Jeffrey Vogl, DVM
Ask the Veterinarian
6:21 AM EDT, June 27, 2012
Due to the very nature of our line of work in veterinary medicine, we are exposed to pain and suffering many times every day in our furry friends. From trauma, elective surgery, non-elective surgery, tumors, fractures, periodontal disease, abdominal pain and osteoarthritis, we are continually trying to prevent, alleviate or just plain manage all these types of painful situations. Just like children, our pets are helpless when it comes to pain management and rely on us to be there for them.
Just a simple sliver in your finger, though not the most painful experience you will ever have, can be extremely uncomfortable and affect how you get through the day. Yet the simple act of getting tweezers out and removing it makes you feel incredibly relieved. Our pets cannot do that. In fact, pets do the exact opposite: they hide their pain. It continually amazes me how stoic our 4-legged critters are compared to a bipedal exhibiting pain. Most think animals evolved to hide pain because if they showed any weakness they would have been picked out by other predators, or even lost status in their own ranks. They must still feel pain; they just process or handle it differently. I have had dogs with a fractured femur or dislocated hip come in wagging their tails. Humans would be begging for pain meds.
Some of the most common signs of pain in dogs are anxiousness, pacing, whining or whimpering, restlessness, loss of appetite, hiding, depression, trembling, panting, antisocial behavior, stiff gait, limping, increased licking at a body part, or collapsing. Cats are more prone to hide somewhere unusual, not eat and become antisocial. Some of the most painful conditions come in with very subtle signs of pain. Corneal ulcers or scratches (never had one myself) I have been told are like a red hot iron touching your eye. Dogs and cats may come in with a little squinting or discharge, and that is all you may notice.
Fractures of the legs and feet may simply cause limping (though they still may want to run and act happy). Torn anterior cruciate ligaments (ACLs) are classic. They are running around outside, sharply cry out, and the leg comes up. Regular sprains and strains will improve after a few days, whereas ACLs do not. I tore my left ACL a few years ago and now have a much better appreciation for why these giant football players writhe around on the ground like fish for several minutes in agony when this happens. It was more painful (initially) than any of the fractured bones I have sustained over my half century (fingers, two ribs, nose, orbit of eye, all metatarsals).
Another regular and very painful condition is intervertebral disc disease, otherwise known as herniated discs in the spine of the back or neck. The disc sits between individual vertebrae of the spine and is somewhat softer and flexible to allow our spine to bend. In disc disease the disc basically pops and swells. Our typical patient presents with sudden onset lethargy, won’t move much, won’t go up or down stairs, won’t jump up or even look up with their head (if it is neck or cervical), and often cries out sharply if picked up or moved at all. Our clients may have witnessed an event that caused the herniation of the disc, but more often than not there is no obvious traumatic event. The pain from this is chronic and continual and will also “zing” you with what feels like an electrical shock through your whole body. Medications may help but surgery may also be needed. (Personal experience.)
By far the most common painful condition we deal with is periodontal disease and abscessed teeth. Again, it remains a mystery as to how a dog or cat can have multiple abscessed teeth and exhibit no signs whatsoever of pain. In humans, one bad tooth and you are up all night waiting to get in to your dentist to have it treated and get on some Vicodin. Every week we see patients that need comprehensive dental care yet the owner is really unaware of any pain with chewing or eating. We do often get the reply a few days later that “they are like a new dog or cat.”
All of these conditions require different forms and combinations of pain relief. Some require nonsteroidal anti-inflammatory drugs (NSAIDS), steroids, narcotics, sedatives, or multimodal approaches that use several types at the same time. Pain medications come in different forms such as tablets, liquids, injectables, topical creams or patches. Many new NSAIDS (called COX-2 inhibitors) are available that are safer and better for longer term use such as osteoarthritis. Be careful with many traditional human NSAIDS such as aspirin, which can be used for a few days but has the potential to eventually affect platelet (clotting) function. Some of these are very hard on GI tract like ibuprofen and are not a good idea at all. In cats, human NSAIDS can be very dangerous if not lethal.
Veterinary medicine has come a long way the last 30 years in pain management. There isn’t a veterinary hospital in our community that doesn’t address pain as part of their medical and surgical procedures. Surgeries are premedicated with pain injections as part of the preanesthetic protocol. Post op care will include one if not several modes of pain medications and likely some will be dispensed to go home. With our most painful procedures we like to use enough pain management that our patients “forget” the first three days after surgery. We accomplish this by adding NSAIDS, narcotics and sedatives to make them “very happy” with drooping eyes, are calm and relaxed, and taking naps for the next few days.
I was very disappointed recently with our human counterparts, when a family member was in severe pain, having leg cramps every 45 seconds for over 10 hours and was given a Tramadol tablet which did nothing. The nurse said that these were the doctor’s orders (from two days prior). The cramps were a result of a procedure that was performed just few hours prior and I countered that maybe the orders needed to be changed. I was told that the doctors will be in rounds the next morning and will address it then. It was a tortuous night for my relative and for us to witness. We found out the next morning that a simple change in medication could have alleviated the pain very quickly.
In the midst of my anger, I kept thinking that I would never let one of our patients go through what my relative just experienced. It actually underscored my focus to address and manage pain in those without a voice. In fact, just a few hours later I repaired a torn ACL and gladly gave enough post op narcotics that there was never a whimper. My staff won’t let a patient be in pain for a few minutes, let alone hours. I don’t even have to ask them to get me; they would do that on their own.
It is a little different around the Vogl den however. I have been blessed with a family that loves to laugh…..especially when pain is involved and especially when it is mine. If you stub your toe or fall down a FEW stairs in our house (from shoes laid on the dark steps) this is fodder for great hilarity. When I broke my ribs it was weeks of fun. The ultimate goal was to make me laugh which of course caused a great deal of pain on my part, which just made them howl like the hyenas from lion king, which made me laugh so hard I would start to cry which of course just raised the roof. No sympathy here! By the way, advice from “not a real doctor” if you ever break a rib: never, never, ever, ever….. sneeze!