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Pet Forum / Miscellaneous / Animal Health / March 2008Low, continuous dose, or higher more spaced doses? Metacam
So, I've been working on figuring out just how often Erwin needs to get metacam (actually meloxicam, but same difference right?) in order to maintain a reasonable level of pain control. It seems that if I give it to him a dose every second day its enough, if I skip a day, by day three he is significantly more 'ouchy' (as determined by third party evaluation... basically I didn't tell the other members of the household that I'd withheld metacam. On day three I got several comments about him looking more sore than usual). Anyways, I was wondering what the thoughts of people here are. Given this interval and information about the half life, I should be able to relatively easily determine the minimum clinically effective dose he needs in his system. I could in theory split his dose up, and give it out daily as opposed to every other day (or even twice daily with his phenobarb doses... the initial interaction effects I observed don't *seem* to be present any more), this would even out the drug level in his system. I can see both sides of the issue here. On the one hand, lowering the maximum dose in his system just seems like generally a good idea. But I imagine that these fluctuations in the amount in his system might also have significant benefits. Is a continual low level of 'stress' better repeated high->low->high stress transitions? Also on my mind is the possibility that how good he feels might be relative to how good he has felt. In other words "I feel better than yesterday, so I'm happy", "Yesterday I felt crappy, today I feel crappy, so I'm unhappy". If we even out the drug level, this relative effect disapears. In other words I'm not convinced that the drugs are taking away all of the pain, so if we're only taking away part of it, what is left may become the new baseline. I don't expect any concrete answers here (although if you have some, I'm listening), more just 'gut feeling' type answers. So, what does your gut tell you? Dale > Also on my mind is the possibility that how good he feels might be relative > to how good he has felt. In other words "I feel better than yesterday, so > I'm happy", "Yesterday I felt crappy, today I feel crappy, so I'm unhappy". .......dogs don't think this way. They get up every day, have a pee and are ready for breakfast. Their world doesn't include moaning over what went on yesterday or might happen tomorrow. ......The effect of pain is sort of cumulative.The more you experience, the faster the trigger. http://vettechs.blogspot.com/2005/04/thing-about-pain.html http://www.cvm.uiuc.edu/petcolumns/showarticle.cfm?id=42 buglady take out the dog before replying >> Also on my mind is the possibility that how good he feels might be > relative [quoted text clipped - 7 lines] > on > yesterday or might happen tomorrow. I'd love to hear some evidence that dogs don't think that way. Frankly I have no idea *how* he thinks. I'm not even sure how in his situation *I* would think. I doubt that eliminating all of his pain is really feasible, if we take that as a given, then what is 'normal' for him has to shift. > ......The effect of pain is sort of cumulative.The more you experience, > the > faster the trigger. > http://vettechs.blogspot.com/2005/04/thing-about-pain.html > http://www.cvm.uiuc.edu/petcolumns/showarticle.cfm?id=42 While the articles you cite contain some interesting information, and information I agree with, I have some definite reservations about their credibility, or that applicability to chonic low levels of pain. Particularly this statement irks me: "New medicinal therapies have fewer side effects than older therapies. Hydrotherapy, massage, laser light, magnets, electro-acupuncture, and electrical energy can also aid in pain relief. Often a combination of modalities may be used." I could *maybe* believe some of those, but *laser light* come on. Give me a break. What possible effect could that have? And why laser light? Why not monochromatic light, or polychromatic light for that matter. This is also a rather loaded statement: "Others will reject some very effective alternative pain control modalities, such as acupuncture, because they lack the training and background to fairly evaluate them." So anyone who disagrees with them hasn't fairly evaluated the "alternative pain control modality" "and that letting the animal experience pain will help keep him quiet while he heals from surgery or an injury. All of these ideas are outdated, dangerous, and just plain wrong." This just seems like a load of bull to me, and depends heavily on the animal you're dealing with. *If* the animal when feeling well is likely to run around like a lunatic, and tear their stitches open then you don't want them feeling too good do you? While all other things equal the healing *may* be slower, if the animal does more damage while on the pain meds, then giving the pain meds may not be a good idea. Pain evolved for a reason. It lets us know when we are injured and prevents us from doing further injury to the same location. "Convincing pet owners and, sadly, many veterinarians, that pet pain is real and can and should be prevented and treated is critical." Another loaded statement. I don't know anyone who thinks that animals don't feel pain, but then they could that "can and should" be prevented and treated. All in all, I'm quite surprised that you'd reference these two articles. Dale > I could *maybe* believe some of those, but *laser light* come on. Give me a > break. What possible effect could that have? And why laser light? Why not > monochromatic light, or polychromatic light for that matter. Not even curious? http://www.backpaininstituteri.com/low_level_laser_therapy.html http://www.mayoclinic.com/health/cold-laser-therapy/AN01677 