arthritis in dogs

RE: arthritis in dogs

Beats — Wed, 10 Oct 2018 22:16:09 GMT

[quote user="Anthony Todd"]I wonder if adding very low dose pred to the newer ones might have the same effect[/quote]

Nothing magic about PLT.

Just add some pred to your nsaid of choice

I don't personally think there are significantly more adverse effects to a 30kg labrador on a 30kg dose of metacam to those on a 30kg dose of metacam and 5mg pred, but I warn of the theoretical concerns and unknown. Nice thing about metacam is you can play about with your dose also - nothing to stop you mixing a 25kg dose of metacam with a 5mg pred instead if you wish.

(I go with 0.125-0.2mg/kg pred once daily alongside NSAID's when using as additional drug for bad joints in first instance, higher dose range more likely to reduce NSAID dose a bit)

[oddly, I do remember associating dogs on chronic PLT's with more adverse effects in an early job I had; one in particular with pyothorax springs to mind; might be cognitive bias, or if real might be that this was drug of choice for "spondylosis" and used for years quite often while I tend to add preds to an NSAID quite late on in lifespan in comparison I suspect]

RE: arthritis in dogs

David Mills — Wed, 10 Oct 2018 21:50:48 GMT

N=1

My mother's old lab was on 150mg (4mgkg) carprofen and 5mg pred for years. The pred addition really helped, very much new lease of life. No adverse effects noted, though like most labs pretty bomb proof.

RE: arthritis in dogs

Virginia Campbell — Wed, 10 Oct 2018 21:15:14 GMT

[quote user="Anthony Todd"]I wonder if adding very low dose pred to the newer ones might have the same effect and be cheaper, particularly if you used generic pred......??[/quote]

Interesting thought. I have had a few old arthritic dogs on NSAIDs and low dose pred: one insulinoma that was already on the NSAIDs at diagnosis, and a couple of lifelong chronic skin dogs who we had never been able to wean off pred completely, who became arthritic enough for me to chance the NSAIDs. All did well. I think the response to NSAIDs and also to pred - both positive and negative effects - are a really individual thing, much more "individual dependent" than dose dependent, or at least the beneficial/deleterious dose is very individual dependent.

RE: arthritis in dogs

rhmrcvs — Tue, 09 Oct 2018 18:55:18 GMT

[quote user="Lucy Fleming"]

Laser: no (partly because I'm not aware of anywhere locally offering it, partly because not convinced there is much evidence)

Hydrotherapy: yes, if the owners are keen. Our local hydro unit is ok, but only that. The hydrotherapist has their own opinions about long term nsaid use which don't mesh that well with mine! For specific injury/ post op rehab I prefer one that works closely with an APCAT physio.

Physiotherapy - I always advise but don't have that much take up! Definitely under-used in my opinion.

With exercise I tend to operate on the use it or lose it principle and like them to do as much as they can manage. Sometimes suggest alteration in exercise pattern (shorter more frequent walks rather than massive hikes on the weekend, reduced higher impact things like sprinting/stopping) but not really restriction specifically.

[/quote]which vet school did the " hydrotherapist" go to ?????

RE: arthritis in dogs

Martin Atkinson — Fri, 05 Oct 2018 17:15:36 GMT

[quote user="Anthony Todd"]PLT, because of .or in spite of, the small amount of pred was remarkably effective if others had failed, and used to be very cheap; not any more I fear.[/quote]I have a dog on preds because it has AHIA. It was previously on NSAIDs for OA but of course the 'roids have been controlling that well. The owner has said now we're titrating the dose down he's getting stiff again and asked if she could put him back on NSAIDs. It occurred to me that if it is back in stock PLT would be a useful drug for this case especially as he may have to stay on low dose preds indefinitely.

RE: arthritis in dogs

Anthony Dennison — Fri, 05 Oct 2018 16:12:54 GMT

[quote user="Lucy Fleming"]

[quote user="Robin Grimmer"]Watched a recent webinar with Sarah Caney on this very subject. Studies show that cats with stable ckd are fine on meloxicam, and in some cases their renal function has actually improved.[/quote] I would love to see this information being more widely utilised!

