Hello,
First off, congrats on a truly innovative service.
We have a beautiful 12 year old male Labrador dog with severe hind leg
problems. He finds it extremely difficult to lift himself off the
floor and even has to make several attempts to urinate successfully. I
would like to add that he gets as much freedom and affection in the
house as his human friends and is cared for very well.
He had his first attack about 8 months back when he was unable to get
off the floor for 2 days at a stretch. the vet administered
neurobion and dexamethasone injections and he was a little better and
walking about, but never really recovered since then.
Other treatments tried were meloxicam injections, meconerve(methyl
cabalamine)injections. None of the drugs have had a marked effect as
he is only able to walk with difficulty and has to try several times
to lift himself off the floor.
Some other symptoms noticed were that his tail sometimes moves
completely to one side, almost at right angles to his body and his body
itself seems curved to the side at that time. He is also very ticklish
when touched on his hind side. Due to this we have stopped giving him
regular massage on his hind legs.
I'd like to know if he's being given the correct treatment and if
there is anything more we can do for him. Also please advice on a good
diet ( he weighs approx. 40 kg and we live in India, a country which
has tropical climate).

Thanks!!!
Amar

Hello Amar,

   Thank you for the complement about Google Answers. We researchers
are proud to be connected with such a service.


   I?m sorry to hear about your four-legged friend. It?s painful to
see a family member (as your lab seems to be) suffer. Larger breeds
such as labradors, golden retrievers, and German shepherds are prone
to hip dysplasia and arthritis, particularly if overweight. We are
unable to disagnose your dog?s condition online, but it certainly
sounds as if your friend may have dysplasia of the hip. Has your vet
mentioned hip dysplasia?


 ?Hip dysplasia literally means an abnormality in the development of
the hip joint. It is characterized by a shallow acetabulum (the "cup"
of the hip joint) and changes in the shape of the femoral head (the
"ball" of the hip joint). These changes may occur due to excessive
laxity in the hip joint. Hip dysplasia can exist with or without
clinical signs. When dogs exhibit clinical signs of this problem they
usually are lame on one or both rear limbs. Severe arthritis can
develop as a result of the malformation of the hip joint and this
results in pain as the disease progresses. Many young dogs exhibit
pain during or shortly after the growth period, often before arthritic
changes appear to be present. It is not unusual for this pain to
appear to disappear for several years and then to return when
arthritic changes become obvious.?

?In a recent study done in Labrador retrievers a significant reduction
in the development of clinical hip dysplasia occurred in a group of
puppies fed 25% less than a control group which was allowed to eat
free choice. It is likely that the laxity in the hip joints is
aggravated by the rapid weight gain.?


Older dogs require different treatment than young dogs.  
?Dogs that exhibit clinical signs after the growth phase require a
different approach to treatment. It is necessary to determine if the
disorder can be managed by medical treatment enough to keep the dog
comfortable. If so, aspirin is probably the best choice for initial
medical treatment. Aspirin/codeine combinations, phenylbutazone,
glycosaminoglycosans and corticosteroids may be more beneficial or
necessary for some dogs. It is important to use appropriate dosages
and to monitor the progress of any dog on non-steroidal or steroidal
anti-inflammatory medications due to the increased risk of side
effects to these medications in dogs. If medical treatment is
insufficient then surgical repair is possible.

The best surgical treatment for hip dypslasia is total hip
replacement. By removing the damaged acetabulum and femoral head and
replacing them with artificial joint components, pain is nearly
eliminated. This procedure is expensive but it is very effective and
should be the first choice for treatment of severe hip dyplasia
whenever possible. In some cases, this surgery may be beyond a pet
owner's financial resources. An alternative surgery is femoral head
ostectomy. In this procedure, the femoral head (ball part of the hip
joint) is simply removed. This eliminates most of the bone to bone
contact and can reduce the pain substantially. Not all dogs do well
following FHO surgery and it should be considered a clear "second
choice".?

