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Questions for Dr. Shawn - Arthritis, Glucosamine, Supplements, Joint, Legs

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"Dear Dr. Shawn:
"I have an 11-year-old cat named Harvey. He has arthritis in his knees and is taking joint supplements containing glucosamine and chondroitin for his arthritis. I brought him to the veterinarian last week for what I thought was a cyst on his chest. The doctor examined some fluid from the cyst under the microscope and determined that the cyst is really a tumor. He is scheduled for surgery next week to remove the tumor from his chest and have it biopsied. Do I need to stop giving him his supplements before surgery? They work so well I don't want him to get stiff again."

Answer:
"As you have experienced, supplements such as glucosamine and chondroitin are very helpful for most pets with arthritis. While not as common as in dogs, many older cats do experience joint stiffness from arthritis and do quite well with nutritional supplements. These supplements are unlikely to cause problems from the anesthesia or surgical procedure Harvey needs.

Regarding the general question about supplements and surgery, always tell the doctor what supplements your pet is taking (as well as any medications.) Sometimes various supplements and medications should be stopped before surgery to prevent problems.

For example, ginkgo biloba can increase blood clotting times in people (and probably pets.) While studies are not available, it seems reasonable to follow the recommendation to stop ginkgo supplements about 1 week before and 24 hours after surgery. Kava kava should be discontinued 24 hours prior to
anesthesia, as it has been shown to lengthen barbiturate-induced sleep in animals (although I do not use barbiturates, your doctor may so it's always wise to ask about the anesthetic that will be used.) There is strong evidence that St. John's wort affects metabolism of a number of drugs including warfarin, digoxin and cyclosporine. Talk with your doctor if your pet is taking any of these medications and you are considering this herbal sedative. Because valerian has also been shown to increase barbiturate-sleep in
animals, caution is suggested with anesthetics. The authors caution about a valerian withdrawal syndrome and recommend that patients be weaned off valerian over the course of several weeks prior to surgery.

The Veterinary Botanical Society is looking into negative effects of herbs and how we can use them more safely. While many holistic-minded folks think that all "natural" therapies are totally safe, as can be seen from the answer to your question this is not always true. Do not use any herbal preparations without veterinary supervision, and then only use high quality products from reputable companies (your doctor can make recommendations.) When you remember that many plants serve as the source of conventional medications (for example, white willow bark contains acetylsalicilic acid, or aspirin,) it makes sense to use care when treating with herbs!"


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"Dear Dr. Shawn:
”My boxer is almost ten years old and has been in excellent health until significant cardiac abnormalities and arthritis developed in the last year. He is taking Rimadyl for his arthritis. Would milk thistle be safe for him to take to help his liver?”

Answer:
”Milk thistle is an excellent herb to help promote normal liver health. It is one of my favorite herbs that I use as part of the therapy for almost any disease. As I discuss in The Natural Health Bible for Dogs & Cats, other supplements that can aid the liver include choline, liver glandular extracts, dandelion, boswellia, and burdock. Homeopathic liver supplements are also useful. There are no conventional medications that can support the liver as do these supplements. I also believe liver support is important when pets must be on long term medication, including Rimadyl (which has liver toxicity.)

My question to you is why your pet must take Rimadyl? There are many supplements (hyaluronic acid, glucosamine, MSM, Zeel, etc.) that are much safer and better to help control arthritis without any side effects. I would also recommend supplements for cardiac support, including hawthorn, coenzyme Q-10, omega-3 fatty acids, and homeopathics like Cralonin. Using these suggestions would probably allow you to stop administering medications yet also improve his health.”


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"Dear Dr. Shawn:
”I’ve tried using glucosamine and chondroitin for my older Labrador Sam. However, his arthritis is getting worse and the supplements don’t seem to be helping. Since I don’t want to give him medications, do you have any other suggestions?”

