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Hypertrophic Osteo Dystrophy

Discussion in 'Dog Health and Nutrition' started by Irish Setter Gal, Jul 4, 2011.


  1. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    My 7mth old Irish Setter has just been diagnosed with this condition in the bone above his left wrist. They believe he may have knocked at some point adding trauma and triggering off this development.

    He showed a limp the day we collected him from kennels and it got progressively worse on an occasional basis hence trip to vets. Of interest before the return trip to the vet I rang the kennel and he recalls no specific injury event but he did make a comment about him upping his food as he visibly grew over a three day period. Before anybody asks, the kennel is trusted to his word, it's a very small kennel and I use him for occasional training lessons.

    The vet has said it should heal itself in time without permanent damage and recommends:
    1. One month rest, 10min max on lead, per hour
    2. Rimadyl phased out over two weeks
    3. Change to Giant Dog puppy feed (currently on minced tripe and Skinners for adult mix)

    Apart from dealing with a 7mth on effective house arrest (we may both kill each other), does anybody else have experience of this? Is it genetic, dietary or trauma linked and should I notify his breeder for her information?
     
  2. lucylastic

    lucylastic PetForums VIP

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    Have no experience of this but I would definitely notify the breeder. I'm sure he/she would want to know. I hope your pup makes a full and speedy recovery,
     
  3. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    I've corresponded with his breeder and she's not heard of it as a problem in her lines before, she equally doesn't let them do anything but play in the garden until they are 6-7mths of age.
    She has and always will continue to feed minced tripe and really doesn't believe in complete foods believing them to mostly full of chemical c**p. She has said a switch of food is completely down to me, but she knows what she would do and that'd be rest.

    SO the plan of attack so far is
    1. Hubby is compliant
    2. Purchased today Large dog 'Arden Grange' - only decent food I liked at the local pet shop. Food changeover process started tonight
    3. Dogs isolated at the merest hint of play :(
    4. Lots of bones to chew on
    5. Lead only regime implemented - apparently he's not happy at that already and it's only day one.
     
  4. Malmum

    Malmum PetForums VIP

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    #4 Malmum, Jul 5, 2011
    Last edited: Jul 5, 2011
  5. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    Many thanks Malmum.

    Have just made the error of googling it and found a sobering article on wikipedia

    Hypertrophic osteodystrophy - Wikipedia, the free encyclopedia

    Now quite upset at this :(

    Odd that it's only one leg not the usual two, but it could be linked to that sudden growth spurt whilst at the kennels, and also no real identifiable cause.
     
  6. Malmum

    Malmum PetForums VIP

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    I know, I didn't think it was nice reading but thought you should know. Your vet seems to be giving you a false sense of security and your boy needs you to know just how painful it may be for him at times. It sounds like Rimadyl may not be enough at some point in which case you may need Tramadol added to it for his comfort.
    I didn't want your vet fobbing you off at your boys expense, if you know what I mean - best you know exactly what you're dealing with for his sake.

    Take care. xx
     
  7. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    I find it really strange that I'd never heard of it as 'breed' susceptible with the Irish, nor indeed the Weimeramers.

    Know of all the other Irish potential 'breed' ailments, but not this.

    Other half read the Wiki link and now taking me and the vet even more deadly serious re activity levels.

    Tbh. the vet was really good, certainly had my moneys worth out the consult for this one rather than the usual 10/20min job. We did discuss 'what next' scenarios beyond the month ie a re another xray to check, but she says to play it by ear with the dog - any change and they will take investigations further beyond their hospital expertise. I am more concerned that this is a long term event than a short term 'growing event' which is what the vet believes. Neither article seem to state if it's long term or not ... I will go digging more seriously on my days off.
    His Rimadyl is phased out on the second week and that should give us two weeks of drug free assessment on any lingering associated pain/inflammation issues.
     
  8. 912142

    912142 PetForums VIP

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    I have searched the internet and found this interesting article from S. Gary Brown, D.V.M., D.A.C.V.S.
    Irish Setter Health Committee Member

    Sorry about the length but couldn't get the link to copy.

    This is a revised version of the article by Dr. Brown on HOD. Please note that he has changed the protocol for treatment. This article was taken from the Irish Setter Club of America, Inc. Memo To Members, JUNE 2001.

