Article from AVMA on cats and arthritis

white shadow

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That appears to be a private Vet's blog....not exactly the AVMA.

'Seems like he's been sold the 'Metacam bill of goods':
She’s doing just fine with her anti-inflammatory medication
Sorry, doc...don't you know that cats cannot metabolize NSAIDs - but then, "twenty years ago" in Vet school, that wasn't in the curriculum....and, since then you've been receiving "continuing education" courtesy of the drug reps, right?

So, my question is" Will you fess up when her kidneys start to fail?"

My guess is, likely not...you'll probably chalk it up to "old age".
 
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simka

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My fault for posting this while insanely busy at work. The link came from a listserv that is used and moderated by vets and researchers. I'll ask to have this topic locked.
 
 

white shadow

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Simka......no fault of yours implied!!!!!!!! And, it could even be a focus for some discussion.

In fact, I think it's also a good lesson/reminder for us all that 'all vets are NOT created equal'...and that, not all Vet blogs/sites should be implicitly trusted.

And, who knows, maybe some of my presumptions are ass-umptions!
 

Willowy

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Steroids are anti-inflammatory, and are commonly used for arthritis. Maybe long-term use isn't healthy, but at a certain age you choose comfort over long-term safety. I'd even use Metacam if it meant comfort for an elderly cat.
 

dianeandbooboo

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There are many avenues to explore before using dangerous drugs like Metacam.  Even though I am not a fan of injections I would use Adaquan before I used Metacam and/or Pred.  With that said Adaquan would be a last resort.  There are chinese herbs and holistic supplements along with laser therapy and/or acupuncture.  There is also Reikki.  I try to avoid all prescription drugs at all costs and will only use them when all fails.  What good is it if you get the pain under control but the liver is being destroyed in the process?
 

kathryn41

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My 10 year old Maine Coon, Lion, was diagnosed with spinal arthritis last year when we were trying to find out the cause of him getting hyper and trying to attack his tail and hind paws.  The first obvious sign from the x rays was that he was constipated.  The second observation was that he had arthritis in the spinal vertebrae over the hips and that some of the spinal processes had even cracked and had spiky growths on them. The vet surmised that the full colon put pressure on the nerves in the area of the arthritis and it caused nerve pain - something similar to the tingling and numbness you get when you sleep on your arm - thus he kept trying to stop the strange sensation in his paws and tail by licking and biting them.  We put him on a stool softener to help prevent the constipation and it seemed to work, although every now and then he would give indications that he was getting those same nerve feelings in his legs and tail. I just increased the stool softener for a bit and that seemed to work. 

Fast forward a few months and Lion has a serious attack of non-stop vomiting and is unable to keep any food down. First suspecting and treating (without success) for a hairball in the intestines, the vet once again took x-rays.  They show that his colon is completely full and that the arthritis has definitely got worse.  She suspects that the pain of the full colon on the nerves in the arthritic area made it too painful for him to have a bowel movement so he just held it in instead, until he was vomiting because there was no place for ingested food to go. She gave him two enemas to get the colon contents to shift, which they finally did after several hours.  He came home with an appetite stimulant, a motility stimulant and metronidizole, but he was still obviously in pain around his tail and hips region.

We discussed the different options.  He was obviously in pain from the arthritis and it was impacting his ability even to function in daily life. I couldn't keep subjecting him to constipation and enemas because it hurt too much to have a bowel movement.  Steroids were a possibility, but they too have other side effects and in her experience the vet said were not the most effective method of dealing with arthritic pain.  The most effective method she knew was an anti-inflammatory NSAID - metacam.  Metacam used to be used very regularly but it now has a black box warning for cats due to a serious side effect- irreversible kidney damage which didn't generally respond to treatment.  Cats generally cannot process NSAIDS quickly and a little goes a very long way.  She did say that in all of her years of using metacam she had only had two cats that developed kidney failure, but it was still a concerning side effect and any decision to use metacam should not be made lightly.  She said if it were her cat she would use it.  She also explained that the dosing recommendations had changed substantially over the years as research has shown that a small amount can be maintained and processed slowly by the kidneys in most cats.In countries where the use of metacam is still considered appropriate, the dosage levels are significantly lower than in the US. She wanted to use the dosage levels recommended by Canada which is half the recommended level in the US.

