Acupuncture for arthritis? VIN feedback below.

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Linda and Bear Man

Linda and Bear Man

Very Active Member
My elderly (and overweight) civie, Miss Emily has arthritis which is rapidly worsening. She is on Adequan (weekly), Cosequin, omega oils, and Gabapentin (max dose) for pain. Nothing seems to be working. She will walk a few steps and then have to rest. I seem to be running out of options for her. Has anyone used MSM for cats? My vet is suggesting acupuncture. I don't really believe in that, and wonder if the benefit will outweigh the trauma of taking her there in the carrier. I guess one more pain relief option would be buprenorphine. I hate to think of her being on that for the rest of her life. She is 16. She has struggled with her weight all her life, and weight loss attempts have (clearly) not been successful recently. She is eating Wellness food with all of her medications plus phosphorus binder for CRF mixed in.

Here is a brief clip of her walking (clickable thumbnail). Any thoughts would be appreciated.

 
Re: Acupuncture for arthritis? Other options?

poor girlie - you could try using a heating pad set on it's lowest setting and let her lay on top of it with a towel or cover to prevent burns. the warmth may help loosen her up, and if not, I know maui thinks it's great! of course, with Maui she wouldn't get off it for any reason and her skin got dry and fur came off in clumps. hence limiting the time with it on.
 
Re: Acupuncture for arthritis? Other options?

Dale Ann got some sort of special bed for Silci who could barely walk. I believe it's really helped. I can't recall if it was just heated or had magnets as well. For some reason I think magnets were involved.

For my own Sadie(GA) I learned the T-Touch massage technique and worked on her legs and back with that. She eventually was able to manage stairs and get around the house, although heart failure took her too quickly from me.
 
Re: Acupuncture for arthritis? Other options?

As great as Adequan is, it only works for the joints and won't do anything for arthritis that is not in the joints. Has her heart been checked? The special bed for Silci wasn't heated or magnets. I had read about it in the Animal Wellness magazine. Will be back with more info on it.
 
Re: Acupuncture for arthritis? Other options?

I know there is a tremendous amount of controversy over Metacam, however there comes a point where one has to decide which is worse, your cat in agony with a condition which it might help or kidney damage/failure which may or may not happen. Speak with your vet about a very low dose and see if it helps. My vet tells me she has seen some amazing changes to kitties suffering arthritis.

Gandalf has had acupuncture treatments for over 1 year now for arthritis in his hips and spine. It has maintained his activity level, which compared to your kitty is very good. It is expensive and unless you can afford to do the treatments at least weekly, I cannot see it helping your kitty enough to outweigh the cost. I pay $43.50 per treatment every other week and that is in a small town where the vet I see for it is the only one in the area who does it. She also administers B12 injections and his Adequan in to acupuncture points.

I would consider Metacam for Gandalf if he were in so much pain he could not walk. It's a huge Catch-22, but if it made his end of life less painful, I think that's the trade off you have to make.
 
Re: Acupuncture for arthritis? Other options?

Feb. 2010


Her bed...
100_0769.jpg


March 2010


Aug. 2010


I don't know the name of the magnetic pad but Hope does. Sillci likes her gifts and they make her feel sooo much better.

Sillci has lost 5 pounds since Feb. She eats canned now instead of the DM dry and she's OTJ. She doesn't use the bed too much now that she can jump up on mine! But come winter I'll put it out for her since it's heated. She gets the magnetic therapy at least once a week. And she gets a monthly shot now of Adequin (I think, not sure if Dasaquin or Adequin). I'm hoping she can lose another 3 pounds putting her at the 10 pound level.

When Sillci first came she wouldn't even walk as you can see in the first video. Then she'd walk just a couple feet and stop like your cat. Now look at her. You can even see the weight loss in her pic. She's doing good.

Have you had her heart checked?

I use MSM on myself. Glucosamine didn't do a thing for my pain but MSM makes a lot of difference. Joint pain is no fun.
 
Re: Acupuncture for arthritis? Other options?

Dale, Sillci looks amazing. Linda, I hope you can find something to help your sweet Miss Emily.
 
Re: Acupuncture for arthritis? Other options?

Thank you for all of the suggestions. For those who have asked about checking her heart ... is it because she has to stop to rest, and you suspect it is due to her heart?

She had a surgical procedure done a couple of months ago under sedation, so I'm sure her heart rate would have been checked then.
 
Re: Acupuncture for arthritis? Other options?

