My dog seems sore in its front leg

My dog seems sore in its front leg

What is elbow dysplasia?

Elbow dysplasia is the collective term that describes a number of conditions that affect the growth and development of a dog’s elbow. It is most commonly seen in large and giant breed dogs. Labradors, Golden Retrievers, German Shepherds and Rottweilers are the most common breeds but it can occur in any breed. There are a number of different theories as to why elbow dysplasia occurs but it is often a combination of factors, which leads to the abnormal development of the joint. Defects in cartilage growth, trauma to the joint, genetics, exercise and diet may all play a role in the development and progression of elbow dysplasia.

The elbow is made up of three bones. The humerus is the top bone. It forms the connection between the shoulder and the elbow. The ulna and radius from the bottom part of the joint and connect the elbow to the metacarpals or wrist.  When there is an abnormal development between these three bones, they do not sit together as they should and there are abnormal pressures within the joint. This mismatch of growth and abnormal pressure can lead to a number of different conditions. The different conditions can occur alone or in combination and may include the following:

  • Fragmented medial coronoid process (FMCP)
  • Ununited anconeal process (UAP)
  • Osteochondritis dessicans (OCD)
  • Elbow incongruity

Some conditions are more common in certain breeds but any condition may occur in any breed.

Figure1: Normal flexed (bent) elbow of a dog

The above X-ray shows a normal elbow of a dog to illustrate the different bones and parts of the bone that make up the elbow. If the radius grows more slowly than the elbow it becomes shorter and this puts increased pressure on the medial coronoid process of the ulna. “Process” in this context means a pointy piece of bone protruding from the main bone. Directly translated the medial coronoid process is the “inside crown pointy bone”. With the ulna being longer than the radius this can cause cartilage damage in the joint and sometimes the tip of the coronoid process may fracture or break. This is referred to as the fragmented medial coronoid process. Labradors, Rottweilers and Boerboels are the most commonly affected breeds but it can occur in any breed.

If the ulna grows too slowly then the radius pushes the humerus (upper arm bone) against the anconeal process of the ulna. The anconeal process looks almost like the beak of a bird. If the radius grows too long, it puts pressure on this section of bone or “beak”, which prevents it from growing and maturing properly and may lead to the anconeal process being unable to unite or attach properly to the rest of the upper part of the ulna bone (called the olecranon). This ends up being like a “bird with a loose beak”, and needless to say is very uncomfortable and painful for the dog. The ununited anconeal process occurs commonly in German Shepherds and Boerboels.

If the radius and ulna do not grow at the same rate of speed, a condition called elbow incongruity can occur. This causes wear and tear on the cartilage, as the humerus does not meet the appropriate surfaces on the radius and ulna. Thus, some points of contact are overloaded and this can lead to fragmentation of the medial coronoid process and other abnormalities.

Cartilage is the protective layer that is formed over the bone within joints. Cartilage helps lubricate the joint and reduces friction within the joint. Osteochondrosis is a condition where there is an abnormality of the cartilage and the bone underneath it. Osteochondrosis most commonly occurs in the inside part of the upper arm bone or the medial condyle of the humerus of the elbow joint. Osteochondrosis dissecans (OCD) describes the condition where a flap of cartilage forms. This flap may stay attached or break off and float around in the joint. It is usually very painful. It is commonly seen in Labrador Retrievers suffering from elbow dysplasia.

What are the signs of elbow dysplasia?

Elbow dysplasia can affect one or both elbows. No matter which condition is present, the clinical signs are generally the same. Most commonly, dogs show lameness on one or both elbows, particularly after resting and lying down. They may be reluctant to exercise and may struggle walking up and down stairs. Elbow dysplasia can present as early as five months, but signs are commonly seen in large and giant breed dogs between six to ten months. In some cases, elbow dysplasia may only be diagnosed when the dog is much older and the joint has become arthritic. The lameness is often worse after exercise and often will not resolve completely.

An orthopaedic examination in most cases reveals pain and occasionally swelling of the elbow with a restricted range of movement of the joint. Movement is reduced due to arthritis developing in the abnormal joint.

How is elbow dysplasia diagnosed?

Elbow dysplasia is diagnosed by a combination of a thorough clinical exam and diagnostic imaging. X-rays are generally the first diagnostic step in diagnosing elbow dysplasia. Certain conditions such as an ununited anconeal process are generally quite easy to visualise but other conditions may need further diagnostics such as a CT (X-ray computed tomography or CAT scan) or arthroscopy. Arthroscopy is keyhole surgery where a small camera is placed within the joint to visualise it. It is minimally invasive and, in some conditions, the joint is operated on at the same time.

What are the different treatment options?

The treatment undertaken depends on a number of factors. Age, clinical signs and degree of arthritis in the joint are all deciding factors. It is not possible to reverse the damage that has already been done to the joint, but the progression of the disease can be slowed. All dogs with elbow dysplasia will develop a certain degree of arthritis, even if they undergo surgery and so this should be taken into consideration beforehand. 

Surgery by a specialist surgeon vet may be recommended to help correct a step in the joint (elbow incongruity), remove any fragments of bone or cartilage, or to surgically alter the joint (arthrotomy).

Many dogs may be managed medically or conservatively, particularly if the changes within the joint are minimal.

Conservative management would include:

  • Strict weight control, which helps reduce the stress on not only the elbows but all the joints.
  • Controlling exercise is also an important factor, ensuring that exercise with lots of concussive forces, such as jumping for a frisbee are kept to a minimum. Controlled leash walks and swimming are examples of low impact exercise. Hydrotherapy (controlled swimming exercises) works the muscles without putting extra strain on the joints and is also beneficial in controlling the weight.  
    A veterinary prescription diet for the management of the joint disease or joint supplements has also been found to be beneficial. Omega-3s, chondroitin and glucosamine which are substances which feed the cartilage all help nourish the joint and can slow the progression of arthritis.
  • Medications such as anti-inflammatories and other pain medications may be required daily to control pain and inflammation, but other cases only require them occasionally.

Take home message

Elbow dysplasia is most common in large and giant breed dogs but can occur in any breed of dog. There does appear to be a genetic component to elbow dysplasia and breeds such as Labradors, Golden Retrievers, Rottweilers and German Shepherds have been overrepresented. It is possible to have elbows graded and scored and it is advisable that dogs showing signs of elbow dysplasia are not bred with. This is done by X-ray under general anaesthesia after which the X-rays are sent to a specialist radiologist vet who does the analysis and scoring. Elbow dysplasia can be managed both medically and surgically, but it depends on the symptoms and syndrome present. A lot of dogs will be able to function very well however the long-term prognosis is guarded as most if not all of them will succumb to degenerative joint disease and arthritis in the affected joints.

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

 

My cat is damaging my furniture by scratching it

My cat is damaging my furniture by scratching it

Many people think that declawing a cat means that you cut the nails really, really short so that they do not have the capacity to grow again. Nothing could be further from the truth. When a cat is declawed, the greater part of the last digit of its toe is amputated. Cats’ nails are attached to the last digit on their feet and one cannot effectively remove the nail, without also removing the greater part of the digit itself. There are muscles and tendons attaching to the bone of the last digit and some of the bone should be left intact for the foot to function normally after the procedure. If one was to do a similar procedure in a human, it will be like removing the tip of your finger just in front of the first knuckle.

    

Declawing cats remains a controversial topic because of the views held by opposing parties. Those who argue for it have the view that as humans have domesticated animals, we have done some things to make the lives for both the animal and the human better. As an example, people may argue that zebras live out in the wild and never need shelter and therefore it’s close cousin, the horse, should also be able to withstand harsh temperature and exposure to the elements without having to be confined to stables. Some may argue that stabling a horse deprives them of the natural ability to roam around freely and enjoy not having to be confined. However, we know that providing stabling provides shelter and in turns improves the lives of horses in a harsh climate. More appropriately, some people will argue it is cruel to put a steel bit in a horse’s mouth to let them comply with what we want them to do. And this mostly for our own benefit.

