Dog Pod - Episode 2
Dog Athritis with VET Dr. Kevin
Dog Cloud CEO Scott Groves interview Award-Winning VET, Dr. Kevin Cruickshank again, and this time they chat everything to do with joint pain and arthritis in dogs.
Learn about the causes, relief methods, natural supplements to medications and even the surgery options (which you won't believe!!!) and the costs involved with each.
Discover simple things you can do when dogs are young to protect them from serious issues early.
Listen to episode Here
Podcast Transcript
Scott: All right. Welcome back to another episode of DogPod. We are here with Dr. Kevin again. And we thought in this episode, we would continue on from a conversation we had in our last episode around dogs ageing and how they are sort of considered senior or geriatric by sometimes as early as five or six years of age. So, welcome Kev.
Dr. Kevin: Yeah, thanks. I'm glad to be back.
Scott: So, I thought one of the things that you no doubt see so commonly in the vet clinic as a result of I guess dogs that are aging. I want to sort of talk today a little bit about some of the truths and myths around this, but it is the joint pain and arthritis that is associated with dogs as they age. I think a lot of people are very familiar with it in the human form.
Dr. Kevin: Indeed.
Scott: But I think let us talk about it a little bit from the dog's perspective today and certain things that owners could look for, and just what some of the dogs suffer from, and how they could be cared for a little bit better along the journey.
Dr. Kevin: Absolutely. That is a great topic because it really is one of these things that old age itself is not a disease. It is something that actually is going wrong. If we can actually help, we may not be able to cure it but we can really help them cope so much better. And stiff joints and arthritis is probably the biggest overriding thing that makes a dog that people say, "Oh, he is just getting old.", when in fact he probably actually has some arthritis and actually has a lot of pain. Pain is probably quite poorly understood with animals and dog owners because we think of it as, "Oh, my dogs not crying. He is not whimpering. He is not in pain.". When you think about it, we can be in a lot of pain and we are not shedding a tear. And so, they are very good at masking that pain. I do not think they do it intentionally, but they are just coping and putting up with it.
Scott: Yeah.
Dr. Kevin: But they adapt and we see that the signs of their adaptation to help them cope and that is just getting slow. Avoiding going upstairs, lying in their bed for longer than normal. And we think, "Oh, he is just getting old. He is just sleeping a lot.". But he is actually not getting up and moving because it hurts every time so he waits until they absolutely need to.
Scott: Yeah.
Dr. Kevin: It might even manifest in suddenly a dog that did not used to wet its bed is occasionally wetting its bed. Well, he is holding on for the longest until he really needs to go to the toilet and then suddenly he is caught short.
Scott: And cannot get up quick enough and things like that.
Dr. Kevin: Absolutely. Yes, exactly. But even before it is as dramatic as that. It might just be that we noticed they struggle a bit more to get up after they have been lying down. They stretch quite a bit more.
Scott: Right.
Dr. Kevin: Stairs is the big one that sometimes shows them up that you can see they're not coping there. And arthritis, it's something that affects all their joints. So, every bit of mobility is difficult. Sometimes even leaning over to eat their food. So, it affects their whole life, their willingness to exercise. So, the first little signs might also be that on their normal walk, they just either wanting to turn for home sooner or they lagging. You are having to sort of entice them and encourage them to keep up a bit more.
Scott: Sit down and stop.
Dr. Kevin: Yes, absolutely.
Scott: Pulling up stumps. Yeah, I'm done.
Dr. Kevin: But the great thing is once we realized, once we have identified that that is what is happening. There is actually a lot we can do.
Scott: Yeah.
Dr. Kevin: Unfortunately, we cannot cure arthritis, but that is the same in people, but we sure will really, really help them. And that is from some very simple things that are not even prescription based, all the way through to the most extreme of something like a hip replacement. You know, ten, fifteen years ago, hip replacements in dogs were virtually unheard of. Now, they are routinely done. And not only available in the capital cities. They are available in regional areas as well, in specialist centers only. It is very advanced surgery, not two ways about it. And there is a lot to be considered before you do that.
Scott: Just be your last resort type of thing.
Dr. Kevin: Not even necessarily a last resort, but it is just got to have a lot of serious consideration. Because if things go wrong, if there are complications it's serious stuff because you have actually cut out the original joint and now you have put in an artificial titanium joint and that sort of thing. It's got to be done well. Somebody who really knows what they are doing in a very sterile environment. You do not want infections and that sort of thing. And it used to be that the technology was not that good that maybe an artificial hip would wear out after five years. They now talking at least ten years.
