Dr. Angie Krause (00:00)
Welcome back to Tales of Truth where we tell the truth about veterinary medicine. I'm Dr. Angie. I'm a holistic veterinarian and this is JoJo veterinary nurse extraordinaire and my co-host. Hello.

JoJo (00:14)
Good morning. Happy post Thanksgiving.

Dr. Angie Krause (00:16)
Having post Thanksgiving. It's the Monday morning after Thanksgiving and we're dragging a little bit just a little bit

JoJo (00:23)
A little bit, but this is

I was just thinking this is the most fun we get to have So we're starting our week with some fun

Dr. Angie Krause (00:30)
That's true. Yes, you're my favorite person to work with. We got caught up on our holiday adventures.

JoJo (00:37)
All

right, we were supposed to start recording an hour ago and here we are. So, go ahead.

Dr. Angie Krause (00:40)
Yes. So we were not prepared.

we didn't, we know we're going to talk about arthritis today, we arthritis in dogs as my cat meows in the background. so we're going to talk about arthritis in dogs, which is important because it's a really prevalent common disease that we have a lot of treatments for. In fact, we have so many treatments that it can be really overwhelming.

JoJo (00:47)
specifically.

overwhelming.

I did do a little research because I want to make sure I am up to date because I have a dog that is arthritic. And so I was like what? I bet there are more options out there. So I kind of have thought about this episode for the last six months. You know? So the first thing, can I just kick us off then? Okay follow my lead. Here we go. Okay.

Dr. Angie Krause (01:12)
Okay.

nice.

I'll just follow along. Yeah. Yes.

JoJo (01:30)
So the first thing I thought about is when I first started in practice, we diagnose dogs with arthritis by taking radiographs or x-rays. And I don't think that is the standard of care anymore. Is that fair? How are we diagnosing arthritis?

Dr. Angie Krause (01:44)
I,

well, that's such a good question. You can see arthritic changes on x-ray, but the tricky part about x-ray, just because you see arthritic changes doesn't mean that it hurts. And so we can see that the bones change at the joint and we can see, you know, maybe the vertebra and the back are kind of like growing towards each other.

but it doesn't necessarily mean that's what's painful. And so I don't often use x-ray to diagnose arthritis just because I feel like it's of limited value, but it can be helpful in certain situations. if your veterinarian wants to take an x-ray, by all means do it. But just because they see something there doesn't mean that's what's hurting your dog. Fritz, are you coming? He just wants to talk about it. Just get on my lap.

We're talking about dogs. Join us. Okay, so that's what I think about x-rays.

JoJo (02:36)
Okay.

Okay. And so are there other ways that so mostly we're not diagnosing, we're symptom, we're going by symptom.

Dr. Angie Krause (02:48)
We're going by symptoms and physical exam and response to treatment.

JoJo (02:54)
Okay, got

it. That clears that up. Because I feel like that used to be, like they almost wouldn't prescribe. Is this how it was when you started practicing? Or were these just the clinics that I worked at?

Dr. Angie Krause (03:05)
I think maybe it was the clinics you were working for, because I did not.

JoJo (03:07)
Okay, that's like, yeah, we

x-rayed everything before prescribing, yeah.

Dr. Angie Krause (03:11)
you did? ⁓

there's arthritis. so no one would prescribe an anti-inflammatory without an x-ray.

JoJo (03:18)
And I want to say no one, it's like maybe the first two practices that I worked in, which were very, very conventional. And it's where I did my internships. And sometimes I wonder if where I did internships was just low par. ⁓ At that time, middle aged.

Dr. Angie Krause (03:23)
Okay. Okay.

I wonder how old the veterinarians were too. Which was,

which is this, okay. I'm like, that's a spicy thing to say, but.

JoJo (03:38)
Yeah, anyhow, okay, great. ⁓ So people

can feel comfortable if they're veterinarian is prescribing without having actually done diagnostic x-rays.

Dr. Angie Krause (03:46)
Totally, because if you say my dog is getting up in the morning and they're really creaky and they warm out of it, that's just diagnostic of arthritis. I mean, is it a hundred percent diagnostic? No, but you know, that's what osteoarthritis looks like.

JoJo (04:04)
That was my next question. What are people seeing when they, because arthritis is not necessarily, osteoarthritis is not necessarily just an old man or old woman's disease. We see it, yeah, more commonly, but we do see it in dogs that have degenerative joint disease or have had some types of surgery, you know, osteosurgeries. For lack of a better yeah.

Dr. Angie Krause (04:13)
No, but more commonly. Yeah.

Yeah. like

dogs that have had cruciate tears, like ACL, or we call them CCL tears. So they've had maybe a TPLO or an extracapsular repair. ⁓ we know that when we get to fix those problems with surgery, that they go on to have less arthritis, but it's likely that they're going to have some arthritic changes in that knee. And so that's really common. Arthritis in the hips really common.

⁓ A lot of dogs will get arthritis in their elbows and that's hard. I'd say that's the hardest type of arthritis to have degenerative joint disease in the elbow because then you just have bone on bone and it's much harder to treat. But I mean, any joint can have arthritis.

JoJo (05:08)
Okay, so then we just go into the number of treatments across the spectrum from pharmaceuticals to all the way holistic natural leaning is expansive. ⁓ It's a lot, which is exciting because there's options and choices. And I would say that some are maybe not great candidates, but they still get like big PR, if you will. So yeah.

Dr. Angie Krause (05:21)
It's a lot.

