luxating patella: great/cheap supplement, other therapies, scientific review
Just wanted to let any other small dog owner with luxating patella know about some conservative treatments for "trick knees."
WHY I LOOKED FOR SOMETHING OTHER THAN WHAT MY VET RECOMMENDED
When my vet suggested I get a supplement that would cost about $40 a month (either Synovi 4 or Rejuvenate)(I've also attached a chart from Drs. Foster and Smith comparing common supplements and their ingredients), I started looking for a less costly human supplement, since in my experience they are better grade and most importantly for me, much less expensive since you have to give about 1/6 or so for a 20 lb dog. I have a lot more time than money.
I reviewed the ingredients in both of these products, and found that Rejuvenate looked to be the better of the two. I then looked at recommendations on different sites (including medical reviews) for important ingredients. My very knowledgeable vet said that recent studies have said that MSM is more effective than chondroitin/glucosamine, and also recommended glucosamine/chondroitin, collegen, EPA (fish oil), boswellia, hyaluronic acid, green lipped muscle (perna canalicus), boswellia, tumeric, and vitamin c. I found another site that stressed the above plus tumeric, bromelain, and SAM-e (apologies: didn't save link). Given that my dog is taking Prozac for anxiety, I knew that SAME-e was out, but looked at the other ingredients, as well as others that are common in dog supplements (yucca, devil's claw (harpagophytum), DLP (DL-phenylalanine), bioperinine (black pepper), among others.
Based on this and reviewing different human supplements, I found Mendamine 25 (http://www.amazon.com/Ingredient-Supplement-Glucosamine-Chondroitin-Phytosterols/dp/B006UIY4CG) to be the best and most cost-effective supplement. See ingredients, attached.
I then went through the rather laborious process of checking for toxicity/danger to dogs in these ingredients. Everything checked out, and three vets said it looked like a good supplement.
I give Enzo (approx. 20 lbs) 1/2 a pill 2x daily (the human dosage is 6 pills total daily) based on comparing the dosage of ingredients in the vet-recommended supplements to the amount in Mendamine 25. It is a pretty nasty, large pill, but Enzo will eat anything; I feed him once a day, so in the morning I put half in a pill pocket and at night I mix it in with his food. Scarfs down both.
For $25, I get a 6 month's worth of a great quality supplement for $.12/a day.
note: One site with personal experience on supplement ingredients is available at http://dogaware.com/health/arthritis.html. I think it is a helpful guide, especially with the suggestion of an emphasis on fish oil/EPAs. But again, it is antecdotal. It also has some really good links.
PRESCRIPTION/OTC MEDICATIONS
I should also mention that the vet recommended a medication called Rimadyl/Carprofen, which is not a human medication and therefore cannot be purchased cheaply at a human pharmacy (though you might be able to get it cheaply at Walmart or some Targets). Again, tres expensive, so I did some research and found that although ibuprofen and other NSAIDS are no-nos for dogs, very low dose aspirin can be just as effective. I looked at the dosage for Enzo and one of the low-dose aspirins (81 mg, for prevention of heart disease), 2x a day would be viable. My vet cautioned to watch out for bloody diarrhea, vomiting, etc., but approved of the dosage and the plan. I bought the aspirin (coated, as suggested), but found that Enzo would just vomit it up. So discontinued after two days. I'm glad, too, because one study I found said that it would invariably have a negative impact on kidney function with long-term use. Not interested in that.
METASTUDY OF EFFICACY OF INGREDIENTS FOR HUMANS
A review of multiple studies for HUMANS suffering from osteoarthritis (available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779427/) gave some other information that was helpful. Of course, many of the supplements were not studied in depth. But it found that:
A complex called ASUS (avacodo soybean unsaponifiables) has the most evidence over various studies for efficacy (human supplement available at http://www.walmart.com/ip/40520949?...58530111&wl4=&wl5=pla&wl6=91505055671&veh=sem (note that I cannot vouch for this product or its safety in dogs, although it is apparently an ingredient in Drs. Foster and Smith's Premium Joint Care 3).
There was moderate evidence (often because there haven't been enough studies) favoring the following:
And limited evidence for the following (the authors stressed this was because this was because of questions regarding study design, limited studies, and, in some cases, safety concerns:
See this list for a summary (the higher, the more reliable/efficacious results per the study): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779427/table/T3/
And the whole review of research is at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779427/
IMPORTANT: PHYSICAL THERAPY/EXERCISE SCHEDULES
Another very helpful link I found was about physical therapy for luxating patella and exercise guidelines (http://vetspecialists.co.uk/factsheets/Physiotherapy/Patellar_Luxation.html), with specific exercises outlined (unlike others that require that you sign up or something). Although it is designed for post-surgical purposes, it can easily be adapted depending on the grade of your dog's condition.
Personally, I am going to stick with the Mendamine 25 and fish oil (the one problem I see with it: no Omega-3s) and see how it goes; if it doesn't work I might investigate the ASUS. Hope this helps some other concerned dog owners!
Note: This is NOT a shill or paid. This is totally based on my own research.
I also made a chart comparing ingredients in many supplements, those in Mendamine 25 and those it doesn't have, and those in the two vet-recommended products above. Here it is: http://imgur.com/fLElEsb
WHY I LOOKED FOR SOMETHING OTHER THAN WHAT MY VET RECOMMENDED
When my vet suggested I get a supplement that would cost about $40 a month (either Synovi 4 or Rejuvenate)(I've also attached a chart from Drs. Foster and Smith comparing common supplements and their ingredients), I started looking for a less costly human supplement, since in my experience they are better grade and most importantly for me, much less expensive since you have to give about 1/6 or so for a 20 lb dog. I have a lot more time than money.
