Oliver and the RVC trial
I thought people might like to follow Oliver's progress on the RVC Clinical trial of SM medication, so I'll start on a weekly update. We've just reached the end of Week 1, during which he has been off his normal daily dose of 200mg x 3 of gabapentin and started on a once a day dose of Rimadyl, which is a pain relief and anti-inflammatory. Well, two things have happened:
1. His SM symptoms really haven't been noticeably worse, though the pattern has changed slightly. Usually, on gabapentin, he seems to have a low grade headache quite often, usually showing while dozing especially with his head on his paws, when he starts whimpering slightly. It will often apparently stop if I turn him gently on his side, but evidently his high dose of gabapentin doesn't entirely deal with it. During this week, he has had fewer of the whimpering episodes, but slightly more episodes of jumping up to rub his head hard against a low table edge or a cardboard box. He started this a few months ago, and it seems to be a jab of headache, rather than the more prolonged (though perhaps lower level) headache that makes him whimper.
2. A real plus of this week on Rimadyl is that the wobbliness in his back legs has almost entirely disappeared. We weren't sure whether this was due to his SM or to the spondylosis (osteo-arthritis of the spine) that he also has. He hasn't been on regular medication for this since it first flared up over 4 years ago, when he had metacam and crate rest for about 4 weeks. It appears so far that the wobbliness could be spondylosis not SM, since it improved almost as soon as he was put on an anti-inflammatory specifically used for osteo-arthritis. I think his problem is stiffness after lying down rather than constant pain, as that is when he staggers most. He always walks a bit stiffly - I think because that is the most comfortable, rather than that he is having a great deal of pain. I haven't discussed this yet with our vet and neurologist, but it does look as if keeping him on Rimadyl or similar could really improve his mobility.
No other side effects at all. I just have to mark where I think he is on a line scale each week, but I'm also keeping a daily diary for my own information. We've now started on Drug A for two weeks (note to RVC: if you're trying to do a blind trial, with the participants not knowing which drug they're giving to their dogs, don't supply tablets clearly stamped 'Neurontin 100mg'!!). So for the next two weeks Oliver will be back on a smaller dose of neurontin/gabapentin. I'll let you know how he gets on, if people are interested.
Kate, Oliver and Aled
Thanks for this report, Kate. I hope you can keep them up.
yes it's great that you are writing a report, very interesting.
Well that made me laugh.
Originally Posted by Kate H
I wonder if there are rules against popping these 'bubble wrapped' pills out of their protective packaging?
I wonder if there is there any identification on Drug B?
I'm certainly interested in how Oliver gets on.
I too am interested in following his trial.
This will be very interesting to follow. I look forward to it!
End of Week 2. This week has been the baseline of Rimadyl plus 3 x Drug A (100mg of Gabapentin - half the dose of gabapentin Oliver was on before the start of the trial).
The Rimadyl still seems to be controlling Oliver's wobbly back legs. We had a long pavement walk on Wednesday (about 1.5 miles) and he was unusually tired (for him!) at the end of it, and a bit wobbly; I think this was because his longer walks aren't usually just slowish walking on a hard surface but include some trotting around off-lead in a park, and the increased pace takes the pressure off his back at least for that time. After a good sleep he was fine again and not a wobble since (not much exercise either, given the British weather this week!).
The lower dose of gabapentin doesn't seem to be making much difference. He is perhaps a little bit more scratchy, but whimpering when dozing is about the same - no better but no worse, and it always stops if I can turn him onto his side. I went to the vet's to get his Optimmune prescription for his dry eye on Thursday, and she gave his ears a quick check, but no cause for scratching there. We at last seem to have got the flea problem under control, so no scratching there. I asked the vet to give me a referral to an ophthalmologist once the RVC trial is over, because I think we need to find out more if we can about what's happening with his eyes. A high dose of gabapentin and four years of diuretics don't seem to have done anything to reduce his photophobia; if anything, it's getting worse. We went up to London for our session at the RVC on a small train with strong fluorescent lights and by the time we got to the college Oliver's eyes were almost shut and he was obviously uncomfortable (it was also sunny) - as soon as he got into the more subdued and gentle light inside the college, his eyes were normal again; and this Friday (a grey and wet day) the light coming through the windscreen of a car onto where he was sitting at my feet had him squinting. An MRI might give us some information, but would need to be done from a variety of head angles, not just the mini-scan head and neck, and would be expensive (and Oliver's insurance won't cover anything to do with CM/SM). I'm hoping an ophthalmologist would be able to tell me whether any damage to the eyes (and I know he's got a problem with the mechanism controlling the movement of his pupils) is actually caused by his dilated ventricles (which we have always assumed) or whether it might have a cause entirely unconnected to his CM/SM, since neither a neurological pain blocker nor a diuretic intended to reduce the size of the ventricles seem to have any effect. I think it's going to be a Doggles summer (he does look VERY posh in them)!