⁓ yeah, especially a lot of

the supplements out there. Mm-hmm. Mm-hmm.

JoJo (05:36)
Yeah, the supplements I would say that too. So

I mean I just when I googled osteoarthritis and dogs supplements this morning. I was just like wow the number the number of different brands just trying to capitalize on on that is far-reaching Yeah

Dr. Angie Krause (05:45)
What'd you find? What was?

is far reaching. Yeah.

JoJo (05:57)
So I don't know if we should start on the more, I mean, I would guess that our audience is more holistic leaning. So I wonder if we work our way from, you know, the more natural supplements up to the pharmaceutical interventions. And some of them are not even supplementation. Some of it is just stuff that you can be doing at home to increase muscle mass or laser therapies. I mean, there are so many therapies that are not supplementation.

Dr. Angie Krause (06:09)
Yeah, yeah.

Right, like I always think of arthritis treatment with supplements, pharmaceuticals, physical modalities, like body work, chiropractic, PT, acupuncture. And then there are some other really cool interventions that you can get with surgeons like PRP, platelet-rich plasma, like all of those kind of regenerative therapies that I see less of only because I think you just, they're so expensive.

JoJo (06:39)
PRP

I wonder if insurance will start to cover the PRP because really I feel like it's just getting so, it's getting some good ground or it's becoming more commonplace I think. Probably because it works.

Dr. Angie Krause (06:48)
So I.

doubt it.

I think it has pretty good success, I think it really depends on the dog and it depends on the joint. And I think you have to do it multiple times, which for some people that's really expensive

JoJo (07:11)
Really really really expensive. Okay. So where do you want to start? Do you want to start with physical modalities? Are you gonna start with?

Dr. Angie Krause (07:12)
Yes. Let's start with.

Yeah, let's start

with actually, you know what we should start with a little prevention. We should start there. Yeah, like how can you prevent arthritis in your dog? And one thing you can do is keep them at a lean body weight, which is really hard to do sometimes. But keep them lean and well muscled. Especially with big dogs, you don't want to grow them too quickly.

JoJo (07:22)
Okay, ooh prevention, yeah.

So true.

Dr. Angie Krause (07:42)
You want to grow them with as little inflammation as possible. And so when we think of giant breed dogs, I think that that is important. And so you want to grow them a little bit more lean and there's a lot of controversy about like calcium phosphorus balance and all that that we won't get into in this episode. But anything you can do to grow them with less inflammation and more lean, ⁓ the better. So you don't want to have a

You don't want your puppies to be too roly-poly as they grow up. If you have big dogs. Now, if you have little dogs, it's less important. keeping dogs well-muscled is really great. Keeping them active, keeping them strong, which is same for people. that's a great way to prevent arthritis. And the other thing is if your dog does have a cruciate tear, so an ACL CCL tear in a knee, the sooner you can get it fixed, the better.

And when I say fixed, like the sooner you can have surgery, the better. Now that doesn't mean if it tears that you need to have it fixed in days or even weeks, but if you let it go for months and years, then that can lead to a higher chance of having arthritis.

JoJo (08:51)
Tell me more about that. why is that?

Dr. Angie Krause (08:54)
⁓ just because there's been more wear and tear on the joint. so when they go in there and clean up the joint and then they change the angle of the joint. the, the TPLO what they do is they, they go in and clean up the joint. they take out the ligament that's torn and causing all the inflammation and maybe a meniscus. So the little pillows that sit in the knee need to get, fixed. so that they, they can do that, but then they changed the way.

the knee works, like the angle, and so it stabilizes it. And so when it's moving, it's moving in a more stable way.

JoJo (09:29)
That was so important to talk about. I like where you started with, you know, weight maintenance and these things in terms of prevention because coming off of Thanksgiving, I just stayed with my brother who had this dog who I believe she's had a double TPLO on both, you know, her hind end legs and she was really struggling the last time I saw her and she's they now have her on a little weight loss program and

The mobility and happiness and joy that that dog has just from the weight loss aspect of it was significant. It was just a significant change in her demeanor. And her ability to get up and down the stairs. Yeah, exactly. And she actually seems happier. I mean, I'm sure it wasn't a happy process, you know, because feeding is fun. But she is happier and her quality of life is significantly better. Yeah.

Dr. Angie Krause (10:02)
Yes.

Yes. And it's free. Yeah. Yeah.

Right.

Yes. Food is love.

Oh, that's good.

JoJo (10:22)
So fun.

Dr. Angie Krause (10:22)
Yeah. Yeah. Weight loss is huge. But when your dog gets arthritis or maybe, you know, you have a 12 year old lab and maybe you have kept them lean or haven't and here you are and your dog has arthritis. So they're having trouble getting up. Maybe they don't want to go up the stairs. They're not jumping in the car. They're not getting on the bed to sleep with you. Um, and so here you are. Um, what can you do naturally?

And supplements I really like are fish oil. I think that's the most underrated supplement because not only does it have great anti-inflammatory properties for the joints, but it has anti-inflammatory properties for all the organs and it helps the skin barrier. It's really important and overlooked. And so I usually have people start there. glucosamine and chondroitin I feel a little mixed about. It's never my go-to.

JoJo (11:13)
Yeah, and they are the ones

that this like the number one go to I feel like

Dr. Angie Krause (11:17)
No,

it is. I know, you know, 20 years ago, when I got out of school, we, we were taught that it's a better preventative than it is treatment. And I think that's still true. But now I think we're just realizing that it's just okay. Like when people say, I'm doing this. Should I stop? I never tell people to stop because could it be beneficial? Yes. It's not that it's not beneficial at all. It's just not my favorite.

