Options for Arthritis in Dogs: Not another article about drugs by Shelley R. Epstein, VMD, CVH

First, could your dog have arthritis? Arthritis can affect dogs of any age. This condition develops typically when the bones of a joint don’t move normally. The smooth lining of the joint, known as the cartilage, starts to wear down, and this is painful. Over time- weeks, months, and years- the body responds by forming new bone that looks like bone spurs on X-rays. The joints may swell, and the nice sticky joint fluid, or synovial fluid, becomes thin and watery, losing its ability to lubricate the joints. The most common locations for arthritis are the knees, hips, and elbows, with the wrists (carpi) and hocks (tarsi) less commonly affected.

Arthritis can develop in the knees secondary to a condition known as “luxating patellas,” which is fancy terminology for the knee cap moving around in the wrong direction- side to side, versus up and down in its designated groove. This condition affects mostly small dogs. People often report that their dog “skips” when on walks- that’s actually the kneecap locking in the wrong position, then moving back into its correct position. 

Arthritis can also develop in the knees after an “ACL” tear. This is a torn ligament in the knee, and it results in the knee being unable to move in its normal hinge motion. The result is the abnormal wear in the cartilage. Even dogs that have had surgical repair of torn ACLs will develop some degree of arthritis in that knee. This can be severe, too. The dog may persistently limp or act stiff in that leg. We see a lot of this condition in Pit Bulls and Labs, especially.

Larger breeds can develop arthritis in the hips secondary to poor formation of the hips known as hip dysplasia. German Shepherds, Labs, Golden Retrievers, and Rottweilers commonly suffer from this condition, but it can affect any breed. These dogs are slow to rise from lying down, especially after they’ve been lying for a while. Slippery surfaces are particularly difficult for them.

The veterinary pharmaceutical companies have been particularly effective in marketing drug answers for arthritis. The pain is gone within hours and the dogs can run through beautiful fields of grass. At WAH, we reserve these drugs for our cases that don’t respond to any other therapies. Why? It turns out that all of these drugs can have side effects, including potentially fatal ones. If your dog is placed on one of these drugs, it would have to have bloodwork testing every 3 months to make sure the liver and kidneys are still happy. And you would need to keep a very close eye on the stools to make sure there is no evidence of bleeding from the stomach or intestines. (The stools would look dark and tarry, signaling digested blood.)

What are the kinder therapies that we recommend at WAH?

The simplest therapies are joint supplements containing GAGs, which is short for glycosaminoglycans, and which is why we like to shorten that to GAGs. You’ve probably heard of glucosamine and chondroitin. These are GAGs. The green-lipped mussel is also a natural source of GAGs, and VetriScience makes a wonderful supplement from this called Glycoflex Classic. Most dogs find relief and an increase in joint function on this supplement. Some dogs, in more advanced stages of arthritis, require even more joint support, and VetriScience makes levels 1, 2, and 3 for these dogs. By the time you get to the Glycoflex 3, they’ve thrown in just about every nutritional supplement known to help joints, and it seems to work.

For the past year, we’ve also been using Trixsyn, which is a joint supplement made from hyaluronic acid, or “HA,” that is actually made by bacteria. HA is the substance that bathes the joints. This particular supplement, when taken orally, has been shown in studies to go directly to the joints. It seems to work well when Glycoflex doesn’t. This supplement is in an almost-tasteless thick liquid form.

Ozzie: Read his story:http://wilmingtonanimalhospital.com/site/view/143142_OzziesLaserTestimonial.pml

For the past 3 years, we’ve been offering laser therapy.  We use a Class IV laser, which is the most effective in treating arthritis. The dogs just hang out with the owners while a tech runs a probe over and around the affected joint(s). Depending on the size of the dog, this takes anywhere from 4 minutes (one knee in a small dog) to 16 minutes (2 hips in a large dog). While the laser is stimulating all the good inflammation and squelching the bad inflammation, while the cartilage is being stimulated to heal, and while the nerve pain is going away, the dog’s happy hormones known as endorphins start to flow, making this a great experience all around. The results have been AMAZING.  For more information, visit: http://wilmingtonanimalhospital.com/site/view/137905_ClassIVLaserTherapy.pml

