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Last edited 06/28/05Arthritis in Dogs
Arthritis pain control
Enteropatic arthritis possible
Arthritis and Heart Murmur in older Poodle
Systemic enzyme therapy for arthritis
Arthritis treatment in Golden
Problem getting up after laying down in older hound
Immune mediated arthritis disorders
Dalmatian with Arthritis
Advanced arthritis - treatment and pain control
Rimadyl, liver problems, death
Arthritis Treatment
Advanced Arthritis - Treatment options
Arthritis in rear legs
Arthritis and Lick Granuloma
Immune mediated arthritis
Anti - arthritis medication
Glucosamine and Chondroitin for arthritis
Osteoarthritis
Osteoarthritis
Chronic back problems
also see Dysplasia
also see Immune Problems
also See Lameness
also see Motion Problems
also see Neurological Problems
also see Orthopedic Problems
also see Spinal Problems
also see SpondylosisMedications for treatment of Arthritis
also see Drug side effects
also see Etogestic
also see Aspirin
also see Non-steroidal anti-inflammatory drugs (NSAID)
also see Rimadyl
also see Herbs, Supplements and Nutriceuticals
also see Adaquan
Warning:
At present it appears that Rimadyl will cause liver damage in some dogs.
There have been some deaths in dogs with this reaction, although I think
that the use of the word "many" is misleading. The predominant breed
affected by this reaction has been the Labrador retriever but there are
reports of other breeds being affected.Question: My sweet dog, Tofu (11yr old female Dalmatian/terrier mix) has severe back
and shoulder degenerative arthritic changes. Although she does not act like
she's in pain, her ambulation is getting much worse. We have been giving
her 50mg Rimadyl BID & Cosequin DS BID. A few months ago I had taken her
off Cosequin DS and put her on Glycoflex BID. I put her back on Cosequin to
see if it would make a difference. It didn't. Do you have any other
thoughts about possible treatments/meds?
LenoreAnswer: Lenore-
Carprofen (Rimadyl Rx) is the best of the approved arthritic medications based on our clinical experience. When it doesn't control pain well enough we usually add a narcotic because there isn't much interaction between the medications and the additional pain relief afforded by the narcotics can be beneficial. We usually use hydrocodone or codeine in one of the combinations (like Vicodin Rx). We have used sustained relief morphine in a few patients and it helps a lot but we try to keep this as a short term treatment or to help patients whose owners simply will not consider euthanasia and there is significant suffering (which doesn't sound like your situation).
Sometimes Adequan (Rx) injections work better than oral glucosamine products but not enough better that we rush to try this frequently. Still, it is an option.
Corticosteroids work really well to control the inflammation (and therefore the pain) associated with degenerative joint disease. We use these when a pet is in good shape otherwise but the owners are considering euthanasia due to pain or poor mobility. At that point, the side effects become much less of a concern, since they are always less severe than the euthanasia option. Sometimes a dog will have a year or 18 months of comparative comfort with very few side effects after we start using prednisone or one of the other corticosteroids. However, side effects will eventually occur and so it is important not to start these medications too soon.
I know that there are veterinarians using Celebrex (Rx) for arthritis in dogs. Anecdotally it is reported to work well. I have not seen any sort of scientifically established dosage, though. I hate to use medications without a pretty firm idea of the effects and dosing information, so I have not attempted to use this medication. I have heard (but again no firm data) that Vioxx (Rx) is harmful to some dogs, so it isn't used at the present time as far as I know.
Stuff like regular moderate exercise, weight control, warmth when the joints are sore, icing when acutely inflamed and similar things that help people will help dogs. It is hard to overstate the importance of weight control. In at least one study in dogs weight control was more beneficial than any of the medications used in controlling disability and pain associated with degenerative joint disease.
I hope that this help some.
Mike Richards, DVM
Enteropathic arthritis possible -Enteritis and LimpQuestion: Dear Doc:
I am a new subscriber but I already think this is
a great web page and a great service. My
question concerns my 6 year old mixed breed named
Oba. About a month ago my Vet scoped and biopsied
Oba and determined he is suffering from irritable
bowel disease. She has prescribed Hill's
prescription diet w/d along with 500 mg of Flagyl
(Metronidazole). Oba's symptoms seem to be
improving in that he suffers less from diarrhea
but now seems somewhat constipated.Anyway I had a conversation with a nutritionist
last week who told me the above condition could
manifest arthritis type symptoms and Oba has been
limping, progressively worse, for three or four
months now. My Vet has x-rayed his hips, leg and
back, as well as sedated him to perform ligament
knee surgery. The surgery was not performed as
the orthopedic Vet determined the leg was not
"loose" enough to warrant surgery. I was told to
leash walk him for a couple of weeks to see if the
leg would heel, but the condition is getting
progressively worse. Is there any way there could
be a connection between the limping and the
irritable bowel disease? The bowel symptoms
started a little over six months ago and the
limping a couple of months later.Thank you in advance for your input.
Yours truly, Jeff
Answer: Jeff-
There is a form of immune mediated arthritis that is called
enteropathic arthritis and also called Type III non-erosive arthropathy. This
affects approximately 15% of dogs who have non-erosive arthritis according to
Hay and Mansley, writing in "Saunders Manual of Small Animal Practice". A
connection between gastroenteritis from food allergies and arthritis
is also made in an issue of the "Veterinary Clinics of North America",
(Blakemore, July 1994). This condition is also discussed in the
"Textbook of Veterinary Internal Medicine" by Ettinger and Feldman.There appear to be two theories for the simultaneous occurrence of
enteritis and arthritis. The first theory is that the disorders are
both caused by the same underlying immune system abnormality, which
probably does occur in some cases. The second theory is that the body's
reaction to the chronic bowel disease and to immune complexes in the blood stream
from this cause the arthritis. This probably also happens in some cases.
Regardless of what the actual cause is, it does seem to help a great
deal to successfully control the gastrointestinal disease so that should be
the main thrust to the treatment effort. If the enteritis can be
controlled then the arthritis should either resolve or require minimal treatment.
In the meantime, if non-steroidal anti-inflammatory medications help with
the arthritis and don't make the gastrointestinal disease worse, they are
probably the best medications to use. The other choice is to use
corticosteroids. It is pretty important to be reasonably certain that
this is an immune mediated arthritis and not osteoarthritis or infectious
arthritis prior to using corticosteroids, though. On X-rays
non-erosive arthritis usually causes very little changes to the bone so the joints
look pretty normal except for soft tissue swelling. Aspirating fluid
from the joint can also be helpful in making the diagnosis of immune
mediated arthritis.It is hard to be sure that there is a connection between these two
problems. The X-rays will help some and joint fluid aspiration might
help, too. The best evidence would be if the arthritis clears up when the
digestive problems are resolved.Good luck with this.
Mike Richards, DVM
8/9/2001
Arthritis and Heart Murmur in older Poodle
Question: Hello Dr. Richards,
I have a poodle mix, Bonni, that is 11 years old. She is my baby and I am
very concerned about her. I adopted her (at 6-8 months) from the
Humane Society in Texas, she had been abused and was
aggressive towards men, but they were doing their best to find a suitable
home for her. As a puppy she was diagnosed with a mild heart murmur and
her only other problem until recently was skin allergies. Noticing that
she hasn't been feeling good lately (she had been really chewing on the
same spot on her right hip and been hobbling a bit), I took her to my vet
for a geriatric exam, where the vet did a series of tests. The blood
tests revealed that all of her levels were within acceptable standards
except for the LDH or LHD (?), the vet explained it as a "feel good"
level. The norm, I believe, was 300 - 800, and she was at 1200. Her
x-ray also showed mild enlargement of her heart, and he noticed that she
was favoring her front legs. This led to a diagnosis of enlargement of
the heart and osteoarthritis of the hip. The vet placed her on Rimadyl
and Enacard, in addition to the Benedryl I give her occasionally for itchy
skin. Here are my questions:Is it safe to mix these medications?
Is there anything I can do without medication to help her feel better?
Can you estimate her life expectancy with these health problems?
Would you recommend a different course of treatment?