?When an older dog is exhibiting signs of pain associated with this
condition it is often possible to help them dramatically through
medication and simple steps like providing a warm bed or warm spot to
rest during the day. There is no advantage to pain and steps should be
taken to ensure that the older dog is not in pain. Regular exercise
can be very helpful and weight loss can have dramatic effects on the
amount of discomfort a dog experiences.?
Please read the entire web page, as I am only able to post snippets
here due to copyright restrictions.
http://www.vetinfo.com/dencyclopedia/dehipdysp.html 

   ?Difficult to prevent and treat, canine hip dysplasia is among the
most studied and the most frustrating diseases in veterinary medicine.
 Canine hip dysplasia is a developmental orthopedic disease in which
an abnormal formation of the hip leads to looseness in the hip joints,
causing cartilage damage.  Progressive arthritis can result, and when
it does, it can be crippling.  Hip dysplasia is not the same thing as
arthritis in the hips rather, it is the most common cause of arthritis
in the hips.?

?Hip dysplasia is most common among larger breeds of dogs, especially
German shepherds, rotweillers, Labrador retrievers, golden retrievers,
mastiffs, and Saint Bernards.  It can also be seen in smaller breeds
such as the cocker spaniel and the springer spaniel; mixed breeds may
suffer from it as well.?

?Aimed at treating hips that have already become arthritic, the
therapeutic procedures available for dysplastic dogs include total hip
replacement, femoral head ostectomy, and investigational surgeries
such as the DARthroplasty. In a total hip replacement procedure, which
is generally performed on a severely debilitated dog weighing more
than 50 pounds, a prosthetic hip socket and a femoral head are
implanted into the dog, forming an artificial ball-in-socket joint.
This gives the dog a pain-free hip joint and nearly normal function
after the recovery period. Total hip replacement is a technically
demanding surgery, and usually is done by highly trained individuals
at referral practices and universities.  When performed by experienced
surgeons, the success rate approaches 95 percent; nevertheless,
complications, while uncommon, can be devastating. For this reason,
this procedure is reserved for animals with the most severe signs of
hip dysplasia.

Femoral head ostectomy is a surgery performed on severely arthritic
dogs. With this procedure, the femoral head (ball part of the joint)
is removed, allowing the femur to float about freely and causing scar
tissue to form. As the scar tissue hardens and thickens, it serves to
create a false-joint called a pseudoarthrosis. The femoral head
ostectomy is a last resort procedure and generally is not recommended
for mild cases of arthritis. This procedure is more effective in
smaller, well-muscled dogs. Among dogs weighing more than 50 pounds,
the results will vary.?
http://www.workingdogs.com/vchipdysplasia.htm

?Medical treatment includes three components: Weight control,
medication and exercise restriction. Weight control is extremely
important. Obesity causes excessive forces to be transmitted to
already abnormal hips exacerbating soreness and accelerating
arthritis. Medications are used to control soreness flare-ups and slow
the arthritic changes and process. Exercise restrictions must be
observed for medical therapy to be effective. Full out running,
jumping and roughhousing should be limited as much as possible.
Extended walks or jogs, on a leash and swimming can be beneficial.
When soreness flares up, exercise should be extremely limited for a
few days, often crate rest works best.?
http://www.grr-tx.com/resources/hipdysplasia.htm


Symptoms
========

?Clinical Signs:
Decreased activity; difficulty rising; rear limb lameness; reluctance
to use stairs, particularly to go up; reluctance to jump or stand on
hind limbs; swaggering gait;  bunny-hopping gait; pain from
manipulation of the hip(s); decreased range-of-motion in the hips;
crepitus in the hip joint; positive Ortolani sign; positive Barden?s
maneuver; subluxation or complete luxation.
Symptoms:
Less energy and movement; difficulty rising; lameness in the back
legs; reluctance to use stairs (particularly to go up); reluctance to
jump or stand on hind limbs; swaggering gait, bunny-hopping gait;
soreness after lying down; soreness after heavy exercise.?
http://www.workingdogs.com/vchipdysplasia.htm


Medications
===========


Injectables

   ?Polysulfated Glycosaminoglycan (Adequan): Adequan is a product
that is administered as an injection. A series of shots are given over
weeks and very often have favorable results. The cost and the
inconvenience of weekly injections are a deterrent to some owners,
especially since the oral glucosamine products are so effective. This
product helps prevent the breakdown of cartilage and may help with the
synthesis of new cartilage. The complete mechanism of action of this
product is not completely understood, but appears to work on several
different areas in cartilage protection and synthesis.
Hyaluronic Acid (Legend): Hyaluronic acid is an important component of
joint fluid. Including it in the management of osteoarthritis may
protect the joint by increasing the viscosity of the joint fluid,
reducing inflammation and scavenging free radicals. Most of the
research on hyaluronic acid has been done in people and horses, but it
may also be effective in dogs. This is an injectable product which is
administered directly into the joint.?
http://www.peteducation.com/article.cfm?cls=2&cat=1569&articleid=444


