Orthopedic Disorders of Dogs

Stiff Hind Leg Walk - Luxating Patella and Other Problems

Q: Dear Dr. Mike,

For the last four years or so (my dog is about 5 and a half) my dog has been walking with a stiff hind leg walk (does not bend her knees) although her trot looks fine. She's a scent hound (beagle cross) and has been able to run for many hours chasing rabbits and such with no apparent problems. However, she now seems to be rubbing fur off the outside of her paws after a long run and her hind leg/s become sore (she may limp) for a day or so afterwards. I'm also noticing that her back legs are a little stiffer than usual when she gets up after sleeping.

The vets have diagnosed my dog with luxatting patellae but as you already know I am also wondering if hypothyroidism could be the cause of her stiffness.

I'm wondering if luxatting patellae is the problem how to decide if surgery is necessary. If my dog has been walking for the last four years with a stiff hind leg walk... does this mean she has always been in pain? Now that she is rubbing fur off her paws and appears to becoming a little arthritic... should I now be considering surgery and be taking her to a specialist?

My dog leads a very active life and I would hate to make her hind legs worse if the surgery is unsuccessful.

Your comments are appreciated. Carolyn

A: Carolyn-

There are several things that seem possible with the signs that you are seeing. The first thing is that you are seeing a progression of the luxating patella problem, as it does tend to cause more arthritis as dogs age. It may not be too late to do surgery for this, if that is the case, but the more arthritis that is already present, the harder the surgery is for the surgeon. For this reason, I do think that it would be best to seek the help of a surgical specialist and to get an opinion from him or her about the potential for improvement, how often things get worse instead of better and how often they just seem to stay about the same, for dogs with her degree of disability.

Seeing the specialist would also allow for an examination to rule out another possible problem, which is spinal disc disease or lumbosacral instability that may be leading to the new sign of rubbing fur off. Often, these problems lead to this clinical sign because there is a decrease in feeling in the foot and also of motor control. So carefully evaluating for this, prior to considering another orthopedic procedure, such as the luxating patella repair, would be a really good idea.

There are some dogs that seem to develop neuropathies or significant muscular weakness associated with hypothyroidism, but this also seems to be fairly unusual. So even though it is possible and it is reasonable to rule it out, the odds of this actually being the problem are probably low. Since testing poses essentially no risk to the patient the only real concern is if the cost of testing would interfere with the financial ability to pay for other necessary procedures. If that were the case I'd go for the consult with an orthopedic specialist over this test, but if it is not difficult to do both, that is definitely reasonable.

I really believe that surgery to help with luxating patellae should be done by someone who does the surgery a lot. So I refer these cases in almost all instances, since our practice is rural enough that we don't have the opportunity to fix enough of these to feel really confident about them. Your vet may do enough of these surgeries to feel comfortable with the procedure but I still think I'd get a second opinion on this surgery, considering the age of your dog, if possible.

If surgery isn't possible, there are good anti-arthritis medications available for dogs and it would almost certainly help to use one of them.

Good luck with this.

Mike Richards, DVM

Growth Abnormality in Leg Bone of Sheltie

Q: Dear Dr. Richards,

We recently purchased a Shetland Sheepdog from the pet store, she is 4 months old, and her right front leg seems to bow, sometimes it appears she limps on it, and other times she doesn't. Is it possible this is something she'll grow out of, or is this something that we concerned about. She doesn't seem be in any pain when her front leg that she seems to keep weight off of is touched or bent.

Any help or references that you can give us would be greatly appreciated.

Thank you, Christopher

Answer: Christopher-

It is important to have your vet determine if there is a problem with the growth of the bones of the right front leg. This should be done within the next two months and the sooner you can manage it, the better. If there is substantial deviation of the leg bones, it is usually due to one bone having deficient growth while the other one lengthens normally. This leads to a bowing effect as the longer bone has to bow against the pressure of the shorter bone. In some cases it is possible to fix this situation by breaking the shorter bone and inserting a pad of fat between the bone ends to make it heal slowly and allowing the leg to straighten. In other cases, it is necessary to go more complicated surgeries that correct the situation. It is almost always possible to help, although it can get to be expensive. It is important to fix this situation, if possible, because it leads to degeneration in the joints above and below the bowed portion of the leg and some dogs have very difficult times late in life due to the growth abnormality.

Good luck with this. I hope that it is unnecessary to consider surgery but if there is substantial bowing it would be worthwhile to do surgery if it is possible. Your vet can refer you to a surgical specialist, if necessary, for a consultation and/or surgery.

Mike Richards, DVM

Sesamoid Fractures in Australian Shepherd

Q: Hello, I have a one year old female Australian shepherd, Chloe. For approximately three months Chloe has been limping following a rest after strenous activity (fast walking, off leash romping with my other Aussie, chasing the cats around the house, ect...). She limps for the first minute or so then is fine. The carpals of her right paw are the problem area. I took her to my vet three weeks ago. He sedated her and took x-rays. He found some decreased ROM but no sign of arthritis/disease or fracture. Her paw seems to rotate out laterally. I was told to rest her and give her Rimadyl for 5 days. I did and the lameness decreased. During the holidays she had to be boarded at the vet's for 10 days. Upon picking her up I was told she had not been limping. However, after we went for a long walk she began limping after her nap. The soreness does not affect her ability to run,leap,or play but I'm concerned that she is still lame. Also, should I be giving her pain medication? I was under the impression that masking the pain may lead to further injury. Any advice would be greatly apprectiated. Thanks.  