Answer:
”While glucosamine and chondroitin work in most arthritic pets, some pets don’t respond as well as others. Hyaluronan is another natural joint supplement that is often used to help pets with arthritis. It is so effective that I often use it when other joint supplements fail to work. The proposed mechanisms of action of hyaluronan are to reduce swelling at the site of injury by decreasing white blood cell migration and infiltration into the affected tissue. Secondly, hyaluronan inhibits the inflammation pathway, resulting in decreased pain. The 2 commercially available hyaluronan products are very helpful in treating many pets with arthritis. Cholodin Flex (a chewable treat for dogs and cats which also contains choline to decrease the chances of the pet developing cognitive disorder) and Chologel (a potent gel form that should only be given to dogs,) have been shown as effective as NSAID medications without the side effects often seen with this class of drugs.

I would suggest you talk with Sam’s doctor about trying either of these supplements, possibly with homeopathic (using the remedy Zeel) or herbal (Flex SC, Nutriflex) support.”


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"Dear Dr. Shawn:
”I’ve recently stopped using Vioxx due to the new warnings that have come out. I was wondering if drugs like Vioxx are safe to use in pets, or whether there should I should be concerned. My dog doesn’t have arthritis now, but from what I’ve read most dogs get arthritis as they get older.”

Answer:
”This is a great question. While pets are not prescribed Vioxx and Celebrex for arthritis, they are prescribed similar non-steroidal medications (NSAIDS.) The most commonly used NSAID medications in pets include Rimadyl, EtoGesic, and Deramaxx. While these drugs have not to date caused heart problems or strokes in pets (as in people,) they are still associated with a wide array of serious and potentially fatal side effects. The side effects most likely to cause problems include gastrointestinal problems (ulcers and perforations of the stomach and intestines;) kidney problems (including kidney failure;) and liver problems (including liver failure.)

As a group, NSAIDS may also cause damage to cartilage, making arthritis worse as time progresses. Reading the package insert from both human and animal NSAIDS clearly allows doctors to know about these potential problems. The package inserts further state several important points:

  1. Side effects are most likely to occur in older pets.
  2. Side effects are most likely to occur in pets receiving other medications (especially for heart disease and high blood pressure control.)
  3. Pets (and people) should not use the medications for more than a few days unless the diagnosis is confirmed.
  4. The LOWEST effective dose should be used (this is typically much lower than the label dose.) How many of you using NSAIDS for yourself or your pet talk with the doctor frequently in an attempt to lower the originally prescribed dose?
  5. If NSAIDS need to be used for chronic problems, regular examinations and blood/urine testing MUST be done to allow early detection of serious side effects.

While NSAIDS can be used safely in people and pets, I prefer to use them very infrequently. For arthritis, joint supplements are much safer and more effective in most patients. (To learn more about safer alternatives to NSAIDS, drop me an email and I’ll send you more information; sorry, I can only respond via email.)”


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"Dear Dr. Shawn:
”My older Labrador has developed arthritis. I take glucosamine for my own arthritis and it helps a lot. I was wondering if I could use the glucosamine I take and give it to my dog? Would it be better to use a supplement made for dogs? Is there any difference?”

Answer:
”This is a question I get asked a lot. First, I would make sure that you are taking a high quality supplement. There are many companies which now make supplements, but in my opinion many of them are not making quality products. Therefore, I would make sure that the product you use has been recommended by your own doctor. Also realize that there are 3 basic forms of glucosamine that can be made into supplements. Once again checking with your own doctor will assure you’re using the correct form.

To answer your question, assuming you’re using the correct form of glucosamine, and that the product you use is a high quality product, there is no difference between “people” glucosamine and “pet” glucosamine. However, I usually prefer pet products for a few reason. First, they are specifically formulated for pets. The products I use also contain other ingredients (such as anti-inflammatory herbs and other joint supplements) that work better than “plain glucosamine.” Second, the products are often formulated in a flavored base (powder or chewable treat) which makes is easier to give to your pet. Finally, the products are made in the correct dose for pets, which also makes them cost effective.

The best way to compare cost is to look at the “per dose” cost, not the “per product” cost. While one product may cost less than another product, it’s been my experience that more of the cheaper product may need to be given per day, which actually makes the “cheaper” product cost more on a “per dose” basis.”