Rimadyl (Carprofen)
This drug is commonly used, but it does have side effects.
http://www.vetinfo4dogs.com/drimdyl.html


   In the US, there are low calorie/fat dog foods available with
glucosamine and chondrotin in them. These ?nutraceuticals? seem to
help with joint pain.
?Glucosamine is the primary component of nearly all multi-ingredient
nutraceutical formulas and seems to be the most important. It is
essential for the formation of joint cartilage and synovial fluid. 
Glucosamine should certainly be an ingredient in whatever formula you
use.?
?The benefits of chondroitin are much less clear. It is a large
molecule and poorly absorbed when taken by mouth. Most glucosamine and
chondroitin formulas are probably useful only because of the
glucosamine.?
Oral Methylsulfonylmethane (MSM) and antioxidants may be helpful as well.
http://www.placervillevet.com/nutraceuticals.htm


   ?Glucosamine and chondroitin are also often used as an aid in the
treatment of spinal disc injuries or post operatively in dogs that
have undergone joint surgery.

The typical patient that is placed on and responds to glucosamine and
chondroitin therapy is a middle aged to older medium to large breed
dog. Dogs may show symptoms of limping or stiffness especially in the
morning and during cold weather. They usually loosen up as they move
around and exercise. Some dogs have difficulty climbing stairs or
getting into or out of a vehicle. Many dogs respond to treatment with
buffered aspirin (Do NOT give your cat aspirin unless prescribed by
your veterinarian) or carprofen (Rimadyl), but when the product is
discontinued the pain and symptoms return. Osteoarthritis also affects
small dogs and cats and glucosamine and chondroitin have been used
very effectively in relieving their symptoms.?
http://www.peteducation.com/article.cfm?cls=0&cat=1448&articleid=670


Cosequin
?Cosequin is a patented combination of glucosamine, purified
chondroitin sulfate and manganese ascorbate for optimal functioning of
the skeletal joints. Helps reduce inflammation and rebuild cartilage
and its major components.?
http://www.valleyvet.com/search_pages/Cosequin.html
http://www.entirelypets.com/cosdsdoubstr1.html


This page outlines the pros and cons of canine medications for arthritis and CHD:
http://www.srdogs.com/Pages/care.cd.html


Health Issues of Labrador Retrievers
http://www.dogbiz.com/dogs-grp1/ret-labrador/labrador-health-issues.html


   I found nothing concrete on your dog?s tail angle, but I would
guess it may have something to do with muscles getting pulled due to a
subluxation - when two bones in a joint separate due to dysplasia or
injury. He may move his tail that way to alleviate pain. X-rays or
scans of your dog?s hip can substantiate this, or rule this out. It
could also be some form of nerve damage.

?Your veterinarian or the veterinary staff can show you how to perform
physical therapy and massage on your dog to help relax stiff muscles
and promote a good range of motion in the joints. Remember, your dog
is in pain, so start slowly and build trust. Start by petting the area
and work up to gently kneading the muscles around the joint with your
fingertips using a small, circular motion. Gradually work your way out
to the surrounding muscles. Moist heat is also beneficial.?
http://www.peteducation.com/article.cfm?cls=2&cat=1569&articleid=444

I hope this has helped you and your friend out. Please request an
Answer Clarification if anything is unclear. I will be happy to assist
you further, if possible, before you rate the answer.