A: Melissa-

I would be concerned about the possibility of sesamoid fractures with the clinical history that you give. This is not a really common problem, except maybe in rottweilers, but it would produce the signs that you are seeing. The sesamoid bones are the small little bones that form the knuckles and serve as pivot points for tendons as the run down the length of the metacarpal bones and toes. When these fracture there is persistent lameness that seems to be associated with the area around or just below the carpus. It is very hard to diagnose this problem by physical exam and it may not show up clearly on X-rays, especially if someone is not looking specifically for it.  The other things that I would think about would be elbow dysplasia, osteochondrosis, valgus deformities of the long bones (this causes the foot to be angled compared to the rest of the leg and will produce lameness in some dogs affected by the condition), osteochondrosis, immune mediated joint diseases (usually affect more than one joint), bicepital tendon bursitis and there are probably other chronic conditions that I am just not able to come up with at this time.

The reason I included several conditions that do not affect the carpal or paw area is that it can be really hard to be sure where the pain is coming from. This is especially true of elbow dysplasia and the bicepital tendonitis problems.

When I can't figure out a lameness, I tend to send the patient to an orthopedic specialist. This is not always helpful, especially when we have done a really good work-up at the office, but many times the orthropedic surgeon has been able to identify a problem that we could not. You should keep this in mind as a possibility.

We have treated two rottweilers with confirmed sesamoid bone fractures leading to chronic lameness. In one dog we removed the sesamoid fragments and in the other one we just used non-steroidal anti-inflammatory medications on an "as needed" basis. I think that both dogs got along about equally well but the owner of the dog that had surgery was sure it had made an improvement in the dog's condition.

I think it is better to use pain relief medications. This may be due to a personal bias since I am a long time runner and rower and have a lot of opportunity to test how well pain relievers work in orthopedic conditions. I think they dull pain and make it easier to live with but they do not provide enough pain relief for me to run or row when I have a real injury. I'm as stupid as the average dog when it comes to exercise, too. As soon as I feel better I go out again. So far, I don't think that pain relief has led to me re-injuring myself any sooner than I would have managed it otherwise.

Hope this helps some.

Mike Richards, DVM 

Cracking Joints in Young Golden Retriever

Q: I have a 10mo Golden Retriever. For the last couple weeks I have noticed that her joints crack as she walks. The weird thing is that it is coming from her front and back legs. I think mainly from her ankles and wrists. She is so no pain that I can tell. She has been extremely active. This started after three days in a row of 3-4 mile walks at 5am. Could I have just overstressed her joints? I have decreased her walks to see if the cracking would stop and it does not seem to help. She plays all day with my other dog so it is nearly impossible to keep her activity down though. Any input would be nice. Thank You Shari    

A: Shari-

I was at a seminar at which the speaker said that joint cracking noises had no diagnostic meaning, at all. They just occur in some cases for no reason. But they have been associated with things like tendonitis, ligament irritation and cartilage damage, too. Once in a while there is a distinct clicking sound associated with hip dysplasia but usually it is possible to localize this to the hip joint and when we have been able to hear this without manipulating the leg ourselves, the dog has usually been obviously lame. My guess is that she will be OK, but do take any lameness seriously, if it becomes evident.

It is better to try to stick to moderate regular exercise, rather than episodes of activity and inactivity, when possible. Try to break her into long walks gradually, unless you have been taking her on these regularly, already.

Mike Richards, DVM 

Orthopedic Problems in Older Labs

Q: Dear Dr. Richards, We have a 10 year old black lab who will be 11 in September. We have been told that he has some muscle loss in his hips which is apparently typical of older labs. He has recently been having a lot of trouble walking up and down stairs and getting up from lying down. His hips seem to be collapsing when he attempts to engage in these everyday tasks. We have been told to give him buffered aspirin to ease the pain, but it does not appear to be working. My question is, "Is there any procedure at all that you would recommend to correct this muscle loss?"

We love him very much and want to make his life more comfortable and last as long as possible. We are not concerned with cost; we want to do whatever we can. lease help!!!!! Thanks! Shannon

A: Shannon-

Labrador retrievers are prone to orthopedic problems and they will sometimes have muscle wasting as a result of one of these conditions. It is often worthwhile to try to figure out which of the problems is present, though.

Hip dysplasia is probably the most common cause of orthopedic problems in older Labs. Sometimes stifle (knee) problems contribute to the problem. Less commonly, spinal problems such as lumbosacral instability or disc problems are responsible for the muscle weakness. The treatment for these conditions differs, so making an effort to find out which one is actually present is a good idea.

If X-rays have never been taken of the hips and spine, that is a good place to start. X-rays alone are often not enough to diagnose disc disease or lumbosacral instability, though. If there is a specialty practice in your area that can do MRI exams, that is a better test for these conditions. I know that this is impractical for many people but if it is possible to get a diagnosis it allows for a more specific treatment plan.

In the meantime, glucosamine and chondroitin products help some dogs and are very safe to use. Carprofen (Rimadyl Rx) and etodolac (Etogesic Rx) are more potent pain relievers than aspirin and may make your Lab much more comfortable. Rimadyl can cause liver problems in some dogs and Labrador retrievers may be more prone to this problem than other breeds so if this medication is used careful monitoring for liver disease would be necessary. Weight control helps almost any dog with orthopedic problems that is not at its ideal weight already. Sometimes Vitamin E administration is recommended, as well, usually 400 to 2000 IU per day.

