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   Now What?




By Jacquelyn H. Burns, DVM

Copyright © Jacquelyn H. Burns
All rights reserved
Please, visit your vet.
That’s what they’re there
           for.
   When we veterinarians say
    osteoarthritis or arthritis, we mean
    Degenerative Joint Disease or DJD
    ◦ In dogs and cats, degenerative joint disease
      means bone, muscle, tendon, ligament
      and/or joint changes have occurred as a
      result of joint instability or structural
      unsoundness
    ◦ The body attempts to rectify instability by
      forming extra bone at/around affected
      joints.
    ◦ There is also inflammation with a snowball
      effect that tends to make itself worse over
      time.
   Injury
    ◦ Blunt force trauma (hit by car)
    ◦ Athletic type injury (―football player‖ injury)
      Torn ACL ligaments
   Heredity
    ◦ Hip dysplasia
    ◦ Patellar luxation
    ◦ Elbow dysplasia
   Acquired/Developmental/Other
    ◦ OCD (osteochondritis dessicans)
    ◦ Angular limb deformity
 The   results are the same
 ◦ Chronic pain
 ◦ Chronic lameness
   Animals are usually
    rather stoic and do
    not always show
    outward signs of pain
   Many never cry out.
    ◦ In a pack atmosphere,
      showing outward signs
      of pain shows weakness
      and vulnerability
   Dogs tend to ―Keep
    calm and carry on.‖         ―If it didn’t hurt, he
                               wouldn’t be holding his
                                       foot up.‖
                                               Dr. Burns
   There are only two
    reasons why a patient
    might limp
    ◦ PAIN
    ◦ Structural instability
      Bones or ligaments that
       support the
       musculoskeletal system
       are broken or torn
Gosh
                            darn, this
                              hurts.
                            How am I
                           going to tell
   Unusual or different     the big
    posture                  people?
   Decreased appetite
   Decreased play
   Decreased
    interactiveness
   Becoming withdrawn
   Sleeping a lot more
    than usual
   Irritability/snappy
   Structural instability
What is this here
  thing you call
                       PAIN
 inflammation?         Inflammation
Inflammation


