Holistic Arthritis Management: Cure Your Pets Pain
There is so much that can be done for your arthritic cat or dog that does not involve giving them drug medications, and every holistic treatment plan should include some or all of the things I'll discuss with you today. Arthritis treatment must consider the whole animal as well as their environment.
Once arthritis has been diagnosed, (you can read about arthritis symptoms and diagnosis here) a lot of people want to know if there is anything that can be done for their pet with arthritis that doesn't involve giving them drugs. The short answer to this is yes. While drugs are by far and away the most effective form of treatment there are also plenty of other options that can either delay the need to start these, or that can mean we get away with giving them at a lower dose.
After diagnosis, a long term structured treatment plan needs to be formulated. We need to keep in mind that we are treating rather than curing the condition, as well as the fact that arthritis is a progressive disease. This means that what may work at first will need tweaking and changing as our pet ages and their disease becomes worse.
Now is also a good time to take some baseline blood and urine tests. We do this for two reasons. The first of these is that our arthritic patients are generally older and so there is always the possibility that they are suffering from another condition that would be good to know about before treatment is started. The second reason is that in rare instances, a patient may experience a significant drug side-effect and this initial blood test will provide a base-line against which future monitoring tests can be compared.
The treatment plan
A treatment plan is not just a case of starting a single medication and continuing with it indefinitely. Instead a holistic approach needs to be taken. This involves a process of evaluating many different options and introducing those felt best suited to each individual cat or dog. There is no one size fits all approach and it is only after a considered discussion between you and your vet that an appropriate strategy can be decided upon. This treatment plan will likely consider:
lifestyle + exercise
Lets work through the list of drug free options available and how they may form part of an overall arthritis management plan. Some options you are likely to be very familiar with while others you may not have considered.
One of the most important if not the most important treatments of arthritis is weight loss in those patients who are overweight or obese. We know that a weight loss of as little as 6% can result in a significant improvement in comfort levels in overweight arthritic pets. The more they lose the more comfortable they get. This improvement may be enough to avoid the need for multiple drug treatments and so is an ideal first step. Weight loss will improve the health of arthritic pets in many other ways too.
Check out our obesity series to answer the following questions:
Exercise and physiotherapy
Next on the list comes exercise and physical therapies. We know that an excess of exercise will make an arthritic individual more stiff and painful. Conversely, no exercise at all will also result in our patients seizing up and likely gaining weight so we need to strike a good balance. This may be a 20 minute walk off lead twice a day for some but may be limited to 10 minutes 3 times a day and on a lead in others.
What should certainly be avoided in any arthritic patient is one off days of extreme exercise such as the dog who stays in the house all week but then goes on a 10 km run with their owner at the weekend. They may enjoy it at the time but they will certainly suffer over the following days. It is the impact and stresses on the joints caused by exercise that is responsible for making things worse and so we should avoid high impact activities such as ball chasing where rapid acceleration, quickly changing direction, sudden stops and jumping all result in a massive increase in the forces a joint experiences.
For cats this may mean chasing a mouse on a string is OK but flying around a room after a laser to is too much.
There are other ways of providing low impact exercise, perhaps the best one being hydrotherapy with physiotherapy and massage therapy also helping to maintain muscle condition as well as help prevent the range of motion of a joint from reducing. These exercises and stretches are best formulated by consulting a veterinary physiotherapist who will come up with an exercise plan best suited to your individual pet. This therapy will also have an impact on comfort levels and so help to reduce the need for additional drug treatments or allow a lower dose of drug to be used.
Managing the environment
Next on the holistic treatment plan list is environmental management. These are generally quick, easy and cheap solutions that can add greatly to an arthritic animals comfort and well-being. When thinking about these changes, put yourself in your pets shoes and you will understand how much difference they might make. Lets start with bedding. Warm soft thick bedding will reduce pressure on painful joints and help prevent them seizing up after a rest. Beds with a soft lip or even fully enclosed (amazon links) that are still easy to get in will help contain warmth and reduce drafts which will further improving their benefit. Want the best for your pet? A memory foam bed with sides can't be beat!
Along the same lines, insulating and draft proofing the bed area (be it in the house or kennel outside) are simple changes that can have a huge impact. In cold weather an insulated, warm, waterproof jacket will keep your dog nice and cozy warm. In the same way using heat pads for the bed or heat packs on the affected areas can help ease the symptoms of arthritis. Heat can help as it causes dilation of blood vessels. This increases oxygen and nutrient delivery to the joint and surrounding tissues easing stiffness and encouraging healing. Heat can also reduce the transmission of pain signals to the brain. Any heat pack used should be warm but not so hot as to cause discomfort or even burns. It also needs to be in place for around 15 to 30 minutes to really make a difference to the deeper structures of a joint.
Conversely in an acute injury or a sudden deterioration in comfort in an arthritic individual, cold packing should be used for the first few days to limit swelling and inflammation before then applying heat over the following days.
The final consideration for environmental management is the fact that jumping, steps and uneven ground can all pose problems to arthritic patients. This means that other modifications to their environment to consider include having ramps to get up stairs or into the car. This can also save our backs as lifting a Labrador is not much fun at the best of times.
