August 18, 2013

Drugs

I saw the first x-ray of my hip in March, 2007.  One cm bone spurs coupled with the fact that I had just completed the 320 mile Race to the Sky dumfounded the orthopedic surgeon. 

My hip had to be replaced. The one bit of good news was that a surgery was available that, once completed, would let me do anything.  Moreover, in the interim, I could abuse my hip as much as I wanted without any risk of changing this.  I decided to push as far as I could and see where it got me. 

I reached my limit at Yentna Station, 85 miles into the Klondike 300.  I had never adapted to walking in soft snow and several feet of it were falling.  I withdrew from the Klondike and then from the 2008 Iditarod.  Given how bad the hip was, I’m not sure how I made it that far.  What I do know is that without a combination of modifying what I did and pain-killers, my season would have ended much sooner.  I regularly doubled up Celebrix with acetametaphin---it is an allowed combo.  During the last month before I had my hip replaced, I didn’t get a single good night’s sleep, and I was doubling up the two painkillers 24/7.

As my dogs get older, I am finding that I am managing their meds much like I did for myself while dealing with my hip.  Right now, Otter is just being switched from carprofen a.k.a. Rimadyl to prednisone (b.t.w. there’s a required protocol to do that switch safely).  Sima is on an intermediate dose of carprofen and has been since last fall.  That has allowed him to run with the team---something he very much enjoys. 

The reality is I managed dogs’ meds, specifically Dawn’s, for years before I had the accident that would eventually lead to my hip replacement.  Dawn had regular episodes of epileptic seizures.  The first four years I had her, a very low dose of phenobarbitol kept her nearly seizure free.  In September of 2002, this changed without any known cause, something every vet I talked to said happened frequently.  From then on, I had her on a more typical dose of phenobarbitol as well as potassium bromide.  The dementia she eventually developed may have been from the drugs, the seizures themselves---she still averaged a two to three seizure episode every month---or just old age.  She was ten when the dementia started. 

Dawn died from cancer just two months short of her thirteenth birthday.  A month earlier, my friend Eric had specifically commented that, even though the dementia had progressed so far that I was no longer anything more than a caregiver, he thought she was still enjoying life.  Dawn’s basic philosophy was that if you really believe in it, everything is edible.  Her love of food made her life worthwhile. 

When Dawn died, she had been on phenobarbitol for eleven years, potassium bromide for seven years, and prednisone---the first symptom of the cancer was it affecting her spine and prednisone helped with this---for seven months.  I’d add that all three of these drugs were very cheap.  Their costs were driven by handling, shipping, and packaging---pharmaceutical companies weren’t getting rich off of Dawnie.  With the drugs, Dawn lived a pretty normal life.

The key to all of this is balancing the benefits and risks for the dogs.  I work with my vet to figure out which and what drugs to use for the dogs, just like I did all those years for Dawn.  The benefit to doing this is just how much better drugs can make my dogs’ lives.  That’s the difference between giving dogs drugs like these to help them deal with medical issues now verses during a race, the latter being against rules everywhere.  Regardless of the rules, I’d never administer a drug to a dog that had any risk at all just so I could do better in a race, but others would.  The only reason for anybody to give Sima the carprofen now is for Sima.  It’s been great to have Sima run with the team, something I had real doubts he’d be doing before I started him on carprofen. 

My first Siberian, Sapura, died in December of 1989. She had just had her fourteenth birthday.  Since that time, veterinary medicine as well as my understanding of it have come a long way.  If I had simply known to use a thermometer, she might have lived longer.  She died from peritonitis and I probably would have caught the fever in time for a course of antibiotics to work.  She would have been happier too, had I known what I know now.  I had hesitated to put her on cortisone----nobody used prednisone at that time.   It was only during her last week that I had her on the steroid, but I saw her wag her tail for the first time in more than a month.  I had been hesitant to put her on the steroid because of its long term effects without realizing that, at 14, Sup had no long term.  It’s been said that no animal should die without steroids in its system.  Sadly, Sup had them in her system for only a week. 

Otter---13y 8m---has been on prednisone for three days.  We’ll see what happens, but it’s looking pretty good.  She seems to be moving easier than when she was on the carprofen.  More than anything, I want to make sure every day is a gift for her and not a burden.  With a little luck, I’ll succeed.