So in the domestication of cats, those who argue for declawing will say that it is for the animals’ benefit that they are declawed because the alternative to having expensive furniture ripped up by a cat scratching it, is an animal shelter or even worse – death. They further argue that if the procedure is done with the animal receiving full general anaesthetic in a fully sterile operating theatre, and the surgery is performed by a competent and qualified veterinary surgeon, all should be fine. If one can provide the animal with appropriate painkillers in the post-operative period and prevent them from contracting an infection, and the healing process is closely monitored and managed with an outcome where the animal has no after effects, then it warrants doing the procedure and providing a loving and safe home for the animal. 

Clearly one can understand that this becomes a very emotive issue because those who argue against declawing will be quick to add that there are many alternatives to removing the cat’s digits and nails altogether. Firstly, they will argue that going to the extent of doing an amputation in an animal, merely for protecting furniture, is a form of mutilation and is going too far. Further to that, they may argue that you are creating an unnatural situation for the animal by taking away one of its primary self-defence mechanisms. Declawing the cat may also leave the cat exposed in a social environment where most cats never stay confined to the human residence only, but tend to venture outside, especially at night, and explore their territory. Many people forget that a cat’s territory is not defined by the boundaries set by humans. So, your high fence around the property, even if it has an electrified security fence on top of it, will in most cases not suffice to confine your cat to your own property. Their territory often extends three houses up the street, two down the street and even to properties across the road from yours. Leaving a cat without nails to defend itself is almost unthinkable, will those say who object to declawing.

This territorial movement and exploration of cats is to a large extent dependent on their ability to climb and jump up and down walls and trees. Their nails are a pivotal part of the ability to grab onto something, especially if they must jump very high, almost out of reach. Not even to talk about the risk of being chased by the next door neighbour’s dog and having to get away via the quickest and sometimes least accessible route.

One way to reduce territorial movement is to sterilise your cat either by neutering (castrating) your mail cat or by spaying (ovariohysterectomy) your female cat. Roaming and territorial exploration is significantly reduced in sterilised cats.

So, what then is the solution to removing the cat’s nails and front digits completely and permanently to save your furniture?

Firstly, we should acknowledge that scratching is part of the feline makeup and is a normal behaviour. It is a way for cats to remove the dead and broken parts (husk) of their nails. As with humans, cats’ nails never stop growing. As humans, we trim our nails and take really good care of them by manicures and pedicures. Because our feline friends’ nails also keep on growing, the excess should be removed in some way or other and scratching is the way this happens. A kid, seeing a cat scratching up against a tree or a scratching pole will sometimes make the remark: “Look mom, that cat is sharpening its nails”. Although cats do not consciously decide: “I need to sharpen my nails today”, the effect of scratching and removing dead and breaking pieces, is in fact that the nails stay healthy and naturally sharp. Scratching is also part of stretching and cats are notoriously supple animals and benefit from the anchoring that is provided by “clutching down” onto something and extending their stretch as far as possible.

Because scratching is part of cats’ normal behaviour, one should make provision for this necessary part of their health and wellbeing if you decide to keep a cat. It is as much part of feline care as providing food, fresh water, a sandbox, vaccinations, deworming and tick and flea control. If you decide to keep a cat, you must provide a means for them to scratch. This may be in the form of a scratch post, cardboard box scratch pad, a tree stump or log, preferably covered with some hardwearing, short length fibre carpet or hardwearing fabric, or a piece of wood or cardboard with rope tightly wrapped around it. There are all kinds of shapes and sizes and the vet will be able to give you advice on which one you can use if you are not sure.

If one provides for this normal habit in cats, it will often resolve the issue of the cat scratching your furniture. However, as luck would have it, sometimes you will provide all the scratch pads and posts needed, and that darn cat will still choose that favourite piece of furniture of yours, as its favourite scratch pad. In this instance, you may have to temporarily wrap something around that piece of furniture to protect is until you have dealt with the unwanted behaviour. Discouraging the cat from picking your favourite or expensive piece of furniture for scratching may entail putting a spray bottle with water near this point, and squirting the cat with the water every time it comes close to this point. This negative experience will hopefully deter them sufficiently. Alternatively, you can take an empty cooldrink can and put a few pebbles or marbles in it and throw it in the cat’s direction every time it gets close to the site you want to keep it away from (obviously missing the cat and not actually aiming for the cat itself). The noise is bound to make that part of the house less pleasant and to be avoided.

There are commercial products on the market which one can stick to the furniture which will deter the cat in some cases. Alternatively, there are nails caps which one can put over the cat’s nails which may protect the furniture. Some of these products are not readily available in South Africa and the long-term practicality of it remains debatable.

The best thing you can do is to discuss the situation with the vet and come up with a solution which will work for you. You may have to try several things before you find the solution which will work best for you and your cat.

Vets are the advocates of your animal and will suggest the solution which is in their best interest, as a priority. The South African Veterinary Council, the governing body of the veterinary profession in South Africa, has the following view: “If the benefit of a procedure outweighs the risk to the animal, then it is in the animal’s best interest to have the procedure done. If the procedure provides no benefit or a very small benefit compared to the risks, then the procedure should not be performed.” (http://www.savc.org.za/tail-docking)

Declawing cats is a procedure which has not been “banned” in South Africa and in extreme cases, with the correct considerations taken, (usually a medical condition like a cancer of the nail bed), may still be performed. However, to do this procedure as a quick fix for a cat damaging furniture through scratching is certainly not the first option which should be considered. 

© 2018 Vetwebsites – The Code Company Trading (Pty) Ltd

My dog did not go out of the yard and is now limping lame on one of his hind legs

My dog did not go out of the yard and is now limping lame on one of his hind legs

Often time vets are confronted with this situation in veterinary clinics. As far as the owner knows their dog would not have been subject to any trauma, yet they can hardly take weight on one of their back legs. There are many possible causes but by far one of the most common reasons for this situation occurring is a tear of the major small ligament inside the knee.

The anterior cruciate ligament, also known as the cranial (front) cruciate ligament, is a small but very strong ligament right inside the dog’s knee. This ligament works together with the rest of the ligaments around the knee to give the dog the amazing functionality and strength it has to make the back leg work properly.

As humans we are all too familiar with our own knees and the kneecap or patella which has a strong ligament that attaches it to the upper part of the lower leg or the tibia. As kids, we often had fun sitting up on a table or bench and tapping each other’s patella ligament to see our leg shoot out involuntarily to produce what is called the patella reflex.

Dogs have the same anatomy as humans with the strong muscles of the front part of the upper hind leg all coming together at the front of the leg and amalgamating on the kneecap or patella which is connected via a strong ligament – the patellar ligament – to the front part of the lower leg. The bone in the upper hindlimb is the femur and the major bone in the lower leg is the tibia. Dogs, the same as humans, also have a second bone in the lower leg called the fibula, but in dogs this bone is much smaller in comparison to humans and sits right at the back of the leg almost hiding behind the tibia. The lower end of the femur, the upper end of the tibia and the fibula and the kneecap in front of them make up the knee joint. Apart from the strong patellar ligament in the front of the joint where the kneecap is situated, there are also two strong ligaments on either side of the joint called the collateral ligaments which stabilises the knee joint to the sides. And then right inside the joint, one finds two ligaments that run across the joint from left to right and right to left with one situated more to the front of the joint and the other more to the back. The cross shape of these ligaments gave them their name – cruciate (cross) ligaments. The front (cranial) cross (cruciate) ligament is the bigger of the two and provides a lot of stability to the lower part of the femur. Apart from the ligaments that stabilise the joints there is also a joint capsule which keeps the joint fluid inside the joint and keeps the lubricated to be able to function well.  

A rupture of the cranial cruciate ligament is arguably the most common orthopaedic injury vets see in dogs where there were no third party involved. Most acute ruptures happen during strenuous or exuberant activities such as chasing balls, jumping over fences and walls, playing rough with each other or making any sudden turns while the leg is still taking the full bodyweight. Other causes include starting an abrupt chase or sprint, making a sharp turn when running, trying to stop too quickly when at full speed, jumping up or down stairs, jumping up in the in the air to catch a ball, slipping on a smooth surface, or sometimes just twisting the leg in an untoward position when sitting, standing or lying down. There is often no particular incident that the owner can recall where the dog injured the leg.

