Health Concerns: Musculoskeletal System
After an extra long Frisbee session, my Golden Retriever, Mandy, has a hard time getting up the next day. She has also been having trouble with the steps lately. Could this be hip dysplasia?
Dear Pet Owner:
Hip dysplasia is the malformation and degeneration of the ball and socket joint that makes up the hip. It is a developmental defect initiated by a genetic predisposition to subluxation or joint laxity (the ball not fitting into the socket well). This increased laxity leads to degenerative joint disease or arthritis. It is most commonly seen in large breed dogs such as St. Bernards, German Shepards, Labrador Retrievers, and Rottweilers.
Symptoms may include difficulty in rising, reluctance to run, jump or climb stairs and intermittent or persistent hind limb lameness.
Your veterinarian can make the diagnosis of hip dysplasia with an x-ray. Most cases can be treated with conservative medical management such as some of the new arthritis medications for dogs. Medical therapy only treats the symptoms that result from pain because the joint instability is not being corrected. There are corrective surgical procedures that are designed to return the joint to its correct orientation, everything from a triple pelvic osteotomy to a total hip replacement. These procedures are best performed by a board-certified surgical specialist and should be done prior to the onset of arthritis. After arthritis has caused severe joint degeneration, there is a surgical salvage procedure called a femoral head osteotomy that will remove the cause of the pain. Following the removal of the head of the femur, the dog's body forms a false joint and the dog is much more comfortable. Your veterinarian can help you make the diagnosis and discuss the best treatment option available to you in your dog's particular case. Neutering is recommended for all dogs with hip dysplasia so that the genetic tendency is not passed to the offspring. When buying a large breed purebred dog it is best to ask about the condition of its parents' hips. Most breeders use the OFA (Orthopedic Foundation for Animals) standards of certification before breeding their dogs. The OFA is located in Columbia, Missouri.
My older golden retriever Misty is starting to get a little stiff in the back legs. I heard that glucosamine and chondroitin, supplements used for arthritis in humans, may be helpful for dogs as well. Is this true?
Dear Pet Owner:
Glucosamine and chondroitin are substances normally synthesized by the body that are essential for good joint health. It is believed that glucosamine stimulates cartilage cells to make the substances that serve as the building blocks of new cartilage. Also, it has been shown to have anti-inflammatory properties and to actually inhibit the enzymes that contribute to the breakdown of cartilage. This means that glucosamine may help repair damaged cartilage, relieve pain by decreasing inflammation, and help slow the progression of arthritis by preventing further damage.
Although most of the research has concentrated on glucosamine, chondroitin has been shown to work synergistically with glucosamine to prevent cartilage degeneration. Therefore, the effect of each is probably enhanced when given together. Most veterinarians advocate the use of both glucosamine and chondroitin, as they alone may provide a satisfactory level of improvement for arthritis. They can be given safely with the likelihood of little to no side effects and may allow you to avoid or reduce the dosage of other anti-inflammatory drugs that may have long-term side effects.
When buying these substances, it is important to realize that they are considered "nutraceuticals". This means that although their role is somewhere between a nutritional supplement and a pharmaceutical agent (a drug), they are classified as a nutritional supplement. As a result, they are not subjected to the same degree of rigorous testing and documentation as that required for registration of a drug by the FDA. Therefore, it is very important to look carefully for products that can provide evidence of a clinically proven beneficial response, as they are not all the same.
It is also important to know that Glucosamine and chondroitin are just some of the substances that may help pets with or prevent or delay the onset of arthritis.
A complete physical and consultation with your veterinarian will insure a correct diagnosis and a proper treatment plan. Your veterinarian can help you with this and discuss veterinary labeled products available.
Joint health may also improve with weight loss and regular exercise so ask your veterinarian about an exercise regimen that is safe for your pet.
My 8 year old retriever mix dog had been limping on and off for 2 months on his right front leg and the problem has gotten worse. My veterinarian took x-rays and found arthritis of the elbow joint. What can I do to keep him comfortable?