Mike Richards, DVM

Orthopedic Surgery

Q: We have a 2-3 year old female Labrador Retriever in our rescue and we have just been told she has severe problems and we are trying to determine her prognosis. I love your site and trust your opinion and would like to seek a "second opinion" from you.

Daisy has severe hip dysplasia in both hips and the right one is "ready to pop". In addition, she had torn ligaments around the knee on her right front leg and possibly the second. She had arthritis in all four legs. Her feet are becoming deformed as she is clearly placing all her weight on her front legs. Some days she struggles a little and walks funny, others days she is fine. She has great energy, tries to run and play, but the foster home is trying to keep her quiet. We are wondering if the various problems make her an unlikely candidate for the multiple surgeries required (financial issues aside). While she is young, is she "too far gone" to endure the surgeries and recovery periods? If not, which surgery would be first and what would we have to do in the meantime to keep her comfortable and not let her additional conditions deteriorate further?  She is at least 20 pounds overweight which clearly has made her conditions worse, if not possibly caused them in part (torn ligaments, etc). While we are taking her to my vet next week for an honest assessment and review of the xrays, I am wondering if you have a recommendation? Thanks for your help.

-Midwest Labrador Retriever Rescue and Daisy  

A: The most aggressive surgeons that I know feel that it is possible to do total hip replacements and stifle surgery at the same time, first on the most affected leg and then on the other one, if necessary. I am not sure how I feel about this (no personal experience) but I also don't agree with the tendency of some surgeons to rule out hip replacement entirely in dogs that have stifle instability. It seems to me that if the owners are willing to pay to have one joint improved it is worth doing that, as long as everyone knows the problems that exist and that the prognosis is not as good.

If the stifle is just threatening to go, I'd go for the hip replacement surgery first. In a case in which a cruciate ligament in the stifle was torn in a dog with severe hip dysplasia, I think I'd have to rely on the surgeon to figure out which joint to do first and whether it was OK to do both at once.

Elbow problems are much more vexing to me. They don't seem to respond all that well to surgery and dogs with severe degenerative disease in the elbows really seem to be in pain. I do wonder if it is possible to get them much relief by fixing problems in the rear legs but again, if money is set aside in the decision making I have a hard time figuring out why it isn't worth trying. We have only had one hip replacement surgery that went really badly in the patients we have referred for this procedure and all the rest of the dogs were very much improved.

Weight loss is VERY important -- maybe even more important than surgery. This is a time to get advice from your vet on a good weight loss plan and try hard to make it work. That is a hard thing to do and sometimes seems almost impossible --- but it is really worth the effort. Almost nothing impacts comfort in arthritis patients more than weight loss.

Hip replacement is costly but when it is possible it works very well, almost all the time.

Mike Richards, DVM

TMJ in Dogs  

Q: Hi - I got into the cybervet because I have a 13 year old westie who is now crying after she eats. She walks around with her pillow in her mouth wailing for about 15 minutes, no matter how much food I give her (tsp or plate). She has been to the dog psychiartrist in the past for faking limping, but I would never forgive myself if she had a stomach problem and I dismissed it for that. Also, she has a malignant tumor in her arm pit 1.5 years ago, so I wanted her checked out. My regular vet in on vacation so I took her to the associate who said she was faking for attention. I am not comfortable with this, so i am taking her to the regular doctor when he returns. Do you think this is a real problem? Please help!!!  

Lynne-

A: You should watch very very carefully for signs of swelling around either eye with the symptoms you are seeing. There are a number of potential causes for pain around the time of eating but the most serious one is a retrobulbar abscess, or an abscess that forms in the space behind the eye. These can cause serious problems fairly quickly, including blindness and in severe cases, death. In most cases, dogs with retrobulbar abscesses are really pained by having their mouths opened -- some dogs refuse to allow this and others just scream when someone attempts to open the mouth beyond a certain point.

Our dog had a retrobulbar tumor and had similar signs -- but she would open her mouth part way before it hurt. She continued to eat but sometimes acted as if she was in pain afterwards. So this would be a concern, too.

Dogs that have periodontal disease will sometimes have pain but I can't recall a patient having severe pain for fifteen minutes after eating.

Dogs with marginal liver function can have behavioral changes associated with the period immediately after eating. In severe cases this can cause severe neurologic signs, including stupor or seizures.

Older dogs get a condition known as canine cognitive dysfunction that can cause odd behavioral signs. We have one patient in our practice who wailed for ten to fifteen minutes at a time, several times a day who responded well to selegiline (Anipryl Rx), the medication approved to treat this condition.

Gastic problems are conceivable, as well.

Westies are prone to craniomandibular osteopathy. If she had difficulty with this as a puppy, there is some chance that she has arthritis in the mandibular joints now. This can happen without having the craniomandibular osteopathy, too. Recognizing TMJ in dogs isn't easy, since they can't complain effectively.

I think that it is worth continuing to look for a medical cause of this problem, personally. I am sorry that the list of differential diagnoses for the symptoms is long enough to make it difficult to search through. Please keep checking to be sure she can comfortably open her mouth and that there is no visible swelling around one eye. If these signs develop, don't wait for your regular vet.

