Dogs, Rimadyl, and the liver

[anakiwa]

First the precautionary part of this: If your dog is ever put on Rimadyl watch very closely for any signs of stomach or liver problems (decreased appetite and/or vomiting). If this happens stop the drug immediately and have the dog checked out by the vet.

Here's the story. My BF has a 12 year old lab (well mostly lab with a little bit of who knows what) named Sara. Two weeks ago he took her into the vet and was given a prescription for Rimadyl for arthritis (she's been slowing down and has a lot of trouble getting up the stairs sometimes). She seemed to do well on the drug at first, but last Wednesday she stopped eating (not normal for Sara). We figured the drug was bothering her stomach and stopped it. The next day her urine was dark and BF took Sara in. Her ALT (blood test measuring liver inflammation/injury) was off the charts. The vet said it was certainly from the Rimadyl and kept the dog there for intravenous fluids and antibiotics. We went to see her on Saturday- her spirits seemed great (she's wagging her tail and acting normally, just doesn't want to eat). At that point the ALT was coming down, but the alk phos and bilirubin were going up. The vet (a different one from the one who had seen her last week, but the one who originally prescribed the Rimadyl) was concerned that it could be a gall bladder mucocele. She recommended taking the dog to a bigger clinic (1 1/2 hrs away) and having an ultrasound to make sure she doesn't need gall bladder surgery. BF thought it over and decided that the ordeal (for us and the dog) and expense weren't worth it given her age. (He had also been given the impression by the other vet that the rimadyl was to blame and that care was supportive only.) Since then she's stayed at the vet. She continues to seem fine, but her bilirubin continues to go up (it's now 22- very high). After a lot of thought, he went in there today to take her home (with the realization that she may die, but the desire to have some time with her if possible). The vet keeps pushing him to keep her there and to have an ultrasound. While he's not upset that the dog was given Rimadyl (it seemed a reasonable thing to try- and it has helped my dog a lot in the past), he is getting frustrated by the fact that the vet keeps pushing this gall bladder problem (it's starting to feel like they're worried the dog will die and want to avoid blame).

So here are my questions:

Anyone with any experience with liver toxicity from Rimadyl?

Anyone with any experience with gall bladder mucocele problems?

Anyone ever watched a dog die of liver failure? Was the dog uncomfortable? Right now the dog appears to be perfectly comfortable- it's therefore hard to imaging putting her down (and after all she could still get better). If we take her home we're prepared she may die, but we don't want to be in a situation where the dog is suffering and we can't do anything about it.

[Blueberry]

No experience to share - just wanted to express my sympathies We're dealing with our share of fur baby problems too (congestive heart failure and a yet unexplained stomach issue), so we certainly can sympathize.

CA

[sundial]

Anakiwa, I've switched my seniors to Prevacox for the very reason you have mentioned--the potential for adverse reactions to Rimadyl. Many of my gsd friends will not use Rimadyl and have chosen instead to use Ester-C, glucosamine and chondroitan. I use enteric coated aspirin for my foster boy while he's being treated for heartworms--no Prevacox. Let me check and see if I can find an article about complications using Rimadyl.

I have not lost a dog to liver failure--just kidney failure. I'm sorry that your Sara is having problems and I hope she gets to feeling better soon.

[sundial]

Here's a website of information about Rimadyl and other NSAIDs. If you will scroll down the page, you can read about reactions to Rimadyl.

http://www.srdogs.com/Pages/rimadylfr.html

[HoosierGiant]

My heart goes out to you!

We lost our 15-year-old Border Collie to sudden kidney failure shortly after starting Rimadyl for arthritis. While Rimadyl has been shown to be extremely effective in most cases, there's no doubt in anyone's mind that Hoosier was another member of the group of canines that are adversely affected by the drug.

Best wishes to all of you...

[makbike]

It is possible that the Rimadyl tipped the scales and there was already a preexisting liver/gall bladder issue. The push for the ultrasound is not an unreasonable one - it will let you and the vets know if they are treating the problem correctly or if they need to take a different path.

Rimadyl can cause problems - did the vet run a blood panel before prescribing the Rimadyl to check values (liver, kidney, etc)? Please don't let whatever the problem is go untreated - liver failure is a terrible way to die. The dog will often stop eating, develop diarrhea, vomiting, abdomen can become very uncomfortable, etc. Did they send home a prescription diet? Any medications?

Keep us posted and I hope things work out for you guys and dog.

[nic840]

Thank you for the heads-up. My Big Boy, Oscar, will be 10 in May and I started him on Rimadyl a few months ago because of severe arthritis in one of his shoulders. He is a hunting dog and has been active his whole life.

He seems to be doing really well on it. I have tried a few other things and this is the one that has made the biggest difference.
His prescription ran out a few weeks ago and I stopped it to see if it made a difference and he came up lame quite a bit more. Poor guy...he is my first baby and its hard to see him sore. I put him back on it a week ago and so far so good.

I will definitely keep an eye on his eating habits...he eats anything and everything...typical Lab.

Sara is at an age where little things start to compound and they just can't recover as fast. Twelve is getting up there for a Lab and I think as long as she is comfortable you should just enjoy the few years she may have left. I am not looking forward to those days and my heart goes out to you.
I will keep thinking good doggy thoughts for you, your BF and Sara.

[smilingcat]

I wish Sara will pull through this ordeal with the liver and all. It is just so hard to see your animal being sick. It feels so hopeless at times.

