Long term pain relief

[LucyP]

Hi all

Sorry for the long post!

Looking for views on long term meds please.

This is for our lovely Mabel (age unknown but based on the rescue’s guess, she may be 3 years old, we got her when she was 1 and she came from a neglect situation). Mabel has some health issues:

1. She was hospitalised last year for fluid build up in her chest. It was touch and go for a couple of days but she made a good recovery with frusol and another drug.
2. She had antibiotics for a possible lower respiratory infection around then.
3. An ultrasound showed no obvious abnormalities of the heart or thorax. Blood tests were inconclusive.
4. A CT scan showed some scarring of the lungs (fibrosis) suggesting some permanent damage (from when or what, we don’t know but she is now described as a lung diseased piggy.)
5. She’s had long term slightly laboured breathing and occasional head bobs. Very grunty/honky breathing at times, this is helped quite a lot by twice daily nebuilsation and she generally seems to be breathing more easily now but we keep an eye on it.
6. She eats and interacts well, begs for food etc and seems ok in herself and with her friend Winnie.
7. She has had some minor/ borderline bumblefoot despite good dry housing, we are treating this. She seems to place more weight on her front legs than other pigs.
8. She’s lost a bit of weight over the last 6 months but it’s stabilised now. She’s about 1170. She has been between 1130 and almost 1300 over the years.
9. At her recent health check she was diagnosed with 1.5cm ovarian cyst/s and some hair loss on her flanks can be seen.

We are happy with the long term plan for managing her lung disease (nebuliser and keeping an eye out for any signs of infection which she may be prone to, so we can act quickly). We also have access to good vets including at weekends and always take her promptly with any issues.

What concerns us is that the hair loss on her flanks had a small area that was a bit stubbly rather than smooth and we realised she had been biting that area now and then, suggesting discomfort or pain which we were gutted to find and obviously don’t want that for her. So following discussion with the vet she’s on twice daily metacam (0.4 per dose) for a few weeks so we can see how well that seems to manage the pain. So far she doesn’t seem to be nibbling at herself but it’s only been a couple of weeks so I will keep feeling her stubbly bit to make sure it grows back smooth and she isn’t chewing. Sometimes it’s hard to tell if she’s grooming or chewing so I want to check the fur.

We are trying pain meds because her health issues make her quite a risk for a major spay surgery.

My questions are- if the metacam keeps her comfortable and we decide to keep her on that permanently, are there any risks we need to be aware of? Long term pain relief is our preferred option.

If we don’t find the pain relief is helping I think our options are:

Up the pain relief/change pain relief meds to something stronger?

Or risk the spay. Our vet is a very experienced exotics surgeon who has been spaying small animals for a couple of decades and she explained it’s not always easy for pigs. I asked about the op where they just take out the ovaries and she does do those, but she wouldn’t recommend this for Mabel’s situation- (she explained why but I can’t remember all the details).

Mabel is not a pig we’d want to put under GA if there were other options that worked for her. If we have to do it then they would take normal precautions such as monitoring the response to GA and in her case they could also consider precautionary antibiotics beforehand to reduce the chances of her going into surgery with any underlying chest infection. But it is still quite a risk and their view is that going for a spay needs to be weighed up carefully re pros and cons.

Our other rescue girl Winnie who is an older pig, has a 1cm cyst and this has never given her any issues, so with vet discussion, we opted to leave that and monitor it every 6 months and it has not grown in 4 years. I was hoping that doing the same might be an option for Mabel, but her stubbly fur shows she’s been in pain I think and we don’t want that.

Our vet says based on experience they tend to assume many/most sows will get cysts eventually, and not all need of those necessarily result in having spays but I’m gutted this is happening to Mabel and causing her pain.

Hormone injections they are less keen on as they say in their experience it doesn’t last for very long and doesn’t always help. I know others have had success though.

I’d really welcome the opinions of people who have other pigs on long term meds.

Many thanks

Lucy

 

[LucyP]

Just giving this a bump in case anyone has any views. I will be speaking to the vet so it’s fine if no-one here has a comment, but I do value the years of collective experience on here too. Thanks!

