What You Absolutely Must Know About

the Risks of Prescription Medicines When

Treating Your Dog’s Arthritis:
A guide to making intelligent choices for your dog’s
health.

Christopher Durin, Veterinarian

Page II
STOP! You Have The Power To Control Your Dog’s Arthritis Suffering...
…But It MIGHT NOT Be By Giving The Medication Your Vet
Recommends

Your dog is suffering the pain of dog arthritis and you feel helpless.

Your vet recommends non-steroid anti-inflammatory drugs (NSAIDs) such as

Rimadyl, Metacam, Previcox or Deramaxx.

You vet knows best, right?

Usually; but please read this first:

Before you begin a NSAID treatment program for your dog, you need to read
the important information in this e-book. There are potential side effects. You
could end up impacting your dog’s health and NOT the way you intended! While
there is a place for NSAIDs, and I do recommend them in those instances, they
are not the end-all when it comes to treating dog arthritis.

I know. I’m a vet and I’ve dedicated much of my career to treating dog arthritis.
I’ve seen treatment miracles, and I’ve seen treatment failures. I’ve seen the
unexpected side-effects of NSAID treatments. Yet I have also seen the NSAIDs
bring dogs back from the brink of euthanasia.

Yes, prescription medications are commonly recommended by veterinarians.

Why? Because they work. But do you want to rely on them or would you prefer
they took their place within a broader, more balanced treatment plan?

These prescription drugs fall into two categories: pain killers and anti-
inflammatory drugs, mainly the non-steroid anti-inflammatory drugs (NSAIDs).
While prescription medication will be central to the treatment plans I suggest,
there are times when I do not recommend NSAIDs. It’s important to your dog’s
health that you know why I feel this way. Very important.

This e-book (and its follow-on book) focus on the medical treatment of dog
arthritis, specifically the prescription medications. But it also details available
supplements you should know about. In my many years of treating dog arthritis,
I have found that the combination of these medicines and supplements creates
a powerful regimen that can greatly reduce your dog’s pain and suffering.

Page III
Please read this book carefully. It’s not very long. In fact, it’s only 25 pages of
just-the-facts information designed to help you make an informed choice about
treating your dog’s arthritis.

And if you want to be truly informed about the most up-to-date dog arthritis
treatment medication, I urge you to read the follow-on from this book:
Modern Dog Arthritis Treatment – Advanced Medical Therapy for the
21st Century.

Also keep in mind that I am mainly discussing medical therapies - this e-book is
not intended to be an all-encompassing plan for dog arthritis treatment. There
is much more you need to know so you can best assume the role of guardian
of your dog’s health. I encourage you to visit www.DogArthritisBlog.info and
download the Dog Arthritis Survival Guide from the Members Section. It’s free!

One last request. Please feel free to share this e-book with anyone you know
who is also struggling with making the right decisions about how to treat their
dog’s arthritis. We dog owners have to stick together.

Christopher Durin
Christopher Durin, Veterinarian

Page IV
Acknowledgement
This book builds on the work of Dr Lester Mandelker DVM, who has researched
and pioneered much of what we know about concepts such as oxidative stress,
the scientific use of natural products and many of the modern treatments I will
suggest to you. He more than anyone made me think long and hard about the
use of NSAIDs in dogs and of ways to minimize them.

Copyright
All contents copyright (c) 2011 by DogArthritisBlog.info. All rights reserved.
No part of this document or the related files may be reproduced or transmitted
in any form, by any means (electronic, photocopying, recording, or otherwise)
without the prior written permission of the publisher.

Limit of Liability and Disclaimer of Warranty

The publisher has used its best efforts in preparing this book, and the information
provided herein is provided “as is.” www.DogArthritisBlog.info makes no
representation or warranties with respect to the accuracy or completeness of
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limited to special, incidental, consequential, or other damages.

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In addition, terms suspected of being trademarks, registered trademarks,

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of a term in this book should not be regarded as affecting the validity of any
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is not associated with any product or vendor mentioned in this book.