[/quote]

There's an ISFM study which showed the safety and efficacy of long term meloxicam in cats with CKD, don't think it's free to access though. They used doses of 0.01-0.03mg/kg

RE: arthritis in dogs

Lucy Fleming — Fri, 05 Oct 2018 15:59:55 GMT

RE: arthritis in dogs

Robin Grimmer — Fri, 05 Oct 2018 15:57:59 GMT

[quote user="Lucy Fleming"]

[quote user="Robin Grimmer"] Renal and hepatic damage are much rarer. This also applies to cats.[/quote] I have a small number of cats under my care with stable CKD and OA being managed with meloxicam (I have another on long term gabapentin. he does have CKD, but it's actually the suspect inflammatory bowel disease that is currently precluding metacam use...)

[/quote]

Watched a recent webinar with Sarah Caney on this very subject. Studies show that cats with stable ckd are fine on meloxicam, and in some cases their renal function has actually improved.

RE: arthritis in dogs

Lucy Fleming — Fri, 05 Oct 2018 15:49:57 GMT

RE: arthritis in dogs

Robin Grimmer — Fri, 05 Oct 2018 15:07:01 GMT

Agree. There is often a bit of reluctance to use nsaids effectively, often resistance from owners but sometimes vets as well. The commonest side effects are gastrointestinal, ie vomiting and diarrhoea. Renal and hepatic damage are much rarer. This also applies to cats. If an animal needs an nsaid, then it should be on it daily. However, the daily dosage can often be reduced to the lowest effective dose.

RE: arthritis in dogs

Lucy Fleming — Fri, 05 Oct 2018 14:43:39 GMT

[quote user="Julie Innes"]I have a friend who runs a rehabilitation centre, and I have been pleasantly surprised by the results I've seen in animals I've referred there. She offers hydrotherapy, underwater treadmill and laser therapy among other modalities. I'm happier referring to her (a vet) than to random physios who seem to have cropped up who I have never heard of.[/quote]

We're lucky enough to have a physio near us who is also a vet, and agree the combination is great! There are some other good APCAT physios in the area, who are great at feeding back to us and ensuring continuity of care.

[quote user="Julie Innes"]She said that being in pain makes your movements different and can end up with you causing more damage due to altered posture[/quote] So true! I once had a client reluctant to use nsaid but happy to be referred for physio. Promptly received a request from the physio to prescribe some nsaid to the patient as their discomfort was making it very difficult for them to perform any exercises! Muscle release itself can also be quite uncomfortable.[quote user="Anthony Todd"]Dog was fine after one or two [expensive] tablets and has been on and off so owner gives tabs when dog is lame, and not as a course which seems very effective.[/quote] I think this certainly can be the case with some early cases, or specific problems such as elbow arthritis being aggravated by excessive high impact exercise. However, in many cases I think owners don't perceive chronic low grade pain well - I think of the obvious limp as the tip of the iceberg, but the chronic pain remains below the waterline - and most do better on long term daily dosing (sometimes at a slightly reduced dose) to reduce wind up etc. Rather embarrassing to admit that the same was true of me and my own dog who has had severe arthritis in one hock for as long as I have had her (vehicle trauma at about 15 months of age) who I used to dose when she was "painful" - since switching to daily dosing she is much more mobile and use of the affected limb is noticeably improved. So depends on the condition and owner I guess, but I tend to advise against in most cases, especially where more advanced disease present

RE: arthritis in dogs

Thomas Johnson — Fri, 05 Oct 2018 08:39:41 GMT

[quote user="Robin Grimmer"]

Surely the newer generation of nsaids are more effective than PLT was?

[/quote]

I think it is as effective as most of the newer NSAIDs, it's often dismissed as old fashioned and while it would rarely be my first line medication for a dog with arthritis I think it is still a very useful drug.

