arthritis pain mgt - update - more questions see below

My civvie Sydney (age 16, 5.3 pounds) has really bad arthritis in her hips. She is all skin and bones, her muscle mass has deteriorated, probably due to early stages of kidney disease.

Anyway, we went to the vet, they took an xray as they thought they felt a mass in her tummy. Luckily, no mass, but the arthritis showed up and it's really bad.

So, was given some buprenex for pain management, but they won't give that long term.

Then was given tramadol to try. I gave Syd 1/4 tablet and she spent yesterday going crazy - she made circles in the house, wouldn't stop or lay down and was nuts. I also learned after that this is a steroid - UGH ohmygod_smile .

I'm giving her the glucosamine, MSM, chrondroitin - she's been getting that for years and I recently increased the amount she gets. I also just ordered salmon oil (as I heard that should help as well.)

My pet sitter used adequan years ago for her cat. When I look it up, it's made for horses and dogs and has some ugly side effects too.

So, while I wait for the vet to call tomorrow, I was wondering what you may have used for your cat to handle long term pain management that I could research and discuss with the vet.

 

Re: what to give for arthritis pain management

Tramadol is NOT a steroid!!!

PubMEd
"Tramadol is in a class of medications called opiate agonists."

 

Re: what to give for arthritis pain management

adequan in dogs is just fine, not sure about felines.

I would do some serious research on whether you could give a very very low dose of metacam. Yeah, controversial, but quality of life is important.....my canine has been on it for some time now and it makes a huge difference. Hopefully there are some better options but you may want to talk about it.

 

Re: what to give for arthritis pain management

Hi Hillary!

Sorry to hear Sydney is having trouble with arthritis pain :sad: For Zoe I have been using Dasequin which is glucosamine and something else (can't remember) and that seemed to really help her. I know a lot of people that are using Adequan (which is injectable) - here is some information on it:

http://marvistavet.org/html/adequan.html

I have been thinking about switching Zoe over to that as she is not tolerating the Dasequin anymore - seems to bother her tummy. :sad: I also have some fish oil capsules my vet wants me to try with her....haven't done that yet as she doesn't seem to need anything right now - she is jumping and walking fine.

FWIW - Tramadol is a non-steroidal anti-inflammatory - so no steroids in it. It has narcotic like side effects but is effective in pain management. Sorry to hear Sydney didn't do well on it - sounds like she had an awful day. I would be hesitant to try it again - but what about 1/8th of a tablet - maybe the 1/4 tab was too much.

Would be nice is she could have bupe and be done with it!

 

Re: what to give for arthritis pain management

My civie, Miss Emily, has severe arthritis, and has done well on Adequan, buprenorphine, acupuncture, and heating pads. She used to take some oral supplements as well, such as Cosequin and omega oils, but is now refusing to take those. Tramadol does often produce the side effect of agitation. You could possibly try Gabapentin.

Emily had a thread here once which received a ton of great suggestions on managing arthritis, so I am linking it here:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=25345&p=260951&hilit=miss emily#p260951

ETA: I wouldn't give metacam to a cat. There is a black box warning on the package now that it is not to be given to cats.
http://www.metacamkills.com/

 

Re: what to give for arthritis pain management

Thanks everyone. It was the person who answered the phone who said tramadol was a steroid and that is where I got it from. Glad to hear she was wrong.

Sherry - given how she was on 1/4 tablet, I would hate to experiment with her and try any more.

I do have some bupe that I can give her, but I know long term, the vet won't script it or sell me a decent amount. I've asked and they won't budge.

I won't even consider the metacam route, too much controversy and I've been on this board long enough to know better.

I give her the cosequin (equivalent) in treat form so she is good with that. I am just looking to see if there is anything more I can do to help her.

I ordered another set of steps so she can get on the coffee table and bed easily. she uses the shipping box to get on the sofa, but not the table, silly cat.

If I use the heating pad, sadly Maui will hog it and not share, so that's not a viable option. I know because I use to have two of them out and Maui would always manage to be on both at the same time....

Thanks for the ideas and please keep them coming.

 

Re: what to give for arthritis pain management

There are 2 aspects to arthritis management - pain and slowing progression of the arthritis. If you can slow the progression, it will help with pain.

