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Interview with Dr. Tobin, DVM
Dr. Stephen Tobin is a holistic veterinarian who providestreatment using homeopathic herbs and nutrition. He speaks with us about hisphilosophy of animal care, pet nutrition, and his experience with the LonglifeProgram in the treatment of his patients.
If a dog is having trouble performing routine activities, or crying or limping as it attempts to perform acts that were once routine, it may be suffering from Canine Arthritis, also known as degenerative joint disease (DJD).
How Does Longlife Treat Arthritis in Dogs?
Longlife for Dogs contains essential, all-natural calcium, phosphorus, and carbohydrates to heal cartilage tissue, ligaments, and tendons, while also improving joint fluid and joint lubrication. Longlife for Dogs also contains 100% pure shark cartilage, which has been proven highly effective in the treatment of arthritis in dogs. Over 90% of animals tested have shown a remarkable decrease in pain and swelling. It acts as an all-natural, anti-inflammatory agent and increases antibody production to improve immune system response.
Canine Arthritis: Overview
Arthritis can arise from joint tissue destruction subsequent to an infection, from congenital defects affecting structural architecture, and from stress and trauma to joint surfaces and supporting structures. Occasionally, disorders of the immune system lead to joint tissue inflammation and degeneration. The cartilage is adversely impacted and wears away faster than it can regenerate. The bony layer beneath the cushioning cartilage can be exposed and becomes inflamed; the joint capsule surrounding the joint members becomes thickened, less elastic, and highly sensitive. Blood vessels to and from the area of the joint dilate, and the joint becomes swollen and inflamed. Elastic tissues of the joint stiffen, calcium deposits can build up, and nerve endings send pain signals to the brain. Motion becomes more and more restricted due to joint degeneration, and the discomfort and pain prompts the dog to reduce use of the joint. Unfortunately, the reduced use further compounds the problems associated with arthritis because the patient then gains weight and continued disuse further limits joint mobility.
Symptoms of Canine Arthritis
Some early warning signs of canine arthritis include stiffness in the joints, favoring of a limb, or difficulty standing or sitting. Some other signs may include hesitancy to jump, an overall decrease in activity, general lethargy, an onset of stiffness in the mornings, or pain or palpitation of the joints. Also included are trouble running and climbing stairs, audible "clicking" when walking, change in behavior that seems to indicate pain, swelling and inflammation of the joints, limping, limited movements, and lack of desire to exercise.
If any of these symptoms are present, a dog may suffer from Canine Arthritis. Occasionally, the symptoms will be so visibly minor as to escape detection by the naked eye. One must also remember that as a survival tactic, animals have evolved into stoic creatures that rarely display outward signs of pain or discomfort. Fortunately for our domestic dogs, no less stoic than their wild ancestors, veterinarians today are much more "tuned in" to pain management than in the past. Veterinarians look for subtle signs in patients to discover early stages of arthritis, since outright limping or vocalizing from pain may be the end stage of long-term joint degeneration. For instance, during a routine exam of an aging dog, a client remarked to his veterinarian that the dog seemed to be moving a little more slowly lately and was more careful about lying down and getting up. There were no obvious indicators of pain or limping, just a careful attitude on the dog’s part when changing positions. The vet's evaluation of the dog’s limbs showed a reduced range of motion in the hips. The knees were normal, and the vet found no evidence of back pain when he pushed and probed along the spine. The vet considered early arthritis in the hips as a possible explanation for the subtle signs the owner had observed and decided to sedate the dog and take some X-rays. They were met with a surprise. This dog, only displaying the subtlest of signs of discomfort, had advanced degeneration of both hip joints and early bony changes of the lower spine.
Typical Arthritis Symptoms Appearing in Early Stages
Dog owners really need to be aware of these subtle changes in their dog's behavior. Typically, the symptoms that will be noticed first are increased weight gain, increased sleep, less interest in playing, and a change in attitude or alertness. If your dog becomes less excited to greet you when you come home, vacillates about jumping on the couch, or becomes overly cautious when climbing stairs, be aware that these may be the first indicators of joint discomfort from arthritis.
Because there are so many variables associated with joint degenerative changes on both a microscopic and macroscopic level, each case must be evaluated individually; every dog responds uniquely to discomfort and pain.