Yes, because what you may be thinking is arthritis pain that makes her stop and lay down, it could be a heart problem that only a cardiologist would be able to check. Reiki is another wonderful option to try and it does work. Maybe Traci/Boomer(GA) could try some long distance for you?
 
Re: Acupuncture for arthritis? Other options?

Hope, I hadn't thought about the Reiki. Traci was doing that for Tucker when he was at his worst earlier this year. My vet was suprised how quickly Tucker rallied, he loved the Reiki.
 
Re: Acupuncture for arthritis? Other options?

viewtopic.php?f=28&t=25364
this thread has info I found about MSM for cats.

I assume you have had her back/legs xrayed? If not, it might be worthwhile to see what is going on. She looks humpbacked, like her spine is deforming. We had a cat at the shelter that had Spinal arthritis.
 
Re: Acupuncture for arthritis? Other options?

Lisa and Merlyn (GA) said:
I assume you have had her back/legs xrayed? If not, it might be worthwhile to see what is going on. She looks humpbacked, like her spine is deforming. We had a cat at the shelter that had Spinal arthritis.
Click to expand...

Thank you for mentioning the spine. I have been concerned about the shape of her back. That's a recent development. The knees were diagnosed years ago.
 
Re: Acupuncture for arthritis? Other options?

Linda, her spine seems very prominent. Is the arthritis in her legs/hips? Or spine? I watched the video 3x, and got DH to watch it twice too, and it wasn't clear to us. She doesn't walk like Meowzi does. Meowzi has bad arthritis, hip dysplasia, and what now looks like the beginnings of spinal arthritis in her most recent May rads.

We do a combination of om-3, Dasuquin, Adequan and Denamarin, as well as acupuncture. On really bad (extra stiff) days I add in reiki.

My personal opinion on acupuncture, is that it may be hit or miss. Meowzi once insisted on walking up and down the block and all around after coming home from one session. I think it also depends on how good the practitioner is. Their philosophy on how to approach it - holitistically (edited b/c i kant spel ohmygod_smile ) holistically (TCM approach) or from a pain management perspective (I attribute this to the Western approach) - may also be a consideration, or not. For severe arthritis like Meowzi's, I personally prefer to focus on pain management; I just want her to stop hurting, at this point I don't really care what's causing it. But that's not our current acupuncturist's philosophy - she's looking at the whole cat, and how this is all linked to the kidney meridian; her pancreas, kidneys, arthritis are all connected (if I understand it correctly).

Bottom line: acupuncture shouldn't hurt; it may or may not help. I don't think there's anything to lose by trying it out. In the beginning, it took 3 sessions or so before we saw any effect.

I have a few other thoughts - and I am prefacing them with a caveat - these are less common options and I can't say I know much (risks/benefits), if anything, about them. Please understand I am not in any way advocating any of these; I don't fully understand how they work and/or the adverse effects, if any. If you're interested, you should consult your vet and see if she can find out more information. (but I'd be very interested, if you'll share what you find out)

1. S-Adenosyl Methionine (SAM-e). There's anecdotal evidence that it *may* help with osteoarthritis. But to my knowledge - and I haven't searched very hard for it- there's not miuch formal study on it for this purpose just yet - most research focuses on its use for liver support. There are also cautions on overusing it, adverse effects, and the question of whether vit B needs to be supplemented with it and if not, what adverse effects. We do use denamarin, and a month after we started Meowzi on it (we also raised her om-3 dose by 50% in that same month, starting around the same time), she showed marked improvement in her mobility and gait, and hopped on Cali's kitty tower for the first time ever since the tower was built (2006). I don't know which supplement helped, or maybe both did. Or not.

2. Laser therapy. See here for info. I've heard good things about it, from two different vets who both use it. We chose not to do this because the one contraindication for laser therapy is direct stimulation of cancer cells, and with her being a cancer survivor, we didn't want to risk it. Not yet. Maybe when it becomes a quality of life issue ... Meowzi's oncologist was not comfortable with the idea too, for our little princess, because of her hx. Emily doesn't have that issue.

3. Niacinamide. I know practically nothing about this, but its use has been suggested to us.
 
Re: Acupuncture for arthritis? Other options?

Thanks again for the additional input.

WCF,
Her arthritis was diagnosed in her knees a long time ago. She has become increasingly stiff over time, but this issue with her spine has accelerated quickly. The vet has watched the video now as well, and I am taking Emily in tomorrow to have X-rays done. Once I have some idea of what is going on, I will explore all of these suggestions with the vet.

