Let’s get started on the causes of arthritis.
But before we get started about the causes, one of the things I’d like to say is with all the modern medications that are available; there’s almost no pet that ever needs to be euthanized because of arthritis or arthritic pain or bone pain. And that’s a little bit different to the way it was, even as short as five years ago, but there are so many modern things available.
The causes and the causes of arthritis fall into three broad categories;
‘trauma’ or environment.
For example, hip dysplasia, 40% of all cases or causes of hip dysplasia 40% of the cause is genetic; it’s the genes, it’s what you’re born with.
Little dogs don’t tend to have very much genetic predisposition; the large and giant breeds do.
Nutrition can be in utero nutrition while they’re in the womb and then nutrition in the first, say six months of their lives and unfortunately, not all dog foods are made equal, and some are made a lot less equal than others, and we don’t have enough time to go into it here. But essentially, the more you pay for dog food, the better quality you get, and if you feed a large and giant breed dog on a cheaper quality dog food, you are opening yourself or your pet up to more of the nutritional causes of joint disease or arthritis.
I could spend half a day going through this topic tonight, so I’m really trying to condense it down.
And then the third predisposing cause is trauma or environment. For example, if you have a working kelpie who jumps in and out of the back of the ute 50, 60, 70 times a day, that dog is a lot more likely to become affected with arthritis than a pug who lies on the couch all day.
If you have a dog that has a major accident and dislocates an elbow or a hip or something else, then there’s a lot more chance of that dog is going to develop arthritis in that joint and obviously other joints, because if this elbow is affected, then that dog will offload this elbow and load onto the other three legs and that’s a lot more likely to predispose to arthritis, going forward.
Now let’s talk about diagnosis, and this is unbelievably difficult.
We’ll break this up into dogs and cats, and both dogs and cats are incredibly excellent at hiding pain.
I have an example today of a pet that came in today, and this pet fell down last night or this morning and was really sore in one of the front legs; and I admitted that dog and took x-rays of both his elbows and they were horrible, severe arthritis in both elbows.
I’ve known that dog forever since I’ve been at HVH, three and a half years now, and we’ve done lots of work on him for other bits and pieces and at no stage during this three and a half year that I’ve known him has he shown signs of arthritis or pain in his elbows, but his elbows on x-ray are quite terrible.
The good news is that there are lots of things we can do for him.
But he has arthritis in both elbows, which means that he can’t limp on either elbow because they’re both equally sore.
When he fell last night or this morning, his right elbow became a lot sorer, and so he started to limp on that leg, and so it became obvious.
And he’s 13 now, and this arthritis in his elbow, according to the x-rays, has been going on for probably four or five years, but he’s been hiding it really, really, really well, and because it’s been equally in both elbows, he hasn’t shown lameness in either leg.
Take home – dogs are great at hiding pain!!
Let’s talk about cats.
When cats are in pain, they will hide more; they’ll decrease their levels of activity, dogs may pant more.
Think about it this way – a million years ago, dog or cat in the wild, if you showed signs of weakness or pain, then you were someone else’s lunch.
So you had to show pain but not show obvious pain.
That involved hiding, carrying a limb, decreasing your levels of activity, panting, which allowed you to dissipate the pain but not show it.
For example, a normal cat can jump two meters up or down… if you’ve got a washing machine dryer combination, the average cat up until quite late in life can jump up and down that stack of washer dryers quite easily.
What you’ll notice in the cat with arthritis- what you may not notice in a cat with arthritis – is the cat will jump from the double story down to say a little ledge and then onto the ground.
You’ll see a cat not jumping as well, and it’ll be really hard for you to notice unless you really know what to look for.
And the other thing is that when the cat jumps down, a normal cat will jump down and then move away, whereas the cat with arthritis in its elbows or anywhere else will jump down, pause to gather him or herself for a couple of milliseconds and then move away.
Simply a decrease in activity levels or the tiny changes we’ve described above can show you that a cat has arthritis.