Osteoarthritis in Dogs
By far the most prevalent form of canine arthritis is osteoarthritis, a progressive,debilitating disorder. It is characterized by the loss of cartilage that coversand protects the end of the bones in a movable (synovial) joint. The smooth cartilagehas no nerves, so when it touches the cartilage of another bone, there is nopain. When the cartilage wears away, the bone is exposed. Bone does have nerves,so when the two bones in a joint touch (hence the term "bone on bone"),the result is pain and inflammation.
In plain terms, cartilage is the buffer between bones in a joint. The breakdownof cartilage can reduce the function of the joint and create pain or stiffness.
Chondroitin sulfate consists of repeating chains of molecules called mucopolysaccharides.Chondroitin sulfate is a major constituent of cartilage, providing structure,holding water and nutrients, and allowing other molecules to move through. Thisis an important property, as there is no blood supply to cartilage. In degenerativejoint disease, there is a loss of chondroitin sulfate as the cartilage erodes.
Causes of Osteoarthritis in Dogs
Osteoarthritis can occur in any joint, but is most often found in the hip.The factors that can cause osteoarthritis or increase the potential for it todevelop or worsen include the following:
- Developmental defects: abnormalities of growth that alter the shape or stabilityof a joint (e.g., hip dysplasia, luxation of the patella) or result in a defectivejoint surface (e.g., osteochondrosis) (These developmental defects are discussedfurther in the age factor section.)
- Obesity: overweight dogs are much more prone to osteoarthritis and are morelikely to develop osteoarthritis in several joints because of the excessive loadon their joints; they are also more difficult to treat than dogs in more idealbody condition
- Poor limb conformation: bow-legged, knock-kneed, or cow-hocked conformationcauses uneven load across the joint surfaces, which can predispose the dog toosteoarthritis
- "Wear and tear": repeated load at or near the physical limits ofthe joint may, over time, lead to osteoarthritis in very active dogs (e.g., dogsworking or competing in physically strenuous activities)
Regardless of the specific cause, the particular factor (or combination offactors) ultimately triggers a common sequence of events that result in the hallmarksof osteoarthritis. Depending on the cause, the process may begin with either(1) damage to, or degeneration of, the articular cartilage, or (2) inflammationof the joint capsule lining.
Effects of Inflammation
Inflammation begins at the cell level with production of pro-inflammatorysubstances by the outer membrane of a damaged cell. These substances begin acascade of biochemical events in the surrounding tissue which cause the outwardsigns of inflammation: pain, heat, swelling, and redness (may not be obviouson hair-covered or pigmented areas). Following trauma or in the cases of jointdefects and disease, inflammatory products are released into the joint fluidthat can damage the articular cartilage. This causes the cartilage to lose thicknessand elasticity, making it difficult for the joint to bear stress or weight load.Next, the chemical products produced from inflammation trigger the release ofpro-inflammatory enzymes, leading to loss of function. All these materials thenspill into the joint capsule, breaking the long chains of the molecules inside,causing the joint fluid to lose viscosity and cartilage to become more degraded.This then makes the joint even less capable of bearing stress and weight load,triggering more inflammation. Once this cycle of joint inflammation and cartilagedegradation begins, it causes the secretion of even more inflammatory and catabolicenzymes. The result: increased pain to the joint and an ongoing cycle of jointdeterioration within surrounding tissues.
Risk Factors for Young Dogs
Osteoarthritis mostly affects dogs in their middle years and old age. However,it can develop in young dogs in the following circumstances: (1) the joint hasbeen badly damaged by injury or infection, or (2) the joint is misshapen or malformedas a result of a developmental defect. Developmental defects are abnormalitiesthat occur during growth or development. The more common developmental problemsthat may predispose young dogs to osteoarthritis are:
- Osteochondrosis dissecans (OCD): defective development of the subchondralbone can result in flaps or loose fragments of cartilage or cartilage and bone(osteochondral fragments) in the joint.
- Elbow dysplasia: dysplasia, or abnormal growth, in the elbow joint includessuch specific conditions as fragmented medial coronoid process, ununited anconealprocess, and OCD (osteochondritis dissecans).
- Patellar luxation: displacement or dislocation of the patella (the equivalentof the human kneecap) is a fairly common problem in several small breeds of dog;it is usually accompanied by dysplasia of the groove in which the patella islocated at the lower end of the femur (thigh bone).
