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Hip Dysplasia in Dogs
Cosequin effects and pain management for hip dysplasia
Hip dysplasia in Golden
Hip dysplasia possible in Mastiff pup
Hip Dysplasia
Hip Dysplasia and glucosamine and chondroitin
PennHip evaluations
Hip Dysplasia - abnormal movement of the rear legs
Hip dysplasia or back problems in Dauschund
Bilaterial hip dysplasia, mass cell tumors and assessing pain
OFA Certification
Severe Hip Dysplasia
Hip Dysplasia, food and Dobies
Hip dysplasia in young Rottie
Treatment for CHD
Hip Dysplasia question
Mild Hip Dysplasia in Athletic DogPlease note: The most recent medical information is at the top of the page to least current at the bottom.
also see Hip dyplsia surgery
also see Elbow Dysplasia
also see Lameness
also see Medication
also see Motion and Motor problems
also see Orthopedic
also see Tibial plateau leveling oseotomy
Cosequin effects and pain management for hip dysplasiaQuestion: Dr. Mike,
My 8 yo GSD has been diagnosed with mild hip dysplasia. She has been
given Rimadyl in the past for a flare but suffered from bloody diarrhea
and vomiting after 4 days of treatment. At the same time she was also
started on Cosequin DS. Obviously she should not be given Rimadyl
again but I'm have a couple questions regarding treatment:1. Could the Cosequin DS have also contributed to her adverse
reaction? I'm not sure about the side effect profile of this product.2. What are her future options for treatment for acute pain? I'm not
sure I'd be comfortable with even a short course of steroids given her
reaction to the NSAID.3. If she truly needs steroids do you have any information about the
addition of a drug like ranitidine or omeprazole to prevent GI
problems?Thanks. Pat
Answer: Pat-
I have not heard of bloody diarrhea associated with the use of Cosequin
(tm) or other glucosamine/chondroitin products. However, we have had at
least one dog in our practice who developed diarrhea without blood when
given glucosamine/chondroitin products that was a repeatable
circumstance and I have talked with other vets who have had similar experiences. So I
suspect that there are a few dogs who develop diarrhea as the result of
the use of glucosamine and/or chondroitin use. In general these are pretty
safe products, though. We have had some clients who reported vomiting
associated with the administration of glucosamine and chondroitin and there are
anecdotal reports of disturbances in glucose levels in diabetic patients
when using glucosamines. There is some concern about exacerbation of
pre-existing bleeding disorders due to the similarity in chemical
structure between glucosamines and heparin. Since shepherds are somewhat prone to
bleeding disorders this may be something to think about due to the
bleeding that occurred in association with the diarrhea when Rimadyl (tm) was
administered, even though it isn't highly likely to be a problem.I would not rule out the use of all non-steroidal anti-inflammatory
(NSAID) medications based on a reaction to one of them. Individual patients seem
to react differently to the various NSAIDs and it is often possible to use
a different one without problems. Among the NSAIDs it seems reasonably
safe to use aspirin, carprofen (Rimadyl Rx), etodolac (Etogesic Rx),
ketoprofen (Orudis tm - 1mg/kg/day, may be best to use intermittently) and
meloxicam (not yet available in the U.S., in in Canada). All of the NSAIDs do
have some potential to cause problems, usually gastrointestinal, liver or
kidney related. This risk has to be weighed against the potential for pain
relief and improvement in the quality of life. Based on our practice experience
the quality of life improvement can be dramatic and justifies taking
small risks, however your experience with carprofen does give rise to higher
worries than exists in most cases. I wouldn't totally rule out the
possibility of trying a different NSAID in the future if the arthritic
pain associated with hip dysplasia becomes more severe.It is acceptable to use cimetidine (Tagamet tm), famotidine ( Pepcid AC
tm), ranitidine ( Zantac tm) and misoprostol ( Cytotec Rx) to lessen the
gastrointestinal effects of NSAIDs in cases in which they are irritating
but it still seems necessary to consider their use.For pain relief associated with hip dysplasia there are several
additional options. Narcotics can be used with good success in some dogs. We use
hydrocodone/acetaminophen (Vicodin Rx) combination medications in our
practice for chronic pain fairly frequently and it seems to be
beneficial to many patients. This combination can't be used in cats due to the
acetaminophen and rarely acetaminophen causes liver damage in dogs, as
well. Hydrocodone is available without acetaminophen and it is
acceptable to use codeine (0.5 to 2mg/kg every 8 to 12 hours). Amitriptyline
(Elavil Rx), seems to help in chronic pain when used alone or in conjunction
with narcotics. While I think it works better when used with narcotics, we do
have one patient on amitriptyline alone for chronic hip dysplasia
because it seems to do well with amitriptyline as the sole drug. Morphine (
0.5mg/kg every 4 to 6 hours) works well for chronic pain relief as well
but we usually try to reserve this use to really difficult cases when all
other medications fail. Fentanyl patches (Duragesic Rx) are an effective
short term solution for moderate to severe pain in dogs and some veterinarians
use these more chronically but we have not tried this approach, yet.Corticosteroids are very effective anti-inflammatory medications. They
have wider ranging systemic side effects than most of the other medications
used in veterinary medicine, though. For this reason, most veterinarians
prefer to avoid the chronic use of corticosteroids for conditions that can be
treated with other medications. However, there is a time in the course
of hip dysplasia when the risk/benefit balance begins to favor the use of
corticosteroids, as well. While corticosteroids can cause
gastrointestinal problems, including ulcers, this effect is less common with cortisones
than with non-steroidal anti-inflammatory medications. Misoprotol doesn't
seem to help much with cortisone induced ulcers but the H2 blockers
(famotidine, ranitidine, cimetidine) might be helpful. In general, though, I don't
think that it is really necessary to use these medications in conjunction with
steroids unless the dosage is high or daily use (as opposed to every
other day use) has to be continued for long periods of time.Using anti-oxidants, such as Vitamin E (up to 2000U/day) and marine fish
oils (3V Capsules tm) may be beneficial to some patients with chronic
inflammatory disorders. Glucosamine (500mg/25lbs body weight/day) and
chondroitin (400mg/25 lbs body weight/day) are widely used for chronic
anti-inflammatory effects and there are now some better studies that do
support their use.I wouldn't rule out hip replacement surgery, either. This works really
well in 90% of the patients who have surgery and the relief post surgically
is sometimes really dramatic. It is more costly initially but I suspect
that many of our clients spend more money in the long run treating the
chronic pain and the dog gets the benefit of not having the pain that has to be
treated. While it is probably overkill for most dogs with mild pain I
don't see any reason not to consider it for a patient who has reactions to
pain medications.I hope that this is helpful. I think that there will be additional
choices in non-steroidal medications for dogs, including one or more of the
newer C0X-2 inhibitors (a human example would be celecoxib (Celebrex Rx))
being approved for use in dogs. That may be helpful for dogs like yours who
have stronger gastrointestinal reactions to the medications that have more of
a COX-1 or mixed COX-1/COX-2 effect.Mike Richards, DVM
12/7/2001
Question: My golden was just diagnosed with chd in both hips. I
started her on glucoflex already. I just read several
studies on ester-c and they sound really promising.
Have you heard of this and if so would you reccomend
this? Also her parents were just bred again. I was
told they have both been xrayed and had good hip. I
looked on the ofa registry and there is no record of
this. Her mother is due at the end of the month. I
know that some of the people are planning on breeding
the female puppys from that litter. If the puppys are
ofa good could they be bred. I would think that they
could carry the genes for chd and should not be bred.
Am I wrong? Thank you Shari
Answer: Shari-
I am sorry that it took so long to get to your question. I checked the two
databases that I have access to for studies on esther-C and found none that
seemed to relate to hip dyplasia. Vitamin C, but not specifically
ester-C, has been studied several times in relation to hip dysplasia and
was not helpful in controlled studies. To the best of my ability to tell,
there is little risk associated with the use of Vitamin C in a dog past the
growth phase, so it wouldn't worry me if one of my clients wanted to try
it, though.The genetics of hip dysplasia are pretty complicated, since it is a
disorder that is affected by the more than one gene and also by
environmental influences, especially the weight of the puppy as it grows.