Acupuncture is another therapy that we have found to be very effective in treating arthritis and the rest of the dog that is sporting the bad joints. We have two veterinarians on staff, Drs. Green and Hanna, who are trained in acupuncture. This usually requires a series of 4 weekly treatments. For more information on acupuncture, visit: http://wilmingtonanimalhospital.com/services_acupuncture.php

Steve Fries, DC, has been our right arm for many years now. He’s a chiropractor who’s trained for over 1000 hours in animal chiropractic, and who devotes most of his practice to animals. He’s been coming to WAH to adjust our patients for over 10 years.  Most dogs with arthritis develop misalignments (known as subluxations) in their spines secondary to shifting the weight unequally. Some throw out their backs at the time of the trauma that resulted in the ACL tear, for example. Dr. Fries has been absolutely indispensible in our anti-arthritis drive. By realigning the spines and working on the arthritic joints, he’s restored the quality of life to hundreds of our patients. Here’s more on Dr. Fries: http://wilmingtonanimalhospital.com/veterinarians.php

And finally, the diet. Many dogs find relief from converting to a raw or home-cooked diet. It seems that the less the food is processed, the more anti-inflammatory it is for the dog. We’ll talk about diets for dogs in a later blog. For now, you can visit:http://wilmingtonanimalhospital.com/info_nutrition.php

Inaugural Blog: The Raw Facts on Feeding Your Cat by Shelley R. Epstein, VMD, CVH

Raw diets for cats? When it comes to feeding cats, Ben Franklin had it right: “An ounce of prevention is worth a pound of cure.”   In my estimation, the number one cause of problems in cats is an inappropriate diet…and conversely, the easiest way to reverse many problems is to convert cats to a more species-appropriate, a.k.a. raw diet.

If you’ve seen me in the office with your cat, you know I just about stand on my head to get you to feed high quality diets. Cats need to eat high protein, grain-free diets, with high quality, easily digestible ingredients. This just about rules out most of the commercial cat foods out there. Sorry.

Think of their wild diets: mice, moles, birds… Now think of the typical dry pet food: Meat-by-products, corn/wheat/rice, soy protein, and a host of added single nutrients to make up for the deficits that cooking this food to high temperatures causes. And while the mouse is 80% water, the dry food is only 10% water- way too dehydrated for a creature that derives most of its fluids from its diet.

Canned food is a little bit better: 80-90% water.  Since it doesn’t have to stick together in neat little pellets, it doesn’t have to have as much grain added to it. But it’s still cooked, and still tends to have its share of fillers and added nutrients to compensate for those that are destroyed from the cooking stage.

And then there’s the concern about how meats are altered in the cooking process. This alteration may actually change the proteins so that the carnivorous cat’s system recognizes these proteins as foreign, as shown in one study.[i] In my observation, this is one reason for the rise in inflammatory bowel disease (IBD) that results in vomiting and/or diarrhea that we see in cats. Many of my patients with this problem have normalized with a combination of change to a raw diet plus homeopathic prescribing.

What are some other problems that can be prevented with proper diet? The big ones include diabetes- these cats always seem to be eating dry, grain-containing diets and become overweight; obesity- cats don’t use carbs for an energy source so they convert dietary carbs to fat; protein malnutrition- yes, even obese cats can have skinny toplines thanks to the high carbs and relatively low protein content of their ingested calories; hairballs; greasy haircoats and lack of grooming; low energy couch potato syndrome; periodontal disease (Have you looked in your cat’s mouth lately?); and a host of other problems.

What diets do we recommend? Again, if you’ve seen me in the office, you know what’s coming. I really love raw diets for cats. It’s tough to beat a raw diet when it comes to the proper form of nutrients.  The good news is that there are many companies making these diets commercially, so besides taking the time to visit some of the more upscale pet stores to purchases these, (shout out to Concord Pet Supply, GiggyBytes in Glen Mills, Four Paws in Media, and Good News Natural Foods in Dover and Milford- if I missed your store in the DE/PA region, feel free to Facebook Wilmington Animal Hospital to get in your free plug!), the major challenge is converting your cat to this better diet.

