Sunday, June 20, 2010

Another kind of hip hop

With almost an hour drive time between work and home, I have a lot of time to listen to the radio. One of the commercials I hear lately tells the story of a man who's arthritic hip is causing him enough pain that he can't enjoy his usual activities (golf) and causes him to walk with a noticeable limp. His children call the limp his "hip hop". The ad educates us about the benefits of seeing a particular hospital's Orthopedic Surgical Department for arthritis diagnosis, education and treatment.

Degenerative joint disease occurs in cats too. It is more commonly known as osteoarthritis, or just plain arthritis. Arthritis is commonly present in shoulders and elbows; hips, stifle (knee), hock (ankle) and lower spine. So, you may see more than just a "hip hop" when a cat has arthritis.

When I was a veterinary medical student,we were taught that cats did not get arthritis. Years later, I read an article about new studies indicating arthritis was more common than was previously assumed, yet the number of cats with arthritis was nonetheless still incredibly low. The most recent study we have has now revealed that over 90% of cats 12 years and older actually show arthritic changes on x-rays. Studies also now show that arthritis isn't even limited to elderly cats! While arthritis is most commonly an older cat disease, it is now often seen in much younger cats.

Amazingly, most cats with arthritis will not limp or refuse to use the painful limb(s). In fact, some cats with arthritis show no obvious signs at all!

Ok, I know what some of you are thinking right now..."of course they don't show signs, how can they show signs when they sleep 18 hrs a day?"

In my post about the Veterinarian as Detective, I explained how veterinarians pick up clues through observation. You can do this too.

Observing your cat's body language and knowing what to look for can help. Is your cat is slower or stiffer when he or she first gets up after a nap or sitting on your lap? Does going up or down the stairs take longer than it used to, or your cat just doesn't go up or down as often? Will your cat stand up in the litter box when he or she used to squat? These may be important clues in our diagnosis.

Moreover, even when you observe changes that please or displease you, they may be important in our diagnosis. When Fluffy doesn't jump up on the counters like she used to, you might be so happy with this change you don't realize she doesn't jump because it hurts her to do so. Just the opposite, you might be frustrated with the fact that Boots isn't using his litter box as often without realizing that it's because it's too painful for him to bend his hips & knees to get over the high sides. The normally affectionate Sweetie is now irritable and bites when petted or picked up because arthritic joints hurt. "Grizabella the glamour cat" might look pretty ragged these days because painful joints won't let her reach the places she needs to in order to keep that coat well groomed. So, be sure to tell us about all behavioral changes you see.

What should you do if you think your cat has arthritis? See your veterinarian. A thorough exam that includes an orthopedic exam is a good start. Such an exam may reveal swelling or crepitus (the medical term for the creaks and cracks we hear when your cat's joints are moved). Range of motion (an evaluation of how well or poorly the leg can be bent or extended) may show poor range or discomfort. X-rays may not detect very early arthritis changes, but are helpful to rule out other diseases. With increasing frequency I am finding obvious changes on x-rays. I never cease to be amazed at how severe some of the x-ray findings are in a cat that only has the mildest of limps.

Arthritis is a chronic condition, and while it may not be curable, there are a few things that you can do to help your cat live a more comfortable life. Weight management is something everyone can do and it is important in order to decrease stress on arthritic joints. Controling your cat's weight is also one of the few things you can do to help prevent or delay arthritis development.

You can also make changes in your cat’s environment at home so that your cat's life will be easier and more comfortable after diagnosis of arthritis. This can include adding ramps to allow your cat to reach higher areas (beds or furniture) without having to jump, providing litter boxes with lower sides to make it more comfortable to get in and out; and having a box on each floor so that your cat doesn't have to go up & down stairs as often..

Medical management has come a long way from the early days when we treated symptoms with aspirin and hoped for the best. We now have supplements such as Dasuquin and Adequan that help support joint health. Omega 3 fatty acids, and anti-oxidants such a SAM-e can decrease inflammation. When supplements alone are not enough to decrease discomfort, there are an increasing number of pain relief medications such as buprenorphine or gabapentin that are now available that can help. Other non-traditional treatments such as Acupuncture or Massage can also decrease your cat's arthritic discomfort.

Recognizing and treating arthritis can make a difference in your cat’s quality of life. And while your cat may not be a golfer like the gentleman in the radio ad, diagnosing and treating your cat's "hip hop" can help them enjoy many if not all of the things they used to do.

This cat has severe arthritis in both hips. The normally smooth ball and socket hip joints are not smooth, and are flattened instead of rounded as they should normally should be. The red arrows show additional bony deposits resulting from arthritis.

The red arrows point to arthritis changes in this cat's knee joints. None of these structures would be here in a cat without arthritis.

This large extra bony deposit confirms shoulder arthritis.

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