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To wrap-up our dog blog series on arthritis and joint issues for senior dogs, we spoke with Dr. Priya of ARK Veterinary Rehabilitation who has been a big supporter of dogs in shelters and is an expert in the area of veterinary rehabilitation.

LD: Can you tell us a bit about yourself (how long have you been working as a Rehab Vet) and your areas of specialty as a Rehab Therapy Vet?

Dr. Priya: I graduated from Melbourne University in 2010 and started pursuing my postgraduate certification in rehab in 2015. I started working as a full-time rehab vet in 2017 at the Soi Dog Foundation in Phuket, Thailand. My areas of specialty include integrative pain management, using a combination of acupuncture and laser therapy, myofascial therapy to soothe and relax the nervous system and relieve tension in the body as well as strengthening and conditioning of animals with mobility disorders.

LD: What are the most common old age issues in dogs and cats?

Dr. Priya: The most common orthopedic issues in both dogs and cats is osteoarthritis (aka arthritis). Hindlimb weakness is a common presenting clinical sign in aging animals and can be caused by not only an orthopedic (bone/joint-related) issue but also neurological (nerve) and medical (cardiorespiratory, endocrine, hepatic, and renal). Like in humans, aging animals have lower cellular repair and regenerative capacity which means that the machine (the body) is slowly and naturally breaking down.

LD: How do you differentiate between regular aches and pains and degenerative diseases like arthritis in dogs and cats?

Dr. Priya: Regular aches and pains from a small traumatic incident or muscle fatigue especially post-exercise generally resolves on its own within 24-48 hours. Arthritis is a chronic progressive disease, meaning that it is there for the long term and only gets worse with time.

LD: What breeds of dogs or cats are more likely to develop arthritis?

Dr. Priya: 10 years ago, I think the difference in breed predisposition to arthritis was much greater than it is now. These days I see all breeds of dogs presenting with clinical signs of arthritis at an early age due to poor breeding causing poor confirmation and improper nutrition or lack of exercise causing improper growth and development of the musculoskeletal system. Improper diet and nutrition also causes obesity in most of our companion animals which naturally does cause wear and tear of their joints and soft tissue structures.

LD: What are the signs to look out for to know if my dog or cat is suffering from early-onset arthritis?

Dr. Priya: The earliest clinical sign that there may be a problem is the loss of muscle mass of the affected limb. One limb may be skinnier than the other. Some dogs may be less active than usual preferring to rest frequently during walks, going for shorter walks, or even just preferring to be at home. Once the cartilage is diseased and the inflammation sets in, this is when there is pain and when the animal will show signs of lameness (limping) and difficulty rising with the affected limb. They also will appear very stiff in their movement.

LD: Which joints/areas on a dog/cat are more prone to onset arthritis?

In general, the major weight-bearing joints such as the elbow, shoulder, spine, knee and hip are more commonly affected. However, literally, any joint in the body can be affected and cause the animal to be in pain, including the toes!

LD: Is there anything that can be done to prevent, delay, or at least reduce the chance of a dog/cat developing arthritis to ensure they can lead a healthy lifestyle?

Dr. Priya: Yes there is, good nutrition and making sure that your companion is in optimal body condition and regular moderate-intensity exercise. Swimming is a great form of exercise as it works the entire body! However, the type of exercise will need to be tailored to the individual dog. Remember, just like humans, not all animals are sprinters neither are all of them marathon runners. Some like water, others are petrified. It would also be helpful to learn how to massage and stretch your dogs so that you can keep their body flexible.

LD: Could you share some tips on diet and supplements for a dog/cat that is diagnosed with arthritis?

Dr. Priya: Research has shown that the only supplement that has an impact on osteoarthritis is omega-3 fatty acid. This can be found in green-lipped mussel, salmon or krill. There are many products out there in the market, be sure to purchase a good quality product to ensure that it is effective when consumed by your companion. Other supplements such as rosehip oil, curcumin (golden paste), glucosamine/chondroitin etc. can be used but should not be relied upon solely.

As for diet, it is actually very simple. If you are feeding the correct diet at the correct amount, your animal will be energetic and produce good quality stools. You can feed dry food, home-cooked food, raw food, tinned food, whatever it is, observe the animal's response to what you are feeding them. Their energy level, their body shape, their stools. Always read the label, especially when you are feeding kibbles, tinned food and treats. Most pet food out there has so much preservative, sugar, and salt to make it taste good so your companion will eat it. Also remember, too much good stuff is equally bad.

Treats should be treated as treats! They do not need treats every single day. Also, if they are getting a treat, they do not need a whole stick of it. You can even use their kibbles as treats/rewards if you are training them. I love pure dehydrated meat, I generally stay away from poultry and pork unless it is organic. I only use dehydrated treats from The Barkery for my rehab patients. Lastly, strictly NO HUMAN FOOD! Meaning, no roasts and gravy, no curry puffs, no cheese etc.

