Degenerative Joint Disease

Degenerative joint disease or osteoarthritis is among the most common condition affecting pets and can significantly impact a pet’s mobility.  Although arthritis is incurable, identifying the condition early and initiating appropriate management strategies can help keep your pet active and improve their quality of life. 

It’s easier to stay lean than to lose weight.  It’s easier to stay strong than regain muscle mass.  It’s easier to treat acute pain than chronic pain.  Therefore, we need to consider how to diagnosis arthritis earlier and start preventative treatments sooner.

Once arthritis has been diagnosed, either on exam or via radiographs, we must shift our focus from prevention to management.  A multimodal treatment plan can help slow the progression of arthritis and provide years of pain-free mobility.  The appropriate treatment plan must be customized to your pet.  Discussing your pets’ concerns with your veterinarian is the first step in creating a plan to provide long lasting pain free life for your furry friend.

Components of a multi-modal treatment plan may consist of any number of the follow treatments we can offer.

•  Weight management
• Rehabilitation Training
• Omega-3 Supplements
• Joint Supplements
• Anti-inflammatories
• Pain medications
• Regenerative Medicine- Using the natural ability to improve healing
  • Stem Cell Treatments
  • Platelet Rich Plasma injections
  • Pulse Wave Therapy
• Environmental Modifications
  • Non-slip rugs
  • Ramps
  • Help em up harness
• CBD

Obesity is a major cause for joint pain and progression of arthritic changes.  It can be especially hard to lose weight once arthritis sets in as mobility can become limited.  There are special diets that can help facilitate weight loss.  We recommend Purina OM Joint Mobility.  OM Metabolic Response + Joint Mobility has been specially formulated to help dogs lose fat while maintaining muscle. This diet also includes a high level of long-chain omega-3 fatty acids plus glucosamine to help support joint health.  It contains natural fiber to improve satiety.

Purina food can be ordered directly at www.proplanvetdirect.com  

 

The atrophy of muscle is a major reason for progression of arthritic symptoms and a reduction in quality of life.  Our staff have been specially trained in rehabilitation and can help create a plan for you to follow at home or we offer complete rehabilitation training here in hospital.  Exercises may consist of placement exercises, massage, Passive Range of Motion exercises, wobble boards, TENS units, laser therapy and so much more.

 

Omega 3 oils, like Docosahexanoic acid (DHA) and Eicosapentanoic acid (EPA), when fed as a supplement, can lower total body inflammation and help with arthritis.  Fish oils are high in these special fats, but supplements vary wildly in whether they actually contain what the label says, since they are not required to have FDA oversight.  One product we recommend is Welactin.   (Click here to order it from BHVH) This product has been extensively and independently studied and has reliable levels from safe sources.  The dose of fish oil supplement varies greatly though, depending on the system you are treating. So please ask for your veterinarian to recommend a dose.  Please allow 4-6 weeks to see maximum benefit.

 

Dasuquin Advanced

Dasuquin Advanced made by Nutramax, is another supplement that can be beneficial in the treatment and prevention of arthritis.  It provides glucosamine, chondroitin and MSM; which are necessary building blocks for healthy joint fluid.  Healthy joint fluid slows down wear and tear and provides better joint lubrication.  (click here to order from BHVH).  Joint supplements take 4-6 weeks of administration to obtain maximum benefit.  The decision to continue the supplements for the rest of your pet’s life should be directed by whether you observe measurable benefit in comfort and mobility.

 

Adequan

There is an injectable supplement called Adequan that provides an essential nutrient for healthy joint fluid formation called polysulfated glycosaminoglycans.  Many owners have been taught how to give these injections to their dogs at home (they are painless).  It is recommended to start with a dose injected in the hind leg muscle twice a week for three weeks.  If it works well, then we start to extend the time between injections.  An injection once a week for three weeks, then an injection every other week for 6 weeks.  If the symptoms are under control at this level, we would reduce the frequency to once a month.  Many dogs are able to achieve this monthly dose.  The drawback is initial expense.  Depending on your dogs weight, each injection may cost between $40 and $100.  However, many patients see a noticeable improvement in mobility and quality of life on a once a month treatment so it is worth trying.  This would be something our veterinarians could prescribe for your dog, along with the necessary needles, syringes, and training on how to administer the injections.

 

Flexadin

               Flexadin is a unique joint supplement that is specially-formulated to help ease joint discomfort and stiffness by supporting your pet’s healthy immune system, which can play a significant role in reducing the naturally-occurring joint inflammation that can lead to discomfort.  Flexadin contains a blend of undenatured chicken collagen type II (UC-II), omega-3 fatty acids and vitamin E, that help to alleviate inflammation, fight free radicals and maintain healthy cartilage.

