Dog pain management notes

Starbuck-a-Roo's right shoulder goes lame-ish from time to time. Episodes have gotten worse and more frequent since this last summer. I'm not sure if it's age (she was 10.5 as of summer), or just that she was always less aggressive with running and playing with Autumn and Linden, but since we've gotten Cricket, she's been putting on hard miles. She loves to bound through the snow, and it's impossible to make her stop, even when she is in obvious pain. Only once have I seen her self-correct, and then limp straight home. The other times, she has continued to bound through snowdrifts and play chase with Cricket.

These are my notes on doggy pain management. I hope they help some folks out there!

Pain management strategy in general:
I have adopted the philosophy that quality of life is more important than quantity of life. For an active dog, not going for walks, runs, hiking, and skiing adventures is torture. So I lean toward more aggressive pain management, possibly at the risk of liver damage later.

NSAIDs are supposed to be particularly hard on the liver. One of the most common doggie painkillers for both arthritis/aging and surgery recover is Rimadyl. This is basically the doggie version of ibuprofen. The anti-inflammatory properties actually aid healing, in addition to blocking pain. However, the downside is apparently it can be stressful on the liver if given in high doses over a long period of time. Roo's former musher uses it rather liberally and says that the risk of liver damage is tiny compared to the benefits. Lately, veterinary advice has skewed that way as well. They say that when a dog starts limping, it's already in quite a bit of pain, since they tend to ignore smaller amounts of pain. I expressed concern about masking pain that would otherwise force them to rest. Dr. W said that that should not be a concern, since playful dogs, like Roo, will run and play through pain, so it's better to give the NSAID. Dr. F, our regular vet, said to give Rimadyl as a healing aid AFTER exercise, but to give before exercise increases the stress on the liver. BT has indicated she read similarly for human NSAIDs.

The regimen that Dr. F. prefers is Gabapentin BEFORE exercise; Rimadyl AFTER exercise, to aid in recovery.

Roo is also WAY more into our weekend skiing and hiking than she is into the weekday morning runs in the dark, by headlamp. I almost wonder if her low-light vision is starting to fail, because she is much happier to head out into the dark when there is a full moon. Anyway, I asked Dr. D., who does Roo's acupuncture, whether when she really needed to rest, it would be a good strategy to let her skip out on the weekday morning runs and let her come out and play on weekends. She said no, "weekend warrior" dogs tend to get the most injuries; it was good to keep her moving consistently. That is consistent with what Dr. F. had said: "Just keep her moving. Let her determine what she does. Do not push her. Give her Rimadyl as needed."

Meds:
1) Rimadyl. Details above under "Pain management strategy in general". It is an NSAID.

Dosage: 3.5 mg/kg body weight. So Roo is 100 mg/day. I break them in half and on bad days give her 50 mg in the morning and 50 mg in the evening. On milder days I give her just the 50 mg after our morning run.

2) Gabapentin. Developed to treat seizures in humans; used for long-term pain management in dogs. It is NOT an anti-inflammatory; rather it blocks nerve signals of pain. Supposedly easier on the liver than Rimadyl and other NSAIDs. Supposedly safe for long-term use. It also has a cumulative effect, so it might not help for the first several doses. A single article on the internet suggested that stopping suddenly may induce seizures, so if you want to quit, you should taper down as well. Dr. D., disagreed, but I did not push the discussion since we're not taking Roo off it anyway.

Dosage: 3.5 mg/kg body weight. So Roo is 100 mg/day, before her morning run, ski, or other adventure.

3) CBD oil.
Now that marijuana and its products are mostly legal, there is increased interest in the benefits of its compounds. CBD is supposedly a potent anti-inflammatory, and they sell it as an extract, in olive or coconut oil as a base. It is isolated completely from THC, the psychoactive part, and does not cause any psychoactive effects.

If you google "cbd" alone, you'll get a broad spectrum of information, a lot from pro-marijuana advocates, so they may present skewed data. If you google "cbd + dogs" the internet information seems to be much more stable and consistent. Our friend MK said that the painkilling and anti-inflammatory effects of CBD oil have been so great for her elderly gentleman doggie that she was able to quit Rimadyl. We are only just starting on Roo. Supposedly, tolerance does not increase with time.

