Understanding Chronic pain in Cats

Chronic pain in cats often goes undetected. Acute pain is easier to detect since it is a drastic change whereas chronic pain happens gradually and the cat and the owners both adapt to those changes. Sadly, there are many misconceptions about how cats express pain and the direct influence that pain has on their behavior. Cats live in the moment, hence, when they experience pain they also develop anxiety and behavioral disorders due to their expectation of living in that state of pain in a continuum. Therefore it is up to us and their loving owners to find out if they are in pain and address it.
One of the common cat health issues we see in practice involves behavioral changes, inappropriate elimination, inter-cat aggression, over-grooming, insomnia, lethargy, decrease appetite, and changes in routine. After a thorough physical exam and performing diagnostic tests like bloodwork and X-rays, we can rule out many conditions and rule in pain as the root of the behavioral issues. All declawed cats eventually develop chronic arthritis and joint pain from the abnormal gait created by the amputation of the third phalanx aka their fingertips. Luckily, declawing is becoming a thing of the past, and many cat advocacy organizations like the American Association of Feline Practitioners are taking a stand against it due to increasing evidence and research on the chronic pain it causes. Other signs of chronic pain include reluctance to jump, and increase hiding. Although osteoarthritis is the most commonly recognized cause of pain, other conditions like bad teeth, interstitial cystitis, ulcers, dermatitis, diabetic neuropathy, pancreatitis, cancer, and IBD can create chronic pain.
Treating Chronic pain and arthritis in cats has always been a challenge due to their sensitivity to medications like NSAIDs. The most popular prescription for pain is gabapentin because a lot of oral, and osteoarthritis pain have a root in neuropathic pain signals. New advances in pharmacology have resulted in better products like Zorbium topical pain control that lasts 4 days. The only FDA-approved NSAID for use in cats is called Onsior and it is a very effective oral pill given for three consecutive days. Another new product that we are super excited to carry is the FDA -approved frunevetmab injection called Solensia, the first monoclonal antibody (mAb) new animal drug approved by the agency for use in any animal species. This is a once-a-month injection given at your veterinarian’s office that will work with your cat’s immune system to reduce the pain signals and it is paving the way into a future with safer pain control for our kitties. Solensia will work after the first injection but most studies revealed the optimal control comes after 3 months. All chronic pain can benefit from this treatment even though it is marketed for cat osteoarthritis.
Of course in our practice, we use the integrative approach which includes acupuncture, laser, and herbal therapy in addition to other pain control medications as needed. Chronic pain management requires a multi-modal approach for a successful outcome.

Post-Ian warning

Polk County just went through the devastation of hurricane Ian but for pet owners, there are still potential threats to deal with. The excessive rain brought flooding and saturated yards and this provides the best condition for the transmission of bacterial and parasitic diseases. One of the most common threats includes a potentially deadly bacteria called Leptospira.
Leptospirosis is an infection caused by bacteria that is found in soil and water. There are several different strains of Leptospira bacteria that can cause disease. Leptospirosis is a zoonotic disease, which means it can be spread from animals to people. Infection in humans is characterized by flu-like symptoms but it could also cause acute liver or kidney disease. Infection in dogs can happen in multiple ways but it is commonly caused when their mucous membranes or cuts get in contact while drinking from rivers, streams, ponds, and stagnant water in which infected wildlife have urinated. Therefore the severe water-filled backyards in the aftermath of Ian will be acting as giant Petri dishes.
The thing with leptospirosis is that some dogs show mild if any signs of illness, whereas others get critically ill and even die. Cats seem more resistant to actually developing the disease and I haven’t diagnosed feline leptospirosis in almost 30 years in practice.
Symptoms of leptospirosis may include fever, vomiting, diarrhea, loss of appetite, lethargy, and yellowing of the skin and mucous membranes also known as JAUNDICE. It is also common to see affected dogs develop acute kidney failure with or without liver failure. Other less common symptoms include acute pneumonia and acute bleeding disorders characterized by vast amounts of red tinge urine, nosebleeds, or tarry diarrhea. Affected dogs can also accumulate excess fluid in their chest, abdomen, or under the skin. Sadly, all these symptoms could be caused by multiple other conditions and sometimes the diagnosis might be missed. The history of exposure to water sources, as in the aftermath of Ian, will help direct your veterinarian to do the blood test that specifically detects this bacteria and prompt treatment could save your dog’s life. Currently, there are easily available vaccines that effectively prevent leptospirosis and protect dogs for at least 12 months. Annual vaccination is recommended for at-risk dogs, hunting dogs, and lake-loving pups. If your pet has been diagnosed it is important to take precautions in order to avoid human infection. Consider the infected dog’s urine as very infectious and make sure the pets urinate in a secluded place where other pets do not have access. Make sure to follow proper hygiene practices like washing your hands after touching your pet and avoiding any bodily fluids. Make sure to give the life-saving antibiotics as directed by your veterinarian. If you develop any flu-like symptoms, please seek physician care as soon as possible. The best way to prevent this is to keep your pet vaccinated and away from flooded areas. Please ask your veterinarian for more advice on how to keep your pet safe from this disease.