http://www.clinicaltrials.gov/ct2/results?term=Laser+Therapy%2C+Low-Level+ http://www.backpaininstituteri.com/ml830_clinical_research.html > This is also a rather loaded statement: > "Others will reject some very effective alternative pain control modalities, [quoted text clipped - 3 lines] > So anyone who disagrees with them hasn't fairly evaluated the "alternative > pain control modality" ......No, only that modalities like acupuncture seem too woo-woo to the vast majority of professionals, so they dismiss it out of hand........sort of like you did with cold laser therapy, without doing any homework. To come to some kind of personal conclusion one at least needs to do some homework first. What you decide after that is up to you. > "and that letting the animal experience pain will help keep him quiet while > he heals from surgery or an injury. All of these ideas are outdated, > dangerous, and just plain wrong." \*If* the animal when feeling well is likely to run > around like a lunatic, and tear their stitches open then you don't want them > feeling too good do you? While all other things equal the healing *may* be > slower, if the animal does more damage while on the pain meds, then giving > the pain meds may not be a good idea. ......Yup, proved her point didn't you? Now an honest question for any vets reading. If you've been in vet practice for a while, how long ago was it that pain control started to take a more prominent position in vet med? When did you start sending a patient home with analgesics after a routine speuter? I realize that part of the problem was meds, but I think it was also the outdated notion (which I also held at one point) that the less activity the better, thus pain serves a purpose and is *good*. http://www.blackwell-synergy.com/links/doi/10.1046/j.1467-2995.2000.00018-2. x/abs/ http://www.aahanet.org/PublicDocuments/PainManagementGuidelines.pdf > "Convincing pet owners and, sadly, many veterinarians, that pet pain is real > and can and should be prevented and treated is critical." > > Another loaded statement. I don't know anyone who thinks that animals don't > feel pain, but then they could that "can and should" be prevented and > treated. .......Really? I had surgery done on a dog about 15 yrs ago for mast cell cancer and he came home with a nine inch incision. I was given no pain meds. That dog laid on the floor on his incision for 2 days without moving. He got up to pee once. Don't you think he would have been better off with pain meds and in a crate? Or is a crate crueler than suffering pain so bad you didn't want to move for 2 days? I shudder now when I think of it. >Pain evolved for a reason. It lets us know when we are injured and prevents us from doing further injury to the same location. ........Animals do pain response differently. Every critter will try to avoid pain. Our response would be to stop doing anything that causes that pain (unless you have a high tolerance for pain). Cats and dogs try to stay on their feet, despite chronic pain. http://www.dolittler.com/index.cfm/2007/10/18/pet.vet.veterinary.veterinaria n.pain.dogs.cats > All in all, I'm quite surprised that you'd reference these two articles. .......Oh? Why is that? Surely you don't think the UI is a less than credible resource? And whatever you think about Christie's viewpoints, one thing you can say about her. She does her homework. I have to say that your singular lack of curiosity and immediate condemnation of issues you're not familiar with are highly unattractive in a prospective vet student. Whatever you're learning in your volunteer job at a vet's office, I hope you'll crack the window open a little more if you get to vet school. You may be surprised to find that current viewpoints differ significantly from what you think you know from your job. One thing I've found true over the years. You can even learn something from someone whose POV differs drastically from yours. buglady take out the dog before replying > To come to some kind of personal conclusion one at least needs to do some > homework first. Such as learning some basic physics. > I have to say that your singular lack of curiosity and immediate > condemnation of issues you're not familiar with are highly unattractive > in a prospective vet student. I have to say that his respect for actual science is highly attractive in a prospective vet student.  SignatureJohn Hasler john@dhh.gt.org Dancing Horse Hill Elmwood, WI USA > I have to say that his respect for actual science is highly attractive in a > prospective vet student. .......I guess this board certified surgeon is all wet too? http://www.vetsportsmedicine.com/rehabServices/index.html > I guess this board certified surgeon is all wet too? Quite likely, yes. Argument from authority does not convince me, especially when the authority doesn't even hold relevant credentials. Why should I believe that a man who has demonstrated his skills with a knife is therefor an expert on lasers? SignatureJohn Hasler john@dhh.gt.org Dancing Horse Hill Elmwood, WI USA > .......I guess this board certified surgeon is all wet too? > http://www.vetsportsmedicine.com/rehabServices/index.html Interesting page. I find nothing in there to be particularly critical of, but by the same token nothing to convince me of the benefits (although the pages I was looking at weren't aimed at that, so thats hardly surprising) I am marginally concerned by the statement that "Some of the well known biological effects of laser are ..." on http://www.vetsportsmedicine.com/rehabServices/Laser.html . From the reading that you've provided me, the effects of laser light are anything but well known, and in nothing else poorly documented, so I'd be very hesitant to call these "well known biological effects", but again, the page is aimed at selling the treatment, rather than debating its merits, so I can forgive that, and say it doesn't really speak one way or the other as far as its