Mike Richards, DVM

Hind Limb Weakness in Older Dog

Q: Dr. Mike, I am a new subscriber and hope you can help us with regards to our dog. We have a 11 yr. old Wirehair Fox Terrier who has always been quite active and full of vigor. About 6 months ago we noticed he was having trouble getting up on the ottoman where he normally sleeps in the early evening. He was showing signs of weakness in his legs, but more in the left than in the right. Since then he has shown weakness in both legs to the point that he sometimes can't get them to move in the right direction, and they get wrapped around each other, and he almost falls down. He drags the toes of both rear feet, but at no time has he shown any symptoms of pain. No yelps, no groaning, moaning, etc., just gradually more weakness in the hindquarters.    

On our first visit to our vet, x-rays showed a slight narrowing of the spine where the vertebrae stop, and he suspected a disc injury, but nothing truly conclusive was determined. He prescribed Prednisilone, dosage for 5 days, then gradually reduced over the next 3 weeks. At the end of that time no change in the symptoms were noticed. We were then referred to another vet, an orthopedic specialist, who wanted to do an MRI. Pre-screen bloodwork showed elevated liver and kidney levels. He then ran a test to eliminate the possibility of Cushings Disease, which did not show anything conclusive one way or the other.

Dudley (dog's name) has a history of these elevated levels since he has an episode 5 yrs. ago where he couldn't move. I could set him down and he would just stand there, staring. He wasn't eating or drinking, so off to the vet. Given IV's, was improved overnight, and hasn't had anything similar since. At this time the vet wanted to change his diet and put him on K/D because of the high blood levels. Dudley does not show any of the "classic" symptoms of a Cushings dog, no hairloss, no extended belly, no weight gain, etc.

As to the MRI, we are faced with a decision. We have a dog who is perfectly normal in all aspects except for the weakness in his hindquarters. With the elevated kidney and liver levels, will the anesthesia have a more harmful effect than the results we might get. In addition, if something was revealed that required surgery, that's more anesthesia, and possibly a tough recovery period with physical therapy, etc. So, do we risk the life of our normal dog, for a problem that may or may not show up on the MRI. His age is also a factor, since he's 11, but he's the healthiest 11 yr. old I've seen.    

We decided to forego the MRI for now, went back to the vet and he prescribed Rimadyl 25mg, 2x a day. Dudley has only had 3 of these, so it may be too early to tell yet. I know I'm probably making this too detailed, but better too much info than too little. Several questions I have, if you could respond:

1. Can Spondylolisthesis (Wobbler's Syndrome) appear in Fox Terriers, or is it strictly found in large dogs? Same question for hip displasia.

2. If Dudley has a disc injury, wouldn't he exhibit some sort of pain? As previously stated he hasn't shown symptoms of pain.

3. I read somewhere where a dog showed the same symptoms as Dudley, but it was a case of a bacterial infection, treated with antibiotics. Have you run across anything like this in your practice?

4. With the weakness in his hind quarters, his legs seem to give out and he looks like he's doing the "splits". Again this is with no crying out, and no demonstration of pain. Could he have some sort of ligament or tendon problem that does not allow him to keep his legs in?

5. Do dogs get diseases similar to muscular dystrophy, and if so, would the symptoms appear only in the hind legs?

I appreciate any information you can provide that will allow us to do what's best for Dudley, since it appears he still has several good years left. Your website is so informative, since there are other people who all have similar questions, it allows us to be more informed regarding the health of our pets. Thank you very much. Respectfully,

Chris  

A: Chris-

I will try to answer your questions first.

1) Spondylolisthesis can theoretically occur in any breed but from a practical standpoint it is very rare except in Dobermans and Great Danes and it is not really common even in these breeds. Hip dysplasia can occur in any breed but is more common in larger breeds.

2) Dogs with disc injuries usually show signs of pain but it can be very hard to discern the presence of pain in some dogs. Pain is hard enough for me to evaluate that I tend to just assume it is present in any situation in which it seems logical to expect it. Most of the time disc related pain is exhibited in dogs by behaviors such as hiding, reluctance to be picked up and avoidance of activities like jumping or stair climbing. Lots of dogs are in enough pain that  there is no question it is present when they have intervertebral disc disease.

3)Discospondylitis is an infectious cause of back pain. Bacteria invade the ends of the vertebrae leading to inflammation and pressure on the spinal cord or the nerve roots. This is also most commonly a problem in large breeds but can occur in any breed. X-rays are often diagnostic for this condition but it can be hard to see on them. Most dogs with this condition seem to be painful but I have seen at least one case in which muscular weakness was the primary complaint.

4) I wouldn't want to say that a ligament problem couldn't be present but I do think it is unlikely. Cruciate ligament injury of the stifle in dogs can lead to weakness of the affected limb and it can mimic spinal cord or disc injuries when both cruciate ligaments are affected.

5) Dogs can have muscular dystrophy but it is a juvenile disease (has an early onset of clinical signs) in all cases that I know of. There is always a chance that a disorder exists that I am unaware of. Myasthenia gravis can cause weakness in older dogs and it conceivably could show up as apparent hind limb weakness first. It is a possible problem but also pretty low on a differential list for the situation you describe. Degenerative myelopathy is a disorder that occurs in older dogs in which the myelin sheaths that cover the nerves degenerates, leading to muscular weakness in the hind limbs. Most of the time there are identifiable neurologic signs other than weakness, though.

Hind limb weakness in older dogs is a frustrating problem for clinicians to deal with. There appear to be a number of cases in dogs in which the disorders commonly associated with hind limb weakness are not present but neurologic signs are not sufficient to diagnose a spinal or peripheral nerve problem, either. There really does seem to be a syndrome occurring in some of these dogs that just doesn't have a name yet and for which diagnosis and treatment have not been studied. My best description of the problem is poor nerve function associated with the aging process that is not severe enough to cause continuous problems but does cause problems when dogs have to react quickly such as when walking on a slippery floor.

