Older Pets and Arthritis

My pet has osteoarthritis?

All the medical advances in veterinary care and improvements in nutrition have resulted in our pets living longer lives.  We get to enjoy their company and unconditional love longer, but unfortunately with a longer life our beloved pets get to experience some of the consequences of older age.  One of the most common orthopedic problems seen in geriatric animals is arthritis. Arthritis (from Greek arthro-, joint + -itis, inflammation) is inflammation on a joint or multiple joints. So now you can tell your friends that you speak Greek!!! A joint is where two bones meet allowing motion (shoulder, elbow, carpus, among others). There are many different types of arthritides, which can be classified as inflammatory or non-inflammatory.  The most commonly seen in older pets is osteoarthritis (OA) or degenerative joint disease classified as a non-inflammatory arthritis. OA is commonly the result of loss of articular cartilage and damage to subchondral bone.  If you just learned that your pet has arthritis, please know that your pet is not alone. OA is the most common type of arthritis in people in the United States and is also the leading cause of disability.  Clinical signs associated with osteoarthritis include joint swelling, pain, stiffness when walking and lameness. With time, decreased joint motion due to pain and discomfort leads to a reduction on muscle mass (muscle atrophy) because of disuse. Use it or lose it! As your pet ages the water content of the cartilage decreases with reduction of proteoglycan content, with the loss of the structural framework the cartilage becomes more susceptible to damage. 

How do I know that my pet has OA?

Watch your pet for any evidence of acute or chronic lameness (limping) such as difficulty standing, climbing stairs, reluctance to jump and stiffness when walking. Approximately 20% of dogs over 1 year old are estimated to be affected with OA. Cats also can have clinical signs as a result of arthritis, but they are masters at hiding pain so the condition is underdiagnosed in cats. 

How does my veterinarian diagnose OA?

Diagnosis is based on history, physical exam findings and radiographs of the affected joint(s). On physical examination the affected joint may be swollen, unstable, painful and may have decreased range of motion. Radiographic evaluation of the affected joint(s) is the most common screening tool used by veterinarians. Collecting joint fluid of the suspected joint and analyzing it under the microscope can also give you invaluable information that can help you localize the problem joint as well as rule out other problems that may be affecting the joint. Other advanced imaging that can be used to evaluate the joint are CT scan and MRI, but are not used as often due to added expense. Minimally invasive procedures such as arthroscopy can be used to explore the joint and rule out underlying disease leading to OA. 

How can I help my pet with OA?

Once your veterinarian definitively diagnoses OA on your pet, medical management should be implemented to improve your pet’s quality of life.

The five mainstays of medical management are:

Weight loss or weight management- Your pet may be obese because of inactivity, sometimes associated to the OA pain. Reduced weight decreases that stress and forces placed on the joints. A variety of commercial weight management diets are available to control the daily caloric intake of your pet while giving them the sense of satiety. Visit your veterinarian for diet recommendations. Weight management will require regular visits to your veterinarian (Doggy Weight Watchers, if you will) to monitor weight and diet.  

Nutritional supplements- Nutraceuticals are not marketed to diagnose, treat, or prevent disease, but are presumed to protect the cartilage and inhibit degradation of cartilage with positive effects in experimental and clinical trials. The most common nutraceuticals used are Glucosamine, Chondroitin, Methylsulfonylmethane (MSM), and Omega-3 Fatty Acids. Chondroprotectants include Adequan (Polysulfated glycosaminoglycan), sodium hyaluronate, and pentosan polysulfate.

Controlled regular exercise- Your pet should be rested during the initial onset of clinical signs. During the recovery period low impact regular exercise improves and maintains joint range of motion and muscle mass. Swimming is a great exercise since it helps joint motion without the added stress to the joints.  

Pain management- A multimodality approach to pain control should be followed when it comes to pain control on these patients. Pain management may include some or all of the following modalities depending on the severity of pain:

Veterinary non-steroidal anti-inflammatories such as Carprofen (Rimadyl®), Deracoxib (Deramaxx®), Etodolac (EtoGesic®), Meloxicam (Metacam®), Tepoxalin (Zubrin®), Firacoxib (Previcox®), are frequently used for pain control of orthopedic conditions. Potential side effects include vomiting, diarrhea, inappetence, anemia, and dark tarry stool. NSAID use can result in stomach ulcers, colitis, and can be toxic to the liver and kidneys. If any side effects are noted it is imperative that the medication is discontinued and to contact your veterinarian for further recommendations.