I do have SAMe (Denosyl) in the house, as I have been giving it to Bear. I am unable to comply with the instructions to give it two hours before food, due to timing issues with other meds and binder, and he has recently started vomiting food and the undissolved pill back up, so I am going to discontinue it in him for a bit to see if his vomiting improves. It seemed to help him with his cognitive issues.

I would be hesitant to use something that might stimulate tumour growth, due to Emily's history with lipomas and mast cell tumour.

Thanks again. I am pretty worried about her.
 
Re: Acupuncture for arthritis? Other options?

KB had several acupuncture treatments. I think they may have helped. He has spondylosis near the base of his spine and used to have more of a hump in his back when his neuropathy was worse. Since he is on several supplements and his BG is more stable, I don't know which of his regimen was doing the most good but I did not regret any of the acupuncture sessions.

Nancy has started Cody on gabapentin and so far has been pleased with those results, would that be an option?
 
Re: Acupuncture for arthritis? Other options?

Results of vet visit:

X rays done of front and hind limbs, pelvis, and spine. Heart sounds normal. No obvious tumors or growths seen.

Left knee (where her arthritis was first observed) shows a lot of thickening and arthritic changes.
Right knee has arthritic changes, but not as severe.

Tech noted that Emily objects more to having her arms manipulated than legs.
Left elbow shows significant sclerotic changes and spurring.
Right elbow shows changes, but not as severe.

In comparison, the hips and pelvis don't look too bad. Some OA changes seen in left hip.

Spine shows spondylosis and evidence of degenerative disc disease in the T12-T13 and L1-L2 area.

There is a large fat pad over her shoulders, which increases the deformed appearance of her back. The sway in her back would appear to be a result of her manipulating her body to attempt to find a comfortable position. The vet will post the X rays on VIN and see if she can get radiologist input. We still have to discuss treatment and pain control options for her. The vet still thinks acupuncture would be helpful. I have been putting a heating pad under her bedding (when I am home). I used to give a powder called Tri Acta, which contained glucosamine/chondroitin/MSM, but had replaced that with Cosequin. I will resume the Tri Acta, as it contains MSM. The poor girl must be in a lot of pain.
 
Re: Acupuncture for arthritis? Vet update below.

Aw, poor baby, so much going on in her little body. You feel so helpless watching them struggle. Almost sounds like the best that can be done is pain management. Thanks for the update, Linda, and sending prayers that there is something you can do that will help her feel better. Sometimes you wonder why if they don't get a cancer or CRF, why they have to get a deteriorating disease like arthritis. Why they just can't grow old gracefully with no problems. Please let us know if the vet gets any good feed back from VIN radiologists.
 
Re: Acupuncture for arthritis? Vet update below.

My sweet Henry(GA) had spondylosis. His backed was curved, he also had very bad athritis. Along with the special bedding, he needed prednisolone. He lived very comfortably for another year and half. He was already over 16 when I adopted, vet put his age at "ancient."

I hope you can find some relief for Emily.
 
Re: Acupuncture for arthritis? Vet update below.

oh dear. (((emily)))

i don't think you have anything to lose by trying acupuncture. most kitties (not meowzi) relax during acupuncture - have you seen pics of cassandra's sasha during tx? also ask the acupuncturist if she can show you any acupressure points that you can try at home.

i had forgotten about her MCT, you're right, laser therapy may not be appropriate then. i haven't completely written off that option altogether for us, but it's not at the top of my options - it does rank above metacam though, for us.

i hadn't realized your vet has access to VIN. ask her if she can consult with Dr Mandelker - he's one of the pharmacology consultants for VIN. he may be able to give her more info on SAM-e and niacinamide. ask vettybean to mention that she has renal disease too.
 
New article from Veterinary Practice News

Treating Arthritis With Integrative Medicine


By Nancy Scanlan, DVM
For Veterinary Practice News

[Arthritis generally is treated using NSAIDs, especially the newer COX-2 inhibitors, and often with the addition of tramadol if pain control is incomplete.

But what can a practitioner do if liver and kidney function are compromised and tramadol is not enough? Glycosaminoglycans have become part of mainstream medicine, and the effectiveness of acupuncture is widely recognized. But these two treatments are just the beginning as far as other integrative methods are concerned.

In addition, some clients are mistrustful of any drug, no matter how widely used, but for them there are options as well.

