Saturday, June 12, 2010

Gee Doc, do you think he's in pain?

"Gee Doc, do you think he's in pain?". I hear this question countless times each week. In some cases, it is code for "Is treating him going to be expensive? Because he's getting to be more trouble than he's worth and the kids are bugging me for a puppy". After 20 years I have gotten pretty good at reading between the lines and separating out the folks who are looking for an excuse to euthanize their dog, and those who are really concerned about their pets wellbeing.

It always surprises me just how BAD people are at interpreting signs of pain in their pets. When their 8 week old puppy decides to scream bloody murder when someone tries to look in his mouth almost every owner is convinced that the puppy MUST be in agonizing pain. In reality, the puppy screams because a) puppies are dramatic and have exaggerated reactions b) he's never been asked to tolerate any restraint before and c) every time he screams like that his owners stop whatever it is that he doesn't like so it works for him. On the other hand, very commonly owners will bring in an old, overweight, large breed dog who has to work really hard just to get up once he lies down, and tell me they are sure he isn't in any pain "because he never cries".

Dogs (and cats) RARELY will cry out or whimper when they are in pain, unless there is something sudden and traumatic that occurs to cause that pain (usually the crying even in that situation is related to a fear response as well as pain). Animals tend to bear their pain much more stoically than we do; when you think about it, it makes sense that they often show few outward signs because in the wild, animals who show signs of weakness often end up as lunch; or at the very least, vulnerable to challenge for status by lower ranking pack members.

Determining if your pet is in pain is easier if you know your pet well, but sometimes still can require close observation skills and a little detective work. If your pet limps, is stiff and/or has difficulty rising, or shows reluctance to jump up or climb stairs when they previously had no issues, it is very likely that they have significant pain. Most of us have no trouble observing these signs (though it is amazing how many owners discount them and still do not believe their pet is painful). However, more subtle, early signs of pain can be an elevated heart rate, increased respiratory rate or panting, shifting weight frequently from limb to limb while standing, or slightly decreased willingness to exercise (however, MANY pets will still chase balls, squirrels, etc even if they are quite lame and painful at other times- I can tell you from personal experience that adrenalin is a GREAT pain reliever! I never hurt when I run my dog in agility, but my knees will pay the price later!). Look at your pet's expression; are his lips tight, tense, and slightly downturned at the corners? Does he have a sad, uneasy, or glazed expression in his eyes? Pets have a wide repertoire of facial expressions, and if you know your pet well or are accustomed to reading animals' body language, you can often recognize signs of distress quite easily. Lastly, dogs who are painful can often show increased aggression, so if your pet is suddenly exhibiting behavioral issues, be sure to consider a physical cause. Also, be aware that dogs who have suffered an injury and are painful WILL bite, even if they normally are quite gentle; if you need to move a dog who is injured it is best to muzzle it in order to protect yourself. If you don't have a muzzle on hand, you can cut the leg off of a panty hose; tie it over the top of the dog's muzzle (tightly), then underneath the dog's muzzle, then behind the dog's ears.

Thanks to Michelle Ragsdale DVM for the beautiful photo of her beloved "Popper".

Fortunately we have many options for pain control. One very useful product that is available and may help to slow progression of joint disease as well as decrease stiffness and discomfort is glucosamine. This product is considered a nutroceutical or dietary supplement, so it is not FDA regulated and is available without a prescription. There are many, many products available with glucosamine in them, both veterinary and human. In many cases there are other active ingredients as well, such as antioxidants. Because they are not FDA regulated, there is a wide variation in the quality of product available and, not surprisingly, in price as well. I personally like the products made by Nutramax; Cosequin is the veterinary version, Cosamine is the human version which is identical to the double strength veterinary product. The veterinary version is available in a capsule (can be sprinkled on the food if preferred), a chewable tab, or a tuna flavored sprinkle for cats. This product is a "pharmaceutical quality" supplement and is the one used in many/most of the studies that have been done. I generally suggest my clients start with this; after 3 months they probably have seen what type of response to expect, and if they would like to try a cheaper product I usually suggest visiting a site called which reviews dietary supplements and determines if their actual ingredients correspond to what is on the label. They would like to sell you a report, but will provide a short list of supplements which have passed their testing and is a good place to start. I start my dogs on glucosamine supplements when they are about 3 years old, to help protect their joints from wear and tear since we do a lot of different canine sports. You may notice that some diets also contain glucosamine; however in my opinion they generally don't contain enough to negate the need for a supplement.

Fatty acid supplements can also help to decrease inflammation in the body (and usually are good for coat as well). It is important to choose a supplement that has the proper ratio of omega 6 and omega 3 fatty acids; and ideally to feed a diet that has an appropriate ratio. Talk to your veterinarian about what fatty acid supplements may be appropriate for your dog.

One of the major groups of drugs that are useful for chronic pain control in dogs are the NSAIDs- non-steroidal anti-inflammatory drugs. This includes veterinary drugs such as Rimadyl, Deramaxx, Metacam, Etogesic, Zubrin, and Previcox. Human drugs in this category include aspirin, tylenol (acetominophen), and ibuprofen. Because all drugs in this category have the potential for side effects, it is important to use them only under the direct supervision of your veterinarian. NEVER give your pet a human NSAID unless specifically directed by your vet- failing to heed this advice can have disastrous results. For example, a relatively small dose of tylenol is likely to kill a cat; ibuprofen in dogs has a very high rate of gastrointestinal ulcers and potentially kidney failure as well. The veterinary products generally are very safe when used properly. This includes routine monitoring of blood panels to ensure that liver and kidney values remain normal, watching for signs of GI distress, and NEVER, NEVER mixing drugs in this category with each other or with steroid medications. We require our clients to have at a bare minimum a 48 hour wash out period between stopping one medication and starting another. When these precautions are followed, the vast majority of pets tolerate these medications quite well and their quality of life can be dramatically improved.

In recent years other medications have come into popular use for pain control either alone or in conjunction with the above medications. These include such drugs as tramadol, gabapentin, and amantadine. Injectable medications such as a drug called adequan can greatly help many arthritic pets, while having very, very few side effects. And, just very recently, stem cell therapy is becoming commercially available. This involves harvesting the animal's own fatty tissue, extracting the stem cells, and injecting them either into the joints or the circulatory system. While pricey, this technology appears to hold great promise for treating many diseases in the future.

So if your pet is getting older and showing signs of slowing down, and you think he may be in pain, talk to your vet! There are many options which can make his remaining years as comfortable as possible.

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