Shen or spirit disturbance in a kitty

Anxiety is a common disorder seen in practice that has serious implications for the human-animal bond. One of the leading reasons that dogs and cats are relinquished to shelters is due to behavioral issues including destructive behaviors. It is important to use the integrative approach to strive to salvage the human-animal bond and improve the quality of life of the affected pets.
In general, anxious dogs exhibit the following symptoms; Visual body signals like a tucked tail, self-licking and biting, diarrhea, escape behavior, hiding, reduced activity, trembling, and nervousness.

Traditional Chinese Veterinary Medicine (TCVM) classifies anxiety as a Shen disturbance. Shen could be translated as Mind or Spirit and this energy resides in the Heart meridian(energy pathway) and is considered part of our consciousness. In Traditional Chinese medicine for humans, Shen disturbance is generally due to Qi and blood deficiency, emotional trauma, and fire in the Liver meridian. The TCVM approach to diagnosing anxiety includes a good physical exam and palpation of special points in the spine. In addition, taking a good history and asking the time of day where symptoms seem worse helps in finding which meridian is affected. The physical signs we often find include a thin, fast pulse, a red, dry tongue, restlessness or nervousness, and insomnia. For example, a dog that starts restlessness after dark could be suffering from global Yin deficiency because the night belongs to Yin whereas the day belongs to the Yang energy. A dog that consistently wakes its owner between 1 am to 3 am could be manifesting Liver Qi stagnation because those hours are where the Liver meridian energy dominates.The constitution of the patient is a big clue as to the root of anxiety. The Water (shy), Wood (dominant), and Fire(friendly and hyper) constitutions are at high risk of developing Shen disturbances when unbalanced.

The best way to demonstrate the positive effect of acupuncture is to share a recent case. Medes is a 5 years old neutered domestic shorthaired cat that came to visit us due to excessive grooming on his belly to the point of self-mutilation! he was also hiding, and being distant for about 3 months. There were outdoor strays coming outside to the house and also a new kitten in the household which caused a lot of stress and perceived fears. His physical exam was unremarkable except for the eosinophilic granuloma and alopecia on his ventral abdomen.
Medes is an affectionate vocal cat which in TCVM is considered a trait of a Fire element personality. His tongue was red and thin, his ears were hot and his left pulse was weaker. A diagnosis of Heart Yin Deficiency with Shen disturbance and Liver Qi stagnation was made. Balance Acupuncture was done using vitamin B 12 subcutaneous injections. The Chinese herbal formula Shen calmer powder was prescribed, 1 small scoop in the food once daily. After just one session Medes was doing great and quit self-mutilating. The owner was impressed, and Medes was enjoying interacting with the family, even with the little kitten.

Chocolate and dogs do not mix!

