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A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS



                                                                        DECEMBER 2003 VOLUME 1, NUMBER 2




                                              Home Care for the
                                              Veterinary Dental Patient
                                              Daniel T. Carmichael DVM, FAVD, DAVDC
                                              Columbia University School of Dental and Oral Surgery
                                              The Center for Specialized Veterinary Care
                                              Westbury, New York


   As we all know, pet dental health goes         • Systemic health.                                Professional dental treatment,
beyond bad breath. Plaque and tartar              • Preexisting advanced periodontitis.         performed when needed and under general
buildup can lead to more serious health              The goal of dental home care is to         (inhalant) anesthesia, is the cornerstone of
concerns ranging from tooth loss to               control the accumulation of plaque and        preventive dental health. On average, dogs
organ failure.1 Studies have shown dental         calculus. Plaque bacteria can colonize on     and cats benefit from an annual
problems to be the most common problem            teeth in a period of 24 to 36 hours—          prophylaxis starting at the age of 3, but
in dogs and cats.2 Dental problems can be         within a few days following your              each patient needs to have its dental
very painful, although our patients usually       professional dental cleaning, the teeth are   program individualized. For example, some
mask their pain. When our pets receive            already starting to accumulate the            feline patients will present at 8 months of
good dental care, they undoubtedly live           bacteria that will again cause periodontal    age with severe gingivitis and early signs of
longer and better lives.                          inflammation and disease. If nothing is       periodontitis (gingival recession, furcation
   In the vast majority of cases, the cause       done to prevent or retard the accumula-       exposure). These cats, with their juvenile-
of periodontal disease can be traced to           tion of plaque, the periodontal disease       onset gingivitis/ periodontitis,3 are already
the colonization of plaque bacteria on the        process will continue.                        candidates for dental prophylaxis. Dogs
tooth surface. There are several factors                                                        (especially Maltese) with ulcerative
that can influence the tendency to                Home Care: Where to Start
accumulate plaque:                                    Dental home care for the veterinary             IN THIS ISSUE:
                                                  patient starts at the veterinary office.
• Size. Smaller dogs are more at risk.            Patients must be evaluated for the                  Home Care for the Veterinary
• Age. Older pets are more at risk.               presence of dental disease and treated,
                                                                                                      Dental Patient ............................    1
• Masticatory habits. Pets that chew              if necessary, prior to beginning a home             Senior Pets and Joint Health .....             4
  and/or consume hard food are less               care program. The fact is that 85% of               Ask the Vet ................................   7
  at risk.                                        dogs over the age of 3 and at least 50% of
                                                                                                      Animal Health Institute Selects
• Breed. Certain breeds are more prone            cats have significant periodontal disease           Hartz for Membership ...............           8
  to developing periodontal disease.              that requires professional treatment.
stomatitis require frequent prophylaxis;                and continued for 5 days posttreatment.                           A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS

  they have an exaggerated inflammatory                   Antirobe® (Pfizer) is a good choice for
                                                                                                                        DECEMBER 2003 VOLUME 1, NUMBER 2
  response to minimal amounts of dental                   treatment of oral infections, especially
  plaque and require professional cleanings               when bone involvement is suspected.
                                                                                                            Consulting Editors
  every 3 to 4 months.                                       Another somewhat controversial use of
                                                                                                            Albert Ahn, DVM
      Annual (or as-needed) dental cleanings              antibiotics is “pulse therapy,” where an
                                                                                                              Corporate Vice President
  under anesthesia offer opportunities to                 antibiotic is administered intermittently           Chief Scientific Officer
  perform a good oral examination. Make                   on a chronic basis. Pulse therapy should            The Hartz Mountain Corporation
  sure you and your clients are prepared for              not be thought of as part of a routine
                                                                                                            Bruce Truman
  the advanced treatments or extractions                  home care program but as a tool that
                                                                                                              Divisional Vice President
  that may be required.                                   can be used when treating advanced
                                                                                                              Animal Health and Nutrition
      When patients are discharged                        periodontal disease or stomatitis cases. A          The Hartz Mountain Corporation
  following professional dental cleanings,                common dosing schedule is Antirobe (5
  a home care program needs to be part of                 mg/lb) once a day for 5 days every month.         HARTZ® COMPANION ANIMALSM
                                                                                                            is produced for The Hartz Mountain
  the take-home instruction sheet.                           Analgesics can be administered before,         Corporation by Veterinary Learning
      Ideally, dental home care programs                  during, and after dental procedures where         Systems, 780 Township Line Rd.,
  should be started with the puppy or                     pain is an issue. Regional and local              Yardley, PA 19067.
  kitten. If your patient is already at an age            anesthesia can be administered and will           Copyright © 2003 The Hartz Mountain
  where dental pathology has set in, it still             afford the patient postoperative pain relief      Corporation. All rights reserved.
  is “never too late to start.”                           as well as reduce the amount of inhalant          Hartz® and other marks are owned by The Hartz
                                                          necessary to maintain a surgical plane of         Mountain Corporation.
  Home Care: What to Do                                   anesthesia. It is best to use a long-acting       Printed in U.S.A. No part of this publication may
  Antibiotics and Analgesics                              agent such as bupivacaine HCl. Narcotics          be reproduced in any form without the express
     Antibiotics are used for systemic                    and/or NSAIDs should also be routinely            written permission of the publisher.
  prophylaxis from bacteremia and/or as                   prescribed for 2 to 3 days following oral         Inset photo on page 1 © Daniel T. Carmichael,
  primary treatment for oral infections.                  surgery or other potentially painful              DVM. Used with permission.
  Every animal that receives professional                 procedures. Patients that receive proper          For more information on The Hartz Mountain
  dental care does not automatically need                 pain management regain their appetites            Corporation, visit www.hartz.com.
  antibiotics. Antibiotics can be used for                more rapidly and feel better faster.
  systemic protection from oral-induced
  bacteremia. Patients with advanced                      Toothbrushing                                  discourage the use of human toothpaste.
  periodontal disease and concurrent                          Daily toothbrushing is the best thing         To start, advise the client to place a
  disease conditions or immunosuppression                 pet owners can do to promote good oral         small amount of toothpaste on the finger
  are candidates for systemic prophylaxis                 hygiene. Owners should be taught how to        and let the pet sniff and then lick it. Next,
  with a broad-spectrum antibiotic.                       brush their pets’ teeth. The first thing to    they should gently rub the toothpaste on
  Therapy depends on the route of                         stress to a neophyte pet toothbrusher is to    the teeth. If things are not going well, tell
  administration, the goal being to achieve               go slow and make it fun. Advise your           them to wait a few hours before trying
  adequate blood concentrations at the time               client to start with canned food or baby       again. When the pet has accepted the
  of the procedure. Clavamox® (Pfizer) is a               food on the finger. Let the pet smell it       toothpaste by finger, it is time for the
  good choice as a broad-spectrum                         and then try rubbing it on the outsides of     brush. A conventional toothbrush
  antibiotic that treats oral infections and              the teeth. They should concentrate on the      (children’s soft bristle) works well, or
  provide systemic prophylaxis.                           buccal (toward the lip) surfaces of the        perhaps a finger brush. The toothbrush
     When considering the treatment of                    teeth. The lingual surfaces (toward the        should be held at a 45-degree angle to the
  oral infections, antibiotic therapy alone is            tongue) and palatal surfaces are kept          tooth surface, with the bristles pointing
  rarely successful. The antibiotics must be              clean for the most part by the tongue.         toward the gingival margin. This allows
  combined with appropriate dental therapy                Once the pet has accepted this, it is time     the cleaning of the gingival sulcus during
  (extraction, root canal, surgery, etc.).                to introduce the toothpaste. Pet               the toothbrushing process. The tooth-
  Antibiotics can be used prior to oral                   toothpastes are available in a variety of      brush should be worked in a circular
  surgery to improve tissue quality and                   flavors such as chicken, beef, and             motion, concentrating around the canine
  make oral surgical procedures more                      malt. They are made to be swallowed            tooth and upper fourth premolar tooth.
  successful. Ideally, antibiotics should be              and do not foam up in the mouth.               Advise them to try for 30 seconds on each
  instituted 5 days prior to dental treatment             Always recommend pet toothpaste and            side of the mouth.