However, the best advice seems to be to try to get information from
multiple generations. The reason for this is that even when two dogs with
hip dysplasia are bred, there are likely to be as many as 25% or more of
the puppies who will have good hips despite their parent's problems. But
these dogs have a much higher risk of passing on hip dysplasia to their
offspring than if they had been from a breeding in which both parents had
good or excellent hips. In that case, the odds of a puppy having good hips
might be as high as 75% or more. I have attended one seminar in which this
issue was discussed in detail and the person presenting the talk said that
knowing only the parent's hip status improved your chances of getting a
puppy without hip dysplasia only by about 25%. Knowing two generations
improved the odds by about 50 to 75% and knowing three generations improved
the chances to about 75%. These were not presented as hard facts, just as
general guideline for the value of the information. She felt that even
knowing more generations than this did not help in breeds prone to hip
dysplasia but that it was obvious that with a large number of generations
in which selection was made to eliminate carriers hip dysplasia could be
eliminated. She used greyhounds as an example. They have been selected for
speed for so long that orthopedic conditions that might interfere with
speed are lower in the breed, including hip dysplasia.It would help a lot if there was good reporting of all testing for hip
dysplasia in a breed so that it was possible to look at multi-generational
pedigrees and the occurrence of this and other disorders and then make
breeding selections based on that knowledge. At this time, that isn't
possible, though. It is definitely worthwhile to ask for proof of an OFA or
PennHip test result for hip dypslasia, though. I know of many instances in
which clients of mine purchased puppies with the assurance that the parents
had "good hips" when they were never actually tested.Mike Richards, DVM
7/2/2001
Hip dysplasia literally means an abnormality in the development of the hip joint. It is characterized by a shallow acetabulum (the "cup" of the hip joint) and changes in the shape of the femoral head (the "ball" of the hip joint). These changes may occur due to excessive laxity in the hip joint. Hip dysplasia can exist with or without clinical signs. When dogs exhibit clinical signs of this problem they usually are lame on one or both rear limbs. Severe arthritis can develop as a result of the malformation of the hip joint and this results in pain as the disease progresses. Many young dogs exhibit pain during or shortly after the growth period, often before arthritic changes appear to be present. It is not unusual for this pain to appear to disappear for several years and then to return when arthritic changes become obvious.
Dogs with hip dysplasia appear to be born with normal hips and then to develop the disease later. This has led to a lot of speculation as to the contributing factors which may be involved with this disease. This is an inherited condition, but not all dogs with the genetic tendency will develop clinical signs and the degree of hip dysplasia which develops does not alway seem to correlate well with expectations based on the parent's condition. Multiple genetic factors are involved and environmental factors also play a role in determining the degree of hip dysplasia. Dogs with no genetic predisposition do not develop hip dysplasia.
At present, the strongest link to contributing factors other than genetic predisposition appears to be to rapid growth and weight gain. In a recent study done in Labrador retrievers a significant reduction in the development of clinical hip dysplasia occurred in a group of puppies fed 25% less than a control group which was allowed to eat free choice. It is likely that the laxity in the hip joints is aggravated by the rapid weight gain.
If feeding practices are altered to reduce hip dysplasia in a litter of puppies, it is probably best to use a puppy food and feed smaller quantities than to switch to an adult dog food. The calcium/phosphorous to calorie ratios in adult dog food are such that the puppy will usually end up with higher than desired total calcium or phosphorous intake by eating an adult food. This occurs because more of these foods are necessary to meet the caloric needs of puppies, even when feeding to keep the puppy thin.
If clinical signs of hip dysplasia occur in young dogs, such as lameness, difficulty standing or walking after getting up, decreased activity or a bunny-hop gait, it is often possible to help them medically or surgically. X-ray confirmation of the presence of hip dysplasia prior to treatment is necessary. There are two techniques currently used to detect hip dysplasia, the standard view used in Orthopedic Foundation for Animals (OFA) testing and X-rays (radiographs) utilizing a device to exaggerate joint laxity developed by the University of Pennsylvania Hip Improvement Program (PennHIP). The Penn Hip radiographs appear to be a better method for judging hip dysplasia early in puppies, with one study showing good predictability for hip dysplasia in puppies exhibiting joint laxity at 4 months of age, based on PennHIP radiographs.
Once a determination is made that hip dysplasia is present, a treatment plan is necessary. For dogs that exhibit clinical signs at less than a year of age, aggressive treatment may help alleviate later suffering. In the past a surgery known as a pectineal myotomy was advocated but more recent evidence suggests that it is an ineffective surgical procedure. However, administration of glycosaminoglycans (Adequan Rx) may help to decrease the severity of arthritis that develops later in life. Surgical reconstruction of the hip joint (triple pelvic osteotomy) is helpful if done during the growth stages. For puppies with clinical signs at a young age, this surgery should be strongly considered. It has a high success rate when done at the proper time.
Dogs that exhibit clinical signs after the growth phase require a different approach to treatment. It is necessary to determine if the disorder can be managed by medical treatment enough to keep the dog comfortable. If so, aspirin is probably the best choice for initial medical treatment. Aspirin/codeine combinations, phenylbutazone, glycosaminoglycosans and corticosteroids may be more beneficial or necessary for some dogs. It is important to use appropriate dosages and to monitor the progress of any dog on non-steroidal or steroidal anti-inflammatory medications due to the increased risk of side effects to these medications in dogs. If medical treatment is insufficient then surgical repair is possible.
The best surgical treatment for hip dypslasia is total hip replacement. By removing the damaged acetabulum and femoral head and replacing them with artificial joint components, pain is nearly eliminated. This procedure is expensive but it is very effective and should be the first choice for treatment of severe hip dyplasia whenever possible. In some cases, this surgery may be beyond a pet owner's financial resources. An alternative surgery is femoral head ostectomy. In this procedure, the femoral head (ball part of the hip joint) is simply removed. This eliminates most of the bone to bone contact and can reduce the pain substantially. Not all dogs do well following FHO surgery and it should be considered a clear "second choice".
Hip dysplasia may not ever be eliminated by programs designed to detect it early unless some effort is made to publish the results of diagnostic tests such as the OFA evaluation or PennHIP evaluations, openly. This is the only way that breeders will be able to tell for certain what the problems have been with hip dysplasia in a dog's ancestry.
When an older dog is exhibiting signs of pain associated with this condition it is often possible to help them dramatically through medication and simple steps like providing a warm bed or warm spot to rest during the day. There is no advantage to pain and steps should be taken to ensure that the older dog is not in pain. Regular exercise can be very helpful and weight loss can have dramatic effects on the amount of discomfort a dog experiences.
Working with your vet to come to the best solution for your dog and your situation will enable you and your dog to enjoy life to its fullest, despite the presence of hip dysplasia.
Mike Richards, DVM
Hip dysplasia possible in Mastiff pup
Question: Female Mastiff, 5 months old. Two weeks ago she started doing "the walk"
....back legs close together, difficulty rising from laying position. Some hopping. I know the walk.The gate into the barn area had been left open by the kids. The goats were out and our older
mastiff goes literally 'nutso' when he has a chance to chase the goats. The puppy was in on the
crazyness...and I believe she got knocked around by the older mastiff possibly running over
her or running into her. I didnt see the action, although I did rescue her from the barn area when I
realized what was going on. This of course is my preferred reasoning for her new walk, although
hip dysplasia is seriously bothering my questioning area of the brain...!!From that date to present, we are doing the bunny hop occasionally and the legs close together
walk. She seems to be getting somewhat better as the weeks go on, although this 'bothers' me
greatly....those words of 'hip dysplasia' pop up. Yesterday a visitor over here, knowing nothing of
the previous weeks rough play, said that dog has 'hip dysplasia'. The bunny hop....This visitor also
did not know she was a puppy either...1. Assuming she was injured a few weeks ago, what is the standard healing period of a
growing puppy with some kind of back end injury?
