Sara
Alexandria, VA

Limping is one of the most common problems I am asked to assess. There are many causes of limping in dogs.

Soft tissue trauma–strains, sprains, and pulled muscles–is the most common cause of limping in dogs and cats in my experience. Limping due to these sorts of mild injuries usually resolves with a few days of rest.

Young (less than two years old), large dogs are subject to a syndrome called panosteitis, or growing pains. Panosteitis causes intermittent limping that often shifts from one leg to another. Panosteitis generally resolves over time. Many dogs with growing pains require no treatment. Others need anti-inflammatory medications or other types of pain killers.

Bernese Mountain dogs are predisposed to certain hereditary conditions that can cause limping. Elbow dysplasia can lead to early arthritis and limping on the front legs. Wobbler syndrome, in which the spinal column develops improperly, can lead to limping especially in the rear legs.

Older dogs are at risk of degenerative joint disease, also known as arthritis. Arthritis can lead to chronic or intermittent limping on multiple legs.

If Hogan’s limping has resolved and not returned, you probably have nothing to worry about. However, chronic or recurrent limping is a solid reason to see the vet.

Read more about limping at my website:

http://drbarchas.com/limping

About two hours before they brought him to me, the dog’s owners gave him 200 mg of ibuprofen (a non-steroidal anti-inflammatory drug, or NSAID, that is the active ingredient in Advil and Motrin) to try to help with his pain.

Ibuprofen has a low safety margin in dogs. It is potentially toxic. Fortunately, the quantity that the clients had administered to their pet was well below the toxic dose.

Unfortunately, the ibuprofen prevented me from treating the dog’s pain as aggressively as I would have preferred. Dogs who receive ibuprofen should not receive any other NSAIDs or steroids for at least three days or they will be at very high risk of suffering from gastrointestinal ulcers. Of course, NSAIDs and steroids are the main drugs used to treat neck pain in dogs.

Being unable to use these classes of medicine made helping the dog much more complicated. I had to hospitalize him and give him drugs related to morphine to make him comfortable.

Talk to your vet before you administer any human medications to your pet.

Photo: Sage Ross.

NSAIDs are commonly prescribed for arthritis, postoperative pain, and syndromes caused by inflammation. Rimadyl, Deramaxx, and Previcoxx are commonly used NSAIDs.

All NSAIDs are metabolized by the liver and excreted by the kidneys. Therefore, all NSAIDs can exacerbate or cause liver or kidney problems. Also, all NSAIDs have the potential to cause upset stomach and gastrointestinal ulcers.

To be sure, pets can suffer from severe adverse reactions to NSAIDs that may be fatal. Every drug in the class has the potential to cause these events.

Veterinarians have a duty to discuss side effects and adverse events before prescribing NSAIDs. Pets who receive NSAIDs should undergo regular testing of liver and kidney function. Pet owners should make informed decisions about NSAIDs.

If you google any NSAID, you will find web pages detailing heartbreaking experiences of pet loss after NSAID use. People very reasonably want to share this information after suffering a tragedy, so that others might avoid the same fate.

But this leads to a skewed perception on the internet. In fact, the vast majority of pets who receive NSAIDs do not suffer any adverse reactions or side effects. NSAIDs have helped millions of pets.

In fact, NSAIDs often save pets’ lives. A patient I saw yesterday drove this point home to me. He was a 13 year old Labrador who had received Previcox for years to treat arthritis. The owner ran out of the medication, and he did not receive it for three days. The dog was miserable. He could not stand or walk. The owner told me that he thought he “was going to lose” his dog.

A few hours after receiving Previcox, the dog was up, walking, and acting like himself. Previcox saved the dog’s life.

If you google Previcox you won’t see stories like this. People who have good experiences with NSAIDs aren’t motivated to create web pages. But don’t forget the message of the story: NSAIDs aren’t always bad.