2 HARTZ COMPANION ANIMAL
        ®                  SM
                                • DECEMBER 2003 • VOL. 1, NO. 2
Diet                                            exert its effects over a 24- to 48-hour                      masking halitosis may not be addressing
   There are several commercial diets that      period. Chlorhexidine kills the bacterial                    the primary source of oral pathology.
have been scientifically tested and shown       pathogens that contribute to periodontal
to significantly reduce plaque and tartar       disease, halitosis, and plaque accumulation.                 References
as compared to “regular” dry food diets.        Chlorhexidine is supplied as a liquid or gel                 1. Wiggs RB, Lobprise HB: Veterinary Principles and
                                                                                                                Practice. Philadelphia, Lippincott Raven, 1997, pp
This is not marketing hype—studies              that can be rubbed on the gums or gently                        186–187.
document significant reduction in the           brushed onto the teeth. In chronic cases                     2. Harvey CE, Emily PP: Small Animal Dentistry. St.
plaque index for the foods tested.                                                                              Louis, Mosby, 1993, p 89.
                                                of gingivitis, instruct owners to use                        3. Williams CA, Aller MS: Gingivitis/stomatitis in
Specifically, these foods are Iams Daily        chlorhexidine twice a week and regular                          cats, in Harvey CE (ed): The Veterinary Clinics of
Dental Care™, Hill’s Prescription Diet®                                                                         North America Small Animal Practice. Philadelphia,
                                                toothbrushing on the other days.                                WB Saunders, 1992, p 1371.
t/d™, Science Diet® Oral Care, and (only           Other oral rinses, containing zinc                        4. Lage A, Lausen N, Tracy R, Allred E: Effect of
for cats) Friskies® Dental Diet. With the       ascorbate or chlorine dioxide, work well                        chewing rawhide and cereal biscuits on removal of
                                                                                                                dental calculus in dogs. JAVMA 197(2):213–219,
incidence of periodontal disease so high        for combating halitosis with their                              1990.
in dogs and cats, there are few reasons         neutralizing effect on malodorous sulfur                     5. Stookey G, Warrick J, Miler L: HMP significantly
                                                                                                                reduced the rate of calculus formation in dogs. Proc
why anyone would not want to provide            compounds. It is important to realize that                      Vet Dent 94 World Vet Dent Congr:80, 1994.
a diet that promotes good oral health.

Chew Toys
    Rawhide treats for dogs are readily
available to pet owners and are effective in
                                                                        ®
                                                                                                     L™                        A D VA N C E D C A R E ™
the control and removal of plaque and                                                                       Hartz® Advanced Care™
tartar from dogs’ teeth.4 Rawhide is highly       Hartz® Dental™                                            Enteric-Coated Aspirin
digestible and has not been observed              Brush 'n Clean™                                           For Dogs
                                                  ●    Fluoride free.                                       ● For the temporary relief of
to cause the digestive problems that              ●                                                          everyday aches and pains and
                                                    Beef flavored.
conventional wisdom ascribes to them in           ● Helps to remove tartar,
                                                                                                             inflammation associated
numerous scientific studies. It has also been      plaque and debris from
                                                                                                             with arthritis.
                                                                                                            ● Specifically formulated to
shown that coating rawhide treats with             your pets teeth and gums.
                                                                                                             reduce stomach upset,
calcium-sequestering substances such as                                                                      a common side effect
sodium hexametaphosphate can further                                        Hartz® Dental™                   of aspirin.
                                                                            Breath-Strips™
enhance plaque and tartar reduction.5
                                                                            For Dogs
Various types and designs of compressed                                     ● Sugar free, alcohol free.
rawhide are also beneficial for promoting                                   ● Easy to use dispenser.
good oral health.                                                           ● Dissolves quickly to
    There are chew toy-type products that                                     leave breath smelling fresh
are not recommended due to their                                              and clean.
tendency to cause tooth fracture. 100%
                                                  Hartz® Pet Shoppe™ Dental™
nylon bones are too hard and often are            Flavor Infused™
associated with slab fracture of the              Chew-Dent™
carnassial teeth. It is recommended that           ● Reduces the
pets not chew on tennis balls manufac-               accumulation of plaque                                     Hartz® Advanced Care™
tured for human sport, because they are              and tartar up to 54%.
                                                                                                                Joint Maintenance
                                                   ● Preferred over the
notorious for causing attrition (mechanical          leading competitor
                                                                                                                ●   Vitamin enriched.
wearing of the tooth surface).                       3 to 1.                                                    ●    Specially formulated with Glucosamine
                                                                                                                    to help support healthy joint function.
Other Products                                                                                                  ●   Highly palatable.
   Oral rinses, sprays, and other such                                                                          ●   Available for both dogs and cats.
products also have a role in home dental
care. When pets refuse brushing, these
products may be the only kind of home
care possible.
   Chlorhexidine gluconate is an excellent                                                                                                                   AD-168

oral disinfectant. The chlorhexidine will
                                                  If you would like to receive a copy of the Hartz Veterinary Catalog, please call (800) 999-3000 x 5118.
actually bind to gingival tissue and can
Senior Pets and Joint Health
                                                         Erin Paster, DVM
                                                         Amy Kapatkin, DVM, DACVS
                                                         School of Veterinary Medicine
                                                         University of Pennsylvania
                                                         Philadelphia, Pennsylvania


      Osteoarthritis (OA) is a common,                    depression, lameness, poor grooming          Evidence-Based Treatment
  debilitating disease of older animals that              habits, and inappropriate elimination           It is important to emphasize that the
  results in discomfort, impaired                         outside the litter box.9                     radiographic severity of OA does not
  ambulation, and diminished quality of life                                                           always correlate to the degree of symp-
  in some patients. OA is defined as an                   Evidence-Based Diagnosis                     toms and thus the need for treatment.15
  insidious progressive, noninflammatory                      Diagnosis of OA is primarily based on    Treatment of OA is palliative with the
  degenerative joint disease characterized                clinical features, physical examination,     goal of restoring comfortable function
  by synovial membrane changes, peri-                     and radiographic evidence.2 Synovial         and is classified as medical or surgical.16
  articular osteophyte production, and                    fluid analysis and synovial biopsy may
  degeneration of articular cartilage.1–2                 rule out other causes of joint disease.2,9   Pharmacologic Agents
  Although the etiopathogenesis is not                    Specific radiographic methodologies are         Medical treatment consists of a
  entirely understood, OA is a lifelong                   recommended to screen for predisposing       combination of pharmacologic agents,
  disease. Clinical signs may surface at                  conditions such as hip dysplasia. The        weight management, and controlled
  different times depending on genetic and                PennHIP methodology has been                 exercise.16–18 Pharmacologic agents include
  environmental factors. Despite the                      scientifically proven to predict suscepti-   NSAIDs and glucocorticoids.16–19 Most
  assumption that OA is an idiopathic,                    bility to hip dysplasia at 16 weeks of age   but not all NSAIDs have analgesic and
  geriatric change, other hypotheses exist;               by measurement of passive hip laxity (the    antiinflammatory properties, inhibiting
  manifestations of OA may be caused by a                 greatest risk factor for the development     the cyclooxygenase (COX) pathway.17,18,20
  humoral substance or systemic disease,3–6               of OA)10 as compared to other                The development of newer veterinary
  which may explain the presence of                       methods.3,11,12 This is supported by a       NSAIDs (Rimadyl® [Pfizer], EtoGesic®
  multiple joint OA in mature dogs.3,6,7                  lifelong study of 48 Labrador retrievers     [Fort Dodge], meloxicam, and Deramaxx™
      OA is highly prevalent in dogs in the               that revealed a 55% false-negative result    [Novartis]) that are more selective for the
  hip joint, representing 93% of the cases in             when using OFA-type scoring to               COX-2 isoform has resulted in fewer
  one study, although the elbow, shoulder,                diagnose hip dysplasia and thus predict      adverse effects.17,21 Zubrin™ (Schering-
  stifle, and lumbar vertebral joints are also            the development of OA.3 The PennHIP          Plough) is another NSAID purported
  affected.6,7 Hip dysplasia, elbow dysplasia,            method was accurate in predicting that       to inhibit both the COX and
  osteochondritis dissecans, and cruciate                 these 48 dogs were susceptible to            lipoxygenase pathways. The most
  ligament rupture are common predispos-                  developing degenerative joint disease.       common adverse effects in dogs are
  ing conditions. Clinical signs in dogs                  Radiographic evaluation of elbows by an      gastrointestinal signs,17,20 although renal
  include stiffness, reluctance or inability to           orthopedic surgeon or radiologist is         and hepatic abnormalities can develop
  jump or use stairs, and lameness,                       recommended to examine for elbow             infrequently.20,22 In vitro studies have
  especially after inactivity or prolonged or             dysplasia and requires specific views for    demonstrated that NSAIDs are capable
  high-impact activity.2 Despite the well-                observation of evidence of osteochon-        of decreasing cartilage metabolism.20
  characterized clinical signs and                        dritis dissecans, fragmented coronoid        Steroids are potent antiinflammatory
  manifestations of OA in dogs, cats                      process, or ununited anconeal process.       agents that prevent prostaglandin and
  frequently harbor OA and remain                         However, unless there are radiographic       leukotriene synthesis.20 Due to the high
  asymptomatic, contributing to infrequent                signs of OA, only about 9% of elbow          frequency of adverse systemic effects and
  diagnosis.2,8 In one study of 100 cats, 90%             dysplasia conditions will be evident on      the potential for promoting cartilage
  had radiographic evidence of OA even                    radiographs.13 Both CT and MRI scans         damage with long-term use,20 some
  though all cases were subclinical and                   are significantly better at identifying      surgeons have reserved oral steroids for
  diagnosed as incidental findings.8 Clinical             these conditions, even in joints lacking     short-term use in dogs exhibiting acute,
  signs in cats include weight loss, anorexia,            radiographic evidence.13,14                  severe exacerbations of discomfort.23

