PSOM and NAC Supplement

[ppotterfield]

I mentioned in my update about our Buddy that he is taking a supplement called NAC (N-Acetyl-L-Cysteine) related to his PSOM (he also has SM and is on Gabapentin and Omeprazole). A couple people asked about the NAC and so I thought I would respond in a separate thread. I am, of course, not a veterinarian, so if you think you would like to give this a try you should definitely talk to your Vet. There are all kinds of drug interactions and other factors that need to be taken into consideration.

NAC is is a pharmaceutical drug and nutritional supplement used, in humans, for multiple purposes but primarily as a mucolytic (mucus-dissolving) agent in respiratory diseases. Lynnette Cole, DVM at the Ohio State University Veterinary School is trying it with her PSOM patients after they have had the mucus flushed from the middle ear in the hopes that it will help prevent the mucus from returning. There are no studies which have clearly demonstrated this but it is something she feels is worth trying with little to no downside. Here in the States you purchase NAC over the counter at large drugstores that sell lots of supplements or at nutrition or health food speciality stores or places like Whole Food Markets.

For those of you who might not know Dr. Cole at OSU has been conducting a study on PSOM in Cavaliers in an attempt to find a way to make the diagnosis without needing to do a CT Scan or MRI. Since she started the study she has adopted several rescue Cavaliers and is also the state coordinator for Cavalier Rescue USA (for Ohio). She was instrumental in OSU putting out a special pamphlet on Cavalier health which you can see here by clicking where it says "Cavalier King Charles Spaniel": http://www.vet.ohio-state.edu/555.htm.

Our Buddy had PSOM diagnosed, had his middle ears flushed and then two years later had to have it done again. Since the second surgery he has been on NAC. We do not know for certain that it has not returned (unfortunately still need to do a CT scan or MRI to make a diagnosis unless you see a bulging eardrum) but we are not seeing anything that makes us suspicious right now so we are keeping him on the NAC and his SM medications and watching.

Hope this is informative to some of you.

[Soushiruiuma]

NAC is, as you say, a mucus thinner (expectorant). It works by disrupting the structure of the goo that is mucus, forcing the mucus to incorporate more water, thereby making it easier to expel (or drain, in the case of ears). The chemical structure is quite simple, the cysteine is what causes the change, cysteine is a sulphur containing amino acid, the sulphur changes how the molecules of mucus protein bind, making them looser.

I have used this in my lab to rid gut sections of mucus, and have to say it is quite effective.

I could see how this may be beneficial to PSOM dogs, but be sure to check with your vet to before starting, and also for dosing.

[Karlin]

Thanks so much for this post and additional explanations. Three of my four that have been MRId have PSOM. None have had their ears flushed, but I wonder about doing this with Jaspar as he is bothered by something in his ear on the left-hand side only but has been clear on two MRIs for SM and has only very mild hindbrain compression so it probably wouldn't be CM. I am going to get him in to see if it looks like the eardrum is bulging at all and it is useful to have this information.

[Blondiemonster]

Very interesting.. My girl also has both.. One remark my second neurologist Dr. Chad West said is that according to him, PSOM and SM are connected. He says that in his practice he has yet to see a dog with PSOM that doesn't have SM to some degree.
Ofcourse he said that it is only his opinion. It has something to do with a nerve connection int he inner-ear and something with pressure. Just wanted to share this

[Karlin]

I have an SM clear dog with PSOM, for what it is worth. And another clear one without!

[Blondiemonster]

I have an SM clear dog with PSOM, for what it is worth. And another clear one without!

yeah, he wasn't claiming his opinion to be 100 percent, but that's what he has generally experienced in his practice.

[Furrfoot]

Are you using this to flush the ears or as a dietary supplement? I ask because NAC that has been packaged and exposed to air is much less effective than NAC that is packaged in such a way that the oxygen exposure is limited. You have to be choosey where you get it to get the most for your money, and with some brands, to get anything at all, since they are not regulated in the US.

There is a liquid prescription mucus thinner called Mucomyst that you may be able to get (it comes in generic, and has been around for 20+ years, usually inhaled through a nebulizer, but I know a few people who drink it too- smells like rotten eggs, the dogs should love it :P ), or there is a fizzy tab that you can order from Canada called PharmaNac, that is made to the Canadian 'script standards. There is also a company called Theranaturals who has properly packaged and buffered NAC for ingestion. Just an fyi so that you are getting what you pay for if you try it . I take the PharmaNac myself (I have Cystic Fibrosis, and am taking the NAC with my doctor's blessing. They are also doing clinical trials in CF patients for NAC) and it does make a difference .

NAC is what they give people who overdose on Tylenol to protect the liver, also just fyi .

[ppotterfield]

Are you using this to flush the ears or as a dietary supplement? I ask because NAC that has been packaged and exposed to air is much less effective than NAC that is packaged in such a way that the oxygen exposure is limited. You have to be choosey where you get it to get the most for your money, and with some brands, to get anything at all, since they are not regulated in the US . . . .