 Valentine’s Day is around the corner and every retail store is brimming with all kinds of chocolate-inspired candies and gifts. This is a dangerous season for pet owners because your dog is going to be extremely attracted to the chocolate aroma.  Accidental ingestion of chocolate by dogs can result in serious consequences including severe vomiting and diarrhea, seizures, and death. The severity depends on the concentration of the active ingredient theobromine. The darker the chocolate the more lethal it is. The smaller dogs are at higher risk as the minimum dose is 20mg per kilogram body weight. at that dose, the symptoms of toxicity are milder and mostly related to the gastrointestinal system. In higher doses of 40 mg per kilogram, the effects involve the heart system and in even higher doses over 60mg/kg the nervous system is involved. Imagine chocolate as having the same effect in dogs as amphetamines have in humans! Therefore, special consideration is given to the kind of chocolate ingested. Luckily, there are many sugary, milk-laden, and processed chocolate candies that only have 5-10% of real cacao. The baking chocolate, however, has the strongest concentration of theobromine.  If your pet ingests chocolate, try to contact the nearest veterinarian and bring your pet for induction of vomiting. Most pets ingest the chocolate with the wrappers, and most chocolates are dense and harder to digest. Therefore on any ingestion within 1-1.5 hours is worth to try inducing vomiting in order to remove most of the toxic material. In our practice, we use special drops that induce vomiting almost instantaneously. The funny thing is that the vomit often smells and looks like chocolate pudding.  Then we give supportive treatments with fluids and anti-vomiting medications to settle their stomachs. The vast majority of patients make a full recovery. In the case of dogs that have ingested the chocolate past that time frame, the best is to take your pet for supportive treatments and to get auscultated to see if they are experiencing any tachycardia ( fast heart rate). Medications to suppress the symptoms will be administered and a baseline chemistry blood analysis can help monitor the progression of the toxicity. Take the wrapper or information of the product so that the veterinary staff can make the calculations and adjust treatment based on the weight of your pet and the concentration of theobromine. My granddog Pluto sneakily stole a chocolate bar from our pantry. he woke us up at 3 am vomiting and acting painful. He ate a bar that was  85% pure cacao and even though he is 50 lbs, the concentration was above 20mg/kg. Thankfully, my two pugs did not partake in the mischief because they could’ve easily died. The moral of the story is never underestimate your pet’s obsession with sweets. The only time I willingly give chocolate to dogs is at the time of euthanasia. I keep a jar full of Hershey’s kisses for them to try because I want them to get away with eating the forbidden treat at least once in their lives.

Hip pain is a tricky problem for pets!

When I was in Veterinary school 31 years ago, they taught us in anatomy 101 that the sacroiliac joint was fused and of little importance in locomotion. Fast forward to three years ago when I was training in spinal manipulation at the Integrative Veterinary Medicine Institute and they discussed how important the sacroiliac joint is in locomotion, and its role in pain and gait abnormalities. Needless to say, I was amazed at how traditional medicine differs from the osteopathic perspective.
The sacroiliac joint is composed of the Sacrum, which in dogs and cats is usually 3 fused vertebrae that have 2 sets of large foramina. The Sacrum is like an inverted pyramid in which the wider base articulates with the last lumbar vertebrae (#7) and on either side with two flat bones called the Ilium: that is the sweet sacroiliac joint! The ilium is fused to other bones that make up the pelvis. Therefore, the Ilium interaction with the Sacrum could definitely affect the motion in the hip joints.
So, how can this joint get in trouble? Well, there can be three different chiropractic adjustments based on the displacement of the Ilium and in spinal manipulation of animals we still use those human terms to describe displacement in the sacroilliac joint. The wing of the Ilium could be displaced dorsally (aka posterior) and towards the tail (caudally aka inferior) resulting in that side looking higher than normal (called PI) and causing the surrounding muscles to be very tense. The hip is resistant to be extended and the pet is uncomfortable. In that case a quick manipulation in the opposite direction or cranioventrally will bring immediate relief and will reset the affected muscles. The Ilium can also be stuck ventrally (anterior) and towards the head (superior) which will cause difficulty flexing the hip and cause the muscles to be tense as well ( this is called AS).When we evaluate the pets, we observe them from behind, looking to see if there is a higher or lower side, then test the range of motion to determine if there is a restriction. The third displacement is really the apex or end of the sacrum being displaced to either side and causing friction with the ilium.
I have personally experienced a left PI when I moved quickly to help an acupuncture patient and the awkward angle pushed my sacroiliac joint out of normal position. It was painful and I could barely walk. I used cold laser and acupuncture and it made the pain decrease by 50% but it was only when I went to my chiropractor, Dr. Briggs, and had a simple adjustment that my pain completely disappeared. That experience was invaluable because I now know the importance of diagnosing and treating the sacroiliac joint in our senior pets. The range of motion in your senior dogs and cats might be limited by osteoarthritis as well as the sacroiliac joint displacement. Distinguishing between those issues is a must if we want a quick resolution of pain and return to function.