Scott: Okay.
Dr. Kevin: So, willing to do it at a younger and younger age that if it needs it so that it can be our last resort options because also that does come at a very big price.
Scott: I was going to ask about the cost.
Dr. Kevin: Yeah, you know, we are talking about probably but over $10,000.
Scott: For a hip replacement?
Dr. Kevin: It is covered by most pet insurance or at least partially covered. But if you don't have pet insurance, it is quite understandable that might be beyond the means of a lot of people. There are lots of other options. There is what we do consider sort of a salvage procedure or a last resort procedure is actually called a femoral head excision. So, the hip joint is a ball-and-socket joint.
Scott: Yeah.
Dr. Kevin: And if it is got so arthritic that there is bone rubbing on bone. Well, you can actually cut off or amputate the head of the femur. The ball part of the ball and socket, it is quite crazy to think that and all that is done is that is amputated. And then, we put some tissue in between the bone that is left there. And there is enough muscle around the hip joint that still stabilizes it. And those dogs are almost instantly relieved of their pain and they can be walking the very next day after that radical surgery.
Scott: Wow.
Dr. Kevin: Dogs always amazed me at work.
Scott: It is not like they end up short legged?
Dr. Kevin: No, they do not. Good question. Because the muscles keep it from the leg pushing up above.
Scott: Wow.
Dr. Kevin: It is a more crude type of resolution to it and it's probably not done as often as we used to do it. And that is because we have now got so many tools, medication wise so we may not be able to fix that joint or correct the arthritis, but we can help them cope with the inflammation and the pain. And what I really find is that if we use them, what is referred to as a multi-modal approach. So, not just relying on your painkillers. Not just relying on your supplements. Looking at a very holistic view and that is where there are lots of new therapies becoming more available now as well that may help with those things as well. So, looking at all of that physical therapy can play a very big role as well. There are now physios who have actually had specialist training in animal physiology as well. So, you get qualified animal physiotherapist who really know what they're doing.
Scott: Yeah.
Dr. Kevin: They work on animals from horses, dogs, cats. So, that can help a bit as well.
Scott: And post therapy, the sort of recovery protocols that they need to follow. I imagine that is quite a bit and is it further costs involved with I suppose of using physios and stuff.
Dr. Kevin: Using physios but most of it can be done by exactly most of us as vets will be able to give general physio advice and guidance for people. And look, it is probably only a minority of dogs with arthritis that end up having any form of surgery.
Scott: Yeah. I am sure.
Dr. Kevin: Most of them are managed medically with the medications. And so I think it will be good idea. We can talk about some supplements that are helpful for dogs and that sort of things. As well as obviously, it is something I always advise people, take advice from your vet.
Scott: Yeah.
Dr. Kevin: Every case is slightly different. Don't just make assumptions and whilst the supplements can help a lot, I think the money shot really is your anti-inflammatory pain killers. There are quite a few different ones on the market. They're generally very well tolerated and of moderate cost.
Scott: Okay.
Dr. Kevin: So, they are not cheap, but they certainly within most people's means too. They are something that the dogs are on permanently.
Scott: Yeah, for their whole life then from...
Dr. Kevin: I am a big believer in making it easy for people to give those medications because a lot of dogs taking tablets is a struggle. We are not there to make people's lives and the dogs lives more misery. But a lot of the medications nowadays actually come as a liquid. My own dogs got arthritis and we just store his anti-inflammatory medication right next to his food bowl. It goes on his dinner once a day.
Scott: Liquid over the dinner.
Dr. Kevin: Tasty liquid and they take it very well. There are some steps to make sure that their organs are okay to keep getting those medications on an ongoing basis. And it is recommended sort of at least twice a year for an otherwise healthy dog that they have a blood test to check that it is safe to stay on those medications.
Scott: Okay.
Dr. Kevin: But they are not just a pain killer that is like a band-aid and masks the symptoms. They actually slow down the process of arthritis.
Scott: Yeah.