2. I dont want to run the gamete with unnecessary x-rays so your knowledge will help me in
knowing how long to expect healing or take a look at possible hip displasia.
3. Is it possible for a pup this age to show clinical signs of hip dysplasia?
4. What can I do for her?
5. Is walking and training safe to do with her while she shows these signs of back leg problems.
i.e. teaching sit and heel. She is sitting off balance and rarely straight on her back feet.Thank You
Answer: Yankee-
It is definitely possible for a five month old puppy to have clinical signs of hip dysplasia. When clinical
signs are present, it is almost always possible to diagnose hip dysplasia from X-rays, if it is the cause
of the signs. This would be a good age to get a diagnosis, if you would consider reconstructive
surgery of the hip joint (triple pelvic osteotomy), a procedure that must be done while the puppy is
still growing. It is also possible that the clinical signs could be due to another problem, such as a
strain or sprain of one of the joints in the leg, a pelvic injury or a back injury. Other problems, such
as osteochondrosis, sometimes cause lameness in one or both rear legs as well.Puppies with hip dysplasia often have more discomfort at some times than at other times. There can
be periods of soreness and then apparent recovery even though the disorder is present the whole
time. Recurrences of the soreness are common, though. It is a good idea to consider X-rays if you
see a pattern of intermittent lameness in a young dog.Strains and sprains usually heal within two to three weeks. Back injuries can take a very long time to
heal, or may not ever heal completely. At some point, it may become necessary to try to differentiate
between hip dysplasia and a back injury. If back problems are present, neurologic deficits are more
likely to be visible, with signs such as dragging the toes or problems with placement of the feet
occurring. It is often possible to tell if a neurologic injury is present through a physical exam but it
doesn't rule out a problem with hip dysplasia being present at the same time.It may be helpful to use glucosamine and chondroitin at this age to try to limit the inflammation and
provide the necessary nutrients for joint repair. Pain relief can be useful. I still like aspirin as first
choice for puppies with hip dysplasia but it can be irritating to their digestive tract. Weight control is
very important in limiting the progression of hip dysplasia. If the puppy is overweight at all, a diet may
help more than anything else.I think that moderate exercise is not likely to cause additional problems and may help due to
increases in muscle strength and possibly joint mobility. Heavy exercise will increase joint
inflammation and could potentially make the dysplasia worse. Sitting can be pretty hard on puppies
with hip dysplasia and if pain is observed, or if the puppy shows obvious reluctance to sit, it would
be best not to push the issue. Teaching the puppy to heel should be no problem.It really would be best to have X-rays taken to see if hip dysplasia is present, to assess how bad it is,
if it is present and to plan what to do for the puppy. This is especially true if it is possible to consider
surgery such as the triple pelvic osteotomy. If you know that surgery is out of the question, then it
isn't nearly as important to have the X-rays because medical therapy, weight control and restricting
exercise to moderate activity will have to be plan.Hope this helps some.
Mike Richards, DVM
10/6/2000
Hip Dysplasia and glucosamine and chondroitin
Question: My mastiff mix has been diagnosed w/ hip
dysplasia. I have him on gloucosamine
(glyco-flex)
and was wondering if Synovi-Msm is better, worse,
the same or no comment. It's all very confusing.
The glycoflex has made a world of difference...
that is until I took him to the vets on Thurs for
vomiting (at 12:30 AM), to which his doc put him
in the hospital on an IV and took xrays. All very
good measures since he diagnosed 'pancreitis". I
know... what a week of GREAT?!? health care news.
Anyway, he was hospitalized for two days. After
which I brought him home and promptly allowed him
to swim(after a little rest. since it's almost
impossible to keep him out of "his" pool). Well,
after being confined for 2 days, and with bad
hips to boot, I let him swim,which he LOVES!!! to
do. Well he has carried his back leg,to the point
I thought he had broken it, since Saturday. Upon
another recheck by the doc, he said complete rest
. NO SWIMMING!! That was probably the worst thing
to do after his confinement. Well, he has his
acupuncture treatment in the morning(1st ever).
Hopefully this will help!! I've had good
referrals from other patients who received it for
dysplasia, and they swear by it.Doc, any comments
that you think might help?The glyco-flex? The vet
has him also on ammoxycillyn for the pancreitis,
and changed his diet.
Thanks, MichaelAnswer: Michael-
There are studies that support the use of glucosamine and chondroitin for
chronic degenerative joint disease in both dogs and humans. The best of the
studies involved stifle injuries but it seems reasonable to assume that
there would be similar effects in other joints.I am not aware of similar good scientific studies supporting the use of
methylsulfonylmethane (MSM), but there are veterinarians who believe that
it is helpful and there is no reason that I know of that you can not use
MSM and glucosamine at the same time.At some point it is likely that glucosamine, chondroitin and other
"neutroceutical" agents will not be sufficient for control of discomfort
associated with hip dysplasia. At that time, the use of non-steroidal
anti-inflammatory medications such as aspirin, carprofen (Rimadyl Rx) or
etodolac (Etogesic Rx) may be necessary.If there is severe degenerative joint disease hip replacement surgery works
well in large breed dogs and provides more comfort than medications,
although it is an expensive option.I am not aware of any problems with glucosamine leading to pancreatitis so
I would not worry too much about using it again, unless there was a
recurrence of the problem with future administration of the medication.We have some clients who have had acupuncture for their dogs with hip
dysplasia and the opinions have varied from not helpful to very helpful. It
is a safe thing to try so I see no reason not to.I think that swimming is usually a good exercise for dogs with hip
dysplasia since it is low impact but it does help if exercise if regular
and moderate, rather than intermittent. It is probably a good idea to give
a dog whose had recent pancreatitis a few days off from exercise, though.Mike Richards, DVM
9/4/2000
Question: Hi Doc!
Recently attended a lecture on PennHip, given at our Dog Obedience Club. It
was very convincing! It included a slide show where OFA GOOD Rottie hips
were PennHip-ed and found to have unacceptable laxity. Scary, because OFA
"Goods" and "Fairs" are considered acceptable breeding prospects.What are your thoughts on PennHip vs. OFA?
The vet that did the presentation is one of the two in our county even
offering PennHip. He mentioned that if you PennHip at 16 weeks, and you get
a good rating, you can feel free to start running and jumping your dog at 1
year old. This is contrary to what I have always heard, specifically, that
you shouldn't do any heavy jumping or street work with a dog until 24 months.
What are your views on this?I'm really interested in this area because I'm hoping to get a Doberman puppy
for obedience work, this fall. Currently, I have a Bullmastiff with cruciate
problems and a "Pitboxer" with hip dysplasia.You may recall that I wrote to you last year in a quandary about whether to
have a total hip replacement on my 8 year old HD Pitboxer, Leda, and whether
or not to go with the cemented or cementless procedure. Well, in March of
2000 she had a Zurich cementless hip replacement on the right side. She's
had no apparent complications so far. She's still recovering (can't be off
leash yet, climb stairs/furniture, play with her dog buddies) and has an
x-ray recheck scheduled for Aug. 7th. She still doesn't put full weight on
it when she's standing, but walks well with it. The muscles on that side are
still somewhat atrophied, but improving. I'm hoping for the best and praying
I did the right thing for her. My only complaint so far, and it isn't really
a big one, is that when the surgeon was promoting the operation, he gave the
impression that after eight weeks my dog would be off chasing squirrels and
the like. There really is a lot of diligence required to manage a dog
properly during recovery. I would say that an owner should be prepared for
more than eight weeks of recovery. Just my opinion.So, I want to thank you for all the information you gave me that helped make
decisions regarding Leda.I'm trying to do everything I possibly can to avoid similar heartbreaking
orthopedic problems in the upcoming Doberman pup.