Page V
Table of Contents
Prevalence of Dog Arthritis... 1
Prescription Medications & Dog Arthritis 2
The Side Effects of Prescription Medications 3
The Shift to More Natural Therapies 3
Understanding Dog Arthritis 4
Anatomy of a Dog Joint 5
The Disease Process of Arthritis 6
How to tell when your dog has arthritis 8
A Grading System for Dog Arthritis 8
Traditional Treatment for Dog Arthritis 10
A 21st Century View on Treating Dog Arthritis 10
Side Effects of Pain Killers... 11
Opioids (Narcotic Analgesics) 12
NMDA Antagonists (Pain Killers) 14
Cortisone (Steroid Anti-Inflammatory Drugs) 14
Prescription Glycosaminoglycans (GAGs) 15
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) 15
A Shift in Dog Arthritis Treatment Patterns 20
Trend towards natural medication 21
Shift away from NSAIDs 21
Does Your Dog Absolutely Need NSAIDs? 22

Page VI
Prevalence of
Dog Arthritis and
Potentially Harmful
Effects of Arthritis
Medication
Dogs are not just pets - they are
part of the family where they spend
a greater part of their lives bringing
joy to young children and providing
companionship to adults. A dog is still
‘man’s best friend’.

Dog years, however, are shorter

compared to humans and, like us,
dogs require special care and nutrition
as they grow older. The most common disease affecting dogs is arthritis, which
has led to the development of a host of medicines to manage its symptoms
such as pain killers, anti-inflammatory drugs and supplements to help protect
the joints against ongoing disease.

Just like human arthritis, dog arthritis, when left untreated, can be a debilitating
illness which reduces the quality of life for dogs. This leaves them unable to
perform basic activities such as walking, running, climbing short steps and even
going to the toilet.

Prescription Medications & Dog Arthritis

Pain and inflammation are the main symptoms of dog arthritis, which is why
most treatments focus on pain relief & anti-inflammatory medication.

Unfortunately, the increased use of prescription medicines, especially non-steroid

anti-inflammatory drugs (NSAIDs), has been accompanied by a phenomenal
rise of reported cases of organ damage, toxicity, overdosage and other harmful
side effects of drug use.

Statistics show that NSAIDs kill more animals than any other class of pain
medicine, damage more vital organs than all other prescription medicines
combined and are responsible for the death of at least 16,000 people every year.
The US Food and Drug Administration (FDA) maintains an even higher rate of
NSAID-related deaths with approximately 20,000 deaths in the United States
alone.

While Rimadyl (carprofen) currently appears to be the most notorious among

NSAIDs, medical forums mention other NSAID formulations which produce
similar side effects.

Page 2
The Side Effects of Prescription
Medications
Veterinarians and pet owners are aware that
arthritis management through medicines such
as opioids and NSAIDs (non steroidal anti-
inflammatory drugs) significantly improves
the condition of their dog.
However many are concerned about
prescription drug side effects including
vomiting, constipation, bleeding and internal
organ problems.
This concern is understandable given that
dog arthritis, very much like human arthritis,
is a lifelong illness with no known cure. Long
periods of treatment expose dogs to serious
risks that vets and pet owners must weigh up
before adopting a particular treatment plan.
The Shift to More Natural
Therapies
Despite the effectiveness of these
prescription medications, many pet owners
are now searching for natural and safer
substitutes. Some wish to avoid these drugs
entirely, others are simply looking for options
to minimize their use if they can. Some dogs
have known side effects from the NSAIDs,
some are already on other medication that
interferes with the NSAIDs.
There are lots of reasons for people to move away from the NSAIDs! I can
show you how to do this.
The FDA and NSAIDs
In the US, the FDA has a
reporting system for adverse
drug reactions (ADR). ADR
is defined as “a noxious and
unintended response to any dose
of a drug (or biological) product
for which there is a reasonable
possibility that the product caused
the response.”
Currently, the FDA maintains
reporting systems such as the
MedWatch where consumers and
healthcare professionals can report
ADR directly to the FDA.
ADR reporting is mandatory for
manufacturers who should submit
to FDA reports from consumers
and healthcare professionals.
Unexpected ADRS must be
reported to the FDA within 15
calendar days from the time the
manufacturer became aware of
it. Thus, it is clear that while
information on benefits of a
medicine is well controlled, the
same cannot be said of its side
effects which are largely voluntary
and anecdotal.
Page 3
Understanding Dog
Arthritis
When exploring a treatment plan for dog arthritis, a clear understanding of this
disease becomes necessary to choose prescription medicines, supplements and
natural therapies that target the symptoms and disease processes of arthritis.

