Deer Run Animal Hospital 308-310 East US Highway 30 Schererville, IN www.deerrunanimalhospital.com (219) 864-7180 TREATMENT OPTIONS FOR FELINE ARTHRITIS Because many pain medications commonly used in people and dogs can be toxic to cats, multi-modal therapies are the best way to treat arthritis to minimize the use of drugs that can have serious side effects. Combining several treatments together can improve results and can keep drug doses low to minimize risk. 1. ONE OF THE FIRST AND MOST IMPORTANT TREATMENT METHODS FOR FELINE ARTHRITIS IS DIETARY THERAPY. a. Weight loss diets and joint diets are ideal choices. WEIGHT CONTROL is crucial. Maintaining an ideal body weight is very important and requires periodic weight checks to achieve ideal weight and monitor and maintain it. There has been good scientific evidence of the efficacy of weight control on the prevention and minimizing progression of arthritis. . Prevention of obesity is best as safe weight loss in cats is difficult. One of the best ways to help prevent weight gain or achieve weight loss is to AVOID FEEDING DRY FOODS. Dry foods of all kinds and brands tend to contain much higher carbohydrate levels than canned food and therefore promote unhealthy weight gain in cats who do best on high protein canned foods There is no more natural way to treat arthritis than through dietary means and recently therapeutic joint diets have been showing good efficacy for arthritis treatments without worrisome side effects. The use of dietary therapy can help minimize the use of drug therapy and keep drug doses low. b. Recommended therapeutic prescription diets. Can be ordered through Deer Run or elsewhere by written prescription from your veterinarian. Prescription diets are not available over the counter without a veterinary prescription. Joint Diet: Hill’s Prescription Diet j/d Feline Mobility our best recommendation for treating arthritis with a therapeutic diet is about 152 calories per 5.5 oz can It also comes in a dry formula but again we prefer canned diets for cats. A small amount of dry Kibble and even canned food can be used in FOOD TOYS to increase mental and physical exercise. Weight loss Diet Hills Prescription Diet Feline Metabolic Three flavors available and about 65 calories per 2.9 oz can Also in a dry formula but again canned preferred. Click for a chart of Estimated Calories needed for weight Maintenance and weight loss Remember this chart contains rough estimates to get you started. An individual may need more or less than the amount indicated on this chart. Cats may need to eat different amounts during their lifetime depending on health, age, genetics, and activity level. Instead of memorizing an amount to feed, memorize what you cat should weigh and feed to achieve that weight. Cats should lose weight slowly, typically about a ½ pound per month would be a great goal. Weight your cat and adjust amount fed to maintain an ideal weight. For example to get a cat to lose weight to be about 10 lbs the chart suggests feeding 174 calories per day. You can start there but then see if you are achieving about ½ lb per month. You may need to adjust up or down depending on your results. To maintain a cat at 10 lbs the chart suggests feeding about 218-262 calories per day depending on if the cat is obese prone or a normal neutered cat. But again weight monitoring and adjustments need to be made to see if you are truly maintain a stable weight 2. NEUTRACEUTICALS AND SUPPLEMENTS: Since these products have no FDA regulation, products and brands other than those listed are NOT recommended. The quality and efficacy of other products varies widely to learn more read THIS. These products are available at Deer Run or can be found elsewhere. They are not drugs so prescription is not required. They are meant for long term use. a. Dasuquin for Cats The glucosamine and chondroitin sulfate support healthy cartilage matrix production and help protect against the cartilage breakdown that occurs in arthritis. This medication does not have a rapid onset of benefit. It helps to nourish and protect the cartilage over time. It is most effective when used early in the course of disease before cartilage is worn away or severely damage. Benefits often take 4-6 weeks to begin. It is easy to give as a powder mixed into food. b. Nordic Natural Fish Oils. The best way to utilize the omega 3 fatty acids to help arthritis inflammation is to feed the J/d diet to ensure that the proper ratio of omega 3 to omega 6 fatty acids is achieved. Using a supplement added to regular food does not always do that. But if you are not feeding the joint diet, this is another way to get some benefit from Omega 3 fatty acids. 