I think my vet is great, but am just interested in another
opinion. Thanks for your service. LeslieAnswer:Leslie-
I do not know of any reason not to use carprofen (Rimadyl Rx),
diphenhydramine (Bendryl Rx) and enalapril (Enacard Rx) together.Weight control is the best non-medical treatment for both arthritis and
heart disease. If Bonni is overweight, even a little, weight control would
benefit her. We recommend trying glucosamine and chondroitin to see if they
are helpful. These are available over the counter at most pharmacies and
health food stores.We have lots of small poodles in our practice with heart murmurs that do
not cause problems for years or even never cause problems, in some cases. I
usually wait until there are clinical signs prior to using enalapril but
many vets think it helps to use this as soon as a murmur is audible. If and
when the heart disease gets worse there are other medications that may be
helpful. Trying to keep extra salt out of the diet is helpful and I think
that moderate exercise is beneficial, especially early in heart disease.All the things that help with arthritis such as massage, heat therapy,
comfortable beds and adequate rest probably help dogs, too. Dogs don't
always like this kind of attention but you might find some aspect of this
sort of nursing care that helps a lot.Mike Richards, DVM
3/21/2001
Systemic enzyme therapy for Arthritis
Question: Hi, Dr. Richards,
What do you know about systemic enzyme therapy? I subscribe to a
publication for non-vets called the Whole Dog Journal (holistic veterinary
publication) -- the January 2001 issue had an entire article devoted to the
merits of systemic enzyme therapy, and in particular showcased a German
product called Wobenzym N (made for people, but there is a canine version as
well called Fido-Wobenzym). It contains, as you may have guessed, enzymes,
as follows: pancreatin, papain, bromelain, trypsin, chymotrypsin, and
rutosid. Given with meals it aids digestion, but given inbetween meals it's
supposed to be good for lots of things, including arthritis, both immune and
non-immune in origin, and chronic UTIs.I am considering trying it with my severely arthritic 12 year old lab who
has suffered from chronic UTIs as of late, who does not respond to NSAIDs
and does not tolerate steroids well. The only pain reliever she is on now
is a Chinese herbal supplement (OA Plus) that I told you about last year.
While it still helps her get around a bit (big difference when I take her
ff of it), I can see she is in pain when she tries to stand up. So I want
to try this now. The article seemed to indicate that the medication was
relatively safe, but did not mention interactions with other drugs (except
to say that it improves absorption of antibiotics). I am of course concerned
bout interactions with other drugs and vitamins as well as the herbs, even
though I know that some of these enzymes are actually produced by the body.
Right now the dogs is taking Pepcid AC, OA Plus, Pet Tabs Plus, calcium
supplements, Cipro (prevent recurrence of UTI), metronidazole (for diarrhea
from Cipro), Vitamin E, Lipiderm and bethanechol (for urinary retention).Any thoughts you may have would be appreciated. Carol
Answer: Carol-
There are individual studies of enzyme use that show all the effects that
you have listed according to Schoen and Wynn's book "Complementary and
Alternative Veterinary Medicine". If you search the PubMed site using
Wobenzym as the search term, there are 33 articles on the various uses of
this product. It appears to be very safe in humans based on looking through
a few of these and it is used in some orthopedic conditions. One article
mentioned that there was no interaction with the usual medications or
hormones used to treat mastopathy in women and I suspect that holds true
for the herbs and medications you might use to control arthritis. I could
not find any references specifically for veterinary medicine but there is
no reason to suspect that there would be much difference.I'd put this in the category of safe stuff to try that hasn't been proven
to work yet. I hope that helps in your decision making.Mike Richards, DVM
1/23/2001
Question: Hi Dr. Mike! I am new here. I have been watching your website with great
interest. I have been reading about the various treatments for arthritis
in dogs. We have an 11 yr old Goldren Ret. mixed, female, name
Amber. She has been under treatment for 1 yr for arthritis. She has
taken prednisone, Rimadyl and Adequan injections....all of which seem not
to work after a while. We have decided to try Glucosamine Sulfate with
aspirin. My question is....what dosage should I be giving her for
Glucosamine and aspirin? Also, can i use Ibuprofen instead of aspirin? WE
have given her Ibuprofen which seems to help. Although, I am worried
about the dosage. She is a a restricted diet of Science Diet (RD) and she
has lost weight. Originally, she weighed 78 lbs, but since her restricted
diet and snacks of carrots, she has now weighs 66 lbs. The carrots are a
great snack that once she got used to them, she now begs for them. I also
find that warm baths make her feel better. I would really appreciate any
input you may have. Thank You! Diane
Answer: Diane-
A lot of clients tell me they have given their dogs ibuprofen on an
occasional basis and it has not seemed to harm most of them, but we have
seen three or four dogs with gastric ulcers from this medication and it is
reported to cause gastric ulcers in most dogs if it is given on a
continuous basis for very long (in some dogs as short as two or three days).The most commonly prescribed dosage of glucosamine is 20mg/lb of body
weight, or 1 of the standard 500mg tablets per 25 lbs. of body weight.
There are several dose recommendations for aspirin but the one I like is
10mg/lb twice a day. We have a number of patients who use both glucosamine
and aspirin. I like the glucosamine/chondroitin combination better than
glucosamine alone.Aspirin causes GI upsets and ulcers in some dogs. If Amber stops eating
while on aspirin it is imperative that you stop giving the aspirin and
contact your vet if the loss of appetite lasts for more than one day.Hope this helps her.
Mike Richards, DVM
1/23/2001
Problem getting up after laying down in older Hound
Question: Dear Doctor Richards:
What would you recommend giving a 11 year old red hound for problems
getting on her feet after laying down for a period due to i assume hip
and joint problems.Ray
Answer: Ray-
There are two things to consider. The first is that it really does help to
know for sure if the problem is arthritis from wear and tear or conditions
like hip dysplasia. In this case, there are a number of medications that
might be helpful. If this is a condition other than arthritis, such as
lumbosacral instability, pressure on the spinal cord from tumors or chronic
disc disease, or degenerative myelopathy, then a different set of
medications is necessary.It is usually safe to go ahead and try the medications for arthritis
conditions for a short period of time to see if they help, though. I still
prefer aspirin as a first choice because it is inexpensive, readily
available and relatively safe. The usual dosage is 10mg/lb of body weight
twice a day, for dogs. I think that it is worth trying glucosamine and
chondroitin, at a dosage of one tablet of the 500mg glucosamine/400mg
chondroitin tablets per 25 lbs. of body weight, if the cost is not a major
factor. These are very safe medications but the degree of effectiveness you
can expect using them is still not very clear. If these medications are not
effective enough, then carprofen (Rimadyl Rx) and etodolac (Etogesic Rx,
Lodine Rx) are very good medications for arthritis. It is best to monitor
pets for liver and kidney damage prior to starting these medications and
then to recheck these values two weeks to a month after starting the
Rimadyl or Etogesic, if chronic use is anticipated. In severe cases, we
add a narcotic medication, like hydrocodone, in addition to a non-steroidal
anti-inflammatory like one of the previously mentioned medications.It is usually possible to improve the quality of life for arthritic pets a
great deal. If there is not a quick response to these medications, looking
for problems other than arthritis would be a best. Your vet can help you
decide if this is necessary.Mike Richards, DVM
1/4/2001
Immune mediated arthritis disorders
Question: Dear Dr. Mike,
I am so happy to find your website and become a subscriber to VetInfo Digest. A must have for all pet owners
who care about the well being of their beloved pets.Lily, my 3 1/2 year old (DOB 3-31-97), red smooth haired dachshund suddenly started limping
on her right rear leg on February 4, 2000 after a visit to the vet to have her anal glands expressed
and her nails trimmed. Her nails had been cut extremely short, so I thought this might be the cause
for her limp. But after a week or so went by and she continued to limp, I took her back to the
vet. I was told it was probably just a sprain as they could not find anything wrong after physically
examining her. Her limp continued to worsen but still no one found anything wrong on physical
examination.Lily was also having some severe skin rash problems which had started about six months before the limp and
had been on several different rounds of medications but with little success. The vet decided to refer us to a
dermatologist in a specialty clinic three hours from our home. We visited the dermatologist in April and skin
tests we done and we were told Lily was allergic to almost everything outside. One of the worst cases they had
seen, and we started her on antigen shots.I also had an orthopedic surgeon at the clinic examine Lily's right rear leg. He did not detect anything until he
examined her while under sedation for the skin tests. He said she had a possible cranial cruciated ligament
beginning in her right rear knee. He advised us to restrict her activities and since she was overweight at 20
pounds, he wanted her to lose 5 pounds before considering surgery.Six weeks later we returned for our follow-up visit with the dermatologist. Lily's skin rash had improved greatly
with the antigen therapy and the amitriptyline she was taking. We were to continue giving her the antigen
injections.
