Chronic pain and what you can do about it.

It's one of those things that most doggy people will have to deal with eventually: chronic pain. Either from arthritis, or hip dysplasia, or simply weary old dog bodies, or, as is the case here, from an accident that left lasting damage.

Chronic pain in dogs, like in humans, can either be a constant factor or it can come and go, be better and worse over time. Sadly, just like in humans once again, there are things you can do to make it better, but rarely things you can do to fix it completely. You can manage it, though, and by taking an active role in pain management, you can improve your dogs quality of life quite a bit.

With that in mind, here is a list of things you can do to help manage pain:

1. See your vet.

Dogs are stoic creatures, and especially old dogs often have their quiet, reserved habits attributed to being old, in stead of to being in pain. This puts the onus on us to make sure what we're seeing is in fact old dog (or calm dog) behaviour, and not behaviour that signals "I'm in pain". It's like the vet joke about tooth and gum disease in dogs - the main symptom is none at all.

In Talos's case, times when she is in more pain are marked by her disappearing for stretches of time. Not exactly the easiest marker to spot, since she alternates being out of sight with being on my lap, very close to me. She also sleeps more, is less playful, and is much quieter. Our vet (and other professionals) recommended we keep a journal, this has been absolutely crucial in figuring out a pain scale, with which I can assess when we're at crisis level and need to go see the vet, when I can just medicate at home, and when she's sore, but it's not yet time to medicate.

When you suspect you're dealing with pain, go see your vet.

2. Medication

This is, for many reasons, a tricky one. You don't want to dope your dog. Many painkillers over time cause liver damage, or stomach upset. That said, having a supply of non-steroidal anti-inflammatory medications (or whatever is most relevant to your dogs type of pain) that your dog both tolerates well, and is effective, is worth its weight in gold. Some dogs will need a pill every day, especially if they have the kind of chronic pain that stays constant throughout. Others, like Talos, will need a pill during a bad spell.

We use Rimadyl  - not necessarily the best choice. But, since we only need it infrequently, it is readily available and reasonably inexpensive, Talos tolerates it well and it relieves her pain, this is our choice. It is well worth reading your medication's information leaflet. Here is the one for Rimadyl:
https://www.rimadyl.com/other-links

3. Exercise

It may sound weird to recommend exercise for pain, since usually the advice is to rest. However, especially joint pain from joints that are surrounded by muscle can be kept at bay by having exactly those muscles strong and capable of supporting the joint. This is not as easy as it sounds, however, given that your pooch is likely to be compensating for pain by avoiding the use of that (or those) joints. Also, given that your dog is in pain, and that your dog is compensating for this in various ways, the injury risk is actually quite high. If you have one available, I encourage you too consult with a doggy physiotherapist or other doggy exercise specialist to help you make, stick to and frequently evaluate an exercise plan. We have a three pronged approach, using swimming, slow, controlled leash walks, and specific exercises that if you blink, you'd think are tricks.

For swimming, we go to a fantastic hydrotherapy place where we both swim in the conventional way (into the pool you go, little pug) and walk in an underwater treadmill. As a first line of defense against muscle atrophy, this is perfect. Her weight is supported, so she can safely use the full range of motion in her limbs against a resisting force (water) that really gets those muscles working. Swimming works all her muscles, especially the core (they actually have to use their core muscles to keep their bums from sinking - good swimmers have good core muscle strength, and one of the things that makes many pugs such poor swimmers are just plain old weak muscles).  In both cases, the dogs are closely supervised and their progress is tracked and recorded.

At first, Talos did not swim very well. She's gotten much better, considerably less splashing!

Slow, controlled leash walks we do in the neighbourhood in the mornings. 30 minutes of slow, close heelwork. It can be very boring, but it can also be a lot of fun if you put some energy into it. We criss cross the roads, turning every which way, weaving around decorative lawn boulders, turning both with us in sync, or with me and dog turning in opposite directions. I add in spins (see below) and various sits/downs/stands. I heel with her on the left and right of me. Generally, I do my best to keep her engaged and happy, and generally, I succeed. Half her breakfast she earns on these walks. The benefit of slow walking is that it makes them use all four of their limbs more evenly than they do if they're at a faster pace, plus it encourages good use of the entire range of motion available to them. It really builds muscle and muscle control where those have been lost. In the interest of full disclosure, this is also the thing we cut out when Talos is having a more sore period.