Let’s move on to the dog.
Once again, panting, hiding, sleeping more, being not as active, not socializing as well, all those things are signs of arthritis.
And then the question becomes, is my dog simply aging or is my dog arthritic?
The same question applies to cats.
Cats are really covert at hiding pain. Dogs, not so much, but still to some degree.
It’s really hard to say aging or arthritis.
Tail down, offloading the sore leg – these are classic giveaways.
If you’ve got a dog and you’re watching that dog from behind, that dog may be offloading on the sore leg. Standing off the sore leg, and it’s really hard to notice unless you’re actually watching for it.
A dog with hip arthritis, for example, before that dog lies down, may spin three or four or five times before he or she finally plonks down, and when getting up, it may be an exaggerated effort loading more onto the front legs; all very, very, very subtle.
Slow to get down, slow to settle, slow to rise, turning around a lot, and that can go all the way through the overt pain.
Overt pain may be limping excessively, vocalizing; it may be even something as challenging as being cranky, snarky or even biting or mouthing, and that is totally abnormal behaviour.
It can be really hard to notice pain in our pets.
I had someone in not too long ago, and this dog had arthritis, and we treated the dog with a product called Zydax, which I’ll talk about later on. And what this gentleman noticed – what he hadn’t noticed, but what he noticed once we had treated the dog was, the dog once again started to follow him around the house and follow him around the backyard.
Whereas what he hadn’t noticed was, previously before we treated the dog, the dog had laid in the lounge room in the house and watched the owner as the owner walked around and did things but hadn’t followed the owner around.
And when we treated him, the dog once again followed the owner around.
But the owner had never noticed that the dog had stopped following him until he started re-following him if that sort of makes sense.
So it could be really, really, really subtle.
Let’s talk about treatment.
As I said a minute ago, there’s almost no patient now that needs to be euthanized for arthritic pain because there are so many treatment options, treatment modalities available and let’s divide things into two basic classes to start with;
- that’s disease-modifying agents and then
- the second one is pain relief.
Disease-modifying agents actually fix the joint, fix arthritis, improve the joint function and therefore improve the pain.
They don’t; they do not pain killers, they don’t improve the pain by being pain killers, but they improve the joint function and therefore, the pain decreases.
Let’s go to the product that I had up a minute ago, and the one I’m holding up now is a product called Zydax; it’s a fourth-generation product.
The previous generations were called Cartrophen Synovan and Pentosan.
This is a newer version. It’s made from the bark of a tree in Scandinavia, and I was involved in the studies of the first one, Cartrophen when it came out in 1987, and we actually injected dogs with this product and then x-rayed the dogs over a period of six months, and we actually saw the x-ray changes regress or improve.
One injection a week for four weeks, no side effects at all and what I tell clients it does is a grease and oil change on a damaged joint.
If you’ve got a damaged joint, the synovial fluid, the fluid inside the joint becomes either too thick or too thin; this normalizes the joint fluid.
The synovial membrane, the membrane around the outside of the joint, becomes inflamed; this takes the inflammation out of that synovial membrane, and the last thing is, the bone above – so the bone is very springy at a microscopic level; it’s like the innerspring mattress of a bed, and when a joint becomes arthritic, the bone above and below that joint becomes filled with blood clots and becomes much stiffer and no longer springy, and this product dissolves those blood clots and re-springs the mattress.
It’s one injection a week for four weeks, and it’s repeated twice a year.
Now – there are many variations.
Some vets will give a course of four twice a year as I do; others will give a course of four once a year and an injection at the six months mark; other vets will give an injection every month for 12 months, etc.
There are many, many, many, many varied forms; it’s brilliant.
Good evening, good evening and welcome to the final part of our series on arthritis and where we finished off last week was talking about the different modalities or treatment options for arthritis.
How many pets get arthritis?
