21/11/2024
What health condition is a leading cause of elective euthanasia in dogs, possibly THE leading cause?
Answer: osteoarthritis
Osteoarthritis is the most common cause of chronic pain in dogs. Initially affecting moving joints, it can result in widespread debilitation. It is progressive and irreversible. It is a leading cause of elective euthanasia in dogs, possibly THE leading cause.
Did you know that osteoarthritis is a disease of younger dogs? Osteoarthritis affects at least 20% of dogs older than one year (recent figures claim 35%) and 80% of dogs over eight years of age.
In younger dogs under diagnosis & under management results from failure in early recognition. Not surprising as dogs make value-led decisions which can be misleading with regards to pain magnitude i.e. chasing a ball frenetically does not exclude severe, chronic pain.
We should hold our hands up that under diagnosis and under management can also result from failure by us, as clinicians, to present the condition in a more positive light and failure by us to allay potential fears regarding medication.
For senior patients, caregivers inherent acceptance of ‘slowing down’ leaves palliative treatment dismissed.
And not forgetting cats too. Osteoarthritis is more common and more severe in older cats. A study found 90% of cats over 12 years of age have radiographic evidence of degenerative joint disease if spinal osteoarthritis is included; 60-90% if looking at limb joints alone. And cats are absolute masters at hiding clinical signs, as we all know.
As a disease osteoarthritis is usually advanced by the time clinical signs are suspected. Only half of all in–pain canine osteoarthritis cases are treated. If left untreated negative consequences of osteoarthritis may embed and become resistant to future attempts to treat. There is potential for musculoskeletal deterioration, deep seated central sensitisation (an amplification of neural signalling within the central nervous system that elicits pain hypersensitivity) and, as in humans, there is a correlation between chronic pain-driven mood disorders & cognitive decline.
Undoubtably care of companions with osteoarthritis is emotionally consuming, physically demanding, and carries significant financial pressures – all potential barriers to healthcare choices. I often think it is the hardest chronic condition a family can be faced with for their pet.
A single mono-pharmacy approach is not enough. Polypharmacy is usually required to target different parts of the pain pathway.
Single mono-pharmacy is certainly not enough to be able to declare that ‘nothing more can be done’. Then anticipatory grief can negatively skew choices: euthanasia may be chosen or veterinary care abandoned.
In reality there is much to be optimistic about in the care of osteoarthritis. All treatment options-conservative (pharmaceutical, physical therapy etc), surgical, regenerative (e.g. stem cell therapy) can be discussed. Osteoarthritis welcomes an integrative and multi-disciplinary approach.
We can be fearful of medication and yet accepting of obesity; yet there can be a two-year difference in life expectancy between lean and overweight.
Simple environmental enrichment tools e.g. extended feeding, nose work, can be introduced & offer a substitute for activities that can no longer be engaged in. Pain relief by distraction and mental stimulation.
Increased social contact allows for emotional engagement and release of pain relieving endorphins.
There can be a significant negative impact on the caregivers’s mental health of long walks no longer being routine and use of simulated mobility, a dog buggy, considered on this point alone. Increased car rides are another option.
A caregiver’s prerogative is to choose to invest more or less in comfort care as the disease progresses. Yes, there are a lot of treatment options available but intelligent choices can be made as to which to prioritise. Financial input should always be targeted where possible to proven treatment options first. The rest can be optional add ons. With changing patient & caregiver needs as the disease progresses care must be flexible.
It can feel overwhelming and difficult to know where to look for reliable information. It is such a vast field that there isn’t time in a 10-15 minute primary care veterinary consult to cover it all. In looking in to the options available to you as a family in helping your companion stay comfortable with mobility issues I always recommend visiting Canine Arthtitis Management at https://caninearthritis.co.uk/
Please see also CAM’s main page and additional pages Holly’s Army and CAM Product Share & Review.
CAM is a fantastic & reliable resource.
We are also very lucky to have here in the Southwest access to highly qualified veterinary pain specialists and veterinary physical therapists. Along with your primary care practice this multidisciplinary team can help you care for your companion & help them enjoy an improved quality of life and maybe even an extended lifespan.
