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Neb's liver and arthritis

Posted By: jarn

Neb's liver and arthritis - 05/08/21 10:11 PM

So - Neb has arthritis. We realized this and started him on cartrophen (not caprofen or whatever it's called) which is supposed to rebuild cartilege. We gave him his shot weekly for a month (at which point he would've moved to monthly) and there was no improvement in his stiffness.

He had his annual during that and they agreed he has spinal arthritis.

So, we contacted them at the start of the week to say 'We need to think about pain management'. In their opinion, the options were NSAIDs, gabapentin (which is a nerve pain med so it's not my first choice), and tramadol (kinda opiate-y for a 13 year old dog? I don't know I want him on it long-term, and I am hoping he'll be around long-term).

He hadn't had bloodwork (beyond heartworm) since late 2019, so Toby took him yesterday for kidney and liver.

Kidney is great.

Liver - ALT is elevated (not horrifically, but enough that he can't just start a NSAID). They said we could try gabapentin or tramadol, but that in the vet's opinion, NSAIDs would be the first choice.

They had to order it in, but we are going to give him milk thistle for 3-4 weeks then retest. It's supposed to be liver supportive. I would expect that if it helps he'll have to stay on it while he's on the NSAID? But I didn't think to ask.

They think the ALT is likely just age-related changes. I know he's had issues with vomiting bile (GI upsets can also affect ALT) but that's almost stopped lately. So I doubt that. He did throw up this morning, but that's AFTER the test.

So, sigh. Never rains it pours.
Posted By: middleofnowhere

Re: Neb's liver and arthritis - 05/09/21 05:22 AM

For arthritis, lazier (sp) treatments help a lot, so does chiropractic adjustment paired with acupuncture. That's been the deal with my dogs. Don't have anything to offer on liver support.
Posted By: jarn

Re: Neb's liver and arthritis - 05/09/21 12:02 PM

We've done chiro with Neb (and Luc) before - I'm a bit worried his arthritis is too bad for adjustments - Timothy's elbow arthritis is. I suppose we'd have to x-rays, but we're living on a tight budget at the moment. Something worth saving up for. I'll ask about laser when we pick up the milk thistle next week.

For whatever reason, our vets do not seem to be enthralled with laser therapy - at least, when I asked about it for Timothy they were meh. At least, the injections worked with him. He's rebuilt cartilege I guess.
Posted By: jarn

Re: Neb's liver and arthritis - 05/09/21 04:37 PM

I found a vet nearby that does laser therapy. I'll talk to them and see if they need to see records from our vet (who I am pretty sure does not do it).
Posted By: Mary Jane

Re: Neb's liver and arthritis - 05/09/21 05:31 PM

I wish I knew something helpful-but I do have a small concern: opiates are really not for everybody. When Nova had a minimally invasive spay (another story), she was supposed to take tramadol for some days. She couldn't tolerate it-within hours the little girl couldn't walk in the house with the e-collar on-food was an enemy. I hope you have alternatives for Neb-especially for the long-term.

MJ
Posted By: jarn

Re: Neb's liver and arthritis - 05/09/21 05:44 PM

Thanks MJ. We tried Luc on tramadol at some point in the last few months of his life. He also couldn't tolerate it. He went off it close to immediately. That experience is definitely colouring my perceptions of it.

That, and Nebbers is only 13 - we hope he'll be around for years yet, and I don't want him on an opiate long term, at all.
Posted By: DarkEyes

Re: Neb's liver and arthritis - 05/11/21 03:59 PM

I haven't shared what has been happening with Abbey simply because there was too much going on. But concerning pain mgmt, I thought to share our experience in the last couple of months. I will keep it short. Abbey was on Tramadol from November to March-ish. Only reason she was taken off of it is because it did not help with pain mgmt and she messed up her leg from her obsessing over it. Her blood work last done a couple weeks ago and done in late March showed her organs are functioning fine. Prozac and... Some other medicine I cannot remember were awful on Abbey. She has been on gabapentin since I think November and has been on deramaxx for a few years. Cannot remember the name of it, something like Anypril dang, its $100 for a 30 days supply. Her current diagnosis is *something* neropathy, spinal arthritis, hip dysplasia, and severe arthritis in her right rear paw. She has lost feeling in her right hind leg and her left hind leg is showing signs of similar loss of feeling as well. She turns 13 next month.