Lily's limp had continued to worsen and she was walking very little.The orthopedic surgeon arranged for our local vet to start Lily on Adequen injections, two injections per week
for four weeks and then one every six weeks. Although Lily had been on a diet and had lost 2 pounds she still
weighed 18 pounds and the doctor thought she would have a better recovery from cranial cruciated ligament
repair if she could get down to her ideal weight of 15 pounds.It was on the return home that Lily first fell down while trying to urinate. Within the next day or two, she was
not walking at all and was having trouble standing while urinating. I called the orthopedic surgeon and surgery
was scheduled.On June 29th cranial cruciated ligament repair was done on her right rear knee. The doctor said the surgery
went great and there were no signs of arthritis in the joint and she should have a full recovery within four
months.It was at our eight week check-up that the doctor was somewhat concerned that her leg was not as strong as it
should be and she was still unable to walk on her own and we were still having to assist her while defecating
and urinating. We decided to start doing some aqua therapy with her at home to try to build up her muscle
strength. We began swimming with her in our spa everyday for about ten minutes each day. Her muscle
strength did improve and she was standing on her leg but still not walking.I then noticed her front paws and ankles seemed very floppy and loose and mentioned it to my local vet who
was administering the adequen injections. She immediately contacted the orthopedic surgeon and we
scheduled another visit with him.On September 11th x-rays were taken of her front ankles and fluid was drawn from these joints. The test results
are as follows -
The joint fluid from her left carpus-consisted of 1 EDTA joint fluid sample.
The smears have a high nuclear cellularity consistent with the total nucleated cell count of
13,500/ul. There is a moderate amount of fresh blood containing platelets often in clumps. A 200
cell differential count reveals 97% neutrophils, 1.5% lymphocytes, & 1.5%
monocyte/macrophages. The majority of neutrophils are nondegenerate, few are degenerate.
Neutrophils are increased over the amount of blood that is present. Few macrophages are mildly
to moderately vacuolated. No microorganisms are noted.The joint fluid from her Right carpus-consisted of 2 unstained smears.
The smears have a mild to moderate nuclear cellurarity consistent with an estimated cell count of
<5000/ul. There is a mild amount of fresh blood containing few platlets. The leukocytes appear
proportional to the amount of blood that is present. A 100 cell differential count reveals 93%
neutrophils, 3% lymphocytes, & 4% monocytes. Occasional synovial lining cells are noted. The
neutrophils are nondegenerative. No microorganisms are noted.
I was only told the x-rays did not appear quite right.Lily started taking 15mg of prednisone per day and joint taps were repeated again on October 5th.
The October 5th test results are as follows -
A single direct smear of joint fluid from the right carpus -
The nucleated cellularity is moderate with mild amount of red blood cells including
occasional platelets. There is a moderate amount of granular eosinophilic background material
(mucin), but lack of windrowing of the red blood cells (poor mucin clot?). A 200 cell differential count
consists of 85% nongenereate neutrophils, 5% lymphocytes, and 10% monocyte/macrophages. Several
macrophages are enlarged and contain moderate numbers of clear vacuoles. No cytophagia or
erthrophagia is noted. Occasional binucleated cell (synovial lining cell?) and fibrocyte is noted. No
microorganisms are seen.
Opinion: Although the presence of peripheral blood skews the differential count towards
neutrophils, the neutrophils appear to be increased over that expected from blood contamination.
The macrophages are activated and represent chroncity.Two direct smears of joint fluid from the left carpus -
The nucleated cellularity is moderate (estimated <5,000) with mild amount of red blood cells
including occasional platelets. A 200 cell differential count consists of 98% nongenereate
neutrophils and 2% monocyte/macrophages. Few macrophages are mildly vacuolated without
cytophagia or arythrophagia. Occasional stromal cell is noted. No
microorganisms are noted.
Opinion: The proportion of neutrophils appear mildly increased over the amount of blood
contamination. This is consistent with a mild nonseptic supportive process, which could be seen in
resolving immune synovitis.Two direct smears of joint fluid from the left stifle -
The nucleated cellularity is moderate (3000-5000/ul?) with moderate amounts of red blood cells
including few platelets. Moderate amounts of granular eosinophilic background staining material is
evident (mucin), without windrowing of the red blood cells suggesting a poor mucin clot. A 200 cell differential
count consists of 89% nongenereate neutrophils, 7% small mature lymphocytes, and 4%
monocyte/macrophages. Few synovial lining macrophages contain few cytoplasmic vacuoles. No cytophagia
or erythrophagia is noted. No
microorganisms are noted.
Opinion: Neutrophils appear moderately increased over that expected for the degree of blood
contamination. This would be consistent with nonseptic mild suppurative process, secondary to
immune mediated disease.Lily's prednisone was increased to 20mg per day. After she had been on this dosage for about
five days, she had an accident in her crate. She was not able to hold her urine for an hour and 15
minutes. She was devastated over the accident she had made. The doctor said to decrease her
dosage back to 15mg per day, especially since we were taking her on vacation with us and we
would start her on Azathioprine when we returned.Lily had a CBC done and started taking 25mg of Azathioprine on October 25th. The prednisone was
discontinued on October 24th. Another CBC was completed on November 2nd and I am told it appears okay.
The doctor is watching for bone marrow problems, side effects of the medication.Lily had appeared to be hurting more since stopping the prednisone. I talked with the doctor
today and we have started giving her 25mg of Rimadyl per day. She had taken Rimadyl at this
same dosage when she had the cruciated ligament surgery in June but had been taken off it when
the prednisone was started. We are scheduled to have joint taps done again on November 16th,
after three weeks on Azathioprine, to see if the medication is going to be able to get her disease
under control, before considering surgery to repair the damage which has occurred.We have been told she has rheumatoid arthritis and chances of recovery are not very good. We are devastated
by the prognosis we have received and want to do all we can to make her an exception.I was also diagnosed with an auto immune disease, diffuse scleroderma, systemic sclerosis, in January 1996. I
had to quit working and brought Lily into my life to fill my empty days with love and companionship. Little did
I know she would become my dearest and closest friend. She gave me hope, love, and laughter through some
of my most difficult days as I adjusted to being disabled. It's almost ironic that now she is facing everything
that I had to face with my own disease. I want to do everything I possibly can to help her as she has been a
true blessing in my life.I am hoping that you will be able to shed some new light on our situation and help us in some way.
I would truly appreciate your diagnosis on her case, on her treatment, and on her prognosis for
recovery. I do not want to prolong Lily's suffering but I do not want to give up on her either. Any
insight you share will be greatly appreciated.Sincerely,
JanicePS Lily also has a Home Again ID chip which was inserted in April 1997 when she was spayed.
Are you aware of any problems associated with these ID chips? Could they cause auto immune
diseases in some animals?
Answer: Janice-
The answer to your last question is the easiest. There has been no apparent increase in cases of
immune mediated hemolytic anemia (IMHA) or other immune mediated diseases since the
introduction of microchip identification systems, so I think it is very unlikely that these chips cause
immune system disease.Rheumatoid arthritis is considered to be an erosive, or damaging to the joint surface, form of arthritis
in the dog. In this disease, the appearance of the X-rays and the examination of the joint that was
done during surgery are as important, or more important, to the diagnosis than the joint fluid analysis.
There should be damage to the joint surfaces visible on the X-rays if rheumatoid arthritis is present. It
may be best to have a radiologist review the X-rays for evidence of rheumatoid arthritis, though,
because it may be difficult to recognize joint destruction if complications like partial dislocations of
the joints are present. Due to the possibility of other causes if non-erosive arthritis is present I would
very strongly recommend having a radiologist look at X-rays, if your veterinarian or the orthopedic
specialist is not absolutely certain that joint erosion is present -- or is not present.It is possible to test for rheumatoid factor in the blood, but this is not a very reliable test and some
specialists avoid it, feeling that the results are more likely to be confusing rather than helpful.
Rheumatoid arthritis is most common in adult small breed dogs. It usually causes systemic signs such
as fever, depression, loss of appetite and pain that is hard to localize to one specific area of the body.
It usually affects more than one joint and it usually starts in the joints farthest down the legs, with the
carpus (wrist), tarsus (hock or rear ankle) and toes being commonly affected areas. It sometimes is
very persistent, causing continuous pain, and other times follows a cyclic course, with waxing and
waning bouts of pain and discomfort. Joints are usually swollen when rheumatoid arthritis is present.
