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.

Monkeypox and our pets, what do you need to know?

Monkeypox is in the news and of course, we have been asked if this disease could pose a threat to our pets. This is a zoonotic disease, which means that it can spread between people and animals. The Monkeypox virus is classified as an Orthopoxvirus. It was first seen in West Africa and it is believed that small mammals like rats maintain and transmit the virus. People can get infected with the virus through direct contact with infected animals, their body parts, and fluids including respiratory secretions, and potentially in urine and feces.
The name of the virus is because symptoms were first observed in non-human primates but in 2003, an
outbreak of monkeypox in domesticated prairie dogs occurred here in America. The origin of this outbreak was shared bedding and caging with a shipment of infected small mammals from West Africa. This led to 47 human cases in 6 states in the United States. Instances of animal-to-
animal and animal-to-person spread can easily occur. In order to stop an outbreak, we must isolate infected people as well as exposed and infected pets. Many people vaccinated with the smallpox virus vaccine seem to have protection against this new threat. However, smallpox was eradicated in 1972, and vaccines were stopped, therefore the newer generations seem at risk.
Monkeypox virus can infect a myriad of mammal species, including monkeys, anteaters, hedgehogs, prairie dogs, squirrels, and dogs. Orthopox viruses have not been found in birds or reptiles yet.
The usual clinical signs in people are rashes and ulcerative lesions, but in animals, there may not be any skin rashes or lesions. Instead, it could manifest as a fever, lethargy, and other nonspecific malaise.
Infected animals can spread the Monkeypox virus to people, and it is possible that people who are infected can spread Monkeypox virus to animals through close contact, including petting, cuddling, kissing, and sharing sleeping areas or food.
Monkeypox virus can be found in the rash caused by monkeypox (scabs, crusts, fluids) and infected bodily fluids, including respiratory secretions, and potentially in urine and feces.
How can you protect your pets from this disease? If you are diagnosed with the Monkeypox virus, please make arrangements for your pets to be taken care of while isolated from you. If it is not possible to send the pets away, then limit physical touch and put a safe distance between you and your pets. Wash your hands often and use personal protective equipment (PPE) when caring for and cleaning up after your pets. In case your pet develops the disease, please quarantine it inside the house for 21 days. Flush the pet’s waste in the toilet so as to not contaminate wildlife. The CDC has an information page with more advice on how to disinfect the house and keep it safe. The silver lining about this disease is that has low mortality and that supportive treatment should help both you and your pets recover. If you have any questions please ask your veterinarian.

Glucosamine can help cats with cystitis

One of the most well-known pet and human supplements is Glucosamine. It has been proven and tested for arthritis and joint inflammation in dogs and cats. In cats, it has been a life saver since there are few safe alternatives and pharmaceuticals that work on painful kitties. Did you know that your senior cat might benefit from glucosamine supplements to aid in preventing feline lower urinary tract disease? In fact, glucosamine helps protect the lining of the bladder as observed in clinical practice.
Feline lower urinary tract disease (FLUTD) is a group of conditions that cause difficulty urinating and could result in a complete blockage of the urethra. Among these conditions are infections, cystitis, urinary stones, and cancer.
Regardless of the cause of FLUTD, the symptoms are similar. The affected cat will continuously visit the litter box, trying to relieve his/her bladder. Sometimes the cats find a way to ask for help by urinating in abnormal places, there may be blood clots or red-tinged urine. Most cats with FLUTD overgroom and pull their fur or lick their urethras frequently. They might also become loud and vocalize in pain while attempting to urinate. A cat exhibiting these symptoms constitutes an emergency and needs to seek veterinary care immediately for diagnosis and treatment. The most serious type of FLUTD is a complete urinary blockage because it could be fatal!. Your veterinarian will diagnose the actual cause of your cat’s problem by performing a urinalysis and a physical examination. Bloodwork will reveal if the kidneys are also involved.