Thanks Again!
Sincerely,
ChrisAnswer: Chris-
I am not certified to do PennHip evaluations and have no personal
experience with this procedure, at all. We do not have many dog breeders
among our clients and I do not anticipate a strong demand for this
procedure in our practice, since we only do OFA evaluations once or twice a
year, probably. Because of the my former association with the Pet Care
Forum on AOL and this web site, I have followed the literature on this
technique for some time, though. I just thought I ought to make a
disclaimer for the information that follows, since there is some chance
that I am misinterpreting it due to a lack of experience with the procedure.The PennHip procedure evaluates the amount of laxity in the hip joint. The
distraction index is based on the percent of the femoral head (ball of the
hip joint) that lies outside the acetabulum (socket of the hip joint) when
a distracting force, using special equipment, is applied to the joint. So
if the head of the femur is tightly contained in the socket, it might only
be able to force 10% (distraction index of 0.10) of it out of the
acetabulum with the technique but if it is loosely contained in the socket
it may be possible to force 90% of the femoral head out of the socket
(distraction index of 0.90). Dogs with distraction indices of less than
0.3 are unlikely to develop hip dyplasia as they have little laxity in
their hip joints. Dogs with distraction indices over 0.7 are very likely to
develop hip dyplasia at some time in their lifetime. Dogs with values
between 0.3 and 0.7 are harder to make predictions about but the lower the
value, the less likely it is that hip dysplasia will develop. The procedure
may be done as early as 4 months of age (I have seen some information on
even earlier evaluations). This is my understanding of the basics of this
procedure.The OFA procedure is a standard X-ray view of the hips taken with the dog
on its back and the rear legs extended and rotated inward (an uncomfortable
and unusual position for them to be in). This evaluation is helpful if done
at ages as early as four to six months but the OFA will not certify dogs
until two years of age. There is no requirement that veterinarians submit
all X-rays taken, as with the PennHip procedure, so it is widely accepted
that a lot of people choose not to submit the films for evaluation when it
is obvious their dog has hip dysplasia to the veterinarian taking the
X-rays, making it hard to evaluate the meaning of the data collected using
this procedure. The fact that dogs can not be certified until two years of
age is a problem, since many breedings occur before this age and there are
dogs who are graded fair or good who develop arthritis consistent with hip
dypslasia later in life. Taking the X-rays with or without anesthesia can
affect the results to some degree but I am not sure how much. OFA
evaluation is available to any veterinarian with a good X-ray machine so it
is more widely utilized. Dogs that show clear signs of hip dysplasia on the
X-rays usually develop clinical signs of the disease, but some do not.I think that the PennHip procedure for evaluating hip joint laxity has some
advantages over the traditional OFA (Orthopedic Foundation of America)
evaluation for hip dysplasia and that it is a good tool for evaluating the
desirability of using a particular dog for breeding purposes. I like the
fact that most dogs who are evaluated using this technique have the results
included in a database so that breed trends can be compiled and examined.
The results are less subjective than those obtained through the OFA technique.I think that it is generally accepted that joint laxity is a better
predictor of the potential for the development of hip dysplasia than other
available tests. However, this is a better tool for evaluating the breeding
population than it is for evaluating any particular dog. It is my
understanding that it is not possible at this time to use the PennHip
distraction index score to predict accurately whether an individual patient
will go on to develop clinical signs of hip dypslasia, except perhaps for
dogs with low (less than 0.30) distraction indices. Just because joint
laxity exists and therefore the potential for hip dysplasia is greater,
doesn't mean that it will actually develop in a particular
patients. Weight control during growth, the amount and type of exercise
the dog does, traumatic experiences, pain tolerance and many other factors
influence whether a particular dog will actually show clinical signs of hip
dyplasia. This, and the need for special training and equipment, are
probably the major reasons that the procedure has not gained wide
acceptance yet among general veterinary practitioners. As veterinary
clients become better educated about pet health care, I think that the
difficulty in explaining how to interpret the distraction index for a puppy
will get a little easier, making it more likely that veterinarians will
accept this procedure.With all that said, what would I do in your position?
The first step is to evaluate the parents of a puppy you wish to consider
purchasing. You do have to remember that evaluation of the hips of the
parents is only one part of the puzzle. The parents of a puppy should have
good personalities and it is good to evaluate other breed related problems,
such as von Willebrand's disease in dobermans. With regard to hip
evaluation, though, it would make me happiest if the parents had PennHip
evaluations if one or both are less than two years of age and OFA
certification if they are over two years of age. This gives both the
predictive factors for breeding associated with the PennHip procedure and
an idea of how these factors were expressed. It is probably not likely
that you will find many breeders utilizing both of these tests, though. I
think that either one is OK if the breeding took place between two adult
dogs over two years of age who were judged good by either evaluation.What would I do to evaluate the puppy? If you intend to breed the puppy
later in life, I think it is helpful to the breed to collect PennHip data
and therefore, I would encourage you to do this. This is even true for a
puppy that you are not going to breed, if you wish to further the
information available for the breed. From the standpoint of an individual
puppy's potential for developing hip dysplasia, though, I have mixed
feelings. I think that standard radiographs are pretty good at showing
development of the disorder in an individual and that combined with
clinical signs they are the best way, currently, to decide whether or not
surgeries such as as triple pelvic osteotomy or hip replacement, are
necessary.I wish that I could answer your question about jumping and street work. I
am not sure I know what street work entails but that doesn't matter too
much, because I couldn't find enough information relating to the impact of
early exercise on orthopedic problems to be sure of anything. I will try to
continue to check into this. Please feel free to ask this question again in
the future, in case I forget to post something online that I find.Mike Richards, DVM
7/31/2000
Hip Dysplasia - abnormal movement of the rear limbs
Q: Hi Dr. Mike,
You are the first Vet I have found that I would take my dog to and not worry
about him. Your latest newsletter is Brilliant and I am sure that you take as much
time with your patients as you did writing the newsletter and it is a
wonderful thing to see. Thank You.My question is, what are the signs of Hip Dysplasia? I have a muscle bound,
vibrant 112 pound mutt, GSD/Bloodhound/Lab/ Ridgeback- those are the breeds
that I can see him in readily- that is a Super Frisbee player, he can leap 3
feet up in the air to catch the Frisbees and Loves the game. But sometimes
his legs go out from under him and sometimes it looks like his hind legs
step in the same place when I am walking behind him. He may just be
prancing or it may be something that I didn't notice before but my first dog
was paralyzed in his hind legs and tail from a car accident and while it was
easy to put him in a K-9 cart because he weighed 40 pounds, I don't want to
see Corduroy go thru the same thing because I didn't recognize early signs
of something. He's 2 1/2 years old, doesn't show that he is in Any pain or
any discomfort but I want to make sure that I'm not doing anything to harm
him as well. Basically, I can't remember if it's when they walk kind of
stiff legged or when they walk in the same spot that is an indication of hip
problems.I have a pet care business and of the dogs that I walk regularly it's about
half and half that have hip problems that walk stiff legged or in the same
spot so maybe I'm just worrying for nothing. I just wanted to be sure my
information was correct before going in for X-rays, since he LOVES going to
the Vets and we have to hold his tail still from wagging and his head down
from giving kisses when he needs an X-ray- he once came down wrong from
jumping over a fallen tree and had injured his 'ankle' but that was obvious
since he wouldn't put any pressure on it.Anyway, thanks for your help, my Vet is off on vacation for the next couple
of weeks which is why I'm writing to ask you. And by the way, I agree that
they do just as well, if not better on cooked meats, actually I've seen no
difference and have over 300 regular clients on a variety of diets.
