Rheumatism, Rheumatism, How It Pains

Greetings Bored Surfer!

I must beg your pardon for the late publication of this latest edition of BLOG blog. Alas my muse has been elusive as of late, which makes it difficult to write amusing compositions. Nevertheless, I present the eagerly awaited February contribution to the blogosphere.

Welcome to the festive month of February! The 2nd was, of course, the Day of the Magnificent Punxsutawney Rodent. He has predicted an early spring, but he has been wrong before (many times, actually, in the past 134 years). National Weatherperson’s Day is on Feb 5, presumably because they don’t want to share billing with a groundhog. February 12, 1809 was the birthdate of both Abraham Lincoln and Charles Darwin (as well as a bunch of lesser known people). Though better known for cards, chocolate and dead gangsters, Feb 14 is also the birthday of George Washington Gale Ferris Jr, the civil engineer who created a large, wheel-shaped ride for the 1893 Chicago World’s Columbian Exposition. Though he was born on Feb 22, George Washington’s Birthday is officially observed on Feb 17. Since it is also known as Presidents Day and it coincides with Random Act of Kindness Day this year, it must be a ploy to recognize Jimmy Carter. This year, Mardi Gras is on the fat Tuesday of Feb 25 and Rare Disease Day in on the rare day of Feb 29th.

Rheumatism is an antiquated word that referred, in songs and literature of yore, to a variety of muscle and joint conditions. Nowadays, these conditions, generally characterized by pain and inflammation, all fall under the umbrella term “arthritis”. The most common types are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is a painful disease that is a result of one’s immune system attacking the lining of joints and causing damage. Despite the large number of pharmaceutical ads related to this condition, it is not as common as osteoarthritis.

This blog shall be limited to the discussion of osteoarthritis, hereafter known simply as arthritis. Arthuritis, by contrast, would be the inflammation of an Arthur, such as a certain bespectacled cartoon aardvark, the 21st President of the US, a Dudley Moore movie or the king who used the holy hand grenade to slay the killer rabbit of Caerbannog. For the remainder of this blog, I shall refer to your pet as Bedevere, in honor of King Arthur’s companion played by the late, great Terry Jones.

According to the American College of Veterinary Surgeons (acvs.org) osteoarthritis affects approximately a quarter of the canine population. It is a chronic disease characterized by loss of cartilage, thickening of the capsule and the formation of new bone (osteophytes) around the affected joint. In dogs, it is most commonly a secondary result of a developmental orthopedic condition like cruciate ligament disease or hip dysplasia. Arthritis in cats is not as well understood. The prevalence is not well documented, although it does seem to increase significantly with age.

Arthritis is also called Degenerative Joint Disease (aka DJD), a chronic inflammatory condition affecting the anatomical meeting places of bones, like the hip joint. The latter would be the condition of smoking weed in a trendy, disreputable establishment (the flammation of a joint in a hip joint).

Cats, and to a lesser extent dogs, tend to downplay their pain to avoid showing weakness. In the case of sudden sharp pain, they may vocalize. In the case of chronic pain, their reaction is often limited to subtle behavior changes that indicate decreased function and mobility. It may appear Bedevere is getting old and lazy, but he may be spending the vast majority of his waking hours on the couch because it hurts to move around. Or maybe she has a Netflix addiction. Here (courtesy of AAHA) are some signs that may indicate your pet is in pain:

A new or increased reluctance to walk on a slippery surface – Healthy dogs can use the strength and balance of all 4 limbs to stay upright. If one leg slips, they can use the other three to compensate. If they have 2 (or more) weak or painful limbs, they are less able to adjust their balance and more likely to fall. Dogs quickly learn to associate the slippery surface with an increased chance of falling and do their best to avoid that situation. They also tend to stay home during the most dreaded of precipitations, freezing rain.

Trouble with stairs – For quadrupeds, gravity tends to shift the majority of the body’s weight to the rear when going up and to the front when going down stairs. Some Bedeveres may refuse to use the stairs. Some may only go up (or down) when absolutely necessary and/or require a lot of coaxing to do so. It is also possible that Bedevere is reluctant to go upstairs because she has watched enough horror movies to know one shouldn’t go up there.

Unwillingness to jump – Bedevere may not be willing or able to complete jumps (usually onto furniture or into the car) that were previously performed with relative ease. Cats may start sleeping in different spots that are easier to reach.

Trouble getting up – Most dogs get up hind-end first (like a cow). If their rear legs are painful, they may compensate by getting up front-end first (like a horse). Cats may struggle to get up and /or have difficulty stretching.

Trouble lying down – Many dogs circle as they seek the ideal spot and position to lie down. Dogs that are painful may prolong this ritual. Frequently, it is difficult for an arthritic dog to lower himself into position. She may also avoid resting on a particular limb. A cat with mobility issues may get up and lie back down repetitively. He may also sleep in a less curled position than she once did. These signs could be due to pain or perhaps your failure to fluff Bedevere’s pillows to his satisfaction.

Decreased activities – A lack of normal behaviors can also signal pain. Dogs may do less running and jumping. Cats may be less active at night. They may also groom less and not sharpen their claws. Signs like decreased appetite or a noticeable decline in overall activity and/or endurance could result from a variety of medical conditions. If you notice Bedevere is not acting like her normal self, you should get him checked by your vet.

Changes in social interactions – You may notice Bedevere doesn’t initiate play like he did in the past. This is often a gradual process and may not be obvious unless you are comparing the Bedevere of today to that of a couple years ago. To the surprise of no one, feline reactions vary greatly. Some cats tend to hide more; others seek more affection.