RE: arthritis in dogs

Anthony Todd — Thu, 04 Oct 2018 11:20:27 GMT

[quote user="Robin Grimmer"]

Surely the newer generation of nsaids are more effective than PLT was?

[/quote]

You'd think so, for sure, but I'd see patients "not getting much better etc." on Metacam, and the response to PLT was dramatic and positive; also PLT, BITD, was so much cheaper.

Can't comment on the newer ones.

I wonder if adding very low dose pred to the newer ones might have the same effect and be cheaper, particularly if you used generic pred......??

The other odd thing with my neighbours dog which I walk with is that he was put on one of the newer ones as a course.

Dog was fine after one or two [expensive] tablets and has been on and off so owner gives tabs when dog is lame, and not as a course which seems very effective. [as it is with my recurrent back pain]

RE: arthritis in dogs

Julie Innes — Thu, 04 Oct 2018 08:45:47 GMT

I have a friend who runs a rehabilitation centre, and I have been pleasantly surprised by the results I've seen in animals I've referred there. She offers hydrotherapy, underwater treadmill and laser therapy among other modalities. I'm happier referring to her (a vet) than to random physios who seem to have cropped up who I have never heard of.

Yes yes to weight loss, although it isn't always an easy sell, despite being FOC!! I tell people of the spaniel with chronic elbows that was referred to a specialist. £2K and lots of CT scans later it came back with....a bag of obesity control! (which sorted it!)

And yes to NSAIDs. I used to be reluctant to take pain meds for my back, but when I proudly told this to my physio she told me I was an idiot! She said that being in pain makes your movements different and can end up with you causing more damage due to altered posture (she was right, my knee issues only settled down when I sorted my back!) I always say to folk that it is very difficult to assess pain, especially chronic pain, in animals, so it's well worth a trial of NSAIDs, just to see, and they are often surprised at how much happier their animal is

RE: arthritis in dogs

Robin Grimmer — Thu, 04 Oct 2018 07:58:17 GMT

Surely the newer generation of nsaids are more effective than PLT was?

RE: arthritis in dogs

Anthony Todd — Thu, 04 Oct 2018 04:23:00 GMT

[quote user="Anthony Todd"]

PLT, because of .or in spite of, the small amount of pred was remarkably effective if others had failed, and used to be very cheap; not any more I fear.

Ofcourse a jab of the dreaded 'roids always gave a remarkable improvement overnight.

[/quote]

A thinly disguised anonymous disgreement, without any justification, does no credit to an experienced practicioner, not does it advance EBVM, which should be the aim.

RE: arthritis in dogs

Clare Tapsfield-Wright — Wed, 03 Oct 2018 18:51:57 GMT

[quote user="Thomas Johnson"]

[quote user="Anthony Todd"]PLT, because of .or in spite of, the small amount of pred was remarkably effective if others had failed, and used to be very cheap; not any more I fear.[/quote]

Unfortunately still unavailable at the moment, I regularly hear rumours of their return and will be very pleased when they do, and if they could be sold in smaller quantities than 1,000 that would be a big bonus!

[/quote] when I’m even older I want PLTs and lots of red wine or rhubarb gin

RE: arthritis in dogs

Thomas Johnson — Wed, 03 Oct 2018 17:09:16 GMT

[quote user="Anthony Todd"]PLT, because of .or in spite of, the small amount of pred was remarkably effective if others had failed, and used to be very cheap; not any more I fear.[/quote]

RE: arthritis in dogs

Anthony Todd — Wed, 03 Oct 2018 13:06:25 GMT

PLT, because of .or in spite of, the small amount of pred was remarkably effective if others had failed, and used to be very cheap; not any more I fear.

Ofcourse a jab of the dreaded 'roids always gave a remarkable improvement overnight.

RE: arthritis in dogs

Clare Tapsfield-Wright — Tue, 02 Oct 2018 19:24:35 GMT

Having had numerous arthritic elderly labs and retrievers I agree with David weight loss is crucial. Then there are loads of things clients can do themselves which helps and also makes them feel empowered with forming out a lot of money.

