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Friday, September 2, 2011

Arthritis in Dogs (and Veterinarians)

About ten years ago, a podiatrist prescribed Celebrex, an anti-inflammatory drug, (think ibuprofen) for plantar fascitis in my feet. I still have the condition, and since then I take the Celebrex as-needed. What I have noticed, however, is that as I get older, my joints are sore, and the Celebrex helps that a lot! So...I'm taking the drug more often, simply to be able to walk up the stairs in the morning without wincing in pain.
Experiencing the aging process (and the soreness that accompanies it) first-hand has made me more empathetic to my old arthritic patients. I haven't seen any statistics, but degenerative joint disease ("DJD", another name for arthritis) is an extremely common occurance in older dogs. DJD is especially debilitating in large-breed dogs, and is possibly the most common reason these dogs are euthanized.
There are a number of strategies we employ to treat DJD, and it is widely accepted that "multi-modal" therapy is most effective, although not every patient needs every form of treatment. Identifying at-risk dogs is very helpful in delaying symptoms and reducing the severity of DJD. At-risk dogs include those who have experienced bone or joint injuries in their youth (fractures, torn ligaments), overweight breeds prone to hip dysplasia, and dogs with conformational problems which could lead to abnormal stress on their joints. In my opinion, these dogs should be started on medical-quality glucosamine/chondroitin supplementation as early as possible.
Weight control and regular exercise are probably the two most important factors in preventing and treating DJD. As stated in a previous blog, dogs at ideal weights live about two years longer than obese dogs, primarily because of healthier joints. Regular exercise keeps the tissues which support the joints strong and helps the joints stay "lubricated." We have a physical therapy routine we prescribe for dogs with moderate to advanced arthritis, and some specialty hospitals even offer high-end PT (swimming, underwater treadmills, etc...)
As far as drug therapy is concerned, this is reserved for patients showing signs of pain. However, many owners don't recognize these signs! I get a lot of comments such as, "He's not sore, Doc. He just has a hard time getting up in the morning, like me." OK, Gomer, your dog is in pain. He does feel better as he starts to move around, but the pain is his body's way of saying, "There's something wrong here - I need help." Like me and my Celebrex, these dogs should be made comfortable to maximize their quality of life. We routinely use anti-inflammatories (like my Celebrex!), and supplement them as-needed with the pain reliever Tramadol.
There are now prescription diets for arthritic dogs. According to the veterinary orthopedists I have spoken with, the key ingredient in these diets is super-high levels of omega-3 fatty acids. These high levels of fatty acids have a significant anti-inflammatory effect on the joints. I am told that the levels are so high that it would be difficult to achieve them by giving fish oil, or some other fatty acid supplement. The problem is that these foods are quite expensive, especially for large dogs.
Veterinarians are now using stem cell therapy to treat arthritis. The stem cell cultures are grown from the patient's own surgically-acquired fat cells. When injected into an arthritic joint, the stem cells help control inflammation and pain, and possibly aid in the healing of damaged cartilage. While there are a lot of anecdotal success stories with veterinary stem cells, there is still a lack of hard evidence. Having said that, I recommend stem cell therapy for patients whose owners want to try everything possible. We do offer it at our practice. It aint cheap!
So if your dog, like me, is moving slowly and stiffly in the morning, or struggles to get up the stairs, or pays a big price for a day of fun and play, get him some help! He would do it for you if you were hurting.