LD: What are the common medications dogs with arthritis are given?

Dr. Priya: Medical pain management is important especially when there is a flare-up in the joints. Non-steroidal anti-inflammatories such as Rimadyl (carprofen), Meloxicam and Previcox are important to bring down the inflammation quickly. I believe short term use of non-steroidal anti-inflammatories is absolutely essential in animals experiencing flare-up of arthritis. The only contraindication is if the animal has kidney issues and/or if they have a sensitive stomach that causes them to have vomiting or diarrhea when administered this class of medication therefore your veterinarian may recommend a blood test prior to starting these medications. Long-term inflammation can prime the nervous system to be particularly sensitive to pain therefore the pain sensation is heightened in these animals. This is when drugs such as gabapentin and amantadine will be used. Tramadol, although dispensed frequently, does not have a consistent pain relief effect in dogs. Plus, it is incredibly bitter!

Cartrophen (also sold as Pentosan) injections given once a week for four weeks then monthly is not a medication but is the building block of cartilage. Some animals respond very well to them and others don't. From my experience, when an animal has less damage to the cartilage (early onset of arthritis), they tend to have better response to cartrophen injections compared to at the end stage of arthritis. Cartrophen injections and other natural anti-inflammatories (omega-3-fatty acid, curcumin) do not offer sufficient pain relief in animals experiencing arthritis flare-up.

LD: What physical therapy is best for dogs suffering from arthritis (eg. hydrotherapy, acupuncture, massage, laser treatment)? And costs/time involved?

Dr. Priya: The type of therapy will depend on what stage of the disease the dog is presenting with. If there is a significant amount of pain then the initial course of therapy will focus on pain relief. If the degree of pain is mild to moderate then these animals will benefit from concurrent use of integrative pain management techniques such as acupuncture and laser and functional therapeutic exercises.

In an animal with severe arthritis, especially when they are large or overweight, I do prefer the use of the underwater treadmill as a form of exercise. In the underwater treadmill, we are working on balance, proprioception (body position awareness), gait and coordination, and strength all of which are components of mobility in an animal. Recruitment of the myofibers and signaling of the neuromuscular system when an animal performs an exercise in the underwater treadmill differs from when they are swimming as movement on the treadmill mimics movement on land. If the animal is non-acceptant of the underwater treadmill, then I would recommend swimming.

For animals that are not severely debilitated by arthritis or for those who do not like the water or where hydrotherapy is contraindicated, land-based circuit training (not synonymous with agility training) plays an important role in the conditioning of the body.

Rehabilitation requires patience and dedication in the form of time, money, and energy. Monthly rehabilitation sessions performed at twice a week interval (8 sessions) will cost about SGD$1200-1500. Therefore remember that prevention from a young age with good nutrition and regular moderate-intensity exercise and EARLY intervention ensures that the costs long term are kept to a minimum. Most people wait until it is absolutely necessary to do something about their animal's mobility issue but this is when the problem escalates to a point where more intense rehab for a longer duration is required with suboptimal recovery when compared to if they started intervention earlier.

LD: Besides the medical advice from a trusted vet, what can we as caregivers do to keep our pets comfortable when they develop arthritis?

Dr.Priya: As soon as you find out about a mobility issue in your animal, a rehabilitation consultation is a good place to start. Here is usually where you will be given a plan to manage the mobility issue to ensure that your companion stays comfortable and mobile as long as possible. You will be taught how to massage and stretch your animal, advised on home pain management tips using hot and cold packs, advised on the best types of exercise for your companion's mobility issue and weight management.

More importantly, mobility care for your arthritic animal needs to become one of your priorities which means that you have to actively participate in ensuring that your companion stays comfortable and mobile. This literally means making sure they have proper nutrition and ensuring that they are at optimal body condition, following the recommended exercise plan and performing the massage and stretching techniques at home on a regular basis.

I would like to take this moment to emphasize the importance of body condition and exercise in animals with arthritis. Strong and healthy muscles will protect a diseased joint and being lighter means less stress on the diseased joint. No amount of rehabilitation or supplements will truly help if the animal remains overweight.

LD: How can people get in touch with you for rehabilitative therapy?

Dr. Priya: They can contact us on whatsapp at +65 8616 3573 and check us out on Facebook and Instagram @arkvetrehab. Our website www.arkvetrehab.com is currently being worked on and once it is up and running we will notify the public through our social media platforms.

READ more here:

- PART 1 - Healthcare Tips for Senior Dogs - Arthritis & Joint Pain Management

- PART 2 - Healthcare Tips for Senior Dogs - Fostering Senior Shelter Dog CX