Lastly, the 'tricks' we do. Some of these are stretches. Leg tucked up against her body, in full extension forward, down and back. A 'bow' stretch. A 'reach up as high as you can' stretch, for her core. We do some balance work, on a balance ball or, at hydrotherapy, on a boogie board in the pool. Both of those she enjoys. We do 'doggy pushups' sit-down-sit-down-sit-down repeat (if they keep their bum stable, this exercises their forelegs). You can do 'doggy butt-ups' too, bow-down-bow-down-bow repeat, but we're still learning bow, so we're not there yet. Give paw is a great way to get your dog weight shifting, as long as you include all four paws. Our front-right paw is super good at targeting all sorts of things... our front left paw is getting there (my girl is rather right-pawed). Our back paws... yeah. Once she realises they exist and can move independently we'll get to working on her picking them up. Lastly, we do slow, controlled spins. 'Sit pretty' or 'beg' (whatever you call the meerkat sit, where they sit on their haunches) is another really great core muscle workout, but we cannot do this one. These things are done under the recommendation of a physio - I am not suggesting a workout for anyone else.

4. Alternative therapies

We make use of a few alternative therapies to help with pain. I say 'alternative' therapy in the sense that some vets (or doctors) would only consider medication or surgery true therapies. Many of these have good research backing up their efficacy, some have hearsay only. But heck, my dog is sore, if it actually helps, onwards!

Massage, cold laser, acupuncture, chiropractics, and hot and cold therapies are what is available in our area. We have good experience with all of them aside from chiropractics, which I have not yet been able to overcome my skepticism of and actually try. A lot of research shows chiropractics does more harm than good, especially over time, and there is little support for their 'alignment' ideas of bodies, but I have to immediately veto this with the hundreds upon hundreds of dogs who have  gotten help from chiropractors. Massage is something you can learn to do at home, it stimulates blood flow and makes everything loose. Cold laser helps with pain. Acupuncture (or more accurately, dry needle, my skepticism is with me always) has seriously helped us. Talos lies down on the mat, and relaxes as the needles go in. Afterwards, there's a spring in her step and a lightness to her bearing that we only see otherwise on really good days. She's also more active, and the improvement lasts for a few days at least.

Talos at the vet, getting acupuncture. 

Hot and cold is another thing we do nearly daily. An ice pack in the morning, a hot pack in the evening. They numb pain, stimulate blood flow, and are easy to do (and can do no harm).

5. Supplements

This is another grey area. We give a joint supplement, chondroitin, glucosamine, MSM. Research here is dodgy. Some say it works, others say under double blind tests no difference can be seen in comparison with a placebo. We take this supplement because our specialists say we should, and I have not seen a difference on it (but maybe there would be one if I stopped it and found out). I've put our older dog on this same supplement, hoping that it might help with arthritis down the line  -  she currently has no issues. I am not ashamed to say that while I try my best to research these things, I also succumb to my fair share of 'try and hope'.

Another supplement often recommended is coconut oil  -  it has anti-inflammatory properties and is good for the skin/coat. And it feels nice. And tastes nice. Much love for coconut oil here.

 Spirulina has shown some promise as an alternative protein and as a supplement too.

Then there's the great mess of quackery that is also variously expensive, like 'stempets' (which we're finishing a bottle of, because some people swear it's miraculous... I've seen none of that, but I've also seen none of the bad side effects other people have ... and there's perhaps some case to be made for cyanobacteria as a supplement ... maybe). Of these, there are hundreds. I'm trying to keep an open mind. So many of my doggy friends have had results with some of these, but if you look online, so many have had bad side effects... most therapy people have some types that they prefer. That's probably the place to start.

There's also joint soup, which is rich in glucosamine/chondroitin too:
http://www.cookevet.com/2012/02/10/make-your-own-glucosaminechondroitin-tendonligament-soup-for-dogs-cats-people/

All that said, a good multi-vitamin, the best diet you can manage (which is probably not for sale at your vet's office... just saying) and nutritious treats (not the flour-and-flavourant biscuits that some people seem to think is a good idea, and probably not spray cheese or peanut butter either) will all make a difference to quality of life, if not to pain management directly.