Anatomy of a Dog Joint

The main joints of a dog are the shoulder, elbow, wrist (carpus), hip joint, knee
and hock (ankle). These joints consist of bone and a smooth cartilage surface,
which serve as cushions to absorb much of the impact experienced by the
joints during movement or trauma. Joint (synovial) fluid lubricates the joints for
smooth movement and tendons / ligaments hold the joints together.

Cartilage is a matrix of materials, primarily composed of collagen and

glycosaminoglycans (GAGs) which keep the cartilage strong and spongy. This
matrix is populated by cartilage cells (known as chondrocytes) which create new
cartilage to repair or replace damaged or worn tissues.

Page 5
The Disease Process of Arthritis
Arthritis develops when chondrocytes are unable to keep up cartilage production
against the constant wearing down and damage of cartilage. It is a complex
disease but our understanding is improving quickly. Here are a few key points:

• Osteoarthritis is a disease of the cartilage

• Arthritis starts with cartilage damage
• Damage to cartilage leads to an ongoing cycle of cartilage damage.
• If enough cartilage is damaged, the chondrocytes will also die.
• This process will continue unless we slow or stop it.

Osteoarthritis is a Disease of the Cartilage

Osteoarthritis is a disease of
cartilage loss. New cartilage is
always being made by chondrocytes
(cartilage cells) and old cartilage is
always being destroyed. This is a
normal process called remodeling.

In the arthritic joint old cartilage

is breaking down too fast and/or
new cartilage production is too
slow. The net result is a loss of
cartilage over time, leading eventually to the exposure of the bone underneath
the cartilage.

Whilst cartilage has no blood or nerve supply bone certainly does. When the
cartilage is worn down to expose the bone the joint will become much more
inflamed and much more painful.

Page 6
Arthritis Starts With Cartilage Damage
Arthritis always starts with damage to the cartilage. Cartilage may be damaged
as a result of traumas such as:

• OCD (osteochondritis dissecans)

• Luxations (hip dysplasia, elbow dysplasia and knee cap luxations)
• Excessive wear and tear / old age
• Ligament injury (cruciate ligament and shoulder injuries)
• Immune disease (immune mediated polyarthropathy)
• Infections

You can find more detail about the causes of arthritis on my blog or in my
introductory e-book “The Dog Arthritis Survival Guide”. This is located within
my FREE Members Area for immediate download.

Damage to Cartilage Leads to A Cycle of Ongoing Cartilage

Damage
Damaged cartilage, either through wear and tear or blunt injury, triggers a vicious
cycle. Enzymes are released that chew up more cartilage (I will call these MMPs
for now). On top of this, oxygen free radicals and inflammatory chemicals help
to destroy remaining cartilage.

The release of these chemicals causes painful inflammation in the affected joint.
If severe, the loss of cartilage creates bone on bone contact within the joint,
which causes excruciating pain.

If Enough Cartilage Is Damaged the Chondrocytes Will Also Die

Chondrocytes are responsible for the renewal of worn cartilage. They live within
the cartilage and if there is enough cartilage destruction there will be damage or
death of chondrocytes.

This will lead to more inflammation and poor communication between cartilage
cells, which makes their function very difficult.

The Process of Cartilage and Chondrocyte Death Will Continue Unless We

Slow or Stop It

Page 7
This cycle of cartilage and chondrocyte destruction will keep going. As more
chondrocytes are lost there is a reduced ability to produce new cartilage. Over
time more cartilage will be destroyed than can be made and the joint will lose its
cartilage, exposing the bone underneath.

Once the bone is exposed there will be a much more intense inflammatory
reaction and there will also be much more pain.

How to tell when your dog has arthritis

Dog arthritis is best treated at the earliest stage when cartilage and bone damage
is minimal and much of the tissues may still be saved.

The onset of this condition, however, is unnoticeable as dogs generally tolerate

discomfort and tend to hide pain well. Regular visits to the vet can help detect
the early signs of arthritis and are highly recommended.

Nonetheless, the following signs often indicate joint problems requiring an

immediate trip to the vet.

