion on first line treatment for OA? Would you start with just an NSAID? Or just Cartrophen? Or a combination ie. NSAID while the Cartophen is taking effect? Obviously with weight control and exercise regulation. Also, any use in supplements eg. Synoquin?

Re: Cartrophen- your views.

James Allsop — Wed, 03 Nov 2010 13:04:12 GMT

Im in general agreement with most of the above re Thromboembolism in cats. I have treated a couple of what appeared to be partial blockages with some success with temporary return to function (lasting upto 6 months before recurrence and PTS). These cats have normally thrown a clot because they have an underlying heart prob or hypertension or both so they are not good candidates for heroic measures IMHO.

I have used cartrophen in several CRF cats with arthritis where I was not happy to use NSAID until the do-or-die stage and there seems to be some response (according to owners perception of arthritis symptoms). and I feel it is likely safer than NSAID for these patients.

We use it quite regularly with our OA cases in dog and I would say approximately 50:50 response rate - I do not repeat the course if it is not working 1st time. Many of our cases end up on monthly injections as maintenance rather than the 4 week course repeated at intervals. This is easier for the owners to comply with in our experience and sometimes a repeat 4 week course when they start to deteriorate helps.

I have used in in FLUTD cases instead of glucosamine where owners cannot orally medicate - i am somewhat sceptical as to response rate as this is again often a self limiting but recurrent disease with multiple influencing factors. I am happy that both products are safe in these patients though.

Well those are my anecdotes for their limited worth

Re: Cartrophen- your views.

Mark Holmes — Fri, 29 Oct 2010 07:16:20 GMT

My issue with ITE is this. The painful ones maybe have a better prognosis because if painful they probably have some praising remaining, BUT they are very painful. The non painful ones are so because their legs are ischaemic and slowly sloughing off. It generally has a poor prognosis which is difficult to predict and will not become apparent for several days. The ultimate recovery will not be known for weeks, and permanent disability might be considered a good outcome. A vet times article on the subject cited a cat who spent 6 months crawling around the house before reblocking as a good result. It is a symptom of heart disease. Not just heart disease but significant CHF, which in cats is much less favourable to treatment than dogs. Even if you get them through everything they still have thrombus in their left atrium and are likely to reobstruct. I feel that treating them is akin to spinal surgery on a dachsy with late stage CHF the only difference being that spinal surgery carries a reasonable and predictable(ish) prognosis.

Re: Cartrophen- your views.

Charlotte Marshall — Thu, 28 Oct 2010 23:31:34 GMT

I do use cartophen occasionally and have been using it a bit more recently. I do agree there is no point in giving it to really advanced cases. I have found it useful in some idiopathic cystitis cats which it apparently has a license for in Australia.

I do treat some thromboembolism cats - it all depends if it is possible to control the pain. Some seem excruciatingly painful (I do put them to sleep)and others seem much less so. I had one cat came through two episodes with medical management. I am definately not brave enough to start attempting surgical removal - very impressive!

Re: Cartrophen- your views.

Martin Atkinson — Thu, 28 Oct 2010 18:49:08 GMT

[quote user="chris jones"]

like most I find cartrophen works well in some cases or not at all in others.

I have used it in cases of thromboembolism in cats and have had some success, can't remember the regime but off hand I think it was repeated injections several times daily but would have to look it up. did seem to help more that the usual acp aspirin etc.

[/quote]

Now that is an interesting idea, as Cartrophen has a thrombocytopaenic effect I can see some logic but would it work as a clot buster? I don't think its fair to write off cats because of thromboembolism, some do recover so I at least give them the chance and believe it or not I did once remove a iliac saddle thrombus. The cat was seen within 1/2 hr of onset of symptoms, with complete bilateral hind leg paresis and no history or or symptoms of heart disease., I clamped the aorto with a bowel clamp incised into the distal aorta pulled out a beautiful clot, sutured with 6/0 Dexon and released the clamp with no leaks, all within 5 minutes. The owner moved away but the cat went on to live for another 10 years before it had another episode and it's new vet wasn't (not surprisingly) keen to repeat the excercise. I've not seen a suitable case or felt heroic enough myself again since either. I have my own cat on Cartrophen for OA (diagnosed on X-ray), its helped but he's not 100% sound, I'm very reluctant to use NSAIDs and he's a bugger about taking his nutricuticals. However I took blood tests after the first injection and found urea of 11mmol/l (4-11), hyperglycaemia 11.5mmol/l (3.9-8.3) - he never gets stressed taking his blood, HCT 26.4% (24-45) and platelets191x10^9/l (175-500) 2 days after the injection, everything returning to mid normal ranges after 6 days. Food for thought.

Re: Cartrophen- your views.

Simon Neuhoff — Thu, 28 Oct 2010 14:18:59 GMT

I administer Cartrophen on a daily basis as it is commonly used in the practice and clients ask for it. I am not very convinced by it - some dogs do seem better for it but many seem not to show any response at all. The clients like it - but I think a lot of this is placebo effect.

To my mind it is an adjunctive treatment - I focus much more on weight and excercise control, pain relief as required. To a certain extent the cartrophen detracts from this though - clients would rather take the easier option of relying on the drugs than change the dog's diet or lifestyle.

Re: Cartrophen- your views.

Mark Hedberg — Thu, 28 Oct 2010 13:47:36 GMT

I am quite pro-cartrophen; it appears to work well in a large majority of cases i use it in. Client compliance is improved when we do the work instead of them, and a weekly vet visit seems to suit them very well.

Re: Cartrophen- your views.

Andrew Mellor — Thu, 28 Oct 2010 12:36:45 GMT

I have to agree, blue juice tends to be my drug of choice too! they are in so much pain with such a poor prognosis!

Re: Cartrophen- your views.

Mark Holmes — Thu, 28 Oct 2010 12:32:20 GMT

[quote user="chris jones"]

like most I find cartrophen works well in some cases or not at all in others.

[/quote]

You treat thromboembolism???? I invariably euthanase.

Re: Cartrophen- your views.

Anonymous — Thu, 28 Oct 2010 12:16:07 GMT

like most I find cartrophen works well in some cases or not at all in others.

Re: Cartrophen- your views.

Martin Atkinson — Thu, 28 Oct 2010 09:50:03 GMT

[quote user="Andrew Mellor"]

does anyone else use it for idiopathic cystitis in cats ? seems to work really well.

[/quote]

I have used it for OA in a cat with concurrent idiopathic cystitis and it seemed to help both but this is not surprising given the proposed similarity in mode of action to glucosamine. However, more surprisingly, I successfully treated a case of 'snuffles' in a rabbit when I mistakenly gave it a shot of Cartrophen instead of Convenia (don't ask)!! Does this indicate an immunomodulatory action or was the rabbit going to get better anyway? I think like with a lot of these anti-inflammatory substances we use (even corticosteroids - nay especially) we haven't even begun to scratch the surface of how they work and, as raised before in this thread, rely on anecdote.

Re: Cartrophen- your views.

Andrew Mellor — Thu, 28 Oct 2010 09:15:31 GMT

does anyone else use it for idiopathic cystitis in cats ? seems to work really well.