Don’t get me wrong. Here on Dolittler we’re near-fanatical about the use of pain control measures in veterinary medicine. We also spend a significant amount of time rehashing the side effects some of these alternatives offer along the way. But that’s not what this post is about.
Nope, this post is about how the use of pain relief in pets provides a reasonable escape hatch for those who would prefer to treat pain than treat the disease that causes it. And it’s not just about hip dysplasia. We’re also talking cruciate disease, intervertebral disc disease, chronic ear disease, elbow dysplasia and any other process for which pain control measures offer a stop-gap for what ails our pets.
In the case of elbows, it recently came to pass that a new patient presented with his owner in tow. The five year-old dog had been suffering pain in one elbow since he was a six month-old puppy. His previous veterinarian had passed on recommending an orthopedic consultation with a specialist:
“There’s nothing to be done about bad elbows,” he’d claimed. And that’s true...IF the disease is advanced enough...IF there’s not a huge hunk of stuff floating in the elbow area that’s realistically amenable to surgical excision.
Long story short: The dog should have been offered an orthopedic surgery at six months of age. It may have kept him near pain-free for life. It would almost certainly heve prevented this degree of degeneration. Instead, the effectiveness of the pain relievers had granted him a reasonable degree of comfort. No long walks, no major exercise, no normal dog stuff, but a modicum of comfort, nonetheless.
Dog moves to Miami at middle age and sees a new veterinarian. Off he goes to the specialist and finally gets a surgery to alleviate what’s evolved into a horrible problem. One he needn’t have suffered so seriously in the first place.
Now, it’s true that if this owner hadn’t had the financial means to undertake a major surgery early on the dog would still be in the same boat. But that wasn’t the case, it seems. And nothing irks me more than a client who wants to do the right thing and doesn’t get the chance––much less a patient whose suffering could have been largely prevented.
But let’s take the vet-bashing off the table. We all know there are great vets, good vets, well-meaning but not-so-up-to-date vets and then there are the serious losers. No industry, no profession, no job is devoid of its bottom-of-the-barrel bunch so let’s not belabor the point.
The more relevant issue here is the existence of pain relief protocols that work so well we can often manage diseases that sometimes deserve another approach.
It’s a double-edged sword, for sure. Pain relievers are keeping a number of my large dog patients living well into their fifteenth year. Most of these are dogs who would have succumbed years ago to the “can’t get up” syndrome old dog owners know so well. In fact, that’s how many of them came to me:
“Doc, it’s time to put him down. He just can’t get up.” After a round of X-rays, discussion of options and a side-effects lecture, most of these owners took home a bottle of pills in place of surgical alternatives. And I couldn’t necessarily disagree with them. One day you think your dog is dead, the next day he’s running around “like a puppy again, Doc.” Would you go for the surgery after that kind of success? Maybe not if the surgery goes for $3,000.
But it’s one thing to treat a geriatric pet in that manner, quite another to allow a younger pet with plenty of time on his ticker to forgo more definitive alternatives. Still, it’s understandable that the price may not be right––not when a client is faced with a bird in the hand solution in the guise of an Rx.
Yet this oh-so-effective approach is not always so perfectly safe––less so when it comes to the long term use of drugs. And it’s also not so inexpensive as it may appear at first blush. Sure, you can find deals on the Internet, but even then, most of my chronic pain-treating clients pay at least $30 every month for their pain-relieving meds (though it’s usually closer to $60). So let’s do the math on a sample patient:
A ten year-old dog with cruciate disease in his knee will pay $30 (best case scenario) every month until he’s thirteen, at which time the meds can no longer power through the pain and weakness. That’s $1,080. Add the necessary labwork every six months (required to safely remain on the meds) and that’s another $100 a pop (at least). So now we’re at $1,680 for three years...for a painful solution that could have been repaired for $2,000.
Sure, that’s a simplistic scenario that portrays the height of frugality. But I see this kind faulty thinking based on the power of meds play out day after day in my practice. Because surgery is scary. Because it’s a one-time hit below the belt. Because the medicine works.
Now let’s take this one step further: Is the use of pain-relieving medication at all responsible for the continued presence of hip disease in our canine population? I’d argue it’s inevitable. If the use of NSAIDs and other pain relievers makes it easier to accept that dogs will all suffer pain as they age, does it not stand to reason that assiduous breeding for best hip conformation might take a breather? I wonder.
In any case, it’s all too clear that pain relieving methods, for all the good they do, are only as good as the industry that supplies it, the docs who deliver it and the owners who choose to wield this weapon––judiciously or not.
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I'm inclined to agree with you. However, my concern is that this could be turned into "let's restrict meds" and it's take oh so long to get them to be available for pets. There's a frightening pendulum of opinion when it comes to meds, especially pain meds.
PJBoosinger August 5th, 2009 10:54:40 AM
Isn't it the case with any kind of treatment, that it's only as good as the person making the calls on how to use it?
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Breeding for hip conformation isn't really something I've encountered personally; all my dogs are mutts/rescues of unknown breeding. Almost anyone who ends up with a shelter/rescue dog has this same issue. I suspect there'll always be dogs of unknown breeding or accidental breeding or strays breeding, so I think there'll always be dogs whose hips are just not great. As long as rescues and supporters are pushing "don't buy, adopt a dog" I think we need to acknowledge the drawbacks of adopting dogs as well as the benefits, one of which is that we couldn't pick the dog based on the quality of the parents/grandparents/older siblings/etc.