Although I do think that they do better on All Natural or Organic kibbles-
with fresh stuff mixed in- like Flint River and Innova than on Dog Chow and
the other grocery store and pet store brands, but that's just a personal
bias.Wags- J
A: J
I think that any abnormal movement of the rear limbs may be an indication
of hip dysplasia, since the arthritis associated with this condition can
occur in one or both legs and can occur to varying degrees. In addition, it
is not uncommonly associated with elbow dysplasia, which can further alter
the normal gait. I think that in young dogs the movement that is considered
to be a strong sign of the potential for hip dysplasia is a gait in which
both hind legs move in unison, usually referred to as "bunny hopping".
There may be some correlation between laying on the chest with the rear
legs straight out behind as the "preferred" resting position and hip
dypslasia but I am not as convinced that this sign correlates strongly with
hip dysplasia among my patients. In dogs that are beginning to suffer from
the arthritis associated with hip dysplasia the first signs noticed by many
owners are difficulty rising from a lying down position and reluctance to
exercise as much as was previously the norm for a patient.I worry more about cruciate ligament rupture and tendon/muscle injuries in
Frisbee playing dogs than I do hip dysplasia. I have lots of athletic
friends who suffer similar injuries but continue to play their sports, so I
assume that this is a risk that dog would probably chose to take, though.
So I don't advise my clients to stop playing with pets just on the chance
they might be injured by the activity unless it is really high risk to the
patient.The best way to determine the potential for hip dysplasia is to take
X-rays. It isn't a bad idea to check for this in susceptible breeds,
especially in active patients. It can help in planning how much exercise to
encourage and makes early use of analgesics reasonable to consider. Since
Corduroy is a willing patient, it should be possible to get reasonably good
X-rays without anesthesia, which makes it a very safe procedure.Hope this answers your question. If not, feel free to write for clarification.
Mike Richards, DVM
9/4/99
Hip Dysplasia or back problems in Daschund littermates
Q: Dear Dr. Mike:
We have two miniature daschunds (litter mates) who enjoyed long, daily walks
around the neighborhood for the 1st year of their lives. At one year, they
each developed a limp on the back right leg, as well as a bunny-hop when we
walked very far. The limp looks like they are skipping by not putting
weight on the back right leg. This symptom is variable, and usually shows up most
at the beginning and end of a walk, with "skips" occurring every half dozen
steps or so.Our vet diagnosed Sasha with hip dysplasia based on results of a standard
x-ray and said that she was almost already a surgical candidate at the age
of one year. Sasha's sister, Alafair, showed nothing seriously wrong that
could be identified on x-ray, but the diagnosis was similarly presumed to be
hip dysplasia due to her symptoms and her litter-mate's x-ray.I have read useful information on your web site about hip dysplasia, and am
glad to have discovered you. I am hoping that you could also provide some
specific answers to the following questions about my little dogs:1) Since Sasha's limp has improved, is she less likely to need surgery
someday?2) Do you agree that Alafair has hip dysplasia despite her lack of
standard x-ray findings? Should I take her somewhere for more precise diagnostic
testing? If so, any idea where (we are in Las Vegas)?3) Both dogs seem happy and playful. Limping is not observable in the
house or yard, only on walks. Sasha is sometimes hesitant to jump up on the
couch and often prefers not to be picked up, occasionally protesting with a
little yelp.
Do you suppose their discomfort is mild?4) Do you agree with regime of 250 mg cosamine and one-quarter tablet of a
300mg etogesic tablet daily for 13 lb. Sasha and 11 lb. Alafair?
Rimadyl was discontinued when one dog had stomach upset and we read more
we grew concerned about side effects in dogs starting medicine so young.5) Do you agree with our exercise regime (much reduced) which we limit to
leisurely strolls of 200-400 yards twice a day? They would like more
but favor that back right leg a bit more when we go further.6) What do you think is likely to happen with our dogs condition in the
future at this rate with regard to progression of the problem, changes in
treatment plan, etc. ? Is there anything else we can do to remediate the
problem or at least slow its progresssion?We will eagerly await your reply. Thanks so much!
Sincerely,
Dachshund Lovers
A: Melissa-
I'll try to answer your questions in the order you asked them and put some
clarifications in later.1) If the limp is improved that is a good sign that Sasha would not need
surgery.2) The degree of pain and disability with hip dysplasia does not always
correlate well with the X-ray signs. Some dogs have really bad hip X-rays
and no dysfunction while others have only moderate damage visible on X-rays
and seem to have a lot of pain. If there are almost no signs of hip
dysplasia then I really do think it would be a good idea to consider other
possible causes, though.3) OK, here is where I have to let my prejudice show. I think that for a
dachshund patient with these signs it would be a good idea to consider the
possiblity of intervertebral disc disease, even if hip dysplasia is
present. I just think that it is a good idea to always keep in mind the
particular problems known to occur in a breed when symptoms of it appear.
Not wanting to jump on the furniture and crying when being picked up could
be signs of disc disease (and do occur with hip dysplasia or luxating
patellas, too). Luxating patellas (dislocating kneecaps) are are really
common in small dogs and cause many of the same signs as hip dysplasia and
back disorders. You can often feel the kneecap dislocate if you rest one
hand on it and then flex the leg with the other hand.4) Sasha weighs about 6 kg and Alafair weighs about 5 kg. The dose for
etodolac is 10 to 15mg/kg. So Sasha should get 6 x 10 (60mg) to 6 x 15
(90mg). Alafair should get 5 x 10 (50mg) to 5 x 15 (75 mg). Since 1/4th
of a 300mg tablet is 75mg, Sasha is in the mid dose range and Alafair right
at the top of the dose range. While this is theoretically OK, it would be a
good idea to keep a close eye on Alafair for signs of gastrointestinal
upset or inappetance. If these occur, discuss this with your vet right away.The dosages used for glucosamines vary some among vets but it seems to be
pretty same to use, so this dose should be OK.5) I tend to favor exercise but that is a personal bias that doesn't have
to do much with science -- I am a runner and a rower and so I think
everyone and everything should exercise. It does help with weight control
and if you stick to flat surfaces it shouldn't hurt to go further. In
humans, it really does appear that exercise is gaining favor in the face of
arthritis problems and even disc problems, though. But you should ask your
vet, too. After all, he or she knows the degree of damage visible.6) I think that you are actually doing most of the things necessary. Weight
control is very important. There is a small chance that one of your dogs
might actually be overweight for their body size but it doesn't seem too
likely, given their weights. I think moderate exercise is important and I
would include distances as long as a mile or so as moderate for a
dachshund, personally.There are a couple of points I think I need to expand on, a little.
First, I think that there is at least some reason to consider back
problems. Back problems can be hard to evaluate and the treatment for them
isn't different from what you are doing -- but if sudden weakness or
paralysis develops you should be prepared for it and know what to do
(surgery within 24 to 48 hours is necessary, so a decision has to be made
before the problem occurs). If there is an orthopedic or neurology
specialist in your area, it might be worthwhile to consult with them. I
don't honestly know how frequent hip dysplasia is in dachshunds, but we
don't find it very often. I think the prognosis is good that Sasha will do
OK -- but having someone experienced in the possible disorders check her
will give you the best idea of the long term prognosis.Your dogs are too small for hip replacement surgery, unless there are new
prosthetic devices I am unaware of. Therefore, your surgical options are
limited. At their age (past their growth period), the only surgical option
I can think of is femoral head ostectomy. Since this surgery essentially
destroys the hip joint there is no real reason to rush into it. The surgery
works best when it is done before muscle wasting occurs but it is almost
always successful in dogs weighing less than 30 lbs., so your guys are in
the right weight range. If Sasha has to have surgery later, it will
probably work well. In the meantime, I think I'd base medication and
exercise and things like that on the amount of pain she is showing -- if
she seems to be doing well, she probably is.Lastly, lots of little dogs don't like to be picked up. That would probably
be true of big dogs, too -- but people don't try to pick them up. Resisting
or crying a little may not be signs of pain, they may be signs of protest.
It would be nice to be able to ask them how they feel but we can't so you
have to guess. You know them best, so you can probably guess better than
anyone else.Hope this helps.
