468 Canine Sports Medicine and Rehabilitation
body. Long‐chain omega‐3 polyunsaturated
fatty acids (PUFAs) including eicosapentae
noic acid (EPA) and docosahexaenoic acid
(DHA) decrease production of proinflamma
tory mediators such as IL‐1 and IL‐6 and
decrease expression of mRNA for inflamma
tory mediators including MMP‐13, MMP‐3,
COX‐2, 5‐lipoxygenase, TNF‐α, IL‐1α, and
IL‐1β (Curtis et al., 2002; LeBlanc et al., 2008). In
addition, long‐chain omega‐3 PUFAs improve
kidney, gastrointestinal, cardiopulmonary,
nervous system, immune system, and cogni
tive functions as well as skin health, and aid in
diabetes mellitus and cancer treatment (Bauer,
2011; Chandler, 2015). Improved mean peak
vertical force and subjective lameness scores
were noted in 82% of osteoarthritic dogs fed a
diet containing omega‐3 fatty acids in one
study (Roush et al., 2010). Consideration
should be given to antioxidants and chondro
protective agents such as polysulfated glycosa
minoglycans (PSGAGs), and possibly
glucosamine, and chondroitin sulfate for oste
oarthritis. PSGAGs reduce the production of
degradative enzymes such as metalloprotein
ases. In addition to improving the health of
cartilage, chondroprotective agents can help
decrease discomfort associated with osteoar
thritis (Taylor et al., 2004; Laflamme, 2005).Physical modalities
Laser therapy is an excellent tool for decreasing
pain and reducing inflammation (Alves, 2013).
Laser therapy is indicated for DJD, interverte
bral disc disease, muscle strains and sprains,
and wound healing. Refer to Chapter 7 for more
information on laser, thermotherapy, and other
physical modalities.Acupuncture, spinal manipulative therapy,
and massage
Table 18.4 offers commonly used acupuncture
points in geriatric patients. See Chapters 6 and
22 for more details on the use of acupuncture,
spinal manipulative therapy, and massage in
canine patients (Figure 18.7).Table 18.2 The HHHHHMM quality of life scale
Score* Criterion1–10 Hurt—Adequate pain control, including breathing ability, is first and foremost on the scale. Is the
patient’s pain successfully managed? Is oxygen necessary?
1–10 Hunger—Is the patient eating enough? Does hand feeding help? Does the patient require a
feeding tube?
1–10 Hydration—Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids
once or twice daily to supplement fluid intake
1–10 Hygiene—The patient should be brushed and cleaned, particularly after elimination. Avoid
pressure sores and keep all wounds clean
1–10 Happiness—Does the patient express joy and interest? Is the patient responsive to things around
it (family, toys, etc.)? Is the patient depressed, lonely, anxious, bored, or afraid? Can the patient’s
bed be close to the family activities and not be isolated?
1–10 Mobility—Can the patient get up without assistance? Does the patient need human or
mechanical help (e.g., a cart)? Does the patient feel like going for a walk? Is the patient having
seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an
animal that has limited mobility but is still alert and responsive can have a good quality of life as
long as caregivers are committed to helping the patient)
1–10 More Good Days than Bad—When bad days outnumber good days, quality of life might be
compromised. When a healthy human–animal bond is no longer possible, the caregiver must
be made aware the end is near. The decision needs to be made if the patient is suffering. If death
comes peacefully and painlessly, that is okay
Total A total over 35 out of 70 points represents an acceptable quality of life based on the parameters
reviewed in this scale*1 is poor, 10 is good.
Source: Adapted from Villalobos & Kaplan (2007)