Month: September 2017

 

Kristin Wolter, CVT, CCRA, CCFT

Since it’s animal pain awareness month I thought it would be a great opportunity to discuss pain prevention. So often we wait for a painful event to occur and then treat it rather than taking the time and consideration to find ways to keep it from happening at all.

There are many medical conditions that contribute to pain – both acute and chronic. Some are preventable and others, less so.  Congenital orthopedic and medical disorders, autoimmune disorders, disc disease, some types of cancer and infection can all result in pain and may be challenging to prevent. However, many injuries and illnesses in dogs, that result in pain and inflammation, are well within our ability to avoid all together.

The best way to reduce the risk of painful conditions is to develop good monitoring and management skills of your dog. Importantly, management of body weight, of physical activity and of environmental access are three key ways to keep your dog safe, happy and comfortable through out their lifespan.

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Weight Management

Weight management, without a doubt, is the number one way to help prevent musculoskeletal pain related to injury and chronic arthritis. Starting at puppyhood and throughout a dog’s entire life, carrying extra weight can have a significant impact on orthopedic health.

A scale is not needed to assess your dog’s body condition at home. You should be able to feel your dog’s (or puppy’s) ribs almost as easily as you can feel the bones over the back of your hand. 

Large breed and bully breed dogs are often grossly overweight because many people do not realize that what they think is ideal body weight is actually obese. Small dogs have their own set of rules as they are often over fed and perhaps get less exercise than other, larger breeds. If you aren’t sure about your dog’s weight ask your veterinarian, or better yet, a veterinary technician to make a body condition assessment.

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Activity and Exercise Management

Central Oregon is a highly active community. Biking, running, hiking, paddle boarding are all common activities that dogs also enjoy.

Managing exercise and activity is a huge factor in pain prevention. I know a lot of you reading this right now are probably of the mind that “A tired dog is a happy dog.” Really, the saying should be “A tired dog is a happy human.” Yes, appropriate exercise is important for every dog’s health, but too much of it can have detrimental affects when it comes to causing chronic pain. Repetitive, erratic games of chase (to a toy, a “SQUIRREL!!!,” or at the dog park)  are key predictors of orthopedic injury which can lead to chronic inflammation, pain and osteoarthritis.

Daily, moderate exercise such as leash walking, swimming, short distance (1-3 miles) jogging coupled with longer hikes once or twice a week is ideal for most healthy dogs.  Weekend warrior type activity is ill-advised for our canine counterparts. 

Certainly, playing fetch is a great way to increase cardiovascular fitness, but it is important to end your session well BEFORE your dog offers to stop. When muscles are fatigued (or are not properly warmed up), strains and sprains are much more likely to happen. Another way to help reduce the risk of “fetch” related injury, is to allow the toy/ball/frisbee to come to a complete stop then send your dog to get it and bring it back.

Alternatively, not getting enough activity can decrease strength, limit flexibility and reduce overall function and longevity. The saying “Don’t use it, you lose it,” applies to our canine friends as well as it does to us. Maintaining core strength and flexibility through appropriate exercise is vital to quality of life. More and more canine sporting competitors are realizing the benefits of dog fitness, and this should not be overlooked for the canine, couch surfing athlete.

Puppies have their own special set of rules when it comes to exercise. In a nutshell, puppies should be allowed to be puppies on their own terms with very little encouragement from people or other dogs. They should not ever play or run to the point of exhaustion. They should be restricted from long walks and hikes and should not ever  “go for a jog” until they are at least a year old. Growth plates are extremely prone to injury.  Severe growth deformities, elbow and hip dysplasia can result from repetitive or high impact play and trauma.  Puppies can appear to be very athletic, but their physical maturity does not truly align with their athletic ability until they are 2 years old.

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Environmental Access Management

Keeping your dog safe (sometimes from themselves), is very important in decreasing the risk of painful events such as GI upset, trauma or injury. It is easy to slip into the thought process that dogs automatically know how to safely navigate a human’s world. They do not understand that eating a fishhook or stuffed animal is not going to end well. Or that getting into the garbage only results in a new cleansing diet followed by an expensive carpet cleaning appointment. Most dogs have the cognitive ability of a 2 or 3 year old. They truly are not aware that stepping in front of a moving vehicle could result in loss of life or limb, or that jumping from a second story deck going after a squirrel will only result in the squirrel getting away while they take a trip to the vet.

Additionally, keeping them safe means teaching them how to rest in a crate or kennel (or reliably on a bed) so that when you are distracted, you know exactly where they are and what they are doing. It means being sure that the garbage is out of reach, that the leash is attached and that your dog has a good recall and will come back to you regardless of what is going on.

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Moderation is the key to helping your dog maintain good health and lead a physically comfortable life. Be your dog’s guardian when it comes to pain prevention.  Keep them at an ideal body weight, keep them active but not exhausted and keep them safe from themselves.  They will thank you for it with many years of smiles and wags.

 

Janice McConnell, DVM, CCRT, cVMA

 

Treating Chronic Osteoarthritis Pain in Our Pets Osteoarthritis (OA) is a common cause of chronic pain in our pets. It is estimated that 20-25% of adult dogs develop osteoarthritis, and that number may increase to 80% of geriatric canine patients over 8 years of age. In studies of cats, the prevalence of radiographic changes of OA ranged from 22-33% when all ages were included; and prevalence went up to 90% in cats over the age of 12 years. Recognition of chronic pain in our pets can be challenging, as the symptoms are often subtle. Please talk to your veterinarian for guidance on how to recognize pain in dogs and cats.

When we identify that a pet is painful due to osteoarthritis, we assess the nature and severity of that pain to develop a short and long-term treatment plan that will best support joint health and the pet’s function.