Some cases present where there is not a complete tear or rupture of the ligament but a partial tear, where some of the fibres of the ligament may still be intact.

Any breed of dog can injure the cranial cruciate ligament but studies have shown that some breeds are more susceptible to CCL injuries. These are: Labrador Retrievers, Poodles, Golden Retrievers, German Shepherds and Rottweilers. Other factors also play a role and can increase the risk of CCL injury:

  • Obesity
  • Unfit dogs that participate in sudden strenuous activity
  • Conformational abnormalities
  • Male dogs neutered at a very young age (younger than 5 months)

Since the CCL is shorter than the back (also called caudal) cruciate ligament, it is more prone to damage. A CCL tear is not always an acute injury and wear and tear caused by repetitive activity can cause the biochemical breakdown of the ligament over a period of time until it reaches a stage where it ruptures completely.

A rupture of the CCL is extremely painful due to the fact that the joint becomes unstable when weight is placed on the leg if the ligament is torn. The clinical signs are very obvious and owners will quickly notice that something is not right. Patients will usually keep the affected leg in the air placing very little or any weight on the leg when walking. Often the dog will stand with the toe lifted off the ground and slightly turned inward. When he/she sits they will sit with the affected leg to the side and not underneath them. In cases where there was a partial tear the pain will be acute but then get better over the following days with the inflammation eventually subsiding and the limp getting slightly better in days to follow. The limping will often worsen with exercise and improve with rest. Often owners will notice stiffness in the morning and the animal will be reluctant to jump or climb stairs as usual. As the animal is not using the leg as he/she should, muscles will weaken and atrophy (shrink) with time and you will notice the difference in size of the two back legs. In these partial tear  cases where the problem is not properly addressed the body lays down new connective tissue to try and stabilise the joint by itself which often time leads to  a hard lump on the inside of the affected knee.

Whenever a dog is lame for more than a day, it is worth the while having the vet check them out. The vet will do a clinical exam and feel up and down (palpate) and manipulate the affected leg to find the origin of the pain. A simple test called the cranial drawer test will be done to evaluate whether the cranial cruciate ligament is intact. While the dog is lying relaxed on his side, the vet will test the stability of the knee by attempting to move the tibia forward whilst stabilising the lower end of the femur. The function of the CCL is to prevent this forward movement of the tibia when weight is placed on the leg, thereby keeping the joint stable. If this ligament is torn, this stabilising mechanism is not present and the tibia will move forward a lot more than what it should. It is important to note that dogs that are tense and painful will guard the joint with tense muscles and this movement is extremely difficult to elicit then. Often you will only be able to feel the cranial drawer sign by doing it under deep sedation. Also, in partial tear cases, the anterior drawer sign may not be pronounced and more difficult to interpret. The veterinarian may request to have these patients admitted for sedation to palpate and examine the leg and also do X-rays while under sedation if required. X-rays are a vital tool in cases where the condition had not been attended to shortly after it happened to evaluate the joint for signs of arthritis secondary to the CCL rupture. With the help of X-rays the vet can also rule out other possible causes of lameness in the hind limbs such as fractures or even bone cancer.

After a diagnosis of a CCL rupture is made, you will have to decide with the help of your veterinarian what course of treatment you are going to follow with your pet. Because of the instability in the joint after a CCL rupture, arthritis will start forming in the joint and will get progressively worse with time. The aim with treatment is to limit arthritis by stabilising the joint and to limit pain as much as possible. Treatment options can be divided into non-surgical (conservative) for cases which were missed and where it may to too late for surgery or surgical for acute cases. To make the decision, the history of the injury, the age and size of the patient as well as the severity of arthritis and degenerative changes in the knee need to be taken into consideration. .

Partial tears could potentially be managed without surgery but most cases, even the ones with partial tears, will require surgery to stabilise the joint. There are many surgical techniques available today and the best will be to discuss with your vet, which method will be the best for your dog. The two main types are intracapsular techniques, where the whole knee joint is opened during the operation, and extra capsular techniques, where the joint capsule is left intact and the operations is done outside of it. Larger dogs usually requires more specialised techniques to give stability. Unfortunately none of the techniques are guaranteed to give a 100 % stability and to prevent arthritis in the long run but it will in most cases prevent the terrible side effects of not doing the surgery at all, leading to excessive connective tissue being formed by the body in an effort to stabilise the knee joint. Aftercare is extremely important as the joint takes time to recover after surgery and owner compliance is of utmost importance. Supportive therapy includes anti-inflammatory drugs for pain management, hydrotherapy, physiotherapy and joint supplementation.

The outcome of surgery is usually very positive with animals making a full recovery in the weeks and months following the operation. Beware though, in large dogs, there is often a scenario where the knee on the opposite side may be affected if the correct aftercare is not taken. Make sure you understand and adhere to the vet’s recommendations to ensure the best possible outcome for your dog.

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

Lameness in old dogs

Lameness in old dogs

As a dog gets older, he or she may start to struggle to get up or get a little slower on walks. You may notice that they are worse in winter than in summer or after resting for a prolonged period. Sometimes they may not to be able to place any weight on a leg at all and this may happen quite suddenly. Lameness in older dogs can be broadly placed in three categories:

  • Arthritis
  • Cancer
  • Trauma and infection.

Because there are potentially so many different causes of lameness, it is important to have your dog seen by the vet. The cause of the lameness will affect the type and length of treatment as well as the prognosis. A thorough history and clinical examination is always a good starting point and after this further diagnostic tests may be required. Let’s look at it in more detail.

Arthritis

Arthritis in dogs is an extensive syndrome with many different causes. Canine arthritis may also be referred to as osteoarthritis or degenerative joint disease and is characterised by pain and inflammation in one or more joints. Arthritis occurs when the protective layer of cartilage at the ends of bones becomes damaged and exposes the bone underneath to wear and tear.

Arthritic dogs may walk stiffly, limp on certain legs and show stiffness or discomfort when getting up. They may be lame on a certain limb and some joints may be swollen or painful. They may be less flexible in their joints and struggle to jump, run or use stairs.

The vet will diagnose arthritis on the basis of a physical exam, history of the dog and diagnostics tests such as X-rays. Arthritis can be the result of injury to a joint, infection within the joint, an inherited or developmental condition such as elbow or hip dysplasia, or immune system problems. Obesity contributes to arthritis as there is extra stress and strain on the joints. If a dog fractures bones that involves the joints or injury to ligaments, tendons or muscle, this can also lead to arthritis later on.

Large and giant breed dogs are more susceptible to developing arthritis but any breed and size of dog can suffer from it. This is because there are so many different causes of arthritis. Regular exercise and good quality food may help prevent or at least help slow the progression of arthritis. It is important for large and giant breed dogs to be placed on a suitable food and monitor the amount whilst they are still young and growing. Arthritis cannot always be predicted or prevented but it can be managed and the progression slowed.

Arthritis can be managed in the following ways:

  • Soft, comfortable bedding.
  • Short, controlled periods of low impact exercise, such as swimming and short leash walks.
  • Physiotherapy and hydrotherapy may be useful to strengthen the muscles and improve the range of motion of joints.
  • Raising water and food bowls will help avoid stress and strain on the neck and back.
  • A joint diet or joint supplement may help maintain weight and joint health.
  • Anti-inflammatories and pain medication may be needed in severe cases.

Cancer

Cancer is a class of disease in which cells grow rapidly and uncontrollably. It can affect one part of the body or spread throughout the body. As cells age, they are more prone to becoming abnormal and cancerous. There are a multitude of cancers in dogs, some which grow very rapidly and others, which grow slowly.