If you have an arthritic cat then having bedding, food and water options in low accessible locations is really important. Ensuring cat flaps are appropriately located is vital and finally using shallow rather than deep litter trays that are in easily accessible locations can help prevent unwanted accidents.
Dietary supplements (do they really work?)
Dietary supplements may be the next addition to the treatment plan. The best of these are the essential fatty acids. Omega 3 fatty acids which are also known as EPA and DHA are the first group of supplements to consider. These omega 3 fatty acids have a well recognised anti-inflammatory effect and by reducing inflammation, pain levels are also reduced. These fatty acids are found in various oils such as fish oils and flax seed oils and they are also added in specific ratios to prescription joint diets.
There is very good evidence that these diets significantly improve comfort and mobility in arthritic cats and dogs and as such they can be recommended to any arthritic individual. In fact when considering all of the neutriceuticals or dietary supplements it is these diets for which there is the best evidence of a positive effect. It is worth mentioning that if your pet is being fed one of these prescription diets there is unlikely any benefit in providing an extra dose of fish oil and in fact doing so may actually reduce the benefit of the diet by changing the fatty acid ratio.
Green lipped muscle extracts and glucosamine and chondroitin supplements are the other major dietary supplement considered by most people. The evidence that these actually work is less strong than you might imagine with there being a lot of contradictory studies and with any potential benefit seen being more modest.
Green lipped muscle also contains essential fatty acids so much of the reported improvement may be due to this component.
Glucosamine and chondroitin are components of normal healthy cartilage and joint fluid. The theory is that by supplementing them we are providing the building blocks to optimise joint health. The plus points of glucosamine and chondroitin supplements is that they are very well tolerated with no significant side-effects apart from cost. If any benefit is going to take place then it can take some time to see. If this treatment option is explored then it is important that enough time is given for a benefit to be appreciated. This may be for as long as 3 months or more.
I personally feel that some individuals benefit a lot from these supplements but in many instances there is a more modest benefit seen (or alternatively no improvement at all). All this means that while they can be worth trying, where funds are limited they are better spent on different treatment options that undoubtedly work better. If an arthritic animal is on one of these supplements but is still showing signs of pain then they should either be switched to a more effective treatment or another treatment should be given at the same time as these supplements.
Glucosamine supplements are often put forward as the be-all and end-all in arthritis treatment but this is definitely overstating the fact.
Polysulphated glycosaminoglycans are another option for the treatment of arthritis which I tend to think of as an injectable supplement rather than a true drug (although you could easily argue against this). This substance is said to be a stimulant for new cartilage matrix production while at the same time slowing ongoing breakdown and improving blood supply. It is administered as an injection and given once a week for 4 weeks. This treatment course can then last for as long as 12 months although generally lasts less than this with various strategies being used for long term treatment. The data sheet typically suggests always using the drug in a course of 4 injections however the drug is frequently used differently such as by giving a regular monthly top-up injection. It all depends on a patient response and individual need.
This is one drug where veterinary experience can be a bit mixed with some vets claiming excellent results and others seeing minimal improvement when used in their patients. The published evidence is also varied. One literature review summerises there as being either weak to no evidence to support its use, while the other reports at most a moderate comfort level that polysulphated glycosaminoglycans have a benefit in the treatment of arthritic patients. Personally I've found results to be very much hit and miss with those patients most likely to respond being in the earlier stages of the disease.
It is certainly also possible that any improvement relates more to the placebo effect, or other management strategies started around the same time as the injection course. Again though, this option is very well tolerated with side-effects being very rare. It is said to have anti-coagulant properties and so should be used in caution in any animal with bleeding tendencies however I believe that the real risk of this is most likely very low.
There are other, what I will call "alternative" treatment options available that may or may not be beneficial. These include acupuncture, laser therapy and stem cell treatment. Lets just say the jury is still out on these. Acupuncture may have a slight benefit though much could be due to the placebo effect, something which absolutely can affect our assessment of interventions in cats and dogs. Laser therapy seems to be a growing trend though I have yet to see anything that convinces me any claimed effect is real and again not just wishful thinking. Studies are limited but a recent review on human knee osteoarthritis concluded that low level laser therapy was ineffective. Watch this space, as the treatment develops then newer therapeutic regimes may prove more effective.
Stem cell therapy is also starting to take off in both human and veterinary medicine. This is a cutting edge technique, and while early reports are promising, we are still very much in the early days of this treatment. This means we are still working out if it actually works and if so what the best way to collect the cells is as well as well as the best route, dose and frequency of treatment. By all means consider this treatment if it is available to you but be aware that the risks and benefits are still relatively uncertain. In a few years it may be a treatment that we use all the time in every arthritic patient but we are not there yet.
As you can see there is so much we can be doing for our patients with arthritis that doesn't involve giving drugs. These strategies do not replace the use of pain killing medications but they might delay the need for them to be started or allow a lower dose to be effective. With arthritis being a progressive disease though it is likely further treatment will be needed sooner or later. It is this that I will discuss in the third and final article in this series and discuss with you the truth about drug treatment of arthritis.
I hope this article has given you some useful measures that you can discuss with your vet and implement in your own arthritic dog or cat. If you have any questions, tips of your own to share, or if there is anything you would like covered in future articles please leave a comment below. I would love to hear from you. Also consider signing up to our newsletter so you don't miss out on future content and let me continue to help you and your pet.
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