A Veterinarian's Perspective

email from Dr. Bob Nagell, DVM

I was really saddened to read your account of Rowdy's death by Previcox...The photo of him really brought home what a great animal he was. 

I am a veterinarian who has my dog on Previcox on the recommendation by a orthopedic specialist for arthritis in my three year old Doberman.  We do not know

what caused the problem at such a young age. 

I am sure that you are aware through your experiences and reading that one of the big problems with the way drugs are sold have to do not only with incentives, but the fact that drug companies now bypass medical professionals and aggressively market their drugs directly to the consumer, often by using fear tactics as in the case of feline heartworm, for example. 

Feline heartworm is exceedingly rare, certainly rare enough that it is ridiculous for the commercial that one drug company promotes advising owners that they need to have their cats on this preventative drug, which is basically an insecticidal poison that you administer monthly, something that would never be permitted in human medicine.  Great profits, but not worth poisoning the entire cat population.

The first anti-inflammatory that I recall being made for dogs was Rimadyl (Carprofen) then Etogesic, then Deramax, and now Previcox and Metacam. 

A drug similar to Previcox and Deramax, called a Cox-inhibitor named Vioxx, was taken off the human market due to fatalities, mostly due to cardiac problems

brought on by the drug.

Similarly Phenylpropanolamine (PPA), was removed from the human marked due to

cardiac fatalities.  We still use it in dogs.  (Our dog Summer (on our website), was given this drug for almost a month for incontinence. When it seemed as if the effectiveness had worn off, we were told to increase her dosage to twice a day, which we did. Two days after increasing her dosage, I awoke one morning to her standing beside my bed on shaky legs while convulsing. Her eyes kept rolling back into her head, she was disoriented and totally lost control of her bladder. This seizure lasted about a minute and a half and was terribly unsettling to witness. I discontinued the medication immediately and she never seizured again. ~Mel )

Most vets feel that if we had to list the side effects of all prescribed medication, the practice of medicine would grind to a halt.  Even aspirin can cause death...but the likelihood of this is exceedingly rare, some might say it is worth the risk to use these drugs, except when the fatal case is ones own pet.

I tell all owners who start their pets on these medications that if they see anything unusual develop, vomiting, diarrhea, blood in the stool or a loss of appetite as examples, to call us ASAP.

As a pet owner, I would be frightened to use many of the drugs that we prescribe based on reading potential side effects alone.

I note that you give kudos to those vets who run liver tests prior to giving the drug, but it really is due to those vets who fully inform owners of the cost-benefits=risk assessment for use of these drugs.

I honestly believe that most folks would opt out of the use of some of these, seeking more benign alternatives. You cite aspirin as one of these, and I wholeheartedly agree with your assessment.  It is a tried and true analgesic and anti-inflammatory.  

The reservation with its use is stomach irritation and thinning of the blood, this latter reason why vets do not recommend it for control of post-surgical pain, as it can contribute to bleeding. 

The drug manufacturers of all the anti-inflammatory's are all seeking to have their medications approved for use in all manner of situations, including post surgical pain management. 

So most vets now are using Metacam, Deramax, and even Rimadyl for post surgical pain. There is serious competition, and the manufacturers continue bringing out

newer, more expensive (of course) drugs, hoping that the side effect issue will be a manageable risk for them. 

Just because a drug is new, does not mean it is better than older standard medications.  In fact, many of them are more dangerous than the older medications.  We live in a country where corporate greed is unbounded. 

Here in San Diego, one can get medication in Mexico that is genuine, made by the

same company for $20 that costs $200 or more in the US.  

Regarding Vets who test before giving medications...Most animals who will have problems with a drug will have completely normal tests prior to the use of the drugs, and unfortunately, those who will ultimately die from the drug often do so quite soon after the drug is started. 

Even those vets who require monthly liver tests may be motivated more by the economics than the desire to "detect problems before they start", especially when the reactions occur before the follow-up tests are done.

I really fear losing my dog to Previcox, and your experience is sobering.  As with human physicians, your experience shows that not only do we need to take our own health care into our own hands by educating ourselves, it is also important when it comes to our animal companions. 

I hope you never have such an experience again.  As a veterinarian, I know that we never intend to cause harm, but the motto for veterinarians is "primum non nocerum" (above all do no harm), and I think we lose sight of this when we decide that more and more is better, not remembering that our decisions could potentially result in a horrible episode such as the one your family and Rowdy endured.  

Regards,

Bob Nagell, DVM