Osteosarcoma is the most common form of bone cancer in dogs. It can grow very fast, is very aggressive and is often extremely painful. It most commonly affects the long bones but can grow anywhere. It does often spread to the rest of the body, commonly the lungs. Unfortunately the prognosis is very poor but chemotherapy as well as limb amputation may be an option in early cases. Sometimes the bone affected by cancer becomes so weak that it may actually break. Osteosarcomas are most commonly diagnosed on X-rays as it has a very distinct appearance, but further diagnostic procedures may be required. Other types of bone cancers may also cause lameness but may not be as fast growing or aggressive. Often tests like a bone biopsy, where a piece of the bone is taken out with a special instrument under general anaesthesia, is required to confirm a diagnosis.

Cancers like lymphoma may also cause lameness. This is due to the fact that the lymph nodes, which are much larger than normal and not functioning properly, do not drain away the lymph and blood. The limb may become swollen and painful. The treatment for cancer depends on the type as well as how far it has spread. Chemotherapy may be an option and the vet will most likely refer your dog to a specialist vet for this. In terminal cases, pain management becomes very important but eventually your pet will succumb to the disease.

Trauma and infection

As a dog gets older, they do become less active and so trauma is less likely. However, as with older people injuries still occurand more so in the very late stages of life. An older dog may still rupture a ligament such as the cruciate which helps keep the knee stable, or break a bone after being hit by a car. Infections in the joints may also occur due to a long standing wound or infections that have spread. A thorough history and clinical exam will help the vet determine a likely cause as well as what further tests to do.

Take home message

There are many different causes of lameness in older dogs. Arthritis is probably the most common cause but there are many other conditions. If your older dog is limping or appears painful for anything longer than a day or two, it is important to get the veterinarian to have a look at him or her. If a definitive diagnosis cannot be made immediately, further testing will most likely be required.

Fortunately with the advent of specially formulated diets and supplements, the onset of arthritis can be postponed quite significantly and if and when it does occur, both therapeutic diets as well as advanced anti-inflammatory medicines, can ensure extended and pain free quality of life.

Vetwebsites The Code Company (Pty) Ltd © 2018

Lameness in young dogs

Lameness in young dogs

Getting home to find your puppy or young dog not placing weight on a leg is always a concern. There are many different reasons why a young dog may limp, some more serious than others. Causes of lameness can be broadly placed into three different categories:

  • Lameness due to trauma
  • Developmental and congenital (inherited) lameness
  • Infectious causes of lameness and cancer

Because the causes of lameness can be so wide and varied, it is important to have your puppy looked at by the veterinarian sooner rather than later when you notice any signs of limping or lameness. 

A thorough history is always an important starting point when trying to diagnose the cause of the lameness. A sudden limp would be highly suspicious of trauma, whereas a young large breed dog that has been reluctant to exercise and occasionally sore on a front leg may be more likely to indicate a developmental condition such as elbow dysplasia. Finding out about diet, exercise and activity, time of onset and progression are all important questions that the vet will ask.

The size of the dog also plays a role. Certain breeds are predisposed to developing certain conditions at different ages, and this can help in making a diagnosis. For example large and giant breed dogs are more prone to suffering from elbow and hip dysplasia, whereas it is rare in small breed dogs.

The vet will start with a clinical examination. It is not always easy to tell which leg the dog is sore on and examining each limb as well as the neck and back will help give a good indication. Sometimes more than one limb is painful and this is also an important factor to consider during the diagnoses. The vet will examine the whole dog, taking the temperature, listening to the heart and feeling the abdomen to ensure that a sore leg is not the only problem.

Trauma related lameness

Trauma may include anything from your dog jumping off a step and straining a muscle to being hit by a car and breaking a leg. If there is any history of trauma it is important to have your young dog checked out by a vet. All dogs respond differently to pain and some may still place weight on a leg despite it being broken. X-rays are usually indicated to rule out any possible fractures or dislocations. If there is nothing severe found on clinical examination and X-rays, rest and pain medication will generally be recommended, but if the lameness does not improve, it is important to take your pet back to the vet. Some dogs may be completely non weight bearing from tearing a nail or having a small bite wound. It is important that these are dealt with as they can lead to a more severe infection. Broken bones and torn ligaments might need more intensive treatment such as surgery but it depends on the severity of the injury as well as the location.

Developmental and congenital causes of lameness

There are several different developmental and congenital (meaning they are born with it or are genetically prone to it) conditions that may cause lameness in a young dog. Breed and history are important factors to consider as well as age at which clinical signs are first seen. Elbow and hip dysplasia are probably two of the most common causes of developmental lameness in large and giant breed dogs. Defects in cartilage growth, trauma to the joints, genetics, exercise and diet may all play a role in development and progression of elbow or hip dysplasia. The vet will discuss the possible treatment options and management of these diseases. Unfortunately most dogs with elbow or hip dysplasia will develop osteoarthritis later on in life.

Panosteitis is another condition that occurs in young dogs. It is most often seen in medium to large breed dogs between nine months to two years of age. It affects the long bones such as the humerus, radius and ulna. The lameness often comes and goes and can be very painful at times but tends to resolve after two to three years of age. It is a self-limiting condition but will require pain management and medication at times. X-rays are generally needed to diagnose panosteitis and follow ups will be needed to monitor the progression of the disease.

Other diseases which may cause lameness in young, growing dogs may include rickets, hypertrophic osteodystrophy and retained endochondral cores. Rickets is usually due to a poorly balanced diet and lack of vitamin D. If it is addressed in time it can be resolved if the dog is placed on a good quality puppy food. Hypertrophic osteodystrophy is a type of bone growth defect and is caused by Vitamin C deficiency and is often seen in medium size and giant breed dogs. Retained endochondral cores affect the cartilage and growing part of bones and occur in large and giant breed dogs that are growing too fast. It affects the forelegs and results in deformation of the carpus or lower part of the leg. The treatment may include slowing down the growth by adjusting the type and amount of food and sometimes surgery is required. Most developmental disorders can be prevented by feeding the appropriate puppy food.

Infectious causes of lameness

Occasionally a young animal may get an infection in the bone (known as osteomyelitis) or within the joint (septic arthritis). These can both be very serious conditions that may need long-term treatment but it is important to try and find the cause first. The bacteria or fungus can spread through the blood or be introduced through an open or infected wound such as a dog or cat bite or open fracture.

Cancer

Although rare, cancer can unfortunately also affect young dogs. Cancer is a class of disease in which cells grow rapidly and uncontrollably. It can affect one part of the body or spread throughout the body. Again history is very important and several sets of X-rays may need to be taken to monitor the progression of the disease.

Take home message

There are many different causes of lameness in young dogs, some more serious than others. Finding the cause starts with the same basic work up, by the vet – a thorough history and clinical exam and then further diagnostics such as X-rays, CTs, also known as Cat Scans (nothing to do with the animal) or computed tomography scans, and possibly joint taps, which is where fluid is taken from the joint with a sterile needle and syringe. Monitoring the response to treatment is an important part of both the diagnosis and treatment of lameness in young dogs and it is really important to take the dog in for follow up examinations if necessary to prevent permanent damage. Some causes of lameness will resolve quickly and not have a permanent effect on the health of your dog whereas others will require lifelong treatment and management.  

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Arthritis Treatment and prevention – Part 2 of 2

Arthritis Treatment and prevention – Part 2 of 2

 

In part one of this two-part article, we looked at the signs and diagnoses of arthritis in pets. In this part of the article, we will look at the treatment and prevention of arthritis in pets. With the advancement of technology and medicine, arthritis is no longer a death sentence. Our beloved pets can benefit from a range of surgical and medical treatment. As mentioned in part one, it can never be stopped or cured but arthritis can definitely be managed and symptoms relieved to give your pet a pain-free life.

Reputable breeders do screen for hip and elbow dysplasia before the age of 18 months and 2 years in giant breeds but it does not guarantee that your pet will be arthritis free come the golden years. The screening ensures that they do not breed from affected animals as screening involves taking an x-ray of the hips and elbows. Informed breeders also tend to ensure that puppies are fed correctly from a very young age. Prevention is better than cure. If you are looking to acquire a pedigreed animal, buy from a reputable breeder.