It's not my go-to. I don't tell people like, you should definitely get your dog on. Yeah.

JoJo (11:50)
Right, I know that

we've been asked so many times why we don't carry it because that is what people are looking for. It seems to be the one that's most well known.

Dr. Angie Krause (11:54)
Yeah.

Yes, because we've all been kind of trained to do that. I mean, I think if you have a large breed puppy, there's nothing wrong with starting them on it early. But yeah, I don't carry it because I don't know that that's what I want people to spend their money on. Like, I don't think that's the most important one. I'd rather see you feed a better diet or keep your dog lean. I think that there are some.

things that are more effective, spend your money on acupuncture. so, chondroitin, glucosamine, it's okay.

JoJo (12:30)
Well, and now I see that they're adding more and more and more things to those supplements like MSM and, ⁓ what other kind of things? The green, what is it? The green lipids muscle, yeah.

Dr. Angie Krause (12:39)
green muscle. Yeah, which

is a kind of omega. they're just they're like, Okay, how many things can we add to one which, mean, is a good source of omega. But it's for a larger dog, I think it's harder to get, you know, I think it's more expensive. And so sometimes when they'll put all these supplements into one or put all these ingredients into one supplement, I don't know that they are able to get

know, therapeutic dose in there.

JoJo (13:08)
Well that and I wonder about the bioavailability when you're combining all of those things and just, you know, your body take care of all of this at once. I just wonder sometimes.

Dr. Angie Krause (13:11)
Yes.

Right.

Which is an interesting, you know, kind of underbelly. Okay, Fritz, I'm sorry, my kiddies. He's like, there are cords everywhere. I know. He's like, you're finally at your desk. I know. Yeah, I think in the supplement industry, you know, I...

JoJo (13:25)
It's demanding microphone time. I'm just waiting for it to become unplugged or for you to go missing because the camera's going to go off.

Dr. Angie Krause (13:41)
I use supplements. Obviously, we sell supplements online, but you do have to be careful to not put too much value in any one that doesn't have really good studies. Like you said, bioavailability. There are a lot of supplements out there. I think most of the time, to make your dog healthy, adding more supplements is rarely the answer. Like, I just think that it's not about the supplement game.

But I do think there are some supplements that help. So I really like fish oil. The other one I really like is CBD. I think that's helpful. We know that has anti-inflammatory properties. We know it has some studies behind it for canine osteoarthritis. And we know it's safe. We also know that it has other benefits besides, you know, increasing serotonin, decreasing anxiety. And so it can be really helpful.

JoJo (14:25)
Right, but.

Dr. Angie Krause (14:33)
in multiple facets.

JoJo (14:35)
And if you are interested in CBD, we do carry CBD. That is something that we stand behind. And we've done an entire episode on CBD. If you want to know all the ways it can benefit. So it's like a one-hit wonder. Well, that didn't sound right because that makes it sound like you to use it one time. I mean, like, if you're going to choose one supplement. That hits so many things. So one-hit wonder was not probably the right language, but it made sense.

Dr. Angie Krause (14:53)
Yes, I do.

You're very close.

JoJo (15:00)
sense in my brain.

Dr. Angie Krause (15:03)
Yeah, no, it can do multiple things. The downside to CBD if you have a 70 pound dog is that it's not cheap. And so that's when I go back to, well, you know, are we well-muscled? Are we lean? And, you know, then we do also have some pharmaceuticals that we can use as well. But I mean, back to the supplements, you're going to see, let's see what other supplements are really common. Like you'll find some like

Western herbs, anti-inflammatory herbs, and I think those can be helpful. I think most of those supplements don't have therapeutic amounts, unfortunately. I'm trying to think of what else you'd see out there.

JoJo (15:38)
Well, and I think now

I'm seeing more of the egg membrane and I think they use it from the yolk and they also use it from the shell. And so, yeah, but I mean, I don't know if that's something that's up and coming, but they're using it for muscling. I mean, I'm using it right now for muscling and my dog, to, yeah, the myos, but there's also other ones. Some are the membrane of the yolk itself and some are the membrane of the shell.

Dr. Angie Krause (15:48)
⁓

Mm-hmm.

you are? the myos? Okay.

JoJo (16:05)
and I think they hit on different aspects, but I'm still learning about that.

Dr. Angie Krause (16:09)
Yeah. And I think you have to be careful about those things because it's not that you shouldn't try them, but you know, doing things just to do them. Like I want people to see benefit. I think I so many times people will come in and they'll bring me like a bag of supplements and you're, I'm just like, okay, are these, any of them helping? And they're like, well, I'm not really sure. And I think I'd rather have you, cause that's a lot of money people are spending on all the supplements.

JoJo (16:22)
Right.

Okay.

Dr. Angie Krause (16:37)
I want to know that you think that they're helping or we have a really good basis to use them. I feel like in canine osteoarthritis, we have some really good markers like, yeah, no, this is helping because we can see the symptoms. There are other disease processes that we're using supplements for that maybe we're not going to see the direct benefit. We just are assuming that there's benefit. But I think with arthritis, it's one of those diseases that you should be able to see like, yeah, no, that really helps.

JoJo (17:06)
Well, and there is science behind the EFA or the fish oils and the CBD. So I think that's helpful. Some of these other things, just be careful when you're shopping for supplements, because I have been doing, I'm on this journey myself. And so I've been looking at a lot of supplementation and they'll say study show or the studies. And if you actually look at the study, it's of 15 dogs that they studied themselves who reported back. It's just, it's not a peer reviewed actual study. ⁓

Dr. Angie Krause (17:06)
on a daily basis.

