Joint Stiffness

[sea4th]

You know the one of the things that jumps out at me from this thread? It's this.....Melanie, Solo is one damned lucky dog to have you. It's no accident that your paths crossed, because no other dog could have taught you so much.

 

Vicki

[SoloRiver]

Hi AK,

 

Solo has to go in for a six-month checkup and x-rays in a couple of months, to make sure everything is copascetic with his root canal. I have been considering skipping this checkup, but since an abscess could get pretty bad before I would be able to tell he had an abscess this probably isn't a good idea. When he goes in then, his behaviorist is going to consult with the anesthesiologist so that he won't get Ace a second time. (I think I'm also going to ask them to do hip and back x-rays while he's under, depending on how much it'll cost me and whether I can afford it. He does agility and has never had his hips checked.) As for pain management, if that's ever necessary I'll ask her to consult on that as well.

 

Solo's problem with the vet is partly the environment but mostly the vet. He's not at his best in an unfamiliar environment, but the real problem is that he doesn't trust people unless he knows them well. There are a number of people other than me who could probably manipulate him without distressing him, but none of them are acupuncturists or chiropractors. A house call wouldn't help because like many fear aggressive dogs, Solo is sensitive to strangers entering the house. If I had a vet friend who came over regularly just to hang out, that would work, but I don't. It is unfortunate, but just a fact of life that Solo is difficult to examine because of his behavioral problems. For example, when I took him in for his dental appointment I had to bring a digital photo of his broken tooth, because I knew they were never going to be able to actually get a good look at it while he was awake. (My digital camera has a really fantastic macro function, luckily.) I also worry that sometimes the staff (and possibly, but hopefully not, the vet) feel hostile and less sympathetic toward Solo than their other patients because he is difficult. This could also compromise his quality of care at times.

 

Vicki, I guess Solo is lucky, but I'm lucky too because he is one special dog. It's very hard to explain, but if everyone knew the same dog I know, everyone would understand. Solo is John Nash in a fur suit -- he's brilliant, charming, handsome, dashing, and, well, nuts. He's a complicated, exciting dog and so many of his good qualities are the same ones that make this breed amazing. He's the reason I'm a Border Collie freak, even though he's a freak Border Collie. I feel sorry for all the people who ditched Solo. They really missed out.

[AK dog doc]

That sounds like a gret plan. Too bad poor Solo is so uncomfortable with strangers (though if you think about it, I'm amazed a lot more dogs don't hate the vet - we take an AWFUL lot of liberties on pretty short acquaintance, and it is a measure of their great good nature that most dogs are so gracious about it... and you can hardly blame most of the ones who are not. Even the poorly-trained ones are usually just uneducated, which is the owner's fault. Very few are really BAD dogs, though there are some.) As masterful as dogs are at reading body language, probably if the vets or techs are even a bit wary in their approach, that would activate Solo's radar that All Is Not Well.... and of course human life and limb have to be protected, so unfortunately that sometimes requires things that would tend to make a scared dog worry. I'd bet it wouldn't take outright hostility, just a little wariness and tension. He's probably EXTREMELY finely-tuned to nuance - at least that's been my observation of fearful dogs (I used to own a combined fear- and dominance-agressive Cairn... talk about a challenge. Thank God he only weighed 16 pounds.)

 

I'm glad you and Solo found each other. It really sounds like he needed a friend he could trust.

[juliepoudrier]

AK Dog Doc,

Have you heard of, or are you using in your practice, any anti-inflammatories other than Rimadyl? I, too, am leery of using Rimadyl for extended periods of time, but in Jill's case, there is an obvious need for some sort of pain control (that said, she ran really well in the trial this weekend, though she was packing her leg a bit on her outruns). I have had Duramax mentioned to me, but a number of people I know with working dogs who have tried it have had major diarrhea problems (the dogs, not the people!). A friend of mine whom I saw this weekend said that her vet (also my vet) had just started using a new medication--she couldn't remember the name--that is a liquid and has been used in Europe for years, but has only recently been approved for use in the US. She is trying it on one of her older border collies who has shoulder problems. I have a call in to my vet to ask if this would be a reasonable alternative for Jill (I very much prefer to use the least amount of whatever works for the least amount of time possible), but I am waiting to take her to see him until after her visit with the holistic vet (who does acupuncture, physical therapy, etc.) next week, so I can be "armed" with her input as well.

 

In my case, my biggest concern is keeping Jill sound enough and pain free enough to keep working, because that's what she really, really wants to do. To me, that's also a quality of life issue, as she would be unhappy being simply a house dog--even if the cats do provide fascinating entertainment (in Jill's eyes anyway).