How can glucosamine help? It is naturally in the body and is found in healthy cartilage. As cats age, less glucosamine is produced, and supplementation aids to preserve the surface from wear and tear. Glucosamine supplements are produced either from shellfish or in a laboratory from fermented corn. Most nutraceuticals combine glucosamine with chondroitin because in some human studies they have improved the mucopolysaccharides lining integrity (glucosamine sulfate, sodium hyaluronate, and chondroitin sulfate) and reduced bladder wall inflammation. Other feline-friendly joint formulas add MSM which is a powerful antioxidant that relieves pain, swelling, and inflammation. Another usual complementary natural substance is Hyaluronic Acid which can be found in animal cartilage and synovial fluid. Because glucosamine is safe, it is often prescribed for off-label use for cats that suffer from FLUTD. The only cats that should not use glucosamine are the ones suffering from Diabetes. It might take 4-6 weeks for the full benefits of supplementation to be obvious so this is a preventative measure, not a treatment for an acute issue.

Nutramax Laboratories, manufacturer of Cosequin for Cats, states its product “is the only joint health supplement brand shown effective, safe, and bioavailable in published, controlled U.S. studies.” However, there are multiple products including treats, pills, and powders that include glucosamine. Most can be hidden in some canned food. If your cat has had an episode of FLUTD, consider asking your veterinarian if supplementing with a glucosamine nutraceutical is indicated for the prevention of a recurrence.

Canine Lymphomas



A large number of patients I treat are actually hospice care due to terminal cancer.  These are very emotional cases and end up being some of my dearest patients.  As a matter of fact, it seems that when you get a cancer diagnosis on your pet something amazing happens: people that would never consider acupuncture will open their minds enough to accept it.  Maybe it is because they are desperately trying to save their pets or at least have more time with them. Sometimes the cure is not what alternative medicine will give you, it’s all about the quality of life and pain control. I always tell my clients that what is important is not the number of days that you live on this earth, but the quality of such days.  
Some owners of pets that suffer from cancers like lymphoma choose to try chemotherapy with a veterinary oncologist because the standard protocols seem to increase survival time for that type of cancer. In general, 70-90% of dogs with multicentric lymphoma treated with the standard UW-25 or Chop protocol experience complete or partial remission of their lymphoma, and this is why we recommend trying it. However, there is still a chance that the pet’s bone marrow can get depleted by all the chemicals and the chemotherapy will fail. Other cancers like certain Mast cell tumors do better with surgery and radiation but still might experience side effects similar to the chemotherapy; inappetence, lethargy, and severe diarrhea.
Most cancers have a common core of energy or Qi deficiency, therefore the approach to “heal” is to replenish the Qi, especially the Wei Qi which is the Defensive or Immune system Qi. Integrative medicine practitioners usually recommend feeding a high-quality protein and low carbohydrate whole food diet along with supplements using mushrooms and other anticancer herbs. Even though some oncologists are against doing acupuncture in conjunction with chemotherapy, in our experience acupuncture can definitively help make the chemotherapy more efficient by preserving the appetite, and energy and controlling diarrhea. I am still grieving the loss of our patient Mr. Bradley, a sweet Yorkie that sadly developed multicentric Lymphoma despite being one of the most spoiled and well cared for dogs I know. He underwent several rounds of chemotherapy but his bone marrow could not handle the chemicals and he lost his fight. We need to understand that Canine lymphomas are a diverse group of cancers, and vary tremendously in their prognosis. Some Lymphomas progress as rapidly as Bradley’s while others progress very slowly and respond better to chemotherapy. Even though we are seeing a large increase in lymphoma diagnoses the cause of lymphoma in dogs is still not known. Although several possibilities such as viruses, bacteria, chemical exposure (roundup), and over-vaccination have been studied and discussed, there hasn’t been a direct link to this awful cancer. The main goal of acupuncture is to stimulate the appetite points, stimulate influential points for the immune system, and control diarrhea. I firmly believe that the integrative approach could work along with western medicine to achieve even longer remission times.

March is Pet poison control awareness month!