Mike Richards, DVM
8/15/99
Bilateral hip dysplasia, mass cell tumors and assessing pain
Q: Dear Dr. Mike,
My dog, Leda, is a Pitbull/Boxer cross, female, seven years old. She
has bilateral hip dysplasia. When she was two years old I took her to an
orthopedic specialist. He said due to arthritic changes present, she was no
longer a TPO candidate. As she was hardly symptomatic at this time, he
suggested buffered aspirin up to twice a day. He said to monitor her and
recheck in a couple of years or as needed if anything changed. My regular
vet, at that time, was going into holistic and alternative vet medicine.
(He now has a holistic only practice and I am now with a conventional vet) He
did a surgery on her where the muscles on the insides of her hind legs were
cut.
He also implanted tiny gold beads at acupuncture points in both hips and
spine. She has been on Glycoflex and antioxidants since the HD diagnosis.
She also gets Adequan IM once every three weeks. All has been going pretty
well. When she turned six, I decided to have her x-rayed again and
evaluated once more at the orthopedic specialist. The reevaluation was delayed by a
bloat incident, which was caught early and resolved without surgery during
an overnight stay at an Emergency Clinic and another day at the regular vet. I
am now doing all the recommended bloat preventative measures (small feedings,
soaking food, raised eating position, restricted activity at mealtimes, etc.) and have
not had another incident. Ortho reevaluation was again delayed by a large, ugly
corneal ulcer that required weeks of treatment by a veterinary
ophthalmologist to heal. Finally, in Jan. we were set up to xray. That
week, a small tumor on her back thigh appeared and started to bleed. While
under anesthesia for the x-rays, they took that one off and found two
others, chest and groin. Histopathology indicated grades 1 and 2 mast cell tumors
with clean margins. The surgeries were redone for wider margins, just in
case. Leda has just finished 6 months of prednisilone, cimetidine and
benedryl. She's still on the latter two meds. Hip radiographs were ugly,
even to the untrained eye.Finally got her to the specialist. Advanced degenerative changes,
severe dysplasia, candidate for THR. He didn’t think FHO was a good choice
because of her size (65 lb.) and the condition of her hips (both pretty
nasty). He said he could and would do the THR surgery now if I wanted but
didn't know whether I would see much improvement in her function. He said
she was stoic, but didn't indicate she was in that much pain. She had
reduced range of motion when extending the legs. He then said he saw no
problem maintaining her with Rimadyl as needed.I don’t really know what I should do, in the best interest of my
dog. She doesn't have to be an athlete or anything, just a pet. She is a
very active dog, who given the opportunity, would fetch and chase game
until she dropped. On the other hand, she is equally happy to sleep on the couch
and just do walks and restricted ball playing. She does not limp at all when walking
or trotting (although her walk is somewhat stiff legged in the back) . Faster than
that, she does lift the leg on the more affected side higher, but she does use
it - she just has a limp (the older, “country” vet at the practice called it a
“hitch in her giddyup”), of sorts. She does put less weight on the
worse side, when standing, but she is using the leg. She still has decent
muscle mass in her hind legs but they are not as muscular as the front of
her body. She seems to have little difficulty rising. She goes up stairs
freely.My concerns surround how much pain she is in, the risks of the
surgery itself, the consequences of delaying due to her age, the consequences of
going ahead regarding the mast cell situation, etc., etc.What length of time without reoccurrence of MCTs would the condition
be “cured” or is it never considered cured? Could the surgery itself affect
the reoccurrence or spread of MCTs? One of my regular vets expressed concern
over the prosthesis and cement causing a mast cell response. The procedure
they're using at the Orthopedic facility I went to uses no cement, just
screws, but what of the prosthesis itself?How can pain be accurately accessed in dogs? Would I be delinquent
in waiting until she shows more impairment? Might she never degenerate
beyond the point she's at now? What are the guidelines for quality of life
assessment? (I’ve seen dogs chained outside for their whole lives that
appear to be happy, yet I would consider that a poor quality of life.) How
is it that her x-rays are so ugly but she is getting around seemingly well?
Have you seen that situation a lot? Makes me think that perhaps the
arthritic changes stabilize the joint or are the body's way of trying to fix
the problem. Could the gold beads possibly be responsible for her getting
around so well? When I agreed to let the holistic vet try it, I didn't have
much faith, but I figured it probably would do little harm.As far as financial concerns, I know it is an expensive procedure
(what credit cards are for, right?) but if it is necessary I will manage it
without regret.Doctor, any opinions or ideas you have on Leda’s situation, would be
welcomed. I realize the difficulty in assessing a case when you haven't
actually examined the patient, but any answers, thoughts and suggestions you
can provide will be greatly appreciated.Thanks for you help and also thank you for VetInfo Digest. It’s very
informative and I look forward to every issue.Sincerely,
Chris
A: Chris-
There were a lot of questions in the text of your note, so if I miss one,
please point it out.Mast cell tumors that are grade 1 are supposed to have about a 10% chance
of being metastatic. Mast cell tumors of grade 2 are supposed to have about
a 10 to 25% chance of being metastatic. So the odds are pretty good that
the mast cell tumors will not recur but 25% is one in four -- so there is
also some chance they will. Rechecking regional lymph nodes, checking the
buffy coat (in a blood sample) for mast cells, possibly considering bone
marrow aspirate, considering spleen and liver biopsy and at least chest
X-rays (+/- abdominal X-rays), would probably be a good idea prior to
considering extensive surgery in a patient who has had mast cell tumors
removed within a year or so. I think that for mast cells it takes about 5
years of being free from them before it is really reasonable to talk about
a cure. That obviously complicates the decision making regarding surgery
somewhat, but I do think they are separate issues in most respects.I wish we could ask our patients questions, sometimes. Pain evaluation is
one of the number one reasons I long for that ability. Just like people,
pets are very variable in their ability to cope with pain and in their
reactions to it. Some dogs and most cats are really stoic about pain. But
I'm sure they appreciate relief from it. It is just really hard to tell who
is being stoic and who really isn't bothered much.Hip dysplasia is notorious for having a poor correlation between X-ray
signs of the disease and the functional ability of the patient. Dogs with
horrible X-rays may have nearly normal activity levels while dogs with
moderate signs seem to be crippled by the disorder.Decrease in the range of motion does seem to correlate some with pain. In
experimental studies, force plate analysis seems to correlate pretty well
with the degree of pain the patient experiences. For this test, a device
that measures the pressure applied by the feet to a force plate as the dog
walks or stands is used. Dogs that are in pain in one or more legs apply
less pressure to the foot that is pained, which can be measured. This works
best for injuries involving one leg but can work for injuries involving
more than one leg as long as not all of them are involved. Obviously, most
practices can't do this test. Difficulty rising is a sign of pain in most
cases, I think. General grumpiness, weight loss, inappetance, decreased
activity and other non-specific signs also occur. In the end the best thing
is probably to assume that there is pain when similar disorders or diseases
cause pain in humans. Using this criteria, there is a good chance that Leda
would appreciate having artificial hips.I have no idea if the gold beads are helping. It is possible.
Hip replacement works a lot better before there is a lot of muscle loss and
sometimes degenerative changes can get severe enough to interfere with the
surgery. I tend to think that it is better to go ahead and do it when it
seems inevitable that it will be required. The problem is that with the
signs seen in your note is it does seem possible that medical treatment may
continue to sustain Leda, although she would have to deal with at least
some pain on a chronic basis. That makes the choice tougher, but I would
still lean towards doing surgery in a dog of my own.I couldn't find anything to indicate that mast cell tumors are more common
around previous surgical sites but some tumors are, so I can see your vet's
concern over that.To sort of sum this up:
If money is not a major concern and it is possible to have a good work-up
to evaluate for the spread of the mast cell tumors, which turns out to be
negative, then I would really lean towards hip replacement, if I was making
this decision. I am an optimist and I'd just hope for the best on the mast
cell metastasis concern.If money is a major concern (as in you would be disappointed to spend $2500
and find out six months later that the mast cells had recurred), then you
do have lots of evidence that Leda is at least accommodating her condition
well and you shouldn't feel guilty about continuing medical treatment. Most
people would make that decision, I suspect.Hope this helps, some.