The nerve pain mgmt, pain blockers, and the mental nerve disorder mgmt all seem to be helping Abbey. She isn't muzzled nearly as often to prevent her from mutilating herself. She is wagging her tail again.
Posted By: jarn

Re: Neb's liver and arthritis - 05/11/21 07:13 PM

Thanks DE. It's good to know gabapentin is helping Abbey. I'm not familiar with deramaxx, will look into it. Luc had similar issues at the end, though his hips were fine (he had arthritis and a polyneuropathy; no matter what/what kind of pain med we tried, nothing helped). I suppose seeing Luc struggle colours my perception of poor Nebbers.

Neb's milk thistle has come in, but I slipped (darn wet grass on a hill!) this morning with the dogs (Agis was fixing to poop after a VERY long time outside, and he pulls right before he poops) and compressed some vertabrae in my neck, my ulnar nerve is causing issues. I drove to the chiro but had trouble turning and looking so I'd rather not drive anymore today. Man but I'm not 'old' yet, but my poor aching body!

I'm so glad Abbey is doing better! That makes me really happy. And wagging her tail, yay!

Neb still has his moments. I was eating half a (small) honeydew melon this morning and "accidentally dropping" small bits for Nebbers (I do that for him sometimes because he's old and deserves it). Was heating my back (turns out ice is better at the moment) and put the melon on the chest of drawers in our entry way as one of our (formerly fat and still has the appetite) cats will go up onto the dining table and eat any sort of food, even if it's not food you'd think a cat would like.

Well - who stood up and grabbed a piece of melon from the bowl but Nebbers (I took it away). Give them an inch, eh.
Posted By: SeanRescueMom

Re: Neb's liver and arthritis - 05/11/21 09:40 PM

Sorry about your neck, Jenn. Regarding the laser therapy that middle mentioned, our vet had recommended it for our cat who has arthritis in his back end. She said it's important who you go to for it but she's seen excellent results so you may want to look into it. I hope the milk thistle helps Neb too. crossedfingers
Posted By: jarn

Re: Neb's liver and arthritis - 05/11/21 11:47 PM

Leaving aside that Toby doesn't feel laser therapy has proven efficacy in a double-blind study or what have you, all of the places here that do it aren't taking new patients (neither is our vet) - yay COVID!

So milk thistle it is.
Posted By: jarn

Re: Neb's liver and arthritis - 05/11/21 11:48 PM

(and thanks about my neck)
Posted By: middleofnowhere

Re: Neb's liver and arthritis - 05/12/21 07:05 PM

For the last duo when I lived in Arkansas, the best for pain management really was a chiropractor who primarily treated humans. He was the heck and gone magic for my aging dogs. Other adjusters help, in particular a vet in Arkansas, but that man was, well, magic. Or at least very very very good.
Posted By: jarn

Re: Neb's liver and arthritis - 05/12/21 11:12 PM

We've taken Neb to the chiro before, when he had an SI joint and sacrum out of joint. It costs $120/visit here though, and while I hate to put a price on that, we don't have that kind of cash to be doing weekly visits of $120. We did Luc when he was middle aged and had mild arthritis, and never particularly noticed much help.
Posted By: jarn

Re: Neb's liver and arthritis - 05/14/21 11:51 AM

Toby got Neb's milk thistle yesterday - it's $68 for a 6 week supply - which is way more doable. Whew. So I hope it helps and he can go on a pain med.
Posted By: SeanRescueMom

Re: Neb's liver and arthritis - 05/14/21 09:57 PM

Thanks for the update -I'm glad Toby got the milk thistle. Do you know how long it takes to show any signs of improvement for Neb? Please let us know if it helps.
Posted By: jarn

