Let’s start with a review of Nick’s history.
An old injury
Back in 2009, we were at Surfer’s End beach car park in Middletown, RI. Nick managed to slip past Rhea exiting the car and went runner across the beach road. He was hit by a car and knocked down without apparent injury. Ten years after, he may have some arthritis in the hips and low back which is clearly identified in a bench check of his hip and back structure.
Keeping weight on Nick
Since we had been feeding a grain-free food (Canidae Pure), Nick has been a grazer. He would nibble on his ration throughout the day. Rhea did the same with her ration so 2 dogs were each eating 1 dog’s worth of food. When Missy joined us, she Hoovered any leftovers and Nick began to drop weight. For 4 years, I’ve tried different food and feeding schemes to keep weight on Nick. The one that works is to offer 1/2 cup at a time when asked until he stops asking.
For Nick’s health, I had to transition from traditional morning and evening feeding to feeding Nick when he wanted to eat. What I found worked was to offer 1/2 cup in the morning with his SLO oil. If he ate, good. If not, pick up and save until evening and offer about 50 grams of pot roast in addition. He’ll eat his pot roast. Save left-overs for when asked. Next ask, give 1/2 c of kibble (Canidae Pure Sea usually). Continue until he asks and leaves half. Save leftovers for next ask. Cut him off at bedtime but save leftovers.
I fed morning ration wet and evening rations dry. Or you can feed all wet. He has a preference for wet but dry is a bit more stable. I’ve not worried about cold storage as canines are carrion eaters. If road kill won’t make them sick, fermented kibble won’t make them sick.
At Missy’s 2018 annual exam in August, Nick was along for the ride. Looking somewhat slouchy, Missy’s vet suggested we start Nick on Phycox, one of several supplements favored by small animal veterinary practitioners for joint health maintenance . Phycox is a strong anti-inflammatory and antioxidant developed to manage canine late in life low back pain.
Nick in Late Winter 2019
At Nick’s annual, the discomfort was more pronounced and weight loss was noted. We added carprofen to his medications. Nick didn’t think too much of the vet visit, presenting significant lab coat anxiety.
Nick was still doing his best to be an elderly male greyhound. He was still going out, still had regular loo habits, and was still Missy’s wingman answering Tally Ho calls to sort a blighter at the fence and occasionally giving the alarm himself.
May 2019, starts gabapentin therapy
After speaking with friends, I decided that Nick needed a different approach to his late in life wellness care than traditional outpatient care and contacted Hampton Roads Veterinary Hospice for an evaluation consultation. Nick’s discomfort had continued to increase and he was eating poorly. HRVH recommended adding gabapentin to Nick’s medications and we continued this regimen for a month. Nick showed some improvement.
HRVH is a specialist practice caring for elderly pets in home. They specialize in late in life pain management which benefits from being able to observe and treat the pet in home. Office visit anxiety is eliminated as a confounding factor and mobility and obstacle navigation can be observed in the home environment.
Treatment measures of effectiveness
I keep track of several measures of effectiveness to evaluate changes in Nick’s care.
- How is Nick’s appetite. Is he eating well? Is he eating a full ration over the course of the evening.
- How is Nick’s sit? Can he sit smoothly on the first try?
- How is Nick’s standing posture? How long can he remain standing before starting to slouch? How is this changing over the day? Is posture recovering after a lie down?
- How is his sleeping posture? Where is he sleeping? Is he stretched out of scrunched up? Is his bum hanging off the bed (ache inducing)?
Quality of life measures
I try to track his quality of life from the activities he maintains. At summer, he’s still doing the following.
- Jumping from the back porch to the ground
- Jumping from the ground to the porch deck
- Charging blighters at the fence. Answering a Tally Ho call to join the course at the fence.
- Peeing and pooing in the yard without assistance
- Waking me at night to be let out.
- Following me around the house on occasion. He’ll check on my location. Follows me to the loo and to bed.
- Not jumping on bed. This stopped when I rearranged the room looking ahead to setting up a crate (not needed)
- How often does Nick require assistance sitting or standing? Currently less than once per day. He likes the Ruffwear Web-Master harness. I tell him it’s his #ZSHQ patrol web gear.