I gave informed consent knowing that he could not continue with this type of pain and hoped we would get a dosage schedule that he could tolerate.  He is 16 1/2 lb so he got .14ml daily for the first 2 days to build up a background level and is now on .07 ml every second or 3day (3 times a week) to keep the level constant as it is metabolized extremely slowly. We tried reducing it to .07 ml every third day but the pain symptoms returned. 

The effect was very fast.  By the following day Lion was obviously feeling better and had a normal bowel movement without stress.  By the next day he was back to the happy, playful, attention demanding cat he used to be.  In retrospect I can see he must have been in pain for some time and it had been slowing him down and making him quiet and subdued.  So far he has had no obvious side effects from the metacam, but we are monitoring his kidney function regularly.  The two cats who ended up with kidney failure from metacam both showed symptoms quickly and were sick within a week and he is well past that mark.

So, yes, I fully understand the controversy around using metacam but sometimes it becomes the lesser of two evils.  Lion's arthritis was severe enough that it was a risk worth taking.  It may come to the point where he will need higher dosages or he may end up suffering side effects but we will cross that bridge when we come to it.  He could not go on the way he was.  We are keeping him on the smallest dose that we can that seems to impact the pain - medicate day 1, rest a day, mediate day 3, rest 2 days, medicate day 6, rest a day, and repeat.   It is so good to seem him out of pain but the arthritis will get worse as that is its nature.  We will have to see what the future holds. For now, I am just so grateful that there is an NSAID that can be used with care because it definitely works.
 
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orientalslave

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There are many avenues to explore before using dangerous drugs like Metacam.  Even though I am not a fan of injections I would use Adaquan before I used Metacam and/or Pred.  With that said Adaquan would be a last resort.  There are chinese herbs and holistic supplements along with laser therapy and/or acupuncture.  There is also Reikki.  I try to avoid all prescription drugs at all costs and will only use them when all fails.  What good is it if you get the pain under control but the liver is being destroyed in the process?
What good is painful life?

And don't assume Chinese herbs are safe - many are not, and what is safe for people may not be for cats.  In humans they have been linked to kidney disease, liver disease and cancer.
 

otto

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I am very happy to see so many postings warning against the use of metacam, a medication I am adamantly against the use of in cats, myself.

However in this situation below (Lion) , I can finally see where sometimes metacam can help a cat. My issue remains that too many vets cavalierly prescribe this for cats, without giving full discolsure of the potential risks, without knowing if the client will use the medication propelrly, without doing blood work first.



My 10 year old Maine Coon, Lion, was diagnosed with spinal arthritis last year when we were trying to find out the cause of him getting hyper and trying to attack his tail and hind paws.  The first obvious sign from the x rays was that he was constipated.  The second observation was that he had arthritis in the spinal vertebrae over the hips and that some of the spinal processes had even cracked and had spiky growths on them. The vet surmised that the full colon put pressure on the nerves in the area of the arthritis and it caused nerve pain - something similar to the tingling and numbness you get when you sleep on your arm - thus he kept trying to stop the strange sensation in his paws and tail by licking and biting them.  We put him on a stool softener to help prevent the constipation and it seemed to work, although every now and then he would give indications that he was getting those same nerve feelings in his legs and tail. I just increased the stool softener for a bit and that seemed to work. 

Fast forward a few months and Lion has a serious attack of non-stop vomiting and is unable to keep any food down. First suspecting and treating (without success) for a hairball in the intestines, the vet once again took x-rays.  They show that his colon is completely full and that the arthritis has definitely got worse.  She suspects that the pain of the full colon on the nerves in the arthritic area made it too painful for him to have a bowel movement so he just held it in instead, until he was vomiting because there was no place for ingested food to go. She gave him two enemas to get the colon contents to shift, which they finally did after several hours.  He came home with an appetite stimulant, a motility stimulant and metronidizole, but he was still obviously in pain around his tail and hips region.

We discussed the different options.  He was obviously in pain from the arthritis and it was impacting his ability even to function in daily life. I couldn't keep subjecting him to constipation and enemas because it hurt too much to have a bowel movement.  Steroids were a possibility, but they too have other side effects and in her experience the vet said were not the most effective method of dealing with arthritic pain.  The most effective method she knew was an anti-inflammatory NSAID - metacam.  Metacam used to be used very regularly but it now has a black box warning for cats due to a serious side effect- irreversible kidney damage which didn't generally respond to treatment.  Cats generally cannot process NSAIDS quickly and a little goes a very long way.  She did say that in all of her years of using metacam she had only had two cats that developed kidney failure, but it was still a concerning side effect and any decision to use metacam should not be made lightly.  She said if it were her cat she would use it.  She also explained that the dosing recommendations had changed substantially over the years as research has shown that a small amount can be maintained and processed slowly by the kidneys in most cats.In countries where the use of metacam is still considered appropriate, the dosage levels are significantly lower than in the US. She wanted to use the dosage levels recommended by Canada which is half the recommended level in the US.

