Kathy Davieds, DVM has been a small-animal veterinarian for 25 years. Active in therapy-dog work, rescue and other canine endeavors, she is also founder of the Virginia Partnership for Animal Welfare and Support (vapaws.org). She is currently owned by several uncropped Dobes.
Wellness: Health Care
Strategies for relieving your dog's arthritis pain
January 29 2016
The easy run becomes a stiff walk; the jump to a favorite chair is no longer possible; lying down is accompanied by a deep groan. As our dogs age, things that were once second nature become an effort. Today, thanks to advances in veterinary medicine and companion animal care, many dogs are living to a ripe old age. On the downside, that longevity also increases the odds that they’ll suffer from some form of degenerative joint disease (DJD), or osteoarthritis. There are several types of canine arthritis, but in this article, we’ll address the most common, the age-related degenerative form.
As dogs get older, the cartilage surfaces of their joints begin to thin, and cartilage cells die. When the cells die, they release enzymes that cause inflammation of the joint capsule and release of excessive joint fluid. Extra bony growths (osteophytes) can develop. With severe cartilage thinning, the normal joint space narrows and the bone beneath the cartilage deteriorates. All of these processes set in motion further changes in the normal functioning of the dog’s joint, and an ongoing spiral of pain, lameness, limb disuse/inactivity and muscle atrophy sets in. Many of these changes may be seen on X-rays.
On physical exam, veterinarians rely on a dog’s pain response to joint palpation, detection of crepitus (a crackling or grating sensation felt within the joint), observation of gait and the presence of muscle atrophy to diagnose osteoarthritis. Not all dogs—even those with significant DJD—vocalize when they’re in pain, but a dog whose muscles are atrophied and limbs are stiff, who requires assistance to rise, and does little more than teeter outside to go to the bathroom is without question suffering pain.
DJD isn’t the only reason for a decrease in a dog’s normal activity level, weakness or reluctance to move, so other conditions that could be causing or contributing to this change need to be ruled out. Among the entries on a lengthy list are infectious and metabolic illnesses, cardiac conditions, cancer (particularly bone cancer), anemia, and endocrine conditions such as hypothyroidism or Cushing’s disease. In an ideal world, all dogs would start life with genetically sound conformation and joints. For purebreds, the importance of responsible breeding and the use of OFA (Orthopedic Foundation for Animals) certification or other screening tests to evaluate hip and elbow conformation of prospective breeding animals cannot be overstated. Regardless of a dog’s origins, feeding her a high-quality diet throughout life and maintaining her at her optimal lean body weight are also crucial. If she’s overweight, a healthy weight reduction plan should be instituted immediately.
When it comes to relief, reaching for a single “big gun” pharmaceutical is rarely the most effective approach. Rather, best results are achieved by working with your vet to develop a plan tailored to help with your dog’s specific issues. An integrative, multimodal therapy regime can maximize your dog’s comfort and well-being as it minimizes the potential side effects of certain therapies, and is often more gentle to boot. Following are a few strategies that have been found to be beneficial.
Around the house: Provide well-padded bedding away from cold or damp drafts. (This will also help prevent the development of pressure-point calluses.) Carpeted or padded steps or a ramp to get on and off the bed or couch are advised. Nonskid flooring wherever surfaces are slippery is also very helpful. Outside, your dog may find a gently sloped ramp easier to negotiate than steps.
Body work: Many arthritic dogs appreciate muscle massages, which stimulate blood flow to atrophying muscles. Certified canine massage therapists are available in most areas of the country; many are willing to demonstrate techniques to owners. (Start your search here: members.iaamb.org/users) Warm compresses over sore joints can be soothing, but care must be used to avoid injury from excess heat.
Supplementation: Countless joint supplements are available to promote healthy cartilage and joint health. These contain varying combinations of glucosamine, chondroitin, MSM, green-lipped mussel and other chondroprotective substances. Many veterinarians and owners have found that a small number of these products seem to be helpful. We don’t yet know whether beginning supplementation at a young age benefits every dog. This decision is best made with your veterinarian, taking into consideration factors such as diet and genetics/conformation (e.g., has a dog been diagnosed early on with hip or other joint abnormalities?). The anti-inflammatory effects of omega-3 fatty acids (EPA, DHA) have also been documented to be of help in dogs with arthritis. These are included in some canine arthritis diets, but to be effective, higher levels via separate supplements may be needed.
