11/01/2025
I haven't talked about this yet because it's too devastating and heartwrenching, however I need to start talking about it. I need to warn other pet parents. I need to add my voice and especially Candles' voice to this conversation since she is the one who suffered the most and paid the ultimate price. This will be a long post but bear with me and please read it all because it could save your pet's life.
Do NOT allow your pets to get a injection (aka and ). If you are considering this arthritis medication for your pet, please educate yourself extensively on this medication, the type of medication it is and how it works. And whatever you do, do not let a veterinarian push it on you or try to change your mind. I will forever carry the guilt of allowing multiple veterinarians to change my mind about Librela and give that injection to Candles. (I do not blame these veterinarians though because they did not know better at the time. They were also under the impression that it was safe and that the deadly side effects were rare. However now everyone is learning the hard way that these are not as rare as led us to believe thanks to the FDA publishing reports.)
The first thing you need to understand and educate yourself on is the type of medication that Librela is. It's a monoclonal antibody medication and more specifically, it's a nerve growth factor medication. Here is a brief snippet about how it works and the potential dangers associated with it. "Librela for dogs is a monoclonal antibody medicine designed to relieve arthritic pain by blocking the effects of Nerve Growth Factor. Librela acts by binding to and blocking a protein in your dog’s body called nerve growth factor (NGF). Once this artificial antibody has bound to NGF, it prevents it from attaching to its receptors on nerve cells and interrupts the transmission of pain signals. But, NGF has many other functions in many other tissues throughout your dog’s body. It’s not only involved in pain signaling, but it’s very important for the growth, maintenance, and survival of nerve cells in the central and peripheral nervous system. It regulates the growth and differentiation of B-lymphocytes and in the maturation of T cells in the face of infection. It has an important role in the regulation of your dog’s immune system. It’s involved in the maintenance and survival of pancreatic beta cells (insulin production). And it’s probably involved in other processes that science has not yet elucidated."
There is a lot more that has been published about this medication specifically and about anti-NGF medications impacts on the body so I encourage you to educate yourself. I have found numerous research papers focused specifically on anti-NGF medications and the domino effect it starts in the body. These aren't specifically about Liberela, however they are specifically about the type of medication Librela is and it's important to know.
With all that being said, here is what happened to Candles.
Candles had arthritis however she also had an increased liver enzyme (that by itself was not serious) that prevented her from taking several pain medications. Because she was 14 and still had very healthy kidneys, the veterinarian wanted to be cautious regarding pain medications as she did not want to potentially hurt her kidneys. That left us with very few pain management choices and most of them were incredibly expensive. That's when Librela came up in July 2024. Her vet admitted that she knew very little about Liberela and that it hadn't been out for very long and research was limited. (It was first released in Europe in 2021 and then released in the US in 2023 and it has not been researched or studied nearly enough. There are way too many unknowns still and her vet did acknowledge that.) However, her vet still thought it was safe and didn't see any reason why Candles could not get the injection. I've never been someone to question a veterinarian's medication recommendation as this is their expertise, so Candles received the first injection in July. As this is a monthly injection that is required every 30 days, her next injection would have been in August. However, shortly after she received the injection, I Googled it to learn more about it. Unfortunately almost everything I found was negative. I found myself reading horror story after horror story of dogs becoming seriously ill and some even dying shortly after receiving the injection. I also noticed a trend that it seemed to negatively impact a lot of dogs after the second injection. Due to that, I told her vet that she would not continue the medication and I watched her like a hawk until it was out of her system. I noticed that it did help though. She was able to walk more easily and use the stairs more easily, so I felt bad not continuing it, however I was not going to risk her health or her life.
Because Candles had an elevated liver enzyme that was not responding to Denamarin and she had also had a high amount of protein in her urine, along with her having those random respiratory distress episodes (that I now know was caused by an elongated soft palate), I decided to take her to an internal medicine veterinarian. Also, because of those respiratory distress episodes, she was seen by quite a few ER veterinarians. Every time she would see an ER veterinarian I would ask them about Liberela and they all told me the same thing as her regular veterinarian; they don't know much about it but as far as they know it's safe and I should continue giving it to her if it helped her. None of them saw any reason why she should not get it. Her internal medicine veterinarian and I discussed this as well and he also could not find any reason why she should not get it. Although she had high amounts of protein in her urine, her kidneys were still in great shape. She had an echocardiogram and her heart was 100% healthy and although she had an elevated liver enzyme, nothing else was wrong with her liver. He did find that she had chronic bronchitis however by itself, that is not serious. He was concerned that she might have Cushing's disease and tested her for that, which came back negative. On October 1st he did an abdominal ultrasound to look at her adrenal glands and those were also normal so he ruled out Cushing's. Her kidneys were great, she did not have any kidney stones, she did not have any gallstones, her bladder was good, her pancreas was normal, etc. The only thing he noted was potential sludge in the gallbladder which could be causing the elevated liver enzyme so he started her on a medication to break up that sludge. The medication was working and her liver enzymes were coming down as of mid-November. He also started her on a medication to reduce the amount of protein in her urine, however that was not working. He had me increase the medication slightly but did tell me it could potentially cause kidney disease, so we need to monitor her kidneys closely. He told me she would need blood work done 3 weeks after the increase, so around December 26.