My approach to these problems is to check for hip dysplasia and degenerative joint disease in the affected limbs and to try to assess nerve function to the best of my ability. I really think that X-rays are necessary to really rule out degenerative joint disease. I try to get X-rays of the spinal column at the same time. I think that lumbosacral instability problems may be more common than they are diagnosed but this is just a personal theory. If the neurologic signs are not suggestive of spinal cord injury or degenerative myelopathy and I can't find evidence of degenerative joint disease I try analgesics such as aspirin, carprofen (Rimadyl), or glucosamines. If there is improvement then I tend to assume that there must be degenerative joint disease or disc disease that I'm just not seeing. If there is no improvement I try to refer the patient to a neurologist for examination, including MRI or CT scans if possible. If not, I usually go ahead and try corticosteroids just to see if they have a beneficial effect.

It is hard to figure out what to do when there is reason to worry about anesthesia. If you do not see a response to Rimadyl in a reasonable time, like a week or two, I think I'd tend to go ahead with the MRI if anesthetic risk is the only worry. Most dogs that live to be eleven will survive anesthesia even with a few disturbances in blood enzyme levels indicating the potential for some liver or kidney disease. If the cost is also a factor it is harder to decide because there is a good chance that nothing will show on it. You just have to accept that it could be an expensive test that only rules out many problems rather than giving a definite answer. If you can afford that information it is a good test to consider.

I wish that I could help more.

Mike Richards, DVM    

Fracture Repair of Toe

Q: My 6 yr old ibezan hound recently fractured her front toe. She is in a long (to the shoulder) splint and she is miserable. The vet says 4 to 6 wks of minimal activity. She is miserable and I'm having a hard time keeping her quiet. Anything I can do to help her heal faster?

Thanks, Annette

A: Annette-

Surgical repair would be a much faster way to get to functional recovery, if it is possible. Often it is necessary to ask for referral to a surgical specialist because toes usually have to be repaired with bone plates that are a specialty item that many veterinary practices just don't have. If only one toe is broken and if it is broken in a spot in which the other toes provide support it is sometimes possible just to let it heal without additional splinting. Your vet probably already considered this option, though.

Mike Richards, DVM      

Limping Problem in Dalmatian  

Q: Dear Sir- We have a female Dalmatian that is 4 years old. She has developed a left hind leg limp. When she exercises/walks/runs-no problem. When she rests, she has a limp and if it is really bad; she actually carries her back leg and looks like an amputee. It seems to be worse at night and is almost absent when she first gets up in AM. Sometimes, when she does not want to bear full weight, she stands with her weight on her other 3 legs and only uses that other leg for balance and that is when the leg looks shorter and shakes. That may all be only because she is just dangling the leg on her tip-toes. If I remember correctly, she may have injured that leg when she was a very small pup. A piece of concrete fell on her toes and that very distal aspect of her leg. She screamed for a very long time.

I am wondering if she might have a "reflex sympathetic dystrophy". I know that dogs used to be used for those studies back in the nasty days. Maybe they still are. I just do not want to know about them. She has had hundreds of dollars of X-rays done and all have been negative. The vet does not know what to do for her. We tried a 2 month trial of Rimadyl without success. I am lost and sickened as to what to do for her. She never cries out in pain, even, when that entire leg and foot are aggressively manipulated by the vet. There is no crepitus, no obvious trauma, no foreign body. I am at a loss. As is the vet. They have recommended us to the University of Illinois for further evaluation. The focus is to be neuromuscular and mostly neurological. There has even been a discussion of muscular dystrophy or myasthenia gravis. Please let me know what your feelings might be on this very frustrating situation that we have with "Storm". She is a GREAT dog. Thank you-Debbie    

A: Debbie-

I have seen some research relating to reflex sympathetic dystrophy syndrome in horses but have not seen this syndrome mentioned in discussions of lameness in dogs. It would seem logical that it could occur in dogs, though. I just can't help much with a way to diagnose this or to treat it. A neurologist might be able to help, though.

I can think of several problems that might produce the symptoms seen, some more likely than others. There are many more possible problems than I am listing but most are easier to find on X-rays or by physical examination. Lumbosacral instability , cranial cruciate ligament instability (partial tearing or degeneration of the ligament) and fractures of the sesamoids are things we have dealt with that caused pain we had a very hard time diagnosing.

The fractured sesamoid problem is more common in the front legs and more common in Rottweilers but can produce lifelong pain and lameness that the dog seems to be able to overcome at times -- at least based on one of our Rottweilers who had that problem. It can occur due to trauma and seemingly without trauma as well. It is very easy to overlook the sesamoid bones when looking at X-rays. Sometimes the sesamoids appear to be fractured in X-rays of dogs that are not lame, too, which does confuse the issue.

Lumbosacral instability can be very hard to see on X-rays. Myelograms, in which dye is injected into the area around the spinal cord so it shows up better on the X-rays, may be necessary to diagnose this condition. MRI and CT scans are also helpful in the larger dog breeds. The instability between the vertebrae associated with this condition puts pressure on the nerve roots exiting from the spinal cord. The pain and lameness caused by this condition may occur unilaterally. This disorder is also called cauda equina syndrome and lumbosacral spondylopathy. This disorder is painful but that can be masked as it is more of a chronic pain than an acute sharp pain.

