It breaks our hearts to see a loved one in pain. Too often we miss the signs in companion dogs and cats because they are very subtle. If pain is acute, like when a puppy plays too roughly at the park, he squeals, and we know that he is hurt. But adult dogs can be very stoic and not vocalize at all, even when in extreme pain. Chronic pain is even more challenging because the animal has learned to expect it and is dealing with it at all times. Cats especially do not show symptoms that are easily recognizable. Cats that display any weakness such as pain are at risk of becoming another predator’s meal; they instinctively mask pain. The signs of pain are so very subtle that it is easy to miss them unless you are extremely observant and spend a lot of time with the cat. Often they stop doing the things that are difficult for them like jumping up on the counter or playing with their toys. We often assume they are “just getting old” because their activity level declines, and the changes are gradual. We used to miss a lot of pain in veterinary medicine practice, but we are getting much better now at identifying and treating it.
For more on how pain affects behaviour and how to figure out if your pet is in pain, see
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1761
http://www.catvets.com/cat-owners/caring-for-cats/signs-and-symptoms
What I really want to talk about is how to treat pain safely and naturally with herbs, and let you know which can be safely combined with narcotics, non-steroidal anti-inflammatories (NSAIDS) or both.
First of all I need to get something off my chest. One of my pet peeves is the issue of over-the-counter supplement quality and safety. Many products have no third-party evaluation for purity and potency, and even have inaccurate or missing label information on the exact source and processing of the herb. In my practice I only use professional-grade products from companies I trust, who share manufacturing details such as GMP and ISO certification, and use DNA or chemical “fingerprinting” to ensure that the plant material is the correct species and potency. Most are members in good standing of industry associations such as NASC .
These products are more expensive than some out there in the online stores and local pet shops. You usually get what you pay for.
Now, on to what you are really here for….
Turmeric, Curcuma longa (root), which contains curcumin, is one of my favourite herbs for pain releif, but it has very LOW bioavailability as a raw herb powder. It acts on nitric oxide pathways instead of the COX pathways that NSAIDS block, so it is safe to combine with those drugs. Use the raw powder mixed with fat in a home-cooked meal or “gravy” for your pet to increase absorption or choose a cucurmin product that is complexed with lecithin or choline so your pet can benefit.
In Traditional Chinese Medicine, the different parts of the root are used differently. The Rhizome, Jiang Huang is used more for pain, especially in the forelimbs, while the Tuber, Yu Jin is used more for liver disorders.
Alfalfa, Medicago sativa (above-ground parts: leaf, stem and flower) is a nourishing and restoring herb. It is usually used as a componant in herbal formulas for pain, not often on its own. Constituents include phytoestrogens, Calcium, vitamins A, C, E, and K, saponin, and phenols.
Corydalis, Corydalis ambigua (root) called Yan Hu Suo in chinese is an excellent analgesic, especially for cancer pain. It inhibits dopamine release in the brain, so caution should be used if combining with medications that change dopamine levels. It lowers blood pressure and interacts with calcium channel blocker heart medications. As well, it can inhibit platelets which potentially leads to increased risk of bleeding, of special concern if surgery is planned.
Many more herbs are used for pain, and will be explored in future posts.
Before using any supplement for your pet, please consult with a qualified veterinary herbalist.
To find a qualified veterinary herbalist near you, check VBMA’s practitioner list.
I recently had a question about what can cause shaking, especially in the legs of an older dog. The most common cause of shaking legs in the young dog that I see is fear- these are dogs that do not want to be in the examination room! But for the older dog shaking at home, muscle weakness is often the root cause. Several systemic illnesses can result in muscle weakness. Kidney disease often causes loss of muscle tissue as well as imbalances in the electrolytes, various minerals that are essential for muscle function. Adrenal gland disease can also cause muscle loss and electrolyte imbalances. Cancer must always be on the list as well, due to the unpredictable nature of the disease. Systemic disorders are diagnosed with blood and urine testing, sometimes x-rays and ultrasound as well, usually on an outpatient basis. Therapy can include dietary modifications, mineral supplementation and physical therapy, as well as medications where needed.
Pain from arthritis is an often unrecognized factor in shaky legs and muscle weakness. When it is more difficult to get up and move, your pet exercises less, and muscles gradually atrophy. While leg joints such as hips, knees and elbows are often affected, don’t forget all the joints in the back. As many of us know, when the back hurts, everything hurts.
