Exercise is a very important part of treating pets with arthritis. Exercise helps maintain muscle strength and increases comfort and flexibility of the joints.  Exercise also aids in weight loss, another important aspect of managing arthritis.  Exercising the arthritic pet can be very challenging because they are already in pain to some degree.  Therefore we recommend specific ways of exercising your pet.

First, before you start any exercises, help your pet “warm up” by applying warm compresses to the affected joint(s).  This can be achieved by using a warm wash cloth or towel and holding it in place for a minute or two.  During this warm up period, passive range of motion exercises should be performed for an additional five minutes to help relax the joints and promote blood flow to the muscles.  Start at the foot and work your way up the leg, gently flexing and extending each joint.  It is important not to go further than your pet will comfortably allow.  Passive range of motion exercises should be done for 10-15 repetitions two to three times per day.  The following video demonstrates these exercises on the rear leg.

Once your pet has had an adequate warm up period, then you can start the actual exercises.  For our arthritic pets, we recommend to start off slow.  Over time, we want to work our way up to longer duration of exercise.  Slow, controlled leash walks are a very good exercise to begin with.  Try to avoid any sudden spurts of speed or high impact exercises.  Initially start out with 5 to 10 minute controlled leash walks.  Your pet may only be able to walk for 2 to 3 minutes at a time, but that is ok.  As your pet gets more comfortable and stronger, increase the duration of the leash walks every other week.

Other types of exercises that are very effective include swimming, stairs, and sit and stand exercises.  Walking on different types of surfaces, such as sand, soft soil, or on inclines also helps increase muscle strength.  Start out with low repetitions for each exercise, and perform these twice daily initially.  As your pet gains strength and comfort, slowly increase the number of repetitions performed each time.

Finally, a “cool down” period of stretching helps keep your pets limber and more comfortable.  This can be accomplished by doing the passive range of motion exercises.  Flex or extend the joint to the point when your pet starts to show very mild discomfort, and then hold the joint in that position for 5 to 10 seconds.  When the stretching is finished, apply an ice pack to any sore joint.  If your pet is excessively stiff or sore the following day, then decrease either the duration of the exercise or the number of repetitions.  Exercise should never be performed to the extent that it is painful to your pet.

Although some pets can be kept comfortable without using traditional pain medication, many pets with arthritis need medications to keep them comfortable.  Here is a brief discussion of the different pain medications that we may recommend using in your pet.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are the mainstay of treatment for arthritis pain.  NSAIDs block enzymes within your pet that are responsible for creating inflammation.  Blocking these enzymes results in decreased inflammation and pain.  There are currently 6 approved NSAIDs for use in dogs.  The ones we use commonly are Metacam^® (meloxicam), Deramaxx^® (deracoxib), and Previcox^® (firocoxib).  Prior to starting your pet on an NSAID, we recommend bloodwork to establish baseline liver and kidney values.  Bloodwork is then repeated 2 weeks later, and every 6 months thereafter.  The most common side effect of NSAIDs is gastrointestinal upset.  NSAIDs should never be given with prednisone or over the counter pain relievers.  Many human OTC pain relievers are toxic to pets.

Tramadol

Tramadol is an opioid-like medication that is used in the treatment of arthritis pain.  It is used 2 to 4 times per day.  It is safe to use with other medications, and is often used in combination with an NSAID.  Sedation is the most common side effect that is reported.

Amantadine

Amantadine is an anti-viral medication that is also useful in the treatment of “wind up” pain.  “Wind up” occurs when there is chronic pain present.  The receptors are then hyperactive, causing exacerbation of the pain response even in mild pain.  Amantadine resets these receptors, allowing the other medications and supplements to achieve greater pain relief.  Amantadine is used in pets that have been in chronic pain, or very severe acute pain.

Gabapentin

Gabapentin was originally used as an anticonvulsant medication.  We do not currently know its mechanism of action, but it has been used for neuropathic pain (pain related to damaged nerves) with good results.  Clinical experience among veterinarians suggests that it is effective for arthritis pain as well.

Adequan^® Canine is the only FDA approved disease modifying osteoarthritis drug available.  It has been clinically proven to be safe and effective.  Adequan^®Canine contains an injectable glycosaminoglycan.  Glycosaminoglycans are components of many types of connective tissue, including cartilage.  These not only help prevent the breakdown of cartilage within your pet’s joints, but can actually help repair small defects in the cartilage as well.  First, it binds to damaged cartilage to stop further damage from occurring.  Second, it decreases the activity of enzymes that break down cartilage.  Third, it stimulates the cells within the cartilage and joint lining to start producing more connective tissue and hyaluronic acid, an important lubricant in the joint.  All of this adds up to a more comfortable pet.