credibility is concerned. Dale > > .......I guess this board certified surgeon is all wet too? > > http://www.vetsportsmedicine.com/rehabServices/index.html > > Interesting page. I find nothing in there to be particularly critical of, > but by the same token nothing to convince me of the benefits Once again, that was not the point. I'm not interested in selling it, proving it or disproving it or even at this point using it. For myself, if this was available in my neighborhood and I had an animal in intractable pain, I might consider it, after more researching, as an adjunct therapy. buglady take out the dog before replying Dale, I didn't think about it till seeing the post on light therapy. I used to give Barney nightly massages which he came to love and along with it when he was particularly sore I would use my infrared massager on him. I know it helps my sore muscles when they are bothering me I figured it certainly couldn't hurt. It might be one other tool you might consider to help give him pain relief. Celeste >> .......I guess this board certified surgeon is all wet too? >> http://www.vetsportsmedicine.com/rehabServices/index.html [quoted text clipped - 14 lines] > > Dale > Dale, > [quoted text clipped - 4 lines] > couldn't hurt. It might be one other tool you might consider to help give > him pain relief. Interesting, and believable. This page however was refering to the use of 'non heating' lasers to give pain relief. I'm assuming an infrared massager would function somewhat like a heat source. Dale I'm assuming an infrared massager > would function somewhat like a heat source. Other stuff seems to be going on with infrared. http://www.sciencedaily.com/releases/2008/01/080124104917.htm Paper on effects of infrared on tissue - pdf file http://tinyurl.com/2bfvem Light is an enitrely new frontier we're just getting around to exploring. http://www.sciencedaily.com/releases/2007/11/071101084950.htm Not to mention nanotechnology. Bucky balls for OA? http://lib.bioinfo.pl/pmid:17907184 And here's that vet surgeon's paper: http://tinyurl.com/ypr85t which I found by entering LLLT pain into PubMed search. Googling LLLT pain gave me this. You'll note there's 79 citations you can look at: http://www.liebertonline.com/doi/abs/10.1089/acm.1999.5.177 And one has to keep in mind the resistance of established medicine to new ideas and how this mindset might perhaps affect what gets published, specifically by who is invited to review prospective articles: http://tinyurl.com/2e7esu Of course this works both ways.....negative AND positive reviews. <g> buglady take out the dog before replying > .......I guess this board certified surgeon is all wet too? > http://www.vetsportsmedicine.com/rehabServices/index.html Out of curiosity I e-mailed them and asked for any supporting research I could have a look at. We'll see what they come back with. Dale > > .......I guess this board certified surgeon is all wet too? > > http://www.vetsportsmedicine.com/rehabServices/index.html > > Out of curiosity I e-mailed them and asked for any supporting research I > could have a look at. We'll see what they come back with. Did you bother to do any homework first at PubMed? buglady take out the dog before replying >I have to say that his respect for actual science is highly attractive in a >prospective vet student. He's applying what he knows. The rest is left as an exercise, &c. SignatureMelinda Shore - Software longa, hardware brevis - shore@panix.com Prouder than ever to be a member of the reality-based community >> I could *maybe* believe some of those, but *laser light* come on. Give me > a >> break. What possible effect could that have? And why laser light? Why not >> monochromatic light, or polychromatic light for that matter. > > Not even curious? Absolutely curious... I've had a bit of a look, here are my initial evaluations of the sources you've provided > http://www.backpaininstituteri.com/low_level_laser_therapy.html "This is because we can now use specific wavelengths of light and give accur-ately measured doses of energy directly to the appropriate treatment site, which was not possible with other light sources." This is absolutely false. We can seperate out specific wavelengths of light from a polychromatic source (ever hear of a prism), we can even have non-laser monochromatic sources (ever hear of neon sign?). We can accurately measure doses only based on knowledge of the efficiency of the device, which is knowledge you can get out of any well understood machine. > http://www.mayoclinic.com/health/cold-laser-therapy/AN01677 Basically said we don't know squat, but it can't hurt. There seems to be a direct conflict with the information presented in your first source though. The first source was dealing with near infrared light, whereas this says its dealing with "The term cold laser refers to the use of low-intensity or low levels of laser light." I'm more inclined to believe the first source though. You can have low intensities of Gamma Rays, but I wouldn't call that a "Cold" source. It seems like the person writing the article didn't necessarily have a good understanding of lasers. > http://www.clinicaltrials.gov/ct2/results?term=Laser+Therapy%2C+Low-Level+ > http://www.backpaininstituteri.com/ml830_clinical_research.html Class is about to start, so I haven't had an opportunity to go over these as much as I would like. I will get back to it later Dale I wrote a whole big long detailed reply to much of this, but somehow it got lost in the ether (I have a feeling it didn't send before I logged off, and that was from a public terminal, so its now blown away). Anyways, the repeat of my reply won't be quite as detailed, but will address many of the same points (so if another version shows up at some point, you know I'm not just going insane and repeating myself ;)) http://www.backpaininstituteri.com/low_level_laser_therapy.html Continued looking over this link. I