Dear Pet Owner:
Unfortunately, arthritis in dogs, as in people, is a chronic condition. But this does not mean your pet has to suffer. One of the first things that should be addressed is your pet's weight. It would be better to keep him on the leaner side to make it easier to get around and not put as much stress on the other legs. Feeding less of a good quality maintenance or senior food is a good idea. Sometimes an actual reducing diet must be used. Next, the pain must be helped with an anti-inflammatory. Sometimes cortisone is used initially to calm things down, or when there is a flare up or worsening of the condition. This is generally done for a short period of time. An injection and pills can be used-injections into the joint are NOT commonly given. To maintain the pain management program, non-steroidal drugs are used, such as aspirin. Buffered or coated aspirin is used. Popular non-steroidal drugs used by people, such as advil, tylenol, and alleve, can be dangerous for dogs and not routinely recommended. Do not use them unless they are prescribed by your veterinarian. There are several nonsteroidal drugs approved for dogs including Rimadyl and Etogesic. These can work well, but monitoring of blood work may be necessary. Supplements that help the joint have healthy fluid and cartilage, known as neutracueticals, are also popular. For example, glucosamine and chondroitin sulfate combinations have been shown to help joint pain in both animals and people. Vitamin E and the Omega 3 fatty acids are thought to have antiiflammatory properties and may be added to the diet. Some pet foods actually have some of these items added to them, so may be good for your dog. An injectible medication known as Adequan, which had been used for many years in horses, is now approved for dogs and may help. It is given twice weekly for up to 8 injections and then given every 4-6 weeks if it is helping.
Moderate exercise is important for weight control and to keep the joints limber. Ask your veterinarian what would be acceptable.
As you can see there are many options available to help your furry friend live a longer and more active life. Seek the advice of your veterinarian to help tailor an arthritis management program that is right for you and your pet!
I have heard of hip dysplasia but my dog, was just diagnosed with elbow dysplasia. Can you tell me more about this?
Dear Pet Owner:
Elbow dysplasia can be a congenital condition usually found in large breed dogs such as German Shepherds, Labrador Retrievers, and Great Danes. It also can manifest itself due to hormonal influences, dietary issues, or trauma. The medical term is an Ununited Anconeal Process (UAP). The anconeal process is a part of the ulna in the elbow that forms the “outer” edge of the joint with the humerus. Around 11 to 12 weeks of age, this part of the ulna is actually separate as it forms bone by itself. It then attaches and fuses with the ulna at around 4-5 months of age. This is a normal growth pattern. Therefore a diagnosis of UAP cannot be made until that time. UAP usually presents itself as intermittent lameness on one side or both sides typically when a dog is between 6 and 12 months old. Some owners may notice stiffness in the morning or after a rest. Sometimes the elbow joint may be swollen or the dog may have an awkward gait. This separation of bone as part of the joint causes the joint to be more loose than normal which can then produce secondary arthritis and degenerative joint disease. Most cases should respond with confinement and limited exercise if a problem exists. More severe cases may need surgery to help stabilize this joint. Follow up with your veterinarian for a progress exam to assess the condition of your dog.
Ms Kitty is a 10 year-old cat that lives indoors. Within the past 6 months she has developed this "crackling" noise in her 2 front paws when she walks. It doesn't seem to bother her. She is declawed. Should I be concerned about this weird noise?
Dear Pet Owner:
Miss Kitty may have some arthritis in her front paws. With arthritis, sometimes the joints are stiff and less lubricated, or the cartilage is worn, so there is a "crunchy" feel and sound at times. The medical term is "crepitus". Also, sometimes with arthritis, because the joints don't have as smooth a motion, the tendons can sort of snap over the joint, and that can make noise, as you do when you crack your knuckles.
The noise should have nothing to do with her having been declawed, unless there is the unlikely occurrence of a claw regrowing under the skin or pad. If that is the problem, the claw can be removed surgically.
The best thing would be to have Miss Kitty examined by your veterinarian, to find out what is actually wrong. A good physical exam can reveal where the noise comes from. Some radiographs (X-rays) may be necessary, to verify the diagnosis.
While we do not have access to the array of drugs we can use for dogs with arthritis, your veterinarian may be able to prescribe something for arthritis if he thinks it is necessary. Sometimes, glucosamine oral preparations are used, and have been found to have some effect against inflammation. Sometimes a corticosteroid (cortisone) is used. It is very important that you DO NOT give your cat aspirin, Tylenol, or any other drug on your own. Cats do not have the ability to metabolize certain drugs, and it is easy to make them sick or even cause fatal consequences if you do not adhere exactly to what your veterinarian prescribes.
