# Pain meds and liver problems



## Jennifer89 (Nov 27, 2012)

My chi turns 11 in June, last year he was diagnosed with a bad liver (I don't understand the point system but he was around 330 both times he was tested), I tried to treat it with some stuff his vet prescribed and a prescription diet but it got worse instead of better. He was also diagnosed with a condition where his knees pop out of place. Last year the vet said it prob happened occasionally, and until the pain got to be bad to get him on some fish oil, I did so for 3 months to no improvement. This week I took him to the vet because he was in a lot of pain, wouldn't walk up the stairs, was walking a lot stiffer then usual and so forth. The vet did an exam and said that she thought his joints were popping out of place every time he stood up! She also said that if he didn't already have arthritis he would soon enough, the only way to diagnose him is to do an xray but they would have to sedate him for that, which they won't do with his liver. His liver is also bad enough that they wouldn't fix him last year when I took him in. The normal course of action would be a surgery, but again, they refuse to put him under due to his liver and age. 

So they prescribed him a pain medication, it helps to bring down inflammation. I started it on him yesterday and could already see a difference! He was running faster, jumping, going up and down the stairs with ease, rolling around... it was nice to see. The problem is that the pain killers are processed by the liver, this wouldn't be an issue if his liver was healthy, but since it is not, it will slowly make his liver worse until he dies. The vet explained all of this to me and told me that I could leave him off of the meds and he would live longer, but my baby is playing fetch again and I can tell a huge difference. So, I am going to continue him on them, his happiness and ability to enjoy what he loves is way more important to me then squeezing out an extra long life. He can now go back to the dog park, hiking and playing extra long games of fetch! 

My question is, if anyone has dealt with this before in a chi or small bread dog, how long did you have with your baby after starting on pain meds? How quickly did his health decline? Did you end up euthanizeing him

I know 11 years is a short life for a dog his size, I rescued him exactly one year ago this month, and I have done everything I can to keep him healthy... high end food, water available 24/7, all the meds prescribed by the vet, got him dental care (the vet was willing to put him under for that bc he said the liver problems could be caused by his teeth), lots of exercise, brought him down to a healthy weight... but I'm pretty sure he came from a puppy mill and is prob inbred, and let's face it, purebreds just aren't as healthy as mutts. 

Any experience would be appreciated.


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## PearlyQ (Nov 2, 2012)

Ask your Vet about using "SAMe" for liver functions. If your dog has a SGPT level of 330, that is very high. Has your Vet ever given you are diagnosis for the high liver values? 
Using pain meds for a dog in liver failure is a two edged sword. They will ease pain but take a high toll on the liver. Not to mention that nsaids for dogs are damaging to the digestive system when using long term. If you have to use the pain meds, consider using a digestive coating med like "carafate". 
At this point, you and your Vet have to find the meds that will help with pain and not hasten the liver disease. 
To answer your question about euthansia; I never gave up on my dog. Of course each person has their own views about that. I feel as long as medications can be used to control a condition, they should be used. Factors should be considered like is the pet in uncomfortable pain all the time, is there loss of dignity, etc. You pet will almost always let you know when they have had enough. 
Thank you for rescuing this sweet dog. This may have been the best year of his life thanks to you. Sometimes the quality of a dog's life overshadows the quanity of a dogs' life.


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## Jennifer89 (Nov 27, 2012)

Ask your Vet about using "SAMe" for liver functions. If your dog has a SGPT level of 330, that is very high. Has your Vet ever given you are diagnosis for the high liver values? 

What type of diagnosis are you talking about? I was told his liver levels were very high and that there's no exact number in which it is too high for a dog to continue to live... they said that they had seen large breed dogs live to 800-900, but there are too many factors to determine what Cosmos's number is. Do you know what the average number is for a chi?

Using pain meds for a dog in liver failure is a two edged sword. They will ease pain but take a high toll on the liver. Not to mention that nsaids for dogs are damaging to the digestive system when using long term. If you have to use the pain meds, consider using a digestive coating med like "carafate". 

Thanks, I'll look into that!

At this point, you and your Vet have to find the meds that will help with pain and not hasten the liver disease. 

I asked about alternatives but this was the number one thing the vet recommended, I am on a small budget but could prob raise money (I have a great group of friends) but his vet didn't have any alternative recommendations. She said that I could keep him on liver supplements but last time he was on them, there was no improvement, in fact, there was a slight increase  He hadn't received any veterinary care for 8 years before I got him, I was given his paper work when I got him and the last time he had been to the vet was when he was 2, he hadn't even been given a rabies vaccine for all those years. I just have to trust that these vets know what they are talking about, they have pulled all his blood work twice, ran several physicals, tested his stool, updated him on everything... it's hard but i have to trust that they know what they are talking about and making the best recommendations for him they can.