had further issues with the claim that these were 'non-heating' lasers. If its going to transfer any energy, then by definition they are heating. "It is a scientific fact that light transmitted to the blood in this way has positive effective through-out the whole body, supplying vital oxygen and energy to every cell." So how is exposing the blood to light supposed to "supply oxygen"?? I suppose it might have an impact on the conformational state of various proteins, which might cause the *release* of an oxygen. Carrying energy? Is this supposed to be the energy from the light, or of the 'vital oxygen', if the energy of the light, the actual energy carried by lasers (in the realm of milliwatts) is very small in comparison to your incandescent bulb at home. (In the realm of Watts). "The majority of conditions treated will take anywhere from 4-5 or 10-18 treatments." Oh, so I shouldn't expect to see any results until I'm significantly (financially) invested in the treatment, and have strong motivation to say I've experienced an effect (and to believe the same). This isn't (necessarily) a point against them, but it is the kind of argument that would be used if there were no measurable effect. > http://www.mayoclinic.com/health/cold-laser-therapy/AN01677 > http://www.clinicaltrials.gov/ct2/results?term=Laser+Therapy%2C+Low-Level+ This page has no results on it (that I can see) and so I see no relevance to the discussion. > http://www.backpaininstituteri.com/ml830_clinical_research.html Most convincing evidence you've presented so far. There are a number of issues I'd like to raise with it though. First, there was the comment that the control group randomly ended up with a higher proportion of subjects who had previously had hand surgery. Why was no attempt made to control for this effect? They recognize it, but don't include it in their statistical analysis (one possibility would be a two factor ANOVA, but there are others... you could always go for an ANCoVA or something like that). Then there is also the question as to whether this was truely a double blind study. In the first page you referenced, you'll notice that they point out that a certain percentage of people experience 'tingling' during the treatment, and 'some' experience a warming sensation. If these are real effects (as opposed to imagined) then it is likely that those experiencing the 'tingling' and 'warming' might guess that they are in the study with an active laser, whereas those that didn't might conclude that the laser was off. Evidence needs to be gathered that this is an appropriate control (can individuals do better than chance at guessing if the laser is on?) >> This is also a rather loaded statement: >> "Others will reject some very effective alternative pain control [quoted text clipped - 13 lines] > to some kind of personal conclusion one at least needs to do some homework > first. What you decide after that is up to you. I will remind you that I have a fair amount of experience with lasers (BSc in Physics) and a fair amount of experience in Biology (Nearly a BSc... I'm weeks away from the end of my last term). I've read your articles, and while there are some interesting pieces, I'm very far from convinced. I'll certainly continue to read more, but this isn't something I would ever go for, or advise anyone to seek. >> "and that letting the animal experience pain will help keep him quiet > while [quoted text clipped - 18 lines] > also the outdated notion (which I also held at one point) that the less > activity the better, thus pain serves a purpose and is *good*. Getting close to time to start classes again... My knowledge here is mostly experience based, I'm open to new ideas, but in my experience this isn't the case. Many owners are unable or unwilling to confine their animal to a crate for extended periods, especially if they show no signs of an ailment. Speaking with people who have had spays done with, and without post operative pain meds (both done with a pre-operative dose of medication though), the ones I've spoken to have been in support of not giving them post operatively. > http://www.blackwell-synergy.com/links/doi/10.1046/j.1467-2995.2000.00018-2. > x/abs/ > > http://www.aahanet.org/PublicDocuments/PainManagementGuidelines.pdf No time to read now. But I will. >> "Convincing pet owners and, sadly, many veterinarians, that pet pain is > real [quoted text clipped - 13 lines] > bad > you didn't want to move for 2 days? I shudder now when I think of it. He should have had some drugs. I certainly wouldn't advocate letting an animal endure large amounts of pain just to keep them quiet. That is a totally different story than not treating relatively mild amounts of pain. >>Pain evolved for a reason. It lets us know when we are injured and >>prevents [quoted text clipped - 7 lines] > http://www.dolittler.com/index.cfm/2007/10/18/pet.vet.veterinary.veterinaria > n.pain.dogs.cats Haven't read the link yet (class about to start), but there are of course competing effects here. Animals will try to hide pain, although they do feel it. This is a reasonably well understood evolutionary response. This however does not mean that they won't adjust their behavior to avoid more pain. (for example, Erwin is quite good at 'faking' soundness on his right hind, but if you look closely, the signs are visible) Gotta run. Dale I've read your articles, and while > there are some interesting pieces, I'm very far from convinced. ........The point of it was not to convince you. Research is ongoing (the point of posting clinical trial information) and there's hardly any kind of conclusion yet. The point was to let you know there is some information out there, which was easily found. I asked my chiro about it today. He said it's interesting, but no firm conclusions yet, so insurance won't pay for it. Don't know how health care works in Canada, but if insurance won't pay for it here in the