 

[Eriathwen]

I have several piggies on long term pain meds, metacam, gabapentin and paracetamol. Some have been on these for years, even my 2 lethal whites who are considerably more fragile than my others.
Considerations would be damage to kidneys and liver, however guinea pigs metabolise drugs quicker than some other animals and tolerate even high doses pretty well. My own are on 0.6ml 2xs a day and the ones who have had bloods done haven't shown any issues with liver or kidneys so I'm personally not concerned, and have had palliative doses considerably higher than that.

Personally I always opt for spays with ovarian cysts where possible, but I agree with such lung damage, I would be very hesitant to do so in your place. The injections can help, but only on cysts that are hormonal, some are just fluid filled and won't respond. These injections can be very painful and over time can begin to cause an inflammatory response, almost like an allergic reaction and become less and less effective.
Some people have used hormone implants, my own vet says that these can actually make them worse, but some people seem to have had success with them, I do have a spayed girl who gets these implants due to being intersex and producing too much testosterone, they certainly seem to help, so in theory they must do something, hormonally speaking.

Large cysts can be simply drained, again painful and requiring sedation but a quicker and less invasive procedure but again, not always suitable.

I have an almost 9 year old who has ovarian cysts but to be honest, they're the least of her problems and she certainly would not survive a surgery. She also does well with long term pain meds, some of them she gets 8 hourly at this point with no ill effect.

 

[AidaB]

Our Hamish is on long term pain relief for his back- he has pain at the base of his spine, and one back leg.
He has been having Metacam/Loxicom daily for coming up to 2years now. No issues at all, and a much happier pain free piggy.

I hope you can find a solution that works for your girls.

 

[Viennese Furbabies]

Living in Austria, where spaying is still a high risk operation even for otherwise healthy sows, I usually only consider spaying if it absolutely has to be done. Most of my girls (during my more than 30 years of keeping piggies) have had ovarian cysts and I only risked the spaying once (it worked out but very touch and go).
I think that most sows with ovarian cysts don't suffer as long as the cysts don't dramatically upset the hormonal equilibrium or get so big that they cause discomfort due to their size.

I have had more than one piggy on long term pain medication (2 years plus) and my Billie who was on heavy medication for quite a long time had to be PTS due to kidney failure in January.
So yes, long term pain medication can have fatal side effects. But in my personal opinion, quality of life always comes before overall life expectancy. A piggy always lives very much in the present. So it's the quality of life in the present that's most important.

I always try to find a balance between how much pain medication is necessary and how little is possible to manage the symptoms.
So I monitor my piggies closely for changes in weight, feeding and behaviour and adjust the dosage accordingly.
Some like my Odi at the moment are/were on a low dose of Metacam long term. It doesn't work without the pain medication for him and he needed a much higher dose last winter around christmas. But once the crisis was over, I gradually reduced the amount.
Other piggies were on the maximal dose for the rest of their lifes, some on a combination of two pain meds.

 

[LucyP]

Thank you all SO much for all these replies, they are really helpful. I’m due to speak to the vet again soon re next steps and I think pain relief and close monitoring feels like the better option right now. If things take a dramatic turn we would intervene but given the risks, if she can manage without the op and live without pain (even if that’s a shorter life) that feels better than a risky op in her case. I am happy to monitor her more often with vet visits re any growth/physical changes, the vet seems to have very good palpation skills and is often finding things that others cannot.

My vet is experienced in spays and pigs and she isn’t especially pushing us to spay which I think is interesting. I also asked hypothetically if it would be an absolute no brainier to spay her if she didn’t have the lung disease- she said the odds would be more in her favour but she still wouldn’t necessarily consider it the only option, depending of course on the symptoms the cysts were causing.

Thanks all, and I hope your various piggies are doing as they well as they can with their different issues under your great care.

I’ll keep the thread updated in case helpful for anyone else.

Best wishes
Lucy

 

[Wiebke]

Hi

I have (and have had) several piggies on long term painkillers, sometimes for several years; mostly for sterile IC, arthritis or end of life care when an operation is not an option.