Exercise: Maintaining mobility through reasonable exercise is important regardless of a dog’s age and the extent of her arthritis. (I’m convinced that what kept a certain red Dober-gal of mine going to 15-plus was her daily quarter-mile walk down the driveway, albeit at her own pace.) A dog with mild, early arthritis can and should get more exercise than an ancient pooch with severe cartilage erosion. Non-weight–bearing exercise— swimming, for example—is excellent if not contraindicated by other medical conditions. Look for a Certified Canine Rehabilitation Practitioner (CCRP) for help with designing an appropriate exercise program. (Visit canineequinerehab.com to see if there’s one in your area.)
Complementary therapy: Many arthritic dogs can be made more comfortable and more mobile by acupuncture. Alternative veterinary practitioners sometimes prescribe formulations of Chinese herbs to support the benefits of acupuncture. (Click on “Find an Acupuncturist” at aava.org.)
Laser: Class IV therapeutic laser is a newer form of treatment that stimulates blood f low to tissues and can greatly improve arthritic conditions.
Pharmaceuticals: When it comes to drugs, there are several options. Adequan injections have long been considered the gold standard for treating arthritis and other degenerative joint diseases in dogs. A potent chondroprotective agent, Adequan (polysulfated glycosaminoglycan, or PSGAG) provides the body with the building blocks of cartilage it needs to assist in repairing its own tissues. Unfortunately, it is often not employed because the initial treatment consists of six injections over three weeks, and it is somewhat expensive. However, rarely have I seen an arthritis patient it did not help, and in my own senior dogs, I get clear reminders if I forget one of their maintenance injections (every three to six weeks, depending on the dog). Adequan is largely without side effects; the main reported side effect is the potential for increased bleeding, but in 20 years of use in dozens of patients (including von Willebrand disease-affected dogs), I have never encountered this problem.
We can add an analgesic such as tramadol, a synthetic opioid. While not an anti-inflammatory, tramadol is a fairly potent pain medication, as well as being inexpensive and reasonably safe. Sedation and constipation are possible side effects, but in my experience, dogs tolerate tramadol wonderfully within the proper dose range. Gabapentin and amantadine also target the nervous system, altering the transmission and strength of pain signals.
We can elect to try a steroid for its anti-inflammatory effect. The caveat with steroids, of course, is that over time, they have a “breakdown” effect on body tissues, including joints. Also, if used for any length of time, they may contribute to the development of diabetes, medically caused Cushing’s disease, liver inflammation, immune suppression or other problems. In order to prevent gastric erosion or ulceration, vets will often prescribe medications such as histamine blockers (famotidine, cimetidine), proton-pump inhibitors (omeprazole) or gastrointestinal protectants (sucralfate). If ulcer symptoms develop, steroids should be discontinued. All this having been said, many ancient dogs with advanced arthritis can get four to eight weeks of benefit from a long-lasting steroid injection.
If none of the above provides sufficient relief, one of the veterinary NSAIDs (non-steroidal anti-inflammatory drugs) might be considered. Canine NSAIDs include Rimadyl, EtoGesic, Deramaxx, Previcox, Metacam and Feldene. While these drugs are highly effective at reducing inflammation and pain, they should not be casually dispensed. I use them on a very limited basis with exceeding caution.
Few drugs are without possible side effects. The potential side effects of veterinary NSAIDs are numerous; they can be severe, and even fatal; their development can be completely unpredictable; and most importantly, they can be irreversible. I hold the “above all, do no harm” portion of our oath close to heart at all times. Unpredictable, irreversible side effects are scary.
For dogs whose systems tolerate an NSAID well, they can be wonderful. However, more than a few dogs, including healthy non-geriatrics, have succumbed to irreversible organ-system failure from sometimes no more than a few days’ worth of NSAID therapy. I have also heard of fatalities from perforating gastric ulcers, seizures and other “adverse events.” The FDA has documented thousands of such deaths, which by their own estimation represent a fraction of total cases.
Blood work should be done before an NSAID is dispensed to confirm normal liver and kidney function, red blood cell count, and other parameters. These tests should be repeated at regular intervals to confirm that the NSAID is being tolerated. Ask your veterinarian for a copy of the pharmaceutical company’s Client Information Sheet; he or she should also advise you about symptoms to watch for, including, importantly, any increase in water consumption or urination. The medication should be stopped immediately if symptoms develop. NSAIDs must never be given with aspirin or any form of steroid; doing so can result in death.
And please, do not give your dog over-the-counter pain medicines without consulting your veterinarian! Dogs have died tragic, unnecessary deaths from a variety of seemingly innocuous pills, including a healthy five-year-old dog whose owner gave her several days’ worth of Ibuprofen, which is toxic to canines (and, for that matter, felines too).