We have another week on Rimadyl plus Gabapentin. Apart from the possibly useful information about his wobbly legs (and my vet agrees it would be worth keeping him on a pain killer - though not Rimadyl), it's useful just having to observe Oliver more closely than I normally do, and I'm increasingly sure that gabapentin is not a very effective drug for him. It will be interesting to see what difference Drug B makes. We have one week (Week 4) on just Rimadyl, to get gabapentin out of the system, and then start two weeks on Drug B: a round beige pill with 100 on one side (100mg) and TOP on the other - I suppose I shouldn't cheat and ask if anyone recognises them, but the RVC were so daft over the gabapentin, I'm not sure it matters all that much! I don't think knowing what it is will influence how I observe Oliver when he's taking it - I just note down what I see (though I suppose I might not have said what I have above about gabapentin if I hadn't known what it was and already had reservations about it). But my daily notes simply record 'No difference' for most days this week.
Wait for next week's exciting instalment!
Kate, Oliver and Aled
Thank you for doing this Kate it is really helpful and interesting to follow the trial.
With regards to the drugs being identifiable I suspect this is for legal reasons, also most people following trials would not have the knowledge about drugs that many of us have garnered and would not therefore know what was being prescribed. From your description I think I have identified drug B, this should be good news if it proves to be effective, not only is it another drug to add to the arsenal to help pain management but it appears to be cheaper than Gabapentin. Knowing what the drug is will as you say not influence your record keeping.
I avoid pavement walks with affected dogs after having read messages from human sufferers who state that hard surfaces are painful for walking upon, aggravates symptoms so that might be why he was feeling worse? I noticed that myself with the Trigeminal Neuralgia that even going from carpet to tiled floor was far more painful.
It's really good that the wobbliness has greatly reduced - I know that the treatment algorithm suggests use of something like Metacam or Rimadyl together with Gabapentin, personally I do not like long term use of either drug but nor would I leave a dog in pain when they can be helped, I prefer Metacam to Rimadyl but it depends what works for your dog. Rimdayl is possibly easier to give as it is a flavoured tablet.
I was interested in your comment about pavement walking. He has not had any problems before, but usually I include a period running around off-lead - if we walk the 1.25 miles into town, for example, which we do quite regularly, about a third of it is through a park where the dogs can trot around off-lead, and I think that is enough to relax his back. I suspect with the other walk, which was only pavement, the temporary wobbliness was tension from having to walk relatively slowly for a longer period, without the chance to relax off-lead. Something I'll have to watch.
If we keep him on a painkiller after the trial ends, it will probably be Previcox, as our vet practice prefers that to Rimadyl as being gentler on the stomach. Given his weight at 10kg, Oliver would be on the smallest dose (57g once a day), and if it works well on his osteo-arthritis, I suppose it might be possible to reduce the dose further over time by not giving it every day, or giving it for a couple of months and then seeing how he gets on and if the wobble comes back, having another course - it's not generally used long-term. But I'm so pleased to find that something can be done to help that wobble.
Kate, Oliver and Aled
This week's report, end of Week 3.
This week we've finished the 2 weeks of Rimadyl plus Drug A (which I know is gabapentin). For 2 weeks Oliver has been on half his previous dose of gabapentin, but there doesn't seem to be any obvious change in his symptoms - for good or ill. Perhaps a bit less whimpering when resting, not so many episodes of jumping up and roughly rubbing his face (though these have never been frequent). No sign of wobbly back legs, so the rimadyl still seems to be working. There is some scratching at his head, but it isn't very frequent or frantic, as if he's in pain; the lady who did his BAER test last week thought that tinnitus might be a real possibility with dilated ventricles, and I do wonder if this is responsible for his head scratching. He does move around quite a lot - from crate to floor to settee to his bed to floor... obviously trying to get comfortable but not whimpering or showing obvious signs of pain. But is this his SM, or is it a general achiness from his spondylosis?
One reason he may have seemed better this week is that we have been busy and he is always better when his mind is occupied. On Monday we travelled by train to Chester. We spent almost the whole of Tuesday at Chestergates (7 hours!), and while Aled had his scan and recovered from it, Oliver appointed himself Meeter and Greeter for dogs and humans coming into reception! On Wednesday we had a lovely afternoon walk and then travelled home to Coventry. Yesterday and today we have had longish walks - 3 miles or so walking off-lead across fields. Not a sign of discomfort while running around or engaged with people, and sleeping soundly when we come home tired.
Now we have another week just on rimadyl, to get the gabapentin out of Oliver's system before starting on Drug B for 2 weeks.
Kate, Oliver and Aled