Last month, we talked about how to best prevent arthritis in your pets; this month we will talk about how to treat it. Here is your new word for the day: multi-modal. Treating an arthritic patient truly requires an approach from many different angles, this is called multi-modal therapy.
To take a step back though, we need to look at where the arthritis is, as not all joints are created equal. Insert your Colorado marijuana joke here. The joints here I am talking about are synovial, fibrous or cartilaginous. The vast majority of joints we deal with are synovial; they have a true capsule and joint fluid. Cartilaginous joints occur mainly in the spine, for example, intervertebral disks. Identifying where the problems lie is crucial to developing an effective treatment plan. This means a good physical examination, lameness exam and radiographs.
MANY TREATMENT AND PREVENTION OPTIONS
I referenced the most effective phase of our multi-modal plan in the last article and that is maintaining a good body weight. It is also the cheapest therapy, but one of the most difficult to accomplish. Americans like feeding their pets.
Anti-inflammatory medications are the most common treatment used for arthritis and they come in two pharmaceutical classes: steroidal and non-steroidal, or NSAIDs. When NSAIDs first hit the market for pets in the early ’90s they were a game changer. I don’t care how holistic your approach to life is, when you see a pet who is in obvious discomfort smile the first day you give them an NSAID, you will be convinced of their effectiveness. Common NSAIDs in pets are Rimadyl, Metacam and Previcox. We discourage against human NSAIDS like aspirin and ibuprofen because the side effects are more severe than those approved for pet use. If you are using a human product, consult with your veterinarian.
Steroid anti-inflammatory medications fell out of favor when pet-approved NSAIDS hit the market, but they still have a large place in treating arthritic pets. To start with, they are much more effective in reducing inflammation around cartilaginous joints like intervertebral disks in a pet’s back. They also are better at reducing swelling around nerves that become inflamed in disk disease and thus, better alleviate neurologic symptoms of disk disease. Second, they need to be used in rheumatoid or immune mediated arthritic patients; NSAIDs just don’t do the trick for these pets. And lastly, if your pet is on NSAIDs and other remedies and not getting any relief, you owe it to your pet to try steroids as a last resort. I have extended many a pet’s life who came in for euthanasia by placing them on steroids. As an aside, these are glucocorticoids, not anabolic body-building steroids.
Next up in the arsenal is nutritional products. Glucosamine, chondroitin sulfate, hyaluroic acid and a newer product called UC-II chicken collagen all help make the fluid in synovial joints healthier. Many people call these joint juices. There is an injectable product called Adequan that, while a little pricey, is very effective. These products primarily help hip, knee, elbow and shoulder joints and not so much back pain. But since they are relatively cheap and harmless to your pet, we do recommend them for all types of arthritis, even back, because there are joints in your back called facets that are synovial joints.
FEED YOUR PET FISH OIL CAPSULES
Fish oils are my favorite nutritional supplement of all time. Just ask my nurses who get tired of hearing me rave about them. They have great natural anti-inflammatory properties, stimulate good immune system function, are cheap and well tolerated by pets. And I firmly believe our western diets are out of whack regarding omega-3 ratios. So take omega-3 rich fish oils and give them to your pets. Pets need around 30 milligrams per pound of the active ingredients DHA and EPA, which are on the label. Do your math and slowly build up to the full dose for your pet. We carry a liquid for use on pet food but many pets will chomp the human pills.
Here are a few short suggestions to round out our multi-modal approach. Antioxidant vitamins can’t hurt the process either, so choose a National Animal Supplement Council (NASC) approved pet vitamin and have at it. Mild exercise is recommended. You are getting the joints warm and moving and pumping out the bad joint fluid and replacing it with good, new fluid. Swimming is perhaps the best exercise. It is not weight bearing and provides a good range of motion for most joints. A soft bed is a must for your older, arthritic pet.
Acupuncture can also be very helpful and a few veterinarians in the valley are approved veterinary acupuncturists, like our own Dr. Nadine. Chiropractic manipulations are also an emerging field and we have helped a few pets with the help of Dr. Christine. Lasers you ask? Eh, I’m on the fence about their use on arthritic pets. Yes, at the cellular level they are impressive, but I want to see my patients walk better, not have better cells.
On the ultra-new scene are things like stem cell injections and plasma-rich protein. A recent article in the Daily suggested the jury was still out on PRP injections for humans. Ditto for stem cell injections, which are about a $3,000 expense. That could pay for a lot of Rimadyl and Adeqaun injections.
Treating your arthritic pet is a challenge. Early recognition and treatment are highly encouraged. Don’t bury your head in the sand if your pet is limping. Many older arthritic pets had an incident when they were young that was not treated. Home remedies are great; just communicate with your veterinarian!
Dr. Stephen Sheldon practices at Gypsum Animal Hospital. He can be reached at 970-524-DOGS or by visiting the clinic website, www.gypsumah.com.