Re: Neb's liver and arthritis - 05/15/21 12:17 PM

Thanks SRM. I'm not sure as I didn't notice Neb showing any signs of being unwell from the liver - just old age/arthritis we noticed. Bloodwork is scheduled for four weeks from now so I'm guessing by then we'll know if it's doing anything. Will update for sure.
Posted By: Shilohsmom

Re: Neb's liver and arthritis - 05/16/21 05:41 PM

Jenn, how's your neck and how's Neb doing? It's so hard with everything being so expensive. I was lucky. I was able to cash in some of my life insurance in order to pay Eli's pain meds which were over $500 a month. I don't know what I'd do now if I had bills like that.
Posted By: jarn

Re: Neb's liver and arthritis - 05/16/21 08:53 PM

Thanks Rosa. Neck all back to normal.

Neb's okay - holding about the same. Toby took him yesterday to the park across the street, so he could slowly wander around off-leash. He brought his favourite leather rag to tug with and Neb was half-hearted, especially with shaking his head and 'killing' the rag. So he does have discomfort.

Yes, we don't have any other sources of income than what we do currently. Though Toby's going to be working 5 days a week again (for now) so that should help some. And I'm thinking chiro would supplement, not replace, pain meds, so we need to be prepared for both costs.

We have insurance on the three youngest - last year I looked a bunch of places to see if they would insure Neb, and none of them would due to his age.
Posted By: Shilohsmom

Re: Neb's liver and arthritis - 05/17/21 04:40 PM

Glad to hear your neck is better happyboogie

Too bad no one would insure Neb. Glad he was able to get out and enjoy some time in the park with his favorite toy. All we can do is the best we can do. Your doing a great job with your fur family. hugging
Posted By: jarn

Re: Neb's liver and arthritis - 05/17/21 07:20 PM

Thanks Rosa.

An intriguing development. A week or two ago, when his liver values came back elevated, I asked the vet if him getting pepcid (which he gets twice a day for vomiting bile - he also gets fed 4x/day now) could affect it. She looked and said no evidence. I called today to see if there was anything else we could do for him before he gets the retest of ALT.

She called me back and said 'I was going to call you today. I poked around and found that while there's no evidence that pepcid raises ALT in dogs, it has been shown to do so in humans.'

Hmmm...not a definite causal link but enough that we're going to slowly transition him off of pepcid and see how he does. We'll keep him on the milk thistle as well and retest June 11th as planned.

And I pick up gabapentin today to help with pain until the retest.
Posted By: Woodreb

Re: Neb's liver and arthritis - 05/17/21 10:49 PM

Originally Posted by jarn
Thanks Rosa.

An intriguing development. A week or two ago, when his liver values came back elevated, I asked the vet if him getting pepcid (which he gets twice a day for vomiting bile - he also gets fed 4x/day now) could affect it. She looked and said no evidence. I called today to see if there was anything else we could do for him before he gets the retest of ALT.

She called me back and said 'I was going to call you today. I poked around and found that while there's no evidence that pepcid raises ALT in dogs, it has been shown to do so in humans.'

Hmmm...not a definite causal link but enough that we're going to slowly transition him off of pepcid and see how he does. We'll keep him on the milk thistle as well and retest June 11th as planned.

And I pick up gabapentin today to help with pain until the retest.


Well, many of the medications that we take are first studied in other mammals because they can give similar responses to the medication. There may be data somewhere that could support what you think, it's just not necessarily available and/or published for the general public. If I were your vet, I think I's see if I could find out what animals were used in initial studies of pepcid for people before it first came on the market.
Posted By: jarn

Re: Neb's liver and arthritis - 05/18/21 11:55 AM

I believe she looked for that. I trust her. Like I said, she wasn't able to develop a clear correlation, but she thought it was worth tapering him off before the retest, especially since he's been doing well on four meals a day.
Posted By: Woodreb

Re: Neb's liver and arthritis - 05/18/21 12:50 PM

Jenn, I wasn't trying to say anything against your vet with my comment.