Mike Richards, DVM
8/4/99
Q: Dr. Mike,
Is it possible to get a good set of hip x-rays on a dog for OFA certification
without using General Anesthesia? Also, what are the views required for this
certification?I have a problem with using GA for something that is technically an elective
procedure, but I suppose as a predictor of possible future health concerns it
might be considered worth the risk.Your thoughts would be appreciated.
Melissa
A: Melissa-
The short answer is yes. The longer answer is that it depends a lot on the
dog and it also depends on what state you live in. Positioning is critical
for OFA films and the positioning is a least a little uncomfortable, to
outright painful, for the dog, depending on how bad its hips really are. To
position a dog for an OFA film the dog is rolled onto its back and then the
rear legs are stretched out straight and the stifles (knees) turned in so
that they are parallel with the kneecap centered in the patellar groove.
The legs usually have to be pressed down toward the table to keep them both
straight and parallel. This full extension of the hip is painful for a dog
that has hip dysplasia and probably uncomfortable even for a normal dog. I
imagine that it feels a little like a person does when they try to stretch
too far when doing toe touches.We will try to get OFA films without anesthesia if a client requests it and
understands that we may charge extra if it takes several attempts to get a
good radiograph. When it is obvious that the dog is not going to cooperate
with us we usually try sedation with acepromazine and butorphenol or
oxymorphone. Most of the time this will work and it seems to be a little
safer than general anesthesia. When even this is insufficient the dog is
usually sedate enough to allow us to mask it down with isoflurane gas and
we have not yet had an anesthetic death using this protocol. Plus the
isoflurane is rapidly excreted from the system, so the dog wakes up
quickly. Currently propofol may be another good option in anesthesia for
quick procedures like an OFA film but we haven't used this anesthetic agent
yet. It is rapidly absorbed and recovery is also rapid so anesthesia time
is reduced.I don't practice in New York but it is my understanding that veterinarians
and their assistants are not allowed to hold patients for X-ray procedures
in that state. If that is the case then anesthesia is the only option I can
think of to obtain proper positioning.When we are suspicious that the patient does have hip dysplasia we will
sometimes do a preliminary film without trying to achieve perfect
positioning, only pushing the dog as far as it will allow us to showing
pain or discomfort. If these films show obvious hip dysplasia there is
little need to try for OFA certification. This does skew the overall breed
evaluations done by the OFA because they don't get the films from dogs with
bad hips but it is better for the individual patient.While there are probably lots of people who would disagree, I view the OFA
testing (and the Penn-Hip testing) as being good for the breeds by helping
to eliminate a disorder that is partially genetic and that affects a lot of
dogs. I don't see a lot of value in doing OFA screening for an individual
patient who will not be bred as a means of predicting future orthopedic
problems since most veterinarians can read the radiographs well enough to
figure out if a dog needs, or may need, surgical correction for dysplasia.Hope this helps in your decision making.
Mike Richards, DVM
Q: My puppy of 8mos. is diagnosed w/ hip displasia in both hips. We understand the humanity of release from
suffering but this is a 4 day old diagnosis, and we are asking for aid or suggestions aquifer funds to get
this surgery. We are willing to arrange payments w/ any source of funding or school, as well as make arrangements
w/ a veterinary training school. We love him he is more than a pet he is a member of my family deeply rooted as
my son or fiancée. Please respond if you have any aid or suggestions or alternatives to euthanasia. We are not willing to medicate him for very long though as it is only avoiding a necessary conclusion.thank youAlways Curious,
StrevreP
A: I can't tell from your email where in the country you are located but the two veterinary schools in my area
(Va-Md Regional College of Vet Med and NC State) will make financial arrangements with owners considering hip replacement therapy. In your pup's age range it is also reasonable to consider triple pelvic osteotomy surgery which is usually a little less expensive. If you are really lucky you might hit a time when a research project is going on and there is funding for studying these types of surgeries which usually reduces the cost to the owner. It is at least worth asking.We have had two puppies in this age range have total hip replacement surgery in our practice and both are
doing very well. Both owners seem to be very pleased with the results.You don't have to make an immediate decision. You have enough time to that you can think this over, check
out the costs and the available payment plans and make a rational decision. If you can work out a satisfactory
payment plan I think that you will be happy with the results of the surgery.Mike Richards, DVM
Hip Dysplasia , food and Dobies
Q: 1. Dr. Mike, I have two male Dobermans, the oldest is now 10 months and the youngest is 12 weeks of age. I feed what I think is a high quality premiun dog food, Eukanuba. The 12 week old gets the large breed puppy formula which has 26% protein and 14% fat, whereas the 10 month old gets their origional formula which has 30% p. and 20% f.
My question is, I have always heard that Doberman puppies should not be fed a diet of more that 28% p. due to fast bone growth causing hip displasia, etc. Is this true and if so should I be feeding my 10 month old 30% p. in his diet?
#2. My 12 month old puppy has a small cyst (smaller in diameter than a pencil eraser) in the skin on top of his head. I would like to have it removed and I was wondering, if this procedure is done properly, will it leave a scar and will hair return to that area?
#3. I am concerned about my 10 month old Dobe. When he's commanded to sit, his right leg seems to stick out to the side. He will tuck it in if you tap on the side of his leg but he rarley does it on his own. The dogs trainer said she does not believe it is anything to worry about, that he is still developing, and that he probably has some discomfort in the hip or the leg from growth or development. Also, I have seen pictures in my Dobe books of world champions who do exactly the same thing. So is this something I should worried about right now or should I wait to have him tested?
A: M-I am not sure that the issue of protein/calcium/calorie/? restriction has really been answered in relation to hip dysplasia. At present the only study I am familiar with showing a postive correlation between a dietary change and avoidance of hip dysplasia (AVMA Journal, Sept. 1992, Kealy, et al.) suggests that calorie restriction is useful in avoiding hip dysplasia. Excessive calcium adminstration has been linked to development of hip dysplasia. These are the only dietary influences that I know of that can be substantiated by research that has been done and that I am aware of.
So: 1) I'd feed the lower protein, lower fat food to your older doberman, too. Because it is calorie restricted in comparison to the higher fat version.
2)Even surgery done well can sometimes leave a scar because the surgeon is not totally in control of the situation. The patient can make a mess of a really good surgery. However, the odds are very good this would work well and no scar will result.
3)I'd wouldn't want to diagnose hip dysplasia or any problem based on the sitting posture of a dog because that varies a lot. I do see a lot of value in checking for hip dysplasia at this age if there is any suspicion of it, though. This is the time that it is possible to make a difference with medical or surgical treatment if hip dysplasia is present.
Hope this helps.
Mike Richards, DVM
Q: We have a 10 month old female rottweiler puppy who has just been diagnosed with hip dysplasia. The x-rays have been read by a Professor of Radiology at the College of Vet. Med. in Saskatoon, Saskatchewan, Canada. The x-rays indicate she has moderately severe bilateral hip dysplasia (Grade III/IV). Acetabula are shallow and poorly formed and she has bilateral subluxation of the femoral heaads. Also remodelling of the hip joint structures. We have been told to limit exercise and to keep her very quiet; however, being a puppy, if there is anything interesting going on or if there are people to see, Meika gets pretty excited and won't stay calm.