Dr. Kevin: Arthritis is an inflammatory process and if you can control that inflammation, then you are going to slow it down from getting worse and help them cope with it. So, it is a blend of having them on those good painkillers and that could then it is a nice positive cycle. Because once they are free of the pain, they are more likely to exercise. It is a situation use it or lose it. If you just totally rest them, then they are going to seize up more. If they have moderate exercise, that is going to keep those joints good. Swimming's a great one because they not take away to using their joints. The more they exercise, the more they lose weight. Now, weight loss is in most cases our fundamental part. Unfortunately, majority of our pets are overweight.
Scott: Yeah.
Dr. Kevin: And they will cope so much better with arthritis if they lose weight. But how do you get them to lose weight if they are sore and cannot go for walks. There is only so much you obviously, you do focus on diet and that side, but weight loss is really burning up more calories than what you eating. And the best way is to increase your exercise. So, that is a nice positive cycle that if we can get them pain-free then go. Now, a lot of dogs just need the anti-inflammatories. There comes a point where they are no longer controlling the pain.
Scott: Or they just getting worse and...
Dr. Kevin: As vets, we actually nowadays have more and more different painkillers. And we look at what is used in the human side and they can be on combinations of medications.
Scott: Okay.
Dr. Kevin: Or those dogs that for whatever reason cannot tolerate anti-inflammatories. They either getting gut upset or they have got a kidney problem. That means there are lots of other options. Sometimes people feel they have exhausted all their means but rather have a chat with your vet. Get things customized because sometimes dogs can be on a combination of three or four medications.
Scott: Yeah. And is this the multi-modal approach to the so many natural therapies popping up now as well.
Dr. Kevin: Yes, and so we look at natural things, a big one that has been known for a long time is a product called glucosamine. It is normally good to have glucosamine in combination with chondroitin. And glucosamine helps improve the quality of your cartilage. And your cartilage is like your shock absorber on the end of the bone. So it's, in a joint, you've actually got cartilage lining the top of the bone. And that makes a nice smooth gliding surface. But if that is no longer sort of got a little bit of give in it, a little bit of sponginess, then it is much harder.
Scott: Does absorbency of nutritional supplements fade over time? Like it does a little bit I think in humans, I believe the stuff I read. Is that the same sort of thing in dogs? Or if they are supplementing well, they are normally...
Dr. Kevin: My understanding is that that should be continued to be absorbed.
Scott: Yes.
Dr. Kevin: But it is a very good point that you raised because certain supplements are not that available for the body to absorb.
Scott: Yes.
Dr. Kevin: So, something that is getting a lot of attention not only for arthritis, but lots of other benefits is turmeric.
Scott: Yes.
Dr. Kevin: But turmeric on its own is very very poorly absorbed. It needs to be potentiated or in a form that is bioavailable. And in a very crude way black pepper is one of the things that I believe, I am not sure how it is exactly combined. So, if you are getting a turmeric product make it sure this one is actually made for health benefits that will be bioavailable. So, there is something called boswellia, is another ingredient that is potentiated with turmeric to help it to be absorbed well. So now you also get combination products. There are some that are available that is a combination of glucosamine, turmeric, green lipped mussel is also a very natural type of anti-inflammatory. You also get a course of injections that are a prescription thing through vets, but they improve the quality of the joint fluid and help to control the inflammation. So, if you are improving the cartilage surface and you improving the viscosity of your joint fluid, so you improving the oil in the joints so to speak.
Scott: Yes. Yeah.
Dr. Kevin: Together that is going to have a better synergistic effect rather than using any one of those on their own. Scott: What about dogs eating fish? We obviously normally associate that with cats. That get a lot of tuna and they get their stinky cat fish bowls and stuff like that. What about dogs for the omega side that I guess for the health of dogs?
Dr. Kevin: The omega-3 and omega-6 is a very important and beneficial part. But to get enough, they have got to have what is referred to as super physiological levels. So, higher than just what you get through your diet. So, to get enough, they would really have to have a lot of fish. A lot more fish. So you actually want to supplement that is like a high strength fish oil for that type of base.
Scott: Okay.
Dr. Kevin: The fish oils or sometimes oils are used in the diet for good skin care. And so things like flaxseed oil. What is key with any of these oils is the omega-6 to omega-3 fatty acid ratio. So again, using a product that is already blended to be in that is going to be better than just picking a fish oil on its own.
Scott: Okay.Dr. Kevin: But on the other hand and it does not have to be dog specific, you can use a human product. I normally, as a rule of thumb, would suggest to people using it at the dose recommended for an adult even if we are typically 70, 80 kilograms. And our dogs our most not going to be that ,but that is going to give you that super physiological level.
