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Casing the Joint

Alternatives to orthopedic surgery for Molossers
Many breeds have orthopedic issues, and Molossers are certainly not immune, sometimes suffering from a medley of mild to severe conditions.
 
With orthopedic problems, emphasis is often placed on surgical correction. But with the giant Molossers, surgical and post-op realities quickly surface: Will the surgical implant work with a 100-plus-pound dog? Will it be possible to carry your dog outside so he can relieve himself? And how bad are the three other legs going to be when all the weight is on them?
 
Medical options for treatment have often been limited for these giant, less-than-ideal surgical candidates – until recently. In the last few years, new options such as physical therapy, stem-cell therapy, and novel pharmaceutical and nutraceuticals have surfaced, leaving alternative options for owners of giant dogs. 
 
 

Physical Therapy

 
Although physical therapy has a long history in human medicine, it has only recently gained popularity in veterinary medicine. Physical therapy covers a number of different modalities that are components of recovery. Often, physical therapy is best used in conjunction with surgery.
 
Of the modalities, underwater treadmill therapy is well suited for the large dog, as it provides natural range of motion, and cardiovascular and muscular workouts, while limiting the amount of weight on the joints. Even swimming outdoors or walking through shallow water can often help the giant Molosser recover, but this self-conducted therapy should be under the supervision of a knowledgeable veterinarian so that appropriate goals and techniques can be achieved. One important note: For dogs with dense coats or ones that are prone to skin conditions, it is important to dry the dog off thoroughly after each session in the water.
 
Canine physical therapists can be veterinarians who have a special interest and have taken additional courses in physical therapy, or human physical therapists who have taken special course learning about the unique animal physiology. A quick search should provide a list of practitioners, and an organized national society is in the works for veterinary physical therapists, so keep your eye out.
 
 

Stem Cell Therapy

 
Perhaps the most exciting new therapy available is regenerative cell therapy, otherwise known as adult stem cell therapy. By first harvesting a dog’s own tissue with a small excision, the fat is sent off and the stem cells are isolated and prepared to be re-injected into the ailing joints or even directly into the blood. Although the therapy currently comes with a large price tag, the initial results are quite promising. Currently dogs can be treated by approved veterinary clinics around the U.S. using a licensed stem-cell service by Vet-Stem (www.vet-stem.com).
 
 

Pharmaceuticals

 
Nonsteroidal anti-inflammatory drugs (NSAIDs) are common, frequently used drugs that work to inhibit inflammatory mediators in orthopedic disease. Canine-approved NSAIDs currently include Deramaxx, EtoGesic, Metacam, Previcox, Rimadyl, Tolfedine (in Canada and Europe) and Zubrin. Although NSAIDs work on the cyclooxygenase pathway (COX), each of these drugs has slightly different methods of action, side effects and dosing options; talk with your veterinarian about the best one for your Molosser. An important note: You can always try a different drug if you are not happy with your dog’s response.
 
• Corticosteroids were often a common method of pain control, but due to their significant systemic effects and hazards from extended use, they are not currently considered a good option for long-term pan control. It is especially important to note that corticosteroids should not be used in conjunction with NSAIDs, as serious side effects can occur. 
 
• Oral opioids are another pharmaceutical option for dealing with orthopedic pain in dogs. Although they can leave your dog sedated, they can be a good option, especially with dogs that are more sensitive to NSAIDs.
 
• Gabapentin is a lesser-known pain medication originally developed for seizures. It is considered especially well suited for neuropathic pain and wind-up in some patients, and can work on the dog with unusual or complicated pain. 
 
• Diacerein is another lesser-known anti-inflammatory drug that works differently from the typical NSAIDs, inhibiting interleukin-1, as opposed to the COX pathway, as NSAIDs do. A recent study also showed how Diacerein may also work through alteration of other elements, including thyroid functions. Although not readily available, easily prescribed or economical, monitoring the progress of this drug is a good idea, especially if you have a Molosser who doesn’t do well on typical NSAIDs.
 
 

Nutraceuticles

 
• Hyaluronic acid  is a building block for healthy cartilage and is a normal component of joint fluid. The equine product Legend by Bayer has been used on dogs, and a new product, Polyglycan from Arthrodynamic, is also available. Both are given via an intravenous or intra-articular injection administered by a veterinarian. 
 
• Oral Glucosamine Supplements are perhaps the best-known supplement for joint care. While these are often all labeled “joint supplements,” not all are created equal. While your Molosser may not require the most expensive supplement your veterinarian can provide, the cheap, over-the-counter formulations may not be ideal, either. The best way to decide which formulation is best for your individual dog is to try a few. Remember to try each one over a month or two, as many products can take time to come into full effect. Some products marketed toward horses may even be appropriate for large and giant dogs.
 
• Pentosan polysulphate is a lesser-known neutraceutical that supports cartilage formation and improves blood flow through the joint. Injectable and oral formulations are currently available – Pentosan 100 Injection and Cartrophen-Vet Capsules. Like many of the other injectable and oral neutraceuticles, it can cause increased bleeding, especially in high doses.
 
• Polysulfated Glycosaminocglycans are compounds similar to naturally occurring elements in the joint. Although the specific mechanism is unknown, supplementation is though to inhibit destructive enzymes within joints, as well as stimulate production of protective elements. Adequan is currently one of the only supplements available. 
 
• Polyunsaturated fatty acids (PUFA) can be supplemented to help decrease the inflammation associated with orthopedic disease. Cold-water fish are the best source of omega-3 fatty acids. Sources dispute the appropriate doses, as well as possible side effects from high doses (pancreatitis, mercury toxicity, etc).
 
While these medical management options for orthopedic disease may not always replace surgery, they can provide much needed additional therapy for the orthopedically compromised Molosser. 
 
 

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