I have had Gandalf on Adequan injections for 2 years now, as well as acupuncture. Although his condition has not greatly improved, it has not gotten worse within that time at such a rate that he seems uncomfortable or reacts like he is in pain. He walks more stiffly now, but he is almost 18 and a large bodied cat in whom arthritis would probably be very painful. He can still jump about 20" high.

Adequan is an injectable type of glucosamine. Even a large cat gets a very small dose (Gandalf gets .26cc and he is 14 lbs). It is used off label in cats. Because the doses are so small, it is very economical, even though a 5ml bottle is over $100. Much cheaper than buprenex! And you can probably find it cheaper than that online. One caution on its use is for animals with liver or kidney disorders. So discuss it with your vet first.

Acupuncture's advantages are 2 fold in our case. My acupuncture vet is a licensed vet, so she is knowledgeable about more than just doing acupuncture. I would highly recommend finding a vet licensed to practice acu on cats and dogs because of that. She also gives him B12 shots and the Adequan in acu points for fluid administration.

I feel the 2 courses of treatment have maintained his activity level over this period. Hope this is helpful.

 

Re: what to give for arthritis pain management

Thanks Vicky

I will discuss with vet and see if there is a combo one in the area too.

 

Re: what to give for arthritis pain management

Ennis has been on Adequan for about 3 months and it has taken 3 years off his age. He can run again. We tried glucosamine and Dausequin capsules, but those were a pain to manage (daily) and only gave him minor relief for a short amount of time. I give the Adequan shots every 2 weeks, 30U. Ennis weighs ~16.5 lbs.

I got 2 5ml vials for $110 from 1800PetMeds. Free shipping over $39. RX required.

 

Re: what to give for arthritis pain management

We had a hard time finding something Taz would stay on and were getting to the Adequan/pain med point because she limped quite a bit and didn't get up very much any more. My last ditch to keep her away from frequent vet trips (they won't let us do the Adequan ourselves) I ordered a product called Synflex in their pet version. I give 1/2 tbsp most days and she has improved sooo much it is amazing. No limping, not sleeping in one spot or staying in the basement all day, she is all over the place and jumping in and out of the cat trees and the bed again, putting the run on the kittens :lol: . She did do well on the other glucosamine products, but wouldn't stay on them for more than a week or two. This one comes with a dropper and I just squirt it into the back of her mouth.

 

Re: what to give for arthritis pain management

No, it is not an NSAID; it is in a totally different class of drugs called opiate agonists. It may cause sedation and can interact with other sedating medications. Please see this PubMed reference.

 

Re: what to give for arthritis pain management

I had a cat yt the name of Missy that had really bad knees. She one broke them and never fixed them so she came that way. When her knees were really bad I had to give her the tramadol and keep her in a large cage. She didn't like it but her knees needed the rest. It usually was just for a day or two them her body adjusted to taking the tramadol and she was okay. It sounds like your vet may have started the dosage to high. It is a powerful drug.


I have had to take it myself. The first time I took it I was scared so I could image what your cat felt like. No one warned me my body would have to get used to it. The first few days until your body gets used to it the room goes round and round and you feel spaced out! After I got used to it I was okay. I also downed the dosage I was taking. After getting used to it Tramadol was very effective. A lot better then the pain. Not sure if it would work the same way for your cat or not. It may be easier to try something else since this is a cat. I understood what was happening and it would take my body a little time to adapt to the meds. A cat doesn't understand that. They just know they feel weird. Missy balance would be unsteady for a day or two so I would keep her confined. She didn't like it but in the long run it was the best thing for her and took the pain away.

The Cosequin worked well for Missy. She didn't like taking pills so I got the capusles and opened them up and put it in her food. It took about 6 weeks to work. I took notice to a differance after that if I missed a dose by mistake. My vet told me to give her a little more then what they bottle said.

However what is better then the Cosequin is something called Excel Senior Vit. However if your cat is diabetic she won't be able to take it. It has sugar in it. It does have a lot of other things in that are very helpful to bad joints and health. It is a paste so I still use it for Mr Blue to put his heart medicine in. He loves the flavor so he licks it right off my finger.

Good luck

 

Re: what to give for arthritis pain management

I have been giving Oliver 1/4 tab of 50mg tramadol BID and he's like a brand new man now!
Other than a horrible drool if he gets a taste of the piece, if not well hidden in cheese or pill pocket, he is acting visibly relieved. He's more relaxed and sprawled out when he sleeps and I have actually seen him stretching which I never saw him do before.
Finally, he is much lighter on his feet, and waddles faster now.

