Need to stop Metacam – advice needed please

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Hello, My 11 yr old labrador, Tess, has osteoarthritis. A blood test 3 months ago showed a raised liver enzyme and a test 1 week ago shows this enzyme to have risen further. (I think it was ALT and the results were 202 and 273.) The vet has spoken with a specialist and she has suggested that Tess either has a liver ultrasound and biopsy or we drop the Metacam for 3-4 weeks and then redo blood tests to see if it’s Metacam that’s causing it. I’ve opted to stop the Metacam – she was off it last summer but this summer she has been on a dose for a 15kg dog; she weighs 25kg. My questions are:

  1. If it does turn out to be Metacam will I have any other options for NSAIDs?
  2. If she struggles in the period before her blood can be retested what options are there for other analgesics? The vet mentioned Tramadol but I’ve read that there are concerns over whether this metabolises effectively in dogs.
  3. In the intervening weeks, would it be sensible to up her hydro and physio sessions? She currently does hydro once a month and physio (underwater treadmill/laser/pulsed electromagnetic therapy) once a month, alternating so she has something every fortnight. She is also on Yumove Advance 360.

Thanks in advance. I’m really worried that she won’t be able to cope without the Metacam and that there won’t be other long term options. Of course, it may turn out not to be the Metacam…

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Gwen – thank you so much for your comprehensive response. There’s lots of really useful information there as well as reassurance that we will have other options if Tess has to come off the Metacam. I have done lots of work at home covering laminate and tiles and Tess uses a step to get into the car. I also have a ramp but need to do more work with her so she can trust it.

Thank you for your help, it’s really appreciated.

Answered question

Hi AmandaT, the answers to the medication side of your question depends on how your dogs liver function is. Your vet can get an idea of function by looking at the blood results. ALT just indicates that there is some inflammation present but that doesn’t always mean liver function is affected. If liver function is ok there are some options such as paracetamol (pardale) that can be used. This is a vet drug licensed for 5 days but it can be used long term at a lower dose and may dogs get good pain relief from it. If used at too high a dose it can harm the liver and it is essential to consult your vet before giving paracetamol.

You are right about tramadol, unfortunately, over the last 10 years or so the human drug – tramadol has become widely popular amongst vets but more recent studies indicate that it is metabolised very poorly in dogs as in some people. If tramadol is not well metabolised then the patient gets no ‘opioid-based pain relief but the drug may have some effect on other neurotransmitters which influence pain but also can cause the ‘dysphoria’ (spaced out effect) that some dogs (and people – me for example!) experience. It takes a long time to get the message out across the profession that perhaps this drug is not the best choice.

There are a couple of human medicines vets are allowed to prescribe ‘off-licence’. Amantadine and gabapentin are not metabolised by the liver but the kidneys have to process these drugs so your vet will check the kidneys are ok. I have treated a lot of painful patients with livers that cannot tolerate NSAIDs with one or other of these drugs. Your vet can phone a pain clinic for advice as these drugs are not ‘standard fayre’.

Then you can consider acupuncture as part of the physical therapy program. Your physio may practice acupuncture if they are a vet or will likely know a vet who can do acupuncture. And yes, get some more physio and hydro help. Your therapists will make sure he doesn’t overdo it.

Finally, do make sure you have taken into account his household environment. With all the best treatment in the world, your vets and therapists cannot overcome the mini-injuries a dog may sustain if he slips on a laminate floor, trips when negotiating steps or jumps out of the car with a great load on his elbows for example. Lots of advice on the website and on facebook @camarthritis as I’m sure you have seen.

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