But before I want to do that, the one thing I realized that I hadn’t talked about in the previous section was what percentage of pets suffer from arthritis?
Arthritis in cats
There is a recent study that came out about three weeks ago that absolutely shocked me. The section that shocked me was the section on cats.
The studies show that something like 80% of cats over 10 years of age suffers from some form of arthritis.
We see a lot of cats coming into the practice, and very few people mention their cat being incapacitated. And when I examine those cats, similarly, very few cats are incapacitated or show pain. But when we x-ray them, we see significant arthritic changes in their joints.
And we find some that clinically have sore elbows or hips or whatever; we put them on medication they improve out of sight.
That just goes to back up what we were talking about last week, in which it was, in which I said how great cats are at hiding arthritis. 80% of cats over 10, 11, 12 years of age have arthritis.
If you’ve got an elderly cat, it’s almost guaranteed that cat has arthritis.
Arthritis in dogs
The numbers in dogs aren’t as strong, but they’re certainly up there as well.
10-year-old dogs and older, at least 50 to 60% have arthritis somewhere that can benefit from treatment.
And speaking about treatment, we started talking about the two different big picture treatment options last time, and one was;
disease-modifying agents and the other one was
I talked about disease-modifying agents. The one I started talking about was Zydax.
This is one injection a week for four weeks, and you use a 4-week course twice a year.
It’s very inexpensive. There are a number of ways to use it, and I mentioned that to some degree last week.
There are no side effects, fantastic treatment. I think most vets have actually used this on themselves. I certainly know I’m one of that group, and it works very well for dogs as a four-part injection, as I said with no side effects, and the simplest way to describe how it works is to think of it this way;
- it does grease and oil changes on the joints by normalising the joint fluid
- it takes the inflammation out of the joint capsule, and
- it improves the blood supply above and below the joint. By doing so, it re-springs the bone, the mattress above and below the joint.
This is a disease-modifying agent that works really well.
There is a lot of other disease-modifying agents about which there isn’t a great deal of science, or there’s not a great deal of science behind it.
I had knee replacements four or five years ago now, and I talked to my orthopedic surgeon about the ‘classic treatments’ which most of know about, and they include glucosamine, chondroitin, green lip sea mussel, fish oil, celery, rosehip, etc. all those sorts of things and he said to me, “In people, the jury is really out. Take them by all means, and if they work, fantastic. If they don’t work, that’s what we’d expect.”
It’s exactly the same in dogs.
The things that we commonly use in pets are the same as those I’ve just listed for humans.
I’ll mention this product here. Paw Osteo Advanced.
Paw produces a number of different products, this, in my opinion, is their best one, and this has glucosamine, chondroitin and green lip sea muscle and a couple of other products that I’ll mention in a minute.
The first three products, chondroitin, glucosamine and green lips sea mussel, are the essential building blocks of cartilage, and if your dog’s cartilage is missing these ingredients, then this can be a really good solution. And similar products can be a really good source of supply and helping those joints improve.
With things like the green lip sea mussel and the other sea mussel type products, the kelp type products, what’s really super, super, super, super important is how they’re processed. They must be processed in a particular way in order for them to be of any benefit.
And many products are not processed in such a way, and therefore the ingredients may be listed on the label of the product, but because of incorrect processing, they DO NOT WORK!!
In the PAW Osteo Advanced product, we know that the green lip sea mussel is harvested and produced in a certain way that it is super, super, super effective, and it works.
Antinol is another one that works really well because it has been harvested and produced in a certain way to make it really useful.
But most of the other green lip sea mussel products and products of that type aren’t produced in the correct way, so that they’re actually not very useful.
What I’m saying to you, and I’ll rephrase it this way, if you’re going to use one of these chondroitin, glucosamine, green lips, sea mussel type products in your pet, then read the literature about that particular product! DON’T read generic literature about green lip sea mussel, chondroitin, glucosamine and green lip sea mussel and assume that it’s transposable to your product, the product you’re using. It may not be.
