Need more vet advice, BSM & Rolfe?

[Disco]

I have an Akita, he's 145 lbs. & 3 yrs. old. We've known for quite awhile that his back knees are under quite a bit of stress and we have been giving him Glyco-flex tabs for about 18 months.

We took him for a vet check up last week. Our vet checked his standing posture, flexed his knees, and they popped very loudly as he manipulated them. I know that it's just the way he was born, and the Vet said to just keep an eye on him to see if he seems in any pain. He said they have ways to manage the pain if/when it comes. I plan to make sure that he stays at this weight.

Is there anything else I should be aware of? He's such a great dog, he has the best temper of any Akita I have ever known or owned. He loves to jump down our stairs; should I stop him from doing that? He also loves to jump & play in our backyard with our other Akita-is that okay?

I really appreciate any advice & insight you have about large breed dogs.

MHB

[Badly Shaved Monkey]

We've known for quite awhile that his back knees are under quite a bit of stress

What does that mean? It's a bit vague.

we have been giving him Glyco-flex tabs for about 18 months.

Probably harmless, but the jury is still out on whether such products do anything useful.

Is there anything else I should be aware of?

If he becomes consistently stiff on rising to his feet or specifically lame on one leg then begin to consider whether his hind limb joints are hurting him so that he might be more comfortable with the definitive pain relief of an NSAID (under veterinary supervision), but for now do nothing other than keep him slim and regularly exercised.

[John Bentley]

Wow!

Finally something I can talk about where I am actually an authority! I'm an orthopedic specialist in veterinary medicine, with an MS in small animal surgery, as well as other alphabetical encumbrances after my name, and have taught orthopedic surgery at a veterinary university for a few years before moving out and performing referral work for other vets in my local area. (It pays much better).

First - when you refer to your dog's "knees", that can mean different things to different people. Some people say knee when they mean hock (the joint just above the foot -- the dog's ankle).

Assuming you are truly referring to the dog's knee - the joint midway down his rear leg, between his hip and his ankle - then there are definitely several things you need to have checked out.

Akitas are prone to several rear leg lameness problems, some of which can be treated medically, and some of which require surgery rather quickly to prevent total degeneration of the joints involved. Considering your dog's age, I would be suspicious of several different scenarios, or a combination thereof:

1. Your dog may have ruptured one of the main stabilizing ligaments for the knee joint. The ligament is called the cranial cruciate ligament and its main job is to prevent the lower leg bone from jutting forward when weight is placed on the leg. It also prevents over-rotation of the knee. It is frequently injured in dogs when they are running along a fence, plant the leg firmly on the ground, and twist suddenly to start their run back up the fence line in the other direction. This is a devastating injury for the joint, and if not surgically stabilized, will lead to debilitating arthritis in a short period of time. Once one knee joint is unstable, the dog shifts more weight to the other side, thereby making it likely that the other knee will suffer the same fate. About 75% of dogs with uncorrected cruciate ligament injuries rupture the opposite side within a year. Determining whether this injury is present can be very difficult if the dog is very large and strong, or is very resistant to examination, and the dog may require sedation to be sure. If the injury is present, the dog's lower leg bone can be made to jut forward abnormally through certain manipulations of the knee.

2. The loud clicking heard when bending your dog's knee could be a sign of a "meniscal tear". The menisci are little cartilage cups that are positioned in the knee joint between the upper leg bone (femur) and the lower leg bone (tibia). The menisci are frequently torn as a result of abnormal sliding motion of the knee joint after a cranial cruciate tear. When the torn portion of the meniscus flaps back and forth during joint motion, a loud "click" is heard. This is not necessarily painful, so your dog may not react painfully during examination. The wonderful thing is that dogs can regrow the torn portion of the meniscus in most cases (people can't), but it requires removal of the torn portion, and the establishment of a blood supply channel from the side of the joint. This is usually done routinely at the time of stabilizing the primary ligament rupture. The menisci play a very important role in proper knee joint alignment and shock absorption, so the effort to restore them is worth the extra surgical trauma.

3. Most large breed dogs are prone to a developmental defect in the cartilage which causes pieces of the joint cartilage to die and break off inside the joint. This leaves defects in the joint surface, as well as free floating pieces of cartliage in the joint (called "joint mice"). Cartilage is transparent to X-rays, so the defects and the joint mice can sometimes be missed on routine x-ray views of the dog's knee. The joint surface can be "smoothed out" by drilling holes in the underlying bone and allowing blood vessels to gain access to the defect (cartilage itself has absolutely no blood supply - wierd, huh?). The joint mice are obviously removed surgically as well.

4. Akitas are particulary prone as a breed to a developmental problem whereby their kneecaps (patellas) do not "track" well in the knee joint. They tend to slide in and out of joint, causing a popping or clicking sound as they pop over the edge of the patellar groove. Over time, the abnormal position of the kneecap will cause deformation of the leg bones and misalignment of the knee joint - which in turn leads to arthritis in severe cases. Additionally, the constant sliding of the patella over the edge of the groove can wear the cartilage off the back of the patella and the ridge surface. Not only is this painful in itself, but the dying cartilage cells release chemicals that incite painful inflammatory responses in the joint capsule - arthritis - as well as causing futher death of more cartilage cells. Its sort of a "vicious cycle".

