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STOP! You Have The Power To Control Your Dog’s Arthritis Suffering...
…But It MIGHT NOT Be By Giving The Medication Your Vet
Recommends
Your dog is suffering the pain of dog arthritis and you feel helpless.
Before you begin a NSAID treatment program for your dog, you need to read
the important information in this e-book. There are potential side effects. You
could end up impacting your dog’s health and NOT the way you intended! While
there is a place for NSAIDs, and I do recommend them in those instances, they
are not the end-all when it comes to treating dog arthritis.
I know. I’m a vet and I’ve dedicated much of my career to treating dog arthritis.
I’ve seen treatment miracles, and I’ve seen treatment failures. I’ve seen the
unexpected side-effects of NSAID treatments. Yet I have also seen the NSAIDs
bring dogs back from the brink of euthanasia.
These prescription drugs fall into two categories: pain killers and anti-
inflammatory drugs, mainly the non-steroid anti-inflammatory drugs (NSAIDs).
While prescription medication will be central to the treatment plans I suggest,
there are times when I do not recommend NSAIDs. It’s important to your dog’s
health that you know why I feel this way. Very important.
This e-book (and its follow-on book) focus on the medical treatment of dog
arthritis, specifically the prescription medications. But it also details available
supplements you should know about. In my many years of treating dog arthritis,
I have found that the combination of these medicines and supplements creates
a powerful regimen that can greatly reduce your dog’s pain and suffering.
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Please read this book carefully. It’s not very long. In fact, it’s only 25 pages of
just-the-facts information designed to help you make an informed choice about
treating your dog’s arthritis.
And if you want to be truly informed about the most up-to-date dog arthritis
treatment medication, I urge you to read the follow-on from this book:
Modern Dog Arthritis Treatment – Advanced Medical Therapy for the
21st Century.
Also keep in mind that I am mainly discussing medical therapies - this e-book is
not intended to be an all-encompassing plan for dog arthritis treatment. There
is much more you need to know so you can best assume the role of guardian
of your dog’s health. I encourage you to visit www.DogArthritisBlog.info and
download the Dog Arthritis Survival Guide from the Members Section. It’s free!
One last request. Please feel free to share this e-book with anyone you know
who is also struggling with making the right decisions about how to treat their
dog’s arthritis. We dog owners have to stick together.
Christopher Durin
Christopher Durin, Veterinarian
Page IV
Acknowledgement
This book builds on the work of Dr Lester Mandelker DVM, who has researched
and pioneered much of what we know about concepts such as oxidative stress,
the scientific use of natural products and many of the modern treatments I will
suggest to you. He more than anyone made me think long and hard about the
use of NSAIDs in dogs and of ways to minimize them.
Copyright
All contents copyright (c) 2011 by DogArthritisBlog.info. All rights reserved.
No part of this document or the related files may be reproduced or transmitted
in any form, by any means (electronic, photocopying, recording, or otherwise)
without the prior written permission of the publisher.
Trademarks
This book identifies product names and services known to be trademarks,
registered trademarks, or service marks of their respective holders. They are
used throughout this book in an editorial fashion only.
Page V
Table of Contents
Prevalence of Dog Arthritis... 1
Prescription Medications & Dog Arthritis 2
The Side Effects of Prescription Medications 3
The Shift to More Natural Therapies 3
Understanding Dog Arthritis 4
Anatomy of a Dog Joint 5
The Disease Process of Arthritis 6
How to tell when your dog has arthritis 8
A Grading System for Dog Arthritis 8
Traditional Treatment for Dog Arthritis 10
A 21st Century View on Treating Dog Arthritis 10
Side Effects of Pain Killers... 11
Opioids (Narcotic Analgesics) 12
NMDA Antagonists (Pain Killers) 14
Cortisone (Steroid Anti-Inflammatory Drugs) 14
Prescription Glycosaminoglycans (GAGs) 15
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) 15
A Shift in Dog Arthritis Treatment Patterns 20
Trend towards natural medication 21
Shift away from NSAIDs 21
Does Your Dog Absolutely Need NSAIDs? 22
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Prevalence of
Dog Arthritis and
Potentially Harmful
Effects of Arthritis
Medication
Dogs are not just pets - they are
part of the family where they spend
a greater part of their lives bringing
joy to young children and providing
companionship to adults. A dog is still
‘man’s best friend’.
