Happy Holidays! We hope everyone had a wonderful Thanksgiving with family and friends. My family enjoyed our own version of a “turkey trot” with a 10k walk down the canal in the morning. In the afternoon we joined friends for a blended holiday feast complete with football and pecan pie.
With the cooler weather and more folks spending time outside, it seems we have more clients asking what they can do for their older dogs with arthritis. Is it good to exercise them? Can I give aspirin or ibuprofen? In fact there are options to keep your pets comfortable as they age.
First, lets look at what arthritis is and isn’t. Osteoarthritis or degenerative joint disease is a chronic, progressive deterioration of cartilage, the protective lining that covers the bones in the joint. (Think about your knee joint for instance. You have cartilage on both the femur and tibia which protects the bones as the knee moves.) Osteoarthritis occurs when there is abnormal wear on normal cartilage such as trauma or instability in the joint, or with normal wear on abnormal cartilage (defects in the cartilage). Symptoms of arthritis may include stiffness, decreased range of motion, thickening of the joint, pain and usually results in difficulty getting up and around or lameness.
It is important to rule out other causes of lameness such as bone tumor, valley fever, or ligament damage, all of which have different treatment options available. Radiographs (xrays) are the easiest way to diagnose arthritis and rule out bone tumor or valley fever. Based on radiographs, your veterinarian will be able to help you determine what treatment options are available. Sometimes, surgery will be recommended if there is ligament damage or in cases of severe hip dysplasia where the pain is not controlled by medication. Once the diagnosis of osteoarthritis is made, there are many options to consider in controlling pain and improving quality of life.
1. Weight Loss
Obesity is a common problem within the American fur family. It is normal to want to treat our pets, and often food is given as a reward or expression of our love. Unfortunately, pets that are overweight carry a higher risk for all kinds of disease including heart disease, cancer, and diabetes. Excess weight also increases wear and tear on joints and makes it more difficult for pets with joint disease to get around. Setting a goal weight and achieving weight loss can significantly improve an animal’s mobility. In the beginning, weight loss will often be achieved with calorie reduction. As the weight comes off exercise will be easier and more comfortable. The best ways to begin a diet are to cut out table food, and decrease calorie intake by 25%. (Side note: Your doctor may recommend a blood test to rule out thyroid disease. Hypothyroidism, or low thyroid hormone, contributes to weight gain and inability to lose weight. If you notice that your pet continues to gain weight despite a reduction in food, a thyroid hormone test may be beneficial.) Sometimes a prescription weight loss food may be recommended. Diets such as Hill’s r/d are formulated for weight loss and contain lower levels of fat, and are higher in fiber to help your pet feel fuller. In addition, there are appetite suppressants (such as Selentrol) that can be used in dogs to help achieve weight loss.
Regular, mild exercise can help reduce stiffness and improve mobility in animals with arthritis. Exercise is also important for building and maintaining muscle mass to support the joints. It is important to start slow, and work within your pet’s abilities. Going for a walk is great exercise. If your pet is used to walking, follow his or her lead on how long is comfortable. If you’re just starting an exercise program, try 10 minutes and build from there. If your pet is unable to go for a walk, you might try passive range of motion exercises or swimming. Many certified canine rehabilitation practitioners also have an underwater treadmill which allows pets to walk with limited joint impact. Try to exercise your pet twice a day to help keep joints lubricated and active. Again, start slow and build up. Monitor your pet and stay within their limitations.
3. Chondroprotective Agents
You’ve probably heard of glucosamine and chondroitin. These agents act to protect cartilage and in pets at risk, may slow down the progression of disease. The downside to using over the counter (otc) glucosamine products is that because they are supplements (not drugs) they are not regulated by the FDA. This means that the actual glucosamine content of the product may vary from what is on the label. Two products used in veterinary medicine have been examined by veterinary practitioners and have demonstrated efficacy. They are Cosequin and Dasuquin, registered products of Nutramax Laboratories. If you elect to try a human glucosamine supplement (which can be found at any grocery or health food store) and you don’t see results, give one of the Nutramax products a try before you give up on glucosamine. Adequan, a registered product of Novartis Animal Health, is another option for decreasing cartilage breakdown. Adequan, a polysulfated glycosaminoglycan, is given by injection twice a week for several weeks and if improvement is noticed, a maintenance schedule may be instituted thereafter.