And hey, so many people who breed dogs are not breeding for...well, ANYthing. And they don't care about their puppies past "make a quick buck." They'll sell sick, deformed, crippled dogs and not change their breeding/handling practices one bit. Unless we can guarantee the shutdown of puppymills, there'll still unfortunately be badly-bred dogs who need lifetime care & pain management.
Galadriel August 5th, 2009 12:11:05 PM
I have mixed feelings about this subject.
A dear friend of mine has two rottweilers, both rescues, both arriving with a myriad of joint, muscle and immune disorders. After many TENS of thousands of dollars, and many, many, MANY surgeries, it is arguable that these dogs are any better off than they were when they arrived in their new home.
Of course, these are not typical cases - but they are certainly cause for me to stop and think before going ahead with any surgical procedure that may not yield a positive result.
It should also be noted that both dogs surgical journies began before age 2. The emotional and financial toll that their owners' efforts to "do the best possible" for both dogs is mounting... and getting worse.
They have finally come to the decision that neither dog will be going under the knife again (at least for their current issues) and management is really the most humane option.
Kim August 5th, 2009 01:27:39 PM
It is my understanding that the Pet Insurance Industry who have a vested interest in these statics say that shelter dogs(mutts) are healthier than pure breed dogs.
Robert Garnett August 5th, 2009 02:09:05 PM
I agree - I can see how more and more clients would write off their dogs' ailments as an inevitable byproduct of aging easily and effectively treated with NSAIDs as opposed to a progressive orthopedic disease which be be fixed surgically before it's advanced.
anna August 5th, 2009 02:50:27 PM
I agree with Galadriel; I don't see bad breeding ever going away.
I think pain relievers are wonderful when used properly. My parents' dalmatian is almost 14 years old. She has some degeneration in her spine that makes it difficult for her to get around, and surgery isn't a reasonable option. But, with medication, she's able to lead a reasonably happy life, and she's outlived most of the dogs we had growing up.
Posey August 5th, 2009 03:08:22 PM
You can't control breeders, as much as it's a good idea. That just goes back to controlling too many things that people in our country feel is a basic right, and the anthrocentric view of "humans can do what we want, and lesser animals must just take it even if hurts them." (As much as stupidty can be a basic *human* right... and then you wonder why animal people prefer the company of animals.) Anyway.
Dr. K, what's your opinion of pain management and quality of life with dogs that have already had surgery? To review my case: 3 y.o. spayed female 80 lbs mix, puppy onset hip dysplasia in a particularly nasty severity (extensive fractures to the femur, no socket for the femur on the pelvis), FHO at 2 y.o... is it appropriate to keep her on a NSAIDs as a pain management regimen? Her behavior and reactivity have both improved and she leads as much of an active life as she can, but is finally getting it through her thick head that laying down is often the best spot for her... that's taken a lot of training, but it seems to be working. I understand that there's a risk of long-term organ damage, but we do blood work at least anually to watch for that. Any other reasons I should or shouldn't be keeping her on a consistent, light dose of NSAIDs with an occasional 'bump' of narcotic pain meds for days when she gets too enthusiastic, injures herself, or the weather's bad?
Karl Katzke August 5th, 2009 05:43:22 PM
Karle: If it's a light dose of NSAIDs you should be just fine as long as you adhere to the safety regimen detailed here. Opiates like tramadol are great for a "bump," but you should also consider the occasional round of Adequan as an NSAID boost (or all by itself for some who respond really well. I use the eight shots in four weeks protocol and it's working out well for my patients. And I assume you're already using glucosamine––preferably the one with avocado extract for maximum benefit as we perceive it by today's standards (Dasquin by Nutramaxx or one of the human versions).
Dr. Patty Khuly August 5th, 2009 07:00:54 PM
Oops, Karle. Here's the link. It's what I offer my dog owners by way of a written explanation.
Dr. Patty Khuly August 5th, 2009 07:02:14 PM
"does it not stand to reason that assiduous breeding for best hip conformation might take a breather?"
I don't think so. Breeders who didn't care about hip conformation before may use new treatment options as an excuse, but the breeders who DO care are still doing screenings through OFA or PennHip for hips, elbows and everything else. Actually - at least in my breed - I would say that a much higer percentage of breeders are doing screenings now than even 10 years ago. Partly because of education efforts, partly because of pressure applied through the national breed club. A knowledgeable breeder understands that even if a genetic disease has good treatment options it is still basically a ticking time bomb.
Barb August 6th, 2009 01:33:28 PM
Good point, Barb. I didn't think of it that way. But isn't it the case that for those who sell litter after a litter (and call themselves "breeders") that purchaser anger against them is diminished when there's a way to "fix" the problem through pain control? I also happen to know plenty of "breeders" happy to get their OFAs and still willing to breed "good" hips––because the offspring aren't likely to have trouble until later in life, once it's deemed "acceptable" and treatable with pain control measures. It's that kind of poor dogsmanship that I'm thinking about in this case.
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