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Thursday, August 29, 2013

Aspirin in Pets - Bad Idea

Last night I had a patient who was in a really bad way. He had a serious arthritic condition which had gotten progressively worse over the past several months to the point where the dog could no longer stand on his back legs. In an effort to help, someone in the house had given the dog aspirin. Ugh. 

First of all, I could have done a whole lot more for this poor dog had he been brought to me months ago. Arthritis is a relentlessly progressive condition in dogs, and once it occurs, arthritic destruction of cartilage and remodeling of bone cannot be reversed. However, the progression of the disease and the pain that accompanies it can be dramatically reduced in most cases IF TREATED EARLY. Okay, that's not the topic of this blog, so...about that aspirin...

Aspirin in dogs is an effective pain-reliever at the proper dose. In fact, I would prescribe it for some of my patients 20-25 years ago. You can still buy "doggie aspirin" with the dose listed on the bottle. But unfortunately, aspirin has a very high potential to cause more problems than it helps. The number-one risk is gastric ulceration, which can cause death from hemorrhage or stomach perforation. I have seen it happen. Aspirin can also cause kidney failure, especially in older pets (which are the ones most likely to receive it).

Now we have newer drugs which are similar to aspirin, but much safer and more effective. These drugs can also cause serious side-effects, but their risk-profile is muuuuuch safer! The problem is, if our patient has been given aspirin for any recent length of time, it changes the dog's ability to handle the safer drugs. What this means is, if you give your dog more than one dose of aspirin before bringing him to see me, you have effectively tied my hands from giving him something much better and safer. 

Dogs who have received previous aspirin therapy should go through a 5-7 day "washout" period of no medication, before we can give the good stuff. During this time, the dog has to suffer with the pain that we could be treating had the dog not been given aspirin. 

As a side-note, aspirin is quite toxic in cats, except at super-low doses and prolonged intervals. Never give aspirin (or Tylenol) to a cat without specific instructions from a veterinarian. You know what? Let's just not give any medication to our pets without first checking with the vet. DVMs know what is safe, and at what dose. Use us! That's what we're here for.

Monday, August 12, 2013

The Difficult Decision

Five minutes ago, I ended the life of an older, but not "ancient" cat on a soft towel in a quiet room in the back of my office. She went to sleep peacefully and painlessly. This cat belonged to some nice folks that my family has been acquaintances with for a long time. The husband spoke to me yesterday about their cat. I was not at work, and we had been talking about something else (probably sports), when he abruptly mentioned that his cat had started urinating and vomiting all over the house. She had ruined several pieces of furniture as well as the carpet in the basement. He said, "I think it's time to put her down, don't you?"

I never quite know how to respond to those situations, because you see, we had not seen his cat in two years. I assumed that since he hadn't brought her for an exam (and possible testing), that he really wasn't interested in trying to find out why she was vomiting and urinating all over. He was really just wanting me to "sign off" on a decision that had already been made. The cat had originally belonged to his son, who had long since moved away.

I'm not judging him. There are often mitigating factors when people decide that it's best to end the life of a pet. We usually are not privy to these circumstances. I believe that sometimes the person making the decision isn't even aware of some of the psychological "baggage" that is influencing their choice. The gentleman in my story is an intelligent guy. He is smart enough to know that maybe I could have done something medically that would have helped his cat. He's also smart enough to know that it might have been expensive, unrewarding (ie ineffective), or labor-intensive (have you ever tried sticking pills down a cat every day?)

So he probably had his reasons for not seeking my medical assistance, but instead my reassurance that they were making the "right" decision. Was it the "right" decision? I am humble enough to admit that I don't know. There are simply too many factors that I am unaware of.

I do know this: His is a good family, and although the cat might not be high on their priority list, I think they provided a comfortable home for her. I also know that humane euthanasia results in no suffering for the pet. I was there to make sure she left this world in a painless manner (which is better than many of us will have.) For reasons of their own, they chose euthanasia over exploring medical options. It's not the decision I would have made, but that doesn't make it wrong.