So far, all my piggies who have had to be put to sleep (pts) for kidney failure or because the kidneys have gone wrong have not been amongst those on long term high-dosed pain relief. Guinea pigs don't seem to suffer from painkiller related kidney problems the way other pet species do; that is why they tolerate much much higher dosages even for long term maintenance.

On the bottom line, the gain in quality of life and the renewed zest for life outweigh by far a slightly shortened life span potentially some years down the line because without the pain relief your piggy would live much less long once the pain starts killing off the appetite and it gets only worse from there...

What is important to keep in mind is that any pain relief for inoperable piggies can only ever mask any progressive health issue for so long; it cannot stop the problem itself. But it can buy your beloved one the possibility of living as normal a life during the time the underlying issue is not yet taking over; however long or short that is.

If you go down that route, I would recommend that you think carefully just how much pain and painkillers do you want to put your piggy through and where you draw line in order to not fall into the rabbit hole of prolonging a life on total support that no longer allows normal species behaviours. It helps you to remind yourself when you come closer to that time because it is much more difficult when you have to make the decision all by yourself and not have it taken out of your hands by circumstances.

 

[LucyP]

Thanks Wiebke, that’s really helpful as ever.

I’m going to bookmark the page about signs of pain and I also took a screen shot of a helpful tool someone put up the other day with quality of life questions, in case we get to this point.

I’m going to keep looking to see if we can see her chewing her fur and also feel it to check that future hair loss is just hair thinning and not barbering. The other signs of pain are not being shown at the moment. Her weight is less than it was this time last year but seems to have stabilised. If that drops again we’d need to consider that a sign of possible pain I think. The vet did mention that weight can be affected by cysts (not sure if she meant re hormones or metabolism or something) but weight is something we’re keeping a close eye on.

Otherwise she’s very much the same noisy, nosey, greedy pig from what we can see, and if you put your arms in the cage she climbs up you (because she thinks she’s getting food) and she chuts and purrs a lot when she’s mooching around or getting a snack. The moment it seems she’s suffering in a way that we can’t adequately support without her losing quality of life, we’d take a hard look at the situation and intervene, even if that means letting her go if that’s best for her. I hope it doesn’t come to that and her cyst is uneventful but I’m prepared for the reality it might get worse.

Thanks again - I’ve really valued the thoughts people have shared and will use this to help me speak to the vet who is also very thoughtful.

 

[LucyP]

Hi all

Just a quick update on this. Had a good chat with the vet today who is happy for us to continue with pain relief instead of an operation and our plan is:

Monitor her hair loss with pictures and also regularly check by hand and by observation that she’s not self-barbering which would suggest her pain is not being managed.

Monitor her for other signs of pain such as weight loss, hunching, being withdrawn, loss of appetite, changed behaviour or anything else that seems off.

If we feel further pain relief is needed then adding gabapentin into the mix would be the next step.

We will bring her in for a vet check every 4-6 months or sooner if any changes occur. Any other future visit to the vets (even for something unrelated like a hay poke) will also now always include the vets checking the size of her cysts and keeping an eye on its growth and discussing her symptoms.

If the cysts start to cause problems that we cannot manage with pain relief alone we could consider hormonal injections to see if it brought any short term relief.

All in all we are not really happy to risk the spay in her case but will keep a very close eye on things.

She has two cysts and their guesstimate by palpating is that we’re talking about a size of about 1.5cm which is apparently some way off the size that tends to interfere with other organs but of course still need to be monitored.

Thanks for all your thoughts on this it helped a lot.

Lucy

 

[Wiebke]

Hi all

Just a quick update on this. Had a good chat with the vet today who is happy for us to continue with pain relief instead of an operation and our plan is:

Monitor her hair loss with pictures and also regularly check by hand and by observation that she’s not self-barbering which would suggest her pain is not being managed.

Monitor her for other signs of pain such as weight loss, hunching, being withdrawn, loss of appetite, changed behaviour or anything else that seems off.

If we feel further pain relief is needed then adding gabapentin into the mix would be the next step.

