I can’t even begin to guess how many times I have heard “oh no doctor, he’s not in pain. He’s old. That’s how old dogs walk.” Unfortunately nothing could be further from the truth. Older dogs (and cats too) feel the wear and tear of their advanced years in their spines and joints. Many of these pets experience chronic pain. Chronic pain is under-diagnosed and under-treated especially in small dogs and cats. Fortunately, there are many tools available. Many of you know that I hate pain. I consider it an enemy to be vanquished whenever it rears its head.
Signs of pain:
- difficulty rising
- Stiff/slow gait
- limping
- licking sore area
- crying/whining
- eating less
- circling/not wanting to lie down
- behavior changes (grumpier)
- Difficulty jumping
Not keeping up with you on walks/reluctant to go on walks
If your pet has pain, the first step is to bring him in for an exam, We will feel all joints, spine, bones, and muscles. We will conduct a neurological exam to look for problems, and evaluate stance and gait (walk and trot if possible). Based on the exam, we might recommend other tests such as radiographs (x-rays), joint aspirates, ultrasound, or laboratory tests. Once we identify a specific cause of the pain, we create a treatment plan.
Treating pain
1. Non-steroidal anti-inflammatory drugs (NSAIDS) are oral medications that reduce pain and inflammation all over the body. They generally work very quickly. But they are not without risk, including stomach problems, vomiting, liver or kidney problems, and blood clotting issues. The goal if these medications are used is to find the minimum effective dosage. Lab work is required on a regular basis to make sure the medication isn’t causing issues. These are commonly our first line treatments. Commonly used ones are Rimadyl/carprofen, Metacam/meloxicam, Previcoxx, and Deramaxx.
2. Tramadol is a narcotic-like drug. Side effects are minimal and we get fairly good pain control. It is rapid acting, inexpensive, and fairly safe. But it needs to be given every 8 hours (optimally) and becomes less effective over time. Can be combined with NSAIDS safely. First line drug when other health issues make NSAIDS riskier.
3. Gabapentin is an anticonvulsant that is also very useful with spinal or orthopedic pain. Not strong enough on it’s own, it can help make other pain control more effective. It can be combined with NSAIDS and/or tramadol.
4. Adequan is an injection that helps repair diseased joints and cartilage. It is given twice weekly for a month and can be repeated if needed down the road. In order to work, some functional cartilage needs to be present. Can be combined with oral pain control above.
5. Cerenia is an anti-nausea medication, but it also has potent pain reducing properties. Unfortunately, no generic is available making it quite expensive for long term use on large dogs. It also cannot be given every day, but on a several days on and several days off schedule to prevent side effects. We generally use it when short term control is required or near end of life.
6. Chondrotin sulfate/glucosamine/MSM are dietary supplements that help to support cartliage like Adequan. They usually take 4-6 weeks to start working, so sometimes we start along with Adequan. Please be aware that as a dietary supplement, there is no governmental oversight to ensure safety or effectiveness. We recommend Dasuquin or our Joint Protect supplement which have been independently tested.
7. Herbal remedies can be used as well. They can be used alone or in combination with medications. They are more unpredictable as to effectiveness, but my previous dog actually fared better with herbs than medication. Herbs can come from the United States or China. Due to heavy metal contamination of herbs from China, these are strongly discouraged.
8. Omega-3 fatty acids reduce pain and inflammation. Their potency is weak, so they are combined with other therapies. In choosing a supplement, we need maximum potency and safety. We advise a supplement with the NASC seal of approval, like our OmegaVet.
9. Weight loss is essential. Extra weight increases wear and tear on joints. Also, fat increases inflammation from any cause. Nutritional evaluation helps determine optimal calories and protein content based on your pet’s needs. Over the counter weight loss diets generally are too low in protein and lead to muscle loss-the opposite effect we want.
10. Laser therapy helps to reduce pain, inflammation, promote healing, and enhance nerve function. I have used laser therapy to overall great success for about 5 years now. Typically we do 6 sessions over 3 weeks, with followups as needed. Laser works with other therapies or by itself. There is an article on laser therapy on our website.
11. Physical rehabilitation is a type of therapy commonly used in humans recovering from injuries or surgery (physical therapy). We can perform similar therapies in pets, which can include cryotherapy, joint mobilizations, TENS electrical stimulation, massage, and exercises. I am certified in rehabilitation therapy and we will be getting more and more tools to use in coming months. Many therapies can be performed at home.
12. Stem cell therapy is harvested from the pets own fat cells. It has proven to be of great benefit but is very expensive. A newer therapy has been perfected that has similar results which involves injection of concentrated platelets from the patient’s blood. These platelets contain proteins that are potent aides in healing.
13. Surgery is sometimes an option. There is no such thing as a pet too old for surgery. But we certainly need to make sure the pet is a good candidate, as older pets may have hidden conditions which could lead to complications. Sometimes once everything else has been tried or if the pain is severe, surgery is the only option. Torn cruciate ligament (ACL) tear, herniated discs, and severe hip dysplasia are common conditions that surgery is extremely effective at correcting.
14. Braces/splints/slings/carts are all used to reduce pain and improve mobility. Psychologically, pets do better when they can perform the activities of daily living. They are all customized to the pet. While labor-intensive, they can make a huge difference in a pet’s life and allow them to enjoy activities with their owners.
15. Hospice/euthanasia is a last resort when all avenues have been exhausted. If we cannot keep your in a good degree of comfort, then sometimes we have to say goodbye.
As you can see, your stiff dog or cat is telling you something, that they need help. Now you know that there are many treatments available and that no pet needs to live in pain or discomfort. If you think your pet is painful, please bring him in for an evaluation.
Dr. Horn