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Be co-ordinated to maintain mobility

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01 March 2016, at 12:00am

James Howie of Lintbells says only by involving the whole team in a co-ordinated, holistic programme of care can we be sure that all the needs of pets and owners are met

MOBILITY IS A PROBLEM THAT AFFECTS MANY OF OUR VETERINARY PATIENTS, both short term in association with systemic illness or injury and longer term due to chronic problems like degenerative joint disease.

A pet that isn’t mobile can’t ask for attention, accompany its owner on outings or even play out its normal role at the centre of family life. Reduced interaction means there are fewer opportunities to bond, which can affect the pet’s overall well-being. If left, it can become a welfare issue. 

While the obesity issue has quite rightly become high profile, mobility is a substantial issue in its own right and the two are often linked. It’s often quoted that one in five dogs over the age of a year have osteoarthritis but that figure arguably masks the 80% of dogs over eight years that are affected.

Studies have shown that even more cats might be experiencing difficulties with mobility. One study found radiographic evidence of degenerative joint disease in 90% of geriatric cats, with severe lesions reported in the elbows of 17% of cats and the presence of neurological disease associated with lesions in the vertebral column. It is estimated that around 60 to 90% of cats have radiographic evidence of arthritis in limb joints.

As fewer cats tend to be presented to practices than dogs, it’s clear that a large number of these animals are not bene ting from professional veterinary care. Persuading owners that there is an issue and that help and support is available is often a major obstacle that has to be overcome. It is a widespread problem and we are probably still just touching the tip of the iceberg with those that are seen in practice. 

Consequences of pain and immobility 

It’s now well established that there is no “good pain”. This may have been contentious in the past, with some arguing that pain leads to restricted activity and that this can be important to allow healing. However, this has since been refuted.

The consequences of enforced immobility can be far-reaching. 

Some of these are obvious such as an increased likelihood of obesity if the pet continues to be fed the same amount of calories when exercise is reduced. There is also the potential for behavioural problems due to lack of environmental enrichment and opportunities to socialise. 

Physiologically, the effects of immobility due to pain can be far worse than just muscle atrophy and subsequent weakness, although that in itself puts additional strain on the joints. Other consequences can include bone atrophy as a result of increased resorption of bone and significant atrophy of the soft tissues, such as the joint meniscus and ligaments. Overall, this can result in a reduction in strength of the bone- ligament-bone complex and, most likely, more joint instability.

In human and animal models, physical activity also has beneficial effects on glucose metabolism, strength of the respiratory muscles and maintenance of left ventricular mass and function.

So clearly, appropriate pain relief plays an important role in restoring and maintaining mobility. Physiotherapy techniques and rehabilitation medicine is an increasingly important area and at practice level there is a role for customised exercise plans for animals with deteriorating mobility, or for those in recovery regaining mobility.

Having adequate knowledge and sources of appropriate aids such as ramps, harnesses and suitable toys is also essential, as is working alongside reputable paraprofessionals such as hydrotherapy centres to ensure the animal benefits from care as and when it is needed.

Nutrition and mobility

It is vital that all pets receive a dietary recommendation, as per WSAVA guidelines, appropriate to lifestage. Supplements shouldn’t be advised purely as a route to bolster a low- quality diet.

High biological value proteins will help support muscle and other tissues and meet protein and amino acid requirements. Some pets may have higher calorie requirements in recovery, while others may need a diet that promotes weight loss if immobility is linked to weight gain.

Adipose tissue is known to result in the release of adipokines, many of which are metabolically active and induce a pro-inflammatory state through the arachidonic acid cascade.8 Chronic, low-grade inflammation may account for the pathophysiology of arthritis in obese patients. Overweight and obese dogs were shown in one study to be more likely to suffer arthritis than non-obese cohorts, with rates of disease reported at 83% and 50% respectively.

Supplementation can be a useful way to deliver specific nutrients that support pet mobility. As the supplement is given daily by mouth, the amount consumed need not depend on the pet’s voluntary food intake.

Working together

Vets and nurses can play a key role in ensuring pet owners receive a recommendation for the highest quality supplements backed by an evidence base. The format and acceptability of the preparation is also important in making a guided recommendation for optimum, long-term compliance. 

In dealing with mobility issues, it’s clear that practices must embrace a multi-modal approach – providing adequate pain relief, advice about diet and supplements, employing good rehabilitation and exercise plans and teaching owners the necessary skills to help them care for and support their pet in its recovery.

This means involving the whole practice team in a co-ordinated, holistic programme of care. Only in this way can we be sure that all the needs of the pet and owner are met.

  1. Johnston, S. A. (1997) Osteoarthritis: joint anatomy, physiology, and pathobiology. Vet Clin North Am Small Anim Pract 27: 699-723.
  2. Hardie, E. M., Roe, S. C. and Martin, F. R. (2002) Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994-1997). J Am Vet Med Assoc 220 (5): 628-632.
  3. http://icatcare.org/advice/cat- health/arthritis-and-degenerative-joint- disease-cats 4. Sparkes, A., Helene, R., Lascelles,
  4. B. D. et al (2010) ISFM and AAFP consensus guidelines: long-term use of NSAIDs in cats. Journal of Feline Medicine and Surgery 12: 521-538. 
  5. Klein, L., Player, J. S., Heiple K. G., Bahniuk, E. and Goldberg, V. M. (1982) Isotopic evidence for resorption of soft tissues and bone in immobilized dogs. J Bone Joint Surg Am 64 (2): 225-230.
  6. Gielen, S., Schuler, G. and Adams, V. (2010) Exercise in Cardiovascular Disease, Cardiovascular Effects of Exercise Training. Molecular Mechanisms 122: 1,221-1,238.
  7. Global nutrition guidelines, WSAVA: www.wsava.org/ guidelines/global-nutrition- guidelines
  8. Eisele, I., Wood, I. S., German, A. J., Hunter, L. and Trayhurn, P. (2005) Adipokine gene expression in dog adipose tissues and dog white adipocytes differentiated in primary culture. Hormone and Metabolic Research 37: 474-481. 
  9. Kealy, R. D., Lawler, D. F., Ballam, J. M. et al (2000) Evaluation of the effect of limited food consumption on radiographic evidence of osteoarthritis in dogs. J Am Vet Med Assoc 217: 1,678-1,680.