Yes. Yes.

JoJo (17:34)
Dig one layer deeper.

Dr. Angie Krause (17:35)
Yeah, and then and just think about is this helpful? You know, this is helpful. The other thing people are using are mushrooms. People are using mushrooms for all kinds of things. I think I'm not in the habit of trying mushrooms for osteoarthritis. And I probably should fix that because I think we're finding that mushrooms are so good for so many things. I tend to use them for other applications. And so that's one up and coming supplement, although

I hate to call it up and coming. It's been around forever.

JoJo (18:05)
Well, it's gaining traction. We're understanding, I think we're understanding it better. There's more research happening in the mushroom world.

Dr. Angie Krause (18:07)
It's gaining traction in the market.

Yeah.

Yeah. So maybe that's it. So I think that could be helpful. I love the supplements when we have, you know, that have other benefits as well that can be helping. But yeah, so don't, don't just buy all the supplements or spend your money. Spend your money wisely.

JoJo (18:27)
Well, I had seen it this morning that creatine is coming up and coming. If we're gonna just keep using up and coming. I hadn't heard of using that in the pet world, but couldn't that work?

Dr. Angie Krause (18:39)
I mean, it

makes sense. I take creatine and I don't take it for muscle mass. I take it for brain health. And I notice a huge difference with my brain fog and like if I'm tired and I haven't had enough sleep. So here's just some anecdotal evidence from Dr. Angie in my own body. But I mean, it definitely makes sense.

I think that, I don't know, do we have any dosing guidelines? I?

JoJo (19:09)
Well, I didn't

get that far into it. I mean, I might, I might. Let me see, I printed it off because I wanted to read it all for my own, my own senior arthritic pup.

Dr. Angie Krause (19:14)
Here, let me look.

Let me get on VIN, make sure I don't crash our recording, but let me get on VIN and see if we have a dose that like, you know.

JoJo (19:27)
Green tea,

oh this is a good one, turmeric. I forget about that one a lot. And it is good.

Dr. Angie Krause (19:31)
my gosh, yes.

And everyone wants to use the golden paste, but no one's dogs like it. Okay, so I like, it's kind of gross. I don't know. It's one that I see, like, I'm sure it's fine, but dogs don't like it. And so therefore I don't push past it, especially. Okay. What's in the golden paste that everyone makes? It's like a

JoJo (19:38)
Again, consumers is kind of gross. Yeah.

I don't know, but we

have a turmeric supplement. I don't know if it's in a taser.

Dr. Angie Krause (19:56)
I don't think we sell it anymore.

Do we still have it? I don't think we do. It was the curcumin. Do we? And because we had, my gosh, I'm just gonna, this is not gonna promote any kind of sales, but I feel like that's the one that I just have to be honest. Like, I feel like if the dogs eat it, great. Cause some dogs will eat anything, right? Like you might have like the lab that's like, I'll eat whatever. Like I'll just eat my

JoJo (20:01)
Yeah, we still have it.

Hahaha.

Yeah, right.

Dr. Angie Krause (20:24)
with nothing in it. I'm just so excited to eat something. But I feel like those kinds of flavors are not, you know.

JoJo (20:32)
I

was going say, I think it has incredible benefit, but I'm not sure about the palatability.

Dr. Angie Krause (20:38)
Right. Yeah.

JoJo (20:38)
So

when it comes to that. Well, now I printed all this out and I cannot find where I found. But I see all these other things that we've talked about. Maybe I should just lay all this out. So we hid all the things.

Dr. Angie Krause (20:52)
Yeah. So I'm looking

on VIN to see if people are using creatine. Cause the first thing you want to do is make sure like it's safe. And I think safety studies in people like that is pretty established, but we have to be careful just because it's safe in people, you know, doesn't mean it's safe in dogs. usually does. Cats are the ones that are like the ones that are going to usually throw us a curve ball. let's see. Here's a nutritionist talking about it.

JoJo (20:55)
Yeah.

Mm-hmm.

Dr. Angie Krause (21:19)
I don't think creatine will be.

JoJo (21:19)
Well, I did pull

it. Yeah, I did pull it off of VIN. so you know, yeah, I did. So it was a veterinary partner.

Dr. Angie Krause (21:23)
you did? Did they give you any dosing on there?

JoJo (21:31)
article on VIN, but it just says taking supplements, taking creatine supplements in modest doses will improve endurance and muscle strength, but it doesn't give a dosage.

Dr. Angie Krause (21:33)
Okay.

Well, that's not very helpful.

JoJo (21:43)
I know, this was like a really broad, all of the things you could help.

Dr. Angie Krause (21:48)
wait, is

this the medications for degenerative arthritis in dogs and cats? Okay, I'm looking at it right now. yeah, there's no supplement. Okay, there's no supplementing guidelines. So that's hard, right? I don't know. Okay, well that's something to think about.

JoJo (21:51)
Yes, that's the one.

Okay, I think we covered most of the supplementation.

Dr. Angie Krause (22:05)
something think about.

Should we talk about the drugs? Let's talk about drugs.

JoJo (22:09)
Right and drugs come

in two categories, pharmaceuticals come in two categories for arthritis, right? They're the ones that are actually supporting arthritis like in terms of helping it improve versus just pain masking. Is that fair to say? Like

there's the two avenues like one's pain control and one is more like like, librela is working differently than like, Tramadol or Gabapentin

Dr. Angie Krause (22:28)
Yeah.