Just like human arthritis, dog arthritis, when left untreated, can be a debilitating
illness which reduces the quality of life for dogs. This leaves them unable to
perform basic activities such as walking, running, climbing short steps and even
going to the toilet.
Statistics show that NSAIDs kill more animals than any other class of pain
medicine, damage more vital organs than all other prescription medicines
combined and are responsible for the death of at least 16,000 people every year.
The US Food and Drug Administration (FDA) maintains an even higher rate of
NSAID-related deaths with approximately 20,000 deaths in the United States
alone.
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The Side Effects of Prescription The FDA and NSAIDs
Medications
In the US, the FDA has a
Veterinarians and pet owners are aware that
reporting system for adverse
arthritis management through medicines such
drug reactions (ADR). ADR
as opioids and NSAIDs (non steroidal anti-
is defined as “a noxious and
inflammatory drugs) significantly improves
unintended response to any dose
the condition of their dog.
of a drug (or biological) product
However many are concerned about for which there is a reasonable
prescription drug side effects including possibility that the product caused
vomiting, constipation, bleeding and internal the response.”
organ problems.
Currently, the FDA maintains
This concern is understandable given that reporting systems such as the
dog arthritis, very much like human arthritis, MedWatch where consumers and
is a lifelong illness with no known cure. Long healthcare professionals can report
periods of treatment expose dogs to serious ADR directly to the FDA.
risks that vets and pet owners must weigh up ADR reporting is mandatory for
before adopting a particular treatment plan. manufacturers who should submit
to FDA reports from consumers
and healthcare professionals.
The Shift to More Natural Unexpected ADRS must be
Therapies reported to the FDA within 15
Despite the effectiveness of these calendar days from the time the
prescription medications, many pet owners manufacturer became aware of
are now searching for natural and safer it. Thus, it is clear that while
substitutes. Some wish to avoid these drugs information on benefits of a
entirely, others are simply looking for options medicine is well controlled, the
to minimize their use if they can. Some dogs same cannot be said of its side
have known side effects from the NSAIDs, effects which are largely voluntary
some are already on other medication that and anecdotal.
interferes with the NSAIDs.
There are lots of reasons for people to move away from the NSAIDs! I can
show you how to do this.
Page 3
Understanding Dog
Arthritis
When exploring a treatment plan for dog arthritis, a clear understanding of this
disease becomes necessary to choose prescription medicines, supplements and
natural therapies that target the symptoms and disease processes of arthritis.
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The Disease Process of Arthritis
Arthritis develops when chondrocytes are unable to keep up cartilage production
against the constant wearing down and damage of cartilage. It is a complex
disease but our understanding is improving quickly. Here are a few key points:
Whilst cartilage has no blood or nerve supply bone certainly does. When the
cartilage is worn down to expose the bone the joint will become much more
inflamed and much more painful.
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Arthritis Starts With Cartilage Damage
Arthritis always starts with damage to the cartilage. Cartilage may be damaged
as a result of traumas such as:
You can find more detail about the causes of arthritis on my blog or in my
introductory e-book “The Dog Arthritis Survival Guide”. This is located within
my FREE Members Area for immediate download.
The release of these chemicals causes painful inflammation in the affected joint.
If severe, the loss of cartilage creates bone on bone contact within the joint,
which causes excruciating pain.
This will lead to more inflammation and poor communication between cartilage
cells, which makes their function very difficult.
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This cycle of cartilage and chondrocyte destruction will keep going. As more
chondrocytes are lost there is a reduced ability to produce new cartilage. Over
time more cartilage will be destroyed than can be made and the joint will lose its
cartilage, exposing the bone underneath.