    Hypertrophic Osteodystrophy (HOD) is a developmental disease in large breed dogs (commonly the Great Dane, Alaskan Malamute, and Irish Setter.) This disease usually begins between the ages of 3 months to 5 months of age. HOD is often sporadic and can vary in intensity although at times several dogs from one litter may be affected. There are questions about the heritable nature of the disease but no answers from an organized study have been documented.

    Most of the affected animals are first presented because of lameness or reluctance to walk. There are often fevers of 104 - 104.2 degrees F and anorexia (refusal to eat). These signs usually get progressively worse. Over days the metaphyseal regions of the long bones (the area next to the growth plate, but towards the mid bone, not the joint) will be tender to digital pressure, slightly swollen and warm to the touch (using the inside of the wrist.) More adversely affected animals will be systemically ill. The fevers and anorexia will continue, and weight loss comes quickly if the affected animal is not treated.

    This disease is bilateral (both sides) and often will effect the metaphyses of front legs as well as rear legs. Symptoms can be episodic and are often relentless. Reports of responses to various treatments can be traced to dogs with episodic disease and varying degrees of severity. This information is anecdotal at best. Early on the metaphyseal area becomes swollen and very painful. It is in this metaphyseal area that HOD exerts its major pain and produces radiographic changes. The distal radial /ulnar metaphysis (above the wrist joints) are the most commonly affected sites, although the metaphyses of all long bones are certainly susceptible. Therefore, it is not uncommon to see clinical disease and radiographic changes in the metaphyses of many long bones in the body. There are severe inflammatory changes going on in the metaphysis and resultant changes in the local blood flow. This change can disturb normal cartilage growth and development of the adjacent growth plate (physis). The resulting interference in the cartilage transformation into bone (endochondral ossification) can be seen as finger-like at times, extending up into the metaphyseal marrow cavity. The result can be premature slowdown or early growth plate disruption, resulting in shorter bone length or even curvature. This, is more common in the Great Dane than the Irish Setter (in my experience). The usual microscopic changes, which are seen in the metaphysis are inflammation, hemorrhage, necrosis (cellular death), microfractures and remodeling of the bone. Periosteal new bone (a thin sleeve of bone around the outside of the cortex) can occur as the result of inflammation.

    The cause of HOD remains unknown, however, there are many speculations. The autoimmune nature of this is currently under investigation at one university. Vira1 causes (even Canine Distemper) have been implicated, although they just might be one more kind of stress precipitating HOD. Vitamin C deficiency has been thought to be a cause, however, there is neither documentation nor scientific reason for this in the dog. Vitamin C therapy has not met with much success. Excessive amounts of dietary protein and high caloric intake have been implicated, scientific support for this is also lacking. However, over nutrition does play an important role in Osteochondrosis. An infectious origin has been proposed, and there are reports where hematogenous (blood borne) bacteria have been noted to produce florid radiographic changes in the metaphyses which perhaps could be confused with HOD. Therefore, if not careful, hematogenous or osteomyelitis (bone infection) could possibly be confused with HOD. A good radiologist should be able to differentiate this. Documentation of the use of possible blood cultures, to isolate bacteria, in HOD cases has not been reported. Therefore documentable cases of actual infections have been few. For most cases, the cause is still unexplained.

    Diagnosis is usually clinical, and later confirmed by radiographic examination. In the very early stages there is point tenderness in the metaphysis. One week later we see radiographic changes. This is represented by a radiolucent line, parallel and immediately adjacent to the growth plate. This line represents bone necrosis and reabsorption of some of the microspicules of bone. This metaphyseal region may remain mildly affected throughout the course of the disease if well treated, or may show early irregular widening if there is some alteration in the growth plate and its endochonral ossification. The periosteal new bone formation may form a collar around the bone, localized to the inflamed metaphysis, or it can be rather extensive and extend several centimeters toward the mid bone. On occasion, severe involvement can affect the growth plate, often the distal ulna, resulting in lateral bowing deformities of the front legs.

    Remember, to make this diagnosis you need the classic metaphyseal point tenderness, and the zone of necrosis parallel to the growth plate (lucency) and usually the metaphyseal periosteal new bone. These radiographic changes appear 7-10 days after the onset of symptoms, ie: fever, lethargy and metaphyseal pain.