We will bring her in for a vet check every 4-6 months or sooner if any changes occur. Any other future visit to the vets (even for something unrelated like a hay poke) will also now always include the vets checking the size of her cysts and keeping an eye on its growth and discussing her symptoms.

If the cysts start to cause problems that we cannot manage with pain relief alone we could consider hormonal injections to see if it brought any short term relief.

All in all we are not really happy to risk the spay in her case but will keep a very close eye on things.

She has two cysts and their guesstimate by palpating is that we’re talking about a size of about 1.5cm which is apparently some way off the size that tends to interfere with other organs but of course still need to be monitored.

Thanks for all your thoughts on this it helped a lot.

Lucy

It's good that you have talked things through and have developed a road map of options. I sincerely hope that it is going to take a lot of the stress and fear out of it for you but also give you the assurance that you are doing the best you can.

 

[LucyP]

Thanks Wiebke, it’s a tricky one as we don’t know for sure she couldn’t manage the op but on balance it just feels too big a risk. As long as we can be confident she’s not suffering pain I’m happy with the plan. I wish she could tell us what’s she going through so we could be sure about the pain as I hate the thought of her suffering… but as the vet said, there are a few options re pain that we can look at, so hopefully we can have that side well covered. Her hair loss on one side is still quite bad but it’s not as stubbly now and she seems to be not biting herself.

 

[Wiebke]

Thanks Wiebke, it’s a tricky one as we don’t know for sure she couldn’t manage the op but on balance it just feels too big a risk. As long as we can be confident she’s not suffering pain I’m happy with the plan. I wish she could tell us what’s she going through so we could be sure about the pain as I hate the thought of her suffering… but as the vet said, there are a few options re pain that we can look at, so hopefully we can have that side well covered. Her hair loss on one side is still quite bad but it’s not as stubbly now and she seems to be not biting herself.

One of the most common ways pain can manifest is by loss of appetite/weight loss - since hay is usually he first to be impacted, which you cannot control by eye. I weigh my own arthritis piggies twice a week first thing in the morning on the kitchen scales for best day to day comparison. If the weight is pretty stable then I know that the pain is bearable; if there is a gradual or sudden weight loss of over 50g (i.e. more than the normal daily weight swing) then I need up their daily metacam dosage and the weight will climb up again once the appetite is back. Please never weigh more than once daily always at the same time in the feeding cycle. The weight is lowest before breakfast.
Weight - Monitoring and Management
How To Pick Up And Weigh Your Guinea Pigs Safely (videos)

One facet of responsibility for other lives is that you have to always live with 'what ifs'. The one thing we never get is a sneaky peek at the outcome; we always have to make our decisions in good faith - the path is only ever clear from hindsight while we always, always have to tread the maze blindfolded. You also have to keep in mind that another way would also not have necessarily have a better or guaranteed outcome just by virtue of you having ruled it out together with your vet.
If you have a problem with doubting yourself, then please stick your decision to your fridge with the comment: 'My head and my heart have both said YES. Don't overthink what you have thought carefully through just for the sake of overthinking. '

As long as it feels right for you when you have made a considered decision you aren't failing your beloved ones.

 

[LucyP]

Thank you so much, this is the best advice ever, as usual.

The last time we faced a dilemma about whether or not to operate was our beloved Betty and her large sudden mammary lump - and sadly that didn’t work out (although I know it was the logical decision to operate and by all accounts we had very rare bad luck to lose her to a stroke nearly 2 weeks later). This was despite so much careful planning, a very experienced surgeon and careful aftercare. I didn’t want that experience to cloud my judgement with Mabel. But when the vet said that spays are a bigger operation and Mabel is potentially quite vulnerable with her lung disease I think that’s helped us feel we are making the best decision we can without a crystal ball. Whatever happens, as long as we don’t let Mabel suffer I think I can live with this plan because all we can do is our best with the information we have available to us at the time.

The weighing info is great- we weigh daily and I have been stressing over minor fluctuations sometimes but it’s good to have a benchmark of around 50g change or a downward trend being significant to look out for.

Thanks again
Lucy