Let’s strive to support fit, structurally sound dogs; maintain them with excellent nutrition and age- and breed-appropriate exercise and at optimal body weights; and begin supplemental integrative therapies when they show symptoms of and are diagnosed with degenerative arthritis. Let’s work our way up to the “big guns” prudently and judiciously. Here’s to long, happy and comfortable lives for all our dogs!
Good Dog: Studies & Research
Is it all in their heads?
May 8 2012
Ariel, my Doberman, lies restrained on her back. She is surrounded by strangers, in a room with frightening smells. In an effort to keep cancer at bay, she has been poked, jabbed and invaded for more than a year and has now developed one of chemotherapy’s dreaded side-effects: an inflamed bladder wall, which is hemorrhagic and painful.
The doctor positions the long needle as the ultrasonographer guides its placement via the monitor. Hugging and kissing her, I cannot watch as the needle plunges into her bladder to retrieve its specimen. Yet I know the moment it happens—Ariel’s eyes dilate like deployed air bags, and she turns and tenderly cleans my face until the hurt is withdrawn. This contact is considered by many researchers to be part of the mechanism of the placebo effect at work in dogs.
Placebo is “the beneficial effect that arises from a patient’s expectations from a treatment, rather than from the treatment itself.” Does the placebo effect exist in dogs? Until recently, the presumed answer was a resounding no, because animals were thought to lack the cognitive capacity to understand the intent of medical care or the power of suggestion, or to have hope of recovery.
What a howl! Such nonsense is summarily dispelled by two pages of technical references underpinning a recent veterinary journal article entitled “The placebo effect in animals,” which documents in detail the existence of the placebo effect in dogs, among other species. A subsequent article, “Effects of human contact on animal health and well-being,” follows up with even more scientific references regarding the substantial benefits of this adjunct therapy.
Both of the articles suggest that the placebo effect in veterinary medicine can enhance the efficacy of medical treatment, and findings make a “strong scientific argument for encouraging in-hospital visitation by owners when animals are hospitalized.”
Experimental studies on the mechanisms of the placebo effect in animals have been underway for at least 70 years. Components of this phenomenon, including belief, expectation and trust, are presumed to be present at a neurobiological level, though cellular mechanisms remain unknown.
In humans, the placebo effect is generally ascribed to one or more of the following: classical conditioning, expectation and endogenous opiates (the body’s own naturally produced pain-relief). In animals, interestingly, a fourth mechanism is also theorized: the effect of human contact. Numerous studies have documented positive physiologic and health effects as a result of animals’ visual and tactile contact with a human. The ability of human contact to optimize an animal’s comfort and well-being provides a strong rationale for pet owners being present for many medical procedures.
A recent double-blind veterinary study involved arthritic dogs randomly assigned to either a treatment or a placebo group. Their response to treatment was objectively assessed by force-plate analysis, which precisely measures the use of individual limbs while a dog is in motion. The result? Fifty-six percent of placebo-treated dogs had an objectively measured, significant, positive response.
When a person strokes a dog, substantial decreases in the dog’s heart rate can be noted. Human contact also consistently elicits major positive changes in canine blood pressure and aortic and coronary blood flow. The placebo effect in animals on immunomodulation, cardiovascular disease, drug withdrawal, tumor growth and much more is well documented. The proverbial bottom line is that an animal’s mental and emotional state has a profound influence upon its physical health. And, human contact has a positive impact on the well-being of animals of all age groups, and produces an array of physiologic, emotional and health effects.
Upon discharging Wendy, my beloved, gentle, 11-year-old Doberman to my care, clinicians at the veterinary school advised me to “take her home and love her, she has two to three weeks to live.” I knew this to be correct. Only a few cases have ever survived Wendy’s untreatable and rare cancer for several months, and those who did required intensive, constant medication. After a month of blood transfusions, a last-ditch effort that in recorded practice has never worked, Wendy became incompatible with all available blood from canine blood banks.
On a hunch, I had her red-and-rust son’s blood tested and found that it was compatible. I communed with her, telling her that this would be the last transfusion; I also promised to discontinue other treatments and stay close by, enveloping her in love. One year later, with no further intervention, Wendy still warms my side. The veterinary school clinicians are in disbelief. There is truly no medical explanation.
That’s all right. I’ll take Ariel, Wendy and the placebo effect any day.
McMillan, Franklin D. “Effects of human contact on animal health and well-being.” J Am Vet Med Assoc 1999; 215, No. 11:1592–1598.
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