Because complementary medicine acts in many different ways, rather than being various versions of the same basic action (as opposed to COX-2 inhibitors), practitioners often will find that using a number of different items works better than trying a single method.

The use of supplements that decrease cartilage degradation, reduce inflammation and help with muscle spasms—rather than just looking to decrease joint pain—often give the best long-term effects. Add physical therapy to increase flexibility and muscle strength, and the maximum benefit will be given.

Uneven Results
Some studies of glucosamine and chondroitin in humans have cast doubt on their benefits for treating osteoarthritis pain.1 Part of the problem may be tied to the unreliability of some sources of glucosamine and the use of long-chain chondroitin that does not have the effects of a shorter molecule.2

Studies in dogs have shown its effectiveness for pain,3 though not all dogs respond this way. However, glycosaminoglycans have the ability to spare or even increase the thickness of joint cartilage in the presence of inflammation.4 So they are to be recommended, even if a client does not recognize improvement in the pet.

Be sure the client is using a brand that truly contains the amount of glucosamine stated on the label. Prolonged clotting time is a possible side effect, so discontinue use before surgery. MSM is often included with glucosamine products. A review of research articles reveals that MSM has helped arthritis pain in humans,5 and there may be an increased benefit when using it in combination with glucosamine and chondroitin.

Pain and inflammation are the two primary problems addressed by veterinarians treating arthritis. Acupuncture is invaluable for treating most cases of arthritis, though occasionally a few cases do not respond well. More often we see dogs that are initially carried into the office, and leave under their own power. The degree of response can vary from slight improvement to almost miraculous (when the immobile dog walks out).

Acupuncture may be performed by a human acupuncturist under a veterinarian’s supervision, but veterinarians certified in acupuncture are often preferable because they know more about drugs and animals.

D-phenylalanine inhibits the degradation of enkephlins6 and can prolong the effects of acupuncture7 and potentiate opiate analgesia.8 It is not commonly available as pure D-phenylalanine, so it must be purchased as the dl form (DLPA). The l-form alone helps with depression, but not with pain.

Other Options
Willow bark (Salix alba) is common in a number of over-the-counter herbal preparations for pain. Willow bark contains salicylates and is similar to aspirin, both in its benefits and side effects. Clients must be cautioned not to mix willow bark with aspirin or prescription NSAIDs. It can be combined with DLPA, giving a result similar to combining other NSAIDs with tramadol.

Inflammation in a joint produces pro-inflammatory products, which result in pain, cartilage degradation and more inflammation in a degenerative cycle. Nitric oxide is produced within the synoviocytes and chondrocytes, giving rise to the free radical peroxynitrite. Tumor necrosis factor-alpha (TNF-alpha) and other cytokines also are involved in the formation of free radicals, partly by increasing the production of nitric oxide.9 Fish oil, a source of omega-3 fatty acids DHA and EPA, has anti-inflammatory effects and can help arthritis in dogs.10--11 The alpha linolenic acid in flax oil first must be converted to EPA, then DHA, and a human study found that the amounts of EPA and DHA in the body are greater when using fish oil instead of flax oil.12

Cats lack the enzyme to convert the alpha linolenic acid in flax to DHA and EPA, and so they can’t use flax oil at all. For vegans, algae oil is available, which has an equivalent action to fish oil, but only as DHA, not EPA, the preferred form for arthritis.13 Note that fish oil can prolong clotting time. While some pets love its fishy taste and will readily eat oil poured over their food, others hate it, so it must be given as capsules.
Other oils may be helpful as well. Borage oil and evening primrose oil block the formation of 2-series prostaglandins (PGs) and 4-series leukotrienes (LTs), which have proinflammatory effects. They have been found helpful to reduce pain and inflammation in arthritis in humans.14

A number of herbs and supplements have anti-inflammatory and analgesic properties. A combination of the proteolytic enzymes bromelain and trypsin has been shown to decrease arthritic pain.15 Antioxidants help quench inflammatory free radicals. Vitamins C and E have been used for this purpose16 as well as grape seed extract and pycnogenol.

Alpha tocopherol is the form of vitamin E most often studied, though gamma tocopherol has been suggested as a more effective form.17

Research results have varied, but this may be because of the wide range of doses used as well as the fact that when E acts as an anti-oxidant it turns into a pro-oxidant and needs vitamin C as a co-factor to return to its antioxidant form. Most studies use vitamin E alone.