If she is comfortable then let her rest and maybe she will rebound from the Rimadyl ordeal.
We have had our dogs on Rimadyl when arthritis became really bad. But we never like Rimadyl for all the things we have heard. So we used it as a last resort. As a supplemental thing. We use glucosamine and chondro??. It does make a difference when the arthritis isn't so bad. We also took our babies on shorter and shorter easier and easier walks. When they got really stiff in the joints, just being able to go out the front door was more than enough. But it was plenty for them to be happy.

So when Sara recovers, adjust her activity to what she can do. She will be very greatful/happy. When our dogs got old, they were just happy to see us and lay by our side, dinner time, watching TV (when we still had one), or lay in th kitchen while I made dinner.

And keep her warm too. The cold is hard on them.

wish Sara and you lots of good healing thoughts,
Smilingcat

[OakLeaf]

Add my prayers, too, for all of you.

I really don't know anything about liver function tests in dogs, but is it possible that the new r/o diagnosis is because of the changes in her blood levels? If it were a gall bladder issue, is surgery the only option?

My dogs had stomach trouble from most NSAIDs, but thankfully no liver issues.

And just throwing it out into the mix since this thread has gone to doggie arthritis generally - my dogs showed little to no response to oral glucosamine/chondroitin, but the one of them who had the shots (Adequan) did really well on those. It's a tradeoff though, because they have to get the shot monthly, and it's IM, so it's a bit painful for the dog.

[anakiwa]

Thanks for all your thoughts.

I should clarify though- Sara is still at the vet. She had the ultrasound this morning and we're still waiting to hear the results.

I think part of the concern about the ultrasound is that as of yesterday the bill was at $1200. It's hard to know how much money to put into a 12 year old dog who may not survive no matter what is done. If the ultrasound shows a gall bladder problem the only option is surgery which we probably wouldn't do anyway. As it turned out the vet really wants the information and offered not to charge for the ultrasound (I think they feel responsible given that the rimadyl started things).

As for other pain medicines- my experience with my own dog is that aspirin made her vomit and glucosamine didn't help. She started taking rimadyl and was suddenly bouncing off the walls (well maybe just jumping on the bed but you get the idea). I don't think it was a bad idea to try it in Sara- we just got unlucky. As for the lab tests- they didn't do any before starting the drug (the idea was to see if it helped and then monitor the liver function if she was going to stay on it). It does seem like overkill to test every dog's blood before starting an NSAID, but on the other hand we'd have known if Sara had some sort of pre-existing liver/ gall bladder condition.

[chickwhorips]

My thoughts go out to you it isn't easy.

Mine just had TPLO surgery and is on Rymidyl and is taking the last of her pain meds. She is 4, but seems to be doing fine with it. It is only temporary, but I know to keep an eye on her eating habits.

[anakiwa]

The ultrasound didn't show any sign of gall bladder problems. They did a biopsy (results won't be back until next week). They're still encouraging BF to keep her in the hospital. He's still thinking things over.

[ccnyc]

No matter what course of action you decide upon, Sara's liver (and quality of life) could probably be helped with some Milk Thistle and/or other liver herbs. The one below is just an example of this kind of product.
http://tinyurl.com/2aby6d
Hope she comes home soon.
Carol

[OakLeaf]

Yes, definitely try milk thistle - although if you can get her to take pills, that's probably best. According to the University of Maryland summary, tinctures (alcohol extracts) of milk thistle may be less effective and they recommend avoiding them. Also, when the ingredients are the same, I usually prefer supplements and medications manufactured for human consumption, since they have stricter controls on potency and purity.

The UMd site doesn't have a specific discussion of toxic liver damage, but their articles on cirrhosis and viral hepatitis have some more information that might be helpful to Sara.

[SlowButSteady]

I so sorry that Sara has liver disease. I hope the biopsy will show what is wrong and that it can be managed successfully. The liver has an amazing capacity for healing and regenerating after an insult.

Rimadyl (and generic Novox) is a wonderful drug for an overwhelming majority of patients who take it. It is my opinion that most of the patients with Rimadyl-related disease had pre-exisitent but undetected liver conditions but that some patients just have idiosyncratic "reactions" to it.

Along with other NSAID's (Dermaxx, Previcox, Metacam, etc) it has the potential for GI upset and is used with great caution in pets with compromised livers and/or kidneys. Pre-treatment blood tests to screen for these issues is fairly routine, and pets taking NSAID's should have enzymes checked regularly while taking them.

The bad news is that pre-treatment blood screens will not catch all pre-exisiting conditions all of the time; a patient with a totally cirrhotic liver can sometimes present with normal enzymes.

Many pets that need long term pain & inflammation management are senior dogs with various other health issues. For patients that are not good candidates for NSAID therapy, there are alternatives: glucosamine-chondriotin supplements, Adequan injections and Tramadol can all fit into a treatment plan, as can physical therapy and accupuncture. Tramadol is a wonderful adjunct to NSAID therapy in terribly arthritic patients and it can be my primary pain control in patients that are not candidates for NSAID therapy.

I haven't been involved in the treatment of a patient with liver disease in a long time--but it can be acute and progress rapidly to death with horrible symptoms (vomiting, anorexia, abdomenal pain) or it can be chronic with weight loss and ascites and patients can go along with reasonable levels of comfort for a fairly long time. In the more chronic cases, there are various drugs and diets that can be used to make the patient's life better & longer.

Best of luck and well-wishes to Sara.

PS my 14 year old German shorthair takes Rimadyl. My tech has his same litter sister and she doesn't do well on it but does well on Previcox. In some dogs some drugs work better than others.