The NAC Buddy is taking is a tablet. He takes 300 mg. orally twice a day. I am interested in your comments about quality. Is there some way I can tell that what I am purchasing is good quality?

I have a sister who has been diagnosed with interstitial lung disease and she is also taking NAC.

[Furrfoot]

From: http://bioadvantexstore.com/usdstore...61f8f36a9cdc96

"NAC is an antioxidant that must be processed in an extremely dry environment with extremely limited exposure to air. If it becomes oxidized to any degree, then it becomes destabilized and therapeutically ineffective. Unfortunately, some OTC NAC supplements sold on the market today are not manufactured under such strictly controlled environments due to the enormous associated control costs. As a result, these products often have little or no active NAC in them, despite labeling to the contrary.
This is precisely why BioAdvantex takes great care in diligently manufacturing PharmaNAC according to strict pharmaceutical standards. Special care is required to ensure that the components of each PharmaNAC tablet do not react during manufacture or within the compressed tablet following manufacture. In fact, each PharmaNAC tablet is individually wrapped in a special 4-layer (paper/plastic/foil plastic) air-tight material to prevent moisture and air from destabilizing and degrading the NAC (unlike other NAC products that loosely package numerous quantities of NAC capsules in a plastic bottle openly exposed to air). Our European GMP-compliant manufacturing process secures consistent quality, content uniformity, and stability in each and every 900mg effervescent tablet."

*red mine

I know this is from the site selling the product, but it was the most concise explanation I could find. They use PharmaNac in the drug studies, if that helps any .

And here is a link to the Mucomyst page at Drugs.com:
http://www.drugs.com/pro/mucomyst.html

(It's pretty long, but you can scroll through and find what is pertinant for lung issues/mucus thinning )

Here is a pic of how Mucomyst is distributed (as you can see, pretty strict in oxygen exposure per dose too): http://www.webmd.com/drugs/image.asp...502&cb=mywebmd

Other than asking about the packaging process, I don't know how to tell. I do know that these are the only 2 that the people who have looked into NAC in the CF community use.

I wish I could help you more, but I take the PharmaNac because it's the one used in the drug studies, and am considering using the Mucomyst instead because it's a good bit cheaper (though I hear you have to mix it with something like Grapico to get it down, lol). I've never used the Mucomyst in a neb, though I would like to (I'm fairly stable, and my doctor is going with the "if it ain't broke, don't fix it" route right now ). In a nutshell, I use the ones the medical community recommends.

[ppotterfield]

From: http://bioadvantexstore.com/usdstore...61f8f36a9cdc96

"NAC is an antioxidant that must be processed in an extremely dry environment with extremely limited exposure to air. If it becomes oxidized to any degree, then it becomes destabilized and therapeutically ineffective. Unfortunately, some OTC NAC supplements sold on the market today are not manufactured under such strictly controlled environments due to the enormous associated control costs. As a result, these products often have little or no active NAC in them, despite labeling to the contrary.
This is precisely why BioAdvantex takes great care in diligently manufacturing PharmaNAC according to strict pharmaceutical standards. Special care is required to ensure that the components of each PharmaNAC tablet do not react during manufacture or within the compressed tablet following manufacture. In fact, each PharmaNAC tablet is individually wrapped in a special 4-layer (paper/plastic/foil plastic) air-tight material to prevent moisture and air from destabilizing and degrading the NAC (unlike other NAC products that loosely package numerous quantities of NAC capsules in a plastic bottle openly exposed to air). Our European GMP-compliant manufacturing process secures consistent quality, content uniformity, and stability in each and every 900mg effervescent tablet."

*red mine

I know this is from the site selling the product, but it was the most concise explanation I could find. They use PharmaNac in the drug studies, if that helps any .

And here is a link to the Mucomyst page at Drugs.com:
http://www.drugs.com/pro/mucomyst.html

(It's pretty long, but you can scroll through and find what is pertinant for lung issues/mucus thinning )

Here is a pic of how Mucomyst is distributed (as you can see, pretty strict in oxygen exposure per dose too): http://www.webmd.com/drugs/image.asp...502&cb=mywebmd

Other than asking about the packaging process, I don't know how to tell. I do know that these are the only 2 that the people who have looked into NAC in the CF community use.

I wish I could help you more, but I take the PharmaNac because it's the one used in the drug studies, and am considering using the Mucomyst instead because it's a good bit cheaper (though I hear you have to mix it with something like Grapico to get it down, lol). I've never used the Mucomyst in a neb, though I would like to (I'm fairly stable, and my doctor is going with the "if it ain't broke, don't fix it" route right now ). In a nutshell, I use the ones the medical community recommends.

Thanks for the information. I will look into this and discuss with BudBud's Vets. I will also mention it to my sister.