Scott: Okay, that it is over...
Dr. Kevin: Three or four times what is thought to be for their weight. The only negative with that is the very high level sometimes fish oils or any of the oils can contribute to Diarrhea. So, if you see that the stools getting bit loose then you just to back it off a bit. Because it is very hard when we look at all the scientific research, you can't actually find a specific dose that is recommended.
Scott: I mean, there are so many different dog breeds. How do you get there...
Dr. Kevin: And dog weights and that sort of thing. Some of it is also just not effective research to know. We do not know what level is needed. We know it is beneficial. What very precise level is needed in the joints? But to me that should not be a reason that we do not use it.
Scott: No, of course.
Dr. Kevin: Again, it is a safe thing. It is not like saying I just take a lot of this drug and that will help. What the body does not need it will excrete, as long as you are not going to high level that you are causing diarrhea.
Scott: I want to ask you about I guess causes or certain lifestyle factors that may contribute to whether it results in arthritis, but particularly just things like joint pain. Because one of the things that we are seeing a lot of, I mean dogs by nature sort of, when I grew up as a kid, we are sort of more country and dogs would be outside all the time. They are on the grass, their claws are on the grass. Now, one of the trends so many dogs are more indoor dogs now. They are on hardwood floors, they are on tiles where they slip you see, and it looks cute on a YouTube video or something like that where a dog slides around a corner and stacks it into a wall. But the fact is that the dog could be really potentially hurting itself and hurting a hip or hurting a joint or whether it's the foot. Are you seeing more of this sort of stuff since a lot more of the dogs are becoming indoor dogs over the last 22 years of being in Veterinary?
Dr. Kevin: I think we do see more arthritis, but that is not necessarily that the lifestyle in that sense has caused it. I think it is made it more be able to be more evident because again coming back to that point that they hide or do not show the symptoms of it. So, walking around the grass they look like they are coping. Put them on a slippery floor, tiles, then suddenly you see that they not coping so well. So it has not been that the slippery floors cause that it is just let it be evidence that they not coping as well as they we think they are. Other lifestyle things though, being overweight for a lot of your life that definitely. And we do love our dogs. They are a part of the family. We spoiled them more than we should. So, a lot of dogs are carrying extra weight. So, that is a lifestyle thing that definitely leads to more arthritis. A lot of injuries when they are young. Over-exercising when they are really young.
Scott: Yeah, which is something we spoke about in the first episode.
Dr. Kevin: It is just sometimes dogs doing a lot of agility work. So that is going over jumps and that is thing they can start to develop some...
Scott: Show dogs.
Dr.Kevin: Yes, some arthritis in their spine and that type of thing later on in life. So, being an athlete sort of thing, you know. They cope very well with it when they are younger, but then they manifest later. Some other lifestyle... Oh another one with, not directly lifestyle, but sometimes it is genetics and there is not much you can do about it. Certain breeds, we probably all heard of hip dysplasia.
Scott: Yeah.
Dr. Kevin: Hip dysplasia is not directly a disease. Hip dysplasia just means that the hips are the wrong shape or not the perfect shape.
Scott: Right.
Dr. Kevin: The result of hip dysplasia is arthritis. So they can have hip dysplasia, technically, you take an x-ray when they are six months old or a year old and you can see that the shape of the hips is not perfect, but they do not yet have arthritis.
Scott: Okay.
Dr. Kevin: But if you have that outcome, then you can know to be even more focused. Perhaps start those supplements before they're needing painkillers. You can start those supplements from a young age. You can be so super conscious about not over-exercising, about not putting on extra weight. Help them cope so that they going to, they might still have arthritis in the hips later on, but they are going to have it milder and they are going to cope better with it.
Scott: What about like the knee joints? I know you and I have spoken obviously off air, but a lot of smaller dogs, and I know a number of friends with dogs or have smaller dogs, that suffer with these kinds of conditions. Is it the tendon pops out of the knee joint?
Dr. Kevin: Yes, or what's called the patella, which is technically the kneecap.
Scott: Okay.