I gave informed consent knowing that he could not continue with this type of pain and hoped we would get a dosage schedule that he could tolerate.  He is 16 1/2 lb so he got .14ml daily for the first 2 days to build up a background level and is now on .07 ml every second or 3day (3 times a week) to keep the level constant as it is metabolized extremely slowly. We tried reducing it to .07 ml every third day but the pain symptoms returned. 

The effect was very fast.  By the following day Lion was obviously feeling better and had a normal bowel movement without stress.  By the next day he was back to the happy, playful, attention demanding cat he used to be.  In retrospect I can see he must have been in pain for some time and it had been slowing him down and making him quiet and subdued.  So far he has had no obvious side effects from the metacam, but we are monitoring his kidney function regularly.  The two cats who ended up with kidney failure from metacam both showed symptoms quickly and were sick within a week and he is well past that mark.

So, yes, I fully understand the controversy around using metacam but sometimes it becomes the lesser of two evils.  Lion's arthritis was severe enough that it was a risk worth taking.  It may come to the point where he will need higher dosages or he may end up suffering side effects but we will cross that bridge when we come to it.  He could not go on the way he was.  We are keeping him on the smallest dose that we can that seems to impact the pain - medicate day 1, rest a day, mediate day 3, rest 2 days, medicate day 6, rest a day, and repeat.   It is so good to seem him out of pain but the arthritis will get worse as that is its nature.  We will have to see what the future holds. For now, I am just so grateful that there is an NSAID that can be used with care because it definitely works.
Thank you for sharing that. You and your vet did everything right. Unfortunately many times the med is simply prescribed without another thought. Many cats die of acute kidney failure from metacam when they never needed to be on it at all. There are safer short term pain medications.


There are many avenues to explore before using dangerous drugs like Metacam.  Even though I am not a fan of injections I would use Adaquan before I used Metacam and/or Pred.  With that said Adaquan would be a last resort.  There are chinese herbs and holistic supplements along with laser therapy and/or acupuncture.  There is also Reikki.  I try to avoid all prescription drugs at all costs and will only use them when all fails.  What good is it if you get the pain under control but the liver is being destroyed in the process?
My Ootay :rbheart: had terrible arthritis in her last couple of years. At the time Adequan was only for intramuscular injection (I have since read it can be given subcutaneously), which I thought would be too painful for her, and laser treatments weren't available. She had tramadol prescribed but I hated to use it because it made her so zombie like, even in tiny doses. Reiki helped her so much in her last six months.

Now that laser therapy is available, I intend to go that route with the next cat I have who has to deal with arthritis pain.
 
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dianeandbooboo

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First I want to make it clear that I only use holistic remedies under the direction of my holistic vet whom I trust and respect. If I had explored all other avenues and nothing worked and I was faced with either putting my cat down or using Metacam, I would give Metacam a try as a last resort.  I would never allow my cat to suffer but at least if (when) she went into liver failure I would know that I had tried everything else first.  I do not take comfort in a vet saying if it were my cat I would use Metacam because I work at a vet hospital and I see vets do things to their own pets I would never, in a million years do to my pets. All I am saying is that I would only use Metacam if my only other option was to put my cat down.
 

white shadow

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...if (when) she went into liver failure....
Metacam - or other NSAIDs - will not damage the liver....cats do not have the required liver enzymes to metabolize NSAIDs, so the drug goes directly to the kidneys - that's where the damage will occur - it kills kidney cells (nephrons).
 

jennyr

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Thank you all for sharing this valuable information. I am in hte situation of monitoring my Dushka as she has early arthritis in the hips and has been put on Cosequin for the moment, which does seem to be helping her. But the vet told me that long term an anti-inflammatory was the answer, and looked very puzzled when I said no. She showed me a recent article about a study done in Sydney, Australia, that 'proved' that Metacam was safe long term in cats. But when I read it in detail it was done on only 76 cats, and was written and published by the producers of Metacam! So I am exploring all avenues and educating myself for the day when Dushka may need something more. There certainly are times when quality of life has to be preferred over quantity, but we are a long way from that yet.
 
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