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"Dear Dr. Shawn:
”In a recent column you talked about joint supplements containing ingredients like glucosamine and chondroitin. Surely you know that there is no proof that these ingredients do any good for the pet. Why are you promoting something that is useless? It sickens me that doctors like you promote products that don’t work just so you can make a quick buck. I expect more of people who offer advice for the public!”

Answer:
”Mark Twain once said that there were 3 types of proof: your proof, my proof, and the truth!” There are 2 aspects of proof or evidence. First, there is raw research data, the type of evidence you are seeking. There is a lot of this evidence, and I would refer you to either of my books, The Arthritis Solution for Dogs or The Natural Health Bible for Dogs & Cats to see just a small amount of the evidence that has been done on joint supplements. Second, there is clinical experience. This is most important to me as it is “real world” and directly affects my patients.

Joint supplements have been used in people and pets for about 20 years, and are even used by many “conventional” doctors as part of their treatment of arthritis. In my experience, they are so effective that most of my patients rarely if ever need non-steroidal medications to control their pain. I have seen many dogs and cats that could not walk without medications do very well when the proper joint supplement is prescribed.

In short, if these products did not work I would not prescribe them. I can “make a quick buck” selling any product I choose. If my therapies did not work and I was deceiving the public, not only would I be out of work but I would lose my license to practice medicine. I think if you will check out the research you will find ample evidence of the effectiveness and safety of joint supplements.”


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"Dear Dr. Shawn:
”My dog Jake is 5 years old and in the last 6 months has been favoring his back legs. It's difficult for him to get up from laying down and takes him a while to "get going". He has had x-rays taken and arthritis and hip dysplasia have been ruled out. His doctor said it could be a nerve disorder. I’ve heard that acupuncture could work. What do you think?”

Answer:
”It is possible that Jake does have arthritis, or at least joint pain, even though his radiographs (x-rays) did not reveal these problems. You don’t mention if you’ve tried any therapies so far. Why does your doctor suspect a nerve problem? Just because radiographs don’t show joint problems doesn’t mean that a nerve injury is present. Does Jake have any nerve deficits? For example, does he have any spots of pain on his body? Does he drag his legs? Does he walk normally once he gets going? These are some of the things to consider before suspecting nerve damage.

To answer your question, acupuncture can help. However, you need a diagnosis before someone simply starts sticking needles into his body (you also need to know where to stick the needles, and from your description this would be hard to determine.) You might request a visit to a specialist for more testing (such as an MRI.) Once a diagnosis is reached, many “alternative therapies” including acupuncture can be helpful. I use acupuncture occasionally, but always with other therapies like herbs and homeopathics. These treatments can always be tried first, and then acupuncture can be added as needed.”


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"Dear Dr. Shawn:
"I have a 1 year old schnauzer. What are your suggestions for the best food? I also have a 14 year old schnauzer that is taking Metacam for his arthritis. I have given him Gylco-Flex for about 4 years. Is there anything else I can do?”

Answer:
”For the best food, I recommend something natural or organic. Look at the label to make sure the food doesn’t contain byproducts (like chicken byproduct or chicken byproduct meal) and chemical preservatives (BHA, BHT, or ethoxyquin.) Read the label carefully, as many brands of food are now coming out with their own version of “natural foods” that are not as natural as their names suggest. Dry, canned, raw, homemade, or freeze-dried foods can be alternated (cats usually do better if fed mainly or only canned or homemade food.)

Metacam is a NSAID medication used to relieve inflammation, most commonly from arthritis. Glycoflex is an excellent supplement for arthritis (see my more about this and other VetriScience products at my website, www.petcarenaturally.com.) I’m not sure why you need both the Metacam and Glycoflex, as using just Glycoflex should be sufficient. If you need Metacam, use the lowest dose possible and try not to use it everyday in order to minimize side effects. Cholodin Flex or Chologel, Megaflex, and other brands of joint supplements may also be helpful and can be used with or in place of the Glycoflex. Various homeopathics such as Zeel and herbs such as Traumanex or Total Inflam are also helpful, and don’t forget about acupuncture or magnetic therapy for sore joints.”