4 HARTZ COMPANION ANIMAL
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                                 • DECEMBER 2003 • VOL. 1, NO. 2
Nutraceuticals                                  weekly.31 Reduced-calorie treats can be            function,35,36 it is difficult to determine if
   Nutraceuticals, such as glucosamine          substituted for table scraps, and calorie          purported therapeutic procedures would
and chondroitin, have grown in                  intake can be reduced with prescription            have resulted in a better outcome. Surgical
popularity despite the lack of scientific       diets or limiting the regular food                 corrections of predisposing causes of OA
evidence to support their use. Glucosa-         offered.17 Unsuccessful attempts at weight         such as cranial cruciate rupture, however,
mine and chondroitin are purported to be        reduction may be confounded by                     are recommended.
chondroprotective by providing cartilage        endocrinopathies such as hyperadreno-
precursors, increasing cartilage                corticism or hypothyroidism, thus                  Salvage Procedures
metabolism, and depressing collagenolytic       necessitating further diagnostic                      Surgical treatments in older animals
enzymes.24,25 Although Cochrane reviews         evaluation.17 A controlled exercise                with OA are primarily salvage procedures
of randomized, placebo-controlled,              regimen of regular, low-impact activities          and should be recommended when
double-blind studies have shown                 can be a benefit by maintaining muscle             medical therapy is unsuccessful or if the
glucosamine and chondroitin to relieve          tone, joint structural integrity, and range        dog’s lifestyle is severely limited.23 The
discomfort and improve function in              of motion while contributing to weight             femoral head and neck osteotomy (FHO)
human OA patients,26,27 none exist in           control.17,18,23 Trial and error is necessary      and total hip replacement (THR) are
dogs. Anecdotal evidence in companion           to arrive at an exercise schedule that             standard orthopedic treatment options
animals appears promising, but further          allows comfortable function without                for end-stage hip OA.16 Pain relief is
studies are needed to prove efficacy. It        exacerbation of lameness.17,18 A study             achieved by the creation of a false joint
also remains undetermined in human              using force-plate analysis in dogs without         and the replacement of diseased tissues
studies whether different preparations          a cranial cruciate ligament in one limb            with synthetic implants. Arthrodesis is
affect efficacy or if glucosamine is safe for   showed improved weight-bearing in                  also an option for eliminating discomfort
long-term use.27 Clients should be              those with exercise instituted daily as            of some joints, such as the carpus and
advised that individual patients will           compared to dogs with limited activity.32          tarsus, although gait is compromised.23
respond differently to an agent, and trial      The regularly exercised dogs also had less         Elbow replacement surgery is currently
and error may be necessary to find the          gross and radiographic evidence of OA.32           under investigation for clinical
product best suited for symptom control.                                                           application in veterinary medicine.23 Knee
                                                Alternative Therapies                              replacement has not been clinically
Weight Reduction and                               Scientific evidence regarding alterna-          developed for dogs.
Controlled Exercise                             tive therapies, including acupuncture,
   Weight control and exercise                  massage, hot and cold therapy, electro-            Treatment for Felines
modification are imperative to the              therapy, and ultrasonography for OA, is               Limited information is available for
success of medical management                          limited. A double-blind, controlled         management of feline OA. Buffered
and must be continued                                     study involving force-plate              aspirin administration every 72 hours,
throughout life.18 Obesity                                  analysis of dogs with cox-             butorphanol, meloxicam, and nutritional
has been shown to be a                                       ofemoral OA treated with              supplements have been used for chronic
risk factor in OA                                            gold bead implantation                OA in cats.9 Alternatively, cats appear to
development in dogs,                                         acupuncture failed to show            maintain comfortable function and better
most likely due to the                                      significant clinical improve-          long-term outcomes with surgical
increased biomechanical                                    ment over the placebo group.33          treatments such as FHO, probably due
forces sustained by the                                  Additional studies are needed.            to their small size.37
joints.3,7,28 This is evidenced by a
5-year longitudinal study of Labrador           Therapeutic/Preventive Procedures                  Osteoarthritis Prevention
retrievers, revealing a significant increase        There are currently no surgical                    Management of OA is best achieved
in prevalence and severity, and earlier         treatment modalities in animals scienti-           through prevention.34 It is the
onset of coxofemoral OA in free-fed dogs        fically proven to reverse or prevent OA            veterinarian’s responsibility to educate
as compared to paired littermates fed 25%       development. Many procedures involving             clients about OA prevention as early as
less.3,28 Weight reduction alone can result     the coxofemoral joint are the focus of             the puppy stage. Purchasing puppies from
in clinical improvement of lameness and         considerable debate, and evidence-based            reputable breeders that can verify the
gait as evidenced by studies using obese        studies are needed to support these                parents’ history is important. As the pup
dogs clinical for coxofemoral OA.29,30          claims.34 With long-term studies reporting         matures, appropriate evidence-based
Effective weight reduction should result        that >75% of dogs treated with medical             screening tests should be instituted for
in the loss of 1% to 2% body weight             management will retain pet-quality                 detection of elbow and hip dysplasia.