Take the heat out of those hotspots!

One of the most common issues seen at our practice during these hot months involves skin infections, rashes, and allergies.
One problem, in particular, is extremely painful and uncomfortable for our pet friends; hotspots. A hotspot is an area of acute moist dermatitis with an infection in the skin that often has a purulent discharge, swelling, and redness. This is usually a very painful issue.
These hotspots are progressive and will continue to enlarge if not tended to. They might not be obvious to see because they hide under the fur. Therefore, one of the first things that the pet owner must do is to clip the hairs surrounding the affected area because the hair acts as a scaffold to hold in the pus and bacteria. Once clipped the affected area is usually 2-3 times larger than expected. We get calls of frantic owners swearing that it all started as a mosquito bite-size and now it’s covering half their neck or a large portion of their pet’s body. We believe them because hotspots are a type of allergic response and it does proliferate quickly. Some patients can become extremely ill with a fever, anorexia and start behaving strangely including becoming a bit aggressive. The veterinary treatment aims at stopping the allergic reaction and treating the skin infection while providing pain relief. at our practice we use a multi-modal integrative approach to treatment and include eastern and western approaches. We use antibiotics for a brief 7-10 days. We also use pharmaceuticals to control pain sensations in the brain like Buprenorphine, gabapentin, or tramadol. Shampoo therapy might be used to provide soothing relief to the whole skin and prevent other spots from developing. The injectable drug Cytopoint is often added to block the receptors of itch in the brain and thus stopping the pet from self-mutilating while scratching themselves. The herbal formula Wind toxin is a great herb to stop the itch, nourish the skin, and relieving the allergic response by clearing the heat.
One big consideration we take into account is the location of the hot spot. The skin of your pet is divided into dermatomes, which are areas of the skin that have innervation by a spinal nerve. What does that mean? if your pet has a recurrent hotspot or skin lesion in a particular spot of the legs or body, it could be a manifestation of an impaired nerve in his/her spine! A bad intervertebral disk could be a cause, or maybe damage to the nerve branch. Regardless, when we see a hotspot, we can do motion palpation of the spine to check for any pain or misalignment, then perform an adjustment ( like a chiropractor would do) to correct it. Once the nerve is free and fully functioning the hot spot could heal and stop recurring. remember, this condition is painful but can be easily treated by your veterinarian. Do not let the allergens and humidity of the season get the best of your furry companions,

How to manage Arthritic pain holistically

Pain-related arthritis in older dogs and cats is one of the most common conditions we see in our general veterinary practice. Oftentimes these patients are senior pets over 7 years of age but occasionally we see younger dogs with a congenital condition called hip or elbow dysplasia that is causing lameness and pain. The age of the affected furry companions is only a factor in deciding how o take care of them long term. In seniors and geriatric dogs and cats, managing the quality of life is the first priority and we do know that these drugs might cause some harm but the benefit is worth using them on a daily basis. In young dogs and cats, the use of non-steroidal anti-inflammatories (NSAIDs) is great for the short term management of pain but when it comes to long term usage, there are some important factors to consider.
First, these powerful pharmaceuticals could have deleterious side effects including damage to the kidneys and liver. We recommend doing a blood function test for the liver and kidneys every 3-6 months in order to monitor the body’s response to the medication. In some cases, we might need to stop or switch the medications, decrease the dosage, or adjust the frequency of the administration. In some pets, we prescribe special nutraceuticals which are supplements full of antioxidants and amino acids that nourish either the liver or the kidney and elect to continue the NSAIDs. In most patients, we use the NSAIDs as just one way to control pain and therefore add other modalities like a cold laser, acupuncture, spinal manipulation, massage, rehab exercises, and Chinese herbals to control pain. These pets have a lot of years ahead of them and we want to help them fulfill their best life for as long as they can.
Second, unlike the older pets who usually have underlying organ disease making them higher anesthesia risks, these pets could have surgical options worth pursuing in order to fix the issue and diminish the dependence on pharmaceuticals. It is always good to consult with an orthopedic surgeon to see what options are available.  
For pet owners facing taking care of painful arthritic pets, there are holistic options that can make a big difference in their pet’s lives. Recently, my patient Bradley, a sweet 5-year-old Yorkie, had a bad fall from the couch that left him painful and walking sideways (trying to compensate and not moving the back). After radiographs, bloodwork, and cold laser were performed, we elected to do a spinal manipulation and he improved dramatically. He was sent on an NSAID called Meloxicam and a Chinese herbal called Body Sore. Although he is 100% recovered, we will continue the herbal formula and a glucosamine supplement to ward off the onset of arthritis. His owners purchased an Assisi loop device to help control pain as an at-home therapy. There are many options for pain relief, make sure you ask your veterinarian which ones are best for your pet!

