Question: Hello--I'm one of your subscribers. I have an 11 month old basset puppy (spayed female) who developed a limp in her left front leg about 6 weeks ago. Our vet. x-rayed the leg, and found nothing. They found a sore place on her right rear leg also. They think it is pano. Since then she's been on buffered aspirin, rimadyl and another non-steroidal anti inflammatory--started with an e--. None seemed to have helped her limp much, and now she appears to be chewing on the right rear leg where they found the sore spot. How long will this go on? Is there anything I can do to help her feel better?
Thanks for any advice. Sharon
I have been trying to research this some because there is a difference between what I have heard about this condition in basset hounds and what I can find in the literature. The difference is that I can't find any strong evidence for panosteitis occurring in bassets based on the literature but I know two or three Basset breeders, and their vets, who really believe that this is a fairly common problem in the breed. Unfortunately, I am still unable to figure out how much of a problem panosteitis is in Basset hounds.
Panosteitis is pain in the bone that usually occurs during growth and is most common in German shepherds and giant breeds of dogs. The pain can be pretty severe and it seems like pain relievers are sometimes not sufficient. At the present time carprofen (Rimadyl Rx) seems to be the favored pain reliever, although others have been advocated at various times. Etodolac (Etogesic Rx) is similar to carprofen. This condition usually has a waxing and waning course, in which there are times of pain and times when the puppy seems to be OK. For this reason it can be hard to tell which pain relievers are really working well, since the pain can go away on its own. The presence of a fever is supportive of the diagnosis. There isn't a strong correlation between the amount of increased bone density seen on X-rays and the amount of pain so this disease does sometimes present as sort of a mystery.
There are other growth defects that might be worth thinking about as possible problems. For a front leg lameness the one that I would worry about the most is an ununited anconeal process. There are several studies on this condition in the chrondrodysplastic breeds like the Bassets and it is apparently not uncommon. I find this condition a little hard to diagnosis in some cases even when I suspect it and often have to send the X-rays to a radiologist for review to obtain a more definite diagnosis. This would cause persist pain in most cases and in our experience pain relievers often are not effective enough to control the discomfort associated with this condition. I have also heard of osteochrondritis (osteochrondrosis) dissecans in Bassets but couldn't find a lot of information on it in the breed, either. In any case, this would be another thing to look for. We have diagnosed this once in a Basset and it was affecting the shoulder joint in our case.
I think that some Basset hounds are pained by the deviations that occur in their legs that are just breed characteristics and we see a lot of Basset hounds with interdigital pyoderma (infections between the toes) who are lame as a result of this problem. Treatment for the inflammation and infection usually resolves this problem and then it usually comes back later on and has to be treated again.
These are the things that I can think of that cause forelimb pain in Basset hounds at least on an occasional basis. There are probably some other things that aren't coming to mind. If this is a persistent problem keep working with your vet to resolve the problem or consider asking for referral to an orthropedic specialist as long as the interdigital pyoderma problem doesn't seem likely.
Mike Richards, DVM 10/15/2001
Panosteitis is a spontaneously occurring lameness that usually occurs in large breed dogs. German Shepherds seems to be particularly predisposed to this condition. Due to this, it is possible that the disease may have genetic causes. Some veterinarians feel that this disease may be induced or worsened by stress.
Affected dogs are usually in the 5 to 14 month age range and male dogs are more commonly infected than female dogs. The disease has been reported in dogs as young as 2 months and can occur in young mature dogs. The lameness tends to occur very suddenly, usually without a history of trauma or excessive exercise. In most cases one or the other front leg is affected first and then the problem tends to move around, making it appear that the lameness is shifting from leg to leg. There are often periods of improvement and worsening of the symptoms in a cyclic manner. This makes evaluation of treatment difficult since many dogs will spontaneously recover with or without treatment and then relapse.
X-rays usually reveal that the bones have greater density than is normally found. If pressure is applied over the long bones, pain is usually present. The X-ray signs do not always match the clinical signs.
In most cases, the worst pain lasts between one and two months but may persist in a cyclic nature for up to a year. Analgesic medications like aspirin can be be helpful. In severe cases, corticosteroids may provide relief.
Currently, a common rumor is that low protein, low calcium diets may prevent this condition. It should be noted that the energy level of low protein/calcium diets is often lower as well. If this is the case, a puppy will eat much more of the diet in order to meet its energy needs, resulting in higher total calcium consumption. It may be preferable to feed a puppy diet and restrict total quantity to keep the dog lean than to use a low protein/low calcium adult dog food.
This condition is self limiting, meaning that it will eventually go away, with or without treatment. Pain control can go a long way towards helping your pet feel more comfortable and should be used, though.