Let’s briefly touch upon converting your cat to raw foods. If your cat is already eating canned food, you’re halfway there. Simply defrost a small portion of the raw food in the refrigerator, and for each canned food meal, hide a ‘pinch’ of the raw. Note that the defrosted raw will start to smell raunchy after 24 hours, so you might want to refreeze it and defrost a second portion during this conversion process. Just keep alternating those two defrost-refreeze-defrost portions.

After a few days of sneaking in that pinch of raw, start sneaking in two pinches for a few days. You get the idea- it’s a very gradual, underhanded process, aimed at deceiving your cat’s highly selective (and addicted) nose and tastebuds. After a while, you’ll find you can totally eliminate the canned food.

The greater challenge is converting from dry to raw. I will defer this explanation to my colleague Dr. Lisa Pierson, who has the excellent website catinfo.org.  She has a section devoted to “Transitioning Dry Food Addicts to Canned Food.” From canned, you can convert to raw as above.

What about the safety of raw diets? Yes, it’s true that if a cat eats food laden with Salmonella, for example, the bacteria may pass in its stool. But it is EXTREMELY rare for a healthy cat to become infected with Salmonella. So rare that it is really not an issue. It is FAR MORE COMMON for cats to become diabetic eating commercial dry diets!

What about the transmission of Salmonella and E. coli and other bad guys to the humans in the house? First of all, if we’re talking bad bacteria in the litter box, I’m going to assume that you wash your hands thoroughly after cleaning the box. If we’re talking direct transmission from cat to human, this would theoretically be a concern if the cat ate the contaminated raw food and then licked the human in the mouth… and the human was immunocompromised, very young, or very old. You can see the odds are very slim.

But get this: Many of these commercial diets have a LOWER risk of spreading Salmonella and E. coli than the foods you eat! Why? First of all, there are laws mandating that food is safe. Here’s a quote from the FDA Center for Veterinary Medicine’s “Manufacture and Labeling of Raw Meat Foods for Companion and Captive Noncompanion Carnivores and Ominivores” guidance document:

It is unlawful to introduce into interstate commerce any food, including food for pets and for other animals, which is adulterated (Section 301(a) of the FFDCA). Among the circumstances in which a food will be deemed adulterated are when: (a) it contains any poisonous or deleterious substance that may render it injurious to health.[ii]

The document goes on to say that Salmonella and E. coli fall under this category.

 Manufacturers like Nature’s Variety use a high pressure pasteurization to kill the pathogens, and they also test their batches for the bad guys.[iii] Bravo! tests each batch before sending it to market.[iv] (I asked the owner, Bette Schubert, what they do with contaminated batches. She told me they send it to a wolf sanctuary.) Compare this to the chicken you buy in the supermarket which has a 30% chance of hosting Salmonella! So the odds of your bringing bad guys into your house are actually greater with your food than with your cat’s commercial raw food! (You should inquire with each company about their testing.)

And one more note about contamination in pet foods. There are many documented outbreaks of Salmonella and E. coli in humans exposed to commercial dry and canned pet foods. These are NOT sterile diets! Most of the infected are the very young.[v]

Finally, what alternatives do you have if 1. You’ve tried and tried and your cat won’t eat raw food or 2. You simply will not feed raw food to your cat?

Again, let me emphasize that raw is the best, in my opinion. But many cats will do well on grain-free canned diets. More and more companies are producing these. As of this date, we have the most experience with Wellness CORE and Instinct brands, and the cats look good on these. Would you consider feeding one meal a day from a can and the other as a raw meal? (I never quit.)

References:

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[i] Cave NJ, Marks SL. Evaluation of the immunogenicity of dietary proteins in cats and the influence of the canning process. Am J Vet Res 2004;65(10):1427-33.

[ii]http://www.fda.gov/animalveterinary/products/animalfoodfeeds/petfood/default.htm Last visited October 9, 2011.

[iii] http://www.naturesvariety.com/learning/raw/quality. Last visited October 9, 2011.

[iv] http://www.bravorawdiet.com/qualityassurance.html. Last visited October 9, 2011.

[v] Behravesh, MS, Ferraro A, et al. Human Salmonella infections inked to contaminated dry dog and cat food, 2006-2008. Pediatrics 2009-3273. http://pediatrics.aappublications.org/content/early/2010/08/09/peds.2009-3273 Last visited September 11, 2011.