Rheumatoid arthritis does not respond well to treatment in many patients. Non-steroidal
anti-inflammatory medications such as carprofen (Rimadyl Rx) or aspirin, seem to have variable
success, with some authors reporting good success and others not much success using these
medications. Prednisone in combination with azathioprine (Imuran Rx) has been recommended
frequently. Methotrexate may work and leflunomide (Arava Rx) is also recommended, although it is
reported to be very expensive.There is a condition referred to as canine idiopathic erosive polyarthritis, which causes signs pretty
similar to rheumatoid arthritis. This condition doesn't usually respond well to therapy. Since it
resembles rheumatoid arthritis it has to be considered. I am under the impression that this condition
might have to be identified through examination of the lining of the joint by a pathologist after surgical
exploration of the joint --- which obviously has to be done very carefully to avoid making any
existing condition worse. There may be some other way of diagnosing this condition at this time that I
am unaware of.If the condition seems non-erosive, based on the stifle joint looking normal at the time of surgery and
if the X-rays do not show erosion, then several other conditions have to be considered. One of the
first things to come to mind is systemic lupus erythematosus (SLE), especially since this can also
cause skin disease (although you do seem to have a diagnosis for the skin disease). Other possible
problems include the tick borne diseases, such as ehrlichiosis, Lyme disease and infections. There
would be a small chance of a link between allergic disease and an general immune response that
could lead to joint pain, as well.If a radiologist reviews the X-rays and feels that the arthritis is erosive and is likely to be rheumatoid
arthritis or canine idiopathic erosive arthritis, then I am not sure why surgery would be contemplated,
unless it is surgery to stabilize the joint through arthrodesis (fusing the joint) --- which may be helpful
in the case of idiopathic erosive polyarthritis.It may also help, in this case, to consider getting an opinion from an internal medicine specialist rather
than an orthopedic surgeon. The immune mediated arthritis disorders are not really surgical diseases
and I think that internal medicine specialists probably have more experience dealing with them due to
this.I wish that I could give you some sort of specific advice other than to try really hard to establish
whether there is erosion of the joint surfaces, or not, but this is the first step in the diagnostic process.
Once that has been established (and it is possible it already has been), then it is possible to consider
the major alternatives and to consider whether the newer therapies for immune mediated joint
diseases might be helpful.I am nearly certain that this has been considered, but in a dachshund, it always seems necessary to
me to look especially carefully for signs of spinal disc disease, even when there are lots of confusing
signs that point in another direction.Mike Richards, DVM
11/15/2000
Question: Doctor Mike,
I have a male, neutered, dalmation and he is 10 years old. A couple of years ago or so he
developed arthritis and we started giving him aspirin. Then our vet recommended Rimadyl.
We administered one pill with his food in the morning and in the evening and this worked well
for him. Recently, he went to the vet for a checkup and our doctor did a blood test and
informed us that his liver enzymes were slightly elevated. He said it wasn' t worrisome at this
time, however, he would recommend changing Rimadyl to Etogesic.Within two days of taking Etogesic, Shelby developed gastrointestinal distress with bloating
and diarrhea. I suspected the Etogesic which was the only change in his diet and we stopped
the medication. It took several days for his bowels to get back to normal and that included
a trip to the emergency animal clinic on a Saturday because of rectal bleeding from straining.
He was miserable.It soon became apparent that he needed something for arthritic pain so we have resumed the
Rimydal at half dose (the pills were scored in half) while we figure out what to do. One half
pill in the morning and at night.What are the alternatives to Rimadyl and Etogesic? I may try Cosequin but I know that s not
a pain reliever but rather a cartilage builder.What about prednisone and what are the side effects or problems with steroids? I have
taken steroids myself prescribed by my ENT (ear, nose and throat doctor) for sinus problems
on a very limited basis. I feel soooooo good on them. But my ENT says they are only for
occasional use since there are problems with long term use. Is that the case in dogs and how
long would it take to cause problems? I m told dalmations only live 10 12 years so maybe
long term effects are not a worry?I would shy away from codeine since that may make him drowsy and he is still perky.
What are your thoughts?
Thanks, Donna
Answer: Donna-
I never know what to do when liver enzymes become elevated slightly and a dog is on
carprofen (Rimadyl Rx). I have used this medication in several dogs that had elevated liver
enzymes when we started the meds, without any apparent problems, so I think that this can be
done. On the other hand, Rimadyl can cause severe liver damage in some dogs and so you have
to be careful when liver enzymes start to rise, even though Rimadyl may not be the cause.
Depending on the response to other medications, I think I would be willing to consider
continuing the Rimadyl and monitoring the liver values closely.Etodolac (Etogesic Rx) and carprofen are the most potent non-steroidal anti-inflammatories
(NSAIDs) approved for use in dogs at the current time. Meloxicam, approved for use in dogs
in Canada, was just approved for use in humans in the United States and should be available in
this country by May or June. It is reported to work well, too. In some cases, using a GI
protectant, like cimetidine (Tagamet Rx) or misoprostol (Cytotec Rx) may be helpful in limiting
the gastrointestinal problems if it seems necessary to go back to Etogesic, or if meloxicam causes
the same problem.I like to use Rimadyl once a day at the full dose (1 mg/lb), instead of twice a day, when I cut
back on it. This seems to work well enough for many dogs to remain comfortable.I think that supplementing the Rimadyl with Cosequin (tm) is a good idea. The recent
Consumer's Reports on alternative medicine said that chondroitin seemed to work better than
glucosamine for arthritis in humans and Cosequin does contain both ingredients.I like hydrocodone for the pain of arthritis. It seems to work pretty well. Drowsiness is not
usually a problem with it, although that effect can occur. I don't usually use it unless the
medications mentioned above don't work, though.Corticosteroids are a true paradox for arthritis. No medications have stronger anti-inflammatory
effects and the improvement on these medications can be astounding in some cases. They do
have detrimental longer term effects, though. They promote weight gain and muscle loss, both of
which are bad for arthritic pets. They tend to weaken articular cartilage, which is also bad.
There is a saying in equine medicine "you can make a horse walk to its grave with
corticosteroids". It is true. So we compromise on their use in this manner --- when anything
else will work, we use other medications --- when nothing else is working well and people are
considering euthanasia, we use corticosteroids. Our thinking is that the side effects can't be
worse than euthanasia, so why not use the these medications at that point? It is important to
remember that corticosteroids can cause liver problems in a small number of patients, just like
Rimadyl, too.Acupuncture is another option that appears to help some dogs.
Hope this helps some. Pain relief is worth a lot. It is worth taking appropriate risks, in my
opinion. Just give the safer approaches a chance and then, if necessary, use the medications
with increasing risk as it seems appropriate to do so.Mike Richards, DVM
4/22/2000
Advanced Arthritis - treatment and pain control options -
Labrador Retriever - Several questionsQuestion: Dr. Richards.
I have already tried acupuncture and homeopathy, too (Arth-Ease). I am
going for one more consult with a new orthopedic specialist (tomorrow) just
to make sure there isn't some other problem before we start the
corticosteroids.One more quick question -- do you recommend Pepcid AC for your patients who
are on long-term corticosteroid therapy for arthritis? My other dog is on
long-term therapy (prednisone) for chronic active hepatitis (10 mg. every
other day for 60 lb. dog) and I have been giving her a 10 mg. Pepcid AC
daily to prevent stomach problems on the instruction of her internal
medicine specialist. So far, so good.Carol
Answer: Carol-
I have not used Pepcid AC concurrently with corticosteroids, mostly because
we don't seem to have significant gastrointestinal problems with its use,
except when using very high dosages. In those cases we have used cimetidine
(Tagamet Rx) in the past but at the present time there seems to be a move
towards using famotidine (Pepcid AC Rx) because it may be able to suppress
acid production longer and also has less interactions with other
medications (information from Plumb's Veterinary Drug Handbook). So I don't
see any reason not to continue to use it but we have not had significant
ulcer problems with corticosteroids in most instances without using any
medications to avoid them.You have tried hard to resolve this problem. I hope that the orthopedist
has good suggestions or that the use of corticosteroids does prove to be
beneficial.
Mike Richards, DVM
12/1/99Question: Hi, Dr. Richards,
I am writing again about my Labrador Retriever with the severe arthritis
(see earlier attached messages). I've tried nearly everything you
suggested (narcotics, Adequan did not work), and am now ready to turn to steroids
for pain relief. I know there are a number of different steroids out there --
when you get to this point with your patients, what steroids and dosages
do you use for an 80 lb. dog? Do you start with higher dosages at the
beginning and gradually reduce over time?FYI -- I have provided copies of some of your e-mails to my vet, and he
likes having your input!Carol
Answer: Carol-
It is depressing when arthritis doesn't respond well to medications. But
there is still some hope with the corticosteroids. I use prednisone almost
exclusively in my practice. There are a lot of suggested dosing schemes for
prednisone and various arthritic conditions but we usually start with
.25mg/lb of body weight once a day for five days and then use 0.25mg to
0.5mg/lb of body weight every other day after that. If necessary we will
increase the dosage to as high as 1mg/lb every other day but we are
reluctant to go any higher than that. Many times we are able to get by with
0.25mg/kg every 48 hours. It is sometimes necessary to use an non-steroidal
anti-inflammatory on the off days (aspirin, etodolac, carprofen) or to use
a narcotic pain reliever in addition to corticosteroids.I haven't used much in the way of alternative therapies but I know a vet
who does acupuncture who is really convinced it is helpful in chronic
arthritis. I can't speak from personal experience on this but don't see
much reason not to consider it, too.Good luck with this.
