Dear Kara: Nutritional considerations for canine osteoarthritis (Sponsored by Hill's Pet Nutrition)

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A 9-year-old Labrador retriever came to us for limping. The doctor diagnosed osteoarthritis of his right knee. What should we recommend to help him with his arthritis —food or medications?

Osteoarthritis (OA) is the No. 1 cause of pain in dogs and affects 20% of adult dogs. To manage OA in dogs, the International Veterinary Academy of Pain Management recommends using a multimodal strategy. This strategy includes nutritional, pain, and weight management, as well as physical rehabilitation. Proper nutritional management of OA includes an eicosapentaenoic acid(EPA)-rich pet food, as EPA has been shown to disable the genes that cause cartilage degradation. Hill's® Prescription Diet® j/d® Canine pet food contains high levels of EPA and is clinically proven to improve mobility in as few as 21 days. No steroidal anti-inflammatory drugs (NSAIDs) are also an important component in the multimodal approach to managing OA. Deramaxx® (Novartis Animal Health) is an ideal NSAID choice because it has a flexible dosing range that allows dose titration. This is one of the reasons why Hill's Pet Nutrition, Inc. and Novartis Animal Health have partnered to raise awareness of the multimodal approach to treating pets.

We sent one bag of Hill's® Prescription Diet® j/d® Canine pet food home with a client whose dog had severe osteoarthritis. We instructed the client to keep the dog on it until her next visit in six months. When the dog came back six months later, the client told us the dog had only eaten the one bag of j/d Canine pet food, and then she had switched the dog back to the old brand. How can we implement a system for ensuring that our patients stay on the recommended food for the recommended amount of time?

Compliance is crucial to the success of all healthcare team recommendations and follow-up is a key component to compliance. Every team should implement a follow-up plan with every client. If your client did not receive any follow-up from your clinic, she probably did not realize the importance of the nutritional recommendation. General steps for a follow-up plan include:

• Schedule a recheck appointment before the client leaves the clinic.

• Designate a technician to call the client three days after the appointment to check on the pet and to see if the client has any questions.

• Calculate the amount of food the pet should eat per day. Write this down for the client and follow up by phone approximately a week before the bag of pet food runs out

• Offer to place an order for another bag of pet food and refill the NSAID prescription.

• Remind the client that the Hill's Pet Nutrition, Inc.-Novartis Animal Health partnership recognizes the importance of compliance and provides clinics with rebates for Hill's® Prescription Diet® j/d® Canine pet food and Deramaxx.® This builds a wonderful hospital client relationship, builds revenue for the practice, increases compliance, and ultimately offers the best care for the pet.

Food for Thought

Several of our clients have a senior dog and a puppy. Can the younger dog eat Hill's® Prescription Diet® j/d® Canine pet food?

Hill's® Prescription Diet® j/d® Canine is a therapeutic pet food that is recommended by a veterinarian following a diagnosis of OA. Any dog that is nutritionally managed on j/d Canine pet food should have a diagnosis of OA and a follow-up plan from the veterinarian. If the puppies in these cases are in good health, they should be nutritionally managed on Hill's® Science Diet® Puppy pet food. As for the adult or senior dogs, if the veterinarian in your hospital diagnoses OA, j/d Canine pet food is a great recommendation as it manages inflammation and cartilage degradation and contains appropriate levels of nutrients for long-term feeding for adult and senior dogs. Dogs that are fed j/d Canine pet food experience less stiffness and a greater ease of movement.

Should young dogs diagnosed with hip dysplasia be placed on Hill's® Prescription Diet® j/d® Canine pet food to slow the progression of the disease and prevent worsening of clinical signs?

Although Hill's® Prescription Diet® j/d® Canine pet food is not recommended for growing puppies, nutritional management should be a component of therapy in each case of hip dysplasia and OA. As proper nutritional management can improve the quality of a pet's life, it's important for team members to reinforce a veterinarian's nutritional recommendation. Team members should educate clients with dogs that are diagnosed with OA on proper nutrition as a component of the multimodal approach to treatment. Team members should reinforce a number of key nutritional factors as the proper nutritional management of OA, such as:

• High levels of alpha-linoleic acid can be converted to EPA in the body.

• High levels of omega-3 fatty acids and a low omega-3 to omega-6 ratio help to reduce the mediators that cause inflammation.

• Added glucosamine and chondroitin sulfate provide building blocks for cartilage repair.

• L-carnitine helps maintain optimal body weight in dogs to avoid additional stress on bones and joints.

• An antioxidant formula with Vitamins E and C, selenium, and beta-carotene helps protect joint tissues against cell damage.

A client brought in Mack, an obese 6-year-old beagle with a body-condition score of 5 out of 5. Mack has a severe limp and difficulty standing up. Would you recommend a weight-loss food or nutritional management of OA for him?

This is a common question. Due to the severity of his obesity, I would recommend Hill's® Prescription Diet® r/d® Canine pet food to get him to his ideal body weight. The healthcare team should also monitor Mack's weight closely, as higher weight puts more stress on joints and exacerbates the clinical signs of OA. If at his ideal body weight he is still demonstrating clinical signs of OA, I would gradually transition him to Hill's® Prescription Diet® j/d® Canine pet food. Remember managing OA is a multimodal approach so while he is nutritionally managed for obesity, he can begin other therapies for OA, such as physical rehabilitation, NSAIDs, and appropriate exercise. Remember to start the exercise regime slowly and to follow up with Mack and his owner to identify and overcome potential problems with any of the therapies.

Kara M. Burns, MS, MEd, LVT Veterinary Technician Specialist Hill's Pet Nutrition

Kara M. Burns, MS, MEd, LVT

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