Sincerely, Crabcakes

Search Terms
=============

CHD + canine
Hip dysplasia + canines
hip dysplasia medication + canines
glycosaminoglycans  + canine
Cosequin + canines

---

Request for Answer Clarification by dogneedshelp-ga on 16 Dec 2005 01:08 PST

Hello Crabcakes,
Thats a lot of information to get started on! Great stuff.
I am working with the vet on what you've sent across. He does not seem
convinced about hip dysplasia though, thinks its some muscular problem
related to the advanced age of the dog.
Meanwhile, I was wondering if there's any information on the following,
   - Are there medical conditions other than hip dysplasia that exibit
       the same syptoms?
   - What are the side effects of Glucosamine and Chondroitin (on the
first trial of these drugs on the dog, he was urinating uncontrollably
inside the house which he's never done before)

Regards,
Dogneedshelp

---

Clarification of Answer by crabcakes-ga on 16 Dec 2005 09:59 PST

Hello again,

   Chondroitin and glucosamine appear to be safe in proper dosages,
and have relatively few side effects. Frequent urination does not
appear to be one of them.

"Two new nutritional supplements, glucosamine and chondroitin, have
been found to not only help control pain, but also improve joint
mobility and improve the damage to the cartilage that is part of the
arthritic process. These two products work together to block the
action of cartilage destroying enzymes as well as increase the
activity of cartilage producing cells and improve the nutrition to the
cartilage. These supplements are available at many veterinary
hospitals as well as health food stores and even some drug stores. The
general dosage recommendation is 1,000 mg. of glucosamine and 800mg of
chondroitin per 50lbs. Combination products are available through your
veterinarian. Some products have additional Vitamin C added as well. I
am currently evaluating other nutritional products for arthritis as
well and will keep you informed about those.

Antioxidants may also be extremely beneficial in the treatment of
arthritis. Antioxidants are helpful by controlling free radicals which
are associated with cartilage damage. The most readily available
antioxidants include Vitamins A, C, and E and the mineral Selenium.
Dosage suggestions vary, I usually recommend 2,000 IU of Vitamin per
50lb. dog per day as well as 1000mg Vitamin C twice a day (buffered
Vit C), 400 I.U. of Vitamin E and 25-50 micrograms of Selenium."
http://www.drschoen.com/articles_L2_11_.html

"An uncommon side effect is gastrointestinal upset; taking the
supplements with food can help. If upset continues or if there is no
improvement within 6 months, other treatment methods are required.
Taking the supplements with aspirin may cause problems in forming
blood clots."
http://www.animalhealthchannel.com/ccl/treatment.shtml
    


   Has your vet checked for a urinary tract infection? This is a
common cause, as well as dogs age. Crystals and stones that develop in
the bladder can cause frequency (and pain).  As dogs age, they lose
control of their bladder easier.
http://www.executec.com/urolith.htm

http://petcaretips.net/bladder_stones_dogs.html

http://www.barkbytes.com/medical/med0080.htm

http://www.belfield.com/article4.html



Chondroitin and glucosamine:

http://www.peteducation.com/article.cfm?cls=0&cat=1448&articleid=670

http://www.umm.edu/altmed/ConsSupplements/Chondroitincs.html

http://www.placervillevet.com/nutraceuticals.htm



Other information:

http://www.thepetprofessor.com/articles/article.aspx?id=210

http://www.vetinfo.com/dogurinary.html#Urinary%20crystals%20and%20bladder%20stones%20in%20Corgi
  

Other:
"When there are changes in posture it is usually worth checking for
the possibility of an
orthopedic problem. This would be a good age to consider taking X-rays to
check for hip dypslasia, since it will show up in most cases by now, if it
is going to be a problem later in life. Some dogs with hip dysplasia will
compensate by adopting a different posture or gait.

I have seen two or three Labs in the last couple of years who developed
lateral luxations of the patellae (knee caps) and these were all labs who
had a narrow stance at the hocks. This causes lameness or pain in most
cases, though. "
http://www.vetinfo4dogs.com/dleg.html

http://www.vetinfo.com/dmotion.html

Degenerative Myelopathy
http://vetmedicine.about.com/od/caninehealthdogs/a/VVP_degenmyel2.htm

"Degenerative Myelopathy is a progressive disease involving the spinal
cord. It is thought to be an autoimmune disease.  It appears with
relative frequency in German Shepherd Dogs.

DM presents itself with waxing and waning of the following symptoms:

*hindquarter weakness, rear limb ataxia (reflex to right foot when
turned backwards, slow, or non existent), loss of balance, difficulty
rising or laying down, knuckling under while walking, limp tail, rear
legs crossing under body, rear leg drag, spinal ataxia, hoarseness of
bark,  leading to paralysis, and incontinence in the final stages...