Feeding the correct food for a new puppy is critically important. Large and giant breed puppies’ needs are different from those of small and medium breeds. The large breed puppy (> 25kg adult weight) needs to grow slower. For this reason, the levels of carbohydrates and calcium in the food should be lower than the levels found in food for small and medium breed puppies. An animal which grows too fast may develop a problem with the density of their bones, which may lead to strain caused by the rapid increase in body weight. Large breed puppies need puppy food until they are about eighteen months old and giant breeds until they are 2 years old. If you are not sure about which category your puppy falls into, just ask your vet for advice. This way you can ensure that you buy the correct food to meet your pet’s nutritional needs.

For pets that are overweight, weight loss is an essential part of their treatment. No pet will respond favourably to the treatment of arthritis if they have to carry excess weight on a compromised joint. Ask your vet for ideas on how to get your pet’s weight down. A moderate, but correct exercise routine should be followed. Swimming is an excellent form of exercise as no weight is being placed on those sore joints and most dogs enjoy this. Professional hydrotherapy classes are now available in the bigger cities. Thick bedding should be used and pets should be discouraged from sleeping on cold hard surfaces.

Dietary supplements such as chondroitin and glucosamine have been shown to benefit degenerating joints. The sooner one starts with this treatment the better the long-term outcome. Some veterinary diet pet foods may include supplements such as chondroitin, glucosamine and omega 3 fatty acids. A huge benefit of using veterinary diet pet food is that it is formulated to be balanced and does not over or undersupply any essential nutrients or supplements. There are different types of veterinary diet pet foods for arthritis which also helps to keep your pet’s weight at the correct level, either by reducing their current weight without starving them, or maintaining their current weight if they are at the correct weight and preventing them from adding on any extra weight.

When your pet is in a lot of pain your vet can prescribe non-steroidal anti-inflammatory drugs. Vets try to limit the use of these medicines as they can have negative side effects on the intestinal and renal system. They are however safe to use on a chronic basis if used correctly. In older patients, blood and urine tests may need to be performed to establish if these drugs would be safe to use. The non-steroidal anti-inflammatory medications usually used by veterinarians are mostly prescription medicines and cannot be bought over the counter.

Surgery can be beneficial in cases where young dogs are already experiencing a lot of pain and where the bones are still growing. The progression of arthritis is then delayed. This will help them a great deal in their older years. Surgery can also be performed as a salvage procedure if the patient is experiencing a lot of pain. The vet will be able to give you more information and tell you if your pet is a candidate for surgery.

Certain surgical procedures, which are performed to treat dysplasia cases, are only effective before a certain age. This is due to the fact that the growth plates (the area where bone grows in length) in young animals fuse and stop growing, to form permanent bone at predetermined ages. If corrective procedures had not been performed before the closure of the growth plates, it may be too late to achieve the desired surgical outcome. The vet will be able to tell you which procedures can still be performed on your pet once the condition has been diagnosed. Procedures that can still be performed on adult dogs include the removal of the ball part of the ball and socket hip joint, or a complete hip replacement where a synthetic hip joint is implanted in the animal. Elbow dysplasia can potentially be treated surgically in adult animals, but several factors have to be considered in each individual case.

Two alternative therapies which have been developed in recent years are becoming more popular, but it still needs to be determined whether these modalities of treatment are effective in the long run. The first is the injection of platelet-rich plasma (taken from the animal itself) into the affected joints. It involves taking blood from the animal and separating it into its main components, namely blood cells and plasma (the fluid which carries the blood cells). The plasma component is then injected back into the pet’s joints. The second new form of treatment is the harvesting of stem cells from the animal’s fat and injecting that into the affected joints. These procedures are typically performed by specialist vets only. A lot of research is still needed to adequately assess the worth and long-term effects of these treatments.

The treatment of cats with arthritis is slightly different than in dogs as exercising a cat is not so easy. Seeing as arthritis is more common in cats that are overweight, weight loss remains the most important treatment you as an owner can perform. Diet and supplements play a big role in the treatment of arthritis in cats as non-steroidal anti-inflammatory drugs are far more dangerous in cats than in dogs. Some human painkillers like Paracetamol can be lethal in cats, therefore, you should never use human painkillers or human arthritis medication in cats.

You may not be able to prevent your beloved pet from getting old but you can certainly help them do so with more dignity… and maybe just make them want to play ball again.

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

 

Arthritis Signs and Diagnoses – Part 1 of 2

Arthritis Signs and Diagnoses – Part 1 of 2

So what happens when your beloved canine friend does not want to go for his walk anymore because he is too sore the next morning?

Unfortunately, older pets, and these days even puppies, get afflicted by a condition commonly known as joint disease. This is the same problem we as humans suffer from as well, better known as arthritis. In dogs and cats and more commonly in larger breed dogs, it is concentrated in the hip, knee, shoulder and elbow joints. The spinal column and back vertebrae (backbones) can also be affected.

Arthritis (joint inflammation) happens when the cartilage that surrounds the end of the bones, (a white, glistening and very smooth surface that makes the joints glide easily) becomes eroded due to various factors, resulting in bone grinding on bone. The most common cause of arthritis in dogs and cats is old age, as the normal degenerative ageing process takes its toll. Arthritis is an extremely painful condition which causes the signs like difficult walking and slowing down, in general, we see in our pets. It gets even worse where the body tries to repair the damage at certain stress points of the joint and new bone growth takes place, which deforms the bones and joints. This process of gradual deterioration is called degenerative joints disease and progresses over a period of time. The deterioration cannot be stopped or cured, it can only be delayed with treatment, diet or surgery.

Large breed dogs tend to be more afflicted with arthritis. Numerous factors predispose pets to get this condition including:

  • breeds with bent legs such as the English Bulldog and Basset Hound
  • large breed puppies that grow too fast or puppies that do not receive the correct nutrition whilst growing
  • over-exercising your puppy whilst still growing
  • inherited conditions (bad genes from the parents)
  • trauma to the bones, ligaments or joints
  • obesity (most common)

Hip and elbow dysplasia (the incorrect fitting and/or growth of the joint) in puppies can be diagnosed and treated effectively as early as the age of 4 months. When hip and elbow dysplasia get left untreated, the dog will suffer from arthritis in the later stages of his life. Not all dogs that develop elbow or hip dysplasia show signs of having such a condition and therefore it is not always possible to diagnose the condition early enough so that steps can be taken to delay the early progression to arthritis. The most common symptom of arthritis seen in puppies and dogs are limping and lameness and not taking proper weight on the leg.

So how do you know if your pet may be suffering from this condition?

Usually, it starts with signs of your pet being sore and stiff after going for a walk or a run. They may not even want to take weight on a certain leg. Older animals will have difficulty in getting up, especially after sleeping for a while, and they may tend to slip easily on slippery floors. Animals suffering from arthritis do not run or jump as they used to, and may not want to climb the stairs anymore. Sitting down for a treat becomes difficult and you may see that your dog may have difficulty to squat to pass a stool or urinate. If you manipulate the affected joint by bending the legs, you may hear a creaking sound or feel something like rubbing sand between your fingers, also called crepitus. If your animal shows any of these signs it will be worthwhile to take your pet for a visit to the vet.

Arthritis in cats is exactly the same as in dogs, however, vets do not diagnose it as frequently as in dogs. The main reason for this is that cats are exceptionally good at masking pain and even if they suffer great pain it will often go unnoticed till very late in the progression of the disease. Cats are also often so stressed during veterinary consultations that normal movement cannot be differentiated from abnormal movement. Even though cats are much lighter than dogs and the wear and tear on their joints is significantly lower as a result of carrying a much smaller body mass, studies have shown that 65% if cats over 12 years are affected by feline osteoarthritis. Cats tend to be more active at night (nocturnal behaviour) and lameness and limping often go unnoticed for this reason. The owner simply does not see them moving around as much. Symptoms which may indicate arthritis in cats can be:

  • inappropriate urination in the house, seeing as they cannot jump so high anymore to go outside through an open window
  • not eating when their feeding bowl is up on a counter, or
  • staying in one spot for longer periods of time.

