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MANAGEMENT OF THE OVERWEIGHT LAME DOG
Barbara Bockstahler DVM Project Group Motion Analysis, Clinic of Surgery and Ophthalmology, University of Veterinary Medicine, Vienna, Austria
The treatment of overweight dogs with orthopaedic disorders is particularly challenging. Overweight can predispose to the development of musculoskeletal diseases or aggravate existing problems, caused by the immense exertion put on joints, tendons and ligaments. In addition to the orthopaedic consequences, adipositas may cause damage to the cardiovascular system and can lead to the development of diabetes mellitus. It further constitutes a higher anaesthetic risk and generally a lower life expectancy. A reduction in weight can lead to an improvement in existing lameness1. It is clear that overweight patients with orthopaedic illnesses require special treatment. In our experience a combination of weight loss and physiotherapy has give the best results. This combination may now allows the cessation of non-steroidal anti-inflammatory therapy in many patients. The special exercise programmes also lead to weight loss in the patient. The close participation of the owner in the course of the therapy also aids owner-compliance.
1. WEIGHT REDUCTION
In order to achieve optimum weight reduction we have to take into account the various influencing factors regarding the energy consumption of the dog. These include e.g. age, breed, activity level as well as the temperament of the animal. Even in a healthy dog there can be great variations in energy requirements. For a complete assessment of the nutritional status we have to not only take into account the weight of the animal, but also work out its Body Condition Score (BCS). This score is a classification system based on a scale of 1 to 5, varying from BCS 1 (emaciated) to BCS 5 (obese).
Dietary plan management
In order to achieve a weight reduction of around 1% of the original body weight per week, we recommend a 40% reduction of the maintenance requirements. The optimum intake will therefore depend on the ideal target weight.
For practical reasons the feeding of commercially available reduction diets has proven good results. These diets support weight loss and offer an ideal balance of nutrients until the animal has reached its normal weight.
The owner may hand out a limited amount of treats, which can be seen as rewards as well as a useful tool in dental care and also play an important role in the owner-compliance. However, it has to be noted that every additional treat has to be deducted from the total original calculated energy consumption amount. Some companies offer treats with reduced calories in combination with their reduction diets. It is recommended to draw up a time schedule for the weight loss and to hand a written copy of this schedule over to the owner.
2. PHYSIOTHERAPY AND EXERCISE PROGRAMME
The physiotherapy treatment should be started at the same time as the weight loss programme. The chosen therapies will depend on the current condition of the animal.
The following methods have proven successful:
The use of hot and cold packs is very easy, constitutes no great financial burden and is also a very simple for the owner.
Heat improves circulation, releases muscular tensions and has analgesic effects.
Cold decreases acute inflammation and has analgesic effects.
Depending on the symptoms, heat treatments can be used to assist warm-up before a training session or in case of limited joint mobility, while cold treatments can be applied after the training session or with joints with higher temperature.
Hot/cold packs are readily available. These packs should be folded in some fabric (never to be put in direct skin contact) and applied to the area to be treated for at least ten minutes.
Depending on the massage technique applied, a massage can increase or decrease the muscle tone, releasing tension and improving circulation. Some simple traditional massage techniques could also be explained to the owner who will then continue them at home.
Good results in pain management have been achieved by the use of low frequency impulse streams and here in particular by the use of transcutaneous electrical neural stimulation (TENS). Nowadays there are a number of different machines available, which can be used at home. Machines with needle electrodes (PT 20, S+BmedVET, Babenhausen, BRD) have proven to be particularly useful, since they can be applied without first having to shave the area to be treated.
A large number of patients show a distinct lack of motivation to move, partly due to orthopaedic problems and partly to being overweight. The therapist faces the task of breaking the cycle of pain, reluctance to move and thus further weight gain. The success of therapy will greatly depend on setting up an exercise programme individually designed for the patient. When setting up a programme, a detailed analysis of the current exercise routine of the animal has to be undertaken while obviously taking into account the medical history of the patient (e.g. cardiovascular diseases). For the period of a week the owner is asked to write down in detail the number and length of any walks taken. The owner's life style also has to be taken into consideration. It is recommended to take several short walks a day rather then one long one. In practical terms this means that the resulting "total length of walks" should be divided into 4 or 5 segments. During these walks the dog should be controlled on a lead. In this manner it can be assessed how long the animal can be exercised without feeling pain. In addition to the physiotherapy (and if necessary medication for pain control) the daily exercise period can be increased by 10% per week. If the animal starts to experience pain while exercising, the exercise rate has to be reduced by at least 30% and thereafter increased again slowly. The owner should play an active role in the complete therapy programme. In addition to therapy in the clinic there will be homework given to the owner (such as massage, thermotherapy or electrotherapy). The dog should be given at least one short massage before each walk and if necessary have a cold treatment after each training session.
1. Impellizeri, J. A., Tetrick, M. A., & Muir, P. (2000) Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. Journal of the American Veterinary Medical Association 216: 1089-1091. SMALL ANIMAL