Unless you’ve got scientific validated independent data about that particular product you’re using, assume it’s not going to work and go to a product that has the scientific basis behind it.
Back to PAW Osteo Advanced. There are also two ingredients in here that are pain killers.
One of them is curcumin or turmeric, and the other one is Boswellia.
Turmeric is not highly biologically available.
If you walk into the local health food store and grab some turmeric, and put it on your dog’s food, it may have some benefit.
But it’s not going to be nearly as beneficial as a turmeric curcumin product that has been treated specifically to be bioavailable.
In the Osteo Advanced, turmeric has been treated to be specifically available for dogs and cats.
Most turmeric is very poorly available.
You may feed a whole heap of turmeric to your dog, but it’s not going to get into the dog’s system to do very much good in most cases.
Be really careful about the type of curcumin or turmeric it is that you’re using.
Boswellia is a very new ingredient; it’s not around in many products at all. It’s harvested from tree bark in Africa and Asia, and it has an amazing anti-inflammatory effect, just like the correct curcumin.
Let’s move on to another disease-modifying agent, fish oil.
We’ve got omega-3 and omega-6 fish oils. Omega-6 fish oil is actually pro-inflammatory. It creates issues, whereas omega-3 fish oil is anti-inflammatory.
You’ve got to have exactly the right ratio of the omega-3, omega-6 fish oil to have a beneficial effect on your dog’s joints.
Just racing out and getting any fish oil type product that may be used on people or horses or whatever isn’t necessarily going to work. You need a product with the right ratio of omega-3 to omega-6 to have the beneficial capabilities.
One of those products again is a PAW product or a Blackmore product. There are many others available, but that’s one that we use.
There is another product, and this will be the last one of the disease-modifying agents that I’m going to discuss – even though there are another 10 or 20 we could talk about…
… this is a product called 4CYTE, which is a very new drug, and it has been shown to grow cartilage.
When you have a dog or a cat or a horse or a person with arthritis, then you have bone on bone contact.
When you have two pieces of bone in a joint, there is a cartilage cap on each piece of bone which stops bone to bone rubbing.
Up until now, there’s been no product that has been able to grow new cartilage.
Chondroitin, glucosamine helps repair cartilage if the cartilage is deficient in those products, as does omega-3 fish oil, it helps the cartilage maintain and what not.
But there’s been nothing up to now that has helped grow new cartilage.
Well, 4-CYTE has been shown to grow new cartilage.
It’s available for horses and dogs and cats, and as of this week actually, and there’s a product coming out for people as well.
Fantastic product and use of 4-CYTE in studies in dogs and cats and horses have shown that it allows a significant decrease, at least the halving or almost the elimination of a lot of pain relievers, especially in the early stages of the disease.
A number of my dogs have arthritis, and they’re 4-Cyte, and they are on the Osteo chews as well.
They’re getting a whole mishmash of things to maintain their joint health and to improve their joint quality as long and as much as possible.
Over time the disease-modifying agents can’t really do what they’re designed to do anymore.
At some stage, most of my clients come in and say, “The Zydax is no longer working. The 4-CYTE’s no longer working. The Osteo chews are no longer working.”
Whatever it is that their pet is on is no longer working, and then we have to move on to a pain-relieving plan.
Initially, we use a combination of disease-modifying agents and painkillers.
Typically the painkillers are on an as-needs basis, but over time, the disease-modifying agents stop working, and therefore, we move more to the painkillers, initially on an as-needed basis and then eventually on a permanent basis.
There are lots of things that we can use for pain relief on an as-needs basis;
Acupuncture; absolutely superb; you may or may not believe in it, and even if you don’t believe in it, it works. So it’s worth doing acupuncture or having acupuncture done with your dog.
Exercise; the other really important thing I’ll deviate sideways a little bit here for pain relief is to maintain your dog’s level of exercise.