3. ADEQUAN INJECTIONS With time and injury cartilage wears down and arthritis results. The body then needs to try to make more cartilage matrix and will require the raw materials to do so. Adequan injections help provide the raw materials to do so and helps cartilage repair. However, Adequan does more than just provide building materials for cartilage repair. It has anti-inflammatory properties of its own that help slow down the actual damage to the cartilage. It also promotes enzyme systems that facilitate other aspects of joint repair beyond simply making more cartilage. It helps the joint create more lubricating fluid as well. Injections aretypically given twice weekly for at least 4 weeks, then once weekly for 4 weeks then repeated as needed. Adequan is FDA approved for use in both dogs and horses. It is commonly also used in cats but is an off label use of the drug. 4. ALTERNATIVE THERAPIES if you are interested in trying options such as acupuncture, laser therapy, rehab exercises or other alternative therapies we recommend referral to Chicago Animal REhab Center or CARE in the nearby south suburbs of Chicago. Many patients can benefit from these options but we recommend consulting with Dr. Whalen at CARE for the best options for your cat. 5. ADAPTING THE ENVIRONMENT with ramps, easy access to low sided litter boxes in many locations, easy access to food and water. 6. ORAL PAIN MEDICATIONS Before we discuss actual medications we want to say a few words about administering oral medications. Administering medications orally to cats is both a skill and an art. Above all we want to find low stress ways to administer oral medications. We will not improve a cat’s quality of life even if he is painful if we force medications down his throat on a long term basis. Before oral pain medications are started it is imperative to learn about dose formulations available and the many methods there are for administering medications to cats. We highly recommend reviewing our webpage on Medicating Cats. We also recommend coming in for some demonstrations and lessons from our staff on various techniques. If we are going to use oral medications we have to have a very stress free administration plan prepared or we may cause more harm than good! a. GABAPENTIN is an oral medication that can be used for chronic arthritis pain. For additional information please read this handout. Its major side effect is sedation. This can usually be minimized or avoided by starting with a very low dose and gradually increasing if needed. With time the sedation usually resolves, especially if the drug dose is slowly increased allowing the cat to acclimate to it. The dose range is extremely wide and so the goal is to find the lowest effective dose for the individual patient. This requires good communication and reporting with your veterinarian. It is a human drug and the human sized capsules are usually too large and cumbersome to use in cats. It can be specially compounded by a compounding pharmacy such as Wedgwood Pharmacy into various forms including liquid suspension if necessary. b. BUPRENORPHINE is a narcotic pain drug that can be administered by the trans-mucosal route. It is inserted with a needleless syringe into the cheek pocket or under the tongue to be absorbed across the oral mucus membranes or gums. It is inactivated if swallowed. It can cause some sedation and mild temporary behavior changes. It can be expensive for long term use but it is a good option for an acute short term flare up of pain when needed. With long term use it may also cause constipation. c. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS OR NSAIDS. Here is a link from an Australian website on the NSAID MELOXICAM for an example. These are probably the most effective drugs for arthritis pain in cats but also the one with the most risk. They must be used very carefully with frequent monitoring of kidneys with blood work and urine samples. Although approved for use for short term post-op use by the FDA they are not approved for long term arthritis use and come with a “BLACK BOX WARNING” for long term use. Meaning there is significant potential risk for kidney damage and other side effects if used off label and without great care and monitoring. Blood work should always be monitored before and during the use of NSAIDS. Many veterinarians have used this drug with good results but strive to use doses much lower than what is on the product label and work to find the lowest effective dose which is often way below the recommendations on the label. This lower dosage has proven to be much safer and still helps many cats. But it requires informed consent and a client who understands the risk and is willing to do all necessary monitoring. It has been labeled for more chronic use in cats in Europe and Australia but the FDA is very concerned about the risk of the use of this drug in cats in America.