What does Steve Jobs, Metacam (or any other NSAID), and your cat have in common?
Ok, let’s help out Ziggy here. And let's go through my metacam rules for cats.
So we gotta get that weight loss to stop. Shrinking muscles and weight loss - we don’t want that for a 15 year old cat. We got to get rid of the ravaging effect of arthritis on the body. If it hurts to move, you move less. When you move less, the pain increases (lack of movement further accentuates stiffness and arthritis signs; movement in the body decreases it). When the pain increases, your appetite and hydration get worse. When you don’t eat as much, you lose even more weight and muscle. When you lose more muscle, it’s harder to move….
We gotta get off of this cycle, right? It’s no good in all of the worst ways.
Now, I ask the question. What does Steve Jobs, Metacam, and your cat have in common?
Steve Jobs had the ability to convince himself and others to believe almost anything with a mix of charm, charisma, bravado, hyperbole, marketing, appeasement and persistence.
This was called his “reality distortion field”.
You know what? The internet is a reality distortion field.
Any single topic out there (cat’s, guitars, cars, hair products, cameras, baby seats, paleo-diet, chiropractic care, Star Wars prequels) is subject to this distortion.
Cat + Metcam = reality distortion field squared.
I know what some people are going to say about. You know what? I give not a shit about what other people say and the distortions they put upon. I have to look that cat, right in the eyes, and promise that I will help them, and not harm them. I have to go to sleep every night, with a clear conscious. I see over a thousand pets every year as a vet. Can you imagine, waking up, walking into my office, with phone calls and messages that someones pet was damaged, hurt, or died because of something I did? Day after day? I couldn't take it that. I would just quit. But then again, my reputation would be crap, and I wouldn't be able to sustain myself in a small community. Or look myself in the mirror.
So my core techniques and advice are water tight. They are triple sealed. There are no bubble gum welds. I hold them dear and close. They are hard won, and were decades in the making. I can look my patients and their people in the eye. I can goddamn stand behind my words.
You know who doesn't have to do any of those things? The internet.
When my daily experience does not jive with what I read online, it’s the reality distortion field.
I trust myself far more than the charm, charisma, bravado, hyperbole or circumstantial connections that exists online.
My experience with cats and NSAIDS (like feline Metacam) is so far divorced from what is written online that the kids will need therapy from the dragged out five year custody battle.
Some will say “its because I'm lucky”. Uhhhh..no. Luck has nothing to do with developing successful core techniques and why they work.
Some will say they gave X medication, then XYZ happened. I don’t have enough breath to explain causation versus correlation in mammalian bodies affected by illness. I could write a book…
Some will say “there are plenty of other options to reduce pain, so why would you even consider an NSAID”? Well - we have to cut that cycle, right? Sometimes alternatives exist to do that. Sometimes, unless you have something that is actively squashing the inflammation (which is what an NSAID like metacam is designed to do), it’s not going to work that well.
Some of you at this point will say that I am “pro-metacam”.
Nope, I'm pro animal welfare :)
And Ive been sticking up for those who can’t talk since the 90’s.
What I am suggesting is that we get way less "internetty" about medication. And I’ve got a toolkit. I don’t demonize or put anything in that kit on a pedestal. I have to choose the right tools for the right problems, or I will fail my patients.
You give it at the right dose only to patients who are candidates for it.
You don’t give it to patients are who are not candidates for it.
You plan your exit strategy, because you are not going to use it forever in a cat.
When any of these things are not correct, you are going to screw up. And if you have these things correct, then your rate of side effects will be no different than any other pain medication you use.
So what are my Metacam rules for cats?
- You have to have stable kidneys. They don’t need to be perfect, just stable. If your vet can’t discuss exactly what this means specifically for your cat, then seek a second opinion.
- You will always get the benefit of the doubt with hydration. I never give it without either giving SQ fluids or in some other way knowing they are hydrated.
- I often give it it paired with famotidine.
- I don’t know what’s up with the American doses. Metacam is not Texas, so bigger is not better. Our labelled dose here in Canada is lower than what is recommended in the US. I have no idea why. I don’t even use the Canadian dose. I never use a “loading” dose. Im lower than that and I still get all the benefits from it. Don’t know why, because I'm just one vet in the trenches.
- I continue to lower the dose over time. Typically I can get up to 50% lower. Theoretically if you are a 4kg cat, you are most likely getting a 2kg dose from me. Then every other day. Then twice a week if the cat in question’s body responds to that.
- Test the response. You just can’t set it and forget it. If you are old and you have stable kidneys today, that doesn't mean you won’t have unstable kidneys 6 months from now. Some cat’s will show improvement. Hawk eye the cats who don’t!
- Clients choice. The client always gets a choice when we are using something to be prescribed for home use that can have side effects with core organs. They know that for the wrong cat metacam can be nephrotoxic, and they also know that in stable CKD the research shows they could get more life from their cat. But it must be a persons choice.
- Exit strategy. Rare is the situation where I am just refilling bottles of Metacam (or any medication for that matter) without knowing what is going on in the life of my patients. Something changed? Well, we have to re-evaluate. Are you much better now? Well lets look for a long term plan to support the mobility, and just use the NSAID to knock down the occasional flare up.
Can you see why it’s easy to screw this up? Especially when life will throw curve balls and you can’t predict everything.
Do any of you have human family members with chronic, debilitating pain? I do. If it wasn't for research I did on the internet, my sister could have died. The research I did led me to a treatment, which led me to airplane tickets and a trip to the US to treat her debilitating pain. You’ll do what you need to do to remove pain and suffering in the lives of those you love. There is power in what’s on the net. There is also a reality distortion field. There is power within the people in your life that you trust. Choose wisely.