The beneficial effects of herbs have been attributed to their anti-oxidant effects, although some other actions have been elucidated. Most research has used humans or mice as subjects, or has been conducted in vitro, but one research article shows the benefits of Boswellia (Boswellia frereana, or frankincense) for dogs.18 Boswellia suppresses the production of pro-inflammatory molecules.19

Yucca (Yucca schidigera) has anti-arthritic and anti-inflammatory action.20 There is a lot of interest in curcumin, the main curcuminoid in the spice turmeric (Curcuma longa). A review of clinical studies in humans using curcumin shows its promise in treatment of arthritis and other inflammatory diseases.21

Curcumin inhibits neutrophil activation, synoviocyte proliferation and angiogenesis. It also was found to strongly inhibit collagenase and stromelysin expression at micromolar concentrations.22

Red ginger (Zingiber officinale var. Rubra), has been shown to have anti-inflammatory properties and to suppress nitric oxide production.23 An Ayurvedan combination of Ashwaganda (Withania somnifera), Boswellia, ginger (Zingiber officinale) and turmeric was shown to be effective in a 32-week randomized placebo-controlled trial involving 90 patients.24 The Chinese herb Dong quai or Angelica (Angelica sinensis) inhibits nitric oxide and prostaglandin E(2) secretions in vitro.25 Corydalis (Corydalis spp.) has anti-inflammatory effects also.26 The most common side effects of these herbs are nausea and diarrhea.

Gui pi tan and Shu Jing HuoXue Tang are examples of Chinese formulas that contain a number of herbs shown to decrease pain and inflammation. Chai Hu Gui Zhi Tang helps with muscle spasms.

Often so much attention is focused on radiographic joint changes that we forget that muscle spasms and soreness are a big part of the problem. When an animal is less active, muscle wasting occurs, making it even more difficult to rise from a prone position.

Massage therapy, trigger-point therapy, heat and underwater treadmill use are helpful for these problems, improving strength and flexibility in the patient.

Human massage therapists are not necessarily aware of the fragility of our patients, especially the smaller ones, and so the best results are generally found with those who have undergone training in one of the physical therapy certification courses.
 
Re: Acupuncture for arthritis? Vet update below.

Hi Linda,
Im really sorry to hear about Ms Emily's condition.

As you remember, Latte had one acupuncture tx before she left. After 5 days of not being able move, she was able to scoot and even walk a little later that evening. I dont doubt if she had been strong enough in other areas (kidney's, infections, etc) that a few more sessions would have helped tremendously. Just didnt have the time to get them in. I wish I had thought about, considered, figured out how to financially do it for her earlier. I think there was a fighting chance it would have made a world of difference for her if done sooner. I could be wrong. I just dont think it can hurt to try, if you have exhausted all other possibilities.

Latte, though immobile during her treatment, tolerated it like a champ. I wouldnt say she was relaxed, but she did not growl or fight it like she had with her exam minutes before. I think if it becomes a regular procedure they are likely to become more and more relaxed. in fact, I think she got poked in some places to help her relax. Any time she became somewhat uncomfortable, the vet knew exactly which needle to take out to help her feel more relaxed.

I hope you give it a shot. But, if you decide its not the best choice for Emily than I respect your decision.

((((((((Linda)))))))))

So much on your plate...and you handle it with such grace. Bless you and all your furry friends.
 
Re: Acupuncture for arthritis? Vet update below.

Many flakes and vines that you find something that helps. (((Linda and Miss Emily)))

Also, though you already know this, if you *do* want to try Reiki, I'm happy to send her some every day. Let me know. And: That of course goes for anyone here on the board - I'm happy to do Reiki anytime.

Jane
 
Re: Acupuncture for arthritis? Vet update below.

My vet posted Emily's case on VIN and received this feedback, which I am finding verry worrisome:


I would recommend hospitalizing this patient and start SQ fluids with low dose lasix (0.1ml)
to force diuresis. Start antibiotics to rule out kidney infection...ie Baytril bid 2.5mg/kg.
For pain start low dose tramadol ie 1/8th tab bid or less if sedated (compound the drug)
and SAM-e for joint disease. Add 250mg/day niacinaminde for arthritis and for use as
a phosphate binder . Stop the ALOH. Continue with other meds but don't need glucosamine
powder if using Cosequin. I think acupuncture is a good idea....

By lowering BUN the cat should feel better as well. Use cyproheptadine 1/4 tab
to stim appetite.