Mike Richards, DVM
11/17/99
Question: Thanks for the information, Dr. Richards.
I have a few quick follow-up questions. My vet and I are now trying a
combination of Rimadyl (100 mg. 2x/day) and hydrocodone (5 mg. 2x/day) on
my lab, who weighs 80 lbs. She has been on it for almost 2 weeks now --
there has been some marginal improvement, but it does not seem to be enough to
justify continuing it. But before we try something else (Adequan is
probably next):1) should the Rimadyl be given at the same time as the hydrocodone (right
now I am giving her the hydrocodone in the morning and evening and the
Rimadyl at noon and before bedtime)?2) is 5 mg. twice per day the right dosage of hydrocodone (my vet has
never used it before for arthritis, so I want to make sure)?3) is 2 weeks long enough to determine that the hydrocodone is not
sufficiently effective?4) if she's not responsive to hydrocodone, would it still be worth trying
oxycodone and/or fentanyl patches?5) if the answer to 4) is yes -- if you were treating my dog, would you
try Adequan next or the other narcotics?6) when using Adequan, how quickly can I expect to see a response (if
there is going to be one)? if a dog does not seem to be responding to Adequan,
how long do you continue using it before you determine there probably
will be no response? (again, my vet hasn't used it before so he doesn't know)Thanks. Carol
Answer: Carol-
1) I usually give hydrocodone two or three times a day and have never
actually stopped to figure out if it should be given at the same time as
Rimadyl or aspirin, or not. I am presuming that most of my clients give
these medications at the same time. I think either way should be OK.A week or so should be long enough to see if it is worthwhile, though ---
so it probably isn't.2) I will use 10mg of hydrocodone three times a day in large dogs and am
reasonably certain a higher dosage could be used. The actual recommended
dosage is about 1mg/10 lbs of body weight two to four times a day, but
that is the recommendation for coughing, which is the most common usage for
hydrocodone. My thinking is that it works well in some patients at the
lower end of the dose range and they are the patients who benefit most, so
I just don't push the dosage.3) Two weeks is plenty of time to see if this helps. It doesn't in all
cases, so you have probably gone far enough with it.4) Fentanyl patches are very effective pain relief but probably aren't
suitable for long term use since they do seem to have more effect on a
dog's outlook on life than hydrocodone (we see some dogs that get overly
mellow on fentanyl -- OK post-surgically but probably not a good long term
thing).I have used Tylenol3 in some dogs. Tylenol is a compromise because
acetaminophen is a little more likely to cause liver problems in a dog
than in a human but I really think pain relief is worth this risk when it is
really necessary. It may work a little better than hydrocodone or Vicodin
(Rx), which we more commonly use (again, knowing that Vicodin has
acetaminophen and thus a little more risk). People I talk to seem to think
so when comparing the use of these medications for their own problems, at
least. Of course, Rimadyl (Rx) also sometimes causes liver problems but it
also seems worth trying, to me, as long as this risk is acceptable to the
pet's owner.5) I would probably try Adequan first, or even try adding oral
glucosamine/chondroitin products.6) Adequan is hard for me to assess. We have had dogs get up and walk
within a few days that weren't even ambulatory and have had other dogs that
seemed to respond only after 5 or 6 weeks of treatment. I suspect that
dogs at both ends of this spectrum may be having coincidental remissions in
symptoms but can't be sure. We stop using it after 6 weeks if there is not
a good response to it.Hope this helps.
Mike Richards, DVM
10/7/99
ArthritisQ: Dear Dr. Richards,
I have more questions -- this time about my 10-1/2 year old spayed female
Chocolate Lab. She has had arthritis since age 8-1/2, but is otherwise
healthy. She has been on Rimadyl (100 mg. twice a day) for about 2 years
and on a glucosamine/chondroitin sulfate (GCS) supplement for about a year.
She weighs about 80 lbs. now, and I am trying to get her down another 10
lbs. using a homemade diet, but it is difficult because she pretty much
refuses to exercise. The medication is no longer working well enough to
control the pain, and she has a great deal of difficulty climbing stairs. I
took her to an orthopedic specialist, who basically told me that she has
arthritis in every one of her joints and is not a good surgical candidate.
He suggested acupuncture, which did not work. I need to figure out where to
go from here, as last night I had to call a friend to help me carry her up a
flight of stairs.1. I asked my vet about Adequan, but he has never used it before and wary
of starting now. I know you have used it in your practice from your web
site. What kind of success rate do you have using it? Can it be used in
combination with Rimadyl and GCS? How do I convince my vet it is worth
trying?2. Also, is there really a significant difference between Cosequin DS and
other GCS products? I am now using the Foster-Smith Joint Care product, and
it was suggested to me by a holistic vet that the difference in the Cosequin
formulation might yield improved results.3. Although I am not opposed to using steroid therapy as a last resort, I
wondered if a different NSAID or a higher dose of Rimadyl might be
worthwhile first. From the product literature, I know that Pfizer tested 3X
and 5X the recommended dose of Rimadyl without too many problems in the dogs
tested. I'd be interested in your comparative risk analysis of steroid
therapy vs. increasing the dosage of Rimadyl. By the way, I have tried
aspirin and Etogesic, but neither worked as well as Rimadyl.4. Is there anything else I should be trying? I already have her on
Lipiderm, Vitamin E (400 IU/day) and Vitamin C with bioflavenoids (1000
mg/day).Thanks again for your helpful advice on my Springer Spaniel.
C
A: C
Adequan (Rx) is relatively easy to use. It is very safe and it can be used
in combination with Rimadyl (Rx) and glucosamine/chondroitin. There may not
be a need to use it AND the glucosamine, since it is a similar product,
just in injectable form. The dosage recommendation varies a lot from vet to
vet, but in general it is used at about 3 to 5 mg/kg (so about 120 to 200mg
for an 88 lb. dog) and used frequently for three to five weeks (once every
3 to 7 days) and then used at whatever interval seems to work after that -
usually one to three weeks. It is expensive and the injections sting but
those are the only drawbacks that I know of. I have wondered if using
glucosamine orally might extend the time between injections but in the
limited experience we have had, I don't think this is the case.How do I know it stings? I was at a veterinary seminar on blood disorders.
The topic of conversation at the dinner table turned to whether or not it
was safe to use Adequan when a bleeding disorder was present, because it is
related to heparin. The specialist's answer was yes. Someone at the table
asked if the medication worked well. Out of eight vets, three or four had
used it, but one vet was adamant that it worked really well. He said the
only drawback was that the injections really stung. I said, "My patients
don't seem to complain much," to which he replied, "It stings!". To which I
said, "I don't see that effect," at which time he pounded his leg in the
way a large animal vet pounds a horse's neck prior to giving an injection
and said "It stings!" Still being dense, I said, "well, I don't see it" and
to which he replied, "It stings, but I can ski again!". At that point, I
understood that he KNEW it stung. And that he really really believed it
worked.I don't know the answer to your question about Cosequin (TM). They are the
only company that has actually paid for research on their product, so they
definitely believe in it. I have a hard time believing there is a huge
difference between glucosamine/chondroitin products if the dosage of the
medications is similar, though.I don't know of a more effective NSAID than Rimadyl. One of the problems in
dogs is that many of the NSAIDs are REALLY likely to cause ulcers,
including indomethocin and ibuprofen, which might be effective if they
could be used. (please note information about liver damage problems in Labs
and some other dogs with Rimadyl)I do like to use hydrocodone in combination with Rimadyl in patients that
appear to need additional pain relief. This combination seems to help some
patients a lot. It is better if the hydrocodone is used intermittently,
since it is addictive, but it can be very helpful. I have used Vicodin
(Rx), which is acetominophen and hydrocodone, but I would be reluctant to
use acetominophen and Rimadyl at the same time since both can cause
idiopathic liver problems in a small number of dogs. Other narcotic pain
relievers may be worth considering, such as oxycodone or even fentanyl
patches, as well. Sometimes, a few days of pain relief can make a huge
difference.When you reach the point that your Lab's quality of life just isn't good
enough with NSAIDs and pain relievers, corticosteroids are a good choice.
At that point you have nothing to lose and a lot to gain.Good luck with this.