All dogs and cats and horses with arthritis should have some level of exercise to maintain joint mobility, joint function, to keep muscles and tendons and sinews strong and supple.
They shouldn’t overdo it, and yes, having them move is going to create some pain; there’s no question about that.
But having them not move, over time, will seize or freeze up all those joints, and consequently, there will be much, much, much more pain.
We don’t want them Frisbee chasing or ball chasing or doing all sorts of crazy stuff. But we certainly do want them to be active.
As I say to many of my clients, “Take your dog for a one or two-mile walk or walk around the block or whatever it happens to be, to maintain flexibility, mobility, joint health, joint strength, muscle strength and tendon and sinews strength and health as well. And yes, it will be uncomfortable, but to not do so will cause a lot more failure, a lot more quickly, and we all know that from a personal perspective.”
If you’ve got a super active dog like my Ava or a dog like the Kelpie or dogs like that, that no matter how sore they are if you throw a ball or throw a Frisbee, they’re just going to go crazy about that.
If you were to throw that Frisbee 40 or 50 or 60 times, then they would just do that Frisbee chasing thing until they drop.
If your dog wants you to throw a Frisbee 20 times, just throw it once and then take them for a long walk.
Mentally get a lot of fun stuff out of that one Frisbee throw, and they’d like you to throw it more, but that’s going to be hugely detrimental to their joint health over time.
Just have a little bit more common sense with that for their benefit.
Also, a jacket in winter to help keep them warm.
Also, a heated pet bed to keep them warm. Get them inside, and we still have clients that even in this temperature – it was minus three when I went on my first farm call this morning at six o’clock – and you don’t want an old pet sleeping outside in this sort of weather. And unfortunately, I still see that happen.
At least get your pet inside, in the garage or preferably in the house or on the porch or something like that.
Nice hot water, a hot, warm blanket, or you get these discs now that hold heat for 10 hours. You put them through the microwave for a couple of minutes.
As I said;
- a jacket,
- a pet heater,
- a bed that’s elevated off the ground
- firm, supportive, but the comfortable bedding,
- all those sorts of things help and help quite significantly.
Let’s get to the non-traditional pain management drugs that we can talk about, and the last one I mentioned is acupuncture.
There’s also avocado and soya bean, which is a fairly new one that works reasonably well.
Then green tea extract, and the last one is Cannabinoids or whatever you want to call it, TCH.
There is now a licensed veterinary medical type product that works very well that we can get for you from an online pharmacy, and that’s all they deal with, and in many pets, that’s been a huge boon. That’s an option as well.
Let’s talk about the classic painkillers.
First of all, we have anti-inflammatories or non-steroidals.
These are two of them.
On this hand, there’s a drug called Previcox and on this hand is an older drug called Carprofen, and I didn’t bring with me a drug called Panadol, which you probably know very well.
If we look at these drugs, the older they are, the more side effects they have, and the more modern they are, the fewer side effects they have.
Previcox is a much more modern drug than Carprofen.
All anti-inflammatories have similar side effects;
- tummy upsets
- kidney damage and
- liver damage is the three big ones.
If we look at an older drug like Panadol, it can be very safe; it can be very useful. We have many dogs on Panadol.
Panadol had actually just been licensed about six months ago; there’s a licensed form of panadol for dogs now in the UK.
It’s now licensed in the UK; it’s not licensed anywhere else around the world. Quick sideline, panadol kills cats. Even a tiny piece of panadol will kill cats, so never give it to your cat.
The more modern these anti-inflammatory drugs have become, the fewer side effects there are
Carprofen and Previcox
Carprofen is older, has more side effects, and Previcox is newer – fewer side effects.
And there’s a new one that comes out about three or four months ago called Galliprant, which is an even more modern anti-inflammatory, and it’s supposed to have almost no kidney, liver side effects at all.
These drugs work very well.
Previcox is one dose a day drug, the Carprofen or the Carprieve is a twice a day drug.