• difficulty or avoidance of flexing • pain

the joints • instability of the joint
• stiffness of the joint • swelling or inflammation
• lameness • muscle atrophy (shrinking)
• head bobbing

A Grading System for Dog Arthritis

Humans have a number of grading systems for arthritis. This helps to more
clearly define how severe the arthritis is which in turn can help to choose a level
of treatment. These grading systems rely on x-rays and arthroscopes to get a
very good look at the joints.

There is talk of such a system in dogs but nothing is well defined. Here is my
take on the subject. You will see in my next e-book how I match suggestions for
arthritis treatment to the grade of arthritis.

Page 8
Grade 1 Arthritis
A mild form of arthritis. Cartilage loss is minimal but there may be some small
fissures in the cartilage. Lameness is intermittent and mild. More pain on activity
but relieved with rest.

Minimal changes on X-ray and endoscopy - no osteophytes or bone spurs, a

softening of cartilage.

Grade 2 Arthritis
Cartilage loss is minimal but there are cracks in the cartilage. Lameness can be
quite obvious but is intermittent, often worse after rest or sleep. The lameness
can be ‘warmed out of ’ which means that the joint will loosen up after it warms
up with use.

X-rays show early new bone growth (osteophytes) and narrowing of joint
spaces. Scar tissue is starting to build up around the joint so it is getting stiffer.

Grade 3 Arthritis
Moderate to severe stage of arthritis. Cartilage loss extends to the bone
underneath the cartilage. Arthritis is irreversible at this stage. Lameness can be
severe and more frequent and is not easily ‘warmed out’ of.

X-rays and endoscopy would show bigger osteophytes or bone spurs and full
thickness fissures.

Grade 4 Arthritis
This advanced stage of dog arthritis displays severe symptoms. Extensive
cartilage loss and exposure of the bone underneath the cartilage results in a
painful and prolonged inflammatory reaction as well as the exposure of nerves
in the bone.

Lameness is severe and ongoing. X-rays and endoscopy would show large
osteophytes, extensive cartilage loss, lots of bone on bone contact and swollen,
thickened joints.

Page 9
Traditional Treatment for Dog Arthritis
Dog arthritis causes a progressive and
ultimately unbearable pain, requiring
treatment to reduce pain and improve your
dog’s quality of life.

The cornerstone of arthritis treatment for

many years has been anti-inflammatory
medications, in particular the non-steroidal
anti-inflammatory drugs (NSAIDs).
Without doubt these drugs have saved
many dogs from early euthanasia and we
as dog owners should be exceptionally
grateful that we have them available.

However pet owners are concerned about the use of these prescription
medicines amidst growing awareness of their harmful side effects. Natural
therapies are available but are not as popular with dog owners and veterinarians
due to inadequate research and information. Thankfully this is changing.

A 21st Century View on Treating Dog Arthritis

We want to avoid joints getting to this severe stage of arthritis. You can see
there is a lot going on in these joints - more in fact than any one drug can
control. Here is how I structure treatment plans to treat dog arthritis:

• Slow down cartilage destruction

• Keep the chondrocytes as healthy as possible for as long as possible.
• Control pain
• Control inflammation
This makes a lot of sense based on everything I have just said but is easier said
than done.

Page 10
Side Effects of
Pain Killers and
Anti-Inflammatory
Drugs
While pain medicines and NSAIDs significantly improve symptoms of dog
arthritis, the choice of which drugs to use, their dosages and combinations
require careful consideration because long term use can lead to side effects.

This section details the side effects of the arthritis medications and a description
of what you may see if you overdose them. It is important to keep these in mind
and to match them to any problems your dog may have now or in the future.

For example, many of these drugs can cause vomiting. Even if your dog has
never vomited on its arthritis medication, if it suddenly picks up a tummy bug
or eats some food that causes vomiting, you would not want to give the arthritis
medication.

So being aware of the side effects can prevent the medications making other
problems worse. Please note this section is by no means written to make you
scared of these drugs, just to be cautious how and when you use them. Let’s
take a look at the following classes of drugs and their side effects.

• Pain Killers
• Opiods
• NMDA Antagonists
• Glycosaminoglycans
• Adequan, Cartrophen
• Anti-Inflammatory Drugs
• Non-Steroid Anti-Inflammatory Drugs (NSAIDs)
• Steroid Anti-Inflammatory Drugs (Cortisone)

Opioids (Narcotic Analgesics)

Opiods are the strongest, most effective form of pain relief that you can get.
They take on many forms and it is difficult to discuss them all together, but in
general they work by bonding to opioid pain receptors on cells in the nervous
system. It would appear there is more to it than this but the research is still in
progress.

