Is your canine companion not as spry as they used to be? In this installment of Tuesdays With Shlomo, we talk about degenerative joint disease (DJD) in dogs, a disease that is both common and sometimes hard to catch. Dr. Shlomo Freiman discusses DJD in detail, breaking down the signs and symptoms of DJD, the best medical approach to treating it, including non-medical solutions for DJD. Dealing with DJD requires a multi-prong approach, according to Dr. Freiman.
The good news is that your dog can live a happy and active life with DJD. But, in order to make that happen, you have to know what you’re dealing with and create a treatment plan that works.
So we are talking today about degenerative joint disease, specifically in dogs. Is it basically canine arthritis? Is that what most people would refer to it as?
Yes, it’s essentially arthritis, which is chronic changes in the joint surfaces — one joint or multiple joints. There can be different causes for it but one of the biggest ones is essentially wear and tear. Another one is trauma and injuries; injuries can create inflammation which then eventually causes changes that result in arthritis. Those are probably the two biggest causes in dogs. There are other causes, like immune-mediated issues where the immune system attacks the joint, similar to what happens in rheumatoid arthritis in people. There are conformational ones, which means the dog has an issue with the way its bone structure is formed, so there’s more wear and tear, like with hip dysplasia.
Is that what famously happens to German Shepherds?
Yes, although we don’t see it as often as we used to because breeders have been really successful at breeding it out. Either way, there are definitely multiple causes for joint disease but at the end of the day what happens is you get these changes in the joint that are permanent, slowly progressing, and quite uncomfortable for the dog. It’s the same as a person suffering from arthritis.
But maybe a lot harder to detect because, as you’ve talked about before in our interviews, animals are evolutionarily inclined to hide when they’re in pain. How do you know when your dog is suffering from something like this, where the pain kind of builds up slowly?
I think the challenges that we have with our patients are multifold. Yes, they evolved to be tough because if you’re complaining and whining you’re going to be somebody else’s dinner. But the other part of it is that your dog doesn’t go on the internet. It can’t google “why are my hips uncomfortable,” so there’s no way for the dog to put a label on it and say, “Oh yeah, I have hip dysplasia. I have arthritis.” It doesn’t mean that they don’t feel uncomfortable, they just don’t have that ability to self-assess. This also means they don’t necessarily act in accordance with their level of pain. Say they love to go and chase a ball and they go crazy for it just like when they were a puppy. They’re not going to stop doing that when they start having joint issues, but they will start paying the price for it the day after in terms of pain.
So it’s really on you as a pet parent to detect it?
Yes, but also remember that it’s a lot easier for us to see an acute injury. As in, the dog was using four legs and running like crazy and now he’s only using three legs and limping.
Obviously, that leg is the problem.
Yup. But if you have something that is slowly ratcheting up, it can be hard for even a very observant pet parent to catch. Also, a lot of wear and tear and injuries happen when pets are older, so you get people saying, “Well, my dog is just tired, it’s just old.” That may be part of it, but actually the dog doesn’t want to go upstairs because it’s in pain. It’s not just because they’re older and less energetic, it’s hurting them.
So it sounds like the eye test is not the best way to catch it. How do you screen for it in a clinical setting?
Well there are some more technical things we can do. We can do x-rays. In a true academic setting there are things like pressure mats, where we have the animal run on the mat and observe the pressure and patterns and analyze them for inconsistencies. But we do actually involve pet parents in our assessment to start with. We give clients a scorecard that can help them know what are the things that they need to watch for.
There are maybe ten points of observation, like jumping up on things, going up and down the stairs, chasing a ball, and so on. We ask them to score their dog, and then if the scorecard suggests it, try a trial of medication for a few days and score the dog again afterwards. If there’s a significant improvement, we can back into the diagnosis that the dog is suffering to a significant degree from arthritis. The medication is obviously having an effect. And we can do that just by pairing good observation with trial and error.
You say you do a trial with regards to medication. Is it safe to put dogs on arthritis medication just to see?
These days we actually have a lot of options for safe, effective drugs and even things like semi-regular injections that work really well. Some of them use the immune system to deal with some of this chronic pain.
Like using the dog’s own immune system to fight the disease?
