Management is dynamic . It needs to change over time because the disease is progressive . It ’ s important for these patients to come in for regular rechecks . One of the main reasons for lack of success for arthritis management is we ’ ve failed to adjust our treatments over time .”
struggle of arthritic patients becoming overweight because of reduced mobility , and overweight patients developing arthritis at faster rates than typical . Dr . Edwards states that pet owners and , unfortunately , veterinary healthcare teams simply don ’ t recognise obesity in pets . Despite obesity being easily visible , more than 50 percent of dogs and cats are overweight . Veterinarians need to focus on the pets that would benefit the most from early intervention , the ones with a 6 to 7 body score ( on a scale of 1-9 ).
“ When talking about obesity and weight control with clients , we need to remove emotion and focus on the health risks of excess weight — that it compromises mobility , compounds arthritis and contributes to the pet ’ s pain .” More importantly , she says , “ Obesity affects quality and quantity of life , which impacts the human-animal bond .”
Dr . Edwards recommends using one of the available scoring systems and recording a body condition score ( BCS ) for every patient at every visit . She says estimating a BCS allows you to determine a pet ’ s ideal body weight , which is necessary to calculate the appropriate calorie intake for the pet . Simply reducing the current volume of food is not ideal for long-term balanced nutrition . It is important to choose a food that is appropriate for weight loss versus one for weight maintenance or obesity prevention . OTC diets are for less than five percent weight loss . Otherwise , use prescription diets that are lower calorie and nutrient dense . You don ’ t want to just reduce the volume of normal food . Doing so may just slow metabolism . Use prescription weight-loss diets when you can .
Dr . Edwards also recommends the use of gram scales to measure feeding portions and encourages the use of food puzzles or games for mental stimulation . Once at an ideal body weight , patients are less likely to regain weight when they continue to be fed the weight-loss diet , adjusted for a caloric intake appropriate for weight maintenance .
TLC tips for the clinic and beyond Giving these patients a little extra TLC in the clinic or at home can go a long way toward patient comfort . Dr . Edwards recommends taking the following steps in your veterinary clinic :
• Increase traction on slippery clinic floors
• Use mats for orthopaedic examinations
• Remember sore joints during handling for catheters , nail trims , and with positioning of sedated patients for dentistry and radiographs
• Send patients home with “ nice feet .” Dr . Edwards takes
SURGERY the time , especially when a patient is anaesthetised for another procedure , to trim the nails and trim the hair between the toes to provide more traction for the footpads .
Dr . Edwards also helps her clients make their homes more comfortable for arthritic and obese pets by having them :
• Take dogs for controlled and structured leash walks , rather than allowing uncontrolled off-leash activity
• Avoid high-impact activities
• Adapt the home environment by limiting access to stairs with gates and supplying ramps for access to the car or furniture
• Provide comfortable bedding
• Elevate feeding dishes
• Increase traction on the slippery floors
• Use assistive devices , such as slings or carts , as recommended by the veterinarian
• Trim nails and the hair between the toes .
According to Dr . Edwards , the overall goal with these patients is to minimize pain while maximizing mobility .
Physical medicine options “ Physical medicine is all about supporting the body as it heals and restoring functional ability ,” Dr . Edwards says . A tailored rehabilitation program can reduce pain and inflammation , improve joint health and mobility , maintain and improve muscle mass , improve proprioception and stimulate overall mental health and physical fitness . Physical medicine options for patients with arthritis and chronic pain include cryotherapy , thermotherapy , laser therapy , acupuncture , landbased treadmills , hydrotherapy and tailored exercise regimens . Low-intensity exercise can benefit patients by supporting the loss of fat versus muscle , increasing oxygen capacity and energy expenditure , improving joint and muscle function , improving stamina and reducing lameness .
She reminds practitioners , however , “ You have to break the pain cycle before you can improve function with physical medicine . Adequate pain management is required for our patients to successfully engage in a rehab or fitness program . We should be assessing pain levels all of the time , at all stages . Any rehab or fitness program should be based on the patient ’ s current limitations and physical fitness . Our goal is to challenge the body over time , based on the goals of treatment .”
Tara Edwards , DVM , DACVSMR , CCRT , CVPP , CVMA , is a certified veterinary pain practitioner and is board-certified in sports medicine and rehabilitaton . She oversees the rehabilitation service at Tri Lake Animal Hospital & Referral Centre in Kelowna , British Columbia , Canada .
References
1 . Johnson JA , Austin C , Breuer GJ . Incidence of canine appendicular musculoskeletal disorders in 16 vet teaching hospitals 1980-1989 . Vet Comp Orthopedics Traumatolog 1994 ( 7 ): 56-69 .
2 . Johnson SA . Osteoarthritis . Joint anatomy , physiology , and pathobiology . Vet Clin North Am Small Anim Pract 27 ( 4 ): 1997 ; 699-723 .
3 . Hardie EM , Roe SC , Martin FR . Radiographic evidence of degenerative joint disease in geriatric cats : 100 cases ( 1994-1997 ). J Am Vet Med Assoc 2002 ;( 220 ): 628-632 .
Issue 01 | MARCH 2018 | 15