Acupuncture and cold-laser therapy are the basic tools that I utilize for my patiens with arthritis. Prolotherapy and stem cell therapy very successful, but are more “invasive” interventions, and must be done with sedation or anesthesia, so are not suitable for all pets. Massage is wonderful because it is usually available from travelling therapists who will come to your home. Some massage techniques are also very easy to learn to do yourself, and are a special close bonding experience for you and your dog or cat. Herbal and nutritional interventions such as high levels of omega-3’s from fish oil, green-lipped muscle extract, cucurmin (turmeric extract), MSM, glucosamine etc. can be very effective in reducing the pain and mobility restrictions of arthritis. Physical therapy is also a very valuable part of a multi-modal approach to arthritis, to help strengthen muscles and the tissues that support the joints.
For more on integrative arthritis care, please read “Arthritis Therapy: Integrative Approach”
Stem cell therapy is a very exciting, relatively new treatment for arthritis. It has only became available in Canada about 18 months ago, and is definitely living up to the hype!
Large joints such as the elbow, shoulder, hip, and knee are currently available to be treated in private practice. The spine is in investigational treatments at this point, as techniques are being refined.
But is is not the right procedure for every pet. It requires a general anesthetic for the initial tissue harvest, then sedation 2-3 days later for implantation of the stem cells in the joint. Pets must be in good health other than the arthritis, as evidenced by blood tests.
Other requirements are a stable joint, as instability as is the case with an anterior cruciate (knee) ligament (ACL) rupture will interfere with the effectiveness of the procedure. The joint also needs to be accessible- the stem cells are injected into the joint space through a needle- so very obese patients or those with calcifcation of the joint capsule can be much more difficult for correct placement of the injection.
Many patients I see suffer from joint pain, loss of mobility, stiffness, and decreased quality of life due to degenerative joint diseases such as arthritis.
A multimodal approach is required for this very challenging condition. Usually an increase in mobility, a decrease in pain and a much better quality of life results. Key modalities are diet, acupuncture, cold-laser therapy, herbal supplements, nutraceuticals (nutritional supplements such as omega-3 EFA, green-lipped mussel extract, glucosamine, chondroitin, MSM, antioxidants), injectable joint-support products such as Cartrophen and Adequan, Prolotherapy, non-steroidal anti-inflammatory drugs such as Metacam, and Deramaxx, and non-sedating narcotics such as Tramadol. Sometimes steroidal anti-inflammatory drugs are used, but they are usually reserved for cases where the benefits outweigh the greater risks of that class of drug. Physical therapy such as underwater treadmill exercises and swimming in a controlled environment is helpful for improving mobility and building muscle strength lost due to inactivity. For the very difficult cases, nerve-pain drugs such as Amantadine and Gabapentin are added. Surgery is needed when there is significant joint instability leading to partial or full luxation (dislocation), bone chips in the joint space or for hip replacement. A new cutting edge modality now available is Vet-Stem Regenerative Stem-cell Therapy for dogs!
The cornerstone of diet therapy is to maintain or acheive a lean body condition. Often these pets have not been able to exercise for a very long time, and subsequently gained weight. This added weight is a serious complication for painful joints, as every extra gram the animal has to carry stresses the affected joint more. Sometimes weight loss is all that is needed for the return to full mobility, but in the majority of cases additional modalities need to be used. To determine how much weight needs to be lost and a safe rate for the slimming program, consult your veterinarian. There are prescription weight loss diets available, as well as a medication (Slentrol-for dogs only) to help acheive ideal body weight.
Acupuncture is an often-overlooked modality, but it really shines for treating chronic pain. In the hands of a practitioner trained in Traditional Chinese Veterinary Medicine, the whole body is treated, not just the affected joints, so many other issues can be addressed at the same time. The cost of acupuncture treatments is usually comparable to or even less than conventional drug treatment. Side effects are rare and usually very minor such as mild bruising at the acupuncture site.
Cold-laser therapy can be used for laser acupuncture, to stimulate acupoints without needles, or as regional therapy directly over the affected joint. The laser treatment reduces pain, increases blood flow and stimulates healing. It is usually given very frequently at first, such as 3-4 times per week, then tapered down to weekly or even monthly.
Herbal supplements are available at many pet and health-food stores, as well as online. The english name of the herb on the label is not sufficient, as many very different herbs have similar common names. The part of the plant used needs to be identified, as some plants have toxic roots but safe leaves, and vice versa. The product should be tested for contaminants, such as bacteria, mold, heavy metals and other toxins. Finally, the extraction process and amount of herb present in the product should be listed. Sadly most of the products available directly to the consumer are lacking in many if not all of the above. Another issue is the use of herbs that may be safe for people, but are toxic to pets; cats are especially sensitive to many things that are safely used for dogs and people. Remeber that herbs, like drugs, can have severe and even life-threatening side effects. Do not be lulled by the fact that they are “natural” products; they contain a wide range of chemical compounds that can work synergistically to help OR harm. Please consult a veterinarian trained in herbal medicine before using an herbal remedy for your pet. Listings of qualified veterinarians can be found at www.vbma.org www.tcvm.com and www.ahvma.org
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