Once the bone is exposed there will be a much more intense inflammatory
reaction and there will also be much more pain.
There is talk of such a system in dogs but nothing is well defined. Here is my
take on the subject. You will see in my next e-book how I match suggestions for
arthritis treatment to the grade of arthritis.
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Grade 1 Arthritis
A mild form of arthritis. Cartilage loss is minimal but there may be some small
fissures in the cartilage. Lameness is intermittent and mild. More pain on activity
but relieved with rest.
Grade 2 Arthritis
Cartilage loss is minimal but there are cracks in the cartilage. Lameness can be
quite obvious but is intermittent, often worse after rest or sleep. The lameness
can be ‘warmed out of ’ which means that the joint will loosen up after it warms
up with use.
X-rays show early new bone growth (osteophytes) and narrowing of joint
spaces. Scar tissue is starting to build up around the joint so it is getting stiffer.
Grade 3 Arthritis
Moderate to severe stage of arthritis. Cartilage loss extends to the bone
underneath the cartilage. Arthritis is irreversible at this stage. Lameness can be
severe and more frequent and is not easily ‘warmed out’ of.
X-rays and endoscopy would show bigger osteophytes or bone spurs and full
thickness fissures.
Grade 4 Arthritis
This advanced stage of dog arthritis displays severe symptoms. Extensive
cartilage loss and exposure of the bone underneath the cartilage results in a
painful and prolonged inflammatory reaction as well as the exposure of nerves
in the bone.
Lameness is severe and ongoing. X-rays and endoscopy would show large
osteophytes, extensive cartilage loss, lots of bone on bone contact and swollen,
thickened joints.
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Traditional Treatment for Dog Arthritis
Dog arthritis causes a progressive and
ultimately unbearable pain, requiring
treatment to reduce pain and improve your
dog’s quality of life.
However pet owners are concerned about the use of these prescription
medicines amidst growing awareness of their harmful side effects. Natural
therapies are available but are not as popular with dog owners and veterinarians
due to inadequate research and information. Thankfully this is changing.
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Side Effects of
Pain Killers and
Anti-Inflammatory
Drugs
While pain medicines and NSAIDs significantly improve symptoms of dog
arthritis, the choice of which drugs to use, their dosages and combinations
require careful consideration because long term use can lead to side effects.
This section details the side effects of the arthritis medications and a description
of what you may see if you overdose them. It is important to keep these in mind
and to match them to any problems your dog may have now or in the future.
For example, many of these drugs can cause vomiting. Even if your dog has
never vomited on its arthritis medication, if it suddenly picks up a tummy bug
or eats some food that causes vomiting, you would not want to give the arthritis
medication.
So being aware of the side effects can prevent the medications making other
problems worse. Please note this section is by no means written to make you
scared of these drugs, just to be cautious how and when you use them. Let’s
take a look at the following classes of drugs and their side effects.
• Pain Killers
• Opiods
• NMDA Antagonists
• Glycosaminoglycans
• Adequan, Cartrophen
• Anti-Inflammatory Drugs
• Non-Steroid Anti-Inflammatory Drugs (NSAIDs)
• Steroid Anti-Inflammatory Drugs (Cortisone)
The other great advantage of opioids is that their side effects can be reversed
partially or fully, at least within a veterinary hospital.
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The opiods are also reasonably cost-effective. Indeed they seem like the perfect
pain killer, but they are not used much in dog arthritis. This is because they are very
strictly controlled to minimize drug abuse in people, which limits their use away
from veterinary hospitals. Also an overdose of an opioid can be life threatening.
The oral (and injectible) opioid-LIKE drug Tramal is one of the most effective
drugs for arthritis available and is key to many of my treatment plans. Its has
side effects but in my experience they are minimal.
Side Effects
Brain problems
Opioids directly affect brain receptors and are known to cause feelings of
distress or euphoria which can sometimes be extreme. Studies show how the
chemicals raise pressure in the skull making it unsuitable for patients suffering
from head trauma or raised cranial pressure.