 

You must see clients with working dogs so I'm wondering what you advise them in such cases? It seems to me that with joint problems, there's something of a catch-22 situation. In Jill's case, she needs to keep well muscled to add support structure to bad hips, but the injury (dislocation by mechanical trauma to refresh your memeory) seems to be preventing me from keeping up any sustained exercise program. I had been using the Rimadyl to help with soreness after exercise because my vet felt that she had reached the point where getting the muscling back was the most important thing and so we needed to use the medication to enable the physical exercise to progress (within reason of course).

 

I should add that since I put an "egg crate" mattress in her crate, she no longer comes out on three legs after being crated a while. We are also becoming intimately familiar with the use of a flexi-leash (something I never thought I'd own) as it allows me to give her some freedom while limiting her from running/racing with the other dogs on our walks.

 

So that's my long, sad story. Any brilliant ideas?

 

J.

[JeanT]

Cheri, back to Briar's limping. I'd like to underscore what Penny said about Lyme Disease. I'm pretty paranoid right now, because we just lost the sweetest 7-year-old to Lyme's. We didn't really have a clue until about a month ago. He had probably had it for years, and by the time we saw any signs, his little system was just devastated. He was always so happy, brave and persevering, I think one of those who just didn't show pain. The first sign we noticed was limping and change in gait.

 

If there are any ticks in your area, it wouldn't hurt to check it out.

 

Jean

[AK dog doc]

Julie, sorry, I didn't see this question in the postings. I was on call last week, which tends to throw things off a bit. Sorry about the late post and I hope it's still of some value.

 

I think your friend is talking about Metacam (meloxicam), which has recently been approved in the U.S. It is a liquid, and it tastes exactly like honey (really! The rep made me taste it. It's yummy) - so you can usually just drip it on some favored food and the dog will just eat it. I have way less experience with this than with the Rimadyl, so I can't really report as well on it, but so far so good. I haven't used the Deramax at all, though at the last meeting I attended one of my classmates (who I ran into there) said her clients liked it because of the delivery system and she felt they got good pain control. But I have zero personal experience with it, so I can neither confirm nor deny the reports of diarrhea (in the dogs OR the owners! ) In addition, I have sometimes coupled the use of Rimadyl with other pain meds - like hydrocodone - to potentiate it. You still have to be diligent in your monitoring of the liver, and some vets are reluctant to do this because of the human abuse potential. In fact, I've had to cut clients off for this very reason. But since the client was claiming the dog had severe pain (this was the excuse for getting the hydrocodone), I called the experts at CSU for something that did NOT have a human abuse potential. They suggested a drug called amantadine, which I *believe* is an OTC human anti-viral medication. The Doc at CSU said they reserve it for severe pain, which I repeated to my client; but though the client later reported that it worked really well, I am virtually certain that they never got it or used it, so I really can't report how well it worked. In any case, I try to reserve the hydrocodone for short-term use or terminal patients where we can temporarily restore quality with good pain control.

 

Your other management stuff sounds good - I do believe in acupuncture where indicated (though not all animals get relief from it) and also the food supplements (ditto) because both of these things can decrease the amount of other medication that you need, and in the case of the food supplements, you have at least a chance of improving the quality of the joint. Other things to think about... massage seems to help in some animals; heat (like a hotpack or a heating pad - be careful not to burn the dog - use it on the lowest setting and put a towel between the heating pad and the dog) may also help. There are some places that do physical therapy on dogs - like the underwater treadmill; this might be of use if you are wanting to build up some strength, since the water provides resistance but decreases some of the weight-bearing, so you might be able to build up without some of the lameness problems you're reporting. We have a place up here called Paws In Motion that does this specifically for animals. I'd imagine that someone down there does it too - your holistic vet might have a contact, if they are not doing this already.

 

How old is Jill? and would a total hip be out of the question for her? They're pretty steep, but if athletic function can't be maintained any other way, it might be worth the cost; I wouldn't presume to predict the liklihood of return to either pre-replacement or pre-injury function (that would be the surgeon's bailiwick), but the experts could advise you about that and tell you if she's a good candidate, as well as what the risks are. Dogs were where the total hip surgery was pioneered prior to its adaptation to humans, so it's been done longer in dogs than in people. Dogs have the added advantage that they carry only 40% of their weight over the hind legs (instead of 100% like us). Plus they don't care about the scar in a swimsuit! I haven't been in on one since vet school, so I can't tell you what has and hasn't changed with them - except that I heard from a human client that they now have ceramic implants that are lighter and maybe stronge than the steel ones. But that's anecdotal and I don't know if they have the appropriate implants for dogs, so take that with a grain of salt.