US, that means it doesn't get used. This is sort of a self-perpetuating circle. Not enough info, so insurance won't pay for it. Insurance won't pay for it, so not a lot of support for trials. Most research is usually done by companies flogging their product (whether machinery or drugs). That's not unusual. Since these companies are not pharma giants like Merial, research is limited. And on it goes. > My knowledge here is mostly experience based, I'm open to new ideas, but in > my experience this isn't the case. Many owners are unable or unwilling to > confine their animal to a crate for extended periods, .....2-3 days after surgery is not an extended period. Speaking with people who have had spays done > with, and without post operative pain meds (both done with a pre-operative > dose of medication though), the ones I've spoken to have been in support of > not giving them post operatively. Because they don't know the signs of pain. If they were told their pets were in pain, they'd be very receptive. If they knew they experienced pain in the very same way we do but didn't show it, they'd listen. buglady take out the dog before replying Few more words before class actually starts: >> All in all, I'm quite surprised that you'd reference these two articles. > > .......Oh? Why is that? Surely you don't think the UI is a less than > credible resource? And whatever you think about Christie's viewpoints, > one > thing you can say about her. She does her homework. Look at where on the University's site this is sitting before you conclude that this is an officially held posistion. Its under "Pet Columns" written by an "Information Specialist". I don't know what an information specialist is, but the title hardly means credibility. > One thing I've found true over the years. You can even learn something > from > someone whose POV differs drastically from yours. I agree completely. > buglady > take out the dog before replying Gotta go. Will return. Dale >I don't know what an information specialist >is, but the title hardly means credibility. OH, PLEASE. I mean, seriously - WTF?. It's obviously not a research article, but that doesn't make it an invalid source of information. To the contrary - a university doesn't allow stuff like that to be published without being reviewed by the people doing the work. Maybe once you start graduate school you'll have an opportunity to learn something about information dissemination in the sciences. SignatureMelinda Shore - Software longa, hardware brevis - shore@panix.com Prouder than ever to be a member of the reality-based community Just another quick note before I go feed and walk the dogs... >>I don't know what an information specialist >>is, but the title hardly means credibility. [quoted text clipped - 4 lines] > allow stuff like that to be published without being reviewed > by the people doing the work. What exactly do you think would be a reasonable grounds on which a reviewer might censor the article? There doesn't appear to be anything patently false in there, in general its a pretty good article. The point I took issue with initial was regarding the credibility of using laser light to treat pain. I'm sure Dr. Greene really did make that comment, so there is no cause to censor it. I'm not sure I buy your argument though that "a univeristy doesn't allow stuff like that to be published without being reviewed by the people doing the work" in any case. I can publish anything I like under the University of Calgary's domain, and spout off what ever absurdities I care to, but it has no affiliation with the university, and the fact that its under the university's domain should not be viewed as adding to its credibility (as buglady was suggesting). > Maybe once you start graduate school you'll have an > opportunity to learn something about information > dissemination in the sciences. I actually know a fair amout about information dissemination in the sciences, its been the topic of several lectures this term, and on top of that I've taken a whole course in the philosophy of science in which that topic figured prominantly. Dogs are complaining they haven't been fed in weeks, so I'd better run. Dale >I'm not sure I buy your argument though that "a univeristy doesn't allow >stuff like that to be published without being reviewed by the people doing >the work" in any case. Feel free, but you'd be wrong. >I can publish anything I like under the University of Calgary's domain, and >spout off what ever absurdities I care to, but it has no affiliation with >the university, and the fact that its under the university's domain should >not be viewed as adding to its credibility (as buglady was suggesting). That's not what I was saying. University news offices do not allow that stuff to go out without proper review. The article in question wasn't by some student and shoved up on his personal website. >I actually know a fair amout about information dissemination in the >sciences, its been the topic of several lectures this term, and on top of >that I've taken a whole course in the philosophy of science in which that >topic figured prominantly. Dude, you've got a bachelors degree. That's not a research degree. For that matter, a DVM is not a research degree. At this point you don't yet have much education, and whether or not you end up getting a substantial education remains to be seen. You might want to consider ratcheting down the arrogance - aside from the fact that it's not matched by your actual expertise, you appear to be on-track to become one of those vets about whose attitude and "bedside manner" clients complain. Stuff that makes it through the peer review process can be wrong but probably isn't. People with research focuses in a particular area just might know a lot more about it than you do. That doesn't mean they're above reproach, but it does mean that you ought to stop assuming that they're missing obvious issues. And