Dr. Kevin: So, yes, that is all common knee problem in small breeds of dogs definitely. And that is primarily due to the shape of the leg, the way they're born. So it is often an alignment issue where the ligament from the kneecap goes, but it also is very commonly the depth of the groove so that kneecap slides up and down in a groove. If that groove is a bit too shallow, then it is going to pop out of place. And so what you see is a dog that is walking along and suddenly it is limping up. It has not got a thorn in its foot or anything. And then some of them, depending on their grade, will correct by themselves and then others will be a lot more lame. Not able to jump up on the bed that type of thing. And they might only manifest it when they are two years old and that sometimes because it has been slipping in and out. But the ligaments have stretched and then maybe one of the co-lateral ligament, they are the ones on the side, might actually have finally torn. That then allows it to slip out a lot more commonly. And so there is surgery that can be done.
Scott: When they are younger, I imagine probably bit like young children. They are a lot more bendy. A lot more flexible.
Dr. Kevin: So they do not, but they tend to show those problems at a younger age like two years of age compared to, another very common knee injury is cruciate disease. And that tends to happen in larger breeds of dogs. It is the same as an ACL in humans. So, it is an athletic injury typically and it is in your bigger breeds. It can happen in any size. But more common in our bigger breeds number like Labradors, Rottweilers, German Shepherds. We see that having a lot of torn cruciate ligaments.
Scott: Is that largely because of their size or is it the way they exercise? Over exercise?
Dr. Kevin: It is a bit of everything.
Scott: Okay.
Dr. Kevin: Shape of the leg to begin with. So just the stresses on that cruciate ligament. So, the cruciate ligament runs inside the knee joint compared to the patella tendon, which is across the front wrap of the top. So this cruciate ligament stabilizes the joint so that when they take weight the leg does not give way. And it is a wear and tear injury. So we typically see it from five years older. Overweight dogs are.
Scott: And this is the over weight issue again here.
Dr. Kevin: More overweight.
Scott: Yeah.
Dr. Kevin: Coming back to a common theme there.
Scott: Yeah, absolutely, so it's a conundrum isn't it though, I guess one of the challenges is that, you've got a dog that is overweight. They are in pain. We know we have got to exercise them to get the weight down, but it is almost sort of semi cruel in some way to just start slow anti-inflammatories like try and reduce the pain to give them a chance to be able to do that stuff. Stuff that alleviates it that allows them to be a bit more mobile.
Dr. Kevin: And you and I have both had our fair amount of injuries and slowly come back from those and rehabbed. And it is exactly that. Starting slow. Picking the correct surface, walking on soft sand on the beach is not good. Nice level concrete feel footpath or that type of thing. The right pace, just doing within what they can cope with. Building up fitness slowly. Not just suddenly having a mindset change. I am going to get my dog and lose weight. And we just suddenly go from nothing to walking 7 times a week. They are not that, their body needs to build up. Even the strength of ligaments those sorts of things.
Scott: Can I ask about the human factor in this? Because I imagine, well, I am like I have had dogs my whole life as well turn and look, you know, Jazz passed away at 17, but she was very different. I could throw a ball with her. She was a psycho for a ball. Would chase it all day. That was her exercise. And I wouldn't have to go do anything. But I know a lot of humans will go out and take their dogs on their human walk.
Dr. Kevin: Yes.
Scott: Now, the humans have got it in their mind that they are going to go walk 4KM, 5KM or whatever they want to walk and they are taking the dog along for that journey with them rather than taking the dog for the dog's walk.
Dr. Kevin: Good point. I think it also depends how we are walking. Taking them along on the walk I think is fine. Taking them for a run, not as good. And certainly taking them alongside the push bike, a bit more of a damaging thing. They will cope. Dogs that have the mental age of a two or three year old. So, we have got to think for them. Coming back to the ball analogy, they will chase that ball until that absolutely tired and they will be crippled the next day. We have got to be the ones that think about it and say, "Hang on, enough. That is enough. A little bit of throwing.". Even how you throw the ball is important. Not throwing it bouncing because they going to tend to be doing a jumpy run similar to a wallaby.
Scott: Okay. It makes me feel like a bad dad.
Dr. Kevin: So rolling it on the ground. And even better is actually keeping them, you have to release them to give a command to go and fetch the ball once the ball has stopped. Because that sudden trying to turn as the balls still rolling and running, those sudden sharp turns are things that can cause injuries.
Scott: Yeah. Absolutely. I look that is a lot of great advice. And as the winds picking up down here we might wrap up episode 2. Kev, I want to thank you so much. Your advice is golden as always. So, we look forward to the next episode with you.
Dr. Kevin: Always pleasure to chat, Scott.
Scott: Thanks.
[END]
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