While the developmental defect usually becomes apparent (typically as lameness)in the first 12 months of life, osteoarthritis may not become severe until laterin life. Early diagnosis and appropriate treatment of the developmental defectcan substantially decrease the risk for, and may even prevent, secondary osteoarthritis.
Osteoarthritis can usually be diagnosed just from the symptoms and from whatis known of your dog's age, breed, and medical history. Nevertheless, a veterinarianwill probably perform a physical examination to evaluate your dog's general healthand to rule out any other medical problems that could be causing the symptomsyou report.
Rheumatoid Arthritis in Dogs
Aside from osteoarthritis, there are six different types of canine arthritis:
Canine Rheumatoid Arthritis (otherwise known as Immune-mediated Arthritis).Canine rheumatoid arthritis is a noninfectious, inflammatory, immune-mediateddisease. Rheumatoid arthritis in dogs is not very common, and it has no sex predilection.It occurs mainly in small and toy breed dogs. Rheumatoid arthritis has been reportedto occur in dogs from 8 months to 8 years of age, with the most common occurrencesbeing in dogs 2 to 6 years of age. Rheumatoid arthritis is a chronic problemthat can result in joint deformity.
Rheumatoid arthritis is caused by an overreaction of the immune system dueto the body misunderstanding itself. In rheumatoid arthritis, the body mistakessome of its own protein for foreign protein and makes antibodies against it.These antibodies are collectively called the "rheumatoid factor." Theantibodies and protein form immune complexes, which are then deposited in thejoint, triggering inflammation. With rheumatoid arthritis, the body tries torid itself of these hurtful immune complexes, but manages only to create moredamage to the joint. Eventually the cartilage and even the bone in the jointare worn away.
Causes of Rheumatoid Arthritis in Dogs
The specific cause of rheumatoid arthritis is unknown. It has been speculatedthat canine distemper virus and the body's immune response to this virus mayplay a role in the development of canine rheumatoid arthritis. Other possibilitiesare that type II collagen serves as an autoantige, and that some type of alteredhost immunoglobulin (IgG) is the inciting antigen that stimulates the immuneresponse. Autoantibodies subsequently are formed and directed against the alteredhost immunoglobulin. These autoantibodies are called rheumatoid factors. Theautoantibodies form complexes with the altered IgG molecules, and these immunecomplexes are deposited in the synovium of the joints. Inflammatory mediatorsare then activated, leading to a severe, erosive polyarthritis known as rheumatoidarthritis.
Symptoms of Rheumatoid Arthritis
X-rays, biopsies, and the history of the pet often lead a veterinarian tosuspect the disease. A special blood test can be done to look for the rheumatoidfactor. The synovial fluid, present in the joints of the dog, may be analyzedto show changes. Cells involved in inflammation, which may be present in largenumbers, may be analyzed to show changes. The fluid is usually of a thinner consistencythan normal and cloudy instead of clear.
Some symptoms are visible to the naked eye. Dogs with rheumatoid arthritisoften present with discomfort or pain in their joints. This can be seen as ashifting leg lameness or difficulty rising, walking up steps, and impaired ambulation.The joints that are most commonly affected are the carpal and tarsal joints.Affected joints may display signs of inflammation, such as excessive warmth and/orswelling on palpation. Anorexia and malaise often are observed by the owner.The dog also may display a persistent fever. Some dogs with rheumatoid arthritisalso have kidney disease, enlarged lymph nodes, tonsillitis, and pneumonia.
Other Types of Arthritis in Dogs
Aside from osteoarthritis and rheumatoid arthritis, there are four othertypes of canine arthritis:
This type of arthritis is caused by a bacterial, viral, or fungal infectionin the dog's joints. The infecting organism is carried to the joint via the dog'sbloodstream from an infection occurring in another part of the body. In thisform of arthritis, the symptoms and effects are the same, but the cause is different.Hence, any infection should be immediately checked by your veterinarian to determinewhether the dog has arthritis. Depending on the source of infection and the organismcausing the infection, this condition can manifest as either acute lameness ora grumbling sore joint. Prompt and efficient treatment is required, as misdiagnosisor the wrong treatment can lead to permanent incapacitation, with joint degradationand sometimes generalized disease. Infection of the joint can occur by two routes:
- Direct penetration of the joint; a bite, thorn, or road accident.