if you really think there's a problem with their research, it would behoove you as a Man Of Science to get in touch with them and air your concerns. SignatureMelinda Shore - Software longa, hardware brevis - shore@panix.com Prouder than ever to be a member of the reality-based community >>I'm not sure I buy your argument though that "a univeristy doesn't allow >>stuff like that to be published without being reviewed by the people doing >>the work" in any case. > > Feel free, but you'd be wrong. Did you just ignore the other part of what I wrote? Or not find it relevant? (i.e. how there is nothing to censor there, as most of the information is good, and the part I found questionable was framed in terms of so and so said such and such). >>I can publish anything I like under the University of Calgary's domain, >>and [quoted text clipped - 6 lines] > article in question wasn't by some student and shoved up on > his personal website. And how do you know that this is a University news office publishing this? I don't. (I'm not sure such a thing exists on either of the campuses I've been involved with) Its possible that it is. Its also possible that this is a student run initiative, or any number of other possibilities. >>I actually know a fair amout about information dissemination in the >>sciences, its been the topic of several lectures this term, and on top of >>that I've taken a whole course in the philosophy of science in which that >>topic figured prominantly. > > Dude, you've got a bachelors degree. Nearly two, actually, but that's beside the point. > That's not a research > degree. For that matter, a DVM is not a research degree. > At this point you don't yet have much education, How much education do you consider substantial? I'd say I'm probably well in to the top 10% of the population at the moment as far as education goes. As far as diversity of education goes, if there were a fairly quantitative way measure such a thing, I think I'd be pretty high up there (not unique by any stretch of the imagination, but fairly rare). > and whether > or not you end up getting a substantial education remains to > be seen. You might want to consider ratcheting down the > arrogance - I am very sorry if this comes across as arrogance. I assure you that very few people that I know in a face to face world would classify me that way. I rarely speak on topics I'm not reasonably well versed in. I always strive to be open to alternative ideas (I've spent much of my off time today trying to conceive of a way in which laser light might be theraputic. So far I've come up with the possibility that a carefully tuned laser light might be able to alter the conformational state of a protein, which might have a cascading effect on a biochemical pathway.) I was acutally relatively impressed with the article buglady posted that was structured like a research article. > aside from the fact that it's not matched by > your actual expertise, you appear to be on-track to become > one of those vets about whose attitude and "bedside manner" > clients complain. From my interactions with clients so far, they all seem to like me well enough. > Stuff that makes it through the peer review process can be > wrong but probably isn't. Which of these links are you assuming was peer reviewed? The one that looked like a research article? Or the column that we've been talking about. FWIW there are plenty of things which make it through the peer review process that are just plain wrong. If you like, I can pull up a reference to an older paper which was pointed out to me by one of my profs... it was a review article of all the statistics found in ecology journals over the past X years. The upshot was that a substantial number of them (it was some ridiculously high percentage) contained errors in statistical design and analysis (ranging from inappropriate tests used, to improper controls and so forth). > People with research focuses in a > particular area just might know a lot more about it than you > do. They probably do, but if you're refering to the link that looked like a research article, I think your missing that the article in question points out many of the flaws with the experimental design itself (I never would have picked up on the possibility that the hand surgery was a confounding variable), but then makes no attempt to actually control for it. Given that this research is published on the website of the company that is selling the treatment, I have to wonder if this was intentional. (in other words if you did include these variables in your design if it would eliminate the statistical significance of the data). Its important as the effects seem (in general) to be only very mildly significant. Any small, systematic error could easily overwhelm the measurement of the variable of interest. A better design might have been to assign people to groups bearing in mind that they had had hand surgery (rather than just a completely randomized design), that way you'd get an equal number in each group who had, and hadn't had hand surgery. You could also then try to look at the effect of having had hand surgery on the effect of the treatment. > That doesn't mean they're above reproach, but it does > mean that you ought to stop assuming that they're missing > obvious issues. And if you really think there's a problem > with their research, it would behoove you as a Man Of > Science to get in touch with them and air your concerns. If I actually thought they'd listen, I probably would. Unfortunately, other than me just being a 'lowly undergraduate scum of the earth', which would cause them to be very unlikely to take me seriously, I'm not totally convinced that the errors in the paper weren't intentional (remember this is published by the company that sells the stuff, which has a vested interest in showing that it works). The author seems to recognize the problems with his methodology, but