We are fortunate to have a variety of therapeutic approaches to choose from and we will be most successful if we take a multi-modal approach to pain relief. The following list is intended to provide information on some available treatment options, including medications, nutraceuticals, and physical rehabilitation methods that can be utilized as part of a multi-modal pain management plan for your pet. While this list is not comprehensive, it does focus on the more commonly prescribed therapies and those with evidential support.

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Pharmaceutical Medications

1) Non-steroidal Anti-inflammatory drugs (NSAIDs): NSAIDs, such as carprofen and meloxicam, are still the mainstay for osteoarthritis care and can be used safely longterm in many OA patients.

2) Galliprant is a new medication that targets a specific prostaglandin receptor involved in mediating inflammation, rather that inhibiting production of prostaglandins, as the NSAIDs do. This medication holds promise for control of OA pain and may be tolerated by some patients that cannot take NSAIDs.

3) Gabapentin plays a role in managing neuropathic pain and has become increasingly prescribed for chronic OA pain. While we have appreciated some benefit of this medication, we still lack studies to support it’s benefit for our OA patients.

4) Amantadine is a medication that helps to prevent or control ‘wind-up pain’. Wind-up pain results when the central nervous system becomes sensitized to repeated pain signals. The result is a more intense and frequent firing of pain signals, and thus the perception of pain become stronger and more persistent. If your pet’s chronic pain is moderate to severe and does not respond well to NSAIDs alone, a course of amantadine may be warranted. Nutraceuticals There are many nutraceutical options on the market, many of which can provide benefit in OA care. But given the lack of regulatory standards on supplements, we will best serve our pets by being mindful toward potential harmful substances in over-the-counter products, and by seeking out good quality control and evidence to support efficacy.

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Nutraceutical Supplementation

1) Omega-3 fatty acids are beneficial for OA by reducing inflammatory mediators. Eicosapentanoic acid (EPA) and Docosahexanoic acid (DHA) are the key omega-3 fatty acids for dogs and found in fish oil. It is important, however, to understand that not all fish oils are equal nor safe. Things to consider when researching a company include whether the source of fish is certified sustainable, and whether every batch of product is tested for toxins and contaminants. Dosing in dogs for joint care starts from 50-100 mg/kg per day of combined EPA/DHA.

2) Polysulfated Glycosaminoglycans (PSGAGs). Adequan ® is an FDA-approved injectable disease modifying osteoarthritis drug that provides cartilage protection by inhibiting enzymes that break down cartilage. There is good evidence to support that the product reaches the joints and helps clinically to reduce pain.

3) Glucosamine/Chondroitin support cartilage health and protection from damaging enzymes but a review of the studies demonstrates mixed results. The data do indicate better absorption and clinical results with low molecular weight chondroitin, as is found in Cosequin® and Dasuquin®.

4) Avocado/Soybean Unsaponifiables (ASU) appear to work synergistically with glucosamine and low-molecular weight chondroitin to support cartilage health and may inhibit some mediators of pain.

5) Others: There are a few other products that deserve mention and may hold promise for joint care but still lack robust clinical data. Curcumin (a substance in the spice turmeric) may help reduce inflammatory mediators. Green-lipped mussel contains components that appear to have anti-inflammatory and joint protective effects. Microlactin is a milk-derived protein with anti-inflammatory effects. Elk Velvet Antler contains glucosamine, chondroitin, and other factors that appear to have an antiinflammatory effect and may promote an increase in muscle mass. Cannabidiol (CBD) products are currently widely available for dogs and cats and have seen mixed results, perhaps due to a lack of data on dosage and production variability. There is currently a clinical study at Colorado State University on use of CBD in osteoarthritis patients and we look forward to the results!

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Weight Control

Arguably the most important thing you can do for your dog with osteoarthritis is to keep him/her lean. Weight loss in even mildly overweight animals can significantly reduce pain from osteoarthritis. And the additional health benefits of weight management include longer life span and slower onset of symptoms of other chronic diseases. Please work with your veterinary team to develop a weight control program and monitor the weight loss in your dog. We recommend targeting no more than a 1% weight loss per week.

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Non-pharmaceutical Modalities

Physical rehabilitation offers several non-pharmaceutical options to provide adjunct pain control and anti-inflammatory effects:

1) LASER stands for Light Amplification by Stimulated Emission of Radiation. Therapeutic lasers are used for photobiomodulation – they emit light waves at specified wavelengths to stimulate cellular change. Clinical effects include a reduction in pain and inflammation, and enhanced tissue repair.

2) Acupuncture is a means of neuro-modulation by placing needles in specified locations to elicit a physiologic response and enhance endogenous pain mechanisms.

3) Therapeutic Massage can relieve pain and stress, improve blood flow and lymphatic drainage, relieve local muscle tension, and reduce myofascial dysfunction.

4) Pulsed Electromagnetic Field Therapy (PEMF) uses electromagnetic fields to induce cellular changes, and shows benefit for wound healing, bone healing, pain management and reduction of inflammation.

5) TENS delivers an electrical currently across an area of injury and can help reduce swelling as well as provide pain control.

6) Therapeutic Ultrasound sends sound waves into tissues to reduce pain & inflammation, and heat tissues to relax them and allow stretch.

7) Joint mobilizations done by a trained rehabilitation therapist can reduce pain in a diseased joint and improve range of motion of a joint.

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Therapeutic Exercise

Positive effects of regular therapeutic exercise in OA patients include maintaining mobility of affected joints through daily activity, strengthening the muscles around affected joints, improving balance, and weight control. An appropriate and safe therapeutic exercise program for your dog is best developed by a therapist trained in canine rehabilitation.