JoJo (22:35)
or the NSAIDs like.

Dr. Angie Krause (22:36)
Right. Yeah,

they all have a little bit different mechanism of action. so, yes, they do work differently. so, yes, pharmacologically, they're all working a little bit differently. I think the most popular one are non-steroidal anti-inflammatories like carprofen, also known as Rimadyl. Let's see, Daramax. What is the other popular ones? I'm just so deep into carprofen.

JoJo (23:02)
Well, it's so funny. have

a question about Rimadyl and Carprofen. These are the same drug, correct? One is just, and it's significantly more expensive. And also it smells, it's one of my favorite smells in all of veterinary medicine. It smells so good. But I noticed, like Bodhi will eat the Rimadyl but he does not like the Carprofen.

Dr. Angie Krause (23:10)
Rimadyl is the brand.

sometimes.

What?

⁓ what carprofen though. So, okay. So even Rimadyl comes in flavor tabs and non-flavor tabs.

JoJo (23:33)
⁓ I think it's the flavored tab No, I don't know, but it smells so good.

Dr. Angie Krause (23:37)
Yes, there.

JoJo (23:39)
I think it smells so good. Other people might be like, this is so gross Jojo. Like, why did you tell me to put my nose in this? ⁓ Yeah. Okay. Well, I don't know. So I'm almost willing to pay more to just let it be so much more. Like he spits it out. He finds it, the caraprofen in his. And I spent a good amount of money for that.

Dr. Angie Krause (23:46)
What a weird thing. Yes. But why not? Let's be weird. Yeah. So those

Yes.

Yeah, yeah, so the generic he's he's not having the generic. That's his name brand all the way mom.

JoJo (24:04)
No, he's totally...

Go, Bodhi. So my kind of, so my kind of boy.

Dr. Angie Krause (24:12)
Meloxicam is the other really like...

JoJo (24:14)
I didn't know if we were

still using that very often. We used it a lot in cats.

Dr. Angie Krause (24:18)
Yeah, I know. And then we have something better for cats. We use on-serum cats now, but I rarely see Meloxicam anymore. But you can, because it came in a liquid, so it was really good for tiny dogs. But now I rarely see it, although some, I don't know. know that it comes, Mobic is the human version, which obviously doesn't come in formulations for small dogs. But non-steroidal anti-inflammatories are really effective. They're one of my favorite pharmaceuticals.

⁓ unfortunately, a lot of people are scared of them, which is so, so unfortunate because man, they can really be life-changing for dogs. What I like about them is that if your dog handles it well, like the, the non-steroidal anti-inflammatory like carprofen, ⁓ you can give it every day or you can give it as needed. And I think that's, that's really cool that it has like some flexibility. I mean, okay. So the, the.

JoJo (25:07)
⁓ What are people afraid of? What are they coming in afraid of?

Dr. Angie Krause (25:13)
The things that can happen with anti-inflammatories is it can affect the liver. I have seen this one time in my whole career where a dog just couldn't handle it and they did go into liver failure for a hot minute and turned yellow. you know, all was well. We recovered from that and they just couldn't ever tolerate it. But every once in a while there's a dog that just doesn't do well. It's pretty rare.

It's, you know, I mean, it's basically the equivalent of Advil for people. Like most people can tolerate Advil, but some dogs, just upsets their stomach. gives them diarrhea or vomiting or causes ulcers. Just like with people. I'm sure if I took Advil every day, I'd be in a world of hurt, just because it would really affect my stomach lining. but I don't, I think that's not most people and it's not most dogs. And so most dogs do really, really well on, on these anti-inflammatories.

JoJo (26:04)
So could someone squelch that concern by starting on carprofen and then just doing a lab test, I don't know, a month to six weeks in and see how they're doing.

Dr. Angie Krause (26:14)
Yeah, I think that's interesting. I have kind of an interesting take on checking for liver enzyme elevations. So some veterinarians will insist that you check liver enzymes before starting a non-steroidal anti-inflammatory and then again, two to four weeks in, usually it's 14 days in, just to see if it's affected, you know, affected them. I...

don't always do this because some dogs are in such a place that if it did affect their liver enzymes slightly, I'm not going to take them off of it. If it's beneficial, I'm going to let their liver enzymes be a little bit elevated. And so I only do it if I think it's going to change what I do. And because I see true

liver failure, true liver disease associated with non-steroidals so rarely that I think this is less important. Some people are like, I can either afford the Rimadyl or the blood test, but I can't do both. Like that's a huge investment saying, hey, yes. And so practically sometimes, and some veterinarians will just be like, hey, just sign this waiver, you know, saying that this

JoJo (27:22)
Yeah, that's

Dr. Angie Krause (27:31)
this could be affecting your dog, but I still use non-steroidal anti-inflammatories even in dogs with high liver enzymes. I mean, there's a conversation that's had about it and I try other things, but I don't think it's a reason not to use it.

JoJo (27:46)
Okay, yeah, that is a different take for sure. Yeah, that comes from being comfortable in practice for so many years.

Dr. Angie Krause (27:50)
It's a different take. Like the new grad veterinarian is going to be like, you know, horrified.

Yes.

Yes. Because sometimes we're literally saving a dog's life with Rimadyl. And so I'm not going to be like, well, on paper, this isn't working out as well. So we're going to have to stop this life saving medication. So I'm careful about doing that. Really careful.

JoJo (28:04)
Mm-hmm.