                                                                                        HARTZ® COMPANION ANIMALSM • DECEMBER 2003 • VOL. 1, NO. 2   5
Weight management in dogs is the                            Pitman Medical Publishing, 1980.                       in dogs. Am J Vet Res 61(7):802–810, 2000.
                                                              5. Westacott CI, Webb GR, Warnock MG, et              22. MacPhail CM, Lappin MR, Meyer DJ, et al:
  only proven method, surgical or non-                           al: Alteration of cartilage metabolism by cells        Hepatocellular toxicosis associated with
  surgical, to slow or even prevent OA.                          from osteoarthritic bone. Arthritis Rheum              administration of carprofen in 21 dogs.
  This evidence comes from the previously                        40(7):1282–1291, 1997.                                 JAVMA 212(12):1895–1901, 1998.
                                                              6. Olsewski JM, Lust G, Rendano VT, Summers           23. Medical therapy of osteoarthritis in dogs. Vet
  mentioned studies comparing free-fed                           BA: Degenerative joint disease: Multiple joint         Exchange:5–7, 9–11, 16–19, 1995.
  (mean body condition score of 6) and                           involvement in young and mature dogs. Am J         24. Anderson M: Glucosamine and chondroitin
                                                                 Vet Res 44(7):1300–1308, 1983.
  limit-fed (mean body condition score of                                                                               sulfate in the prevention and management of
                                                              7. Kealy RD, Lawler DF, Ballam JM, et al:                 osteoarthritis. Purina Nutr Forum:36–41, 2001.
  4) Labrador retrievers.3,7,28,38 These                         Evaluation of the effect of limited food           25. Anderson MA: Management of osteoarthritis
  studies revealed significant reduction                         consumption on radiographic evidence of                with nutraceuticals. Purina Nutr Forum:79–86,
                                                                 osteoarthritis in dogs. JAVMA 217(11):
  in prevalence and severity of OA in                            1678–1680, 2000.
                                                                                                                        2001.
  multiple joints at 8 years of age,7 and                                                                           26. McAlindon TE, LaValley MP, Gulin JP,
                                                              8. Hardie EM, Roe SC, Martin FR:                          Felson DT: Glucosamine and chondroitin for
  hip coxofemoral joint alone at 5 years of                      Radiographic evidence of degenerative joint            treatment of osteoarthritis: A systematic
                                                                 disease in geriatric cats: 100 cases (1994–
  age,28 in limit-fed dogs as compared to                        1997). JAVMA 220(2):628–632, 2002.
                                                                                                                        quality assessment and meta-analysis. JAMA
                                                                                                                        283(11):1469–1475, 2000.
  those that were free-fed. Additionally,                     9. Hardie EM: Management of osteoarthritis in         27. Towheed TE, Anastassiades TP, Shea B, et
  the thinner (limit-fed) dogs also                              cats. Vet Clin North Am Small Anim Pract               al: Glucosamine therapy for treating
                                                                 27(4):945–953, 1997.
  required NSAIDs for symptom control                                                                                   osteoarthritis [review]. The Cochrane Library;
                                                             10. Smith GK, Popovitch CA, Gregor TP, Shofer              The Cochrane Database of Systematic Reviews:1,
  significantly less frequently and later                        FS: Evaluation of risk factors for degenerative        2003.
  than the obese (free-fed) ones.38 It is                        joint disease associated with hip dysplasia in
                                                                                                                    28. Kealy RD, Lawler DF, Ballam JM, et al:
                                                                 dogs. JAVMA 206(5):642–647, 1995.
  recommended to maintain dogs at a                                                                                     Five-year longitudinal study on limited food
                                                             11. Fordyce HH, Gregor TP, Smith GK:                       consumption and development of osteoarthritis
  body condition score at or below 5 (on a                       Correlation of OFA hip scoring to passive hip          in coxofemoral joints of dogs. JAVMA
                                                                 laxity derived from the hip extended and
  scale of 1 to 9).38                                            distraction radiographs. Vet Orthop Soc Annu
                                                                                                                        210(2):222–225, 1997.
                                                                                                                    29. Impellizeri JA, Tetrick MA, Muir P: Effect of
                                                                 Meet:2000.
                                                                                                                        weight reduction on clinical signs of lameness
  Summary                                                    12. Smith GK, Gregor TP, Rhodes H, Biery DN:               in dogs with hip osteoarthritis. JAVMA
                                                                 Coxofemoral joint laxity from distraction
     OA is a disease that is well described                      radiography and its contemporaneous and
                                                                                                                        216(7):1089–1091, 2000.
                                                                                                                    30. Burkholder WJ, Taylor L, Hulse DA: Weight
  in dogs and underdiagnosed in cats.                            prospective correlation with laxity, subjective
                                                                                                                        loss to optimal body condition increases
                                                                 score, and evidence of degenerative joint
  Evidence-based treatment options                               disease from conventional hip-extended                 ground reactive force in dogs with
  include medical management consisting                          radiography in dogs. Am J Vet Res 54(7):1021–          osteoarthritis. Purina Nutr Forum:74, 2000.
                                                                 1042, 1993.                                        31. LaFlamme DP, Kuhlman G, Lawler DF, et
  of pharmacologic agents, controlled                                                                                   al: Obesity management in dogs. Vet Clin Nutr
                                                             13. Snaps FR, Balligand MH, Saunders JH, et al:
  exercise and weight reduction, and                             Comparison of radiography, magnetic                    1:59–65, 1994.
  surgical management, which mainly                              resonance imaging, and surgical findings in        32. Baird DK, Kincaid SA, Rumph PF:
                                                                 dogs with elbow dysplasia. Am J Vet Res                Unpublished data.
  consists of salvage procedures. Using                          58(12):1367–1370, 1997.                            33. Bolliger C, DeCamp CE, Stajich M, et al:
  evidence-based diagnostic tests to screen                  14. Reichle JK, Snaps F: The elbow. Clin Tech              Gait analysis of dogs with hip dysplasia treated
  for disease risk and keeping dogs thin are                     Small Anim Pract 14(3):177–186, 1999.                  with gold bead implantation acupuncture. Vet
                                                             15. Whittick WG: Canine Orthopedics. Philadelphia,         Comp Orthop Traumatol 15:116–122, 2002.
  the best preventive measures.                                  Lea & Febiger, 1974, pp 348–368.                   34. Smith C: Treatments for hip dysplasia spark
                                                             16. Clark DM: Current concepts in the treatment            controversy. JAVMA 201(2):205–209, 1992.
  References                                                     of degenerative joint disease. Compend Contin      35. Barr ARS, Denny HR, Gibbs C: Clinical hip
   1. Lepine AJ: A morphologic and physiologic                   Educ Pract Vet 13(9):1439–1446, 1991.                  dysplasia in growing dogs: The long-term
      review of articular cartilage. Vet Orthop Soc          17. Martinez SA: Medical management of                     results of conservative management. J Small
      Annu Meet:6–13, 2000.                                      osteoarthritis in companion animals. Vet               Anim Pract 28:243–252, 1987.
   2. Taylor SM: Disorders of the joints,                        Orthop Soc Annu Meet:24–29, 2000.                  36. Smith GK, Fordyce HH, Gregor TP:
      noninflammatory joint diseases, in Nelson              18. Tomlinson J, McLaughlin Jr R: Medically                Nonsurgical management of severe hip
      RW, Couto CG (eds): Small Animal Internal                  managing canine hip dysplasia. Vet Med                 dysplasia: Long-term results. Vet Orthop Soc
      Medicine, 2nd ed. St. Louis, Mosby, 1998, pp               6:48–53, 1996.                                         Annu Meet:1999.
      1076–1078.                                             19. Fox SM, Burns J, Burt J: Treating the dysplastic   37. Tacke S, Schimke E, Kramer M, et al:
   3. Smith GK, Biery DN, Kealy RD, et al: Effects               hip: The first steps to follow. Vet Med :701–          Excision arthroplasty of the hip joint in dogs
      of restricted feeding on onset, incidence and              708, 1987.                                             and cats. Long-term results of the veterinary
      severity of hip dysplasia and osteoarthritis in        20. Johnston SA, Fox SM: Mechanisms of action              surgery clinic at the Justus Liebig University of
      dogs: Diagnostic, therapeutic and genetic                  of anti-inflammatory medications used for the          Giessen. Tierarztl Prax 25:373–378, 1997.
      ramifications. Purina Pet Institute Symp:                  treatment of osteoarthritis. JAVMA 210(10):        38. Smith GK, Biery DN, Kealy RD, et al:
      Advancing Life Through Diet Restriction:21–26,             1486–1492, 1997.                                       Clinical significance of osteoarthritis and hip
      2002.                                                  21. Kay-Mugford P, Benn SJ, LaMarre J, Conlon              dysplasia findings in the restricted feeding
   4. Sokoloff L: The Pathology of Osteoarthritis and            P: In vitro effects of nonsteroidal anti-              trial. Purina Pet Institute Symp: Advancing Life
      the Role of Aging. Tunbridge Wells, UK,                    inflammatory drugs on cyclooxygenase activity          Through Diet Restriction:27–28, 2002.




6 HARTZ COMPANION ANIMAL
        ®                      SM
                                    • DECEMBER 2003 • VOL. 1, NO. 2
Albert Ahn, DVM, is a veterinarian, Chief Scientific Officer
                  and Corporate Vice President at The Hartz Mountain Corporation.




                                             ASK TH E VET
Q
Which Hartz® products can be helpful for
medical management of osteoarthritis?
                                                               coagulation and pulmonary artery disease
                                                               secondary to heartworm infestation in dogs. Also,
                                                               low doses of aspirin have been shown to be helpful

A
Osteoarthritis is defined as chronic
inflammation of the joint that is usually
accompanied by pain and discomfort.
                                                               as an adjunctive treatment of glomerular disease.
                                                             • Glucosamine is an amino-monosaccharide nutrient
                                                               and is classified as a chondroprotective agent.
                                                               Chondroprotective agents are thought to aid in
Osteoarthritis may develop from skeletal
diseases such as hip dysplasia or can be                       the healing of cartilage, may stimulate cartilage
secondary to immune joint diseases or                          matrix synthesis, and may reduce enzymatic
trauma. This condition usually involves                        degradation of cartilage. Glucosamine is a
pathologic changes of both the articular                       precursor to the disaccharide unit of
cartilage and periarticular soft tissues. Pain                 glycoaminoglycans, which comprise the
associated with osteoarthritis is often due to                 proteoglycan ground substance of articular
irritation of exposed nerves that is a result of               cartilage. Glucosamine acts by providing the
cartilage and tissue damage.                                   regulatory stimulus and raw materials for
     The following products manufactured                       synthesis of glycosaminoglycans in cartilage.
by Hartz may help in reducing your pet’s


                                                       Q
discomfort associated with osteoarthritis:
• Aspirin is commonly used to treat osteoarthritis           What are the dental benefits of rawhide?
  in dogs. Aspirin is an NSAID with analgesic,
  antiinflammatory, and antiplatelet properties. It
  inhibits cyclooxygenase, which in turn reduces
  the production of prostaglandins and
  thromboxanes. It is relatively inexpensive and
                                                       A     Rawhide dog treats have been used for many
                                                             years to satisfy dog’s natural chewing needs.
                                                             Rawhide is high in protein and low in fat and
                                                             can provide the chewing satisfaction that dogs
  readily available. The use of buffered or enteric-         crave. Studies show that when rawhide is used
  coated aspirin is recommended as it decreases the          daily, it can effectively remove plaque. The
  likelihood of gastrointestinal irritation. The             abrasive action of rawhide chewing helps
  recommended dose of aspirin for treatment of               reduce plaque, calculus, and gingivitis.
  osteoarthritis in dogs is 10 to 25 mg/kg. In               Rawhide also provides the necessary chewing
  addition, aspirin is used therapeutically in the           exercise to strengthen gums and is a great way
  treatment of disseminated intravascular                    to relieve boredom, frustration, or anxiety.