Adequan^®Canine is given as intramuscular (IM) injections twice a week for four weeks.  After this initial treatment period, we recommend to repeat injections every 30 to 60 days as needed.  Your dog will typically start to show signs of increased pain or lameness, letting you know that it is time for another injection.  If your dog is painful on day 30, then we recommend injections every 27 or 28 days.  Call or email us if you would like more information, or to schedule your dog’s first injection.  Together we can work towards keeping your pet as comfortable as possible!

Pain in pets is a subject that is very important to pet owners and to us as their veterinarians.  Pain affects your pet’s quality of life and overall well being.  Osteoarthritis (arthritis) is the most common cause of pain that we see in our pets.  Arthritis is caused by damage to the cartilage in joints, exposing bone to further damage.  Inflammation then occurs and damage to cartilage and bone progresses.  Other conditions, such as hip dysplasia, cause instability in joints.  The body then builds more bone in an effort to stabilize them.  This new bone rubs on cartilage and bone that is already present, resulting in pain and inflammation.  Physical examination gives us indications that arthritis may be present; however, radiographs (x-rays) are the only way to definitively diagnose arthritis.

Pets with arthritis may show signs as subtle as being stiff in the mornings, or being slow to rise.  However, their pain can be severe enough to be debilitating as well.  Other common signs of pain are limping (even if mild), aggression, painful when touched, withdrawal from family members or normal activity, and inappetance.  Fortunately, several treatment options are available for pain control and keeping your best friend comfortable.  Although medications may be needed, there are several non-drug therapies as well.  The best treatment often involves a combination of the following methods.

No pet should have to suffer from pain.  As members of the International Veterinary Academy of Pain Management, our goal is to keep your pet as happy and as pain free as possible.

If your pet is overweight or obese and is suffering from arthritis, weight loss is a must.  Many pets will be much more comfortable simply by losing a few pounds.  Often times all that is required is to decrease how much you feed your pet by 25 percent.  Decreasing the number treats and table food that is given is important as well.  Some pets will do better on a prescription diet that restricts the number of calories.  A reasonable goal for weight loss is 3% of body weight per month.  We recommend visiting the hospital to weight your pet at least once per month.  This allows us to track the progress and see how you and your pet are doing.  If your pet is not achieving its weight goals, we may discuss Slentrol^® with you.  Slentrol^® is the first FDA approved prescription medication to manage obesity in dogs. It is a once daily medication that decreases your dog’s appetite and inhibits fat absorption.  These two mechanisms result in a dependable, steady weight loss for your dog.

Another aspect of nutrition for a dog with arthritis is Hill’s^® Prescription Diet^® j/d^TM.  This diet has high levels of omega-3 fatty acids, and has been proven to decrease pain associated with arthritis.  More information about this diet can be found here.  We have seen excellent results with this diet.

Glucosamine

Glucosamine, an amino sugar derived from shellfish, is a precursor to glycosaminoglycans, the building blocks of cartilage.  Many glucosamine supplements often include chondroitin and/or MSM as well.  These compounds have been shown to protect cartilage and decrease inflammation within the joints.  They are more effective when used as a preventative than as a treatment, but they can help in pets that already have arthritis as well.  All pets that are prone to developing arthritis should be on a glucosamine supplement.  Large breed dogs should be started on a glucosamine supplement at one year of age.

Elk Velvet Antler

Elk velvet antler is an all natural supplement collected from the antlers of elk during the velvet stage of growth.  Studies have shown that elk velvet antler decreases pain associated with arthritis and is myotropic, meaning it will help prevent muscle atrophy.  These studies also showed that when given twice daily, elk velvet antler can actually facilitate muscle gain.  It is available from www.elkantlers.com, www.canevashop.ca, or locally at the Brookside Barkery and Bath, and comes in a powder or capsule form.

Microlactin^TM

Microlactin^TM is a protein derived from milk from hyperimmunized cows.  Studies have shown that it blocks the inflammatory response, which decreases pain and inflammation associated with chronic arthritis.  It is safe for dogs and cats, and in some pets it can actually decrease the amount of other medications that are needed.  It does not inhibit the COX enzyme pathways, so it is safe to use in conjunction with NSAIDs.  Duralactin^® is the brand name for the veterinary product.  Duralactin^® is only available through your veterinarian, so contact us if you are interested in this product for your pet!

Hyaluronic Acid

Hyaluronic acid (HA) is another glycosaminoglycan found in high concentrations in synovial (joint) fluid and cartilage.  It has been shown that the concentration of HA decreases in the joint when arthritis is present.  When it is present in the joint, it lubricates and cushions the joint, even when arthritis is present.  There is good evidence in people that high molecular weight HA is absorbed through the GI tract and provides good lubrication within the knee.  The  two products that provide high molecular weight HA as an oral supplement are Hyaflex ^TM and Lubrisyn ^TM.  Clinical impressions of veterinarians that are using these products suggest that they can be another option for controlling arthritis pain.  These are available through their websites.  Brookside Barkery and Bath also carries Hyaflex ^TM.