There are several classes of drugs which can be used to control arthritis pain. The most common group is non-steroidal anti-inflammatory drugs (NSAID). Carprofen, meloxicam and deracoxib are the most frequently used drugs in this class. With any NSAID it is important to obtain baseline bloodwork prior to initiating long term therapy and every 6-12 months while on the medication. Dogs may respond better to one drug over another, so if a positive response is not seen it may be beneficial to try an alternative. It is important to monitor for adverse reactions including vomiting, diarrhea, and loss of appetite. Bloodwork will also help to determine if a patient has underlying kidney or liver disease, in which case NSAIDs should be used with caution or not at all. Over the counter (otc) medications which are commonly used in people such as aspirin, ibuprofen, naproxen, and Tylenol are not recommended for use in dogs and carry a significantly higher risk of adverse reactions including internal bleeding, kidney failure, and even death. Though prescription drugs are more expensive there are generic alternatives that will be much safer for use in your canine pets.
(IMPORTANT NOTE: MOST NSAIDS AND OTC DRUGS ARE TOXIC TO CATS AND INGESTION CAN RESULT IN DEATH. DO NOT MEDICATE YOUR CAT WITHOUT CONSULTING WITH YOUR VETERINARIAN.)
Another class of drugs is corticosteroids which can be administered orally or by injection. The risks with steroid use are higher than those with NSAID use and therefore long term use is usually avoided. However, in situations where the quality of life is poor, and the alternative is euthanasia, steroids may be used to control arthritis pain. Steroids and NSAIDs should never be administered to the same patient at the same time. Any time you are switching drugs from one class to the other, or changing drugs within a classification, there should be a washout period of 3-14 days to allow the drug to clear the system. Your veterinarian will help you decide how long to wait before starting another medication.
Other pain medications include tramadol, amantidine, and gabapentin. Amantidine is used on a short term basis in specific situations when it is necessary to reduce the amount of noxious stimuli to the spinal cord caused by intense or chronic pain. It is not a pain reliever but acts to reset the spinal cord’s processing of stimuli to allow pain relievers to work more effectively. Gabapentin’s specific mechanism of action is unknown, but is effective against neuropathic pain and is useful in patients with damaged cartilage.
5. Alternative Therapies
More and more, people are looking to more natural remedies to treat themselves and their pets. I always encourage trying alternative therapies as the risks are minimal and the rewards are potentially great. Alternative treatments for osteoarthritis include acupuncture, Chinese herbal medicine, therapeutic laser, massage, and microlactin (a purified dried milk protein that acts to inhibit inflammation). Most major markets (including the Phoenix area) have practitioners that can assist you in alternative therapies.
6. Mesencymal Stem Cells
Don’t worry, these are NOT embryonic stem cells that are cause of big political controversy. These stem cells are actually harvested from an animal’s own fat pad, processed to isolate the stem cells, and then injected back into the same animal’s affected joints. Though expensive, this procedure has shown dramatic results in reducing pain and symptoms associated with osteoarthritis.
As a major problem affecting our pet’s quality of life, osteoarthritis is the focus of major research year after year as we try to find better and safer ways to manage our pet’s pain. It is important to know your options, and the risks associated with each one when making a decision. Though this post focused mostly on dogs, arthritis is extremely common in geriatric cats. I think we tend to see less symptoms in cats simply because they are smaller and don’t have as much weight to lug around on their joints. However, cats can become lame with arthritis and may not want to jump onto furniture or into the window sill. Many of the same options to treat dogs are available for cats as well, though as stated earlier NSAIDs and over the counter medications are often not options for cats. Pain control is important in maintaining a good quality of life and your veterinarian will help you decide what is best for your pet.