The other great advantage of opioids is that their side effects can be reversed
partially or fully, at least within a veterinary hospital.

Page 12
The opiods are also reasonably cost-effective. Indeed they seem like the perfect
pain killer, but they are not used much in dog arthritis. This is because they are very
strictly controlled to minimize drug abuse in people, which limits their use away
from veterinary hospitals. Also an overdose of an opioid can be life threatening.

The oral (and injectible) opioid-LIKE drug Tramal is one of the most effective
drugs for arthritis available and is key to many of my treatment plans. Its has
side effects but in my experience they are minimal.

Side Effects
Brain problems
Opioids directly affect brain receptors and are known to cause feelings of
distress or euphoria which can sometimes be extreme. Studies show how the
chemicals raise pressure in the skull making it unsuitable for patients suffering
from head trauma or raised cranial pressure.

Breathing problems
Opioids cause depression in the respiratory centers of the brain and suppress
coughing as a side effect. In fact, an opioid (dextromethorpan) is an active
ingredient in many cough suppressants. Opioids should not be given to pets
with significant respiratory problems.

Heart problems
Opioids can slow the heart down and cause low blood pressure and must be
used carefully in patients with existing heart problems.

Stomach problems
Opioids also bind with receptors found in the gastrointestinal tract which can
lead to constipation, a mechanism that is useful in anti-diarrhea medicine. Many
can also cause nausea and vomiting.

Overdosage
Dogs that suffer from opioid side effects must visit the vet as soon as possible.
Any of the above side effects may be seen but it is really the breathing problems
that will be of most concern.

Treatment may include negating the opioid as well supportive care of the
respiratory system and nervous systems. Many dogs (and indeed many people)
can die from overdoses of opiods.

Page 13
NMDA Antagonists (Pain Killers)
NMDA antagonists work by suppressing the NMDA receptors in the nervous
system which are responsible for sending pain signals arising from tissue injury,
to the brain.

These pain killers are often used to complement the effects of opioids rather
than as a first-line treatment. They can be very good for chronic pain conditions
such as arthritis and back pain.

It must be noted that NMDA blockers merely treat pain symptoms arising from
cartilage or joint injuries and do not contribute to cartilage repair or protection.

The main NMDA antagonist drugs available would include:

• Ketamine • Gabapentin
• Amantadine • Amitryptiline

Side Effects
The NMDA antagonists are a relatively safe and effective class of drugs. They
can go a long way to settling down chronic pain states.

However any drug has side effects. The NMDA antagonists can cause:

• agitation • diarrhea
• flatulence • sedation
In humans, these pain blockers produce a host of other side effects such as
dizziness and hallucinations but we don’t really know if dogs experience these.

Cortisone (Steroid Anti-Inflammatory Drugs)

Cortisone is a powerful anti-inflammatory medicine that acts just like cortisol,
which is the body’s natural stress hormone. This drug is injected directly into
the affected joint to provide immediate relief from inflammation and swelling.

It can also be give orally but at the ongoing doses for arthritis management you
will quickly experience the side effects.

Page 14
Side Effects
Many dogs experience increased thirst, urination, lethargy,
hyperactivity, panting and diarrhea with cortisone use.
Over the long term, it can affect your dog’s liver, pancreas
and adrenal glands as well as suppress its immune
system. Studies have also shown how the combined use
of cortisone and NSAIDs can damage chondrocytes,
worsening arthritis as a result. They can also cause a severe
gastrointestinal upset - bloody diarrhea and vomiting,

Prescription Glycosaminoglycans (GAGs)

GAGs are commonly found as over the counter supplements such as glucosamine
and chondroitin. GAGs are significant components of cartilage matrix, which
protect and promote cartilage development, fight inflammation and support
joint fluid secretion that can relieve pain during movement.

Here we refer to injectable supplements containing either natural or synthetic

GAGs.

Side Effects
While GAGs are considered safe, these may not be appropriate for dogs that are
being treated for clotting problems or have kidney disease. Prior consultation
and prescription are essential for this treatment.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs can be a wonder drug to reduce arthritic pain and swelling. They have
been the cornerstone of dog (and human) arthritis treatment for many years.

