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Is pain relief the worst thing that’s happened to hips since hip dysplasia?

Posted Aug 06 2009 10:22pm

Don’t get me wrong. Here on Dolittler we’re near-fanatical about the use of pain control measures in veterinary medicine. We also spend a significant amount of time rehashing the side effects some of these alternatives offer along the way. But that’s not what this post is about.

Nope, this post is about how the use of pain relief in pets provides a reasonable escape hatch for those who would prefer to treat pain than treat the disease that causes it. And it’s not just about hip dysplasia. We’re also talking cruciate disease, intervertebral disc disease, chronic ear disease, elbow dysplasia and any other process for which pain control measures offer a stop-gap for what ails our pets.

In the case of elbows, it recently came to pass that a new patient presented with his owner in tow. The five year-old dog had been suffering pain in one elbow since he was a six month-old puppy. His previous veterinarian had passed on recommending an orthopedic consultation with a specialist:

“There’s nothing to be done about bad elbows,” he’d claimed. And that’s true...IF the disease is advanced enough...IF there’s not a huge hunk of stuff floating in the elbow area that’s realistically amenable to surgical excision.

Long story short: The dog should have been offered an orthopedic surgery at six months of age. It may have kept him near pain-free for life. It would almost certainly heve prevented this degree of degeneration. Instead, the effectiveness of the pain relievers had granted him a reasonable degree of comfort. No long walks, no major exercise, no normal dog stuff, but a modicum of comfort, nonetheless.

Dog moves to Miami at middle age and sees a new veterinarian. Off he goes to the specialist and finally gets a surgery to alleviate what’s evolved into a horrible problem. One he needn’t have suffered so seriously in the first place.

Now, it’s true that if this owner hadn’t had the financial means to undertake a major surgery early on the dog would still be in the same boat. But that wasn’t the case, it seems. And nothing irks me more than a client who wants to do the right thing and doesn’t get the chance––much less a patient whose suffering could have been largely prevented.

But let’s take the vet-bashing off the table. We all know there are great vets, good vets, well-meaning but not-so-up-to-date vets and then there are the serious losers. No industry, no profession, no job is devoid of its bottom-of-the-barrel bunch so let’s not belabor the point.

The more relevant issue here is the existence of pain relief protocols that work so well we can often manage diseases that sometimes deserve another approach.

It’s a double-edged sword, for sure. Pain relievers are keeping a number of my large dog patients living well into their fifteenth year. Most of these are dogs who would have succumbed years ago to the “can’t get up” syndrome old dog owners know so well. In fact, that’s how many of them came to me:

“Doc, it’s time to put him down. He just can’t get up.” After a round of X-rays, discussion of options and a side-effects lecture, most of these owners took home a bottle of pills in place of surgical alternatives. And I couldn’t necessarily disagree with them. One day you think your dog is dead, the next day he’s running around “like a puppy again, Doc.” Would you go for the surgery after that kind of success? Maybe not if the surgery goes for $3,000.

But it’s one thing to treat a geriatric pet in that manner, quite another to allow a younger pet with plenty of time on his ticker to forgo more definitive alternatives. Still, it’s understandable that the price may not be right–– not when a client is faced with a bird in the hand solution in the guise of an Rx.

Yet this oh-so-effective approach is not always so perfectly safe––less so when it comes to the long term use of drugs. And it’s also not so inexpensive as it may appear at first blush. Sure, you can find deals on the Internet, but even then, most of my chronic pain-treating clients pay at least $30 every month for their pain-relieving meds (though it’s usually closer to $60). So let’s do the math on a sample patient:

A ten year-old dog with cruciate disease in his knee will pay $30 (best case scenario) every month until he’s thirteen, at which time the meds can no longer power through the pain and weakness. That’s $1,080. Add the necessary labwork every six months (required to safely remain on the meds) and that’s another $100 a pop (at least). So now we’re at $1,680 for three years...for a painful solution that could have been repaired for $2,000.

Sure, that’s a simplistic scenario that portrays the height of frugality. But I see this kind faulty thinking based on the power of meds play out day after day in my practice. Because surgery is scary. Because it’s a one-time hit below the belt. Because the medicine works.

Now let’s take this one step further: Is the use of pain-relieving medication at all responsible for the continued presence of hip disease in our canine population? I’d argue it’s inevitable. If the use of NSAIDs and other pain relievers makes it easier to accept that dogs will all suffer pain as they age, does it not stand to reason that assiduous breeding for best hip conformation might take a breather? I wonder.

In any case, it’s all too clear that pain relieving methods, for all the good they do, are only as good as the industry that supplies it, the docs who deliver it and the owners who choose to wield this weapon– –judiciously or not.

 

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