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Dr. Altman
Dr. Altman, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 5797
Experience:  Practicing small animal veterinarian for 14 years.
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I have a 12year old rough coated collie who has a mutant/mutant

Resolved Question:

I have a 12year old rough coated collie who has a mutant/mutant mdr1 gene. She has always had sensitive stomach issues. She had severe neurological problems with Heartguard and Vectra. She has been on rimadyl for almost a year and has been loosing weight (12%), has severe bouts with anxiety, has lost muscle mass, stumbles, and has general weakness on her right front and back legs. She also has bouts of refusing to eat even though she appears hungry which doesn't help with the weight loss. She reacts differently to some meds such as benedryl which revs her up. Could the rimadyl be causing this or should we be looking into her thyroid? Thanks for your advice.
Submitted: 5 months ago.
Category: Dog Veterinary
Expert:  Dr. Altman replied 5 months ago.

Dr. Altman :

Welcome! I am Dr. Altman, a licensed veterinarian and happy to answer your questions today.

Dr. Altman :

It sounds like Sophie has had quite a history!

Dr. Altman :

Although rimadyl is not on the list of medications that have been documented as causing problems with dogs with this mutation we can never rule this out

Dr. Altman :

Has she had recent bloodwork to ensure her liver values are alright?

Customer: She has! She is a sweet dog that is a working therapy dog. We are desperate to try and help her.
Customer: She just recently had labs and although she used to have moderately high alp values, they are now normal since we took her off grain and commercial dog food.
Dr. Altman :

And a thyroid panel has not yet been done? Have you investigated the use of gabapentin to minimize the need for rimadyl? It is not on the list either.

Customer: A year or so ago, her old vet said she was "flirting
Dr. Altman :

Collies definitely do have a predisposition for hypothyroidism

Dr. Altman :

Was it just a thyroid level (t4) or a thyroid panel (t4, free t4, tsh)?

Dr. Altman :

If she was borderline then than there is a higher likelihood now

Customer: about a year ago her old vet said she was flirting with a thyroid problem but it was not significant enough to treat
Dr. Altman :

It can exacerbate the muscle loss and neurologic signs unfortunately in some cases

Customer: The vet told me that dogs with thyroid problem are overweight. Sophie's problem is weight loss.
Dr. Altman :

I have had a few cases that went against the grain as Sophie does. I try not to put everyone in a box and have found that some cases vary. It sounds like Sophie is in a class of her own and might be one of those cases.

Dr. Altman :

I had a hypothyroid case that was losing weight and having neurologic signs...with treatment the weight maintained and some of the muscle loss leveled out

Customer: So would you recommend a thyroid panel?
Dr. Altman :

Yes I would

Dr. Altman :

No harm in checking it

Dr. Altman :

Do you know if her cholesterol level is normal?

Customer: Her cholesterol was high in January. Last lab was normal.
Dr. Altman :

OK, an elevated cholesterol commonly goes along with hypothyroidism but a normal cholesterol does not rule it out

Dr. Altman :

Have your vet discussed gabapentin for her to reduce the need for the rimadyl?

Customer: No she has not. She just told me to not take her off of it quickly. What does gabapentin do?
Dr. Altman :

Gabapentin (aka neurontin in people) is a medication that is used to dull the nerve firing associated with pain

Dr. Altman :

It is my first line of defense for pain management in senior pets and using rimadyl/ nsaids sparingly as a result

Dr. Altman :

Until end stage arthritis/ pain management is needed

Customer: What are its side effects?
Dr. Altman :

I am definitely a minimalist when it comes to medications and use the safest/ least invasive first and foremost

Dr. Altman :

Benefits: cost, easier on liver/ kidney function, safer for senior pets

Dr. Altman :

Negatives: sedation initially while they get adjusted to the medication which they do get accustomed to and wears off, they have to stay on it consistently and then weaned if removed

Dr. Altman :

Since it dulls the nerve firing associated with pain if they are removed too quickly they can have what is called rebound effect

Customer: How out of range does the lab tests for thyroid have to be before it would be treated.
Dr. Altman :

I usually start on a lower dose and that way as pain escalates as they age I can increase the dose

Dr. Altman :

That is a great question and every case if different

Dr. Altman :

If I have a dog with a really low/ unreadable number with no clinical signs the owner and I will discuss whether a dog is clinical

Dr. Altman :

If they are not I still will not treat unless they do become clinical

Dr. Altman :

Meaning: weight gain/ loss, muscle loss, lethargy, thinning coat, increased panting

Customer: She does pant a lot
Customer: So are you saying to look at the thyroid first or switch the rimadyl to gabapentin first?
Dr. Altman :

I would do a thyroid panel and rule that out which can take 3-5 business days and in the meanwhile research the gabapentin and discuss with your vet so you feel comfortable trying this if the thyroid panel is normal

Dr. Altman :

Or, let's say the thyroid panel is not normal, it doesn't mean you cannot do both

Dr. Altman :

But I understand wanting to try one thing at a time as well

Customer: Makes sense to me. I will follow up with vet next Monday. What do you think the bouts of not eating is from?
Dr. Altman :

I just really prefer not to use the nsaids unless I have to. Using it on bad days as a "rescue" medication and safer meds more consistently until you don't have a choice

Dr. Altman :

I think likely you have two different issues going on

Dr. Altman :

Have you tried her on antacids to see if that helps? Is there one meal during the day that she consistently does not eat as much versus the other (breakfast versus dinner)?

Dr. Altman :

Reduced appetite can also be due to pain as well

Dr. Altman :

The rimadyl can definitely be causing stomach ulcerations/ reduced appetite

Customer: No, she will go for days with me practically hand feeding her and then it's just a portion on any meal that I can get her to eat. This last bout she also had a little mucousy bile throw up too. Vet did labs to rule out the obvious and then out her on Clavamox and a nausea med. she started eating after 3doses.
Dr. Altman :

Were you still giving rimadyl during those days?

Customer: Vet said she thought it was in intentional infection.
Customer: Yes she still had rimadyl
Dr. Altman :

Hmm, it really makes me wonder if it is related

Dr. Altman :

It might be worthwhile until you speak to your vet adding in an antacid prior to the rimadyl

Dr. Altman :

How much does Sophie weigh?

Dr. Altman :

Do you do rimadyl once or twice daily?

Customer: In February 2013 she was 67.2. Today she was 58.0.
Customer: 50mg twice a day
Customer: She is now very boney.
Dr. Altman :

I would try famotidine (pepcid) 10 mg every 12 hours about 15 minutes prior to the rimadyl

Dr. Altman :

I have had cases where this is the case. Rimadyl can be quite hard on the intestinal tract

Customer: Human Pepcid?
Dr. Altman :

Yes

Customer: Thank you very much. I have a lot to digest(and try).
Dr. Altman :

Yes, definitely. I would love to find out how things go. Set a reminder for perhaps 10 days to see if you have additional information? I can do this after you have rated our chat, there is no additional charge

Customer: Yes please!
Customer: How do I give you updated info?
Dr. Altman :

I will set the reminder and you will receive an e-mail at that time to bring you back into the chat

Customer: Thanks
Dr. Altman :

You are welcome

Dr. Altman :

Can I assist with any additional questions this evening?

Dr. Altman, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 5797
Experience: Practicing small animal veterinarian for 14 years.
Dr. Altman and 6 other Dog Veterinary Specialists are ready to help you
Expert:  Dr. Altman replied 4 months ago.
How is Sophie? Were you able to run a thyroid panel on her? Did the antacid help at all with her appetite?

I would love an update when you are able!

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