I have a 7 month old male German Shepherd puppy who has been limping on his right front left leg for about a week. My veterinarian says he has panosteitis. Can you tell me more?
Dear Pet Owner:
Panosteitis is a painful condition affecting the long bones of young medium to large breeds of dogs, mainly males. Although the disease causes lameness and discomfort, it often gets better with time. Since it is commonly seen in young pets less than 2 years of age, many people refer to this disease as ‘growing pains.'
Usually the pet has a history of sudden lameness on a limb with no history of trauma. The lameness may last several days to weeks. In about half the cases, other limbs may be afflicted and hence the name ‘shifting leg lameness.' These recurring bouts seem to subside by the time the pet reaches two years of age.
Despite the commonality of the disease, the cause is unknown, although hereditary factors may play a role. Other factors such as hormonal, infectious, allergic, parasitic, and metabolic influences have been investigated but not proven.
Physical examination of a pet with panosteitis may display pain over the long bone of the affected leg. The bones most commonly involved are the ulna, radius, humerus, femur, and tibia. Some pets may also have a mild fever, lack of appetite, and mild depression. It is important for your veterinarian to perform a complete physical examination and radiographs. Young, large breed dogs may also have other skeletal abnormalities such as fractures, elbow or hip dysplasia, or dislocations. Other causes of shifting let lameness such as rheumatoid arthritis, Lyme disease, or lupus may need to be considered.
Sometimes treatment is initiated to relieve discomfort and improve mobility. A non-steroidal anti-inflammatory may be prescribed. Rest and proper nutrition may be recommended. There is no way to predict how long the lameness may last but most pets are better in a few weeks and make a full recovery.
We recently adopted Belle, a kitten who is missing part of her rear leg. Our veterinarian said she is healthy but suggests a full amputation of her rear leg in the future as there is no padding on the stump and it may get infected. Are there any other alternatives?
Dear Pet Owner:
Animals that walk on all four legs, like Belle, do quite well if they have to resort to three-legged walking. Approximately 60% of the weight is carried on the front limbs and 40% on the hind limbs. If one of the rear legs is non-weight bearing, the other legs can easily support the rest of the animal's weight. One would be surprised at how well 3-legged animals can run, jump and play. Every case is different with respect to an animal having to have an amputation if one of the limbs is severely damaged. What your veterinarian is concerned about is that an open sore can develop where the skin is rubbing the ground as an animal walks, which can lead to an infection. If Belle seems to walk without any damage to the skin, it is plausible to monitor her case and see if a sore develops on the deformed leg. If she can lift the leg sufficiently to avoid any damage when she moves and if the skin is fine, you could probably leave the limb intact without any other treatment. If, however, a chronic, open sore develops, then an amputation from the hip downward may be necessary. Your veterinarian should periodically examine Belle and monitor her condition. Prosthetic devises (K-9 carts) can be used if both hind limbs are immobile. A prosthesis on one leg is usually not done.
My six-month-old Pomeranian puppy has been limping and crying when using her right hind leg. My veterinarian suspects she has Legg-Calve-Perthes Disease and recommends surgery. Can you tell me more?
Dear Pet Owner:
The hip joint is a ball and socket joint. That is, the ball or head of the femur (thigh bone) fits into the socket or cup of the pelvis (hip). Lagg-Calve-Perthes Disease is a spontaneous degeneration of the head and neck of the femur leading to collapse of the joint. As this degeneration progresses, arthritis may set in.
Although the exact cause is unknown, examination of the diseased bone tissue has shown clogged blood vessels, those that nourish the head and neck of the femur. Lack of adequate blood supply and nourishment leads to dying of the femur. This ‘rotten' bone then collapses when even minor stress, like walking, is applied to the bone and joint. This collapse causes deformity to the bone and leads to arthritis and discomfort. Due to the collapse, the leg will appear shorter than the non-lame leg.
Dogs most commonly afflicted with this disease are toy, miniature, or terrier breeds. This suggests a predisposition to inherit the disease. Most patients range in age from 3-13 months old, the age when growth and development is prominent. Sometimes trauma to the hip joint may initiate the damage but many times there is no history of such an event.
The best course of therapy for this disease is surgical removal of the deformed bone. Many pets return to a good quality of life and ambulation after surgery. However, it is recommended to avoid obesity and to discourage breeding of affected pets. Therefore, these pets should be on an appropriate nutritional diet and should be spayed or neutered.