Mm-hmm.

And this is, I have like kind of spider webby brain today, so forgive me. But why doesn't Rimadyl come in a 50 milligram?

Dr. Angie Krause (28:21)
That's fine.

because it comes in a 100 and you can split it in two.

JoJo (28:26)
It's so annoying that there's 2575, 100 and skips to 50, just drives my brain mad. I just wanted to be in a 50. Like, why did you guys just skip that?

Dr. Angie Krause (28:33)
Yeah.

because we have the 100s. And so that way the clinic only stocks three sizes. Yeah, and you're like, this annoys me.

JoJo (28:41)
Right. But my type A personality needs the

50 to be in the lineup. It's just...

Dr. Angie Krause (28:48)
Because do

you think splitting the 100, it's got a nice score on it. It's scored. Yeah.

JoJo (28:51)
It does have a nice score. It's true. It's easy.

But it's always bothered me. Okay, so that is a life changing medication. Do you want to talk about the injectables?

Dr. Angie Krause (29:04)
Well, first we have to talk about gabapentin.

JoJo (29:05)
⁓ okay, but the Gabapentin 's is working on the nerve aspect with pain, the nerve pain.

Dr. Angie Krause (29:10)
I

know, but like every veterinarian, they hand out gabapentin like candy.

JoJo (29:15)
It really does

do bad things for hind end weakness. And so if you have a dog that's already arthritic and slow in their hind end or loss of muscle mass, I am finding this. It's not always a great fit. There's my take.

Dr. Angie Krause (29:29)
Yeah, I, okay. Here's my take. And between Jojo and I, what, we've been doing this for like 40 years, maybe more, like 40 years. It's okay. Yes. For some dogs, it's like life-changing. For most dogs, it's okay. And for some dogs, I think it kind of makes things worse. I always start Gabapentin. So Gabapentin is Neurontin in people. So it's for nerve pain.

JoJo (29:31)
Yeah.

That's so sad. Yeah, it's cheap though. There, there's a win in the win column.

Dr. Angie Krause (29:56)
And I think sometimes there is some nerve pain when you have like some bone on bone or when you have like your vertebra, you know, bridging to each other. So when the vertebra starts growing towards each other, there can be like some nerve root impingement there. So I do think a lot of dogs do have a nerve pain, but I wish gabapentin was a little bit better than it is. Most dogs get over the sedating effects over time, like over a couple of weeks. So it's not as good as nonsteroidal.

It's okay for some dogs and for some dogs it's life-changing. And I always started at night to kind of get them used to it. So if their hind end is a little wobbly, then they, they're sleeping it off and they're getting used to it. So I think it can be useful. do think it's overused. I miss tramadol, which became, yeah, tramadol. I loved tramadol. And then there are all these studies that came out. That's like, it doesn't even work. And I was like, that can't be right.

JoJo (30:33)
they're sleeping that off. Yeah.

I know that was the go-to for a while.

Dr. Angie Krause (30:50)
that's how I feel about Gabapentin. ⁓ but no, Gabapentin does work. I don't want to, I don't want to say too many bad things about Gabapentin, but, I miss tramadol and I still use tramadol. I just, you know, I just need my DEA license for it and I have to call it in and it has like different, you know, most clinics don't carry it. And a lot of people were taking their dog's tramadol, which was unfortunate. So yeah.

JoJo (30:51)
That was true.

We do need to do an episode on that. We

need to do a story time episode. But I also realized that we're like 30 minutes into this episode and we have so much to cover and I knew it was gonna be a big heavy one. I knew it was. Yeah.

Dr. Angie Krause (31:18)
Story time.

This is going be one. Okay.

So let's move on to Librela. Let's just say it. Let's move on to... Yeah. I mean, I guess we could talk about Adequan but...

JoJo (31:29)
injectables, right? Okay.

Yeah, start

with Adequan one because do that.

Dr. Angie Krause (31:36)
It's not that great. I'm sorry. Every, for every once in a while there's a dog, like I don't mind doing it. Some people are like, no, it really helped. And so I think for that reason it stays on the market. And if I have a dog that's already on it, that's like, it's not like I'm like, don't take it or don't do it. It's extremely safe. It's injectable. You know, it's, it's kind of like lubricating the joint. And so

JoJo (31:37)
Hmm, what, what, what?

Dr. Angie Krause (32:00)
You know, I've used it for my own animals. I definitely used it in my horses, but it's disappointing compared to everything else we have. And I find that I would say this is just my statistic that I'm making up. 90 % of the times I try it, people are like, I don't know. I don't know if it helped. And so I feel unimpressed by it. Okay.

JoJo (32:23)
Okay, and it's once

monthly, so they're having to come in once a month on top of it.

Dr. Angie Krause (32:26)
Well, or people

usually learn to do it at home. But then there's like 5 million dosing like schedules for it. So it kind of depends. Like some people do it every week.

JoJo (32:29)
Yeah.

yeah, that's right. I forgot. does have a lot. I haven't, we haven't used it in a long time. So, okay.

Dr. Angie Krause (32:39)
Yeah, if you look at.

Yeah, anyways, so I mean,

try it if you're desperate. It's also kind of expensive, but let's talk about librela Let's talk about Librela

JoJo (32:49)
I know it I am

so interested in in your take on this because it's being pushed where I'm being seen not being pushed but it's being advised Yeah, and I I really don't understand how it Differs in dogs versus cats with the Solensia because they're the same they're the same type of medication Correct, and you're a huge advocate for Solensia and cats So educate me

Dr. Angie Krause (32:57)
Is it really? Yeah.

