DVM: Discuss approaches that may be considered when planning long-term care for the animal. How can the owner be brought into
this plan to achieve the best outcome for the animal?
Budsberg: There's an informal checklist people should go through. The first thing to ask is the dog overweight? The vast majority
of my patients are overweight, so that's the first thing you usually deal with. Obesity is bad for geriatric patients in general,
but it is absolutely terrible for patients with OA.
Then you go down the list. What is the activity level of the animal? Does it get regular exercise? Is it a weekend warrior
or a couch potato? What are the owner's and the animal's expectation of activity? We know with OA patients, humans and animals,
consistent low-impact exercise is much better than high-impact exercise. If they can swim, take walks, if the owners can massage
them — there are a lot of activities that are very good.
And then you ask what kind of therapies are we going to include — nutritional, physical therapy, drugs or a combination of
these. We're starting to see some clinical data that supports the use of high omega-3, low omega-6 fatty-acid diets. The concept
behind them is that changing the types of polyunsaturated fatty acids that go into the animal changes the lipids in the cell
membranes, which actually changes the inflammatory response in the body.
There is no doubt that physical therapy as part of the management of OA is a very positive thing. Hot and cold packing, stretching,
water exercises, underwater treadmill — all are really helpful.
NSAIDs can be used intermittently or for long periods. I think we err on the side of too little for too little time. Studies
on NSAIDs funded by drug companies and pet-food studies have shown not only the improvement you would expect in the first
10 to 14 days but continued improvement over pretty much the life of the study, whether 21, 42, 60 days. With the continued
relief of pain, this allows the animal to rehabilitate itself.
Then you've got a whole cornucopia of things that people have tried and, to be brutally honest, without much data behind them.
The glucosamine/chondroitin combinations are tough because there is no doubt that in the experimental models glucosamines
and chondroitins have positive effects. The problem is, how much do you give, how often do you give, to whom do you give.
Everyone has an opinion but there's not a lot of support data.
And then there's the alternative therapies — herbal therapies, acupuncture, gold beads. When you have clients with animals
that hurt, you're probably going to try all of the different things that are out there. There's excellent data in the human
side and some of the same in the veterinary side that educating the OA client is one of the most effective things you can
do; in other words, education about the process, about all the different sides of it, that you can't just give a pill and
it all goes away. This is 30 to 45 minutes of going over this with them. If you do, you and your client will be much more
successful and everything will work a lot better.
DVM: What part does surgery play in the care of these animals? What other treatment measures can we look forward to in the
Budsberg: Surgery for OA is really a salvage procedure unless you can treat the initial problem surgically.
When you perform surgery for OA, basically, you destroy the joint or the functionality of the joint.
You can fuse the joint, but arthrodeses above the ankle and the carpus are less reliable for a positive outcome. They can
cause a large change in the gait and loss of functionality of the joint, along with other problems.
The second choice is removal of the joint. The only joint this is effective for is the hip, a femoral head and neck excision
— where you take out the ball and socket and build up a false joint.
The third option is replacement surgery. Total hip replacements have been common for 30 years and more total knee replacements
are now being done. Furthermore, total elbow replacements are starting to be performed and will increase in frequency in the
very near future.
Also in the future, either transplanting or regrowing cartilage could become the the Holy Grail of OA treatment. But we're
not there yet.
Wetzel is a freelance writer in Cleveland, Ohio.