Mike Richards, DVM
9/14/99
Rimadyl and liver problems, death
Q: Dr Mike,
You might want to add to the "Rimadyl" section that liver tests and enzyme panels should be done prior to this administration. Many dogs, especially labs, have died from Rimadyl. You should probably speak to Pfizer about this as it has appeared in many newsgroups for the past several months. Apparently, many vets aren't aware of its
life-threatening effect to labrador retrievers.Thank you.
A: William-
We have received a couple of emails recently regarding liver disorders
following the use of carprofen (Rimadyl Rx). This is reported on our site
under side effects of medications but we will add this note to the Rimadyl
page.At present it appears that Rimadyl will cause liver damage in some dogs.
There have been some deaths in dogs with this reaction, although I think
that the use of the word "many" is misleading. The predominant breed
affected by this reaction has been the Labrador retriever but there are
reports of other breeds being affected.Rimadyl benefits a large number of dogs. It harms a small number of dogs.
The harm appears to be reversible by withdrawal of the drug. With all
medications it is extremely important to pay attention to any potential
side effects. With Rimadyl it is very important to discontinue use of the
medication if a dog exhibits a decrease in appetite, lethargy, depression
or any other signs of illness after administration of the medication. This
is not a medication like insulin, in which withdrawal is dangerous to the
pet. If there is evidence of any undesirable side effects the best course
of action is to stop administering Rimadyl and to contact your vet.It is hard to argue against drawing blood and checking serum chemistry
levels to check for pre-existing liver or kidney problems prior to using a
new medication in any pet and especially in older pets. However, I think it
is important to point out that the predictive value of this testing is not
established and that if the reaction to Rimadyl is similar to reactions to
other medications there will not be much predictive value in the lab work.
Most of the reactions to other medications do not occur as the result of
pre-existing liver disease but as the result of an inability of a
particular dog's liver to process the medication. The lab work protects the
pharmaceutical company against claims that the medication caused conditions
that already existed, which is one of the reasons the tests are promoted.
Diagnosing a pre-existing condition may also help prevent further damage to
an already damaged organ by allowing appropriate adjustments in medication
dosage or prompting a decision to use a different medication. These are the
other reasons testing is suggested Still, there is a good chance that dogs
who will react to Rimadyl will have normal serum chemistry values prior to
treatment and lab work should not be viewed as a guarantee that problems
will not occur. Ideally, lab work should be done prior to administration of
the medication and one month afterwards. For families on a budget trying to
help their pets the additional expense of lab work may be inhibiting. If I
had to chose between checking lab values before administration and after
one month, I'd chose the later time. If the cost of lab work will keep an
owner from using Rimadyl then I feel comfortable pointing out that it must
be discontinued if signs of illness after its use occur and not running lab
tests prior to use or after use.Would I use Rimadyl in my own dogs? Yes. In fact, I have done so. Do I
worry about toxic effects? Of course I do. I watch my dogs carefully when
administering any medication to see if there are changes that might be
associated with the medication. Every dog owner should do this. Every vet
should listen to dog owners and take their worries seriously after
administration of a new medication. In many cases there are alternative
medications that can be used or it may be reasonable to discontinue a
medication for a condition that does not absolutely require it.Rimadyl is a very effective medication for dogs with debilitating joint
disease. It provides a measure of comfort to these pets that is worth
taking some risk to provide, because it is more effective than any other
non-steroidal medication I am aware of. It can cause liver damage in a
small percentage of the dogs it is given to. It is important to be aware of
this problem and I am glad that people are aware of it. But it is just a
risk to be considered, not a reason not to use Rimadyl when there is
justification to do so.Mike Richards, DVM
1/99
Q: I have a fourteen year old Afghan who has arthritis. He is currently receiving Adequan shots approximately every ten days to two weeks. I would like to know if I can give him Glucosamine sulphate tablets which I can buy at a pharmacy in addition to these shots. Is Glucosamine sulphate the same thing that is in the adequan shot? Thanks for your help. Carole
A: Carole- Adequan (rx) is a glucosamine so you would be giving similar products. While this would probably be safe there was recently an article in which overdosage of these products in cats led to bleeding disorders, if I remember it correctly. It is conceivable that problem could occur in dogs as well since the glucosamines are related to heparin which does interfere with blood clotting. All in all, I'd probably depend on the Adequan for this mode of therapy and consider adding an additional product with a different effect, such as a non-steroidal anti-inflammatory (NSAID) or a narcotic pain reliever. Carprofen (Rimadyl Rx) has been pretty effective in our practice and we have used it at the same time as Adequan in a few patients without problems, so far. We have used hydrocodone in a number of arthritic patients in combination with an NSAID or Adequan and it has sometimes made a significant difference in the patient's overall attitude. Pain relief can be very beneficial.
Mike Richards, DVM
Q: DEAR DR. MIKE, CAN YOU PLEASE HELP ME? I HAVE A 14 YEAR OLD GOLDEN. HIS NAME IS RUSTY. HE IS NOW 88.4 LBS (SINCE HE WAS ON A DIET) HE HAS AN ENLARGED HEART, AND CAN HARDLY WALK. OUR VET. DR.A. SAYS RUSTYS SPINE IS FUSING TOGETHER DUE TO ARTHRITIS. AND ITS CAUSING HIM TO LOSE HIS MOTOR SKILLS. THIS HAS BEEN GOING ON FOR ALMOST A YEAR. HE'S TRIED ALL TYPES OF MEDICATION ON RUSTY. BUT AS OF LAST WEEK HE TOOK A TURN FOR THE WORSE. HE HAS BEEN VERY RESTLESS AND STARTED A PANTING THAT WON'T STOP. HE CAN HARDLY WALK AT ALL. MY HUSBAND AND I HAVE HAD TO CARRY HIM SO HE COULD GO OUT SIDE TO THE BATHROOM, HE ALSO HAS FOR SEVERAL MONTHS NOW, BEEN HAVING BOWEL MOVEMENTS AROUND THE HOUSE. WERE USED TO THIS , AND ITS NOT A PROBLEM. WE HAD TO MAKE AN EMG. TRIP TO OUR VET SINCE HE COULD BEARLY WALK, AND THE PANTING IS SO EXCESSIVE, AND OUR VET SAYS HIS ARTHRITIS HAS PROBABLY GOTTEN WORSE, ITS CAUSING HIS CENTRAL NERVOUS SYSTEM TO SHUT DOWN. HIS HIND LEG MUSCLES ARE LIKE MUSH. HE HAS NOW ADDED PHENYLBUTAZONE 300 MG. TWO TIMES A DAY, TO HIS 100 MG. TWO TIMES A DAY RIMADYL.( RUSTY HAS BEEN ON RIMADLY 100 MG. TWO TIMES A DAY FOR 2 MONTHS. ALREADY ) AND OTHER THAN THAT , HE CAN'T DO ANYTHING TO HELP HIM. HE SAY'S IF THIS DOES'NT WORK, THAN WE HAVE TO PICK A DATE TO PUT HIM DOWN, AND I CAN'T DO THAT. YOU SEE RUSTY IS MY SON, AND I CAN'T HAVE CHILDREN . SO, I'VE PUT ALL MY HEART AND SOUL INTO MY DOG. I GIVE HIM ALL THE SPECIAL ATTENTION I CAN. I HAVE DEVOTED MY SELF TO HELPING HIM. YET, I AM GETTING A BIT STRESSED I DON'T GET MUCH SLEEP DUE TO THE PANTING SINCE HE SLEEPS ON THE BED WITH US AT NIGHT, MY SIDE, SO I'M ALWAYS WAKING UP DURING THE PANTING TO HELP COMFORT HIM. MY HUSBAND THINKS IT MAYBE "TIME" TO PUT HIM DOWN BUT I DON'T. WE ARGUE ABOUT THIS. DON'T GET ME WRONG MY HUSBAND LOVES RUSTY VERY MUCH TOO. I JUST DON'T THINK I'VE DONE EVERY THING IN MY POWER TO HELP HIM. I CAN'T GIVE UP NOW. AND MY HEART IS BREAKING. I DON'T KNOW WHAT TO DO. RUSTY HAS BEEN ON 300MG TWO TIMES A DAY OF PHENYLBUTAZONE ALONG WITH 100 MG RIMADYL TWO TIMES A DAY FOR 10 DAYS NOW AND VERY LITTLE IMPROVEMENT. SOMETIMES HE CAN GET UP TO WALK, SOMETIMES HE CAN'T. DUE TO RUSTY'S ENLARGED HEART OUR VET IS AGAINST GIVING HIM CORTIZONE SHOTS, ALONG WITH THE RIMADYL.