Tramadol is a centrally acting synthetic analgesic used to treat mild to moderate pain. Tramadol has been used as an alternative to pure opioid medications and also given in combination with a NSAID.  

Acupuncture may result in increase function and muscle strength by ameliorating pain in pets diagnosed with arthritis.

Amantadine is an antiviral medication used in people that may reduce the tolerance to other analgesic medications in animals. Typically it is used in combination with other pain medications because it is unknown if amantadine has any analgesic properties when given alone.

Just like in people, arthritis in animals is a condition that does not have a cure, but can be managed with a combination of exercise restriction, weight management, pain medications and neutraceuticals. Once your pet’s condition is not responsive to medical management other options may include stem cell therapy and total joint replacement. Stem cell therapy in animals holds promise, but further research is needed to confirm efficacy and results of treatment.

The Dreaded "Cone of Shame"

We get it.  We really do.  That baleful look you give us when we say “Your pet will need to keep the e-collar on for 7-10 days.” Or “…..until the wound is healed.” Or “ …until the bandage comes off.”   Some of the many reasons we pass out the despised Elizabethan collar, aka “cone of shame”, “satellite dish”, “lampshade”….whatever term of endearment you chose, we all hate them.  We do not love putting them together. (FYI, watching first timers attempt assembly of an e-collar can provide for at least several minutes of amusement…)  We know what is going through your head when we present you with this lovely piece of plastic secured to your pets head with a white ribbon of gauze.  You are thinking, “How is he/she going to eat?”  “How will he/she fit in the crate?”  Or if you have experienced the displeasure of an e-collared dog in your house before, you might be thinking, “Oh no, the backs of my legs are about to take a beating!”  (Picture a 90 pound canine running up behind you and ramming your calves.)   

Cayleb, my 90 pounder with an allergic reaction and corneal abrasion on his right eye.

Unfortunately these stiff plastic leg bruisers are one of those necessary evil kinds of things.  We promise we aren’t passing them out just to make your life miserable for a couple of weeks.  We really do have your pets’ best interest in mind.  We make them don this head gear to keep us from needing to re-stitch a surgery site, or mend self inflicted wounds or tell you your pet’s eye has gotten worse because they have been rubbing it obsessively. We understand that e-collars are sometimes a huge inconvenience, however animals usually adapt quite well to wearing these “hats”, with the exception of those that just simply refuse, and we know that happens too.  Just try to stick it out and do the best you can to keep your little critter safe from themselves.  It is only temporary, and hey, you can take cute pictures of your furry family member looking pretty pitiful while they wear their collar!

Cayleb sporting his cone!  His eye was back to normal in 7 days.  We did have to bust out our super duper big crate for him to fit in with his e-collar, and of course watch out for the backs of our legs in our tiny living room!

Submitted by Michelle Schoepper  LVT

Break the Chain, Unleash the Love

“Man’s best friend” is sometimes considered a cliché but it is a very true statement.  Dogs are loyal, protective, trusting and forgiving.  So why would you want to keep them on a chain?  You can ride around city streets and even the countryside and see dogs tethered to a chain 24 hours a day, 7 days a week.  They get no socialization, no exercise, are vulnerable to weather conditions and in many cases, injuries can occur.  But if they at least have a fence it gives them area to exercise and can decrease their chances of injury and change their attitude for the better.   Here are some reasons why:

Dogs are very social animals and need contact with people for more than a few minutes when their food or water bowl is being filled.  Imagine lugging a huge chain around your neck every day all day.  Dogs are pack animals and want to be a part of your pack.  When they are left alone all the time it can lead to personality problems like biting.  A lot of times they are so starved for attention that they jump up and down on a person when they are near them.  Many dogs tend to bark quite a bit because they want to be with their person, but in many cases, they are just yelled “shut up” to.  How would you feel?                          

Their exercise is very limited to a circular area around where they are chained.    Dogs need to run and jump and play.  Being chained is a type of imprisonment for just being a dog.  They knock their food and water bowls over with the chain which can be very dangerous given a very hot or cold day.  Often times there is very little cover for the animal to get away from weather.  What if you had to be outside in the blistering heat, freezing cold, rain, sleet, snow?

I am a veterinary technician and have seen what kind of injuries can happen to a chained dog.  Being on a chain, another dog/dogs or wildlife can come into the chained dog’s yard and it has nowhere to escape.  Other injuries I have seen include imbedded collars (the collar/chain has grown into the dog’s neck), chains causing wounds on their leg or body, and sometimes broken legs where the dog has tried to run with the chain wrapped around the leg and snapped it in two.   They are also subject to fleas and ticks especially if they are near a wooded area.  