Back in late October Candles started displaying very odd behavior. She would sit down, spin in a circle and make this screaming sound. I took her to the vet and they could not find anything wrong with her. They recommended a neurological evaluation just to be safe, so I took her in for a neurological evaluation. The neurologist watched videos of her behavior, did their evaluation and did not find anything neurologically wrong with her. The mystery behavior stopped a couple days later. At the time, no one had any idea what caused it.
However, her passing this neurological evaluation made me just a little bit more comfortable with her getting Librela again. The reason for this is because dogs with neurological conditions are NOT candidates for Librela. Because I knew all of her internal organs were normal and now I knew she did not have anything neurologically wrong with her, plus all of these veterinarians were telling me that it was safe for her to get the injection, I felt more comfortable trying it again. That being said, I was still hesitant and I still had my reservations. My intuition was telling me no and I should have listened to it. On the other hand, I saw how much it helped her in July and I could tell that her arthritis was really bothering her, and of course I did not want her to be in pain. In some ways I felt like I didn't have a choice but to try it again.
At the time, these were the published known adverse events: Ataxia, seizures, other neurologic signs including but not limited to paresis, recumbency, urinary incontinence; polyuria, and polydipsia. In some cases, death (including euthanasia) was reported as an outcome of these adverse events.
One thing to note here and this is very important. Dogs with neurological conditions are NOT candidates for Liberela. This includes dogs that have degenerative discs and other spinal issues. The biggest problem with this is that most dogs are very good at hiding pain and most owners have no idea their dog has disc or spinal issues until it becomes very severe. The only way to guarantee your dog does not have a neurological condition is to do an MRI. A neurological evaluation is not nearly enough, as I learned the hard way. In case you didn't already know this, MRIs on dogs are incredibly expensive and a lot of pet owners can't afford that. So that right there is very concerning. The fact that your dog really needs to pass an MRI before getting this medication is mind-blowing and VERY concerning.
* On December 19th Candles received her second injection of Librela. (The first injection that had been given in July was well out of her system by then.)
* On December 21st I could tell the medication was already helping her. She was able to more easily use the stairs and she even jumped up on the couch with me. She had already become a bit more active and seemed to be pain-free.
* In the early morning hours of December 22nd I was woken up by the sound of Candles falling. I got up only to find that she was completely paralyzed in all 4 legs. I took her to the ER vet where they did multiple tests, including an ultrasound, blood pressure, blood flow test to her legs and lab work. Everything was normal, including her kidneys. I was told she needed to see a neurologist and she needed an MRI.
* On December 22nd she was evaluated by a neurologist who thought she most likely had a tumor on her spine that had caused the paralysis. His next theory was that she potentially had a stroke, and according to him, the least likely theory was a herniated disc. I was encouraged to do humane euthanasia that night. I did not. I knew she needed an MRI before I could make that final decision. (Side note: This wasn't my first rodeo with her being misdiagnosed with cancer. She was misdiagnosed with lung cancer in 2023 so I was not going to trust that neurologist without proof.)
* On December 23rd I took her to a neurology clinic in Orange County for a second opinion and an MRI. The MRI showed a completely herniated disc at C3/C4. (This is exactly why I did not trust the neurologist who saw her the evening before. I knew he was wrong.) They also did a brain scan and her brain was normal. She did not have any tumors, she did not have cancer, and in fact her MRI was completely normal minus degenerative disc disease and a recently mild disc herniation at C2/C3. (Remember in late October when she was displaying that odd behavior and a neurologist saw videos of it, did an exam and said it was not neurological? They were wrong. I talked to her new neurologists and they confirmed that behavior was caused by the mild C2/C3 herniation. This part really bothers me because this neurologist completely missed a disc herniation and because of that I thought Librela was safe for her. However, because she had a disc herniation in late october, she was NOT a candidate for Librela. Once again a very strong case for always getting a second opinion.)
* Prior to the MRI on December 23rd she had x-rays and lab work done. Everything came back normal.