Yes, exactly, these treatments use it to help. They can engage the dog’s immune system to target certain pathways of inflammation and reduce the pain. So it’s not medication, per se, and you’re actually not giving the dog any chemicals, just getting the dog’s own body to do the work. You essentially give them monoclonal antibodies. It’s remarkable, it’s very specific. You don’t have a lot of the side effects you might get from traditional drugs and it can really improve the quality of life for a lot of dogs. But even the medications that we have now that are more conventional medications are specifically designed for dogs and are very, very safe.
Have there been medications in the past that were less safe for dogs? Is that kind of why you mentioned side effects? Like, are we getting away from something that was an unpleasant thing for your dog to have to take?
That’s a good question. I mean, early on we didn’t have medication specific for dogs and cats. We used human medication, but while some medication carries the same risk, others represent a quite significant increase in risk. Take Advil, for example — it is not really safe for dogs. Also early on when drugs like Rimadyl came out and were being prescribed to many medium and large dogs without monitoring lab values, you had a very small percentage of dogs having complications from the drug. The key is to monitor lab values after the dog is put on the meds on a regular basis so you can detect any under stable changes early.
Basically, don’t snap a human Advil in half and give it to your dog.
I’ve had human physicians as clients give their dog Advil, as well, and it creates a huge problem. But we now have a range of safe medications that are specifically formulated for pets, and we also have great protocols in place for monitoring animals for side effects. That ties back into some of our previous interviews on baseline lab work and subscription services that help monitor for any potential side effects. Long story short, I think medication is definitely the right thing to do when it’s appropriate. I’m not saying every dog that’s a little bit older and a little bit slower should just be pumped full of medication, but don’t be scared of it when it’s time.
Besides medication, what kind of things can you as a pet parent do to make a dog’s life easier and better if they do develop this condition?
First of all, we have to remember that we’re not talking about an acute condition. This is a chronic problem, so any approach that isn’t total joint replacement is going to be about managing it over the long-term, not curing it. I recommend a multifaceted type of approach to try to deal with it, but my number one thing is weight loss. Weight loss is extremely important because it eases pressure on the joints and even a small weight decrease will make a huge difference. There are also various supplements that can help to some degree, including some diets that are formulated specifically for helping with DJD. You just need to make sure what you get comes from a reliable source.
Ah, but it’s so hard not to give them a little treat when they want a little treat!
Of course, of course. We love them and we show affection with food. But it can become a problem because if the dog is overweight, it’s just more prone to arthritis and having arthritis makes them want to move even less. Then they get even more overweight and it just becomes a vicious cycle. Controlling weight can have a huge impact because even if you just take off a couple of pounds, it’s going to make it so much easier for them to be active.
How active can you realistically expect a pet with arthritis to be?
You’ve got to keep them active, but appropriately active. If you don’t keep them active, it’s like the old grandma or grandpa sitting there in front of TV and not moving anymore. They will only get more and more arthritic. Non-weight-bearing exercise is great, like swimming, but if you can’t do that you’ve got to just keep getting them out. Going on walks, doing other light exercise, or even doing a little bit of physical therapy if you’re really motivated — all of these things can make a huge difference.
It’s kind of just like with humans where it’s like “use it or lose it.”
Exactly. With my own Jack Russell terrier, Mondo, we did trail running. He passed a year and a half ago, but he was 16 and a half.
Wow, he lived a long time.
And he had a very good life. He loved running. But in the last year of his life, I couldn’t take him anymore. He wanted to, but it was just painful for both him and me. I hated seeing him struggle with it. But up until that point he kept himself going. Not as long, not as fast, but he kept going. I think it is really important to keep these dogs moving, not just staying there in a corner, sleeping all day. They need to keep moving those joints and keep their range of motion. It’s extremely, extremely important.
Anyway, as he got older we went on shorter runs but we still went on runs. He used to do 14, 15 miles and look at me like, “What’s next?” Towards the end of his trail running career it was more like 3 miles and a much slower pace. Sometimes I would have to help orient him to the trail. But it was still his favorite thing — he really wanted to go and he liked going. For me it was important to manage his pain so that he could keep doing that, which medication and supplements helped me do. Probably being so active helped him have a better end of life too. He made it right up until the last year of his life, and he was happy until the very end.
Yeah. I mean, it sounds like the ideal outcome: live a long life and don’t spend the twilight years of it in pain.
That’s what we’re going for!
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