I reviewed the ingredients in both of these products, and found that Rejuvenate looked to be the better of the two. I then looked at recommendations on different sites (including medical reviews) for important ingredients. My very knowledgeable vet said that recent studies have said that MSM is more effective than chondroitin/glucosamine, and also recommended glucosamine/chondroitin, collegen, EPA (fish oil), boswellia, hyaluronic acid, green lipped muscle (perna canalicus), boswellia, tumeric, and vitamin c. I found another site that stressed the above plus tumeric, bromelain, and SAM-e (apologies: didn't save link). Given that my dog is taking Prozac for anxiety, I knew that SAME-e was out, but looked at the other ingredients, as well as others that are common in dog supplements (yucca, devil's claw (harpagophytum), DLP (DL-phenylalanine), bioperinine (black pepper), among others.
Based on this and reviewing different human supplements, I found Mendamine 25 (http://www.amazon.com/Ingredient-Supplement-Glucosamine-Chondroitin-Phytosterols/dp/B006UIY4CG) to be the best and most cost-effective supplement. See ingredients, attached.
I then went through the rather laborious process of checking for toxicity/danger to dogs in these ingredients. Everything checked out, and three vets said it looked like a good supplement.
I give Enzo (approx. 20 lbs) 1/2 a pill 2x daily (the human dosage is 6 pills total daily) based on comparing the dosage of ingredients in the vet-recommended supplements to the amount in Mendamine 25. It is a pretty nasty, large pill, but Enzo will eat anything; I feed him once a day, so in the morning I put half in a pill pocket and at night I mix it in with his food. Scarfs down both.
For $25, I get a 6 month's worth of a great quality supplement for $.12/a day.
note: One site with personal experience on supplement ingredients is available at http://dogaware.com/health/arthritis.html. I think it is a helpful guide, especially with the suggestion of an emphasis on fish oil/EPAs. But again, it is antecdotal. It also has some really good links.
PRESCRIPTION/OTC MEDICATIONS
I should also mention that the vet recommended a medication called Rimadyl/Carprofen, which is not a human medication and therefore cannot be purchased cheaply at a human pharmacy (though you might be able to get it cheaply at Walmart or some Targets). Again, tres expensive, so I did some research and found that although ibuprofen and other NSAIDS are no-nos for dogs, very low dose aspirin can be just as effective. I looked at the dosage for Enzo and one of the low-dose aspirins (81 mg, for prevention of heart disease), 2x a day would be viable. My vet cautioned to watch out for bloody diarrhea, vomiting, etc., but approved of the dosage and the plan. I bought the aspirin (coated, as suggested), but found that Enzo would just vomit it up. So discontinued after two days. I'm glad, too, because one study I found said that it would invariably have a negative impact on kidney function with long-term use. Not interested in that.
METASTUDY OF EFFICACY OF INGREDIENTS FOR HUMANS
A review of multiple studies for HUMANS suffering from osteoarthritis (available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779427/) gave some other information that was helpful. Of course, many of the supplements were not studied in depth. But it found that:
A complex called ASUS (avacodo soybean unsaponifiables) has the most evidence over various studies for efficacy (human supplement available at http://www.walmart.com/ip/40520949?...58530111&wl4=&wl5=pla&wl6=91505055671&veh=sem (note that I cannot vouch for this product or its safety in dogs, although it is apparently an ingredient in Drs. Foster and Smith's Premium Joint Care 3).
There was moderate evidence (often because there haven't been enough studies) favoring the following:
- MSM;
- a complex called SKI306X (Korean compound made from dried roots fromClematis mandshurica*and*Trichosantes kirilowii*and dried flower and stem from Prunella vulgaris, possibly available on Asian and European sites; again, cannot vouch for safety in dogs; and
[*]high dose niacinimide (Vitamin B3; not sure if was for short term, acute use).
And limited evidence for the following (the authors stressed this was because this was because of questions regarding study design, limited studies, and, in some cases, safety concerns:
- Chinese cocktail of plant extracts Duhuo Jisheng Wan (see ingredients at https://www.activeherb.com/duhuo/#column2);
- Green-lipped mussels (a COMMON ingredient in dog supplements);
- Cetyl myristoleate (myristoleic acid);
- Devil's claw (a COMMON ingredient in dog supplements);
- Bromelain (a COMMON ingredient in dog supplements);
- Vitamin C.
See this list for a summary (the higher, the more reliable/efficacious results per the study): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779427/table/T3/
And the whole review of research is at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779427/
IMPORTANT: PHYSICAL THERAPY/EXERCISE SCHEDULES
Another very helpful link I found was about physical therapy for luxating patella and exercise guidelines (http://vetspecialists.co.uk/factsheets/Physiotherapy/Patellar_Luxation.html), with specific exercises outlined (unlike others that require that you sign up or something). Although it is designed for post-surgical purposes, it can easily be adapted depending on the grade of your dog's condition.
Personally, I am going to stick with the Mendamine 25 and fish oil (the one problem I see with it: no Omega-3s) and see how it goes; if it doesn't work I might investigate the ASUS. Hope this helps some other concerned dog owners!
Note: This is NOT a shill or paid. This is totally based on my own research.
I also made a chart comparing ingredients in many supplements, those in Mendamine 25 and those it doesn't have, and those in the two vet-recommended products above. Here it is: http://imgur.com/fLElEsb