Dosage: 0.2-0.5 mg/kg body weight. Roo is on slightly under 0.2 mg/kg, at 5 mg per day. This dosage was agreed upon by Dr. F., Dr. W., two different CBD oil manufacturers, and MK, so I'm sure it's solid!
Manufacturers: Green Gorilla (we get this one at Cold Spot Feeds). The dosage instructions on the bottle are confusing, because instead of dosing by, say, mL per weight of dog, they sell the bottles with droppers that are calibrated for dog size. So they say, if your dog is this weight, buy this bottle, and feed him 5 squirts a day. If your dog is that weight, buy that bottle, and feed him 5 squirts a day. 5 squirts a day for everyone, if you use the correct bottle! It's a bit annoying, because that's not! how liquid drugs! are usually sold! And what if I want to buy a bigger bottle to save money? Well now I have to do math to dose Roo. Anyway, other than that, it seems to be a good company.
Dogs Naturally Market. The recommendation from MK. I need to do some math on this one to figure out how to get to our 5 mg/day.

Other treatments:

1) Roo had her first acupuncture + cold laser treatment last Thurs; Dr. D., who is the founding vet of our regular veterinary clinic, said her symptoms make her an excellent candidate. She said she could feel her muscles more relaxed afterwards. Roo is on the mend from her last bad episode... She went skiing for the first time after it, the morning before our first acupuncture appointment. Dr. D. found a tense spot in her lower back where Roo had been babying the shoulder. She did acupuncture on the shoulder, and cold laser on that tense spot. Dr. D. said she felt more relaxed already. :) The following weekend, we skied both days. Roo was still a little gimpy, but did not get worse. Today, a week later, was our second treatment, and Dr. D. said she seemed slightly better, but definitely not worse, and were given the green light to keep skiing. :) Cricket won't come skiing with us humans without Roo. We tried to sneak out with just Cricket once, but Roo cried and howled from the house at being left behind, and Cricket ran back and refused to leave her.

If we ever need to go to regular lasering, we may look into getting a vetrolaser for home use. Our friend MB got one before moving to the Falkland Islands, which does not have as good veterinary care as Alaska, with her middle-aged lady dog, Kaia. She said that a combo of acupuncture from Dr. D. and the cold laser brought Kaia back to running and leaping, which she could not do earlier last summer.

2) Cricket's former musher recently attended a workshop on care for racing and retired sled dogs, and here are some notes she passed on to me:
CBD oil
Tumeric, a potent anti-inflammatory in humans (I have not had the courage to try that!) JB: "Tumeric can thin blood, so you want to be more careful with that one"
Glucosimine / chondrotine - for cartilage
Hyaluronic Acid HA - lubricating,
MSM -can improve pain and flexibility
Vit C - antioxidant, good for collagen and connective tissues (although one commenter says, "Research the vitamin C some more. A vet was very uncomfortable with me giving my dog Vitamin C as the dog produces their own, and if you augment their diet with Vit C, they lose this ability. (?)")
(the last 4 items, we have been getting in a single supplement, which I have been getting from Alaska Feed for years. I put my dogs on it immediately after I get them.)

Other notes from JB: "topical massage balms, they make them for dogs... Not sure what Cold Spot has for massage right now. There was one called Algyval (not one I really liked) but it is not being made anymore I think. I like one called Mushers First Aid with emu oil, herbs and essential oils, but mostly I get one made by Michelle Phillips in Tagish Yukon... There is a good homeopathic cream I like called either Traumeel or T-Relief, and cold spot used to have that. Good for humans too ... I think Freds has it too, But human type arnica creams/gels are good for dog muscles too..."

In the class, they also talked a lot about damage to fascia, which is the interconnective tissue. (from JB: "It involves working gently with the dogs moving the outer layers around, you know cuddling." I THINK I CAN DO THAT! I THINK I CAN CUDDLE!). Here are links:
Soft Tissue Injury & Myofascial Disease
Animal Muscle Release Therapy

A final note is while in the midst of this, I read the memoir of Leland Melvin. And here is his official NASA photo:


:) :) :)

Anyway, when he was playing with the NFL, he pulled a hamstring and was told he'd be out of playing football for six! months! Torture for an athlete! But acupuncture and aggressive physical therapy brought him back in the game in three! weeks! So I have high hopes for the Roo. After all, athletic dogs and pro athlete humans have a lot in common--they train hard, ignore pain, and tend not to rest when they should.

Roo's pain is heartbreaking to witness, but as I've said in an earlier post, I comfort myself with two things:

1) Dogs can and do run and play and have fun with only three legs! Surely a bum shoulder is not as bad as that!

and

2) If Starbuck had not had a bum shoulder, she would not have been pulled from mushing to live with us! She'd still be working, and living outdoors. I think, surely she prefers her life with us and her couch!