However as has been stated above, the NSAIDs are not without side effects
or risks. Medical forums are abuzz with observations, updates and startling
revelations of NSAID side effects which affect major organs of the body. The
concerns people have for these drugs are deep and to a certain extent valid. My
own client surveys reinforced these concerns to me.

Am I against the use of NSAIDs? No. They can really help. However, like any
drug, I think they should be used with caution in dogs that are at risk of side
effects. They should not be used as a first line of treatment unless it is for an
acute inflammatory injury. Other drugs should be used in their place in many
cases of acute and chronic arthritis.

Page 15
The main veterinary prescribed NSAIDs are safest and have been thoroughly
tested in dogs. These would include:

• Carprofen (Rimadyl) • Deracoxib (Deramaxx)

• Meloxicam (Metacam) • Firocoxib (Previcox)
• Tepoxalin (Zubrin) • Etodalac (EtoGesic)
There are also human NSAIDs, some of which which are readily purchased
over the counter. Most of the human NSAIDs are toxic to animals so you
should absolutely consult with your vet before using them. Common human
NSAIDs are listed below. Note that of this list, only aspirin is safe to use and
even aspirin has a dubious safety record.

• Aspirin • Naproxen
• Ibuprofen • Celecocoxib (Celebrex)

Side Effects
Most of the side effects of the NSAIDs can be understood if you are aware of
how they work.

NSAIDs block the action of 2 closely related enzymes called cyclooxygenases

(COX-1 and COX-2). These enzymes are produced in response to injury or
infection. Both produce prostaglandins, potent pro-inflammatory molecules,
which play several roles in important bodily functions:

• they sensitize nerve endings that transmit pain signals to the spinal cord
and brain
• regulate movement of lung muscles and uterine muscles
• increase blood flow to the kidney
• protect stomach lining from digestive acids

This is why NSAID use leads to gastrointestinal damage including stomach

ulcers, bleeding and other related disorders.

Page 16
Kidney problems
NSAIDs can lead to sudden kidney failure. The inhibition of prostaglandins
(which is a function of NSAIDs) causes decreased blood flow to the kidneys,
causing acute renal failure in dogs. NSAIDs can aggravate pre-existing kidney
disease, so often blood tests are performed to assess the kidneys before use. If
your dog has kidney problems you should remind your vet of this if he or she
is considering NSAIDs so that alternative forms of treatment and medication
can be prescribed.

Gastrointestinal problems
NSAIDs affect the gastrointestinal tract causing stomach upset, ulceration and
stomach bleeding. This is often indicated by dark stools or vomiting. NSAIDs
irritate the stomach by reducing the stomach lining’s ability to resist stomach
acids.

As a result, NSAIDs cause:

• vomiting with or without blood • diarrhea

• reduced stomach blood flow • stomach ulcers
A marked improvement in stomach ulcers have been observed in patients that
have discontinued NSAID treatment. It is possible to use medications alongside
NSAIDs to minimize the stomach problems but better to avoid them if there
are problems.

Liver disease
NSAIDs, particularly Rimadyl, are notorious for causing liver damage and
sudden liver failure even in dogs without pre-existing liver disease.

It is advisable for your vet to blood test for existing liver problems before
prescribing NSAIDs, or risk further liver damage. Unlike opioids where serious
side effects follow prolonged use or high dosages, liver damage from NSAID use
has less to do with dosage or long term use, it just seems to happen to some dogs.

Pregnancy
NSAIDs may be harmful when given during pregnancy.

Cartilage repair
NSAIDs may reduce arthritis pain but studies on animals show that this could
be counterintuitive - some NSAIDs can actually damage cartilage, making dog
arthritis worse.

Page 17
This may be due to two things: decreased prostaglandin production and excess
use of the damaged joint. Decreased levels of some prostaglandins slow down
cartilage repair and promote cartilage deterioration. Moreover, when pain at the
damaged joint is minimized, it encourages excess use that can lead to further
cartilage damage.

Low blood pressure

Patients with low blood pressure (hypotension) should avoid NSAIDs because
these can dramatically reduce blood flow to the kidneys, leading to severe kidney
problems. Low blood pressure can be the result of:

• dehydration • diuretic use

• shock • anesthesia
• heart failure • blood loss
In any of these cases, blood pressure should be monitored closely before
considering NSAID treatment.