To answer your question about euthansia; I never gave up on my dog. Of course each person has their own views about that. I feel as long as medications can be used to control a condition, they should be used. Factors should be considered like is the pet in uncomfortable pain all the time, is there loss of dignity, etc. You pet will almost always let you know when they have had enough. 

I do believe that there is a time when many dogs need to be euthanized, I will not leave him in pain for weeks on end... I guess I'm just wondering if it's something where his liver failure is going to cause him a lot of pain or if he'll just pass away one night?

Thank you for rescuing this sweet dog. This may have been the best year of his life thanks to you. Sometimes the quality of a dog's life overshadows the quanity of a dogs' life.

Thank you, that's what I'm going for, he loves the dog park and hikes and fetch, so we are going to focus on that this summer. I'll be taking online classes and should have plenty of time with my dogs to play. I just want him to be able to do the things he loves for as long as possible.


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## ChiChiLove (Feb 4, 2013)

Have you tried other pain meds? Why is your vet only suggesting NSAIDs? There are many other pain meds that do not affect the liver, such as tramadol, which can safely be given in multiple doses through out the day. Plus it can be used very long term. I've seen patients on tramadol 3 times a day for two plus years with no ill effects. Also, I would start this pup on high quality joint supplements and start getting him adequan injections. Adequan helps the body to create the fluid inside of the joints. You do biweekly injections, then weekly, then every other week, then as needed. This miracle drug saved my dogs life... She has hip displaysia that is so bad that her hips barely sit in their sockets. She was in excruciating pain, regardless of pain meds, until the adequan injections. Now she is pain (and pain med) free!

If I were you, I would be looking for a new vet, too. There is testing that can be done to further evaluate liver issues and can determine what is safe or not (such as anesthesia). Please consider getting a second opinion or visiting an internal medicine specialist.


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## Jennifer89 (Nov 27, 2012)

ChiChiLove said:


> Have you tried other pain meds? Why is your vet only suggesting NSAIDs? There are many other pain meds that do not affect the liver, such as tramadol, which can safely be given in multiple doses through out the day. Plus it can be used very long term. I've seen patients on tramadol 3 times a day for two plus years with no ill effects. Also, I would start this pup on high quality joint supplements and start getting him adequan injections. Adequan helps the body to create the fluid inside of the joints. You do biweekly injections, then weekly, then every other week, then as needed. This miracle drug saved my dogs life... She has hip displaysia that is so bad that her hips barely sit in their sockets. She was in excruciating pain, regardless of pain meds, until the adequan injections. Now she is pain (and pain med) free!
> 
> If I were you, I would be looking for a new vet, too. There is testing that can be done to further evaluate liver issues and can determine what is safe or not (such as anesthesia). Please consider getting a second opinion or visiting an internal medicine specialist.
> 
> ...


It could also have to do with the budget I'm on? I'm assuming the injections would add up in price really quickly. I can raise money for a treatment but raising money for ongoing treatments would be difficult. I'm a student and pretty low on cash. That's kinda why I haven't gotten a 2nd opinion either, I'm assuming another vet would want to run more recent blood tests, plus the price of the appointment, plus the cost of new meds... 

Honestly I'm very sad that Cosmos is in bad health, but if I had hundreds of dollars I would rather give it to a shelter then to ongoing treatments, injections, antibiotics, you name it... Cosmos HATES all of those and I am not going make him spend every other week for the rest of his life at the vets office. We will go to the dog park, on hikes, play games of fetch and enjoy our months together... I wouldn't want my last few months on this earth to be spent in and out of a hospital and I'm sure my dog would feel the same way. That may sound uncaring and cruel but if I was diagnosed with cancer, I wouldn't spend my months in chemo, I would spend it enjoying every minute of every day, and that's what I'm going to do for my dog, not torture him with endless needles and vet visits... I know a lot of people disagree but I don't feel that it would be right for Cosmos.


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## Yessicah (Nov 1, 2012)

Oh my sorry to hear that  I wish you guys the best 


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## ChiChiLove (Feb 4, 2013)

Jennifer89 said:


> It could also have to do with the budget I'm on? I'm assuming the injections would add up in price really quickly. I can raise money for a treatment but raising money for ongoing treatments would be difficult. I'm a student and pretty low on cash. That's kinda why I haven't gotten a 2nd opinion either, I'm assuming another vet would want to run more recent blood tests, plus the price of the appointment, plus the cost of new meds...
> 
> Honestly I'm very sad that Cosmos is in bad health, but if I had hundreds of dollars I would rather give it to a shelter then to ongoing treatments, injections, antibiotics, you name it... Cosmos HATES all of those and I am not going make him spend every other week for the rest of his life at the vets office. We will go to the dog park, on hikes, play games of fetch and enjoy our months together... I wouldn't want my last few months on this earth to be spent in and out of a hospital and I'm sure my dog would feel the same way. That may sound uncaring and cruel but if I was diagnosed with cancer, I wouldn't spend my months in chemo, I would spend it enjoying every minute of every day, and that's what I'm going to do for my dog, not torture him with endless needles and vet visits... I know a lot of people disagree but I don't feel that it would be right for Cosmos.



