Karin
Phoenixville, PA

Erythropoietin, also known as Epo or Epogen, has gained significant notoriety in recent years because it can be used as a performance enhancing drug by athletes. However, Epo has many legitimate medical uses. Among those uses is treating anemia in cats with kidney disease.

Healthy kidneys secrete erythropoietin, which is a hormone, as part of their natural function. Erythropoietin stimulates the bone marrow to make red blood cells.

Cats with kidney disease produce significantly less Epo. They therefore develop anemia. Cats are treated with synthetic Epo in order to reverse the anemia. The treatment has been available for over a decade.

(Some athletes take Epo in order to build up excessive red blood cells. This is a type of blood doping.)

In cats with kidney failure, Epo may lead to increased strength and appetite. However, it does nothing to treat the underlying kidney disease. Blood test results related to kidney disease, such as BUN, creatinine, and urine specific gravity will not be affected by Epo.

The Epo used in cats is human erythopoietin, which is slightly different from the feline version of the hormone. Epo therefore has the potential (in very rare cases) to cause serious complications in cats. However, in markedly anemic individuals the benefits greatly exceed the risks.

Photo: Danilo Di Luca does not have chronic renal failure. From telegraph.co.uk.

NSAIDs are commonly prescribed for arthritis, postoperative pain, and syndromes caused by inflammation. Rimadyl, Deramaxx, and Previcoxx are commonly used NSAIDs.

All NSAIDs are metabolized by the liver and excreted by the kidneys. Therefore, all NSAIDs can exacerbate or cause liver or kidney problems. Also, all NSAIDs have the potential to cause upset stomach and gastrointestinal ulcers.

To be sure, pets can suffer from severe adverse reactions to NSAIDs that may be fatal. Every drug in the class has the potential to cause these events.

Veterinarians have a duty to discuss side effects and adverse events before prescribing NSAIDs. Pets who receive NSAIDs should undergo regular testing of liver and kidney function. Pet owners should make informed decisions about NSAIDs.

If you google any NSAID, you will find web pages detailing heartbreaking experiences of pet loss after NSAID use. People very reasonably want to share this information after suffering a tragedy, so that others might avoid the same fate.

But this leads to a skewed perception on the internet. In fact, the vast majority of pets who receive NSAIDs do not suffer any adverse reactions or side effects. NSAIDs have helped millions of pets.

In fact, NSAIDs often save pets’ lives. A patient I saw yesterday drove this point home to me. He was a 13 year old Labrador who had received Previcox for years to treat arthritis. The owner ran out of the medication, and he did not receive it for three days. The dog was miserable. He could not stand or walk. The owner told me that he thought he “was going to lose” his dog.

A few hours after receiving Previcox, the dog was up, walking, and acting like himself. Previcox saved the dog’s life.

If you google Previcox you won’t see stories like this. People who have good experiences with NSAIDs aren’t motivated to create web pages. But don’t forget the message of the story: NSAIDs aren’t always bad.

When I evaluated her mouth I noticed a strong odor. The odor was typical of dogs suffering from kidney failure. Because the dog’s history and symptoms were consistent with kidney failure, I strongly suspected that the dog’s kidneys were the source of her problems.

To prove it, I had to run blood tests. But there is a problem with blood tests: no animal enjoys having blood drawn.

That night I had an epiphany. Blood tests are barbaric, and they shouldn’t be necessary–at least not to diagnose kidney disease, diabetic ketosis, certain types of cancer, some infections and other diseases that cause labile (vaporizable) products to build up in the blood.

Any time a such products build up in the blood, they are released into the lungs and expelled when the animal breathes. The levels of these products can be measured in the breath. The levels in the breath can be used to calculate the levels in the blood.

This concept has been used for years by law enforcement agents. Breathalyzers measure alcohol in a person’s breath, then calculate blood alcohol concentrations.

So why can’t we stick a probe in front of a dog’s nose and determine whether she is in kidney failure? The technology has existed for years, but it hasn’t been put to use yet.

Fortunately, there is hope for the future. Researchers are working to develop instruments that will diagnose kidney disease, diabetes, liver problems, infections, some types of cancer and a large number of other medical conditions through non-invasive analysis of the breath, skin, saliva or sweat (cats and dogs produce sweat on their feet).

I am looking forward to the day when I can diagnose my patients’ problems without using needles. I hope that day comes soon.

Photo credit: moacirpdsp. Photo licensing information: CC.