Relief for Itchy Pets

Pet allergies are one of the most common reasons to seek a veterinary care. In dogs, allergies can develop into skin and ear infections that can be hard to treat and extremely uncomfortable for them. Pet owners complain that listening to their pet’s incessant chewing and licking is very upsetting. So, how can you help these itchy, scratchy dogs?
First of all, we must determine if the root of the itch is an allergy or another underlying issue. We do a simple skin scrape and tape test to determine if there are mites, fungus or bacteria in the surface of the skin as well as slightly deeper around the hair follicle. There are many cases of dogs with chronic skin infections that just had Demodectic or Sarcoptic mange! Even fleas can cause dermatitis and allergy symptoms. These are so easy to treat with just certain topical flea products like Bravecto, Nexguard or Advantage Multi, that we insist all patients with “allergies” get treated right away.
Certain cancers can also cause chronic skin ulcers, crusts, and other skin changes. Mast cell tumors could be extremely itchy and could cause a generalized red, itchy skin. I have diagnosed patients with rare nonhealing ulcers as having a paraneoplastic syndrome, in which an internal cancer is manifesting in the skin. Adrenal gland disease could also be a cause for recurrent skin infections and hair loss in both dogs and cats. Deficiency in the production of the Thyroid hormone can also cause hair loss, thickening of the skin and could make the pets more susceptible to getting skin infections.
When it comes to determining if your pet is allergic to something in the environment or something they are eating, a food trial is an inexpensive way to differentiate between those 2 causes. Take into account that for a food trial to be effective, the pet owner must commit to feeding their pet ONLY one kind of diet ( no treats, no table scraps & no cheating) for at least 6-8 weeks. I usually see drastic improvement within 2 weeks of switching the diet to Royal canine hydrolyzed or Wellness Simple Solutions diets. Using food energetics and acupuncture as a way to determine how to treat skin allergies is another option for pet owners interested in the holistic approach. Nutraceuticals that are rich in natural anti-inflammatories and omega fatty acids could be used to improve any skin condition and they could be administered orally or topically (shampoos,leave-on creams, and mousse).
In cases in which the itch-scratch cycle is consuming the pet’s energy and quality of life, there is an injection called Cytopoint that could block those itch receptors and bring much-needed relief that lasts up to 8 weeks. In some cases of deep-seated obsessive compulsive licking behavior, a mild anxiolytic drug could help. In other words, do not despair if your furry companion suffers from allergic skin disease because there are multiple treatment options available. Ask your veterinarian for an in-depth physical examination of your pet’s skin.