RUSTY IS VERY ALERT, HE CAN SEE, SMELL, TASTE, HEAR, AND EVERYTHING ELSE, BUT STOP PANTING AND STAND AND WALK WITHOUT FALLING. CAN YOU PLEASE HELP ME, I DONT WANT TO LOSE MY DOG, I LOVE HIM SO MUCH, I'D DO ANY THING I COULD TO HELP HIM, EVEN IF I COULD HAVE SURGERY TO TAKE A PIECE OF MYSELF AND GIVE IT TO HIM, SO HE COULD WALK AND STAND WITHOUT FALLING I WOULD. PLEASE RESPOND TO MY E-MAIL, I WOULD TRULY APPRECIATE ANY HELP YOU COULD GIVE ME.. BY THE WAY, MY NAME IS SUSAN, I HOPE TO HEAR FROM YOU. THANK YOU.
A: Susan-
I don't understand the reluctance to use cortisone when the alternative is euthanasia. It seems to me that no matter how bad the side effects could potentially be the option to euthanize is always there -- so why not try it? There is a reasonably good chance that corticosteroids such as prednisone would be helpful and often the side effects are minimal, even when it seems like they are more likely than under "normal" circumstances.
I don't have much other advice for medical help except perhaps to suggest asking about referral to a neurologist if that is possible in your area.
I am pretty sure your husband is trying to do what is best for Rusty, too. One of the problems with having euthanasia as an option in veterinary medicine is that there are many people who can not stand the thought of making a life and death decision for their pet. Often these people live with someone who really believes that euthanasia is a viable option to end suffering for their pet. That makes for an even more difficult time when a pet is struggling with a serious problem. Just try to remember that he is probably sincere in his desire to do what is best for Rusty and try to let him know why you are not able to accept that option. It isn't a decision you can take back and it is best to be sure about it, if possible.
I hope that this helps some.
Mike Richards, DVM
Q: My friend has a Collie [11 yrs old] that has arthritis in the hind legs. Should he be on medication? He has been walked all his life. Can he still go for long walks or should he rest more? Any other useful information would be appreciated. Thanking you in anticipation.
A: M- There are good medications available for arthritic dogs now. I think that most dogs with arthritic conditions should have the benefit of pain relieving, anti-inflammatory medications. I personally believe that it is best to keep walking dogs with these conditions since activity tends to keep the joints as mobile as possible. It probably isn't a good idea to have long weekend walks and no activity during the week or some situation with widely varying activity levels, though.
Please encourage your friend to talk about pain relief with his or her vet. It should be possible to find a medication that will work well for your friend's dog.
Mike Richards, DVM
Q: Dear Dr. Mike, We have a 10 yr old Lab and she is a little stiff getting up and down and the vet says it was arthritis. She also has a Lick Granuloma on her rear foot and seems to limp on that leg. We have tried everything to stop her from licking her foot and the only thing that helped that was a bucket on her head and then she could not get at her foot, but she looks so sad and at her age I cannot do that anymore even though it did help. My vet said for her to swim 15 min a day in our pool and she loves that, but it really has been too hot this summer. What do you know about Arthroflex for Arthritis. It is a powder made from sea shells and you sprinkle it on their food. My sister's neighbor gave it to their dog and was helped tremendously. Any help you can give me would be appreciated. Thank you so much. Rita
A: Rita- There are a number of products containing glyscosamines, such as Arthroflex (tm) that are used for arthritic conditions in dogs. It is still somewhat debatable how effective these products are but they appear to be very safe and therefore I see no problem in trying them to see if they work for your dog.
Weight control is the best treatment for arthritis. If your Lab is overweight, as Labs tend to want to be, you may see great benefit if you can achieve weight reduction.
Lick granulomas will sometimes respond to therapy with oral hydrocodone. This is a narcotic pain reliever/cough suppressant. I think the theory is that some dogs continue to lick these sores in order to stimulate endorphin production and the narcotic effect lessens the dog's need for continued endorphin stimulation. Weaning away the hydrocodone allows the dog to become free of the habit. That's the theory, anyway. This doesn't always work but it works often enough to make it worth a try if your vet hasn't already tried it.
Mike Richards, DVM
Q: I have a 6 year old female rottie. 5 weeks ago I noticed she was limping and took her in to the vet. X-rays were taken; arthritis and some pain & swelling in the joint area were noted. A shot of cortisone was given, 10 days of antibiotics for any possible infections, and rimadyl were prescribed and we were to return in 3-4 weeks. We did, she was still limping, but the pain and swelling had gone down. It was written off as arthritis settling in and a prescription of cosequin was given to aid in the discomfort. 5 days later I noted a bump in her back leg (the same leg she had been limping on) so back to the vet we went. It was a swollen lymph gland-I had it removed and sent in for a biopsy, while she was under, my vet decided to draw fluid from the joint on that leg. I got the results back yesterday from the joint fluid - 1)septic arthritis or 2)immune mediated joint disease. The biopsy results from the lymph gland will be back next week. I was given an antibiotic after the surgery and was instructed to make sure I give them to her. What is immune mediated joint disease, is it treatable, how painful is it for the dog, and what can be done to aid the discomfort?
A: Lumpy - Immune mediated just means that the immune system is involved in producing the clinical symptoms. I think that it can be said fairly that almost all vets use this term to indicate inappropriate immune responses since the immune system is involved in most disease situations. So, in its general use the term "immune mediated" in front of the description of an illness, such as immune mediated synovitis or immune mediated hemolytic anemia, means that the immune system is inappropriately causing a a disease process.
Immune mediated arthritis occurs when the immune system causes an inflammatory response in a joint. It is painful. Sometimes terribly painful. It includes a number of possible underlying causes, including rheumatoid arthritis, lupus, drug reactions (sulfa antibiotics in particular), immune reactions to systemic diseases or sub clinical joint infection and unexplained instances of immune mediated inflammation. Sometimes, immune mediated arthritis occurs and the response is "sort of" appropriate. An example would be Lyme disease. The immune system may be doing its best to attack the problem but causing a secondary problem in the joints at the same time. This can happen with several infectious agents.
Most of the immune mediated arthritis diseases are treated with corticosteroids or other immunosuppressive medications. As you can well imagine, suppressing the immune system if an infectious agent is present is not a very good idea so it is important to differentiate between septic arthritis and immune mediated non-septic arthritis prior to initiating treatment with immunosuppressive medications if possible. This can be difficult to do and sometimes it is just necessary to treat with antibiotics while awaiting joint culture results and to try to judge the response. At some point it generally becomes apparent that antibiotic therapy is not the answer and that
rheumatorid factor testing, through repeated joint fluid evaluation or response to therapy.
The hardest question to answer is whether or not these conditions are treatable. The answer depends on the cause. Immune mediated arthritis due to Lyme disease may respond to continued antibiotic therapy and pain relief medications. We have several patients with unexplained immune mediated arthritis conditions that have responded very well to corticosteroids. Rheumatoid arthritis is extremely difficult to treat successfully long term but can sometimes be managed. In my experience arthritis associated with systemic lupus erythematosus is not very responsive to treatment -- but this is based on limited experience.
Mike Richards, DVM
Q: Dear Dr Mike, I have a 4yr old chow-chow dog who was diagnosed with arthritic spurs in her front legs at the age of 14 months and she underwent surgery to treat a bilateral patellar luxation & hip dysplasia in both her hind legs about the same time. She is currently treated with Cartrophen injections or capsules on a six monthly basis - this is supposed to build up the synoval fluid in these joints. She does weigh around 31-32 kg and she is on diet to help reduce the weight. I only take her for short walks everyday approx. 75m & back; anything more & she tends to yelp/cry when getting up form the floor to walk. Please tell me whether glucosamine sulphate or shark cartilage can help reduce the arthritis and help strengthen her hind legs. Plus any suggestions on vitamin or herbal alternatives. Your advice would be greatly appecriated. (Couldn't find the active ingredient of Cartrophen used here in Australia, checked my Martindale book but couldn't find a listing) thank you, G.
A: As you suspected, Cartrophen is a brand name not used in the U.S. to the best of my knowledge, so I can't really be sure what it is. Despite that, I think it would be acceptable to use one of the glycosamine products in conjunction with it since they appear to have almost no safety risk associated with them. I think that we still do not have sufficient scientifically based information to really say whether or not glycosamines work and even less information on shark cartilage but given that these are safe to use, I feel it is worthwhile to try them.