neglects to do anything about them, even though doing something likely wouldn't be overly troublesome (assuming he collected the data in the first place in such a way to allow matching of patient records to treatment results... its possible given that confidentiality issues may have caused this to be a bit more tricky than I'm imagining, but if he bothered to collect the data on previous hand surgery in the first place, then he must have recognized its potential importance before conducting the study. Dale >If I actually thought they'd listen, I probably would. Excuses, excuses. SignatureMelinda Shore - Software longa, hardware brevis - shore@panix.com Prouder than ever to be a member of the reality-based community > Look at where on the University's site this is sitting before you conclude > that this is an officially held posistion. Its under "Pet Columns" written > by an "Information Specialist". I don't know what an information specialist > is, but the title hardly means credibility. ........dont be silly Dale. These are pet columns written for the lay person. It's nothing more than translating vet info for the pet owner. Here's the home page of the Vet school which has the Public Engagement office as a link on the left and under the banner across the top Client Education takes you to the pet columns. It doesn't read like a research article because it isn't! And Melinda is right, no way this stuff gets out there w/o review. Once again I'll say, that it is unattractive to make comments without checking it out yourself. I'm not interested in engaging in debate on every little point. You may find that interesting. I don't. http://www.cvm.uiuc.edu/ No one is asking you or anyone else to swallow something whole cloth. The whole point of looking at any of these is to try to figure out if it has validity, not based on only one source. It's information. It's not good or bad in and of itself. It's a starting point. That's it. What U. do you go to? I'll bet I can find some kind of public information function. It may not be structured in the same way. Unless they're publishing professional journal articles, professors don't have time to write stuff for lay people. Now if this was sociology, there might not be a big demand for public info. You can bet there is for vet med. Or maybe the UIUC vet school is just better than most at getting info out there. As I recall I find a lot of articles from U of Cal and U. of Washington on the web also. Oh, by the way, here's another one on pain: http://www.cvmbs.colostate.edu/ivapm/ Maybe it's fake too. buglady take out the dog before replying Are you sure you should be skipping days? Isn't the point of the medication not only pain control but inflamation control to. By doing this you create a yo yo cycle which can't be good I'll admit there have been days when I've forgotten to give Buddy his Rimadyl and realized it the next morning. He doesn't seem to have any ill effect and I've wondered if I should cut the dosage down some on these days because he seems ok. On the other hand there are days where it's rainy and cold out and he has problems getting up off the floor so I know he needs it. I can tell the bad weather affects my joints adversly so I'm sure it does with him to. I know when Buddy is in pain he's in a bad mood and just as likely to snap at you as look at you. When he's feeling ok he's a happy dog who wants to be petted and taken for a walk. Pain management definately has an impact on their quality of life and their mood. Celeste > So, I've been working on figuring out just how often Erwin needs to get > metacam (actually meloxicam, but same difference right?) in order to [quoted text clipped - 35 lines] > > Dale > Are you sure you should be skipping days? Isn't the point of the > medication not only pain control but inflamation control to. By doing > this you create a yo yo cycle which can't be good The half life of metacam is roughly 24 hours. So even after 48 hours there is still metacam in his system (~1/4 of what he had at the peak). The vet basically left it to me to give 'as needed', what ever that means. Every day at the dose recommended is too much. His 'no metacam days' (like today) don't seem significantly different than his 'with metacam' days. The inflamation in his joints seem to be significantly reduced since starting treatment. As he's going to be on this for life (he's just about 4 years old), I'm obviously concerned about minimizing the long term side effects. Spliting up the dose in to smaller amounts could maintain his 'drug level' at a more constant value, but I'm not convinced that this is entirely a good thing (in other words, as I can't totally eliminate his pain regardless of dose, it may be the relative difference in pain which is leading to his improved condition). Also, would it be better to 'rest' the kidneys a bit, rather than continually send low levels of the drug through them. > I know when Buddy is in pain he's in a bad mood and just as likely to snap > at you as look at you. When he's feeling ok he's a happy dog who wants to > be petted and taken for a walk. Pain management definately has an impact > on their quality of life and their mood. Absolutely, in fact the only real sign we had of the arthritis in his elbow as that he was more and more often in a rotten mood at the park, and we couldn't figure out why. He's a *much* happier dog now than he was 3 months ago. I just want to make sure I'm doing the best I can for him. > Celeste Dale I can understand you being concerned considering his age he's very young to be dealing with this.. My dog Barney was only 5 when he was diagnosed with severe luxating patellas and arthritis from it. He eventually blew out both knees and I had him on pain medication from the age of 5 till he died from cancer at the age of 12. I know labs are more prone to issues but not all of them have problems with these medications. My Barney was