So how do vets know that an animal has arthritis and it isn’t just a sprained muscle?

The vet will start with a proper examination including feeling and manipulating the joints of the front and back legs, moving the head from side to side and up and down and placing pressure on the spine from head to tail. A patient that cannot bend a knee or that has a joint which creaks whilst being manipulated is more likely to suffer from arthritis than having just a muscle sprain. A definitive diagnosis of dysplasia and arthritis can only be made by taking an x-ray of your pet. This may show how the joint is malformed and/or where the new bone growth and arthritic changes are taking place. Sometimes in the early stages of the condition this is not clear on the radiograph and the vet can then take a sample of the fluid that surrounds the joint and analyse it microscopically to see if there is any sign of inflammation.

In part two on Arthritis we look at the treatment and prevention of this debilitating condition.

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

What causes back pain in dogs?

What causes back pain in dogs?

Introduction

Intervertebral disc disease is a term that describes the condition in which the softer cartilage like material in between the bones of the spine, called an intervertebral disc, pushes onto the spinal cord, causing clinical signs that varies from slight back pain and discomfort to complete paralysis of limbs. Even with the slightest clinical signs, your pet should be examined by the vet to establish how serious the condition is and be treated accordingly. The earlier this is attended to, the better the overall outcome. 

A bit of anatomy

The spinal cord is surrounded by a bony structure made up of vertebral bodies. They protect the extremely sensitive spinal cord from injury. They run from the head down to the tail tip and can be divided into cervical (neck), thoracic (chest), lumbar (mid-body) and sacral (tail) vertebra. The different vertebra all have different structures, but fulfil the same role. Between every vertebral body is an intervertebral disc that provides flexibility of the back as well as absorb shock when moving and jumping around. The intervertebral disc is composed of a soft gel centre that gives it its flexibility, and a harder fibrous outer layer, surrounding the gel centre. When the fibrous layer starts to degenerate, the gel centre follows the path of least resistance and starts to push upwards onto the spinal cord that runs directly above it. 

How does it happen?

This is a disease mainly seen in dogs, and cats are very seldom affected. Factors that increase the risk are breed or genetic predisposition, excessive weight and weak muscle development. Breeds with short legs and long backs like the Dachshund, Pekingese, Shih Tzu and Corgis are often affected. These breeds are also referred to as chondrodystrophic breeds. This term describes the condition in which the cartilage develops abnormally and tends to degenerate at an earlier age compared to other breeds. It is important to note though that disc disease is not exclusive to these breeds and can occur in many other dog breeds as well. There are two types of ‘slipped discs’, called Hansen type I, and Hansen type II. Hansen type I is the more serious one where the disc tears or ruptures and where the disc material almost “explodes” (also referred to as prolapse or herniate) up into the spinal cord, causing severe damage and subsequent paralysis. This typically happens in middle aged to older breeds mentioned above. This prolapse can happen at any point in time, and it may or may not be related to an event like a fall or a jump. As an owner of such a dog you may think that the dog was perfectly normal up to the point of the incident, but in most cases there would have already been damage or degeneration which may have started a long time ago. With Hansen type II, the onset is much slower, and the disc material only pushes up or protrudes and press onto the spinal cord -partially. This causes a variety of clinical signs ranging from low grade pain to instability in the hind quarters called ataxia or muscular weakness also known as paresis. Disc disease in non chondrodystrophic dog breeds is often a result of a specific event where the dog injures themselves by falling or jumping. A normal healthy disc only tears with severe abnormal force applied to it and is very uncommon. In most cases in other breeds where there is disc disease it is as a result of aging and or degeneration of the cartilage which make up the disc material. 

Clinical signs

The spinal cord consists of nerve tissue that conveys impulses to and from the body to the brain. It is extremely sensitive tissue that does not regenerate well after it has been damaged. When damaged, it heals by scar tissue formation and depending on the level of damage rarely regains its function. The damage done to the spinal cord when a disc pushes onto it are both due to mechanical compression, as well as secondary inflammatory changes to the nerve tissue. When the disc material presses onto the spinal cord, the pressure on the spinal nerves causes pain and it disrupts nerve impulses traveling to and from the body. The clinical signs will differ depending on where the compression happens. The disc material can prolapse anywhere from the neck down to the lumbar area. Due to the relative rigidity of the spine in the chest area and the extra support and protection provided by the ribs, disc prolapse will rarely happen in the chest area and is more likely to happen in the neck and at the lower body area. One area which is particularly vulnerable is the area behind the last rib where the chest and mid body or lumbar spine meets.  If a disc herniates in the neck, before the front limb nerves, both the front and the back limbs will be affected. If the protrusion happens in the area between the front and back limbs, only back limbs will be affected and front limbs will be normal. 

Signs usually seen are pain, weakness and instability of the back legs with the body swaying from side to side when the animal walks. In severe cases the animal may lose the ability to walk altogether and become paralysed. Dogs in pain will often yelp when picked up or moved and they may walk with an arched back and tucked in abdomen. If the neck is involved, the animal will walk with a stiff lowered neck, unwilling to move it from side to side or up and down. Ataxia can be seen as uncoordinated movements of the limbs. The back limbs will frequently cross over and affected dogs will not know where they are placing their limbs in space. In severe cases affected animals cannot use their back legs at all and might drag them along completely. 

Diagnosis

A provisional diagnosis can be made by looking at the breed and age of the dog, the presenting clinical signs, and by doing a thorough clinical exam, which will include a neurological exam. The clinical signs will provide some clues to the vet of the type of disc disease. To make a definite diagnosis, further diagnostic imaging will be required, with an X-ray being the first step. Unfortunately an X-ray cannot show up the actual degree of protrusion of the disc due to the fact X-rays do not show soft tissue as well as bone. It does however show a narrowing in the disc space between vertebrae compared to normal healthy discs. X-rays are a necessary and useful step in the diagnostic process as it rules out other potential cause of back problems like spinal cord tumors and fractures. 

After an X-ray is done, a myelogram should follow. With this procedure a dye is injected into the space surrounding the spinal cord. If there is a compression of the spinal cord, it will show up clearly on the X-rays taken afterwards. An MRI or a CT scan can be done in place of a myelogram, but these procedures are often more expensive. The reason for doing a myelogram or an MRI is not just to make a definite diagnoses of a disc herniation, but also to localise the area where the disc is herniating and assess the degree. If surgery is a possibility, the exact location of the herniated disc is of utmost importance. 

Treatment

It is important to get your pet to the vet as soon as possible if you suspect it to have a disc problem or if you see any of the symptoms described above. Keep it as quiet as possible in the meantime. There are two ways to deal with a dog presenting with disc disease, and the decision will depend on the presenting clinical signs. It can either be treated medically or surgically. In both instances the aim is to get the pressure off the spinal cord to prevent damage. It is important to realise that medical management is only reserved for patients showing very mild signs for the first time and this will be decided after a full clinical exam neurological evaluation and diagnostic procedures have been done. Medical treatment comprises of strict cage rest and anti-inflammatory medication to reduce swelling of the spinal cord. 

Probably more than 50% of cases presenting with disc disease require surgical treatment. A dog presenting with complete paralysis and with decreased sensation in the hind limbs needs to be treated as an emergency. There are different surgical techniques used, all of them taking pressure off the spinal cord to prevent further damage. Recovery can sometimes take long and adequate nursing care and physiotherapy is needed. The earlier the compression is fixed, the easier recovery will be after surgery. 

Prognosis and prevention

Prognosis after surgery depends on how severe the spinal cord has been damaged, and for how long. With rapid intervention and proper after care, prognosis is good. Unfortunately surgery cannot prevent another disc from herniating at a different location and 33% of dogs can have another slipped disc after surgery. Prevention includes regular exercise and a good diet, keeping dogs fit and slim. In dogs that are prone to disc disease, jumping on and off furniture must be restricted to a minimum. 

The importance of getting your dog to the vet if you suspect that it may have disc disease cannot be overemphasised. Sometimes even waiting and hour or two may mean the difference between life and death for your pet. If damage to the spinal cord has progressed to the point where your animal cannot feel deep pain when their toes are pinched, it is usually too late, even for surgery. 