I still like aspirin as my primary anti-arthritis medication since it has both anti-inflammatory and analgesic properties but not all dogs can take it without GI upset. If you dog can, it is inexpensive and it is effective in many dogs. Carprofen was just approved in the U.S. under the brand name Rimadyl (Rx) and it is less likely to cause GI problems and is very effective in many dogs. Either of these medications can be used long term if necessary.
I am not well versed in herbal medicine and can not make recommendations in that regard. If you do elect to use herbs please consult with a veterinarian familiar with their use as there are potential interactions with medications in some instances.
Vitamin E is reported to have moderate anti-inflammatory properties and it does seem to help several of our patients. We use 2000 IU/day/dog for dogs over 50 lbs. It is a good idea to take a week or two to build up to this dose, though.
Weight control is the single best thing you can do for a dog with arthritis, as you also seem to know already. It can be difficult in a dog that is not exercising much but it is worth the effort. It is all natural, very effective and almost entirely free from side effects! Keep working on this.
Hope this helps.
Mike Richards, DVM
Glucosamine and Chondroitin for arthritis:
Q: Dear Dr. Mike, I have a 10 year old Lab who has osteoarthritis, after walking a couple of miles she usually will carry her hind leg. We have been to the vet several time in the last couple months and she has had X-ray done on her hips to determine the severity of the arthritis. The vet doesn't believe that she is dysplastic nor does she have any problem with her spinal cord or elbows. We have tried several drugs such as asprin, phenylbutozone, and now we are on Rimadyl. This seem to eliminate most of her pain. I have recently read about some clinical trials with glucosamine and chondritin on humans suffering osteoarthritis and was wondering if you would suggest this as an additional method of treatment. I was also wondering if it was available without a prescription since it is a food supplement and would you suggest administering it concurrently with the rimadyl.
A: It is hard to tell you much about glucosamine and chondroitin that is scientifically validated. These products are used widely in veterinary medicine and it seems likely that that work for at least some dogs based on their popularity. Unfortunately, when evaluating medications for pain relief and for for chronic debilitative conditions there is a strong desire for the medications to be effective and a high "placebo effect". As an example, in the clinical trials for Rimadyl (Rx) the placebo group was estimated to have improved by 15% of the veterinarians and 25% of the clients. On the other hand, these products appear to be safe to use, so why not try? That is the basis we work on in our practice. To the best of my knowledge there should be no problems using these products in conjunction with carprofen (Rimadyl Rx). My personal experience with glucosamines (we have not used chondroitin) is that about half of the owners feel that it makes a significant difference. This seems a little higher than one might expect with a placebo alone so I tend to think they work for some dogs - but have no real proof of this.
Mike Richards, DVM
Q: I have a 13 year old golden retriever/collie mix...weight 110 lbs. He has been diagnosed with osteoarthritis in back right hip which, as expected, is getting worse. He has been on numerous drugs to help with the pain and stiffness and most recently is taking Rimadyl along with dexazone (cortisone). He had been doing fairly well but going up steps was becoming a problem (fortunately, I have a ranch style home) so I had a ramp built to get from the outside into the house after walks. But on Jan 1, he took a fall and since that time, he is severly lame. Some days are better than others but most days he needs assistance lifting his back legs up and then he needs support under him to walk (I use a towel supporting his belly and help him walk). However, the lack of mobility has caused the muscle in his right hind leg to atrophy. When he walks, his paw is bent over in half (ie., his "toes" are bent underneath the foot) and sometimes he drags his one hind leg. My vet has said that when the weather changes, this situation should improve. He has suggested that I do range of motion exercises and messages to his leg/hip which I am doing. Obviously, I love my dog, Brandy, very much and I want to make sure that I am doing everything possible to help him. His appetite is still good (on a prescription diet food to help reduce his weight); he is alert and attentive; he does not seem depressed. Your comments and suggestions will be much appreciated.
A: The "knuckling" of the one rear leg can be a sign of nerve damage, which would be a little different than the arthritic condition previously being treated. The nerve damage could be to the sciatic nerve or possibly to the nerve roots coming from the spine. If this is the case, recovery may occur but it becomes less likely the longer the signs remain. It is sometimes very hard to tell if nerve damage is present when there is chronic degenerative joint disease since the atrophy and sometimes even the posture can also occur over time from that problem as well. There is not much else you can do if nerve damage is present, unfortunately. Some people believe that Vitamin E is beneficial in doses up to 2000 IU/day for degenerative neurologic conditions of older dogs. It is not too likely to be harmful, so we do try it pretty often. I have to admit that I really don't know if it ever helps, but sometimes it seems to. This is also a time we consider use of the "nutriceuticals" -- food products like Arthroflex (Rx) or Cosequin (Rx) which may be beneficial in chronic debilitating conditions. Weight loss might help your dog. Keeping an arthritic dog thin is one of the best things you can do to alleviate the clinical signs of arthritis but it is also a very hard thing to do, especially in a dog in which you can not encourage more exercise and are using corticosteroid medications. If it is possible, it could be beneficial. I wish I had better suggestions for you.
Mike Richards, DVM
Q: Dear Dr. Mike, My friend has a golden retriever that has osteoarthritis and has been prescribed Rimadyl by her vet. The dog is 11 or 12 years old and gets very weak after a short walk. She would like to know if she should continue the exercise and to what extent. She would also like to know if there is anything that she can do to keep the dog comfortable ie. ice packs, heat, massage etc. Any suggestions you could give her would help, as her main concern is to keep her comfortable .
A: There are a number of non-medical things that can be done for osteoarthritis problems. Dogs are just like people --- they respond well to warming a sore joint in many cases, they are comforted by touch, moderation in exercise is better than not exercising or intermittent hard exercise and they do better if they know that someone cares about them.
Given all of that, your friend's dog has some advantages. She does seem to care and I bet she wouldn't mind gently rubbing the sore areas for her dog. Finding a way to provide a warm bed on cold nights is helpful. Using a warm compress can be beneficial if her dog likes it. Once in a while a dog does seem to respond better to icing a sore area but in chronic conditions heat works better most of the time. Consistent use of anti-inflammatory pain relief medications like aspirin and carprofen (Rimadyl Rx) helps a lot. Some people believe that using Vitamin E or glycosamines (Cosequin Rx, Arthroflex Rx, etc.) is beneficial. They are not likely to be harmful, so it seems reasonable to try them.
Lastly, it is a good idea to be sure that osteoarthritis is the problem. It is easy to assume that it is the problem in older dogs since it is probably the most common cause of lameness and weakness in older dogs. Still, it is best to confirm the diagnosis with X-rays if at all possible. Once in a while, something else is going on that gets missed because a problem like arthritis is present.
Hope this helps!
Mike Richards, DVM
Chronic back problems in Sheltie
Q: Dr. Mike: I have a nine year old female sheltie who has had intermittent arthritis problems since the age of two. Last week she started walking with an arched back and slightly rigid tummy muscles. I took her to my vet and we agreed to wait 24 hrs before atttempting any therapy. (The dog was eating and eliminating normally.) On the second visit the vet X-rayed Kelsey's spine and we discovered that her limping and assumed dysplasia were most likely due to chronic back problems--some separation and scarring in the thoracic vertebrae. The vet gave her cortisone and amitol(?) IV and prescribed 35 mg rimadyl twice a day. The dog is obviously not in as much distress as she was, however I have noticed that her rear legs are much weaker than they have ever seemed before. Her feet slide out from under her on our tile floor when she attempts to turn or move faster than a cautious walk. She's much steadier on the carpet or in the yard. We are carrying her up and down any and all steps and keeping her on flat surfaces outside. My vet suggests waiting several days to see if the weakness improves. Do you have any experience or information about rimadyl and limb weakness? I'm hoping there is not a connection as my vet is set against giving the girl any more aspirin for fear of gastrointestinal bleeding. He is impressed with the research on rimadyl, but I have some concerns about putting an older dog on a new drug when aspirin (buffered) has worked fine for nine years. I'd appreciate your input.
A: The current information available on carprofen (Rimadyl Rx) suggests that it is pretty safe. I do not recall mention of weakness associated with its use in the package insert or in any literature I have seen. It probably has more pain-killing effect than aspirin does but it may not have as much anti-inflammatory activity. Sometimes it is good to use a stronger pain reliever for a few days to help relieve muscle spasms associated with pain or just to let your dog rest comfortably. On the other hand, if aspirin works it is less expensive and it has been used very long term in many dogs without serious secondary effects. It may not be a necessity to change to a new medication. I'd just give it a few days to see how it works and make up your mind about which medication to continue with based on that experience.
If the weakness gets worse or particularly if paralysis occurs it may be necessary to provide more than pain relief. Don't delay in contacting your vet if this happens.
Mike Richards, DVM