Galliprant is a one a day drug.
These work very well. However, those classic side effects that I just mentioned are potentially fatal.
Therefore any pet that’s on these drugs should receive regular kidney and liver function tests, and it depends on your vet as to how often that happens.
In my model of the world, it’s TWICE a year.
These work really well, and as I said right up front in training, there’s no reason in the modern-day and age for any pet to be suffering from pain.
I’ll go to this one next which is Tramal or Tramadol. A very good drug.
It’s the first synthetic opiate or the first synthetic morphine if you like.
Let’s talk about anti-inflammatories.
If your dog or cat has a sore wrist, there is inflammation which consists of;
swelling and loss function.
These medications are anti-inflammatories;
they take away the heat,
they take away the pain,
they take away the swelling and
they improve the function at a local level.
Anti-inflammatories work at the site of the pain – they work at the local level.
Tramal or Tramadol works at the spinal level and changes the perception of the pain.
It’s almost like putting on rose-coloured glasses about the pain.
And so, anti-inflammatories and the Tramal can be used really effectively together because they work in different ways.
Tramal has no side effects on kidneys or liver or anything else, fantastic drug, and works really well.
Perhaps there is one side effect that maybe is some dogs get a little bit dozy on it as some people do with opiates.
Another drug we’re using a lot lately is a drug called Gabapentin. Gabapentin is fantastic for spinal pain, and again, this is a human drug.
Many of us have been on Gabapentin for all sorts of different pain type problems.
It works very well, as I said for spinal pain, you know, absolutely sick, and we’re using it more and more and more and more for osteoarthritic pain as well. Minimal liver, kidney, gut side effects. I still recommend doing regular blood tests to check on the liver, kidneys, etc., but a fantastic drug.
Symmetrel and Lyrica
Then we have two drugs that are relatively new in our field. They have been around in people for quite a while, and we’ll often use these together.
One is a drug called Symmetral or Amantadine, and then there’s a drug called Lyrica or Pregabalin.
These two together, fantastic combinations their methodology of working is quite complex. They work on the transmission of the pain sensation. They don’t actually kill the pain; they just prevent the pain message from being carried on.
Really good drug, a bit more expensive than the others, with minimal side effects, so absolutely fantastic.
One last thing – if a pet is on any of these medications for more than a few weeks – we NEED to run a min-blood health screen once or twice a year to ensure that there are no side effects from the medication.
Those are the main things that I wanted to go through with respect to pain relief.
Heat and Cold
A couple of other things to think about are heat and cold.
Cold- if you’ve got a dog with an acute or a cat with an acute injury, let’s say been kicked in the leg by a horse. The cold will take the swelling out of the leg and decrease the bruising and the inflammation, cool it down and help a lot.
Heat – if you’ve got a chronic injury, for example, if you’ve got a dog with a sore knee with arthritis, putting heat packs on that during winter will really help mobilize that dog.
You can even use things like a TENZ machine.
There are many, many, many other modalities that we can use that are not classic painkillers.
In many cases, we’ve locked ourselves into this; ‘we need to give a drug’ scenario when there are so many other things available.
Like I said, like acupuncture, massage, chiropractic, reiki if you believe in Reiki and then, hot and cold and things like that.
I’m hoping that everything we’ve been through tonight has answered a lot of questions that you have about arthritis in your pet.
If have, if you have any other questions at all, please reach out.
If you’ve got any questions at all, please give me a ring at the practice or send me an email, and I’m only too happy to help answer any questions.
I’m absolutely, absolutely passionate about pain relief in pets and everything that we can do now to mitigate against it, to minimize it, to control it.
In my opinion, there is no reason why any pet should live with pain. There are so many, many things that we can do about it.
I hope you’ve enjoyed tonight…
Our next live session will be on the first of September, and it’ll be all about a very challenging topic, why are vets so expensive, and what can you do about it!
I look forward to seeing you then, bye.