a lab/husky mix more of him lab than anything. He took aspirin from age 5 to 6.5 when he blew his first knee. At that point he went on Rimadyl for probably 3 years then he was switched to Deramaxx when we maxxed out the dose of Rimadyl. He stayed on Deramaxx at the original dose we started him on till he passed away. Considering the length of time he took medication for his arthritis he suffered no ill effects to his liver or kidney. At some point you are going to have to make the decision where it's a quality of life to provide adequate pain relief verses the possible side effects. I hope it doesn't come soon is all, I just know from experience that at some point it happens. Good luck with him I hope all goes well. Celeste >> Are you sure you should be skipping days? Isn't the point of the >> medication not only pain control but inflamation control to. By doing [quoted text clipped - 33 lines] > > Dale >I can understand you being concerned considering his age he's very young to >be dealing with this.. [quoted text clipped - 4 lines] > the age of 12. I know labs are more prone to issues but not all of them > have problems with these medications. That's comforting to hear. Thank you. I should also mention that I'm particularly worried because Erwin's full brother died after a course of Rimadyl (liver failure...I know they have different modes of action, but its still cause for concern) > At some point you are going to have to make the decision where it's a > quality of life to provide adequate pain relief verses the possible side > effects. I hope it doesn't come soon is all, I just know from experience > that at some point it happens. Good luck with him I hope all goes well. In some ways, I know I'm already there. He needs the drugs. The drugs will likely eventually cause him harm (although we can hope we'll be lucky and they won't), at the moment though without them he's in constant pain. With them, the pain is managable, and he's in much better spirits. He'll run and play much more readily, whereas before he'd warn off most dogs before they even came close (and those that didn't take the hint would get a severe talking to, flipped over on their backs and had the message delivered to their face.). So really I'm just trying to put myself in the 'best pool', where the probability of long term side effects are minimized, and the pain is reasonably controlled. > Celeste Dale Obviously there is no concrete answer. My dog is on metacam, and I find that giving it every other day works well for her. If we did a thorough evaluation of the pharmacologic data, we might be able to come up with a more scientific answer. You'd need to look not only at peak levels achieved after one dose, but also trough levels, when they were reached, and then how long you maintain "therapeutic" levels. Drug companies determine dosing interval (i.e. "once daily") based on the drug achieving "therapeutic concentrations" for something like at least 80% of the time (I don't know what the actual numbers are, unfortunately). Even if the drug lasts longer, it's not in the financial interests of the company to get a label for every 48 hours ;-). It seems to me that if you give a half dose daily, you might achieve pain control but perhaps not good antiinflammatory control. I'd rather give a full dose at a longer interval. My $0.02 worth. Deborah, DVM p.s. I'm also with you with wanting to give as little as possible but as much as necessary. No one wants there animal to be in pain, but these drugs are NOT innocuous, and animals WILL develop tolerance over time, so the lower the dose you can give, the longer you can go without having problems. > So, I've been working on figuring out just how often Erwin needs to get > metacam (actually meloxicam, but same difference right?) in order to [quoted text clipped - 35 lines] > > Dale > Obviously there is no concrete answer. My dog is on metacam, and I find > that giving it every other day works well for her. If we did a thorough > evaluation of the pharmacologic data, we might be able to come up with a > more scientific answer. You'd need to look not only at peak levels > achieved after one dose, but also trough levels, when they were reached, > and then how long you maintain "therapeutic" levels. In principle this shouldn't be too hard should it? I mean if we assume that he's not at theraputic levels when he is showing pain (3 days), and he is when he is not showing pain, and we know the half life of the drug (~24hours), we should be able to work out what the peak and trough value is, and then back out a daily dose that would give the same trough. (absorbtion % should cancel out of the equation). > It seems to me that if you give a half dose daily, you might achieve pain > control but perhaps not good antiinflammatory control. That's a good point. I hadn't considered the possibility that these two might be at different levels. > I'd rather give a full dose at a longer interval. My $0.02 worth. I'll probably keep doing it that way. > Deborah, DVM > [quoted text clipped - 3 lines] > the lower the dose you can give, the longer you can go without having > problems. What's your gut reaction on the effect of different dosing schedules on the development of tolerance? I would tend towards thinking that a constant level would have tolerance develop more quickly. Dale P.S. Please forgive any really poor english in the above (I've corrected a few really attrocious mistakes already). I'm roughly the equivalent of a vegetable right now, as I had my interview today, and I'm in kind of an odd place mentally right now With the liquid you can reduce and reduce the dose until you find the lowest dose that shows reappearance of symptoms - that tells you it's too low. Then go back up to the previous dose for maintenance. Just returned from a conference and had a nice chat about Metacam. -Sharon |
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