*DM can attack one or both sides of the body. 
 
	

There is no cure for Degenerative Myelopathy, although there are
programs which can possibly slow the progression of the disease. Onset
of DM can be between 5-14 years of age, but has shown up as early as 3
yrs of age. Usually, the progression of the disease is slow and
gradual in the early stages, and can sometimes be mistaken for hip
displaysia or arthritis.  In the latter stage of the disease,
progression is more rapid. Vets are often too ready to "write off" DM
dogs, telling the owner that nothing can be done to help their pets,
other than trying to make them comfortable. Too often, vets do not
inform their clients of the program to help slow the progression of
DM, and many are completely unaware of the existence of Dr. Clemmon's
program"
http://www.mzjf.com/signs.html

Special "Lift leash"
http://handicappedpets.com/resleash/resleash.htm


   Would it be possible for you to seek the second opinion of another
vet? It surely appears to be a hip dysplasia problem, but without
x-rays and other tests, it is hard to know. Please have the vet check
him for urinary tract problems as well.

Please give your dog a big hug and pat from me!
Sincerely, Crabcakes

Suggested answer undergoing trial. Researcher was through in my opinion.

Beautiful work, Crabcakes!

I'd also be concerned with spondylosis, or spinal arthritis.

Weight loss is always a good idea for a dog that is having difficulty
getting up and around. Unfortunately this can be a vicious cycle: it
hurts to get up and move so they become lethargic; lethargy leads to
weight gain; weight gain leads to watching Oprah; Oprah leads to Mad
Cow disease... or something like that.

I would like to take some exception to the following from your quotes:
"The femoral head ostectomy [or osteotomy] is a last resort procedure.
Among dogs weighing more than 50 pounds, the results will vary."

Femoral head ostectomy (FHO) is about one-fifth to one-twentieth the
cost of a pelvic replacement (TPR). When performed by a skilled osteo
surgeon the results are nothing less than miraculous. I know a
surgical specialist near Washington DC who has had no problems with
his FHOs so long as the client and patient follow proper post-op
procedures, and has similar perfect success with patellar luxations
and anterior cruciate ligament repairs using a procedure he developed
(he has never had one fail-- one dog with a moderately irate owner
came back eight years after knee surgery; it turned out he blew the
OTHER kneecap).

As TPR is so far out of a normal person's price range, involves
complex and long surgery, is possibly contraindicated in a
12-year-old, has a lengthy recovery period, has (admittedly minor)
risk of infection and rejection, FHO is doubly recommended. But ONLY
from a surgical specialist, not your run-of-the-mill vet.

Amar, you should have your vet take some x-rays. Depending on the
diagnosis you must give serious thought before you subject your pet to
complex procedures that involve long and painful recovery. Your dog
relies on you to make sensible decisions for him-- not decisions based
on emotion.

Best of luck to you!

markvmd-ga,

Thank you for your comments, I'll be definitely following up with the
vet on your views. We strongly feel that surgery should be a last
option as limited facilities are available and we do not want to
subject the dog to extreme procedures at his age.

Regards,
dogneedshelp

I'd like to let you know about our German Shepherd, Jesse.  Since
birth, she acted like she had hip dysplasia, but several vets said
that was not the case.

After taking her to a specialist, we found the answer: the bone near
the spinal column was interfering with the transmission of the signals
from the brain to the hind legs.  In fact, the signals were crossed:
when the vet pinched her left rear paw, her right one hurt, and vice
versa.

She also slightly drags her back paws, has a difficult time climbing
and going down stairs, and needs to have rugs underneath her to help
get up.  Also, her tail hangs straight down behind her or slightly to
the right.

The vets think she was stepped on after birth or it's a congenital
defect.  She's been like this since we got her about 11 years ago, and
naturally she's gone down hill with each passing year ~ but haven't we
all?

We do what we can:  rugs are all over our hardwood floor, my husband's
built a ramp for her to go outside (instead of steps), and we give her
arthritis medicine.

Hope this helps!

This is a follow up to my last comment:

Oops!  I forgot the most important info ~ Jesse underwent spinal
surgery about 9 years ago to "shave" some of the bone touching the
nerves.  That helped her a great deal.