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Hip Dysplasia in Airedale Terriers
Angus's Story, by Zoe & Criag
 

Angus started showing signs of a problem at 5 months, he would have difficulty rising from sitting or lying down, he would equally look like an old man sitting down, as he would gently ease himself onto his left butt cheek only and sit all crooked. He was also very stiff after naps. Out for walks, he would take no more than 10-15 steps and he would then lie down and would insist on a rest for several minutes before taking another few steps before resting again. Running was adorable; he had this delightful bunny hop going on where he ran (hopped) with his back legs together. We initially put these symptoms down to a couple of things, the hot Las Vegas weather, and our cold stone tile floors, which Angus loved, to keep him cool.

It was during a crazy summer afternoon, when Angus was tearing around the yard demanding we play with him, throw the ball, the Frisbee, anything, that disaster struck.

We bounced the ball for Angus; he jumped up high in the air to catch it, twisted his body and fell backwards landing hard on his right hip.

He was screaming in pain, something we had never heard before and NEVER want to hear again. It was a public holiday, so our own vet was closed. Instead we rushed Angus to the emergency pet hospital. The emergency vet took an x-ray, and said it was possible his hip had dislocated, but it appeared to have popped back in, and she thought he may have torn a ligament, so to just have him 100% rested for 2 weeks and he would be fine. His records would be forwarded to our vet, and our vet would contact us if they wanted to follow up.

A week later Angus was not any better, he was lame, and had stopped using his back right leg entirely, so we took him back to our own vet. The emergency vet had also not forwarded Angus’s records of his visit to our vet, so she had no idea he had be injured. We felt terrible.

Our vet confirmed Angus had dislocated his hip. She expressed concern that everything we had described was evidence of the onset of hip dysplasia, but in order to confirm she wanted to take X-rays with Angus on his back so that they could stretch his back legs out and look at the hip. Due to the extent of this test, and the need to ensure the muscles are fully relaxed, Angus was first sedated.

Sadly, Angus back right hip was so loose that his back right leg was literally falling in and out without help from the vet. His left leg was also showing mild signs of dysplasia, which whilst not an immediate concern could be a problem later as his left hip and back leg were taking all the added pressure from his right hip and back leg.

Our vet, as defined by the Orthopedic Foundation of Animals (OFA), made diagnosis from seven classifications, – we have included a description of all seven below:

·          Excellent - this classification is assigned for superior conformation in comparison to other animals of the same age and breed. There is a deep seated ball (femoral head) which fits tightly into a well-formed socket (acetabulum) with minimal joint space. There is almost complete coverage of the socket over the ball.

·          Good - slightly less than superior but a well-formed congruent hip joint is visualized. The ball fits well into the socket and good coverage is present

·          Fair  - Assigned where minor irregularities in the hip joint exist. The hip joint is wider than a good hip phenotype. This is due to the ball slightly slipping out of the socket causing a minor degree of joint incongruency. There may also be slight inward deviation of the weight-bearing surface of the socket (dorsal acetabular rim) causing the socket to appear slightly shallow

·          Borderline - There is usually more incongruency present than what occurs in the minor amount found in a fair but there are no arthritic changes present that definitively diagnose the hip joint being dysplastic. There also may be a bony projection present on any of the areas of the hip anatomy illustrated above that can not accurately be assessed as being an abnormal arthritic change or as a normal anatomic variant for that individual dog

·          Mild  - there is significant subluxation present where the ball is partially out of the socket causing an incongruent increased joint space. The socket is usually shallow only partially covering the ball. There are usually no arthritic changes present with this classification

·          Moderate - there is significant subluxation present where the ball is barely seated into a shallow socket causing joint incongruency. There are secondary arthritic bone changes usually along the femoral neck and head (termed remodeling), acetabular rim changes (termed osteophytes or bone spurs) and various degrees of trabecular bone pattern changes called sclerosis. Once arthritis is reported, there is only continued progression of arthritis over time

·          Severe - There is significant subluxation present where the ball is partly or completely out of a shallow socket. Like moderate HD, there are also large amounts of secondary arthritic bone changes along the femoral neck and head, acetabular rim changes and large amounts of abnormal bone pattern changes.

Our vet determined that not only had the trauma accelerated the severity of his hip dysplasia, but also, Angus’s knee had been crushed during the fall. The emergency vet did not even take an x-ray of his knee, and so over a week had past where the knee bone had started to heel, badly because no one had caught the trauma.

Angus was initially diagnosed with moderate to borderline severe hip dysplasia, but we were advised to get a second opinion, and see a specialist.

As Angus did not currently appear to be displaying arthritic symptoms we were advised to limit his exercise and play, and we were given a very low dosage of Rimadyl (a nonsteroidal anti-inflammatory drug (NSAID)) and also started him on a very high dosage of Glucosamine, and asked to come straight back if he dislocated his hip again, and in the meantime, schedule an appointment with a specialist to discuss.

By month 6 there was an audible clunk every time Angus tried to get up, and he was starting to cry at night, something he had never done when we brought him home.

He was in good general spirits, very playful, loved balls and Frisbees, and was happiest when he was tearing around the yard full of energy.