Breathing problems
Opioids cause depression in the respiratory centers of the brain and suppress
coughing as a side effect. In fact, an opioid (dextromethorpan) is an active
ingredient in many cough suppressants. Opioids should not be given to pets
with significant respiratory problems.
Heart problems
Opioids can slow the heart down and cause low blood pressure and must be
used carefully in patients with existing heart problems.
Stomach problems
Opioids also bind with receptors found in the gastrointestinal tract which can
lead to constipation, a mechanism that is useful in anti-diarrhea medicine. Many
can also cause nausea and vomiting.
Overdosage
Dogs that suffer from opioid side effects must visit the vet as soon as possible.
Any of the above side effects may be seen but it is really the breathing problems
that will be of most concern.
Treatment may include negating the opioid as well supportive care of the
respiratory system and nervous systems. Many dogs (and indeed many people)
can die from overdoses of opiods.
Page 13
NMDA Antagonists (Pain Killers)
NMDA antagonists work by suppressing the NMDA receptors in the nervous
system which are responsible for sending pain signals arising from tissue injury,
to the brain.
These pain killers are often used to complement the effects of opioids rather
than as a first-line treatment. They can be very good for chronic pain conditions
such as arthritis and back pain.
It must be noted that NMDA blockers merely treat pain symptoms arising from
cartilage or joint injuries and do not contribute to cartilage repair or protection.
• Ketamine • Gabapentin
• Amantadine • Amitryptiline
Side Effects
The NMDA antagonists are a relatively safe and effective class of drugs. They
can go a long way to settling down chronic pain states.
However any drug has side effects. The NMDA antagonists can cause:
• agitation • diarrhea
• flatulence • sedation
In humans, these pain blockers produce a host of other side effects such as
dizziness and hallucinations but we don’t really know if dogs experience these.
It can also be give orally but at the ongoing doses for arthritis management you
will quickly experience the side effects.
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Side Effects
Many dogs experience increased thirst, urination, lethargy,
hyperactivity, panting and diarrhea with cortisone use.
Over the long term, it can affect your dog’s liver, pancreas
and adrenal glands as well as suppress its immune
system. Studies have also shown how the combined use
of cortisone and NSAIDs can damage chondrocytes,
worsening arthritis as a result. They can also cause a severe
gastrointestinal upset - bloody diarrhea and vomiting,
Side Effects
While GAGs are considered safe, these may not be appropriate for dogs that are
being treated for clotting problems or have kidney disease. Prior consultation
and prescription are essential for this treatment.
However as has been stated above, the NSAIDs are not without side effects
or risks. Medical forums are abuzz with observations, updates and startling
revelations of NSAID side effects which affect major organs of the body. The
concerns people have for these drugs are deep and to a certain extent valid. My
own client surveys reinforced these concerns to me.
Am I against the use of NSAIDs? No. They can really help. However, like any
drug, I think they should be used with caution in dogs that are at risk of side
effects. They should not be used as a first line of treatment unless it is for an
acute inflammatory injury. Other drugs should be used in their place in many
cases of acute and chronic arthritis.
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The main veterinary prescribed NSAIDs are safest and have been thoroughly
tested in dogs. These would include:
• Aspirin • Naproxen
• Ibuprofen • Celecocoxib (Celebrex)
Side Effects
Most of the side effects of the NSAIDs can be understood if you are aware of
how they work.
• they sensitize nerve endings that transmit pain signals to the spinal cord
and brain
• regulate movement of lung muscles and uterine muscles
• increase blood flow to the kidney
• protect stomach lining from digestive acids
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Kidney problems
NSAIDs can lead to sudden kidney failure. The inhibition of prostaglandins
(which is a function of NSAIDs) causes decreased blood flow to the kidneys,
causing acute renal failure in dogs. NSAIDs can aggravate pre-existing kidney
disease, so often blood tests are performed to assess the kidneys before use. If
your dog has kidney problems you should remind your vet of this if he or she
is considering NSAIDs so that alternative forms of treatment and medication
can be prescribed.