Tramadol is one of the least expensive pain meds to give. Plus, a little chi only takes about 1/4 of a pill. So one pill could last several days, depending on the dosage. You can get it at a human pharmacy for just a few bucks.
Also, to compare adequan to chemo is not an even comparison. The point of the adequan injections is so that Cosmos CAN run and hike pain free WITHOUT sacrificing his liver (like the NSAIDs are doing). Adequan literally heals the joint by stimulating the body to produce synovial fluid. The adequan injections can be given subcutaneously or intramuscularly and take two seconds to give. And I feel your pain for budget. But there are always ways to make things cheaper. Ask your vet for a script and order the bottle of adequan yourself.

http://www.drsfostersmith.com/product/prod_Display.cfm?siteid=13&pCatId=10309

One bottle should last a couple of courses of treatment for a tiny dog. Then your vet could teach you to do the shots at home. It is very easy to do! Plus, it's not life long. Once you finish a "cycle", you won't give a shot again until you need to start a new course - possibly six months to a year later. Giving these injections could reduce or ELIMINATE the need for ANY pain meds. Why not give your guy a chance at a pain free life? Plus, with no liver damaging side effects, you could be adding YEARS to his life! Without adequan, my rotti mix girl would be unable to even stand up without massive amounts of pain meds. I did ONE cycle about a year ago and she hasn't needed ANY pain meds since.

As far as further testing, at the minimum try to get a bile acids test done. That will give you more info then standard blood work. I know it can be tough financially to get a second opinion, but it really could help. Your vet might be completely missing something that another vet will find. Liver issues are tough, and a lot of "old school" vets don't know the best way to handle things. If you can get me the most recent blood work results that you have, I would be happy to have them looked at by the vets I work with. They might be able to suggest something just by checking out those results. Kind of a free second opinion. Lol.


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## pupluv168 (Mar 7, 2012)

My moms mix Lilly was on rimadyl for a long time for bad arthritis and a leg injury. A couple months ago, she was diagnosed with some liver issues directly caused by the NSAID usage. So the vet said no more rimadyl. 

Now she takes tramadol which is cheaper and doesn't damage the liver. She's also getting adequan (sp?) shots. They are on the expensive side, since she is a larger dog. But this treatment is a miracle for her. She is 10 years old and running around like a puppy again. She doesn't limp. She's constantly wagging her tail and happy. 

There is no reason you should have to choose between your dog living in pain or dying from liver failure. There are a lot of other options some of which are no more expensive than NSAIDs. If your vet hasn't explained them to you, I would get a second opinion. Or at least bring these options to the vets attention. 


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## Jennifer89 (Nov 27, 2012)

My dog is on Metacam, BTW... Pupluv do you think the temadol could help without the shots? 

As a point of reference, Metacam is costing me $11 for a 30 day supply (assuming that he is receiving it every day).


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## ChiChiLove (Feb 4, 2013)

Tramadol will help a lot with the pain, but it won't do anything to fix the problem. So he will be stuck on tramadol. And it makes some dogs sleepy and/or nauseous.


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## pupluv168 (Mar 7, 2012)

ChiChiLove said:


> Tramadol will help a lot with the pain, but it won't do anything to fix the problem. So he will be stuck on tramadol. And it makes some dogs sleepy and/or nauseous.
> 
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This is correct. The tramadol is strictly to help with pain. It doesn't so anything to help the condition.

But if OP is simply worried about keeping her dog pain free while he lives out his life, and is on a very strict budget, I think it is a better option than something that causes liver problems. The shots have been the best for Lilly, but the tramadol was controlling the pain before the shots and still is. She's experienced no side effects but I think that depends on the dog. 


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## Jennifer89 (Nov 27, 2012)

There's just a lot of factors... swelling in his legs, his history of reacting badly to some antibiotics in the past, his weight loss on some drugs... I'm just going to trust the vet on this one. She knows his medical history better then any other vet, she has his best interests in mind, she wants him to be healthy and happy, she has at least 8 years of medical schooling behind her plus many years as a vet. Those are facts. I'm taking her recommendation and I trust her.


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