If you seemed to get a bad / odd reaction, maybe stay away from the tram for sure.

 

Re: what to give for arthritis pain management

Venita, I'm sure you mean .3cc right? ;-)

Also, did you do a load period of the Adequan? I think the protocol has changed slightly, but when we started it needed to be a shot every 3 or 4 days (basically twice weekly) for a month. Check with your vet.

I did some reading on Adequan last night and discovered it is a synthetic heparinoid, meaning it can thin the blood, like Heparin. I am dealing with bloody stool from Gandalf and we recently changed his regimen of Adequan shots from once a month to twice a month, so I am checking with vet to see if we should go back to once a month. Please watch Ennis if you are doing every 2 weeks.

And everyone else should be aware of this also. Signs to watch for are blood in stool and nose bleeds. In diabetic cats, maybe pay attention to how the ear bleeds, but I have not noticed a difference there. Gandalf may have an ultrasound of his belly to determine if there is an intestinal problem, but when I read that about the Adequan, I feel it may have caused the bleeding, especially because there may be a build-up in the system, hence the need for a load period.

Just want to keep everyone's kitties safe! I would still highly recommend Adequan, just be aware of this possible side effect.

 

Re: what to give for arthritis pain management

Yep. In a 1cc insulin syringe, 30U would be .3cc or ml.

LOL. My vet sent me to the internet for dosing amount and timing. I got dosing here on the Board. This is the product information from the manufacturer.

I did do a "ramp up" period, although not quite as frequently as every 4 days. He is now on "maintenance" shots, which I have been giving every two week, to compensate for not having done the "ramp up" period as frequently as suggested. I had found what I now guess was an outdated web site that said the frequency should be every week. Ennis is doing so well that I may lengthen the time between the "maintenance" shots. Last night he was climbing me while I was sitting in a recliner (I am part of the furniture to him) to get to the back of the chair and onto a shelf of the bookcase. He hasn't ever been on that bookcase, which I have had about 5 years. He had seen young Nellie do it and I guess he wanted to try it.

As I said above, I may be lengthening the time between shots. His actions will tell me when he needs another shot. I am aware of the blood thinning effects. I haven't seen any blood in his stool. (He is kind enough not to cover his poops with litter.) Also, no change in the bleeding for ear pricks. Thanks for the reminder about the possible side effects.

 

Re: what to give for arthritis pain management

I give Piroxicam to Mr. Tubs. It's an NSAID similar to Metacam and yes, we are well aware of the risks. He has significant arthritis in his wrists and and lower lumbar. He bears weight as little as possible on his front paws. We are also dealing with cancer so the benefits of the NSAID far outweigh the risks at this point in maintaining quality of life. He's been on the Piroxicam since August of 2010 when diagnosed with fibrosarcoma and he's done very well on the maximum dosage. No stomach upset and no kidney/liver issues.

He's been on cosequin for a very long time and we recently added bupenorphine. We only been giving the bupenorphine as needed since he gets zombied out.

While I know there are risks with NSAIDS, I hate to see them always demonized. I think vets should be forthcoming about those risks so owners can make informed decisions on the benefits and risks. I do feel there is a place for them in pain management, particularly for end of life care.

 

Re: what to give for arthritis pain management

Just following up on this subject. I took Sydney to see a neurologist (long story) but anyway a second opinion was suggested so, I took Syd and her xray. Since she hasn't had recent bloodwork, the neurologist wanted that before recommending or prescribing anything.

The general vet and neurologist said that they don't believe adequan will help her. And of course the neurologist would like to do all kinds of diagnostics to really see what's going on. Sydney is too fragile to go through that, so we talked about supportive and pain management.

There is possible spinal damage maybe from arthritis and the general vet mentioned possible cancer, although the neurologist never said anything.

Depending on the CBC (not showing she is diabetic), he wants to put her on a low dose of prednisone. I asked about buprenex and didn't get any definitive response.

So, while yes I understand prednisone is a steroid and I don't want to get into a debate on the dangers of using this -

What I would like to hear is feedback for beans that do use this for their cats and if they feel it helps.

Also, if there are any other suggestions for pain/supportive management that I can discuss with the neurologist this afternoon.