Gastrointestinal problems
NSAIDs affect the gastrointestinal tract causing stomach upset, ulceration and
stomach bleeding. This is often indicated by dark stools or vomiting. NSAIDs
irritate the stomach by reducing the stomach lining’s ability to resist stomach
acids.
Liver disease
NSAIDs, particularly Rimadyl, are notorious for causing liver damage and
sudden liver failure even in dogs without pre-existing liver disease.
It is advisable for your vet to blood test for existing liver problems before
prescribing NSAIDs, or risk further liver damage. Unlike opioids where serious
side effects follow prolonged use or high dosages, liver damage from NSAID use
has less to do with dosage or long term use, it just seems to happen to some dogs.
Pregnancy
NSAIDs may be harmful when given during pregnancy.
Cartilage repair
NSAIDs may reduce arthritis pain but studies on animals show that this could
be counterintuitive - some NSAIDs can actually damage cartilage, making dog
arthritis worse.
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This may be due to two things: decreased prostaglandin production and excess
use of the damaged joint. Decreased levels of some prostaglandins slow down
cartilage repair and promote cartilage deterioration. Moreover, when pain at the
damaged joint is minimized, it encourages excess use that can lead to further
cartilage damage.
Bleeding problems
NSAIDs prevent blood clotting by inhibiting a clotting substance called
thromboxane. This can cause excessive bleeding or potential bleeding problems
in patients:
Other anti-inflammatories
While patients may display different reactions to specific anti-inflammatory
drugs, combining different NSAIDs even at lower doses is not recommended
because the anti-inflammatory side effects add up, increasing the risks of serious
harm in susceptible patients.
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Overdosage
Increasing dosage without prior medical advice is discouraged because it can
lead to overdosage and irreversible damage to the internal organs. Signs of
NSAID overdose include:
In most cases the side effects of NSAIDs can be treated. However there is
certainly a trend away from these drugs and towards more natural medications.
Page 19
A Shift in Dog
Arthritis Treatment
Patterns
Page 20
Trend towards natural medication
More people are looking for natural alternatives for the treatment of dog
arthritis. The perception of consumers is that natural is safer and better for their
much loved pet - that they are better to avoid the side effects of the prescription
drugs.
Page 21
Does Your Dog
Absolutely Need
NSAIDs?
Page 22
You’ve probably reached the conclusion that NSAIDs are not always necessary
for the treatment of arthritis or, at the very least, you now realize their role in
your dog’s pain management plan can be minimized.
This e-book has taught you that there is a lot more going on in your dog’s joints
than NSAIDs can control by themselves. And now you know that all drugs and
supplements should take their place in a balanced plan which includes medical
and non-medical treatments.
Your next logical step is to visit the Dog Arthritis Blog, and download the Dog
Arthritis Survival Guide.
But beyond that, I think it is imperative that you reinforce what you’ve read
here today by learning more about the medical portion of your dog’s arthritis
treatment plan.
• How to help your vet create a plan that combines natural medicines with
prescription drugs.
• The latest recommended 21st century concepts for arthritis treatment.
• Acceptable non-medical components of the No NSAID treatment
including weight control, physical therapy, acupuncture, and surgery, where
necessary.
• The promising effects of stem cell therapy which involves the removal of
fatty tissue from the dog and processing this tissue for injection into the
affected joint. These living cells are expected to improve the health and
function of the joint.
Please understand that early treatment of dog arthritis is still best. But no matter
when you begin treatment, the solution is not a wonder pill or a single drug.
Your dog will respond best to a multi-modal approach using small doses of
several medicines and supplements that have minimal or no side effects.
If you truly want to reduce your dog’s pain and suffering as quickly as possible,
I recommend you read <<Modern Dog Arthritis Treatment – Advanced
Medical Therapy for the 21st Century >>
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And one more thing; please, share this e-book you’re reading right now with
your fellow dog owners. With as many as 25% of the world’s dogs suffering
from arthritis, the chances are good you know someone who needs this book.
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