NSAIDs have given new leases on life to countless pets suffering from arthritis or chronic pain. They also help to alleviate pain from surgery and trauma. They decrease inflammation and may speed healing in many syndromes. They have relieved a tremendous amount of animal suffering.

Sadly, NSAIDs are not perfect medications. Adverse effects (also known as side effects) can occur when any NSAID is used. The most common adverse effects are gastrointestinal upset, liver damage, kidney damage, and issues with blood cells. In rare instances, adverse effects from NSAIDs can lead to death. It is absolutely tragic when an animal is killed by a medicine that was intended to help it.

Sheilah A. Robertson, BVMS (Hons), PhD, MRCVS, CVA, Diplomate ECVA & ACVA (my goodness, that is the most letters I have ever seen after a person’s name) wrote a very good article in the November, 2008 issue of the NAVC Clinician’s Brief discussing adverse effects from NSAIDs in dogs. Here are some key points.

The number of adverse drug events associated with canine NSAID use reported to the U. S. Food and Drug Administration Center for Veterinary Medicine greatly exceeds that reported for other drugs used in companion animals. However, because so many dogs are prescribed NSAIDs, the actual incidence of untoward side effects would appear to be very low. Pfizer Animal Health has reported that the approximate incidence of adverse drug events is 0.009% in an estimated 1.5 million dogs treated with [Rimadyl.]

Although the percentage is low, there are groups of animals that may be at increased risk.

The most commonly affected group is dogs 10 to 15 years old, followed by 6- to 10-year-old dogs.

Many adverse drug events occur when the drug is used at doses higher than those approved, when another NSAID (including aspirin) . . . [is] used concurrently or in close temporal association, or when concurrent [for instance, liver or kidney] disease is present.

Dr. Robertson goes on to point out that

[h]owever, adverse effects can occur in dogs with no obvious risk factors and when the drug is used correctly.

So, what should veterinarians and people with pets do? In my opinion, it is important for vets to discuss the risks and benefits of the drug in question with the people living with the pets. If the benefits outweigh the risks, Dr. Robertson has several suggestions.

Veterinarians should perform a physical examination and blood tests before prescribing the medication. According to the article, most adverse effects occur within 14 – 30 days of treatment. Therefore, additional diagnostic tests should be performed 2 – 4 weeks after the onset of therapy. For pets on long-term NSAID therapy, tests should be performed every 3 – 6 months, depending on the pet’s age and health status.

People living with pets also should be alert. As Dr. Robertson points out,

[c]lients should be advised to stop administering the NSAID and call the veterinarian if they notice any changes in their pets, such as [lack of appetite], vomiting, diarrhea, lethargy, or bloody feces . . . [t]he key is to catch problems early and err on the side of caution.

NSAIDs have the potential to help millions of pets. But people with pets should make informed decisions about the use of these drugs.

Rimadyl is an anti-inflammatory drug and pain killer. It has been prescribed millions of times since its introduction several years ago.

Rimadyl, like all medications, can cause side effects. Drugs in Rimadyl’s class (called NSAIDs) may cause diarrhea, upset stomach, gastrointestinal ulcers and liver or kidney damage. In extremely rare cases they cause severe adverse reactions that may lead to death.

It is shocking, horrifying and heartbreaking when a medication that was prescribed to help a pet causes the pet to die. And it is therefore no surprise that some people whose pets have suffered serious reactions to Rimadyl have gone to great lengths to publicize the dangers of the medicine (try googling Rimadyl and you will see that some people have dedicated their lives to crusading against the drug).

I have nothing but sympathy for people whose pets have suffered adverse reactions to Rimadyl and other NSAIDs.

I also will go on the record and say that veterinarians have a duty to explain the risks and benefits of any medication fully before they prescribe it to a patient.

However, I believe that Rimadyl is getting a bad rap. First, in my experience, it is no more likely to cause severe side effects than any other NSAID. Try googling Metacam, Deramaxx or Previcox. You will see that they, too, cause severe adverse reactions.