Yeah, so I love salencian cats and here's,

yeah, here's where I am with Librela This is personal, like, cause I just feel like, ⁓ okay, so the FDA, has the FDA come out and given us a warning? Okay. I have to say I didn't keep up on that, but there's been enough dogs that have had adverse reactions or at least adverse events associated with the Librela injection.

JoJo (33:27)
I think so, yes, I believe so, yeah.

Dr. Angie Krause (33:41)
that I don't use it unless a dog is already on it. And this is recording November, no, it's December, it's December 1st of, of 2025. So we might get some more information about this, but, I don't use it unless my patient's already on it. And if they're like, we're on it, it's helping it's life changing. I will totally give it and feel okay about it. I don't usually start dogs on Librela because I need someone to make me feel better.

about it.

JoJo (34:08)
Yeah, when there was all of this happening with all of the information coming out, I know that the manufacturer of Librela was putting out webinar after webinar after webinar of let us tell you what's happening. So there was a whole bunch of PR happening.

Dr. Angie Krause (34:23)
Okay.

No one invited us to a webinar.

JoJo (34:27)
You had to go on their site to see it. But it was, you know, yeah. Right. Maybe, maybe it would go off in the inbox. For things go to die. Yeah. Anyhow, I know that there was some.

Dr. Angie Krause (34:29)
⁓

I got no invitation. Yeah.

my God. Like so many things. Dr. Angie's inbox. dun, dun. ⁓

JoJo (34:49)
Yeah, they, don't know what to Let's just say it wasn't pretty.

Dr. Angie Krause (34:52)
Yeah,

mean, because what would happen, dogs would like go down in the back, could not walk. And it's hard because that demographic, like large dogs that have arthritic hips that are elderly are already going to be predisposed to these diseases. So everyone was like, is this correlation or causation? Meaning did this bad event happen and it just happened to be around the injection time or did the injection cause that?

And I want someone to make me feel better before I recommend it. And I'm not an early adopter of anything. Like I let things, like I let Apoquel go for like two years before I wrote my first prescription. And I, you know, I let Librela go and then all this controversy came and I'm like, I don't know.

JoJo (35:41)
Yeah, no, I don't feel comfortable administering it. Just no, not yet. They maybe go, but why does it work differently in dogs and cats? Why are cats seeing such success with Solensia Why is the Librela not having the same success in dogs?

Dr. Angie Krause (35:42)
That's me.

No. No.

Somebody make me feel better about it.

Well...

I know. I think that's so interesting. I don't know. mean, because it's not exactly the same drug. And cats and dogs are so different. And so I think that's one thing. There are people, like, if you go on to Facebook, I'm part of, because I'm always lurking, I'm a Facebook lurker of like, like, Solensia killed my cat. And, yeah, I like, because I want to see what's going on. Because while I ⁓

JoJo (36:05)
Mm-hmm.

you are on those groups, yeah.

Dr. Angie Krause (36:25)
trust loosely pharmaceutical companies with some of their information. There's always like a healthy skepticism. And you know, I tend to believe people. I you know, I try not to dismiss people's experience. I haven't I have experienced none of what these people are experiencing. But once again, you have a an elderly demographic of cats.

and you know they're doing Solensia injections and something happens was it a lot of these cases we actually don't have a cause it's hard to know maybe there was other underlying disease so it feels a little bit different with Solensia than it does with Librela because what i observe is that a lot of these kitties and if you're listening to this podcast and you need me to know something different like i'm all ears and so

If you've experienced something, you know, an adverse event with Solensia, I'm not telling you that it didn't happen. I'm never going to do that. And I'm not going to tell you that it wasn't related to the Solensia because I can't know that. but when I'm seeing these people post a lot of times I'm like, ⁓ your cat actually had, hypertrophic cardiomyopathy. And it just seemed like it was going to happen anyways. I've just seen so much good from Solensia.

JoJo (37:35)
Right.

Dr. Angie Krause (37:40)
that

I feel so comfortable using it.

JoJo (37:43)
Well, I'm curious if the dog parents that are listening to this, if they've used Librela or if they've heard of it and just what have you heard? Like how is it being presented to the average consumer?

Dr. Angie Krause (37:56)
Well, when I do relief, a lot of clinics are using it and I see it, I mean, people are recommending it still, which I mean, I might be wrong for withholding it from my patients. Like a bunch of data might come out to show that I'm wrong, but I just, I try to treat my patients like I would my own animal. And if I wouldn't give it to my own animal, I just can't.

JoJo (38:02)
Yeah.

Well, and here's the beauty in

it is that we have so many other options. It's not the only player in the game. So that's what's great. Okay. That was the Librela

Dr. Angie Krause (38:22)
So many. Yes.

How was Librela? And then, okay, really quick, because I know this episode's at 42 minutes.

JoJo (38:30)
And yeah. I know. And there's

more I want to talk about for sure. Like, but where were you going to go with your really quick? And then I'll go with my really quick. I don't know. I say we finish it.

Dr. Angie Krause (38:37)
Do we make a long episode or should we split it into two? ⁓

Okay. ⁓ We need to talk about body work, chiropractic, acupuncture, physical therapy. So in, least in really populated areas, there are all these centers popping up, which when I first got out of school, I did physical therapy. So I got certified as a canine rehabilitation therapist and

JoJo (38:47)
Yeah, that's where I was going to go too.