    In all cases of true HOD, treatment is begun by anti-inflammatory doses of Prednisone. The initial dose is 2 mg/kg/day for 7 days. The dose is halved weekly for one month. The last week*s dose may need to be extended for a fifth week. One should always cover with clindamycin or clavamox and use antacids like Tagamet or Pepcid for 3-4 weeks. We*re using glycoflex-plus or synovi-msm as a second anti-inflammatory. Some dogs can*t come off the prednisone without a return of mild symptoms. These cases get 5 mg total every other day for a long time; if necessary until the end of adolescence. In two cases like this their size ended up just as large as their littermates and the wrists were not thickened. Furthermore, their coats did not suffer.

    Mild cases are not difficult to treat, whereas the more severely affected animals require more aggressive care. Those animals that are not treated early on require IV fluids and electrolytes, nutritional support, and tremendous nursing care to arrive at a successful result. On occasion, parenteral nutrition is needed for a severely affected animal. Pharyngostomy tubes have been used for liquid food administration.

    If well treated with anti-inflammatories, the need for pain medications can be greatly reduced to the use of other oral medications such as Torbutrol, being careful not to suppress the dog*s appetite.

    Recurrence after a month or so can also happen. Start back with 1 mg/kg/day of Prednisone for a week. Half the dose for the second week and probably give 5 mg every other day long term. Cover with antibiotics for the two weeks when you restart the Pred.

    Dogs which have been treated solely with Rimadyl (r) have mostly not done well at all. The prognosis for mild cases can have a good prognosis. Severe cases are more difficult. Lately we have seen more effective treatment for the severely affected cases with the above regimen.

    If you have questions or would like your veterinarian to call me, please feel free to do this at 510-657-6343 or by email at: gary@vetortho.com
     
    Irish Setter Gal likes this.
  9. 912142

    912142 PetForums VIP

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    Note his comments on the use of Rimadyl
     
  10. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    Greatly appreciated - yes, noting the comments on Rymadyl I will print this off and try to make another appointment with the vet to discuss.

    Still strange ours does not appear to be on the or around the growth plate areas but higher up in the rounded end of the bone, and only one leg.

    Once again greatly appreciated, many thanks
     
  11. 912142

    912142 PetForums VIP

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    No I think you will find if you research it that this is indeed where it may show up in the Ulna or Tibia. The ulna is the long bone that goes from the wrist to the elbow, and the tibia is the long bone that goes from the hock to the knee.

    The important thing is to stick to the walking regime to a T because what you don't want is to put too much pressure on those joints.

    I have to a certain extent had exposure to something similar and at first I found it all very confusing. I was also advised to ensure my dog was kept calm indoors! You can imagine that was extremely difficult and I had that for 7 or 8 months.
     
  12. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    Run out of 'entertainment' ideas already - just had his tea via a kong

    7-8mths :eek: God help me it should be that long.

    I left a copy of the article with the vet, she was off today though, so I'll wait and see if she contacts me - wanted to speak to her though as didn't want it looking like I was 'challenging' her knowledge.

    Insurance company called for a claim form since I think this problem may get even more expensive, I was trying to avoid a claim since I prefer to save insurance for 'real big ' emergencies :blink:
     
  13. Irish Setter Gal

    Irish Setter Gal PetForums Senior

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    UPDATE:
    Showed my vet your article (took it in the light it was intended to be taken :)) and she has agreed to put him on a course of antibiotics as well, but is reluctant to change from Rimadyl at the moment.

    He does have it in both legs, but only really mild signs in his right as opposed to badly in his left.

    We have also agreed, since he was so well behaved and didn't need a general, that he can be x-rayed again in 6 weeks to check on progress.

    As an aside - a plus point to this is that his walking to heel loose lead is coming on leaps and bounds, what with only 10min an hr to be with him :thumbup:
     
  14. grandad

    grandad PetForums VIP

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    Run out of 'entertainment' ideas already - just had his tea via a kong

    I would try lots of sits, stay, downs, rollovers, find (hide is dinner in small increments under something) watch me and focus exercises, hold, leave it, etc etc.

    Hope your pooch gets well soon
     
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