Partial cruciate ligament tears and cruciate ligament degeneration can produce a non-weight bearing lameness that is not associated with much pain. I can't tell from your e-mail whether pain is a major factor in Storm's case, mostly because pain is hard to assess even in person. These can be pretty frustrating to diagnose before there is enough laxity to produce signs of a drawer movement (instability of the knee, leading to the ability to move the tibia forward in a motion that sort of looks like opening a drawer as the tibia moves forward and the femur stays still).

I would strongly recommend following your vet's advice and having the specialists at the University of Illinois examine her. The great thing about referring dogs to vet schools is that they have lots of specialists so if a patient goes for a neurologic consult on a problem that turns out to be orthopedic or some other type of problem --- there is still a specialist in that field to see the pet.

If it is hard to get to the veterinary school it may be worthwhile to send the X-rays first. I am constantly humbled by the ability of radiologists to see things I miss and to point out that things I see are not really there. Sometimes sending the X-rays saves a trip for a patient.

If you do go, make sure that you bring all the records, all the X-rays, all the lab tests. Write down the important information that you might not remember while at the teaching hospital such as the traumatic incident, when this all started, when it got worse, when the lameness is worse during the day, etc. Write a list of questions you want to be sure get answered, including the phone number to call if more questions occur later.

Storm is young. It is definitely worth continuing to search for a diagnosis and the logical next step does seem to be going to see a specialist. I'd definitely recommend following your vet's advice in this case.

Mike Richards, DVM      

Hind Limb Paralysis

Q: Hi. My dog is part labrador and part doberman. She has been suffering from loss of hind limb motion for a week now and the doctor says that it is some form of paralysis.

Julie (my dog) is 12.5 years old. She developed high fever last week and my mom rushed her to the vet. He gave her an injection of novalgin and neurobian (vitamin). The next day she seemed lethargic and weak. The vet gave her oxalgin (antiinflammatory). The next day she seemed unable to use her hind limbs. Julie also cannot sit on her left side for more than five minutes.

While the vet is looking into the matter I am trying to find out if anyone knows where I could get a cart made for her hind legs. My dog is in India and there doesnt seem to be an option to get one made there. I would like to get a roller cart made here in the U.S, and send it to India. I live in NewYork.

Please help me if you know anything about this type of disorder or where I could get the cart....

Anxiously awaiting news...

Subadhra

A: Subadhra, 

This is the contact information for K9 Cart:

• K-9 Cart Company
• P.O Box 160639
• Big Sky, MT 59716
• Phone: (406) 995-3111
• Fax: (406) 995-3113

The carts work well for many patients. I am sorry to take so long in replying. I had a lot of computer problems this week. I wish I could help with understanding what may be going on with your dog but there are a lot of possible problems. Off the top of my head, fibrocartilagenous infarcts, discospondylitis, cancer of the spine or cancer putting pressure on the spine or brain, intervertebral disc disease, spondylolisthesis and several other conditions are possible. I hope that  the vets at home have managed to come up with a diagnosis and treatment  plan that has helped.

Mike Richards, DVM        

Back Problems

Q: My miniature Dachshund is about a year old and having problems with his back or hind left leg. He doesn't favor his hip (that I notice) or leg area during the day but by night he is crying and biting his leg hip area. I am looking for a specialist to take him to, we don't want him to be a guinea pig to just any Vet. I've been surfing the net for solutions and specialists in this area. Can you give me any suggestions on how I should handle this? We are stumped on what to do for him and which vet to take him to. We live in the Carlin Nevada area which is about 285 miles from Reno.

A: The best approach is probably to ask your vet who to see in your area. He or she will know who the closest specialists are and which ones are most helpful. Most vets are perfectly willing to refer cases to specialists when necessary.

An alternative approach would be to go to a veterinary school if there is one within a reasonable drive from your home. Since I am geographically impaired I am not sure how far you might be from a veterinary school but they do usually have good specialists.

Lastly, you can call the American College of Veterinary Surgeons and ask if there is a board certified surgeon in your area. Their phone number is listed as 301-718-6504 in the AVMA Directory.

It is highly likely that a general practitioner veterinarian would be able to make a diagnosis and recommend treatment options competently. Don't rule out this option, especially if going to a specialist may delay diagnosis and treatment.

Mike Richards, DVM

Painful Spinal Problem

Q: Dear Dr. Mike, We have an 8 year old toy poodle. For the last 2 weeks he has been yelping whenever we try to pet him. When he barks it sounds like a very painful bark. We took him to the vet and told him that Chuey had tripped running down a stair and kind of landed spread eagled on the cement. That's when the strange behavior started. He doesn't seem to have pain in a specific area. Our vet said it is possible he might have injured his back and wants to take X-Rays and prescribe medicine. In the mean time he prescribed an antibiotic and pain killer treating for I believe he said pluritus.

Once Chuey started on the pain killer he was fine. After the last pill was given he started acting the same way again. Shaking, panting, yelping when picked up and every now and then when you attempt to pet him. I took him back to the vet today. He checked him out again and said he could possibly have spinitus. My question is, What is spinitus and is it curable with medications or is surgery possible? thanks, Another mike

A: Mike- Spinitus is not a commonly used word in veterinary medicine. Perhaps your vet was referring to spondylitis. Or maybe your vet was just trying to convey that something was wrong with your dog's spine and just used this word as a general reference to spinal pain or inflammation. Anyway, it is OK to use non-steroidal anti-inflammatory medications long term when it is necessary. The general consensus among veterinarians is that it is best to control pain associated with spinal conditions and allow them to heal without surgery if possible. If paralysis or noticeable weakness appears in one or both rear legs then it will be necessary to re-evaluate the situation. This would also be true if the pain became unresponsive to pain relieving medications.