 

That's the high points... let me know if I left out something you want to know.

[Cheri McDonald]

Jean and AK Doc:

 

I asked about lyme when our vet checked her wrists. We don't have a lot of ticks and I haven't found any on her. Only on Rob. They are both on Frontline. She is also on pheno for seizures and I was concerned that it might be having an effect. She has an appointment in Dec for a bile acids test. She has been on the pheno for six months now.

[juliepoudrier]

AK Dog Doc,

It was Metacam, and my vet gave me a prescription, but I have not used it. The holistic vet I go to does physical therapy and has an "endless pool," treadmill (but not yet an underwater treadmill) and other stuff like that. she also does acupncture and chiropractic.

 

Anyway, the update on Jill is that she apparently injured her knee and may well have a partial tear of the ACL. My holistic vet feels that the lameness is not coming from her injured hip at all, but rather from the knee. Since I have trialled her since the onset of lameness, I am lucky she didn't blow the knee completely.

 

The vet noted that Jill is well muscled in front, but has atrophy in the back, probably from the crate rest after the injury and limited activity after that.

 

Anyway, we now have a physical therapy program that will help to rebuild the muscle necessary to stabilize the hip (which has entirely too great a range of motion thanks to HD coupled with a mechanical dislocation) without putting strain on the knee to give the knee time to heal over the next six to eight weeks. Swimming is out because it actually hyperextends the knee (the vet described the motion of the back legs while a dog is swimming as something of a cow kick). So Jill is on a walking program using a resistance band (Theraband) that will help to build muscle in her hip region without stressing the knee. She is also allowed to walk in water as long as the water level is below the knee. We will be using a tracking harness and encourage her to pull a bit as this will also add resistance for building strength in her hip region (without putting strain on her neck).

 

We still have a ramp in place over the steps leading outside from when she dislocated her hip, so the only real issue right now is the stairs up to my part of the house I rent. I have to make sure that she *only* walks when going up and down those stairs.

 

Another interesting thing the vet pointed out is that Jill is likely having some muscle spasms in her midback as a result of contracting those muscles to compensate for the problems in her rear end when running (as when working sheep). This helps to explain why she likes to repeatedly "scrub" her back in the grass when she goes outside.

 

Anyway, the vet did give Jill a massage, but didn't think acupuncture would be needed as the lameness wasn't ofa nature to be helped by the acupuncture. So now we do the physical therapy and will have a recheck in about a month to see how things are going.

 

Oh, and as for nutritionals, the vet thought I was doing well to "overlaod" a bit on the glucosamines (I give her weekly Adequan injections as well as an oral glucosamine/vit C/etc. supplement, plus Missing Link PLus). She also gets flax oil and vit E for their antioxidant properties. I am to add more fresh protein (now on a daily basis rather than just a few times a week) to give Jill a protein source for muscle building. We're also going to give MSM a try and see if it has any beneficial effects.

 

As for FHO vs. hip replacement, my vets (regular and holistic) think that the FHO is not the treatment of choice for a dog that needs/wants to keep working. They see it as a salvage operation to help with the pain caused by the scraping together of the hip and the socket when all the cartilage has worn away but not as something that will necessarily extend the useful working life of a working dog. We are holding hip replacement as a sort of last resort. Both vets (and me) prefer a conservative treatment program first, but I will have a hip replacement done if we can't solve the problem through the current plan. One thing that does make Jill a good candidate for HR is that she hasn't developed any bony projections around the hip socket, but the extremely poor quality of the socket could make her a poor candidate for replacement. Anyway, we are keeping all options open, but are trying the conservative methods first.

 

Lastly, and sorry this is so long, if JenniferK (?)--I hope I have the name right--is reading this thread I want to add to everyone else's comments about the importance of muscling for keeping a dysplastic dog sound. Aside from what can be seen on her radiographs, you would never have known how awful Jill's hips were if you had seen her working. The only real evidence of her HD was radiographic--no physical lameness, etc. We wouldn't be having a problem now if it hadn't been for an unfortunate accident that caused the hip dislocation (being caught under a truck tire). Jill's saving grace through it all, and she is an open-level trial dog, was the fact that she was very fit and well-muscled. The big push even now is to get that muscling back in her hip area to stabilize the joint, but of course a knee injury has thrown a monkey wrench into the works. So don't wrap your dog in cotton wool--keep him active and fit and most of all let him enjoy life. The main reason I am working so hard with Jill is that she loves to work, so I will do what it takes to get her sound enough to keep working. For her that is a real quality life!