Mike Richards, DVM
Panosteitis in Basset
Question: Dear Doctor Mike,
Our seven month old female basset, Pixel, has been diagnosed with panosteitis (she is 39 pounds). Our vet is very familar with this in bassets. He took x-rays but they didn't show the "swirls" he said he sometimes sees but said that does not mean that she doesn't have this. She first was limping on one leg a month ago and then was all right after a few days. About a week ago she started limping on her back leg and although the limping is over, she is very stiff in the rear, particularly after she has been lying down for awhile. Both rear legs were tender in the long bones when our vet palpated them. She would also have spells of panting when she was merely standing and with no exertion.
Our vet did a complete blood panel and said that her calcium and pancreatic enzymes were slightly elevated as was her white count (but not to the level which noted an infection) but he thought that this was nothing to be overly concerned with and will recheck these things in about two weeks. She was first placed on one half an Ascriptin twice a day but she was still uncomfortable. With this condition, her appetite has been reduced. She has now been placed on three quarters of 150mg. of Etogesic once a day for ten days. She is certainly more comfortable on this medication and the panting has all but disappeared.
My questions to you are:
1. Is there anything else we should do for now other than to keep her quiet? She was supposed to be in a dog show next week-end but we have withdrawn her as we want to keep her from overdoing.
2. Do you believe the panting was related to the pain?
3. Are blood test outcomes ever affected by this disorder? I don't want to unnecessarily panic but we lost our five year old basset Truffle to pancreatic cancer last August. Our vet does not feel we should be alarmed by the outcome of the blood work. Pixel also had a trace of blood in her urine test which he called within normal limits and also felt that this may be a precursor to her going into heat.
Any information you can give in this matter would be helpful
Thank you-- Sally
Basset hounds are one of the breeds noted for developing panosteitis and the clinical signs do fit this disorder. The usual recommendation is to use pain relief medications and wait for the condition to resolve. The type of pain relief necessary varies from one patient to another, with some dogs doing well on pretty mild pain relievers, such as aspirin, and other dogs requiring other more potent pain relievers such as etodolac (Etogesic Rx), carprofen (Rimadyl Rx) or hydrocodone/codeine (Vicodin Rx, Tylenol 3 Rx). Some dogs may even require fentanyl patches (Duragesic Rx) if the pain is very severe. Panting is not an unsual response to pain and I tend to think it is probably the cause if this is panosteitis.
I don't worry much over rises in pancreatic enzyme levels unless they are at least twice the high end of the normal range or even higher, if no clinical signs of pancreatitis are present. The mild increase in white blood cell count is typical for panosteitis, or at least a frequent finding with it.
I hope that the Etogesic continues to control Pixel's pain but if it doesn't, there are alternatives worth considering. Even though veterinarians can't shorten the course of this illness, we can at least help patients remain as comfortable as possible through pain relief.
Mike Richards, DVM 3/19/2001
Panosteitis in Dobie pup
Q: Dr. Mike: Love the WEB site! I have a great relationship with my vet whereby he has encouraged me to look into treatment plans for Panosteitis. My four month old Dobe manifests its symptoms, but we have not done the radiographs in order to avoid the cost (thus far). While we don't have a definitive diagnosis, other litter mates have been diagnosed via symptoms and radiographs. My interest is focused on diet. At present we have adopted the adult dog food route to keep protein low (along with calcium). My breeder has recommended Vitamin C at 2,000 MG via two 1,000 mg does at morning and night. Meanwhile, I have shared with great interest the positons you have in this area and have also seen calcium suppimentation as a possible means of treatment. My vet and I would like to further explore the issue and hope you could provide some additional insights and possible sources for further research. Thanks in advance for your help! Rick
A: Rick- Sorry for the delay in replying to your inquiry. I was thrown by the reference to calcium supplementation and put this aside to research. I have finally had time to get to it. I can not remember ever seeing a reference to calcium supplementation as an aid in treatment of panosteitis. In most growth related orthopedic conditions of large breed dogs the current thinking is that calcium should be kept to the minimum required for growth. The theory is that the higher protein, higher calcium puppy foods may encourage too rapid growth and subsequent problems such as panosteitis. Changing diets may or may not be beneficial. Feeding a puppy adult dog food could actually increase the total amount of calcium intake due to the need to eat more food to meet caloric needs. It is a confusing issue and I am not sure I can make any recommendations that have much scientific basis. The same is true for Vitamin C supplementation. There are many sources of information that suggest it helps and many that suggest it may be part of the problem in some of these disorders. The one consistently recommended treatment for panosteitis is analgesic therapy. Currently, carprofen (Rimadyl Rx) seems to be the treatment of choice. Since almost all dogs will eventually outgrow signs of panosteitis, just keeping them comfortable while they do it should be sufficient.
Mike Richards, DVM
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...