More pain                  Pain




                 More
            inflammation
   NSAIDS= Non-                    Cons
    steroidal anti-                  ◦ Pets must have healthy
    inflammatories                     kidneys and livers to
                                       take these medicines
   Pros
                                     ◦ All senior pets (and
    ◦ Contain no cortisone             some non-senior) must
    ◦ Very decent painkillers          undergo regular blood
      for all types of general         testing in order to use
      pain                             NSAIDS
    ◦ Block the                      ◦ Sometimes cause GI
      inflammation-pain-               upset
      more inflammation –            ◦ Cannot be used with
      more pain cycle                  corticosteroids
                                       (cortisone, prednisone)
   Pros                           Cons
    ◦ Non-drowsy opiate-            ◦ Short half-life means
      like pain killer                dosing three times a
    ◦ Very safe, including            day for best results
      senior dogs and cats          ◦ VERY BAD TASTING
    ◦ Blood work not                  Owners who depend on
      necessary for                    food or treats for
      prescribing these                concealment of pills may
                                       find that pets refuse
    ◦ Can be used at the               them or eat around the
      same time as                     tramadol
      corticosteroids
      (cortisone, prednisone)
   Nutraceuticals are food supplements that
    promote healthy joints
   Nutraceuticals are not all created equal. In
    other words, a cheap one may not work as
    well as a higher end one.
   Generally in a pleasant flavored chewie.
   Most are given once daily.
   Note, these are not medicine and do not kill
    pain. These are vitamins for joint health
   Ingredients vary but usually include
    glucosamine, chondroitin, fish oil
   Gabapentin is a          Cons
    seizure drug but          ◦ Gabapentin is
    used in cases of            formatted for human
    chronic pain has            use, so sometimes
                                we have to get it
    proven very helpful         made to order in
    in pain that is             special smaller mg
    refractory to other         tablets or
    drugs                       suspensions for very
   Convenient one to           small dogs and cats
    two times a day
    dosing
   Adequan is a               Cons
    chondroprotectant           ◦ Expense
    (cartilage protector)       ◦ Necessitates bringing
   Give by injection             pet for injection
                                  every week for a
   Once weekly for               month
    four weeks, then
    every three to four
    weeks as
    maintenance
   Acupuncture
   Cold Therapy Laser
   Physical therapy or
    rehabilitation
    ◦ Underwater treadmill     Wonder
                              where I can
                                 find
                             somebody to
                              do that to
                                 me?
Holistic
                     medicine? Might
                      as well go out
                      in the pasture
 Holistic              and pull a
  ―medicines.‖          handful of
 Recently the       weeds for him.
AVMA has
made a position
statement that
holistic medicines
are not proven to
be safe and
effective
   NSAIDS – carprofen
    (Rimadyl/Novox, meloxicam
    (Metacam), Previcox, Deramaxx
   Tramadol
   Joint Supplements (yummy Phycox soft chews
    are Dr. Burns’ favorite)
   Gabapentin
   Adequan
   Physical Therapy
   Acupuncture
   Cold Therapy Laser
Man, I’m dying
   There have never been       here. What is
    satisfactory safe          wrong with the
                               pharmaceutical
    options for home pain
                                  industry?
    management—either
    long term or short
    term—in cats! While
    we have a few things
    now that we didn’t
    have five or six years
    ago, we still have
    needs that are unfilled.
   Nutraceuticals
   Meloxicam           Cons are many!
   Onsior               ◦ Meloxicam is often used in
                           cats, but it is not FDA-
   Gabapentin             approved for long term use in
   Tramadol               the USA.
                         ◦ Meloxicam requires very
                           healthy kidneys and a good
                           hydration status. Even so, it
                           still can cause kidney failure in
                           some cats
                         ◦ Onsior is only FDA-approved
                           for 3 consecutive days in the
                           USA
                         ◦ Gabapentin and Tramadol
                           have to be compounded
                           (made to order) and are not
                           FDA-approved for cats in the
                           USA
Like I always
                              say, better
                           living through
                              chemistry!
   To make the pet
    have the best
    mobility and quality
    of life that he/she
    can have
   To make good days
    outnumber bad
    days
   Chronic pain is not curable; it
    is a management condition
   It is not reasonable to expect
    your pet with DJD never to
    limp
   Your pet may not be able to do
    the same amount of exercise
    or play that he/she once did
   Like people, there will be good
    days and bad
• People with DJD and chronic pain
  often use mobility devices such as
  walking canes, walkers and
  wheelchairs. Unfortunately, most
  dogs cannot use these.
                             Wonder where
                              I can get a
                             walking cane?
• People with chronic pain have            I’m so
  some days where they are               blessed to
                                        have Rascal
  nearly normal and walk/move             to love!
  pretty well with a cane or
  walker, some days where they
  really feel good…and some
  days when they don’t feel like
  getting out of bed.
• Your dog is           I’m so glad I
                        can still run
the same.                 and play!
                           And that
                           she loves
                             me!!!!
Material is not intended to
be construed as veterinary
  medical advice and not
intended to be a substitute
for examination, diagnosis
 and treatment of your pet
    by your veterinarian.

   Please, visit your vet.
 That’s what they’re there
            for.

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My Dog has Arthritis! Now What?