  We want to hear from you!
  • Have questions or comments? Call our Consumer Relations Department at 800-275-1414 and ask to speak to a Hartz staff
    veterinarian or email us at feedback@hartz.com.
  • To obtain a Hartz Veterinary Catalog of products, please call 800-999-3000 x5118 or email us at feedback@hartz.com.

                                                                           HARTZ® COMPANION ANIMALSM • DECEMBER 2003 • VOL. 1, NO. 2   7
Animal Health Institute Selects
Hartz for Membership

          The Hartz Mountain Corporation has a long history of             interacts with the U.S. Food and Drug Administration, the
       protecting and caring for America’s pets. They have been            U.S. Department of Agriculture, and the Environmental
       innovators in animal health, particularly in the area of flea and   Protection Agency, the federal agencies responsible for
       tick protection, and manufacture scientifically proven products.    regulating animal health products.
       Hartz was recently selected as the newest member of the                Hartz, along with all AHI member companies, shares a
       Animal Health Institute (AHI).                                      deep commitment to providing high-quality products aimed at
          The Animal Health Institute is the U.S. trade association        helping pets lead longer, healthier lives. For more information
       that represents manufacturers of animal health care products—       on the Animal Health Institute, and for a complete list of
       pharmaceuticals, vaccines, and veterinary medicines. AHI            member companies, visit www.ahi.org.


                                        Come Visit Hartz at These Upcoming Conferences!
            North American Veterinary Conference                                    Western Veterinary Conference
            Orlando, Florida                                                        Las Vegas, Nevada
            January 17–21, 2004                                                     February 16–19, 2004
            Booth 511                                                               Booth 249




Veterinary Learning Systems                                                                                           PRESORTED STANDARD
780 Township Line Road                                                                                                    U.S. POSTAGE
Yardley, PA 19067
                                                                                                                          PAID
                                                                                                                         BENSALEM, PA
                                                                                                                         PERMIT #118




                                                                                                                                    400045

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Hartz Companion Animal - Home Care for the Veterinary Dental Patient