I know a lot of people chain dogs because that's all they know - their family has always done it that way.  I volunteer with an organization called The Coalition to Unchain Dogs and we are hoping to change this mindset.  I have seen firsthand the change in a dog’s demeanor when it goes from being chained to running around in a fence.  I have seen them go from barking and scared to receptive and happy once the chain is removed and they are released into their new fence.

The Coalition to Unchain Dogs’ mission is to educate people about the dangers of chaining a dog and to help improve a dog’s life.  Dogs love us no matter what and they have no ulterior motives.  I often feel they are more than what we deserve.  Please help improve the life of a dog on a chain.  If you would like to volunteer your time with The Coalition to Unchain Dogs or learn more about them, you can go to their web page for more information: www.unchaindogs.net.   

We at TVRH are also raising money to build a fence for a dog in September.  We have T-shirts available for $20.00 a piece or for a donation of any amount, we have a bracelet that you could wear as supplies last.  Our goal is to raise at least $500.00.  The dogs that receive a fence are also provided with vaccines and a mandatory spay or neuter which helps with population control.  Anything you can give is appreciated.   Please make checks out to Coalition to Unchain Dogs.  Together with your help, we can change the life of a dog.  So please help us to break the chain and unleash the love.

Michele Kendall, RVT

Bet you thought only kids did that!

One of the things that we love about emergency medicine is that it's so unpredictable.  Just last week, we saw something that a pediatrician more commonly experiences.  You hear about it in kids, but in dogs?

That's right.  It's a peanut.  And it was lodged deep in the nose of a maltipoo.  Mom had seen the dog playing with a peanut, and not long after he developed loud, stertorous breathing.  When Dr Reid, our Internal Medicine specialist, checked his upper airway with an endoscope, this is what she saw:

Once she located the peanut, it was no big deal to push it caudally toward the mouth, and then manually remove it.  Our patient had an uneventful recovery, and went home the same day, none the worse for wear.  We love happy endings!

On the loss of a friend...

As a referral and emergency hospital, we see a lot of loss. I wish that we had happy endings for all the cases that we see but unfortunately, that doesn't seem to be the way it works. All of us can empathize with the losses we see, but some hit closer to home than others. Maybe it's that Jack Russell that you can relate to because you have a “terror” at home too. Maybe it's that grey cat that looks just like your first cat you had as a child. Maybe it's that biting dog that you could barely pet when it came to the clinic but you just couldn't help falling for because of her gumption and zest for life. Many of our patients are not just a cat or a dog, but a family member. We understand their loss because we've lost some of our own families too. Sometimes it's time for our friends to go and sometimes, it just doesn't make sense.

I remember when I lost my first cat –  my parents got me a book to help me understand and grieve. The book was called The Tenth Good Thing about Barney by Judith Voirst.

“Barney was brave, and smart, and funny, and clean;

also cuddly and handsome.  And he only once ate a bird. 

It was sweet to hear him purr in my ear. 

And sometimes he slept on my belly and kept it warm.”

I think about that book a lot. I don't remember all of it but I remember that it helped me cope with the loss of my Bruno. He was hit by a car – we lived on a busy street and he was an indoor/outdoor cat. It didn't seem fair that I lost my friend so soon (it still doesn't). I remember when we first got Bruno – we were told he was a girl and my mom had named him Maggie. That changed at the first vet visit. It's funny the way that pets shape your life – Bruno helped me perfect my cat wrangling techniques when I was only five. Thanks Bruno.

Whatever the reason (or lack thereof), pets must leave our lives at some point. I feel fortunate to have cared for the ones that I have had in my life – whether they belonged to me or not. I have learned something from all of them. Ella taught me that Jack Russells never give up – never. Kitty taught me that she was in charge and she could take care of it. Daisy taught me that a positive attitude is always the best outlook on life and you can never have enough friends – that's a golden for you. I've learned a lot from having pets in my life. I can't say I enjoy crying at work but I'm glad I'm at a place where I can be there to help someone when they've lost their own friend. I know it hurts, but we hurt with you. In time, I hope you remember all that your friend has given to you and what lessons you can learn from them. Here's to all our furry friends – may they rest in peace and watch over us from across the Rainbow Bridge.

submitted by Sarah Ignelzi