* On December 26th she had surgery on the herniated disc. The neurologist said the prognosis was great with a 95% chance of full recovery.
* On December 27th she was already showing signs of improvement. She could once again move all 4 of her legs and all 4 of her paws, and she could hold her head up without falling to one side or the other.
* Late on December 28th the veterinarians were concerned that something had changed in her. They repeated x-rays and lab work and unfortunately found she had pneumonia (most likely aspiration pneumonia), and elevated pancreas and kidney levels. She was moved into an oxygen cage. Because she had chronic bronchitis her having pneumonia was serious and could be life-threatening. They also started treatment on her kidneys and sent out the pancreas labs for further testing. (Increased pancreas levels alone do not diagnose pancreatitis as other things can cause increased levels, such as increased kidney levels. This additional testing is needed in order to actually diagnose pancreatitis and the severity of it.) At the time her pancreas was not the primary concern because she was not showing signs of pancreatitis. The primary concerns were her lungs and kidneys.
* On December 29th her kidney levels were not responding to treatment and were continuing to increase.
* On December 30th her potassium levels were dangerously high, which can cause heart problems and even death. After a couple of attempts the potassium levels responded to treatment and went down. The results of her pancreatitis test came back and showed that she had severe pancreatitis. Her kidney levels continued to increase and she had acute kidney failure. The neurologist could not understand what was causing this and why her kidneys were not responding to treatment. He did a consult with an internal medicine vet that he knows and he consulted with Candles' internal medicine vet. After the consultations, Candles was started on a pancreatitis medication to help reduce the inflammation in her pancreas and they also increased her fluids to help the kidneys more. Lowering the pancreas levels was critical because elevated pancreas levels can cause elevated kidney levels, however elevated kidney levels can also cause elevated pancreas levels. It was critical to get one of them under control so the other one could start to come down. I was so desperate to save her I even started calling dog dialysis centers nearby. It was not an option however I did talk to a veterinary nephrology technician and when I told her Candles had gotten Librela before this, she sighed and said they are starting to hear about and see more of this; dogs that previously had healthy kidneys were suddenly in acute kidney failure after receiving Liberla. The silver lining that day was that x-rays showed the pneumonia was starting to clear up.
* On December 31st she had an abdominal ultrasound to see if anything had changed since October 1st and to also to evaluate her pancreas. Her potassium levels were responding to treatment and seemed to be steadily holding at a level that was still a little high, but lower than it had been, which was an improvement. I was told that the paralysis was wearing off even more and that she was able to apply pressure with all 4 of her paws. When I saw her she was stretching her paws out towards me and moving her head as close to me as she could in the oxygen cage. It was the most I had seen her move since she had become paralyzed.
* Around 3:30 a.m. on January 1st she started experiencing respiratory distress that the veterinarian attributed to pneumonia and the severe pancreatitis pain. He changed her pain medication to methadone at that time. I did not know any of this until I talked to him around 9 a.m. I arrived at the vet clinic at 10:30 a.m. and saw her. She was visibly struggling to breathe. The veterinarian and I had a conversation about her prognosis and it was not good. The results of her ultrasound had come back and it was not good. Her adrenal glands were inflamed, suggesting Cushing's disease, her kidneys had physically changed, she had kidney and gallstones, and the left side of her pancreas was very inflamed. He told me it's possible all of this could have developed since October 1st. He said it's unlikely that all of this developed since receiving Librela on December 19th, however not impossible. I asked him if he had ever seen a dog recover from her condition and he said yes, although it's rare. He told me that not all hope was lost and that she could still pull through, however it was a small chance. He told me to give it a little bit more time to see how she responds to treatments.
* From about 10:45 a.m. until just after 11 a.m. I spent some time with her and then stepped out because they needed to check her vitals and the oxygen cage needed to be closed to keep the levels high enough for her. I had planned on going back in to see her within the hour.
* Just before 12 p.m. I was about to go see her again when they came out to tell me she was in cardiopulmonary arrest and they had started CPR. I went into the back and put my hands on her head while they did CPR. I told her I loved her, I kissed her, I asked her to come back and I begged her not to die. As I did this I saw the vet techs taking turns doing chest compressions, the vet injecting her heart with medication multiple times, the techs injects medication into her IV multiple times and pulling out the intubation tube and quickly reinserting it. This went on for 10 to 15 minutes. Finally the veterinarian took over chest compressions and when he started I heard a crack. It was at that moment I knew she was gone.
* Around 12:15 p.m. the veterinarian stopped compressions, listened with his stethoscope and asked me if I wanted him to continue. I asked him if she was gone and he said yes. I told them not to continue CPR and I let her go. He told me that when I got to her she was still conscious, she was still there, so she heard me and she knew I was there. He told me that he thinks she waited for me.