I worked in the pharmaceutical field most of my career as an analytical chemist and I found that very few of my colleagues seemed to think "outside the box" when it came to looking for solutions to solve a problem. If they were looking for ideas on how to develop an analysis, they would look at pharma articles only. Very few would think to look at articles say from the petroleum field or the food industry. But I would, and if I were a vet or doctor, I wouldn't limit my research to only one area.

Here's to all good vets who think outside the box.
Posted By: jarn

Re: Neb's liver and arthritis - 05/18/21 01:23 PM

Thanks Woodreb. Sorry if I came across snappy - I am in a very grumpy mood today for no real reason! Not sure why, but I am super grumpy.

I went off the pill because I think I'm in perimenopause? Possibly? Anyways, I have my period, and I don't know if the pill previously evened out my moods when menstruating or if I am just grumpy for no real reason.
Posted By: Shilohsmom

Re: Neb's liver and arthritis - 05/25/21 11:52 PM

Just wanted to check in on Jenn and see how your feeling? It's been so long since I've been on the pill I don't remember if it affects the mood. With all you have on your plate right now I'd be surprised if you weren't grump hugging I think this pandemic and coming out of it has affected us in many ways, some that we don't even realize yet.

There's a big grocery story in the same court as where I get my cancer treatment. After treatment I went over and walked through the store picking up a few things. I've got to say it just feels weird being back out there. If the budget will allow I might stick to on line ordering. I use to think what a pain it was not being able to pick out my own food but now its like one less reason to leave my house and just shop online.
Posted By: jarn

Re: Neb's liver and arthritis - 05/27/21 12:25 PM

Thanks for checking in Rosa. I've been better. It is what it is I suppose. Just trying to take care and stay above the drain.

It is weird to shop again. We have been doing it because food delivery is so expensive here, both with delivery fees and tip but also because you have to shop at more expensive stores.

I hope you're well.
Posted By: Shilohsmom

Re: Neb's liver and arthritis - 05/27/21 08:09 PM

I hear ya Jenn. I've really struggled with things. I worry what 14 months of isolation has done to my social skills. It's really weird but I haven't invited anyone over. I made an open invite to Nancy and normally I'd follow up on that, not this time. My house really is a mess. I spent all morning cleaning the living and dining rooms. It took that long and the rooms aren't that big. I JUST NOW took the microwave I bought for the holidays out of the box and installed it. Hopefully Middle will see that as I don't always get to things. But I'm determined to get the house cleaned up. Maybe then I'll ask Nancy over again. She barely knows Sasha.

I'm not fond of shopping, so I didn't miss out on any of that. I'm thinking I'll stick with Amazon Fresh on some of the things I get that are actually cheaper than in the stores. I eat Okra like crazy and they sell it for $1.29. When I stopped at the store it was $2.19 a bag. So that's a big difference. I just need to stir away from the pricier items. There is that $5.00 tip but it's really worth that not to have to go to the store and bring home all the stuff myself. And I've gotten use to waiting for everything.

Hopefully the mental health of all of us will improve soon. We've been through a lot!!! We are living through a global pandemic. There's been so much uncertainty in so many ways of our lives, it's taken a toll on all of us.
Posted By: jarn

Re: Neb's liver and arthritis - 05/28/21 03:32 PM

I hear you on the social skills Rosa. I think everyone's a bit like that. It helps me to live with Toby. We saw one friend in March on a patio - things were open for a week before shutting - and that was lovely.

I have been trying to clean more. Toby FINALLY vacuumed the rug in the living room - when I was doing strength and core I'd be like 'Eww I'm getting cat litter on my knees/etc. We don't have that big a place either.

Hopefully Nancy can come by.

I was ordering lentil pasta from Amazon, here they only have the red lentil penne in the stores. Toby hates it. We've stopped as it's expensive, thought it's a shame, their green lentil lasagna sheets were good, even Toby liked them. But we can't afford them, so no more.

I hope all this ends soon. We've got over 65% of adults with at least one shot in Ontario, so I am hopeful we'll be able to camp in June for our anniversary and Toby's birthday. I've left our neighbour hood once since November.
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