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"Dear Dr. Shawn:
”Our 3 yr old male dog is experiencing pain when jumping and sometimes when being picked up. Our doctor found nothing abnormal on X-rays but still prescribed Rimadyl for two weeks. The problem went away but he now seems to be experiencing some of the same pain. Would it be safe to substitute aspirin therapy for Bailey and if so what dosage and frequency is safe? If not are there alternative treatments?”

Answer:
”Rimadyl and aspirin are NSAIDS, drugs which inhibit inflammation and pain in pets. While aspirin can be used safely in pets, the newer NSAIDS like Rimadyl are more potent pain relievers and are usually preferred. Of course “more potent” usually also means “more side effects” which are not necessarily good.

Here’s what I would suggest. If the pain has returned it means the problem (inciting cause) has not be discovered and correctly treated. Using more drugs, which is often the case with conventional care, only covers up the problem longer but doesn’t really help heal your pet. Additional diagnostic testing may be needed since the initial radiographs (X-rays) did not show a cause for your dog’s pain. These tests can include additional radiographic views, a referral to a specialist, and possibly even an MRI or CT scan of the affected area. Once the diagnosis is made, there are many therapies that can help pets with pain. These include acupuncture, herbs, nutritional supplements, homeopathics, physical therapy, and magnetic therapy.

Work with a holistic veterinarian to determine the best therapy once you have discovered the cause, and then you can heal your pet and not simply cover up his pain with unnecessary medications.”


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"Dear Dr. Shawn:
”My husband and I have a very loving pit bull/lab mix, Oscar, who will be two years old soon. A year ago he was diagnosed with severe hip dysplasia in both of his hips. Daily doses of glucosamine have given him a lot of relief, but we are still concerned for his long-term health. We can¹t afford surgery and are looking for alternatives. Are you aware of any nonsurgical treatments for hip dysplasia? Oscar is so sweet, and we don¹t want to lose him at an early age because we can't afford surgery. Thanks for your advice.”

Answer:
”Hip dysplasia is very common in larger breeds of dogs such as Oscar. Breeds commonly affected include Labrador Retrievers, golden retrievers, German Shephard Dogs, Newfoundlands, and Great Pyrenese. Those with well-muscled hips such as Boxers and Greyhounds are rarely affected. Keep in mind though that any dog or cat can develop this condition.

By definition, hip dysplasia is an abnormality of the hip joints that causes a dislocation of the head of the femur (long bone in the leg.) Dogs with dysplasia have an abnormal fit of the head of the femur (ball) into the acetabulum (socket) of the hip. As they attempt to walk, the ball slips out of the socket. This causes decreased weight-bearing of the affected hip, limping, difficulty arising, difficulty walking and running, damage to the joint cartilage, and variable degrees of pain and discomfort. With time, the body attempts to heal the dislocated hip by laying down new bone in the hip joint (arthritis.)

Decreasing the incidence of arthritis can be accomplished by providing supplements designed to nourish the damaged hip cartilage and relieve pain and inflammation. I recommend that all pets predisposed to joint problems take a joint supplement from the time they are puppies. There are many products on the market, some good and some not so good. My favorite is Vim & Vigor by PetCentrx, and I encourage owners to check with their pets’ doctor to find the best product for them.

Unfortunately there is not a non-surgical option for treating hip dysplasia. Old pets certainly wouldn’t need surgery unless they can’t walk; most of these patients do very well by taking joint supplements. Traditional pain medications are used on a low dose basis infrequently as needed by the pet.

Younger pets will require surgery IF supplements or other natural therapies fail to help them walk normally and comfortably. Hip dysplasia is a condition of bad anatomy, and only surgery to improve the anatomy can help. There are several surgical options that might be available to help your pet. A total hip replacement is the best option but also the most expensive. A femoral head and neck ostectomy, a procedure where the head and neck of the femur are removed, is a fine second choice and much less expensive. A triple pelvic osteotomy (TPO) is also a good choice but can only be done in selected patients. Finally, an older procedure called a pectineal myotomy can be done. This is the least expensive surgery. While many modern surgeons do not like the procedure and feel it really doesn’t help, I’ve seen enough success that I would still recommend it if the only other choice was euthanasia and another surgical option is unaffordable”


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