  • 1. A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS DECEMBER 2003 VOLUME 1, NUMBER 2 Home Care for the Veterinary Dental Patient Daniel T. Carmichael DVM, FAVD, DAVDC Columbia University School of Dental and Oral Surgery The Center for Specialized Veterinary Care Westbury, New York As we all know, pet dental health goes • Systemic health. Professional dental treatment, beyond bad breath. Plaque and tartar • Preexisting advanced periodontitis. performed when needed and under general buildup can lead to more serious health The goal of dental home care is to (inhalant) anesthesia, is the cornerstone of concerns ranging from tooth loss to control the accumulation of plaque and preventive dental health. On average, dogs organ failure.1 Studies have shown dental calculus. Plaque bacteria can colonize on and cats benefit from an annual problems to be the most common problem teeth in a period of 24 to 36 hours— prophylaxis starting at the age of 3, but in dogs and cats.2 Dental problems can be within a few days following your each patient needs to have its dental very painful, although our patients usually professional dental cleaning, the teeth are program individualized. For example, some mask their pain. When our pets receive already starting to accumulate the feline patients will present at 8 months of good dental care, they undoubtedly live bacteria that will again cause periodontal age with severe gingivitis and early signs of longer and better lives. inflammation and disease. If nothing is periodontitis (gingival recession, furcation In the vast majority of cases, the cause done to prevent or retard the accumula- exposure). These cats, with their juvenile- of periodontal disease can be traced to tion of plaque, the periodontal disease onset gingivitis/ periodontitis,3 are already the colonization of plaque bacteria on the process will continue. candidates for dental prophylaxis. Dogs tooth surface. There are several factors (especially Maltese) with ulcerative that can influence the tendency to Home Care: Where to Start accumulate plaque: Dental home care for the veterinary IN THIS ISSUE: patient starts at the veterinary office. • Size. Smaller dogs are more at risk. Patients must be evaluated for the Home Care for the Veterinary • Age. Older pets are more at risk. presence of dental disease and treated, Dental Patient ............................ 1 • Masticatory habits. Pets that chew if necessary, prior to beginning a home Senior Pets and Joint Health ..... 4 and/or consume hard food are less care program. The fact is that 85% of Ask the Vet ................................ 7 at risk. dogs over the age of 3 and at least 50% of Animal Health Institute Selects • Breed. Certain breeds are more prone cats have significant periodontal disease Hartz for Membership ............... 8 to developing periodontal disease. that requires professional treatment.
  • 2. stomatitis require frequent prophylaxis; and continued for 5 days posttreatment. A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS they have an exaggerated inflammatory Antirobe® (Pfizer) is a good choice for DECEMBER 2003 VOLUME 1, NUMBER 2 response to minimal amounts of dental treatment of oral infections, especially plaque and require professional cleanings when bone involvement is suspected. Consulting Editors every 3 to 4 months. Another somewhat controversial use of Albert Ahn, DVM Annual (or as-needed) dental cleanings antibiotics is “pulse therapy,” where an Corporate Vice President under anesthesia offer opportunities to antibiotic is administered intermittently Chief Scientific Officer perform a good oral examination. Make on a chronic basis. Pulse therapy should The Hartz Mountain Corporation sure you and your clients are prepared for not be thought of as part of a routine Bruce Truman the advanced treatments or extractions home care program but as a tool that Divisional Vice President that may be required. can be used when treating advanced Animal Health and Nutrition When patients are discharged periodontal disease or stomatitis cases. A The Hartz Mountain Corporation following professional dental cleanings, common dosing schedule is Antirobe (5 a home care program needs to be part of mg/lb) once a day for 5 days every month. HARTZ® COMPANION ANIMALSM is produced for The Hartz Mountain the take-home instruction sheet. Analgesics can be administered before, Corporation by Veterinary Learning Ideally, dental home care programs during, and after dental procedures where Systems, 780 Township Line Rd., should be started with the puppy or pain is an issue. Regional and local Yardley, PA 19067. kitten. If your patient is already at an age anesthesia can be administered and will Copyright © 2003 The Hartz Mountain where dental pathology has set in, it still afford the patient postoperative pain relief Corporation. All rights reserved. is “never too late to start.” as well as reduce the amount of inhalant Hartz® and other marks are owned by The Hartz necessary to maintain a surgical plane of Mountain Corporation. Home Care: What to Do anesthesia. It is best to use a long-acting Printed in U.S.A. No part of this publication may Antibiotics and Analgesics agent such as bupivacaine HCl. Narcotics be reproduced in any form without the express Antibiotics are used for systemic and/or NSAIDs should also be routinely written permission of the publisher. prophylaxis from bacteremia and/or as prescribed for 2 to 3 days following oral Inset photo on page 1 © Daniel T. Carmichael, primary treatment for oral infections. surgery or other potentially painful DVM. Used with permission. Every animal that receives professional procedures. Patients that receive proper For more information on The Hartz Mountain dental care does not automatically need pain management regain their appetites Corporation, visit www.hartz.com. antibiotics. Antibiotics can be used for more rapidly and feel better faster. systemic protection from oral-induced bacteremia. Patients with advanced Toothbrushing discourage the use of human toothpaste. periodontal disease and concurrent Daily toothbrushing is the best thing To start, advise the client to place a disease conditions or immunosuppression pet owners can do to promote good oral small amount of toothpaste on the finger are candidates for systemic prophylaxis hygiene. Owners should be taught how to and let the pet sniff and then lick it. Next, with a broad-spectrum antibiotic. brush their pets’ teeth. The first thing to they should gently rub the toothpaste on Therapy depends on the route of stress to a neophyte pet toothbrusher is to the teeth. If things are not going well, tell administration, the goal being to achieve go slow and make it fun. Advise your them to wait a few hours before trying adequate blood concentrations at the time client to start with canned food or baby again. When the pet has accepted the of the procedure. Clavamox® (Pfizer) is a food on the finger. Let the pet smell it toothpaste by finger, it is time for the good choice as a broad-spectrum and then try rubbing it on the outsides of brush. A conventional toothbrush antibiotic that treats oral infections and the teeth. They should concentrate on the (children’s soft bristle) works well, or provide systemic prophylaxis. buccal (toward the lip) surfaces of the perhaps a finger brush. The toothbrush When considering the treatment of teeth. The lingual surfaces (toward the should be held at a 45-degree angle to the oral infections, antibiotic therapy alone is tongue) and palatal surfaces are kept tooth surface, with the bristles pointing rarely successful. The antibiotics must be clean for the most part by the tongue. toward the gingival margin. This allows combined with appropriate dental therapy Once the pet has accepted this, it is time the cleaning of the gingival sulcus during (extraction, root canal, surgery, etc.). to introduce the toothpaste. Pet the toothbrushing process. The tooth- Antibiotics can be used prior to oral toothpastes are available in a variety of brush should be worked in a circular surgery to improve tissue quality and flavors such as chicken, beef, and motion, concentrating around the canine make oral surgical procedures more malt. They are made to be swallowed tooth and upper fourth premolar tooth. successful. Ideally, antibiotics should be and do not foam up in the mouth. Advise them to try for 30 seconds on each instituted 5 days prior to dental treatment Always recommend pet toothpaste and side of the mouth. 2 HARTZ COMPANION ANIMAL ® SM • DECEMBER 2003 • VOL. 1, NO. 2
  • 3. Diet exert its effects over a 24- to 48-hour masking halitosis may not be addressing There are several commercial diets that period. Chlorhexidine kills the bacterial the primary source of oral pathology. have been scientifically tested and shown pathogens that contribute to periodontal to significantly reduce plaque and tartar disease, halitosis, and plaque accumulation. References as compared to “regular” dry food diets. Chlorhexidine is supplied as a liquid or gel 1. Wiggs RB, Lobprise HB: Veterinary Principles and Practice. Philadelphia, Lippincott Raven, 1997, pp This is not marketing hype—studies that can be rubbed on the gums or gently 186–187. document significant reduction in the brushed onto the teeth. In chronic cases 2. Harvey CE, Emily PP: Small Animal Dentistry. St. plaque index for the foods tested. Louis, Mosby, 1993, p 89. of gingivitis, instruct owners to use 3. Williams CA, Aller MS: Gingivitis/stomatitis in Specifically, these foods are Iams Daily chlorhexidine twice a week and regular cats, in Harvey CE (ed): The Veterinary Clinics of Dental Care™, Hill’s Prescription Diet® North America Small Animal Practice. Philadelphia, toothbrushing on the other days. WB Saunders, 1992, p 1371. t/d™, Science Diet® Oral Care, and (only Other oral rinses, containing zinc 4. Lage A, Lausen N, Tracy R, Allred E: Effect of for cats) Friskies® Dental Diet. With the ascorbate or chlorine dioxide, work well chewing rawhide and cereal biscuits on removal of dental calculus in dogs. JAVMA 197(2):213–219, incidence of periodontal disease so high for combating halitosis with their 1990. in dogs and cats, there are few reasons neutralizing effect on malodorous sulfur 5. Stookey G, Warrick J, Miler L: HMP significantly reduced the rate of calculus formation in dogs. Proc why anyone would not want to provide compounds. It is important to realize that Vet Dent 94 World Vet Dent Congr:80, 1994. a diet that promotes good oral health. Chew Toys Rawhide treats for dogs are readily available to pet owners and are effective in ® L™ A D VA N C E D C A R E ™ the control and removal of plaque and Hartz® Advanced Care™ tartar from dogs’ teeth.4 Rawhide is highly Hartz® Dental™ Enteric-Coated Aspirin digestible and has not been observed Brush 'n Clean™ For Dogs ● Fluoride free. ● For the temporary relief of to cause the digestive problems that ● everyday aches and pains and Beef flavored. conventional wisdom ascribes to them in ● Helps to remove tartar, inflammation associated numerous scientific studies. It has also been plaque and debris from with arthritis. ● Specifically formulated to shown that coating rawhide treats with your pets teeth and gums. reduce stomach upset, calcium-sequestering substances such as a common side effect sodium hexametaphosphate can further Hartz® Dental™ of aspirin. Breath-Strips™ enhance plaque and tartar reduction.5 For Dogs Various types and designs of compressed ● Sugar free, alcohol free. rawhide are also beneficial for promoting ● Easy to use dispenser. good oral health. ● Dissolves quickly to There are chew toy-type products that leave breath smelling fresh are not recommended due to their and clean. tendency to cause tooth fracture. 100% Hartz® Pet Shoppe™ Dental™ nylon bones are too hard and often are Flavor Infused™ associated with slab fracture of the Chew-Dent™ carnassial teeth. It is recommended that ● Reduces the pets not chew on tennis balls manufac- accumulation of plaque Hartz® Advanced Care™ tured for human sport, because they are and tartar up to 54%. Joint Maintenance ● Preferred over the notorious for causing attrition (mechanical leading competitor ● Vitamin enriched. wearing of the tooth surface). 3 to 1. ● Specially formulated with Glucosamine to help support healthy joint function. Other Products ● Highly palatable. Oral rinses, sprays, and other such ● Available for both dogs and cats. products also have a role in home dental care. When pets refuse brushing, these products may be the only kind of home care possible. Chlorhexidine gluconate is an excellent AD-168 oral disinfectant. The chlorhexidine will If you would like to receive a copy of the Hartz Veterinary Catalog, please call (800) 999-3000 x 5118. actually bind to gingival tissue and can