And adverse reactions are not limited to medications. A neighbor of mine recently tried on some eyeliner at a beauty store. She suffered an adverse reaction to the eyeliner, and later passed away.

These sorts of reactions are absolutely tragic. But they are the exception, not the rule.

I have prescribed Rimadyl thousands of times. It has helped hundreds of my patients. It has caused diarrhea or upset stomach in a few of them. It has killed none of them so far (knock on wood).

So yes, veterinarians absolutely should warn clients about all of the potential risks of a medication before it is prescribed. And yes, it is proper to publicize the risks of medications so that pets can be protected from unexpected adverse reactions.

But at the same time, I am troubled by the fact that so much energy is spent demonizing Rimadyl and other drugs, when the problems they cause are relatively rare. Meanwhile, hundreds of dogs are dying every day because of a different, less publicized risk: irresponsible off-leash activity.

Off-leash dogs account for virtually 100% of those that are hit by cars. They are involved in virtually 100% of dog fights. They escape and are lost. They fall off cliffs, and they drown in lakes. Worst of all, they sometimes attack people, leading to euthanasia and anti-dog sentiment in communities.

If your dog has good recall and is properly socialized, then there is nothing wrong with allowing him to run free in areas where it is legal.

But if you really want to save dogs’ lives, focus your efforts on the people who don’t bother to socialize their pets before allowing them off leash.

Rosie
Humble, TX

Hip dysplasia is a syndrome in which a dog’s (or less often, a cat’s) hip joints do not develop properly. This causes premature arthritis in the hips. Hip dysplasia is most common in large breeds of dogs. It has a hereditary component. Careful breeding has reduced the incidence of hip dysplasia over the last several years.

Hip dysplasia is sometimes confused with age-related arthritis. Many older animals suffer arthritis in their hips that is not related to abnormal development of the joints. However, in either instance the outcome is the same–arthritis that causes pain, stiffness, decreased mobility and a lower quality of life.

There are several techniques (some old, some new) for managing hip displasia and arthritis in pets.

Preventing hip dysplasia is by far the best option. Careful breeding is the most important aspect of hip dysplasia prevention. Less effective, but still important, is to feed at-risk puppies (Labrador Retrievers, German Shepherds, Golden Retrievers and other large breeds) a diet that promotes slower growth. Talk to your vet about this.

For pets diagnosed with hip dysplasia by a veterinarian, several techniques may delay the onset of arthritis. The most effective of these is weight management. Carrying extra weight puts tremendous strain on the hip joints.

Other techniques that can delay the onset of arthritis (or help to ameliorate the symptoms of arthritis after it develops) include administration of oral or injectable glucosamine, oral omega-3 supplementation, and physical therapy (mild exercise, swimming, hydrotherapy, and range of motion exercises). Young dogs diagnosed with severe hip dysplasia may benefit from a surgical technique known as triple pelvic osteotomy.

For the unfortunate individuals that are suffering from arthritis, all of the techniques listed in the preceding two paragraphs (except for triple pelvic osteotomy) can be beneficial. Additionally, treatment with the much maligned NSAID medicines can lead to a dramatic improvement in quality of life. Other, newer pain medicines such as amantadine are emerging as well that may be highly beneficial when used in conjunction with NSAIDs. Some prescription diets may lead to clinical improvement in arthritic pets.

A new generation of treatments for arthritis in the hips is also entering use in clinical practice. These treatments include stem cell injections, stimulation with certain types of lasers, and a technique known as extracorporeal shock wave therapy (it sounds scary, but it’s quite benign).

The treatment of last resort for arthritis of the hips is surgical hip replacement. Recent clinical advances have made this option more attractive than it was in the past.

The long and short of it is that there is a wide array of treatments for hip dysplasia and arthritis in pets. Many of them are new and not widely known. Your best bet is to find a vet who is passionate about comprehensive management of the syndromes. Sit down with this vet and develop a treatment plan that is right for you and your pet.

Image credit: Joel Mills. Licensing information: CC.