Digital Thermal Imaging to visualize Pain

When it comes to figuring out if our dog and cat companions are experiencing pain, we often have to look for cues in behavior and changes in physical activity. Even then, some pets have high thresholds for demonstrating that pain, so, we might be missing the opportunity to help lots of dogs and cats feel their best. Thankfully, technology keeps advancing in veterinary medicine and newer equipment like Digital thermal imaging are becoming a staple in diagnosing inflammation and localizing the source of pains in our furry friends.
What is digital thermal imaging? It is simply a digital camera that detects thermal gradients (body temperatures). This gradients represent a physiological map of your pet and can show you specific areas where there are heat and inflammation. We all know that inflammation generates heat and also pain, so with this equipment, we can narrow it down to the root of the pain which in turn means we can focus all our treatments at that area. For example, in my last column I talked about the benefits of cold laser, well, imagine being able to accurately detect the area that needs the laser instead of guessing? The result will be a targeted treatment that provides pain relief. Not only that, you could then take a picture immediately after the treatment and see how it changes the area, meaning you can determine if that modality was successful right away. I wish that my patients could talk and tell me exactly where it hurts and how good they feel afterward, but of course, they can’t. Therefore, having an objective way to measure pain is very valuable to me not just as a veterinarian but specifically as an acupuncturist, massage therapist and spinal manipulator. Even the most skeptic client can have visual proof of how my treatments worked.
Imagine as well the geriatric dog or cat on chronic pain control meds. What if we could have a way to measure how his/her arthritis is progressing under our treatment? With digital thermal imaging, we can schedule a quick recheck to see how the drugs are controlling the inflammation and pain. If we don’t see measurable changes, we can adjust or change medications and prevent further deterioration of those joints and back.
Another advantage of this technology is that the pet owner who is better at visual learning can understand my diagnosis much better when they actually can see where the problem is. This is crucial in order for them to follow my recommendations of care when I say your pet has a disk issue and needs rest. Scientific based technology is not only important for diagnosis but also for accurate, reliable and measurable treatment results. At our practice, we’ve made a commitment to providing the best integrative veterinary care and as such we have incorporated digital thermal imaging in all our geriatric, lameness and acupuncture consults. The results so far point to a win-win solution: clients love the improved understanding and patients are loving getting rid of the pain at last!

I am a doggie Chiropractor too!

Has your dog ever suffered from a lick granuloma? These are skin lesions similar to a nonhealing ulcer that dogs tend to lick obsessively. If so, your veterinarian probably prescribed systemic or topical antibiotics and or steroids. It probably recurred after the treatment was given and you might have needed to use an Elizabethan collar ( aka cone of shame ) or possibly had to bandage the area to deter your pet from chewing, licking and scratching at the site. In the past, I have treated those granulomas with an acupuncture technique called “surround the dragon”, and although they cleared, they tended to recur. It wasn’t until I was doing my training at the Integrative Veterinary Medical Institute (IVMI) that I learned how the location of a lick granuloma can indicate nerve impingement higher in the vertebral spine or a peripheral nerve. This is great news because it means we can now clear lick granulomas without the need for drugs! In addition, there are many other issues we can help using “doggie chiropractics” or better called Veterinary Medical Manipulation (VMM). Many pet owners are surprised to discover that doing motion palpation or adjustments in dogs or cats are a lot gentler than a regular human chiropractic exam.The following are some signs that a manipulation or adjustment could help;
• Abnormal gait or lameness
• Abnormal posture or stance
• Reduced performance or lack of power
• Sitting to one side or “Puppy Sitting” or refusal to lay down in horses
• Reluctance to move, jump or climb stairs
• Discomfort when being groomed
• Neck or back pain
• Geriatric animals- to maintain function and mobility
Physiologically, treating the restriction in the flow of information from that nerve compression will improve the affected joints range of motion, reduce pain, inflammation and muscle tension. This may also result in improved organ function and generalized wellness.
The main contraindications for a VMM are in pets with fractures, pregnancy, Infectious skin disease, spinal lesions that are unstable, and any significant generalized weakness caused by a disease process. VMM is performed by a Doctor of Veterinary Medicine (DVM) trained in this modality. The term Chiropractic comes from the Greek and loosely means to “work with hands” but this term has been appropriated by human practitioners. Therefore the term Medical Manipulation was adopted by veterinarians. Animal Chiropractic care has been steadily growing since the 1980″s. Nowadays, it is a great modality in clinics that practice the holistic or Integrative medicine approach.
In fact, Veterinary Medical Manipulation can be used in conjunction with massage, acupuncture and herbal therapy. Acupuncture and Veterinary Medical Manipulation work synergistically and can provide excellent results. In my experience using the Balance Method Acupuncture technique along with either Massage, Tui-na, Assisi Loop therapy or Cold Laser prior to the manipulation will not just loosen and relax the muscles near the restricted area but will result in less discomfort to the patient. Also, the overall results seem to last a lot longer. Healing without drugs and invasive treatments is a proven possibility for our companion pets.