- Spreading via the blood supply.
The organisms involved are varied and depend on route of infection. Commonorganisms are B-haemolytic streptococci, Staphylococci, haemolytic E. coli, Erysipelothrix,Corynebacterium, and Lyme's disease (Borrelia burgdorferi). Brucella canis usedto be a problem but is rare nowadays. Less commonly, fungal arthritis has beenknown to develop, and elsewhere in the world ricketsial (Rocky mountain spottedfever) and protozoal (Leishmeniasis) arthritises are well recorded. Interestingly,larger breeds and male dogs appear to be more commonly affected and present withvarying degrees of lameness with a hot, swollen joint or joints, with pain onpalpation or manipulation. There may be swelling of the limb and generalizedsigns, such as raised temperature and enlarged lymph nodes and even multi-organfailure. Radiographs should be taken, as much to rule out other causes of jointdamage as to provide a diagnosis, and a sterile sample of joint fluid shouldbe taken for bacterial culture, antibiotic sensitivity, and microscopic examination.Blood haematology can sometimes be useful with more generalized disease and specifictesting for conditions such as Lyme's disease.
This group encompasses all the inflammatory diseases causing arthritis whereno common feature or cause can be found. They can be divided into four groupsbut have few common denominators. Causative factors can be neoplasia (cancer),gastrointestinal disease, infections elsewhere in the body, and other types ofimmune complex disease. What this indicates is that if arthritis occurs alongwith other disease problems, there may be a link between them.
Polyarthritis, lymph node enlargement, and inflammation of blood vessels leadingto skin rashes have been reported after the use of several antibiotics, suchas the sulfa drugs, cephalosporins, macrolides, and penicillins. Withdrawal ofthe drugs usually leads to reversion to normal health. There have been reportsof polyarthritis after vaccination usually clearing within a few days of thereaction. It must be emphasized that these reactions are rare and are far outweighedby the benefits of treatment or vaccination for the majority.
Acute Traumatic Arthritis
This is a generalized term for changes to a joint resulting from either asingle or repetitive trauma to that joint. Examples are a road traffic accident,a torn cruciate ligament in the knee, or, for repetitive trauma, a dog overextendinghis back when running, resulting in spinal arthritis. Acute trauma to a jointmay manifest as a sudden onset lameness with swelling, heat, and pain and warrantsearly veterinary attention. It is important to differentiate this type of acutejoint pain from other conditions, such as septic or infected arthritis. Earlyassessment and treatment can reduce the long-term damage to the joint. In thiscondition, there is disruption of the cartilage, bone, synovial membranes, andligaments supporting the joint. Inflammatory changes lead to increased synovial(joint) fluid production with swelling and associated discomfort.
Risk Factors and Diagnosis of Arthritis in Dogs
Canine arthritis is one of the most common sources of chronic canine pain.While many cases occur in middle-aged and geriatric animals, dog arthritis canaffect pets of any age. Overweight dogs are likely candidates, but dogs of allsizes are affected. While larger breeds are more prone to canine arthritis, asmore pressure is exerted on their joints, all breeds and mixes can develop it.
Diagnosis of arthritis in dogs is usually done by a physical exam at a veterinarian’s.Examination of your dog (while awake) by a veterinary surgeon is often sufficientto diagnose arthritis and to identify which joints are affected. Sometimes furtherexamination using manipulation or X-ray (under sedation or anesthesia) may berequired to confirm the diagnosis. These methods can give in-depth understandingof the problem and how it is likely to progress. Armed with an accurate diagnosis,a treatment, exercise, and dietary plan can be agreed to ensure the best outcomefor your dog.
Consequences of Canine Arthritis
The major consequences of canine arthritis are, for better or worse, the symptomsthemselves: intense pain, loss of motion, or intense pain in other parts of thebody brought about by a favoring of one joint over another. Though otherwisehealthy, a dog may suffer so much from a lack of cartilage that its entire lifestyleis affected—by constant pain, stiffness, and/or lethargy. The excruciating painand its consequences are present every minute of every day. Chronic pain canalso bring about changes in a dog's personality, such as aggression and withdrawal.All of these changes mean a reduced quality of life for your pet.