March is pet poison prevention month and I wanted to remind all the pet lovers out there to be aware of the household poisons that could affect your pets. The majority of the calls to the poison control lines are related to over-the-counter medications mostly accidentally ingested by pets. Most of them are common medications like Tylenol, Ibuprofen, and other pain control medications that the pet owners are using but were left unattended at the reach of those pets. The situation with those non-steroidal anti-inflammatories is that they can cause severe liver and kidney damage because the human dosages are so high and the pets might not have the same enzymes available to break them down safely. Just one Tylenol capsule could kill a cat!! It is super important to keep your medications securely stored away from curious dogs and cats. Other commonly ingested medications like ADHD pills or Blood pressure medications can cause severe cardiac symptoms and need to be neutralized either by inducing vomiting or by administering medications to counter those effects. Last year there were close to 25,000 cases involving pets eating toxic foods including the sweetener Xylitol, grapes, raisins, onions, and garlic. Xylitol is in most sugar-free candy and bubble gum and it will kill pets with acute liver failure. Grapes and raisins are especially toxic to the kidneys and will cause kidney failure depending on the amount ingested. The popularity of chocolate gifts for occasions like Christmas, Valentine’s Day, and Easter also result in accidental chocolate poisoning. The darker the chocolate the deadlier it is. Corn cobs are another food danger because they do not digest or break down in the gut so the dogs that bit big chunks of corn cobs end up having emergency surgery to remove them from the intestines. Something most pet owners do not realize is that dogs and cats are lactose intolerant. Although cow’s milk itself is not really toxic, it is not in the best interest to give it to them. In addition, most dairy products like ice cream and yogurt are full of unhealthy sugars and fat and those could cause your pets to get pancreatitis. Ethanol can cause signs of intoxication including incoordination and collapse therefore, be careful leaving your wine glass or beers unattended!. The severity of the symptoms corresponds to the amount ingested. Another food culprit is Macadamian nuts. The symptoms of macadamia nut poisoning are similar to any pancreatitis case; vomiting, anorexia, and weakness. However, we see tremors and Central Nervous System signs as well. The toxin is not well known but keep your pups away from these nuts.
There are many ways to secure your foodstuffs and medications but if your pet is naughty and ingests some of those then call your nearest veterinarian immediately. In most cases inducing vomiting is all it takes but in others, activated charcoal, intravenous fluids, and other medications might be necessary. The ASPCA Animal Poison Control Center (APCC) is your best resource for any animal poison-related emergency, 24 hours a day, 365 days a year. If you think your pet may have ingested a potentially poisonous substance, call (888) 426-4435. A consultation fee may apply.

Holiday & Pets thoughts…

The Christmas holiday is not the greatest time to give pets or to incorporate new pets into the family unit yet millions of puppies will be acquired as gifts. What many fail to realize is that these are not temporary gifts, they are long-term responsibilities and as such, they require that the recipient is committed to providing all that is needed for these beings’ happiness and wellbeing. If you are planning to still get a puppy or kitten this Christmas, then you need to read the following safety advice to make sure you will avoid a costly emergency visit;

• Use pet-proof decorations

Buy shatter-proof tree decorations that are safe for toddlers and pets alike. Although tinsel is still a popular choice, it has no place in a pet owner’s home. The reason is that cats (and some dogs) are magnetically attracted to tinsel, they love to eat it and it causes life-threatening blockages in the GI tract. This issue is resolved only by a surgical intervention that can cost thousands of dollars, especially if it’s in an after-hours emergency situation. Beware of holiday plant arrangements. Lilies and poinsettias can be very toxic or fatal if chewed on or ingested. The electric lights can pose a danger if chewed so use cable coverings or good old duct tape to secure them and protect them from pets.

• Keep the pets away from the Christmas tree

The tree is another trouble magnet when you have pets. Cats can climb the tree and get tangled up and injured. They could topple the tree also. I recommend a wall anchoring system that secures the tree to avoid toppling. Alternatively, place furniture around it so that if toppled, it would only lean into it rather than squash your pets. The tree water is another danger, it can cause GI upset and diarrhea if ingested.

• Do a winter vet check-up

Cold weather is a stressor on our pets. Many underlying conditions may be exacerbated and you need to pay attention to the signs. If your pet is stiff or panting more (arthritic pain), shedding excessively (low thyroid), drinking more (kidney disease or diabetes), it might be time to do a winter blood work check-up.

• Prepare your pooch for the fireworks, noisy reunions, and visitors

Load up on over-the-counter calming products. There are so many options like Zylkene, Composure treats, and DAP pheromones. There are also storm capes that help with noise phobias from fireworks so buy ahead. Keep your pets indoors and play some soothing background music to defuse the loud sounds.

• Beware of holiday feast table scraps

I’ve said it a thousand times: fatty and spicy table scraps can really hurt your pet regardless of the amount given. If your pet develops pancreatitis, it is a life-threatening condition and very expensive to treat. Play it safe by telling all your guests to refrain from feeding your pets any table foods. Secure your trash, all those smells will be very tempting to your dogs.

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,

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!