  • 4. Senior Pets and Joint Health Erin Paster, DVM Amy Kapatkin, DVM, DACVS School of Veterinary Medicine University of Pennsylvania Philadelphia, Pennsylvania Osteoarthritis (OA) is a common, depression, lameness, poor grooming Evidence-Based Treatment debilitating disease of older animals that habits, and inappropriate elimination It is important to emphasize that the results in discomfort, impaired outside the litter box.9 radiographic severity of OA does not ambulation, and diminished quality of life always correlate to the degree of symp- in some patients. OA is defined as an Evidence-Based Diagnosis toms and thus the need for treatment.15 insidious progressive, noninflammatory Diagnosis of OA is primarily based on Treatment of OA is palliative with the degenerative joint disease characterized clinical features, physical examination, goal of restoring comfortable function by synovial membrane changes, peri- and radiographic evidence.2 Synovial and is classified as medical or surgical.16 articular osteophyte production, and fluid analysis and synovial biopsy may degeneration of articular cartilage.1–2 rule out other causes of joint disease.2,9 Pharmacologic Agents Although the etiopathogenesis is not Specific radiographic methodologies are Medical treatment consists of a entirely understood, OA is a lifelong recommended to screen for predisposing combination of pharmacologic agents, disease. Clinical signs may surface at conditions such as hip dysplasia. The weight management, and controlled different times depending on genetic and PennHIP methodology has been exercise.16–18 Pharmacologic agents include environmental factors. Despite the scientifically proven to predict suscepti- NSAIDs and glucocorticoids.16–19 Most assumption that OA is an idiopathic, bility to hip dysplasia at 16 weeks of age but not all NSAIDs have analgesic and geriatric change, other hypotheses exist; by measurement of passive hip laxity (the antiinflammatory properties, inhibiting manifestations of OA may be caused by a greatest risk factor for the development the cyclooxygenase (COX) pathway.17,18,20 humoral substance or systemic disease,3–6 of OA)10 as compared to other The development of newer veterinary which may explain the presence of methods.3,11,12 This is supported by a NSAIDs (Rimadyl® [Pfizer], EtoGesic® multiple joint OA in mature dogs.3,6,7 lifelong study of 48 Labrador retrievers [Fort Dodge], meloxicam, and Deramaxx™ OA is highly prevalent in dogs in the that revealed a 55% false-negative result [Novartis]) that are more selective for the hip joint, representing 93% of the cases in when using OFA-type scoring to COX-2 isoform has resulted in fewer one study, although the elbow, shoulder, diagnose hip dysplasia and thus predict adverse effects.17,21 Zubrin™ (Schering- stifle, and lumbar vertebral joints are also the development of OA.3 The PennHIP Plough) is another NSAID purported affected.6,7 Hip dysplasia, elbow dysplasia, method was accurate in predicting that to inhibit both the COX and osteochondritis dissecans, and cruciate these 48 dogs were susceptible to lipoxygenase pathways. The most ligament rupture are common predispos- developing degenerative joint disease. common adverse effects in dogs are ing conditions. Clinical signs in dogs Radiographic evaluation of elbows by an gastrointestinal signs,17,20 although renal include stiffness, reluctance or inability to orthopedic surgeon or radiologist is and hepatic abnormalities can develop jump or use stairs, and lameness, recommended to examine for elbow infrequently.20,22 In vitro studies have especially after inactivity or prolonged or dysplasia and requires specific views for demonstrated that NSAIDs are capable high-impact activity.2 Despite the well- observation of evidence of osteochon- of decreasing cartilage metabolism.20 characterized clinical signs and dritis dissecans, fragmented coronoid Steroids are potent antiinflammatory manifestations of OA in dogs, cats process, or ununited anconeal process. agents that prevent prostaglandin and frequently harbor OA and remain However, unless there are radiographic leukotriene synthesis.20 Due to the high asymptomatic, contributing to infrequent signs of OA, only about 9% of elbow frequency of adverse systemic effects and diagnosis.2,8 In one study of 100 cats, 90% dysplasia conditions will be evident on the potential for promoting cartilage had radiographic evidence of OA even radiographs.13 Both CT and MRI scans damage with long-term use,20 some though all cases were subclinical and are significantly better at identifying surgeons have reserved oral steroids for diagnosed as incidental findings.8 Clinical these conditions, even in joints lacking short-term use in dogs exhibiting acute, signs in cats include weight loss, anorexia, radiographic evidence.13,14 severe exacerbations of discomfort.23 4 HARTZ COMPANION ANIMAL ® SM • DECEMBER 2003 • VOL. 1, NO. 2
  • 5. Nutraceuticals weekly.31 Reduced-calorie treats can be function,35,36 it is difficult to determine if Nutraceuticals, such as glucosamine substituted for table scraps, and calorie purported therapeutic procedures would and chondroitin, have grown in intake can be reduced with prescription have resulted in a better outcome. Surgical popularity despite the lack of scientific diets or limiting the regular food corrections of predisposing causes of OA evidence to support their use. Glucosa- offered.17 Unsuccessful attempts at weight such as cranial cruciate rupture, however, mine and chondroitin are purported to be reduction may be confounded by are recommended. chondroprotective by providing cartilage endocrinopathies such as hyperadreno- precursors, increasing cartilage corticism or hypothyroidism, thus Salvage Procedures metabolism, and depressing collagenolytic necessitating further diagnostic Surgical treatments in older animals enzymes.24,25 Although Cochrane reviews evaluation.17 A controlled exercise with OA are primarily salvage procedures of randomized, placebo-controlled, regimen of regular, low-impact activities and should be recommended when double-blind studies have shown can be a benefit by maintaining muscle medical therapy is unsuccessful or if the glucosamine and chondroitin to relieve tone, joint structural integrity, and range dog’s lifestyle is severely limited.23 The discomfort and improve function in of motion while contributing to weight femoral head and neck osteotomy (FHO) human OA patients,26,27 none exist in control.17,18,23 Trial and error is necessary and total hip replacement (THR) are dogs. Anecdotal evidence in companion to arrive at an exercise schedule that standard orthopedic treatment options animals appears promising, but further allows comfortable function without for end-stage hip OA.16 Pain relief is studies are needed to prove efficacy. It exacerbation of lameness.17,18 A study achieved by the creation of a false joint also remains undetermined in human using force-plate analysis in dogs without and the replacement of diseased tissues studies whether different preparations a cranial cruciate ligament in one limb with synthetic implants. Arthrodesis is affect efficacy or if glucosamine is safe for showed improved weight-bearing in also an option for eliminating discomfort long-term use.27 Clients should be those with exercise instituted daily as of some joints, such as the carpus and advised that individual patients will compared to dogs with limited activity.32 tarsus, although gait is compromised.23 respond differently to an agent, and trial The regularly exercised dogs also had less Elbow replacement surgery is currently and error may be necessary to find the gross and radiographic evidence of OA.32 under investigation for clinical product best suited for symptom control. application in veterinary medicine.23 Knee Alternative Therapies replacement has not been clinically Weight Reduction and Scientific evidence regarding alterna- developed for dogs. Controlled Exercise tive therapies, including acupuncture, Weight control and exercise massage, hot and cold therapy, electro- Treatment for Felines modification are imperative to the therapy, and ultrasonography for OA, is Limited information is available for success of medical management limited. A double-blind, controlled management of feline OA. Buffered and must be continued study involving force-plate aspirin administration every 72 hours, throughout life.18 Obesity analysis of dogs with cox- butorphanol, meloxicam, and nutritional has been shown to be a ofemoral OA treated with supplements have been used for chronic risk factor in OA gold bead implantation OA in cats.9 Alternatively, cats appear to development in dogs, acupuncture failed to show maintain comfortable function and better most likely due to the significant clinical improve- long-term outcomes with surgical increased biomechanical ment over the placebo group.33 treatments such as FHO, probably due forces sustained by the Additional studies are needed. to their small size.37 joints.3,7,28 This is evidenced by a 5-year longitudinal study of Labrador Therapeutic/Preventive Procedures Osteoarthritis Prevention retrievers, revealing a significant increase There are currently no surgical Management of OA is best achieved in prevalence and severity, and earlier treatment modalities in animals scienti- through prevention.34 It is the onset of coxofemoral OA in free-fed dogs fically proven to reverse or prevent OA veterinarian’s responsibility to educate as compared to paired littermates fed 25% development. Many procedures involving clients about OA prevention as early as less.3,28 Weight reduction alone can result the coxofemoral joint are the focus of the puppy stage. Purchasing puppies from in clinical improvement of lameness and considerable debate, and evidence-based reputable breeders that can verify the gait as evidenced by studies using obese studies are needed to support these parents’ history is important. As the pup dogs clinical for coxofemoral OA.29,30 claims.34 With long-term studies reporting matures, appropriate evidence-based Effective weight reduction should result that >75% of dogs treated with medical screening tests should be instituted for in the loss of 1% to 2% body weight management will retain pet-quality detection of elbow and hip dysplasia. HARTZ® COMPANION ANIMALSM • DECEMBER 2003 • VOL. 1, NO. 2 5