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

Why is my dog limping with his hind leg?

Why is my dog limping with his hind leg?

Patellar luxation is a condition where the knee cap does not run in its groove but slips off to the side. Luxation is a learned word for “slipping”. It is a condition which is regularly encountered in dogs and more commonly in toy breeds. The condition can be developmental or traumatic in origin.

To understand the condition better, it helps to know what the anatomy of the knee looks like. The patella is commonly known as the knee cap and sits at the bottom of the big muscle group of the upper front part of the hind leg called the quadriceps. The patella makes up the front part of the knee and glides in the middle groove of the big bone of the upper part of the hind leg, the femur. This groove is known as the trochlear groove. The groove looks like a valley with two mountain ridges on either side. The ridges on either side of the groove are known as the trochlear ridges. The ridge on the inner part of the leg is known as the medial trochlear ridge and the one on the outer part is known as the lateral trochlear ridge. The knee cap or patella fits nicely in between these two ridges and glides up and down the groove as the knee bends. The patella is stabilised by the big muscle group to the top of it, the strong ligament to the bottom of it and the ligaments and connective tissue to the sides of it. The patella ligament which sits below the patella, implants onto the front of the top part of the bone underneath the femur, the tibia, also known as the shin bone.  

Patellar luxation occurs when the patella slips out of the trochlear groove, usually when the leg is flexed or bent.

Medial Patellar Luxation

This is where the patella slides off towards the inside of the leg. It is more commonly seen in small breed dogs like Boston terriers, Yorkshire terriers, Chihuahuas, Pomeranians Miniature Poodles and Pekingese. The condition is also often seen bi-laterally, which means it affects both hind limbs. 

Patellar luxation results in discomfort and reduced functional usage of the affected limb.  

There are numerous reasons why this conditions occurs which are mostly related to anatomical problems like the groove in which the patella runs being too shallow, or the ridges on either side of the groove not going up high enough to prevent the patella from slipping over them, to the front top part of the shin bone not aligning well with the bottom part of the femur and instead of running in a nice straight line, the patella is continuously pulled off to one side as the leg moves backwards and forwards. 

Because the anatomy is passed on from one generation to the next, it is not a good idea to breed with an animal affected by this condition. 

Dogs who suffer from this condition have different symptoms. Some will show no symptoms whatsoever and a routine examination will show that the patellae are slipping off to the side whereas other dogs will be limping lame and will hardly be able to take any weight on the affected leg. Owners of affected dogs often complain that the patient carries the hind limb in the air for a few steps, and then shakes or straightens the leg, after which they can take weight on it again. Stretching of the leg aids in returning the patella into its normal position inside the trochlear groove, and once this is done the patient will be more comfortable and carry weight on the leg again.

A diagnosis is often made by the vet feeling up and down the knee and using the fingers to move the patella from side to side and attempt to slip the patella in and out of its groove. The relative anatomical positions of the big muscle group (the quadriceps), the trochlear groove, the patellar ligament and upper front part of the shin bone (the tibeal tuberosity) should also be assessed. Light sedation may be required to assess the integrity of the ligaments of the knee joint. X rays of the hips, knees and lower limbs will aid in diagnosing any other conformational abnormalities or bony changes. At least two X ray views are required to see the bones and joints from different angles.

Four grades of patellar luxation can be distinguished:

Grade 1: The patella can by hand be manipulated out of the trochlear groove but spontaneously returns. This grade shows minimal clinical signs.

Grade 2: There is spontaneous movement of the patella out of the trochlear groove but it can easily be replaced back into the groove by manipulation or by itself. This grade often goes hand in hand with symptoms described as a ‘skipping’ type lameness. The patella, when slipping out the groove, causes the dog to keep the leg in the air and when it slips back into the groove, the dog takes weight on the leg again. Over time, the cartilage surface underneath the patella and on top of the trochlea is damaged which allows progression to Grade three.

Grade 3: The patella is out of the trochlear groove permanently but can be manipulated back into position but usually slips back out of position as soon as the leg is bent or straightened. Bony deformities are usually present and there is inward rotation of the tibia. Usually a trained hand can feel that the trochlear groove is shallow.

Grade 4: The patella sits outside the trochlear groove permanently and cannot be manipulated back into the groove. Early surgical correction is critical to limit bony and ligamentous deformities which make surgery more challenging.

Damage to the cartilage may take place as the patella continues to slip in and out of the trochlear groove, exposing the bone and resulting in arthritis and pain. With the patella luxating, the cranial cruciate ligament, which is a ligament within the knee joint, is also placed under more strain due to the fact that the patella, if it sits in its normal position in front of the knee, provides stability for the joint. When the patella slips to the side it puts a lot more strain on the ligaments inside the knee and this can cause the ligament inside the knee to tear.

Grade one and two are recurrent luxations. With grade three and four, the patella is usually permanently luxated from the trochlear groove. Surgical correction is considered for grade two luxations when there are significant enough clinical signs to warrant it. In cases of grade three and four luxations surgery is recommended early on to limit damage to the bones and ligaments and progressive skeletal deformity and osteoarthritis. Surgical correction is often more challenging when cranial cruciate ligament disease or hip dysplasia is present.

There are several different strategies that are used singularly or in combination, to correct the luxating patella, and the technique used will depend on severity of the condition as well as the conformational abnormalities present. The surgeon will take all of this into consideration when choosing a particular technique. 

  • Soft tissues around the patella are reconstructed, so that the side to which the patella is slipping is loosened and the opposite side tightened 
  • Deepening the trochlear groove to enhance better positioning of the patella
  • Moving the front, upper part of the shin bone so that the patella ligament runs in a straight line from the top rather than being pulled to the side. 

Lateral Patellar Luxation

Lateral patellar luxation is more commonly seen in young large and giant breed dogs (Great Danes, St Bernards and Irish Wolfhounds). This is where the patella slips towards the outside of the leg.

The main cause of this condition is poor conformation most notably knock knees. Because it is related to the confirmation of the dog, both knees are usually affected at the same time. Intermittent luxation and reduction of the patella in the young and adult animal will result in progressive wearing of the outer trochlear ridge, a shallower trochlear groove and increased instability of the patella. 

Clinical signs can be present from as early as 5 to 6 months of age. Physical examination of the knee joint is often diagnostic and the patella can be felt slipping to the outside of the leg (luxating laterally), but it is often reducible. Just as with a medially luxating patella the cranial cruciate ligament and ligaments to the side of the knee joint should also be assessed. Oftentimes there will be a laxity of the inner side ligament of the knee due to the chronic outer rotation of the limb at the knee joint. X rays are also required to assess potential damage, and/or deformities of the hips, the femurs and the shin bones, which are often more severe than with medial patellar luxation. Three dimensional Computed tomography (CT) may aid in planning where the shape of the femur or tibea needs to be surgically corrected. 

The Grading system (1 to 4) for medial patellar luxations also applies for lateral patellar luxations.

Feeding ultra-premium diets with the correct calcium and phosphorus ratio, will aid in maintaining a slow growth rate, which has been proven to have a favourable effect in minimising hip dysplasia and other bone growth abnormalities, which could complicate and contribute to patellar luxation.

Surgery is the treatment of choice for lateral patellar luxation. 

Post operatively 

Over 90% of owners are satisfied with the progress of their dog after surgery.

For medial and lateral patellar luxations, soft padded bandages are used to aid in reducing the swelling post operatively. Removal of bandages after 3 to 5 days to allow full joint motion is encouraged. Pain medication is used as a matter of course. 

Weight bearing post operatively is desired as soon as possible, as some toy breeds develop the habit of carrying the operated limb in the air. Swimming and hydrotherapy is a good way to encourage movement without having to take weight on the leg shortly after the operation. Restricted movement and leash walks are encouraged for the first 4 to 6 weeks (to promote adequate bone healing). No running and jumping is allowed. Depending on the size of the dog and the severity of the surgery required to correct the problem, dogs operated on one side should usually start taking weight on the affected leg within 10 to 14 days after surgery. 