Mike Richards, DVM

Leg Pops Out of Joint

Q: I have a Dalmatian (father) and german shepard (mother) mixed dog, his hind leg appears to pop out of joint on occasion. Our vet says it appears to be related to the german shepard's common dysplasia, catching up with him. He just turned 1 in April, this has been happening for 4-6 months. When he starts to hop he doesn't whine or cry, we just bend the leg upward and it pops, he walks normal again. Do you have any suggestions, from what I've read we should have it x-rayed. Thank you for any information and your time.

A: You have already figured out the best course of action! It is a good idea to have X-rays taken to confirm that hip dysplasia is the problem and to assess the severity of the problem. Once this is done it will possible for your vet work with you to come up with the best plan for dealing with this problem for you and your dog.

Good luck with this.

Mike Richards, DVM

Joint Problems - Medication Alternatives

Q: I have a 90 pound German Shepard with joint problems. I have used ASA 325mg BID, but it doesn't help. My question concerns the appropriate dose of ibuprofen in dogs. What is the 1/2 life of ibuprofen in the canine? I've been told that canine ibuprofen clearance differs from that in the human. My Vet wanted to use phenylbutazone but I don't like the side effect profile of that med, blood dyscrasias, ulcerative esophagitis, so I'm looking for alternatives... thanks, P.

A: In the veterinary literature there are several case reports of gastric perforation from severe ulcers associated with the use of ibuprofen in dogs. Unfortunately, this is a problem with a number of the non-steroidal anti-inflammatory medications in dogs. It isn't just a matter of half-life. The canine digestive process seems to differ enough that ulceration is more likely than in a human when using medications that are anti-prostaglandin in effect. Aspirin is reasonably safe but we have occasionally seen severe GI effects from it, too.

Carprofen (Rimadyl Rx) is a non-steroidal anti-inflammatory that promises to have less GI effect and still provides good pain control and reduction of inflammation. It is new but our overall experience has been good with it, so far. We have had one case of vomiting post administration and two dogs that the owner's could not discern any improvement in from the medication. But we have had a couple of owners who believe that the medication is virtually a miracle for their older dogs, too. Being new, this medication is fairly costly.

You might want to try glycosamines (Arthroflex Rx, Cosequin Rx, etc.) They seem to help some dogs. Adequan (Rx), an injectable glycosamine is also helpful in some dogs when other medications fail. It is also somewhat costly.

Mike Richards, DVM    

Degenerative Joint Disease

Q: Dr. Mike, We have a 15.5 year old terrier/poodle mix (approx. 35 lbs.) who was diagnosed one year ago with arthritis in her hind legs. She is currently taking 2 Cosequin DS tablets and 2 (sometimes 3) Comfort tablets per day. Although the Cosequin DS initially seem to help her I have recently observed that she cannot stand in one place for more than perhaps 1-2 minutes without her hind legs beginning to collapse. We have heard about Cartiflex, Glycoflex and Rumidoux(sp?). Would any of these medications be more effective than the Cosequin DS? If not, is there perhaps another medication that would be beneficial? What are the amounts of the effective "ingredients" in each of these medications? Any assistance you can provide us would be greatly appreciated. Thank you

A: I do not know for sure, but strongly suspect, that none of the other glycosamine products will work better than Cosequin DS. There haven't been many scientific studies of these products and I have not seen any comparative studies that I can remember.

If these products are not working sufficiently, you might want to consider using aspirin or carprofen (Rimadyl Rx). These are often very effective in the treatment of degenerative joint disease and can be used in conjunction with the other products.

When the situation with degenerative joint disease gets severe it can be useful to consider the use of corticosteroids. Even though these products have a lot of side effects and can weaken bone they are often helpful when nothing else is. When you are at a point where euthanasia is a consideration or where the quality of life for a pet is really poor any risk seems minimal in comparison. It just doesn't seem to make sense to me not to use a beneficial medication when the situation can not be improved in other ways, over a fear of side effects which may not materialize.

Hope this helps some -- and good luck with this.

Mike Richards, DVM  

Glucosamine and Chondroitin for Arthritis

Q: Dear Dr. Mike, I have a 10 year old Lab who has osteoarthritis, after walking a couple of miles she usually will carry her hind leg. We have been to the vet several time in the last couple months and she has had X-ray done on her hips to determine the severity of the arthritis.  The vet doesn't believe that she is dysplastic nor does she have any problem with her spinal cord or elbows.  We have tried several drugs such as asprin, phenylbutozone, and now we are on Rimadyl.  This seem to eliminate most of her pain.   I have recently read about some clinical trials with glucosamine and chondritin on humans suffering osteoarthritis and was wondering if you would suggest this as an additional method of treatment.  I was also wondering if it was available without a prescription since it is a food supplement and would you suggest administering it concurrently with the rimadyl.