  • 1. Now What? By Jacquelyn H. Burns, DVM Copyright © Jacquelyn H. Burns All rights reserved
  • 2. Please, visit your vet. That’s what they’re there for.
  • 3. When we veterinarians say osteoarthritis or arthritis, we mean Degenerative Joint Disease or DJD ◦ In dogs and cats, degenerative joint disease means bone, muscle, tendon, ligament and/or joint changes have occurred as a result of joint instability or structural unsoundness ◦ The body attempts to rectify instability by forming extra bone at/around affected joints. ◦ There is also inflammation with a snowball effect that tends to make itself worse over time.
  • 4. Injury ◦ Blunt force trauma (hit by car) ◦ Athletic type injury (―football player‖ injury)  Torn ACL ligaments  Heredity ◦ Hip dysplasia ◦ Patellar luxation ◦ Elbow dysplasia  Acquired/Developmental/Other ◦ OCD (osteochondritis dessicans) ◦ Angular limb deformity
  • 5.  The results are the same ◦ Chronic pain ◦ Chronic lameness
  • 6. Animals are usually rather stoic and do not always show outward signs of pain  Many never cry out. ◦ In a pack atmosphere, showing outward signs of pain shows weakness and vulnerability  Dogs tend to ―Keep calm and carry on.‖ ―If it didn’t hurt, he wouldn’t be holding his foot up.‖ Dr. Burns
  • 7. There are only two reasons why a patient might limp ◦ PAIN ◦ Structural instability  Bones or ligaments that support the musculoskeletal system are broken or torn
  • 8. Gosh darn, this hurts. How am I going to tell  Unusual or different the big posture people?  Decreased appetite  Decreased play  Decreased interactiveness  Becoming withdrawn  Sleeping a lot more than usual  Irritability/snappy
  • 9. Structural instability What is this here thing you call  PAIN inflammation?  Inflammation
  • 10.
  • 11. Inflammation More pain Pain More inflammation
  • 12. NSAIDS= Non-  Cons steroidal anti- ◦ Pets must have healthy inflammatories kidneys and livers to take these medicines  Pros ◦ All senior pets (and ◦ Contain no cortisone some non-senior) must ◦ Very decent painkillers undergo regular blood for all types of general testing in order to use pain NSAIDS ◦ Block the ◦ Sometimes cause GI inflammation-pain- upset more inflammation – ◦ Cannot be used with more pain cycle corticosteroids (cortisone, prednisone)
  • 13. Pros  Cons ◦ Non-drowsy opiate- ◦ Short half-life means like pain killer dosing three times a ◦ Very safe, including day for best results senior dogs and cats ◦ VERY BAD TASTING ◦ Blood work not  Owners who depend on necessary for food or treats for prescribing these concealment of pills may find that pets refuse ◦ Can be used at the them or eat around the same time as tramadol corticosteroids (cortisone, prednisone)
  • 14. Nutraceuticals are food supplements that promote healthy joints  Nutraceuticals are not all created equal. In other words, a cheap one may not work as well as a higher end one.  Generally in a pleasant flavored chewie.  Most are given once daily.  Note, these are not medicine and do not kill pain. These are vitamins for joint health  Ingredients vary but usually include glucosamine, chondroitin, fish oil
  • 15. Gabapentin is a  Cons seizure drug but ◦ Gabapentin is used in cases of formatted for human chronic pain has use, so sometimes we have to get it proven very helpful made to order in in pain that is special smaller mg refractory to other tablets or drugs suspensions for very  Convenient one to small dogs and cats two times a day dosing
  • 16. Adequan is a  Cons chondroprotectant ◦ Expense (cartilage protector) ◦ Necessitates bringing  Give by injection pet for injection every week for a  Once weekly for month four weeks, then every three to four weeks as maintenance
  • 17. Acupuncture  Cold Therapy Laser  Physical therapy or rehabilitation ◦ Underwater treadmill Wonder where I can find somebody to do that to me?
  • 18. Holistic medicine? Might as well go out in the pasture  Holistic and pull a ―medicines.‖ handful of  Recently the weeds for him. AVMA has made a position statement that holistic medicines are not proven to be safe and effective
  • 19. NSAIDS – carprofen (Rimadyl/Novox, meloxicam (Metacam), Previcox, Deramaxx  Tramadol  Joint Supplements (yummy Phycox soft chews are Dr. Burns’ favorite)  Gabapentin  Adequan  Physical Therapy  Acupuncture  Cold Therapy Laser
  • 20. Man, I’m dying  There have never been here. What is satisfactory safe wrong with the pharmaceutical options for home pain industry? management—either long term or short term—in cats! While we have a few things now that we didn’t have five or six years ago, we still have needs that are unfilled.
  • 21. Nutraceuticals  Meloxicam  Cons are many!  Onsior ◦ Meloxicam is often used in cats, but it is not FDA-  Gabapentin approved for long term use in  Tramadol the USA. ◦ Meloxicam requires very healthy kidneys and a good hydration status. Even so, it still can cause kidney failure in some cats ◦ Onsior is only FDA-approved for 3 consecutive days in the USA ◦ Gabapentin and Tramadol have to be compounded (made to order) and are not FDA-approved for cats in the USA
  • 22. Like I always say, better living through chemistry!  To make the pet have the best mobility and quality of life that he/she can have  To make good days outnumber bad days
  • 23. Chronic pain is not curable; it is a management condition  It is not reasonable to expect your pet with DJD never to limp  Your pet may not be able to do the same amount of exercise or play that he/she once did  Like people, there will be good days and bad
  • 24. • People with DJD and chronic pain often use mobility devices such as walking canes, walkers and wheelchairs. Unfortunately, most dogs cannot use these. Wonder where I can get a walking cane?
  • 25. • People with chronic pain have I’m so some days where they are blessed to have Rascal nearly normal and walk/move to love! pretty well with a cane or walker, some days where they really feel good…and some days when they don’t feel like getting out of bed. • Your dog is I’m so glad I can still run the same. and play! And that she loves me!!!!
  • 26. Material is not intended to be construed as veterinary medical advice and not intended to be a substitute for examination, diagnosis and treatment of your pet by your veterinarian. Please, visit your vet. That’s what they’re there for.