  • 6. Weight management in dogs is the Pitman Medical Publishing, 1980. in dogs. Am J Vet Res 61(7):802–810, 2000. 5. Westacott CI, Webb GR, Warnock MG, et 22. MacPhail CM, Lappin MR, Meyer DJ, et al: only proven method, surgical or non- al: Alteration of cartilage metabolism by cells Hepatocellular toxicosis associated with surgical, to slow or even prevent OA. from osteoarthritic bone. Arthritis Rheum administration of carprofen in 21 dogs. This evidence comes from the previously 40(7):1282–1291, 1997. JAVMA 212(12):1895–1901, 1998. 6. Olsewski JM, Lust G, Rendano VT, Summers 23. Medical therapy of osteoarthritis in dogs. Vet mentioned studies comparing free-fed BA: Degenerative joint disease: Multiple joint Exchange:5–7, 9–11, 16–19, 1995. (mean body condition score of 6) and involvement in young and mature dogs. Am J 24. Anderson M: Glucosamine and chondroitin Vet Res 44(7):1300–1308, 1983. limit-fed (mean body condition score of sulfate in the prevention and management of 7. Kealy RD, Lawler DF, Ballam JM, et al: osteoarthritis. Purina Nutr Forum:36–41, 2001. 4) Labrador retrievers.3,7,28,38 These Evaluation of the effect of limited food 25. Anderson MA: Management of osteoarthritis studies revealed significant reduction consumption on radiographic evidence of with nutraceuticals. Purina Nutr Forum:79–86, osteoarthritis in dogs. JAVMA 217(11): in prevalence and severity of OA in 1678–1680, 2000. 2001. multiple joints at 8 years of age,7 and 26. McAlindon TE, LaValley MP, Gulin JP, 8. Hardie EM, Roe SC, Martin FR: Felson DT: Glucosamine and chondroitin for hip coxofemoral joint alone at 5 years of Radiographic evidence of degenerative joint treatment of osteoarthritis: A systematic disease in geriatric cats: 100 cases (1994– age,28 in limit-fed dogs as compared to 1997). JAVMA 220(2):628–632, 2002. quality assessment and meta-analysis. JAMA 283(11):1469–1475, 2000. those that were free-fed. Additionally, 9. Hardie EM: Management of osteoarthritis in 27. Towheed TE, Anastassiades TP, Shea B, et the thinner (limit-fed) dogs also cats. Vet Clin North Am Small Anim Pract al: Glucosamine therapy for treating 27(4):945–953, 1997. required NSAIDs for symptom control osteoarthritis [review]. The Cochrane Library; 10. Smith GK, Popovitch CA, Gregor TP, Shofer The Cochrane Database of Systematic Reviews:1, significantly less frequently and later FS: Evaluation of risk factors for degenerative 2003. than the obese (free-fed) ones.38 It is joint disease associated with hip dysplasia in 28. Kealy RD, Lawler DF, Ballam JM, et al: dogs. JAVMA 206(5):642–647, 1995. recommended to maintain dogs at a Five-year longitudinal study on limited food 11. Fordyce HH, Gregor TP, Smith GK: consumption and development of osteoarthritis body condition score at or below 5 (on a Correlation of OFA hip scoring to passive hip in coxofemoral joints of dogs. JAVMA laxity derived from the hip extended and scale of 1 to 9).38 distraction radiographs. Vet Orthop Soc Annu 210(2):222–225, 1997. 29. Impellizeri JA, Tetrick MA, Muir P: Effect of Meet:2000. weight reduction on clinical signs of lameness Summary 12. Smith GK, Gregor TP, Rhodes H, Biery DN: in dogs with hip osteoarthritis. JAVMA Coxofemoral joint laxity from distraction OA is a disease that is well described radiography and its contemporaneous and 216(7):1089–1091, 2000. 30. Burkholder WJ, Taylor L, Hulse DA: Weight in dogs and underdiagnosed in cats. prospective correlation with laxity, subjective loss to optimal body condition increases score, and evidence of degenerative joint Evidence-based treatment options disease from conventional hip-extended ground reactive force in dogs with include medical management consisting radiography in dogs. Am J Vet Res 54(7):1021– osteoarthritis. Purina Nutr Forum:74, 2000. 1042, 1993. 31. LaFlamme DP, Kuhlman G, Lawler DF, et of pharmacologic agents, controlled al: Obesity management in dogs. Vet Clin Nutr 13. Snaps FR, Balligand MH, Saunders JH, et al: exercise and weight reduction, and Comparison of radiography, magnetic 1:59–65, 1994. surgical management, which mainly resonance imaging, and surgical findings in 32. Baird DK, Kincaid SA, Rumph PF: dogs with elbow dysplasia. Am J Vet Res Unpublished data. consists of salvage procedures. Using 58(12):1367–1370, 1997. 33. Bolliger C, DeCamp CE, Stajich M, et al: evidence-based diagnostic tests to screen 14. Reichle JK, Snaps F: The elbow. Clin Tech Gait analysis of dogs with hip dysplasia treated for disease risk and keeping dogs thin are Small Anim Pract 14(3):177–186, 1999. with gold bead implantation acupuncture. Vet 15. Whittick WG: Canine Orthopedics. Philadelphia, Comp Orthop Traumatol 15:116–122, 2002. the best preventive measures. Lea & Febiger, 1974, pp 348–368. 34. Smith C: Treatments for hip dysplasia spark 16. Clark DM: Current concepts in the treatment controversy. JAVMA 201(2):205–209, 1992. References of degenerative joint disease. Compend Contin 35. Barr ARS, Denny HR, Gibbs C: Clinical hip 1. Lepine AJ: A morphologic and physiologic Educ Pract Vet 13(9):1439–1446, 1991. dysplasia in growing dogs: The long-term review of articular cartilage. Vet Orthop Soc 17. Martinez SA: Medical management of results of conservative management. J Small Annu Meet:6–13, 2000. osteoarthritis in companion animals. Vet Anim Pract 28:243–252, 1987. 2. Taylor SM: Disorders of the joints, Orthop Soc Annu Meet:24–29, 2000. 36. Smith GK, Fordyce HH, Gregor TP: noninflammatory joint diseases, in Nelson 18. Tomlinson J, McLaughlin Jr R: Medically Nonsurgical management of severe hip RW, Couto CG (eds): Small Animal Internal managing canine hip dysplasia. Vet Med dysplasia: Long-term results. Vet Orthop Soc Medicine, 2nd ed. St. Louis, Mosby, 1998, pp 6:48–53, 1996. Annu Meet:1999. 1076–1078. 19. Fox SM, Burns J, Burt J: Treating the dysplastic 37. Tacke S, Schimke E, Kramer M, et al: 3. Smith GK, Biery DN, Kealy RD, et al: Effects hip: The first steps to follow. Vet Med :701– Excision arthroplasty of the hip joint in dogs of restricted feeding on onset, incidence and 708, 1987. and cats. Long-term results of the veterinary severity of hip dysplasia and osteoarthritis in 20. Johnston SA, Fox SM: Mechanisms of action surgery clinic at the Justus Liebig University of dogs: Diagnostic, therapeutic and genetic of anti-inflammatory medications used for the Giessen. Tierarztl Prax 25:373–378, 1997. ramifications. Purina Pet Institute Symp: treatment of osteoarthritis. JAVMA 210(10): 38. Smith GK, Biery DN, Kealy RD, et al: Advancing Life Through Diet Restriction:21–26, 1486–1492, 1997. Clinical significance of osteoarthritis and hip 2002. 21. Kay-Mugford P, Benn SJ, LaMarre J, Conlon dysplasia findings in the restricted feeding 4. Sokoloff L: The Pathology of Osteoarthritis and P: In vitro effects of nonsteroidal anti- trial. Purina Pet Institute Symp: Advancing Life the Role of Aging. Tunbridge Wells, UK, inflammatory drugs on cyclooxygenase activity Through Diet Restriction:27–28, 2002. 6 HARTZ COMPANION ANIMAL ® SM • DECEMBER 2003 • VOL. 1, NO. 2
  • 7. Albert Ahn, DVM, is a veterinarian, Chief Scientific Officer and Corporate Vice President at The Hartz Mountain Corporation. ASK TH E VET Q Which Hartz® products can be helpful for medical management of osteoarthritis? coagulation and pulmonary artery disease secondary to heartworm infestation in dogs. Also, low doses of aspirin have been shown to be helpful A Osteoarthritis is defined as chronic inflammation of the joint that is usually accompanied by pain and discomfort. as an adjunctive treatment of glomerular disease. • Glucosamine is an amino-monosaccharide nutrient and is classified as a chondroprotective agent. Chondroprotective agents are thought to aid in Osteoarthritis may develop from skeletal diseases such as hip dysplasia or can be the healing of cartilage, may stimulate cartilage secondary to immune joint diseases or matrix synthesis, and may reduce enzymatic trauma. This condition usually involves degradation of cartilage. Glucosamine is a pathologic changes of both the articular precursor to the disaccharide unit of cartilage and periarticular soft tissues. Pain glycoaminoglycans, which comprise the associated with osteoarthritis is often due to proteoglycan ground substance of articular irritation of exposed nerves that is a result of cartilage. Glucosamine acts by providing the cartilage and tissue damage. regulatory stimulus and raw materials for The following products manufactured synthesis of glycosaminoglycans in cartilage. by Hartz may help in reducing your pet’s Q discomfort associated with osteoarthritis: • Aspirin is commonly used to treat osteoarthritis What are the dental benefits of rawhide? in dogs. Aspirin is an NSAID with analgesic, antiinflammatory, and antiplatelet properties. It inhibits cyclooxygenase, which in turn reduces the production of prostaglandins and thromboxanes. It is relatively inexpensive and A Rawhide dog treats have been used for many years to satisfy dog’s natural chewing needs. Rawhide is high in protein and low in fat and can provide the chewing satisfaction that dogs readily available. The use of buffered or enteric- crave. Studies show that when rawhide is used coated aspirin is recommended as it decreases the daily, it can effectively remove plaque. The likelihood of gastrointestinal irritation. The abrasive action of rawhide chewing helps recommended dose of aspirin for treatment of reduce plaque, calculus, and gingivitis. osteoarthritis in dogs is 10 to 25 mg/kg. In Rawhide also provides the necessary chewing addition, aspirin is used therapeutically in the exercise to strengthen gums and is a great way treatment of disseminated intravascular to relieve boredom, frustration, or anxiety. We want to hear from you! • Have questions or comments? Call our Consumer Relations Department at 800-275-1414 and ask to speak to a Hartz staff veterinarian or email us at feedback@hartz.com. • To obtain a Hartz Veterinary Catalog of products, please call 800-999-3000 x5118 or email us at feedback@hartz.com. HARTZ® COMPANION ANIMALSM • DECEMBER 2003 • VOL. 1, NO. 2 7
  • 8. Animal Health Institute Selects Hartz for Membership The Hartz Mountain Corporation has a long history of interacts with the U.S. Food and Drug Administration, the protecting and caring for America’s pets. They have been U.S. Department of Agriculture, and the Environmental innovators in animal health, particularly in the area of flea and Protection Agency, the federal agencies responsible for tick protection, and manufacture scientifically proven products. regulating animal health products. Hartz was recently selected as the newest member of the Hartz, along with all AHI member companies, shares a Animal Health Institute (AHI). deep commitment to providing high-quality products aimed at The Animal Health Institute is the U.S. trade association helping pets lead longer, healthier lives. For more information that represents manufacturers of animal health care products— on the Animal Health Institute, and for a complete list of pharmaceuticals, vaccines, and veterinary medicines. AHI member companies, visit www.ahi.org. Come Visit Hartz at These Upcoming Conferences! North American Veterinary Conference Western Veterinary Conference Orlando, Florida Las Vegas, Nevada January 17–21, 2004 February 16–19, 2004 Booth 511 Booth 249 Veterinary Learning Systems PRESORTED STANDARD 780 Township Line Road U.S. POSTAGE Yardley, PA 19067 PAID BENSALEM, PA PERMIT #118 400045