Bleeding problems
NSAIDs prevent blood clotting by inhibiting a clotting substance called
thromboxane. This can cause excessive bleeding or potential bleeding problems
in patients:

• taking aspirin and blood thinners

• with clotting problems
• undergoing major dental work and abdominal surgery
• liver disease

Other anti-inflammatories
While patients may display different reactions to specific anti-inflammatory
drugs, combining different NSAIDs even at lower doses is not recommended
because the anti-inflammatory side effects add up, increasing the risks of serious
harm in susceptible patients.

Importantly dogs do not seem to tolerate the combination of cortisone and

NSAIDs nearly as well as people do, so be careful if your dog is prescribed
NSAIDs when it is on cortisone for skin or other problems.

Page 18
Overdosage
Increasing dosage without prior medical advice is discouraged because it can
lead to overdosage and irreversible damage to the internal organs. Signs of
NSAID overdose include:

• severe stomach pain • not eating

• vomit with particles that resemble • unusually fast or slow heartbeat
coffee grounds • muscle weakness
• dark stools • slow or shallow breathing
• change in the amount of urine • confusion
• yellowing of the gums • loss of consciousness
When your pet exhibits some of these symptoms, you should take your pet
immediately to the vet who can provide supportive care and give fluids to help
reverse the effects of overdose.

Your vet may prescribe other medications such as synthetic prostagladins,

stomach protectants and antacids to reduce the side effects of NSAIDs.

In most cases the side effects of NSAIDs can be treated. However there is
certainly a trend away from these drugs and towards more natural medications.

Page 19
A Shift in Dog
Arthritis Treatment
Patterns

Page 20
Trend towards natural medication
More people are looking for natural alternatives for the treatment of dog
arthritis. The perception of consumers is that natural is safer and better for their
much loved pet - that they are better to avoid the side effects of the prescription
drugs.

Respecting this sentiment, it is my aim to present people with a range of treatment

options for their dogs arthritis. If people want an arthritis treatment plan that
balances science and nature, it should be available, it should be scientific and it
should work.

Shift away from NSAIDs

With this shift towards more natural medications comes a shift away from the
NSAIDs. Health professionals and pet owners who are aware of the numerous
side effects of NSAIDs are now moving away from their use and testing other
forms of medication, supplements and therapies to replace NSAIDs.

Page 21
Does Your Dog
Absolutely Need
NSAIDs?

Page 22
You’ve probably reached the conclusion that NSAIDs are not always necessary
for the treatment of arthritis or, at the very least, you now realize their role in
your dog’s pain management plan can be minimized.

This e-book has taught you that there is a lot more going on in your dog’s joints
than NSAIDs can control by themselves. And now you know that all drugs and
supplements should take their place in a balanced plan which includes medical
and non-medical treatments.

So where do you go from here?

Your next logical step is to visit the Dog Arthritis Blog, and download the Dog
Arthritis Survival Guide.

But beyond that, I think it is imperative that you reinforce what you’ve read
here today by learning more about the medical portion of your dog’s arthritis
treatment plan.

You can’t make the right decisions unless you know:

• How to help your vet create a plan that combines natural medicines with
prescription drugs.
• The latest recommended 21st century concepts for arthritis treatment.
• Acceptable non-medical components of the No NSAID treatment
including weight control, physical therapy, acupuncture, and surgery, where
necessary.
• The promising effects of stem cell therapy which involves the removal of
fatty tissue from the dog and processing this tissue for injection into the
affected joint. These living cells are expected to improve the health and
function of the joint.

Please understand that early treatment of dog arthritis is still best. But no matter
when you begin treatment, the solution is not a wonder pill or a single drug.
Your dog will respond best to a multi-modal approach using small doses of
several medicines and supplements that have minimal or no side effects.

If you truly want to reduce your dog’s pain and suffering as quickly as possible,
I recommend you read <<Modern Dog Arthritis Treatment – Advanced
Medical Therapy for the 21st Century >>

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And one more thing; please, share this e-book you’re reading right now with
your fellow dog owners. With as many as 25% of the world’s dogs suffering
from arthritis, the chances are good you know someone who needs this book.

Wishing you the best of health for your dog

Christopher Durin, Veterinarian, Author

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