Coming down the stairs one morning during month 6 his back right leg popped out, and did not pop back in again, and he was immediately lame, hopping on three legs and visibly in pain.

We returned to the vet with Angus and she took a look, repeated the x-rays to evaluate the progress of his hip dysplasia, and advised us the severity of the hip dysplasia was accelerating fast and he was now diagnosed with Severe Hip Dysplasia.

Angus’s dosage of Rimadyl was increased, and an appointment made with a surgeon, so that he could evaluate Angus, and make a recommendation.

We decided to research Rimadyl a little further, to better understand this longer term drug therapy we were starting our puppy on. The facts were not good; there are a large number of horror stories out on the web about canine deaths from Rimadyl, many within hours of taking the drug. However, there were a few success stories too. We would suggest that with any drug therapy, do your research first, and understand the pros and cons, as your dog will not be able to tell you his symptoms until it is too late. We learned that signs of Rimadyl intolerance included appetite loss, vomiting and diarrhea, which could indicate rare but serious side effects involving the digestive tract, liver or kidneys.

Angus was already suffering from loss of appetite due to the low dosage of Rimadyl we already had him taking, but sadly, when the dosage was increased he showed all the symptoms of intolerance within 48 hours, very dark tarry stools, and terrible vomiting, several times within a couple of days.

Because of this we immediately took Angus off Rimadyl, and took Angus back to our vet to look at other drug options.

With her advice, we decided to try Angus on Deramaxx, another nonsteroidal anti-inflammatory drug (NSAID), which again has a pretty horrific list of potential side affect, including vomiting or diarrhea, loss of appetite and lethargy. The goal with all NSAID drugs is to go with the lowest dosage that shows benefits to your dog, we were only giving Angus 2/3 of the dosage recommended for his weight to try and limit the side affects.

The good news is that Angus did not display all of the same warning sides that he had on Rimadyl, he had no dark tarry stools, no diarrhea, and no vomiting, however what he did suffer was severe loss of appetite and significant lethargy, but these were trade offs we had to make in order to try and relieve some of the pain he was experiencing.

Angus had to be hand fed small meals 3-4 times a day from July through to just a couple of weeks ago; otherwise he simply would not eat. He also slept a great deal, but we figured sleeping was his body’s best way of coping with the pain, and helping him heal.

Thanks in part to Deramaxx, Angus would have good days and bad days, so on good days we would second guess the vets diagnosis, and decided Angus has been misdiagnosed, that surely our purebred puppy could not possible have hip dysplasia, he looked fine. He was playful, and happy.

After 3 more trips to the vet over the next few weeks when Angus’s hip popped out and would not pop back in, we finally met with a surgeon, so he could repeat the x-rays/tests and discuss options with us.

It was agreed that treatment by drug therapy was a good short term solution, but given how young Angus was, and the severity of his dysplasia, we would have to consider a surgical option if we wanted to give Angus a good quality of life.

There are essentially three surgery options for a pup with Severe Dysplasia:

·          Triple Pelvic Osteotomy (TPO) – This procedure is an option for younger dogs usually less than 10 months old with only subluxation caused by dysplasia. TPO surgery will reestablish joint stability and encourage normal joint development and minimize abnormal biomechanical forces on the joint before osteoarthritis occurs, however this procedure is not an option if osteoarthitis is already present. Recovery time is about 6 weeks and a good success rate has been reported with return of normal hip function.

·          Total Hip Replacement – This procedure is recommended for dogs over 10 months of age, who already have established osteoarthritis and can no longer be medically managed. This surgery will reestablish normal, pain-free limb function and joint mechanics. A high degree of success has been reported with this surgery and like the TPO, post-op recovery is about 4-6 weeks. There are two disadvantages to this surgery, the high cost, and the limited availability of facilities and surgeons who can perform it.

·          Femoral Head and Neck Excision (FHO) – This procedure is considered more of a salvage procedure when there is evidence of significant osteoarthritis and a total hip is cost prohibitive. This surgery eliminates hip pain by removing the femoral head and neck and initiates the development of a fibrous false joint that permits ambulation. The false joint is less stable with a reduced range of motion than the normal joint, which in turn, causes an abnormal gait. Nevertheless, significant pain relief with adequate function can be achieved. Preoperative muscle mass and early postoperative physical therapy are two important factors in determining a successful outcome. This surgery is usually not as successful if there is severe disuse muscle wasting (atrophy) present and/or the animal is obese.

Initially we discussed the TPO surgery with our surgeon, however, after he took a look at Angus, he determined that there was significant trauma from the fall Angus had had, causing additional damage on top of the Dysplasia, and in addition, Angus clearly was suffering from the onset of osteoarthritis, so this made him a poor candidate for this surgery.

Traditional thinking from some surgeons is that a total hip replacement is the only way to go, especially in dogs larger than about 40 lbs, however, there have been tremendous success over recent years in younger heavier breeds of dogs with the FHO surgery (in fact we  found several good success stories of dogs who weighed in excess of 80lbs who had FHO surgery), and in fact we found some research that stated FHO is a better way to go every time. So, we discussed this with our surgeon, as we were prepared to go either way based on his recommendation.