What type of treatment can we give her now to make her as comfortable as possible? As she is still growing, I don't know if there is any surgery that can be done. I understand that hip replacement is usually done in older dogs and may not be the surgery of choice for a younger, still growing, dog. Euthanasia is not something we would even consider now. She is too much a part of our family and as long as we can keep her comfortable we will do whatever it takes. Can we take her out on walks? Can she run with the other dogs? Is obedience school too much for her? Will this do damage to her if she does these kinds of activities? Are there any natural remedies that we can add to her diet that will slow down the development of her condition? I hope you can give me some advice as we sure don't want to lose this little sweetheart. They can sure grow on you in a very brief period of time. Thank you
A: Ole- One of the surgeries for correction of hip dysplasia is a procedure known as a triple pelvic osteotomy. This surgery remodels the hip joint so that it can develop in a more normal manner. It is best done during the growth phase and is an option that you should discuss with a knowledgeable surgeon if possible. Hip replacement can be done at this age if necessary but is usually done a little later.
I think moderate exercise is beneficial for dogs with hip dysplasia. If surgery is done it may be necessary to restrict activity during the healing process, though.
Use of the polyglycosamine products like Glycoflex (Rx), Glucotabs (Rx), Arthroflex (Rx), etc., may be beneficial in dogs in limiting the damage as hip dysplasia develops. This is not a sure bet at this point but the products seem to be very safe so they are probably worth trying. Adequan (Rx), an injectable version of these products has been shown in one report to be beneficial in limiting the progression of hip dysplasia in growing dogs. This is another product to consider.
Mike Richards, DVM
Q: Dr. Mike..I have a 10 month old Golden Retriever who was diagnosed at the age of 7 months with CHD. She is currently on Rimydal and it seems to be working well for her. My vet also put her on a course of nutritional therapy; Cosequin DS. I have been reading your web page (which by the way is wonderful) and seems that in many of your answers you have indicated that there seems to be no reliable data out there that really backs up the use of medicine for nutritional therapy. Is she possibly just benefitting from the Rimydal. Consequin DS is a very expensive drug, however, it is worth it to me if this is also helping her. If nutritional therapy is indicated for CHD, I have found a source for a drug referred to a "Joint Care". It contains all the same ingredients that Cosequin DS contains, Glucosamine Hydrochloride 500 mg, Chondroitin Sulfate 400 mg and Ascorbic Acid 50 mg. Do you believe that Consequin DS is indicated for CHD or are we seeing fairly good results just from the Rimydal. Thank you.
A: Sandy- Even though there doesn't seem to be a lot of scientific data on the oral glucosamines relating to their use in dogs I think that the overall impression among veterinarians is that they seem to do some good. This may be particularly true for puppies in the age range of yours. There was a paper written on the use of Adequan (an injectable glucosamine) in growing puppies with signs of hip dysplasia in which great improvement was seen in the long term outcome for puppies treated during the growth phase. This was done on a small number of pups and has not been verified to the best of my knowledge but it still indicates a possible benefit. I have no clue at all whether a particular brand name of these products may be significantly better than other formulations. If they seem similar based on ingredients and there is a big price difference, I think I'd be tempted to use the lower priced product.
At present I still prefer surgical approaches to this disorder when it is moderate to severe in puppies in their growth phase. Even though surgery such as a triple pelvic osteotomy can be expensive it is still usually less expensive and better for the affected dog over the long run. Usually this surgery does involve traveling to an orthopedic surgical specialist but it is an option to consider. I have to admit that most of my clients still prefer medical treatment, though, even when offered this option.
Carprofen (Rimadyl Rx) is an effective pain reliever and I think that is important and may be the reason behind most of the perceived benefit (less visible pain) but it is probably less likely to provide the benefits seen in the Adequan study than glucosamines administered orally - and they may be less likely to provide the benefits than Adequan.
Mike Richards, DVM
Hip Dysplasia - second opinion
Q: Hi Dr. Mike, My doberman/husky mix dog was recently diagnosed with hip dysplasia, and I would like to get a second opinion; and also to talk to someone who is really an expert in this field about treatment options. Can you tell me how I can find veterinary experts in this area? Thanks
A: If there is a board certified surgeon in your area who handles orthopedic cases, he or she is most likely to be the regional expert. Alternatively, getting an opinion at any of the veterinary schools is a pretty sure bet for getting an expert opinion. Your veterinarian should be able to refer you to a surgeon who is certified by the American College of Veterinary Surgeons. The initials ACVS are usually appended to the veterinarian's name to signify this accreditation. If your dog is still in the growth stage of life, it is important to get this opinion as quickly as possible. Some treatment options can only be done when the dog is still growing.
Mike Richards, DVM
Mild Hip Dysplasia in Dog Athlete
Q: Dear Dr. Mike, My 3 year old German Shepherd Dog bitch was diagnosed with mild hip dysplasia (no arthritic changes) at 2 years during her OFA screening. I of course spayed her immediately. However, she and I enjoy many dog related sports (obedience, herding, agility, and tracking) and I am concerned that some of these may be counter-indicated due to her hips. She has earned her CD title and I have been hesitant about training for the CDX due to the jump requirements (36 inches). Should I limit her activity level? She would go until she dropped and never indicates she is in pain, however, I can tell the HD is limiting her. I am beginning to see effort in standing from a lying position and she is starting to show signs of clumsiness--- especially when tired. Should I limit her to only certain activities? This is a dog who enjoys what she oes and misses it when don't have our "sessions" but I want what is best for her. Secondly, is there anything I can do that might help to prevent or lessen the severity of the eventual arthritic changes? I have heard about shark cartilage, glyco-flex, Cosequin, etc. I would be interested in you opinion as to any preventative treatment regime.
A: It is my opinion, based solely on my personal observations (no science here, unfortunately), that it is much better for animals with arthritic diseases to maintain a moderately active lifestyle. Dogs who are allowed to continue to exercise despite signs of degenerative joint disease seem to do better longer than those whose owners chose to restrict their activity levels. However, this has to be kept within reason. So whether or not to pursue the CDX is questionable. It would be better if you knew how good her elbows are, too. You didn't happen to have them X-rayed at the time her hips were done, did you?
I think it would be OK to start the training and see how she does. A good deal of the impact of jumping is actually borne by the front legs on landing. As long as they are OK she may be able to comfortably complete the training. However, if she shows reluctance to jump or if it obviously causes disability afterwards for even a short duration of time, like the next day, it would probably be best to give up on this goal.
We have tried several of the glycosamine products in our practice but not Cosequin (Rx). Some people thought they worked well and others didn't. Personally, I felt that most of the time I could not perceive a great deal of improvement on these products. That is different than believing it never occurred, though ---- I do not get to see many of my patients in the same situations their owners do, so I lean towards believing the client's perception of whether or not there is benefit. Since the products do not appear to be harmful, it seems reasonable to use them if their expense is not a burden.
On the other hand, I do think that I can perceive a difference in many dogs when they are treated with aspirin. It is less expensive and it seems to work better in our practice. As long as it doesn't cause gastro-intestinal upset, it can be used intermittently, or long term, as necessary.
A new medication, carprofen (Rimadyl Rx) is also available. It has worked very well for several patients and not at all for others. Usually it is possible to tell if it is going to be of benefit in a short trial --- a week or so. The major drawback is that it is pretty expensive, especially compared to aspirin.
There are other alternatives. Using Vitamin E supplementation has been reported to help some dogs. If the problem becomes severe, hip replacement is a good alternative to medical therapy. Other anti-inflammatory medications are available and work better for some dogs, such as Adequan (Rx) and Arquel (Rx).
Quality of life is important and if your dog really likes the exercise and the challenges of training then I really think it is good to continue to enjoy them together. Just be willing to take a break when necessary and consider the use of an anti-inflammatory, such as aspirin, to make your dog more comfortable. Keeping the exercise consistent and moderate will help a lot.
If the stumbling persists you may want to have her examined to rule out degenerative myelopathy, a neurologic condition that affects German shepherds. Often it is confused with progression of hip dysplasia. It would be unusual for this to show up at this age but it just has to be considered in a shepherd with signs that could be neurologic.
Hope this helps.
Mike Richards, DVM
Last edited 08/30/02
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