Is Acarbose really necessary??
Gabapentin may or may not be effective... consider stopping until cat
improves with renal function and appetite.

Lester Mandelker DABVP, FAAVPT
 
Linda, FWIW I took Haley(GA), big black lab-X, in for acupuncture. We only did it one time and ended up doing an MRI on her....nothing was going to help her but.........she just layed there while the vet put the needles in. never moved or felt a thing. It is worth a try for Miss Emily. I would make sure it is a vet, not a human doctore, that did it. Still believe in Reiki though. I have had it done and it works, expecially for pain.
 
Re: Acupuncture for arthritis? Vet update below.

how odd. it's almost like he's seeing/anticipating a renal crash? i don't recall her values being that bad - but then my memory's awful. what values did your vet post? what other info did she give on VIN? did she post the video too?

i'm stumped about the hospitalization and diuresis recommendation. it does sound rather alarming, doesn't it? what does your vet think?

oh, btw i know he doesn't favour ALOH as a phos binder. but meowzi's phos was so well under control with it that i was reluctant to rock the boat. and he seems wary of gabapentin when there's uremia, but it's our next option if meowzi's pain gets out of control.
 
Re: Acupuncture for arthritis? Vet update below.

WCF and Meowzi said:
how odd. it's almost like he's seeing/anticipating a renal crash? i don't recall her values being that bad - but then my memory's awful. what values did your vet post? what other info did she give on VIN? did she post the video too?

i'm stumped about the hospitalization and diuresis recommendation. it does sound rather alarming, doesn't it? what does your vet think?

oh, btw i know he doesn't favour ALOH as a phos binder. but meowzi's phos was so well under control with it that i was reluctant to rock the boat. and he seems wary of gabapentin when there's uremia, but it's our next option if meowzi's pain gets out of control.
Click to expand...

The vet posted the video on VIN. I don't know what else she posted, but it sounds like she posted some sort of synopsis of Emily's medical history, and a list of her meds.

In August, Emily's b/w values (if I converted correctly) were:
BUN 52.66 (June 47.9)
Creat 3.29 (June 2.85)
Phos 5.57 (June 5.88)
Calcium 5.38 (June 5.56)
Potassium 5.5 (June 5.5)
T4 normal
In June her USG was 1.015; in August her urine C&S was negative.

The vet posted for clarification on why hospitalization for sub Q fluids. Did he mean to say IV fluids? She asked for the actual dose of Tramadol (though I prefer Bupe). I wonder if he suspects heart disease at all, mentioning Lasix?

Do you know if niacinimide would be an effective phosphorus binder? I have never heard of this.
 
Re: Acupuncture for arthritis? Vet update below.

I would recommend hospitalizing this patient and start SQ fluids with low dose lasix (0.1ml)
to force diuresis. Start antibiotics to rule out kidney infection...ie Baytril bid 2.5mg/kg.
[/quote]


Yikes don't do that, that's nuts. Giving Lasix with SQ fluids is stupid, I'm sorry. I know exactly why he's recommending it and I still think it's stupid. Also why start Baytril unless a kidney infection is suspected? You can ask your vet if she can post to the Alternative Med folder on VIN; she probably posted to the Pharmacology folder and Dr. Mandelker is the only one who answers in that folder.

The renal values are high, though, and may be contributing to her feeling bleh and her decreased appetite. It is time to discuss SQ fluids (at home) with your vet.

I agree you may want to give tramadol a shot; gabapentin works best as an adjunct to a primary pain-relieving medication using tramadol or buprenex can boost its effect. Buprenex is expensive and is a pain to administer long-term, so you might want to give the tramadol a shot first.

Acupuncture and heat support might help. If your cat is overweight at all, weight loss will help tremendously. Cats who have arthritis should be *slim*. It can make all the difference in the world. If she's having appetite issues right now I wouldn't press it, but when things get back on track I'd work out a plan with your vet to get her to lose a little weight. If you've ever had back pain, knee pain, etc. just imagine how that pain would have been magnified if you'd had on a 20lb backpack. THat's what an extra pound can feel like on a kitty.
 
Thank you, Jess. Good to see you here. Can I give the Tramadol and Gabapentin at the same time? I had a bad feeling about the hospitalization plan. I appreciate your input.
 
Hi Linda

I would clear it with your vet first, as she knows Emily's case best, but yes they are frequently used together. Gabapentin is usually an add-on in dogs: added to Rimadyl, Deramaxx, tramadol, etc.
 
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