The prognosis for Grade one and two luxations is usually good. For grade three and four luxations the prognosis is fair to good, especially if the luxations were treated early in the patient’s life. Should the condition have been there for a long time with significant bony changes, the prognosis is more guarded. Secondary arthritic changes and cranial cruciate trauma could complicate long term function.

Osteoarthritis in the affected knee still progresses even after surgery regardless of the grade of luxation at presentation and therefore, depending on the degree, there may always be some degree of discomfort in the joint after surgery.  

The prognosis for luxations in large breed dogs is less favourable especially when combined with angular deformities of long bones, or hip dysplasia. 

Regular check-ups with the vet will ensure early detection and treatment to ensure your dog has the best chance of receiving the correct treatment and the best possible chance of recovery, should it suffer from patellar luxation. 

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

 

 

Battle of the Bulge

Battle of the Bulge

Overweight catMost people, at some point in time, struggle to shed some extra weight. Obesity in humans has reached epidemic proportions and in a study released two years ago, South Africans were classified as the third fattest people on earth. Worse than this, is the fact that obesity in pets is following this trend and fast becoming a disease on its own. Some studies show that more than 50 % of pets are overweight. This alarming figure effectively means we are “killing our pets with kindness.” Obesity is defined as an accumulation of excessive amounts of body fat. Body fat increases when the amount of energy taken in (by eating food) exceeds the amount of energy used (by exercising). Vets classify a pet as obese if the animal weighs more than 15 to 20 % of his/her ideal body weight.  Body Mass Index or BMI which is commonly used in humans to define obesity is not commonly used in animals, because there is such a huge variation between and within different breeds. In animals, a Body Condition Score or BCS is referred to in terms of the animal’s ideal weight.

Factors that can influence the ease with which pets pick up weight include:

  • neutering or spaying, sex hormones like testosterone and estrogens have a regulatory effect on the animal’s metabolism;
  • breed disposition – Labradors, Dachshunds, Dalmatians and Spaniels, to name but a few, are breeds that tend to become overweight more easily;
  • diseases such as hypothyroidism (a lazy thyroid gland) lead to a decrease in metabolism (the rate at- which the body burns fat and uses energy to maintain body functions);
  • medication such as corticosteroids, which can lead to an increase in appetite;
  • owner related and environmental factors – overfeeding, excessive treats, and no exercise.

Obesity in humans predisposes us to conditions like diabetes and heart disease. Animals are no different and as in humans, there is a myriad of other diseases and conditions which stem from being overweight. Statistically, humans and animals that are overweight have a shorter lifespan and a reduced quality of life. Apart from the excess weight which has to be carried around by an overweight pet, leading to conditions like arthritis and muscle fatigue, there is also the side effect of fat accumulation in organs and everywhere else around the body, which leads to organ failure and weak muscles. A classic example of over-accumulation of fat in an organ is fatty liver syndrome in overweight cats. The cat’s body loses the ability to metabolise fat (use up it fat resources) properly which leads to excessive fat accumulating in the liver which in turn leads to premature death. Other conditions and diseases which stem from obesity are diabetes, hypothyroidism, hyperadrenocortisism also called Cushing’s disease (overproduction of cortisone by the body), slipped intervertebral disks, cruciate (inner knee) ligament rupture, collapsing of the airway, hypertension or high blood pressure, heart disease, cancer, skin abnormalities, bladder stones, urinary tract infections, dystocia (difficulty in giving birth), heat intolerance and being an anaesthetic risk.

For veterinarians an overweight pet is often a difficult patient to examine, assess and diagnose as the vet cannot feel all the structures properly in your pet’s abdomen or hear his/her heart and lungs optimally. This may cause the vet to miss a subtle problem (like a growing tumour) and not diagnose it well in advance.

So how do you know if your pet is overweight? All breeds have an ideal weight range which has been published in numerous books and articles on the internet. A useful tool to use is the Body Condition Score. Ideally, your pet should have a Body Condition Score of 3. This means that your pet’s ribs can be felt when you stroke their chest lightly with the back of your hand. If the skin and musculature underneath your fingers are completely smooth, the animal may be overweight. If the skin is tight against their ribs and you feel every bump, they may be underweight. Dogs must have a waist and abdominal tuck. Cats should also have a waist and an overweight cat can immediately be spotted because of a fat pad developing on the lower abdomen (tummy) between the back legs. If an animal has a body condition score of 3, their body fat percentage should be somewhere between 1 and 24 %. If you are not sure if your pet is overweight, you can ask your vet to show you how to do a body condition score.

Body condition Score in dogs and cats

Fortunately, there is help out there if your furry friends need to lose weight. Keep in mind that weight loss in animals can be just as difficult as weight loss in humans. Our pets have one advantage though……. they cannot go to a store and buy food. They rely on their owners to feed them, and of course to exercise them!

Exercise

As with human weight loss programmes, exercise forms a pivotal role in weight loss. Feeding the correct diet and the correct amounts of the right food are central to weight loss, but the overall results are so much better if it coincides with a proper exercise regimen. Taking your dog for a 30 min walk 3 to 4 times a week can make a world of difference in reducing weight, and once that weight has been lost in maintaining the ideal body weight. If at all possible, walking off the lead or walking on a longer lead tends to give the animal more exercise than walking right next to the owner on a short lead. Playing on the lawn or beach, or throwing a ball to an overweight pet can be very effective exercise. Dogs that suffer from arthritis or any other joint problems can be taken for a swim. Swimming is excellent exercise and does not have the same impact on the joints as walking or running. Cats can be exercised by being lured up and down stairs (or jumping up and down a table or chair) a few times around feeding time. Some cats will also chase a laser light and this too can be used to get them more active.

Diet

Overweight dogDecreasing the amount of food, and starving your animal, is almost as detrimental as overfeeding them. With the help of the vet you can establish which diet is the correct one for your pet and exactly how often, and what quantity to feed your animal. Maintenance diets are balanced and formulated to provide the correct amount of minerals and nutrients. A controlled decrease of a maintenance diet will certainly contribute to weight loss; however animals that are obese or more than 5 to 10 percent overweight need special diets and special attention. For these animals there are specially formulated light and weight reduction diets, which usually have reduced fat and reduced refined carbohydrate components, but are still balanced to ensure proper nutrition. Light diets are usually effective for animals that are mildly overweight or for animals that have lost weight and where the lower weight now needs to be maintained. In certain instances a light diet may even be used to keep animals which are at the correct weight, at that weight, and to prevent them from picking up weight again. The approach to put an animal on a light diet, can be especially useful for breeds which are prone to becoming overweight once they have been sterilised. A veterinary weight loss diet, or calorie restricted diet, is formulated for dogs or cats that are more than 5 % overweight and contains ingredients that help them burn fat and keep the weight off once they have lost it. Some weight reduction diets contain more fibre which helps them to feel fuller for longer as it works in the satiety centre of the brain (the part in the brain that tells them that they have eaten enough). Some weight reduction diets have a low glycaemic index (Low GI), which allows energy from the diet to be released over a longer period of time, which in turn stabilises the blood sugar levels and allows fewer calories to be converted to fat. Ask the vet or staff at the veterinary practice for more information if you are not sure which diet your animal should be using.

In a controlled weight loss program environment, your pet’s goal is to achieve a 1 to 2 % body weight loss per week. For example, a Labrador weighing 45 kg, the ideal weight loss per week should be between 450 and 900g. This converts to a 1.8 to 3.6 kg loss per month. If your pet does not achieve this goal with the adjusted diet and regular exercise, ask the vet to do a general check-up, as a medical condition may be prohibiting the pet from losing weight. Most veterinary practices run weight loss clinics and diet and nutritional assessment programs (backed by excellent research from veterinary pet food companies). At these clinics, a structured feeding and exercise plan can be designed especially for your pet and your pet’s progress will be monitored with a weigh in on a one to two weekly basis, until your pet has reached his/her desired weight.

There is nothing cute about a podgy pet. A lean and healthy pet is a happy pet.

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