 

Re: what to give for arthritis pain management

I'm sorry Hillary--"use this," meaning Adequan, prednisone, or bup?

Adequan, I read somewhere, does not help with arthritis in the spine. Haven't worked with the other for pain management....yet.

 

My sweetest of little men, Henry(GA) had a degenerative spinal cord disease and athritis. I can't recall the name of the disease, but his back looked like a dinasour, it arched upward. I adopted Henry at the age of 16.

I had no problem putting him on Prednisolone, not prednisone. I truly believe that when you need to use a steroid, you need to use one. Tucker would not have lived the extra year had he not been on Prednisolone and we know that because when there was a shortage and he went on prednisone, he went blind for a little over 24 hours from his brain tumor growing.

Henry never became diabetic. Tucker, already diabetic was experiencing lower numbers when on Prednisolone. ECID is always true and for me the choice was steroids or no cat in both situations.

For Henry we added Dasequin to his diet, gave him egg crate mattress beds and self warming matts to sleep on. The heat from the matts helped with pain relief and the egg crate mattresses relieved stress on his body from lying on harder surfaces that decrease blood flow. We installed ramps, not stairs for Henry to get up and down from the bed. He did have steps to the couch. We made it so he never had to jump down and hurt his bones when he landed. He lived two years and I believe they were very happy and wonderful two years. I still watch the videos of him with Tucker and Sam and I can see the love in his eyes. Ooops, sorry, sad moment for me... meant to keep this about you

 

Sorry, let me clarify, both vets feel that adequan will not help her. The neurologist mentioned prednisone yesterday as a possible option. I asked about bupe, but got no definitive answer.

Jennifer - I'll ask about Prednisolone to see if that may be a possibility.

Sydney has taken to living on the back of my futon eating, sleeping and yes using it as her bathroom. I've put down wee wee pads so can go on that and not ruin the furniture. I have to be very careful how I handle her, the slightest movement will make her scream. So she has self limited herself. I have stairs and boxes for her to walk up/down and have to bar her from my bed as she started using that as a litter box.

I even put a litter box on the seat of the futon, but she won't use it.

She has lost most of her muscle mass and is very bony. She always was tiny 5-7 pounds, now she is about 5 pounds and looks so fragile. She is afraid of my other two - Buster more than Maui. Buster will stay on the seat of the futon and Syd is ok with that, as long as she keeps her "distance".

I'm doing my best to hold it together while I figure out how best to help her and thank goodness for wee wee pads - talk about a life saver, not to mention laundry saver!

 

Norton got Prednisolone to help his arthritis and inflammation from a brain tumor.

He got a lot of relief from 6mg per day (dose based on weight).

Note that Prednisone and Prednisolone are related but not the same --- Prednisolone is directly used by the cat.

Prednisone has to be converted in the body to Prednisolone. This means the cat's body has to work harder to get the beneficial effects.

Norton was diabetic and we carefully watched his blood sugar when he started on Pred. His blood sugar did NOT increase.

 

thanks for this thread getting bumped..dealing with arthritis with Carly right now and it was rather suddenly painful. I was adding Dasuquin to her food but she is not eating right now so I will be doing that again. She totally zonked on sedation for xrays as well as the tramadol. She also has arthritis in her spine but will be talking to vet about adequan today. The bupe is also zonking her out but less than the tramadol. she processes these types of drugs very slowly. I have taken her off the bupe to see if she eats and she is more mobile off the bupe but also doesnt want me to touch her lower back.

I did ask about prednisolone but with her OTJ status we are holding off but I told vet that a bit of diabetes didnt matter to me if it helped reduce the inflammation. Adequan looks very good to me as its probably not going to zonk her out.

Will let you know. I hope you can find something for Sydney

OH! And as mentioned to me in a prev thread.... TRAMADOL is BITTER..it needs to be put in a gelcap.. it compounded the not eating problem and made her drool like mad when she even saw me approaching her, worse if I had syringe like for food feeding.

 

I don't think it will zonk her out. Within a hour of his maintenance dose, Ennis is up, and hungry, and running (in his wobbly way) up the stairs. This is a miracle drug for Ennis.

 

I use Metacam for cats at a low dose, rather a more pain free life that may be shorter than a longer pain filled life. ECID but this works for us. She doesn't get it every day, just when I think she needs some help.