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Tramadol and SAMe

Species: Dog
Breed: Jackapoo
Age: 5-8 years
Hello Dr. Marie!

I feel like Oreo and I have become somewhat of a regular here on your question and answer forum!

Oh I tell ya, we have been to hell and trying to get through it the last 6 weeks. My vet bills have been sky high lately.

Let me begin with at the end of July, Oreo had a dental cleaning. They were not that bad but the back molars needed a touch up. So that went well but I requested something they dont normally do and that is feed him an IV with fluids during the procedure and for the rest of his recovery at the clinic, as you might guess, I googled it and watched some youtube vidoes and that is what was recommended but my clinic doesn't do that. So they did it and gave him propofol too for his sedative. However, he jerked I was told, it blew the vein in one arm that was all shaved so they moved to the next arm, shaved that and all was fine. So he recovers fine and comes home to me that night, rather stoned and dopey and if you know me, I was all worried for what? I dunno cos I know it's normal. So the next day he is not himself and he is shaved down on those arms and he chewed the raw. It was awful so 24 hours after surgery we are back because he is still not acting right and she looked at his arms and told me to just watch them she thought they would be fine. She determined he was just slow this time coming out of anesthesia. She also gave me some Gentocin for the arms. So we go home, and day 3 comes. We are outside, and he is still chewing those arms like crazy and he tries to go up my steps on the deck and he struggles to get up them. I panicked and called their after hours #, the vets at my clinic rotate being on call so he would see any one of the 4 rotating vets. It just happened to be our regular vet that night. This is 3 days in a row now and you can imagine the cost plus an after hours call. But you know me, neurotic old me, anything for my darling Oreo. So she is not digging how those arms are looking AT ALL. Says they are worse looking that the day before. No infection but we are heading there she says. So she sent us home with one of those nasty pet cone lamp shades that I swear should be banned. On the way home from the clinic and choking on tears over how much I have spent the last 3 days, I decide to stop at a pet store to see if there is anything else instead of the cone. Sure enough, I get a inflatable collar for him and that has helped alot. The fur is slowly growing back and there is no infection present.

So now to our new problem. A week ago, we were playing ball and Oreo jumped up to catch it and he landed wrong on his right hind leg and that is what we are dealing with now. I took him in a few days ago after waiting 5 days. He can put weight on it sometimes but not all the time, he was getting around on all threes and holding up his injured leg. So on Tuesday of this week, I took him in again! Oh super ugh! Another vet bill and visit. She took him in back and outside to see how he walked and she noticed he was holding up his leg part of the time too. She examined him, felt around the leg, no inflamation and recommended we dont Xray it because she knows it's not broken and he has no inflammation. She just thinks its a soft tissue injury. We spoke at great length about Oreo's vacular hepatopathy and how adamant I am about being very careful about what we put him on. Her first drug of choice is Rimadyl but I have google Dr. Marie and what I read is not pretty. He has taken it a few times and he responds to it but I feel strongly that this class of drug is just not good for any pet with any kind of liver issue. Even though his is not deathly serious, I feel, lets keep it that way. So she spent 15 minutes discussing other pain relievers and we opted for Tramadol. Half a tablet 3 times a day. Sounded good to me but when I tried to give it to him, it was a disaster. I split the pill in half and take note of this, the pill is very bitter, I tasted it, I nearly lost my mine and Oreo rejected it in a hot dog, in peanut butter, in cream cheese and in crab dip. He shook his head so violently that I didnt even recognise this dear little dog anymore. So after trying 4 times, I gave up, went to work and then came home, fed him and tried a whole table this time. I did it, he took it. I put it in hot dog. Down the hatch. Cant say I noticed much improvement on his leg though. His second dose 12 hours later, went well too although with this dose about 30 minutes later, I noticed his panting. Didnt think much of it because it is hot outside. So just a few hours ago, I gave him his third dose of one full pill. I gave it to him after a meal as I did with the other doses. About a half hour later, he had to go outside so I let him out. I heard kind of a squealing but didnt think much of it, our yard is fenced in. I bring him in and with Oreo, I baby wipe is rear. Yes he is spoiled but also he gets some poo stuck in his furry rear end so the baby wipes help out. So he was still acting in great distress. Then after a few moments he had to go out again. He peed and then he frantically roamed the yard in circles as if to poo but couldnt find just the right place or get comfortable. Finally he squatted and I heard another soft yelp as if perhaps having some gas cramps. A reminder he is takng a whole pill and he is 20.4 pounds. So I got him in, he was in distress and I tried to keep my cool but he is like a child to me. So I thougt if it is a belly ache with cramps, maybe some warm air on his tummy so I got him into the bathroom and laid him down and belly rubbed him while softing blowing a warm hair dryer on his tummy. Strange I know! He was panting alot which I read was a side affect. I also read that it is not advisable to take Tramadol while on Denamarin which he is on for the vacular hepatopaty. It said specifically SAM-e but Denamarin contains SAM-e. I dont know whether to be worried or not. I like my vet but she gave me options of what was out there and I didnt know how to choose and finally we just came upon Tramadol. So I dont know if his poo actions were a result of the Tramodol or just gas cramps. I know there are side affects and I just respect you so much and wish you were out vet. I dont want him on Rimadyl as it is harder on the liver as opposed to Tramadol. But is it safe with the Denamarin? Reports say it is not. I feel we are in a deep dark hole that we cant get out of. Pain wise, I guess I would rate his pain a 5-6. He was playing before the Tramadol but that has now stopped. He is pretty sedated. I am near tears as I see no hope. I need to get to bed as it is nearly 6:30 and I have been up 17 hours. Thank you for listening!


Online vet, Dr. Marie

Dr. Marie replied:

Oh poor Oreo. It sounds like you guys have been through a lot.

From what you have written it sounds very unlikely that the things you are noticing in Oreo have anything to do with the Tramadol. Some dogs can get quite sedated on Tramadol and often look a little spaced out but the yelping and difficulty defecating really would not be because of the drug.

The risk of problems with using both Tramadol and SAMe in a dog are extremely small. It is not recommended to use SAMe along with a type of drug called an SSRI as it could cause something called Serotonin Uptake Syndrome. However, this is in theory. As far as actual cases go, there are cases of this happening in cats but there are no reported cases of a dog having this problem. AND...Tramadol is not an SSRI but rather a drug that acts in a similar manner.

I did a search for you on Veterinary Information Network and the veterinary pharmacologists there and here is a quote when asked about the use of Tramadol plus SAMe:

we have not seen or very rarely seen
serotonin syndrome with the combination. More likely with SAM-e and
SSRI's but not as much so with tramadol or tricyclics.

Regarding Rimadyl, while long term use of the drug could potentially contribute to hepatopathy I would have no problem using a short term. Or, there are other similar drugs (NSAIDS) such as Metacam, Previcox, etc.

I think that the best advice that I can give you here is to trust your vet more than you trust the internet. I don't find that Tramadol works as well as NSAIDS for musculoskeletal pain, but if my hands were tied by a client who didn't want to use NSAIDS then Tramadol would be my next choice. Not as good a choice for the dog though, in my opinion as the pain is more likely to respond to an NSAID.

If Oreo is still painful tomorrow you may need to call the vet and ask if an NSAID is a good idea. If there has been no improvement then xrays may not be a bad idea. However, I agree with the decision to not xray first off as it sounds unlikely that anything would be found.

I have found that shelties can be prone to ACL tears so this is something worth asking your vet about as well.

I hope things are better soon,

Dr. Marie

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.