 

Once confirmed a patient has arthritis, the standard of care would be to treat inflammation with an anti-inflammatory medication (Motrin for dogs).  Our doctors would recommend starting with Carprofen or Meloxicam daily and see how much benefit the patient receives.  If there is little or no improvement, it’s less likely to simply be age related arthritis.  If it provides significant benefit, then arthritis is likely, and we would taper to the lowest effective dose long term.  To obtain the lowest effective dose, other medications or treatments may be recommended.  Long term use of anti-inflammatories may cause detriment to the liver or kidneys.  Bloodwork should be monitored, prior to starting a medication, after being on the medication for 1 month, and then every 6-12 months while taking the medication. 

 

Oral

               There are many pain relievers that are used in conjunction with other treatments for arthritis to improve quality of life. Most commonly, Gabapentin, Amantadine or Tramadol may be prescribed for your pet.  Weight, health status and personal preference goes into determining the correct pain medication for your pet.

 

Injectable

               Low dose Ketamine administration has shown great benefit in a lot of patients suffering from chronic pain.  Ketamine blocks nerve impulses and is responsible for reducing “wind-up” pain.  This is a specific phenomenon see with chronic arthritis in dogs and cats. 

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Although an expensive treatment, Stem Cell Therapy is a natural treatment that has shown great benefit in our severely arthritic patients.  Treatment requires one general anesthesia procedure to harvest abdominal fat from which stem cells are obtained.  The patient’s fat tissue is sent to the laboratory (VETSTEM)  where stem cells are separated from the fat, purified and concentrated, placed in sterile syringes and shipped back to the hospital the next day.  The affected joints receive the stem cell injections while the patient is under sedation.  Up to 6 joints can be treated at one time.  Peak benefit may take up to 2-3 months to be realized, but are expected to last for 12-36 months.  Over 90% of patients have shown some improvement and 80% have experienced dramatic improvement in both comfort and mobility.  Treatment can be repeated as necessary from stem cells that are saved after the initial retrieval.   Initial costs range between $4000 and $5000 at our hospital. 

 Human use of PRP is starting to be very popular as a natural treatment for joint disease, following the lead of veterinary research in this case!  Platelets are the blood cells that form blood clots and initiate healing.  They are filled with little packets of stimulators for stem cells to reduce inflammation and provide healing.  A patient’s own blood is drawn, the platelets are concentrated and then injected into the painful joint.  The presence of PRP cells stop inflammation and stimulate stem cells to begin the actual healing process.  This is also something not every veterinarian does.  The BHVH is proud to have multiple veterinarians who have received advanced training to allow us to provide this service.  It costs around $950 per treatment at our hospital and does require sedation.  An additional benefit of PRP is that up to 4 individual joints can be treated at one time.  Benefits of treatment are expected to last between 6-12 months and can be repeated as needed.

 

Pulse Wave treatment.  This modality sends high energy ultrasound deep into the tissues providing energy that stimulates stem cells to reproduce and start healing damaged tissue.  It can be painful to administer so sedation and narcotic pain relief are required during the treatment.  Treatments are performed once every three weeks for three treatments.  This is an FDA approved treatment for humans with many research studies showing its benefits.  Many patients have experienced excellent results and almost every one has derived some benefit.  However, not all veterinarians are familiar with this modality or have the equipment and training to provide it to your pet.  Here at the BHVH each treatment costs around $450- $500.

Librela is an injectable drug containing anti-NGF monoclonal antibody given once a month. It is a key osteoarthritis pain mediator which helps in reducing a dog's arthritis pain. This injection is metabolized and eliminated in the body like naturally occuring antibodies which minimalizes kidney or liver involvement, making it safer for your pets.

Librela is also proven and positively safe. Since it functions like naturally occuring antibodies in your pet's body, the study shows that there are no known interactions with medications, including parasiticides, antibiotics, and vaccines. It is also well-tolerated in healthy dogs when co-administered with Rimadyl for 14 days. 

 

A final supplement to consider is CBD oil.  There are many testimonials to the benefit of CBD, however the true academic studies are still lacking.  It is used as a pain reliever but it is not an anti-inflammatory.  Therefore, it is usually given with either Carprofen or Welactin or both.  It is important to note that CBD is not a benign supplement as it can interfere with the bodies metabolism of other drugs and supplements.  Pets should not be started on CBD without consulting your veterinarian first. 

If CBD is recommended for your pet, we recommend you obtain a product made by Ellevet.com.  This company, like Nutramax, provides the data on their products to show that they are pure, and the ingredients that are on the label are actually present in the product.  They have partnered with Cornell University to conduct research to support their claims of efficacy.  CBD oil only takes a few days to build up therapeutic levels that may improve comfort.

 

If you have more questions about these treatments or would like to see if your pet is a proper candidate for any of these treatments, please give a call to the Burnt Hills Veterinary Hospital, (518) 399-5213