Onset of aggression – This may manifest as Bedevere growling (or hissing) and snapping at other animals (or people) with whom she had previously had only friendly interactions. Dogs may also develop an aversion to being groomed or petted. Cats may avoid being handled or picked up. Being old and crotchety may be a state of mind, but it can also be due to physical discomfort.

Sleep disruption – Even when a painful dog manages to find a comfortable sleeping position, they often cannot maintain it all night. After being immobile for a few hours, they need to get up and move around. Then they have trouble finding another comfy sleeping position. This nighttime activity is disruptive to their rest as well as that of any light sleepers in the household. It is unclear whether these nocturnal waking periods allow Bedevere to see auras and the little bald doctors or if animals see them all the time anyway.

House-soiling incidents – It can be difficult for Bedevere to access the designated area for the performance of bodily functions, especially if stairs are required. Cats may have trouble accessing the litterbox due to its location or size. Decreased mobility and flexibility also make it harder for Bedeveres to assume the proper position (aka squat).

While symptoms of arthritis will vary, the underlying cause is pain. We are not able to cure the disease but we can manage it and improve Bedevere’s quality of life.

There are several different approaches we can take to treating the pain, and most patients benefit from a combination of therapies. The 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats was a vital source for much of the following information.

It’s a heavy topic because it matters. (Hey – that’s a nice turn of phrase. I may use it for a future BLOG blog.) Helping Bedevere lose weight can be quite challenging, but it is a very important (perhaps the most important) part of managing arthritis. More weight causes more wear and tear on the joints. Also, fat cells can secrete certain proteins (cytokines) that contribute to degenerative joint disease and the hypersensitization process. In many cases, a prescription diet from your vet can be very helpful in the weight loss process.

Non-Steroidal Anti-Inflammatory Drugs (aka NSAIDs) are often effective at providing pain relief for dogs. There is a possibility of side effects, so we try to use the lowest dose that is effective for a particular dog. Cats are not only very sensitive to these medications but also more likely than dogs to have kidney disease, so an extra dose of caution is warranted when using these medications in felines. Other medications that work in a different manner to reduce pain (such as tramadol or gabapentin) may be added if an NSAID alone is not providing adequate pain relief.

While its exact mechanism of action is not known, Polysulfated Glycosaminoglycan has been shown to be safe and effective. This is a disease-modifying osteoarthritis drug that is administered by subcutaneous injections on a regular basis with decreasing frequency. There is a product (Adequan) approved for dogs. Its off-label use in cats has shown some promising results.

Nutritional supplements may be helpful. Although there are plenty of anecdotal success stories in people and dogs, the research results for glucosamine and chondroitin use are quite variable. Omega- 3 Fatty acids (EPA in particular) have reliably been found to be beneficial for arthritic dogs and cats. There are products like Dasuquin Advanced which combine these nutraceuticals into a chewy treat. There are also veterinary diets that include these substances at therapeutic levels and have been shown to increase mobility.

Physical Therapy – Therapeutic exercise can help restore musculoskeletal strength and function, flexibility and balance, as well as reducing pain. There are Certified Veterinary Rehabilitation Therapists (think a physical or occupational therapist, but for pets) who can develop a regimen suited to your Bedevere’s particular needs.

Acupuncture is an accepted treatment method for painful pets. It is safe, minimally invasive, and not uncomfortable for pets. This service is available at select vet clinics, including several in the Omaha area. It does make one wonder what would happen if you used acupuncture needles on a voodoo doll…

Some other modalities that may be help Bedevere are massage and therapeutic laser. The same cannot be said of chiropractic and homeopathic remedies as they have not been proven successful in the treatment of arthritis in pets.

If possible, consider making some modifications to Bedevere’s environment. Pets with limited mobility may appreciate good traction, ramps and well-padded bedding. For cats, make sure they have a spacious litterbox on every floor of the house. Also make sure the box has at least one low side, to allow easy access for your cat. Elevated food bowls may be helpful for cats as well as dogs. Special harnesses are available to assist you in lifting and stabilizing your dog with minimal stress.

Avoid overexertion. Mild to moderate activity is beneficial for joints and for weight maintenance. To avoid exacerbating the pain and inflammation, high impact activities like running and jumping should be limited. Consistent low impact exercise (like regular leash walks) can promote stability by building muscle around the joint. This may be difficult if you have a particularly energetic dog. Bedevere may need to give up hunting and take up swimming. You may need to get very small, slow-moving, cooperative sheep for your herding dog.

Remember that human medicines can be toxic to pets. Please do not give Bedevere aspirin, acetaminophen, ibuprofen, naproxen or any other pain reliever designed for humans unless specifically directed by your veterinarian. Cats (and dogs, to a lesser extent) react differently to these medications than humans do, usually to their detriment.

Hopefully you can implement some of the above measures to help Bedevere enjoy his golden years without having to move to a hot climate like Arizona or Duma Key. If you have an elderly Bedevere (or a young one for that matter) who may be experiencing the discomforts of osteoarthritis, talk to your vet about the best approach to managing it.

I must now bid you adieu, Bored Surfer. Enjoy February while it lasts, and be ready for another delightful BLOG blog in a few short weeks. In the meantime, if you are in The Circle City of California, drinking a Mexican beer, beware of the corona. After all, staring at the outermost layer of the sun’s atmosphere is bad for your eyes.

I apologize again for the late appearance of this BLOG blog.

I also feel the need to blame its tardiness on authoritis.

Dr. Debbie Appleby