Metacam nightmares and responsible drug manufacturer responses to adverse reactions
Last week I wrote a frustrated, Vet Stress post on Fido-the-dog (When pet therapies go wrong). The entry detailed Fido’s stressful family and the implication that Fido’s Metacam therapy was responsible for his gastrointestinal undoing.
We’ve come a long way since last week’s semi-confrontational moments. Although she’s relaxed a whole lot, his primary owner still manages to stress me out with every prolonged phone call. Complaints, pseudo-complaints, guilt and blame underlie each telephonic experience. I’m tired.
Fido’s situation has also altered—in rollercoaster fashion. Here’s the whole story from beginning to end…
Fido, a nine-year-old, ten-pound mix came in for a yearly 10 days ago. His list of ailments (as long as my arm) included his heart, liver, joints, thyroid gland, teeth and possibly his adrenal and/or pituitary glands. I had been trying to get him worked up for at least two years now. His owner had resisted—purportedly due to his chronically frail state. Catch 22.
Finally, she relented—just a little. She allowed me to try “shotgun” therapy, otherwise known as empirical medicine or provocative treatment (i.e., we don’t want to do any diagnostics so let’s try some drugs and see how it goes). So Fido got blood pressure meds and Metacam (for his increasingly debilitating arthritis) along with his glucosamine and chondroitin (a nutritional supplement for his joints).
Two days later he was in the hospital in his very own, “room with a view.” Vomiting and lethargy now compounded his basic frailty and orthopedic pain. Things got very messy at this point. His owner blamed the meds. I wasn’t quite sure how to proceed (since I couldn’t do many diagnostics) but since an X-ray showed he’d scarfed up some foreign material (supposedly from a planter) I started treating him supportively for pancreatitis.
He got a little better at first, but Fido didn’t rally for very long. More x-rays and bloodwork showed his liver was huge and his enzymes sky-high. Moreover, he was turning yellow, the hallmark of liver disease of some sort—not just pancreatitis. I needed an ultrasound. His owners wouldn’t agree to serious testing.
Finally, I got on the phone with the manufacturer of Metacam (the arthritis pain medication I used to spare him the potential liver effects more commonly associated with the alternative drug, Rimadyl). All NSAIDs (aspirin-like drugs) can cause liver problems but few are associated with severe, sudden reactions like Fido’s. Nonetheless, I felt the manufacturer might offer some ideas and I could log in a potential “adverse drug event” at the same time.
The vet on Metacam’s emergency help-line was more than helpful. He was knowledgeable and sympathetic, to boot. He understood that Fido and I were in a bind. We needed to get around his owners to get him some proper help. In the end, Metacam’s maker offered to pay for all his diagnostics—even if they revealed, as we expected, that two oral doses of the drug had nothing to do with his sudden illness.
That very day, Dr. Allison Cannon, internal medicine specialist at Miami Veterinary Specialists, agreed to perform all necessary ultrasounding and special testing required to elucidate the source of his problems.
So I drove him over and picked him back up at the end of the day. Dr. Cannon had determined that Fido’s hugely distorted gall bladder (“creepy” and “like the creature from the black lagoon” were her very descriptive terms for its appearance on ultrasound), its apparent rupture and subsequent peritonitis were to blame. She felt it unlikely that Metacam was responsible in any way, but acquiesced that acute inflammation from a simple gastritis (stomach irritation) due to the drug might have created conditions for Fido’s gall bladder problem to rear its ugly head.
Dr. Cannon sent needle-collected samples of Fido’s liver and abdominal fluid to the lab for evaluation. Cancer or gall bladder mucocoele (a nasty, cyst-like structure in the gall baldder) were her top two choices.
After the lab’s 48-hour turnaround, we had an answer: chronic peritonitis from a leaky gall bladder with no evidence of cancer or primary liver disease. In other words, this had been there for a while…a long while.
That seemed like the easy part after dealing with the owner’s response to the finding. In the end, it was hard to ignore. A full week had gone by and the dog had not yet responded to our ministrations. Surgery was offered as a 90% curative option. But I gave no promises that we wouldn’t find cancer and assured her that Fido still had at least three other organ systems with major disease unrelated to this finding.
She then asked me—get this—what I would do if this were my dog. I said I would have taken out a second mortgage two years ago to pay for the diagnostics he needed back then. Actually, I wasn’t quite so harsh but I did point out that she and I had different feelings about our dogs (which she had admitted to previously: “My pets are not children.”).
And so Fido was euthanized. The commitment level needed for a major undertaking to finally help this dog was just not there. What can you do?
Ultimately, what remains of this experience—beyond the sadness of Fido’s suffering and loss, beyond his owners’ stressful nature—is a tremendous respect for the drug manufacturer. Were it not for their intervention he might have suffered for much longer and lingered for weeks. We might never have gotten the answers we all needed to make good decisions for him.
When drug manufacturers take responsible actions it helps everyone. The pet gets proper care, the owners get satisfaction, the vet is off the hook for the possible reaction and the drug company is either exonerated and comes out smelling like a rose or it gets the information needed to make sure problems like this don’t happen again to other pets. What could be better than that?