Dogleg thoughts

[bunn]

Mollydog had her first acupuncture session on Tuesday. It doesn't seem to have helped, so far - in fact, her bad leg is now worse than it was, but apparently this is sometimes the case with acupuncture before the effects kick in, so I'm going to take her for another session on Tuesday.

Problems with Mollydog's leg are manifold:
1) old injury with embedded mystery item (too deep to remove).
2) arthritis around old injury, exacerbated by a couple of newer tripping incidents.
3) 1 and 2 have resulted in a joint that mechanically cannot bend more than about 20 degrees.
4) Corn on one toe on that leg, which may be unrelated (greyhounds do get corns) or may be produced by walking oddly as a result of 1-3.

2 vets have now said they think she should go onto long-term painkillers. I am wary of this because:
1) She's tried metacam and Rimadyl for a couple of weeks each. There was no discernable change in her behaviour, limping or energy levels.

I am not sure how you can be sure a dog *needs* painkillers if you can't tell she's had them, particularly if she is generally a dog who is active, enjoys her walks and is happy to run and play. The vets say 'well it must be causing her some discomfort' - yes, but if I can't tell how much discomfort when I'm observing her all the time, then can the vet?

2) All the possible NSAIDs seem to have the potential for causing intestinal problems, and the longer you use them, the more likely this becomes. Mollydog was 8 in Sept, so could be taking them for 5 years or more (with a bit of luck) if she starts them now. I know someone whose dog died of internal bleeding in a reaction to Rimadyl. OK, that's not common or the drugs would not be licenced, but...

3) if you give painkillers longterm, surely the dog gets used to them and the effect becomes less? (Need to ask vet about this). Then what if she needs them more later in her life?

4) If I give her something that will numb her joint pain (if in fact the painkillers do this, because I can't tell if they do or not), is she not more likely to overdo it and damage that already knackered joint even more? (one vet that saw her a couple years back said this, but none of the other vets have said it since).

I'm really hoping the acupuncture will have some visible effect. If it doesn't, my only remaining choice seems to be either using painkillers for the rest of her life, even if I don't know if they are helping her - OR refusing to use them, despite vet advice to do so. I am not very comfortable with either option.

She has glucosamine supplements, which have helped. She has a magnetic collar, which also, bizarrely and unexpectedly, also seems to make some difference, or at least, she seems worse if I switch to another non-magnetic collar for any length of time.

I am vaguely wondering whether a TENS machine might be worth a try, though these are not widely used in dogs, I have found someone who has had their dog use one with considerable success under veterinary supervision. I might run this idea past the acupuncture vet, I think she might be a bit more open to alternative ideas than our regular vet.

Hum.

Comments

[wellinghall.livejournal.com]

All the possible NSAIDs seem to have the potential for causing intestinal problems

You could try some of the newer COX-2 inhibitors (sort of second-generation NSAIDs). They do have the risk of heart problems, though. Aclar / Loradin is one for dogs, I think.

[bunn.livejournal.com]

I can't find anything googling under those names, could there be an alternative spelling?

One vet suggested previcox, which is newer and supposed to be gentler on the stomach - but because it's very new (2005), there is no data on long-term use in greyhounds. Googling it does turn up some sad stories though, so it's clearly not completely safe - but then, what is?

[wellinghall.livejournal.com]

I've got a note of it at home - I'll check this evening. My dad happened to have been talking to me about it last night.

[wellinghall.livejournal.com]

Lodine.

[bunn.livejournal.com]

I forgot to mention that Mollydog along with her multifarious leg issues has a grade 2 heart murmour, so anything heart-related may not be a good move. If I can find out the commercial name I'll look into it though and ask the vet for an opinion.

[chainmailmaiden]

I've found a TENS machine good for joint pain in the past, though not being a dog (no rude comments please!) I can't say how effective ti might be for Molly. Heat is one of the best things for pain, any chance of getting a heated pad for her to lie on?

[bunn.livejournal.com]

I doubt she'd stay on it (or, there would be a war among the cats all of them wanting it), but I could try some sort of warm wrap, that would be fairly easy to do.

[bunn.livejournal.com]

... I bought a TENS machine today. I will dig out some batteries and give it a go on her I think.