Because Angus was young, lean and remarkably fit, he recommended with go the FHO route.

The thought of putting Angus through such a rough surgery was pretty distressing so we listened to all the advice from the surgeon and went home to give it some thought for a couple of weeks, especially, as Angus was going through one of his good spells, so it was hard to think of putting his little body through surgery.

A week later, our minds were made up for us, for no apparent reason at all, Angus was lame again, could not put his back right leg down, and was very unhappy, we had yet another visit to the vet who after sedating him and trying to push the leg back in, confirmed his leg was now not capable of popping back into the hip – you could physically see it sticking out of his body. To try and rest it the vet bound his leg to his body with a body bandage and told us to try and keep it on for a week, and keep him still. Well…have you ever been able to keep an Airedale still?

Angus howled the whole way home, then had a complete melt down when we got home as he thought his leg had been amputated….it was awful to watch, so we had to remove the bandage immediately to stop him hurting himself, and we called our vet to schedule FHO surgery.

On December 1st 2003, Angus had his FHO surgery. The surgeon confirmed that they found significant damage from the trauma, and onset of bone disease (The bone they removed was gray instead of porcelain white), and they also had to remove some of his cortex that had been shredded from being trapped between his leg and hip bones rubbing together.

Angus was expected to stay in hospital for 2-3 nights, but after 1 night, the vet called us as Angus was insisting to be allowed to go home. We brought him home on Tuesday December 2nd with strict instructions to get him leash walking immediately, and start passive hip range of motion exercises the same day, flexing, extending and abducting his hip and back leg maximally for 20-30 repetitions three to four times a day. The goal was to get him putting his back right foot down as quickly as possible.

For anyone who goes through this surgery, be prepared for the shock of seeing the impact the surgery initially has on your dog physically. Because a large piece  of bone has physically been removed, the leg will literally float freely, and of course this makes it shorter too, so this is pretty distressing when you first see it. In Angus’s case as he had not used the leg for so long, it was really thin too.

Angus was so spirited, on day three after surgery he was actually barking at the front door pawing his leash asking to go out….he had to hop, but his determination was incredible. We could physically see the immediate loss of pain in his mood, and in his face, all he seemed to be coping with was the limited pain from the surgery, not the arthritic pain of his bone and hip rubbing away constantly.

By day seven post surgery, Angus was walking two to three ˝ mile walks a day, and was touching his foot down.

My best advice is keep pushing your pup after surgery, his successful recovery and range of motion is mostly down to your determination to push him as hard as you can, and if you do, you will see the rewards very fast.

At two weeks, when we returned to our vet to have his staples removed, our vet was amazed at his progress, his range of motion was good, and he was rushing round the vet on all fours at break neck speeds. Angus was 3-4 weeks ahead of where he was anticipated to be, based on average data. Airedale Terriers are not an average breed!

We started to find parks with steps and hills, and continued to push Angus.

At five weeks (January 5th) , when we had our follow up meeting with the surgeon, he too, was thrilled with Angus’s progress, and agreed Angus is weeks ahead of where they anticipated he would be.

The best news is that Angus has been off the Deramaxx medication for 12 days now, and his appetite has come back, he now demands food ALL the time, which is a completely novel situation to us. If we are not careful, he will weigh 80lbs by February.

It will take approximately six months for Angus to completely heal, but he is well on his way to recovery, and today we have a 2-3 mile hike planned. It may take us all afternoon, as Angus rests frequently when we are out, but the pleasure of knowing he will ultimately accomplish it is reward in itself.

What we learned along the way.

It is vital that you locate a vet who has experience with Canine Hip Dysplasia, as you will require an incredible amount of support from your vet as you go through this.

Also, if surgical intervention is your only option, find a board certified surgeon, who has extensive experience with Canine Hip Dysplasia too, check out their credentials, where did they go to school, success stories etc., if you have to, visit several surgeons until you find one you are 110% comfortable with, and you trust will not push you in the wrong direction because of their own agenda. We were very fortunate to find a fantastic surgeon, and we also have a super vet who takes great care of Angus.

We found that nutrition has been essential in accelerating Angus’s healing, there is significant evidence to validate that a home cooked diet free of preservatives and by products accelerates healing. We have had Angus on a home cooked diet for six months now, and would encourage everyone to look into this, especially if you have a sick pup.

Educate yourself on everything related to the condition, it is much better to walk into meetings with your vet or surgeon equipped with knowledge of what they are going to discuss with you, and it is very empowering to be equipped with a list of questions, to ensure you are comfortable with what options are being offered for the health and comfort for your Airedale.

Below are just a few of the many resources we found useful during our research of Hip Dysplasia over the past 8 months, our only caution is that you dilute everything you read and look at the positives and the negatives of what you find side by side, as there are many contradiction out on the web.

http://www.offa.org/hipinfo.html

http://www.rimadyl.com/

http://www.deramaxx.com/home/

http://www.vmth.ucdavis.edu/vmth/clientinfo/info/saortho/fhofaq.shtml

 

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