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Integrating Treatments for Joint Pain

Vets use combination of holistic and conventional approaches.

By Lynn M. Tiffany For Veterinary Practice News

Posted: September 30, 2013, 12:40 p.m. EDT

Combining holistic and conventional veterinary therapies, Michael Dym, VMD, advocates a four-pronged approach in using nutraceuticals to treat joint pain and arthritis in dogs and cats. He reports success with a glucosamine/MSN supplement, anti-oxidants, omega-3s and a homeopathic pain-killer, Traumeel, which he said is produced from natural ingredients.

Dr. Dym practices holistic and integrative conventional veterinary medicine at Palms West Veterinary Hospital in Loxahatchee, Fla., and operates his own practice, making house calls in the Wellington, Fla., area. 

"Traumeel has been involved in human clinical studies and is proving as or more effective at reducing discomfort than NSAIDs,” Dym says. He says he has excellent results when treating both dogs and cats with it.

Bonnie Mitchell, DVM, owner of Coastal Animal Clinic in Jensen Beach, Fla., recommends joint supplements as both a preventive and for treatment of dogs and cats with lameness issues.

She says dogs seem to like chewable joint supplements—they think they are getting a treat. "It’s hard to get a cat to chew a tablet, so powder in their food works best for cats.,” she says.

For an 80- to 90-pound dog, a loading dose can be expensive, so if Mitchell thinks economics may prevent a pet from getting the glucosamine/chondroitin it needs, she may recommend human glucosamine/chondroitin, available at drug and discount stores. Then she can expect maintenance doses to be administered as well.
 
"Of course, we’d rather they buy from me,” she says, "but if it comes down to a matter of the dog not getting the supplement without a cheaper way to dose him, I’ll suggest they go to Walmart or GNC and get human supplements, which are much less expensive.”

Jacquie Allgire, DVM, a certified veterinary acupuncturist, is a holistic veterinarian who works with conventional colleagues at Alta Vista Veterinary Hospital in Phoenix.

"By the time we see arthritis in a dog, it’s not unusual to see joint bone remodeling and scar tissue that is not going to be cured by nutraceuticals,” she says.

Allgire and Mitchell regularly recommend glucosamine/chondroitin sulfate to help rebuild cartilage; green-lipped mussel (or perna canaliculus) to help relieve pain; omega-3 fatty acids for their anti-inflammatory properties; and vitamins and anti-oxidants to promote general animal health.
 
With cats, Mitchell gets good results for joint pain with Cosequin, a proprietary glucosamine/chondroitin sulfate supplement.

"Since cats are sedentary, owners frequently don’t notice their cat’s stiffening joints until it becomes very noticeable,” Mitchell says. "A dog will almost always chase a squirrel or a tennis ball, even if he is sore. A cat will show much more restraint.”

Some Results
All three veterinarians say they’ve experienced positive results using glucosamine and chondroitin to slow middle-aged and larger dogs’ joint deterioration.

When a dog comes in really lame, it is standard procedure for these veterinarians to start the pet on glucosamine/chondroitin, in conjunction with NSAIDs and painkillers.

"Glucosamine/chondroitin is not going to repair or reverse advanced joint damage when used alone,” says Dym. "But it may help support healthy joints in asymptomatic animals.”

"Because animals’ aging is accelerated compared to humans, glucosamine/chondroitin tends to help initially early on in a dog’s life,” Allgire says. "After a while, though, it seems to lose its profound effect on slowing damage.”

Pets need to be on the joint supplements four to six weeks, and then there is still a mixed response for consistent pain relief, Allgire says.

Other Options
To alleviate chronic joint or spinal pain, Allgire prefers to use veterinary herbal formulas, avoiding pharmaceuticals as long as possible. She says she best achieves positive pain relief with a combination of acupuncture and herbal formulas.  

Mitchell says acupuncture and hydrotherapy are also good treatments to use in conjunction with glucosamine and chondroitin supplements.

Despite what some owners may tell their veterinarian, a dog just doesn’t one day wake up with arthritis, Mitchell says.

"If a dog comes in lame after running around at the beach all day, it’s probably more than just arthritis,” she says. "A complete physical exam and potentially imaging will help rule out injuries.

Starting this dog on joint supplements is a good idea, but considering more immediate pain control is definitely warranted since supplements take several weeks to take effect.”

Dym and Allgire use VetriScience products. Dym says he’s been using its Glyco-Flex since it came out 20 years ago. Allgire uses the product, too.

"In 20 years of using them, VetriScience formulas have proven to be trustworthy, reliable and economical,” Dym says.

Dym says a new product on the market, VetriScience Dev Cor, a "synergistic group of nutrients and herbs,” is proving to work in relieving cats’ arthritis symptoms.

Quality Supplements
Dym and Allgire emphasize the importance of dispensing quality supplements and nutraceuticals.

"I don’t like proprietary blends,” Allgire says. "I want to know what’s in there when I recommend a supplement.”

She advises veterinarians to look for supplements and nutraceuticals bearing the NASC seal—National Animal Supplement Council, a U.S. trade group that has developed supplement manufacturing guidelines that enhance and protect the health of companion pets and horses.

Dym prefers nutraceuticals over pharmaceuticals when there is a concern of toxicity, which is more prevalent in treating cats. "I’ll use NSAIDs for the short term,” he says, "often after a workup to make sure the liver, kidneys and blood counts are good.”

Both vets say their  conventional colleagues regularly consult them for integrative treatments for dogs and cats.

"Conventional veterinarians are talking to me more about integrating holistic and traditional approaches,” Allgire says. "They are looking for a more natural, gentle approach to caring for pets. Holistic veterinary medicine isn’t so mysterious anymore.”

Allgire says the increased interest in using nutraceuticals over pharmaceuticals is largely client-driven. "People are learning more about natural medicine. They are exploring the Internet, becoming more concerned about drug reactions and interactions.

"Conventional veterinarians are finding it increasingly valuable to integrate treatments,” she says. "We are finding that integration can help increase owner compliance.

"For instance,” she says, "in a clearly arthritic dog, an NSAID such as Rimadyl is prescribed. Six months later, the dog is even worse.

The veterinarian discovers that the owner, concerned about the damage a drug can render, was afraid to give the NSAID to the pet regularly. The dog only received the Rimadyl now and again.

"So when the dog comes into the clinic, he is in a chronic state of inflammation, despite having a prescription for Rimadyl,” Allgire says. "When we add acupuncture and joint supplements to the treatment plan—natural treatments that owners consider safe—owners seem to be more willing to use pharmaceuticals more consistently.” 

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