June 2019, starts acupuncture
After a month of carprofen plus gabapentin therapy, HRVH suggested adding acupuncture to the treatment regimen. Acupuncture has a long history of use in Asia and is finding increasing favor in the US. As of this writing, medical science is beginning to investigate the therapy to determine is means of effect and to develop a better understanding of when it is beneficial and which points are effective for which conditions. Reference 2 describes what has been learned and how acupuncture is effectively used in veterinary medicine. A skeptical head moocher authorized acupuncture and we started weekly treatments. We saw changes in Nick’s behavior typical of acupuncture response. Nick would sleep through treatment and a good bit of that day. Next day, we’d see improved hip function and Nick’s appetite improved.
July 2019, transitions to maintenance acupuncture
Nick showed significant improvement in his hip action, most notably, his sit became smooth and he could manage to complete a sit on the first try. We also noted that his confidence hoping the steps (he uses the Rocky the Flying Squirrel step technique) had improved. Appetite had improved but head moocher had also changed feeding protocol to accommodate Nick’s preferences. We’re continuing acupuncture at a bi-weekly interval and may be able to drop to monthly.
Nick is more alert and his quality of life measures have improved. He’s maintaining weight. He’s dragging me out to the loo at night. Poo accidents are down to zero again. He had been dropping some struggling to a stand. Now he powers up smoothly. A lot of this is from getting him to eat his full ration and some extra.
Thoughts on Therapies
I’ll summarize my impressions so far. Late in life care in a home setting is important. Taking the dog to the vet for an office visit is stressing. The examinations and physical therapies performed for late life pain management are easily performed in a home setting and better evaluations result from seeing the patient in situ rather than in the office. This approach is highly recommended. I feel the improved results from an hour encounter are worth the added cost.
Integrated pain management is an important improvement in late in life care. The combination of caprofen, gabapentin, and acupuncture produce better results than is possible with the individual therapies. Acupuncture is a good adjunct treatment that has improved Nick’s hip function.
Caprofen and Gabapentin
Caprofen is a synthetic anti-inflammatory that sees some use in human and veterinary medicine to treat chronic and acute pain at the receptor. It is commonly used for human arthritis treatment. Gabapentin attenuates the transmission of pain in the peripheral nervous system. Together, the two give significant pain relief and have improved Nick’s use of his hips. Acupuncture also has a place in this improvement. We started the therapies one at a time and see the best hip function with the three in combination.
Thoughts on Acupuncture
Head Moocher began Nick’s acupuncture on faith. If nothing else, it could have a placebo effect. As we continued, Nick responded and I found Reference 2. Since then, I have learned that the Social Security Administration is researching use of acupuncture for human low back pain, its third most costly diagnosis after heart disease and pulmonary obstructive disease. The problems with opioids (ineffective as a chronic pain relief and addictive) have driven the SSA to look for effective alternative therapy.
Glucosamine and Chondroitin
The Head Moocher did not observe a change in activity of Nick’s or predecessors given glucosamine/chondrotin supplementation comparable to that from carprofen-gabapentin pain management therapy.
Our recent foods are enriched in glucosamine and chondroitin. Past use of these supplements has been inconclusive. They may promote cartilage maintenance in the affected joints but don’t appear to promote restoration of worn cartilage.
This is consistent with the literature citations. The literature notes that the few trials conducted (can’t get rich on naturally occurring stuff under patent law). are of poor quality (small, short, unsound statistical design, etc).
Phycocyanin and Phycox(tm)
Phycocyanin (we use Phycox) has significant anti-inflammatory and anti-oxidant actions that may be of benefit in the treatment of arthritis. The Wikipedia article does not site any study results. Reference 8 reviews recent literature to find significant benefits of Phycocyanin as an anti-inflammatory and antioxidant in a number of clinical settings. As an element of multi-modal therapies it can provide pain relief and promote healing. Phycocyanin is low in toxicity and non-interacting so we continue to use it.
Phycocyanin has a long history of alternative medicine use via algae supplements and can be produced by fermentation processes or synthesis from precursors. Phycox uses a purified version and is of known potency so dose rate can be controlled. Because it is non-toxic, Phycox can be offered as a snack or as a food additive (how Nick prefers. It can be quite bitter to our taste). Phycox contains turmeric and other ingredients but it is phycocyanin that is of clinical interest.