Witnessing CPR on my baby is the most traumatic thing I have experienced in my life and it will haunt me until the day I die.
Witnessing her become paralyzed, have surgery, start to recover from the paralysis only to be knocked back down by pneumonia, and acute pancreatitis and kidney failure will also haunt me for the rest of my life.
Knowing that the FDA had released a notice to veterinarians regarding adverse events from Librela on December 16th, THREE DAYS before she got the injection, will haunt me for the rest of my life.
Knowing that the Librela injection likely exacerbated the disc herniation, and also caused the pancreatitis and kidney failure will also haunt me for the rest of my life.
That FDA notice to veterinarians is critically important and every person that has a dog with arthritis needs to read it: https://www.fda.gov/animal-veterinary/product-safety-information/dear-veterinarian-letter-notifying-veterinarians-about-adverse-events-reported-dogs-treated-librela
While disc herniation, pancreatitis and acute kidney failure are not listed as known adverse events of Librela, they have been reported numerous times shortly after a dog received the injection. It is important to note that these dogs also did not have pancreatitis or a history of kidney disease prior to the Liberla injection. All of the veterinarians that treated Candles, including the neurologist and now her internal medicine veterinarian, all agree that Librela is the likely culprit because nothing else explains it. The veterinarians and neurologist who treated her from day one watched her go from being a healthy senior dog to suddenly having severe medical issues that ultimately took her life 10 days after arriving at the clinic and 13 days after receiving Librela. They all agree that too much is not known about this medication and it has not been studied nearly enough to say Liberela did not cause this. Even her internal medicine veterinarian was shocked to learn what was happening to her. It made no sense to him and nothing could explain it. It also made no sense to the neurologist and the other veterinarians treating her and they could not find a cause either. Considering pancreatitis and acute kidney failure have been reported numerous times after receiving Liberla, it's the only thing that makes sense and is the most likely cause of what happened to her.
I reported everything to Zoetis, the manufacturer of Librela, and all of her veterinarians are also filing claims and providing medical records. Many people are encouraging me to sue Zoetis and while I am considering it, I'm not sure I want to put myself through the trauma of doing that because it won't bring her back and ultimately that's what I want. I want her back and they can't give me that.
I don't care what anyone says, it was not Candles' time to go. She was desperately trying to walk again even though she was trapped in an oxygen cage. I know my baby and there was still plenty of life in her. She was not ready to go. It was not her time. Her veterinarians always said how impressed they were with how healthy she was for her age and how she could be one of those dogs that lives to be at least 16. Unfortunately my decision for her to get that injection again cheated her of the time she had left. I knew the risks and my intuition told me not to give her that medication again, but I listened to all of the veterinarians and did it anyway. Again, I do not blame these veterinarians because they did not know then what they know now. Just like I did not know it then because I did not see the FDA notice that was published 3 days prior to the injection. Regardless, I will carry this guilt for the rest of my life and nothing will change that.
To Candles, I am so incredibly sorry for what happened to you. You did not deserve any of that and you deserved to be able to walk again and continue living your life for at least another year. I wanted you to be pain-free and I was hopeful Librela would help you and not hurt you. I'm so sorry that I was wrong and that you had to suffer so much in the end 💔
To everyone reading this, learn from my mistake and please honor Candles' life by not giving your dog Librela.
Resources to learn more:
https://www.fda.gov/animal-veterinary/product-safety-information/dear-veterinarian-letter-notifying-veterinarians-about-adverse-events-reported-dogs-treated-librela
https://www.fda.gov/media/184483/download?attachment
https://www.dvm360.com/view/fda-notifies-veterinarians-of-adverse-events-linked-to-osteoarthritis-treatment
https://www.avma.org/news/fda-adverse-events-dogs-reported-monoclonal-antibody-drug
https://www.dogsnaturallymagazine.com/librela-berensa-wonder-drug-or-disaster-in-the-making/
https://caninearthritis.org/librela-what-we-know-and-dont-know/?fbclid=IwY2xjawHvkZdleHRuA2FlbQIxMQABHYVtYEfRYh3yjxBp8qZYcTRj6Po4Eg_y9A9leEAiuRnNwpM9lXxyZSFelw_aem_dYwCOiz-XgvGRxmypwXlmQ #:~:text=Does%20Librela%20cause%20neurologic%20symptoms,assessment%20of%20the%20dog's%20mobility
The FDA has identified and analyzed adverse events in dogs treated with Librela (bedinvetmab injection).