[tovaglia.livejournal.com]

I know nothing about dogs but have treated lots of humans with similar problems!! Assume the pain here is mechanical rather than "nerve-type" pain (which is treated differently). The latter is always possible, especially after a penetrating injury that could have caused nerve damage. Unfortunately the drugs for nerve-type pain tend to be sedating, and are mainly used to improve sleep quality. Acupuncture may work for both types of pain for some individuals.

I would share your concern about the merits vs risks of drugs if you have tried her already on a good dose of strongish painkillers (if you're sure she is really swallowing them, not spitting them out!) and there is no change in her function over the 2-week trial period. Vets love to give animals painkillers - I am very sceptical about this and think (from my James Herriot readings!) that it may be a cultural thing. If a human person didn't walk or sleep any better with painkillers, I would suggest stopping the tablets and seeing if there is any difference.

Giving painkillers longterm will have only minimal "getting used to" type effects, if dogs are anything like humans. The same is not true of opiate drugs but I assume these aren't what are being discussed.

The NSAID-related stomach problems can be pretty catastophic for dogs, from what I have heard - much worse than in humans. Our family dog was given meloxicam, which is supposed to be a bit more COX2 selective and therefore less bad on the stomach. I am not sure whether it really helped her; it was expensive! The heart problems are probably a very small prothrombotic effect - a murmur shouldn't make much difference to her risk of that, unless it's due to heart failure in which case you wouldn't think she would be running around. It has been suggested that there may be some prothrombotic effect/ risk of increased heart attack with all NSAIDs used long-term, except aspirin - this is a controversial area and we need more data.

An option which I would consider in humans would be to try an injection of steroid into the worst-affected joint. (don't know if vets do this!) - can give excellent relief of pain and inflammation for up to 3-4 months with minimal side effects. However, I don't know if dogs would tolerate this procedure without deep sedation/general anaesthesia, even with lots of local anaesthetic. And you wouldn't know whether it had worked until afterwards.

TENS might be worth a try - certainly shouldn't do her any harm.

Personally though I think you should stick with what you have seen to work. eg If the glucosamine helps, could you try increasing the dose? The most effective dose must vary so much between different breeds of dog that it may be worth conducting your own n-of-1 dose-ranging study!

[bunn.livejournal.com]

Oh, many thanks, that's really helpful info!

Yes the heart murmur is nothing major - it's common for greyhounds to have one. I'll ask about the steroid injection idea.

She's just been haring round Dartmoor like a loon, and I'm trying now to decide if she was running more than she was pre-acupuncture. I can't help feeling she would not be running round, showing off to all the other dogs and generally having a whale of a time if the leg were really painful!

[bunn.livejournal.com]

Oh, yes, she definitely ate the painkillers! They come in liquid form and are served with food. Nothing served with food fails to be eaten by the Ravenous Mollydog.

[kargicq.livejournal.com]

Have to say TENS did nothing at all for me either for late pregnancy backache ("mm, now I have interesting non-unpleasant tingly sensation /and/ backache")or labour (was not even aware I still had it on, think either the NO2 or just the general intense agony must have blocked the sensation, until the midwife took it off just before D emerged). Obviously this says nothing at all for what it's like for joint pain in dogs, but I must admit I was sorely disappointed!

Vets can certainly inject steroids into horse joints, at least...

The cynic in me suggests that the reason vets may be keener than (UK) doctors to prescribe painkillers despite lack of visible effect is that this equals more income for vets, not for doctors. Too cynical? (which means doglike, funnily enough)

Neuromancer

[bunn.livejournal.com]

Haven't tried the TENS machine yet, but I am almost, almost convinced that the second acupuncture session has really helped. She is definitely moving a lot more easily on it. Of course, it could be coincidence.

Although I am naturally inclined to suspect vets of prescribing things not needed, I must say that since moving to the new vet I've seen no great evidence of this (unlike the old vet, who did recommend a number of things that I am pretty sure were aimed mostly at their profit margin).

For example, this new practice has a hydrotherapy pool, and they didn't suggest that: they also had posters up advertising a particular therapy whose name I forget which possibly we should have considered 3 years ago but which my research suggests it's too late for now: they didn't suggest that either, and the acupuncture was my idea not theirs (I found a specialist vet because they didn't offer it at that practice).

I get the impression that the clientele is less well-heeled than at the old vet, so perhaps they are not such good candidates for walletectomy.