Dr. Angie Krause (39:05)
There's a lot of cool stuff available for dogs. We do a bunch better exam. We do gait analysis, like all the physical therapy you can get for yourself as a person is now available for dogs, which is underwater treadmill. We're putting life vests on dogs. They're getting in the pool. We're tracking their gaits I mean, it's amazing.

JoJo (39:17)
Underwater treadmills, yeah.

Yeah.

massage therapy,

laser therapy, acupuncture, and like what are there's so many? ⁓ what about the PEMF mats and a Assissi loops and

Dr. Angie Krause (39:29)
Yes.

ultrasound shockwave.

Yes, the Pulse Assisi

Loops. I mean, there's just so much cool stuff. If you have the funds to do it, do it. And a lot of insurances are covering it. Shout out to Lemonade, which I have no affiliation with other than they insure my cats.

JoJo (39:41)
Yeah.

I think

it's the most shout outs because that's where I lurk. I lurk where people are complaining about their insurance or praising their insurance places. which ones are getting praise? Lemonade gets praise a lot.

Dr. Angie Krause (39:54)
Lemonade?

I love them so

Yes, they covered Fritz's

physical therapy, which is amazing. And so like he got to have an Assisi loop and those things aren't inexpensive. He had a whole, you know, evaluation by a physical therapist, because I don't want to be his veterinarian, you know, I'm his mom. So yes. Yeah.

JoJo (40:17)
Yeah, I know that's I feel about my dogs too. I don't want to do those things. ⁓ The

PEMF mat was that pulse electric What does it stand for?

Dr. Angie Krause (40:28)
so it's like pulse signal therapy. Like it's basically the one thing. Yeah. You don't want to like, the one thing I would say you don't want to do it if your dog has cancer. Cause it, it yes, exactly. Yeah. So it's speeding up cellular activity. Same with laser too. you don't want to laser cancer if you, if you can help it, but there's all these great therapies and I have to show I have to, um,

JoJo (40:30)
Right. Electromagnetic. Password.

because it's increasing cell activity.

Yeah.

Dr. Angie Krause (40:54)
put a shout out to chiropractors, the good ones, only the good ones.

JoJo (40:57)
True.

There are ones trained specifically in animals.

Dr. Angie Krause (41:05)
Yes, in Colorado that's pretty regulated, which is interesting. Yeah, I really like chiropractic. I don't think it's great for all dogs, but it can be really helpful, especially for dogs that aren't gonna sit still for a massage. You just get them adjusted. They can walk out.

JoJo (41:19)
Yeah. Well, I was just thinking about all the at-home applications too. So as my dog is becoming less stable, we now have a very rugged house. So we have rugs everywhere. And it's so helpful, not just for his stability, but for his mental wellbeing that he can trust himself to stay standing. You know? Because I noticed like it can really impact their mental health when they don't feel safe.

Dr. Angie Krause (41:28)
Mm-hmm.

Yeah.

Yeah.

absolutely.

JoJo (41:44)
So rugs, he's got a special bed. Maybe it's the stairs to get up on the bed. So all the ways that you can just, I mean, we could spend, I could spend thousands.

Dr. Angie Krause (41:55)
Thousands, yes. That's why you gotta get that lemonade insurance.

JoJo (41:56)
Yeah.

No, too late for

him. That would be so expensive. Yes. ⁓ Well, that was a lot. I mean, is there more you want to talk about in that field?

Dr. Angie Krause (42:09)
I

mean, I could talk forever about arthritis, but if you want to talk to me about your dog's arthritis and what's available to you and maybe what your dog would be a good candidate for, you can book a consultation with me online. You can go to boulderholisticvet.com and go to book a consultation and you can find a spot on my calendar. I know I need to open up my December times.

JoJo (42:35)
You

definitely, I'm not letting you get off today without doing that. We have people that are like, when is she opening that? So they do go sometimes. And I would imagine December consultations might go quickly.

Dr. Angie Krause (42:38)
I know you're like, we're doing this right now. I know.

Yes, because December is such a busy month. ⁓ So you can book that with me. The other thing is depending on when you're listening to this, it is likely that we will have a pre-recorded online course about arthritis because I could talk about this for much longer than we're doing right now. And so when that comes out, because you might be listening to this episode in two years from now, what is our code to get a free course?

JoJo (43:12)
It is Truth Tales, and you can spell tails T-A-I-L-S or T-A-L-E-S. Either way, we'll get you the free course.

Dr. Angie Krause (43:20)
Yeah, and so you can go under our website. Where do you go again? What's the navigation of our new website?

JoJo (43:24)
it's very

long. So just go to boulderholisticvet.com and then there is a section that says courses are learned with us.

Dr. Angie Krause (43:33)
Oh yeah, it's learn with us. And then it

like goes into courses and other.

JoJo (43:37)
They're in the shop as well.

So if you're shopping, which I would just recommend because also from this episode, we carry a CBD that Dr. Angie really trusts. We carry a fish oil that Dr. Angie really trusts. And we do carry turmeric. We didn't really promote very well in this episode, but we do have it.

Dr. Angie Krause (43:51)
Hahaha

Yeah, I kind of am terrible salesperson. But if your dog likes it, if you have a lab, give it a try. If your dog's not too picky. Okay, so I think that's it. Go grab that course when it comes out. It'll probably come out sometime in 2026.

JoJo (44:02)
Okay.

and thank you for sticking with us for our longest episode yet.

Dr. Angie Krause (44:12)
Longest episode yet. See you next time. Bye.

JoJo (44:13)
OK, bye bye.