A: It is hard to tell you much about glucosamine and chondroitin that is scientifically validated. These products are used widely in veterinary medicine and it seems likely that that work for at least some dogs based on their popularity. Unfortunately, when evaluating medications for pain relief and for for chronic debilitative conditions there is a strong desire for the medications to be effective and a high "placebo effect". As an example, in the clinical trials for Rimadyl (Rx) the placebo group was estimated to have improved by 15% of the veterinarians and 25% of the clients. On the other hand, these products appear to be safe to use, so why not try? That is the basis we work on in our practice. To the best of my knowledge there should be no problems using these products in conjunction with carprofen (Rimadyl Rx). My personal experience with glucosamines (we have not used chondroitin) is that about half of the owners feel that it makes a significant difference. This seems a little higher than one might expect with a placebo alone so I tend to think they work for some dogs - but have no real proof of this.

Mike Richards, DVM  

Prosthetic Limbs for Dogs

Q: Our son just had to have his four year old Bernese Mountain dogs rear leg amputated because of Cancer. He has heard that there is a prothetist available for dogs. We do not know where to get information about this and hope that you can help us. Any information you can give us will be very much appreciated. Thank you.

A: I am not aware of a company making prosthetic limbs for dogs. I do have a book that deals with severe orthopedic problems at the office and I will check on this for you there. If I find anything, I'll write again.

There is a surgery which is called "limb sparing" in which the cancerous portion of the bone is removed and replaced with a graft. This allows wide removal of cancerous bone without the loss of the limb. It is pretty expensive and only done at one or two institutions, as far as I know. I am not sure if this is what you were hearing about.

Most dogs do pretty well on three legs without the need for a prosthesis. I hope that your son's dog will be OK, too.

Mike Richards, DVM    

Prosthetic Limbs for Dogs, Part 2

Staff Response: Sonja just showed us the April issue of Dog Fancy magazine. An article by Solveig Fredrickson talks about the artificial leg Kuma the Akita is now wearing. The leg was made by Hal Moore of Oregon Orthopedic. The exact address is not given but Dog Fancy can be reached at www.petchannel.com.    

Hip Sublaxation, Severe

Q: Dear Doctor Mike, I have just heard from a friend of mine who had a 7month old Newfoundland which had to be put down. The dog was diagnosed as having severe sublaxation in the hip area. Apparently the joints just did not form and grow. Can you shed more light on this subject?

A: Luxation and dislocation are roughly the same term when discussing joints. So subluxation and partial dislocation would be analogous as well. The most common cause of subluxation of the hip joint in young dogs is hip dysplasia. It is sometimes possible to identify the subluxation as early as 3 to 4 months of age with X-rays. It can take up to two years for there to be clear evidence of subluxation sufficient to diagnose hip dysplasia although the great majority of dogs with this problem show signs much earlier. In dogs with moderate subluxation, it is often possible to surgically alter the hip socket so that the luxation is corrected and reasonably normal hip function returned, using a procedure known as a triple pelvic osteotomy. This procedure requires considerable orthopedic surgical skill and equipment and is often done at referral centers and veterinary hospitals in the United States, rather than at a general practitioner's facility. It is also possible to replace the hip joint. In large breed dogs this can be done at an early age due to their size. Both of these procedures are expensive enough that many owners find themselves in the position of having to consider euthanasia when the problem is severe and funds for surgical repair low. There are some other causes of abnormal development of the hips. Infection with Neospora caninum causes muscular atrophy sufficient to prevent normal development of the hip joints in some dogs. Trauma can do this and there are probably other causes I am not able to recall at the moment. I'm sorry to hear about your friend's dog.

Mike Richards, DVM  

Spondylosis and Dysplasia in Basset

Q: Dear Dr. Have you ever heard of hip displasia in the Basset Hound? I raise the wonderful creatures and one of the pets I sold has been diagnosed with hip displasia and spondilosis. He is only 2 years old. As far as I know, all Bassets have hip displasia to a certain extent because of the shallow sockets in the hips. I think this dog is crippled from the spondilosis. Because of this, both parents and all siblings have been neutered and spayed including the ones I was showing. We really can't have this going on. It causes pain and suffering to animals and broken hearts to owners. The spondilosis must be genetic for this dog to get it at such a tender age (my hounds do not become completely mature until about 2 1/2 years of age). What do you think?

A: Spondylosis is the excessive bone production that occurs between spinal vertebrae in dogs. It is only rarely a cause of lameness or disability and should be considered as the cause of such problems only when there is nothing else that would explain the symptoms. So it would be unusual, but not impossible, for it to be the cause of a crippling lameness.

I have heard of hip dysplasia in Basset Hounds but I do not know the prevalence of the problem offhand. How was the diagnosis of hip dysplasia made? I find Basset Hound X-rays to be hard to read for a number of orthopedic problems and often submit them for evaluation by a specialist. This is especially easy to do in the case of hip X-rays, since the Orthopedic Foundation for Animals (OFA) uses specialists to evaluate X-rays for them.

Bassett hounds have problems with luxating patellae as well. This is often part of the problem when there is debilitating lameness associated with hip dysplasia in Bassets. Their anatomy is such that often their entire leg is involved in almost any lameness.

Mike Richards, DVM

Odd Growth

Q: Our 10 month old yellow lab appears to have grown faster in his back half of his body versus his front. He appears to have shorter legs in the front and his head seems underdeveloped. All his teeth are full size except one of his lower canines which never grew in. Will he fill out in time or is this the way it is? Of course we don't love him any less.

A: Your lab is still young enough that he will continue to grow and change but I can't say for sure what the changes will be. If you see evidence that his front legs are deformed, such as his feet turned so his toes point outwards, for instance, it would be a good idea to have your vet examine him. I don't know of anything you can do to influence his growth, though. I wish I did!

Mike Richards, DVM