 

J.

[AK dog doc]

Yeah, I'd consider the FHO a salvage procedure as well, but it's good to know you have a fall-back poistion if it's absolutely the only resort apart from euthanasia or unremitting pain. Total hip would be the gold standard, if the hip trouble becomes unmamageable with your other treatemnts (excluding, of course, the complicating factor of the knee). BTW, there are some good surgical options for knees as well; you're probably aware of this, since you're well-informed as a rule, just thought I'd mention it. If the knee is injured that would indeed alter the acceptable conditioning regimen away from what a simple hip injury might need.

 

I watched the surgeon do a TPLO (knee surgery) not long ago... he seemed to think that many if not most of them have a "bucket handle" tear of the meniscus, which needed surgical attention at the same time as the TPLO.... he didn't just leave the meniscal bucket handle there. So that might be a complicating factor to the knee pain.

 

As an FYI, we usually x-ray hips in dogs we're contemplating knee surgeries on, and if the hips are bad we sometimes don't do the knee, since many owners can't afford to repair both. In that case you're asking yourself, "If I spend $1500 on the knee and still have a bad hip, the dog is still lame, so have I spent the client's money wisely?" - so if this comes up, you may have to let them know where you stand on doing both, or doing whatever is most appropriate to preserve Jill's working ability and hence her joy in life. I think they'll accomodate you, but they might assume that you can't do both for financial reasons (we *shouldn't* assume this sort of thing, but we sometimes do out of habit), so correct them if need be. But hopefully it isn't something you need to think about today, since you haven't run out of options on your nutritional and medical and PT support.

 

I'll keep my fingers X'd.

[Betsy]

Okay, I have no-where near the medical experience all of you have that are posting on this thread, but I thought I would just add this:

 

Riley was on Deramaxx for his OCD, both pre-surgery (for 4 months) and post-surgery (only a few days). It worked really well for him, and did NOT include ANY diarreha.

 

In fact, the first day we had it, I brought him home from the vet and kenneled him (so I could go to work) and placed the Deramaxx on top of his kennel. He has a wire crate with a board on top, covering the majority, but not all, of the top. He must have rattled the cage which caused the Deramaxx bottle to fall into the cage. He ate the entire prescription (2 weeks worth), plus part of the bottle. I do not know what time of day this happened.

 

I got home about 4 hours after leaving him, found the remains of the empty bottle and immediately called my vet. They told me to induce vomiting (which I did with just a taste of peroxide). There was some brown mushy (used to be solid) matter in the vomit, could have been Deramaxx, could have been something else. Then took him in for blood tests, including liver function. All was fine. My guess is he injested about half the prescription. More blood work-up a week or two later and all was still fine. As a side note, all medications are now kept in a very high cabinet in the kitchen.

 

My vet says he likes it because it is much easier on the dog's system, especially for long-term. That's his opinion, of course.

 

On another note, I am curious about the MSM/glucosamine debate (whether MSM works or not). I have a family friend who is a human doctor. My brother has had reconstructive knee surgery on both knees in previous years (10+ years ago). He is now starting to have pains in his knees after playing raquetball, basketball for hours at a time (who would have thunk? )This familiy friend doctor has recommended him to take glucosamine with MSM, saying the MSM must be included in order for it to be effective. Is there a difference betweem humans and canines that would explain this, or might this just be an opinion of the doc?

 

Great info in this thread!

 

Thanks!

 

Betsy

[AK dog doc]

In dogs, apparently, the MSM and the chondroitin have a synergistic effect with the glucosamine - so you add one plus one and get three, not two. So I'd agree with the other doc - at least so far as dogs go. I woulsn't say glucosamine is useless without other supplements - just that it works better with them.

 

Interesting about your doggy Deramaxx O.D. - that's good to know. Glad it ended well.

[juliepoudrier]

Hey Betsy,

I am getting ready (just picked some up today) to start one of my dogs on MSM. She is already on both injectable (Adequan) and oral (Lubrichon and Missing Link Plus) glucosamine. I will be interested to see if I notice any appreciable difference on adding the MSM to the mix.

 

As I said either earlier in this thread or in another thread, the vet that started one of my dogs on glucosamine (probably 5 years ago) wasn't at the time convinced that MSM was beneficial, not to mention her concern over lack of studies in dogs. So that's why I have dogs on glucosamine but not MSM.

 

I told my vet last night that I should forget ever hoping for a travel trailer for trialling--I will instead need a U-Haul for all the medications and supplements my dogs take!

 

J.