NSAIDS to relieve discomfort followed up by gentle exercise on soft ground if possible. Warm soft bedding for creaky old joints, it’s not dementia making them get on the sofa after nine years on the floor

if they get cold and wet after a walk get them home into the warm or they get stiff and sore.

Ge5 a ramp for the car or reverse up to the banking so they can get in without jumping

Regular exercise , not nil all week then six miles at the weekend.

I think It’s what happens every day , not the odd hydrotherapy session that matters . And pain relief promotes exercise so overcome that reluctance owners have of “giving pills“ , their dogs are not going to be on them for twenty years so let them have them and be comfortable mobile and enjoy being a dog.

RE: arthritis in dogs

Roland Bulkyn-Rackowe — Sat, 29 Sep 2018 23:22:57 GMT

I frequently recommend physiotherapy (and the physio has a hydro tank!), weight loss and NSAID. Uptake for physio is pretty good. We do use laser also although I'm not 100% convinced...

RE: arthritis in dogs

Julian Earl — Fri, 28 Sep 2018 20:08:55 GMT

[quote user="Martin Atkinson"]Although the doubters will want their say, IME glucosamine+chondroitin+EFA supplements are beneficial early on while there is still some cartilage to maintain, ditto Cartrophen, and may obviate the need for NSAIDs at this stage but they are of limited use in advanced cases. In humans it has been shown that running, despite the belief that it damages joints, is better than moderate exercise like walking as it stimulates the blood supply to cartilage and therefore keeps it healthier[/quote]

I am very unsure about glucosamine. Sure enough it is a constituent of cartilage but the best analogy that I've heard is, Would eating hair-clippings make hair regrow? I think we know the answer to that and I believe that these supplements are pure marketing hype!

For exercise, I think that it is the twisting of limbs that causes most pain, grinding away at damaged tissue within the affected joints. Some of the best things we can do involve preventing dogs jumping, eg out of a car and slowing them/helping them down steps when the elbows are affected badly. However, I think the quality of life question demands hat we have to allow them to exercise up to a point. That point being slower steady exercise, and not chasing other dogs or rabbits etc, plus for relatively short distances of course.

RE: arthritis in dogs

Gillian Mostyn — Wed, 26 Sep 2018 13:22:40 GMT

[quote user="David Mills"]Do people recommend exercise restriction commonly? To me it seems like prioritising quantity over quality of life.[/quote]

Yes and no. While I agree...quality of life is more important than quantity, it bothers me when I see people walking crippled labradors etc. Dogs are such loyal creatures, they will walk (be dragged behind) their owner for miles without complaint if that is what their owner asks of them.

I just tell people to remember that if their dog is limping, then their dog has pain on walking and running! (Amazing how many euphemisms are used...'he's just stiff' being the most common.) Thus let the dog lead the walk, not the owner!

But I agree that maintaining a low weight is by far the most important thing.

RE: arthritis in dogs

Lucy Fleming — Wed, 26 Sep 2018 13:13:47 GMT

[quote user="Rob Davis"]

[quote user="Lucy Fleming"]Our local hydro unit is ok, but only that. The hydrotherapist has their own opinions about long term nsaid use which don't mesh that well with mine![/quote]

A rather odd stance to take if they wish to receive veterinary referrals!

[/quote]

To be fair, as far as I'm aware it's not anything they have ever expressed to a client. It was just their own personal opinion that they mentioned during a consultation when I was examining their own dog. He is in fact, now on long term nsaid, so they may even have changed their opinion

RE: arthritis in dogs

Rob Davis — Tue, 25 Sep 2018 14:40:45 GMT

[quote user="Lucy Fleming"]Our local hydro unit is ok, but only that. The hydrotherapist has their own opinions about long term nsaid use which don't mesh that well with mine![/quote]

A rather odd stance to take if they wish to receive veterinary referrals!