There are other possibilities that would lead to the symptoms you describe, but they are less common, and this post is probably already challenging your ability to stay awake.

Bottom line: I recommend your dog be examined by an orthopedic specialist to rule in/rule out the above conditions, just to make sure that you aren't ignoring a condition that could be better treated through surgery.

[Rolfe]

Hi John, I'm glad you're still here, I'd missed you.

Glad someone knows about all this, because despite my name being invoked in the thread title, as a clinical biochemist my only real piece of interesting information about Akitas is that they have unusually high intra-erythrocyte potassium concentrations for dogs, and so produce strange K⁺ artefacts if you're not careful with sample processing.

Completely useless in this context I'm afraid!

Rolfe.

[John Bentley]

Originally posted by Rolfe
Hi John, I'm glad you're still here, I'd missed you.


Always lurking, seldom heard.

[Soapy Sam]

Rolfe (on Akitas)-"...they have unusually high intra-erythrocyte potassium concentrations for dogs,..."


Why would that be, do you think? Environmental adaptation?

[MetalSeagull]

Originally posted by John Bentley


I'm an orthopedic specialist in veterinary medicine, with an MS in small animal surgery, as well as other alphabetical encumbrances after my name, and have taught orthopedic surgery at a veterinary university for a few years before moving out and performing referral work for other vets in my local area. (It pays much better).





I apologise if I'm highjacking the thread, but I have a question, if its not an imposition.


I have an Australian Shepherd who's 5 years old, about 40-45 pounds. She had a hip replacement last January. Since that time this foot has turned inward slightly, but otherwise has been ok. However, since the weather has cooled, I have noticed a stiffness in her gait, and a slight limp. Just tonight I was watching her walk, and noticed that this leg seems to be a bit shorter than her other legs (but it may just be the stiffness.)

Our vet told us arthritis was likely, but I don't remember hearing that it would set in so quickly. Is this likely arthritis? If so, is there anything we can give her to alleviate the pain or delay the worsening of symptoms?

[Disco]

Thanks to y'all for your replies!

BSM-Sorry for being so vague about his knees. I had the x-rays done on his first evaluation, and his hips were pretty good. That was my first concern, but one side is perfect & the other is just slightly out-of-joint. But, the vet watched him as he stood up & in the standing posture, and decided to x-ray his knees, too. They showed quite a bit of imflamation from stress. He stands straight-legged with no curve to his back legs at all. Kinda like when we lock our knees when standing for a long time. Sometimes, it looks like he's standing on tip-toes. Hence, the Glyco-flex.

I really appreciate your opinion on the meds-hubby & I don't see any drastic improvement w/ them, but I know they helped our last Akita who had bone spurs growing on her lower vertabrae later in life. I guess I'll keep up with them since he likes them as his evening "treat".

Rolfe-I don't know why I thought you were in vet medicine. But, I like what you wrote about the Akita adtifacts-I'm going to memorize what you wrote & repeat it to folks, just so they know how special my dogs are! BTW, is this why he loves bananas? :D :p

JB-you were just the person I was looking for! Thanks so much! Can I print out your response & show it to my vet? Now I just need to find a specialist like you in my area, which might be a tad difficult. Tehachapi is not near a major city in CA, but maybe I can find someone in Bakersfield or Lancaster.

Some questions for you. Should I try to stop him from his jumping down the stairs, or does he know when to quit? Do the x-rays from last year rule out any of the concerns you wrote about, since all they showed was equal imflamation on both knees? Should I get new x-rays or not, since he hasn't presented any new symptoms since last time?

I'm so glad I made contact with you and thank you so much for taking the time to write out such a detailed evaluation for me.

If you ever find yourself in the middle of nowhere that is called Tehachapi, please know you have a port to call home.

MHB

[John Bentley]

Originally posted by MetalSeagull
I apologise if I'm highjacking the thread, but I have a question, if its not an imposition.


I have an Australian Shepherd who's 5 years old, about 40-45 pounds. She had a hip replacement last January. Since that time this foot has turned inward slightly, but otherwise has been ok. However, since the weather has cooled, I have noticed a stiffness in her gait, and a slight limp. Just tonight I was watching her walk, and noticed that this leg seems to be a bit shorter than her other legs (but it may just be the stiffness.)

Our vet told us arthritis was likely, but I don't remember hearing that it would set in so quickly. Is this likely arthritis? If so, is there anything we can give her to alleviate the pain or delay the worsening of symptoms?

OK, first - why did your dog have hip surgery? I think you have misunderstood your vet's explanation of her surgery, or his explanation of why she might have problems, because the two don't match up. Let me explain.
The most common reason for hip replacement surgery in dogs is for chronic arthritis commonly known as hip dysplasia. The dog's normal hip joint is replaced with a plastic cup in the pelvis and a metal rod in the leg bone with a ball on the end of it that fits into the plastic cup just like the natural parts used to do. Since the joint has been completely replaced, there is no possibility of arthritis developing later. Arthritis is inflammation of the joint. The artificial joint cannot become inflamed, so arthritis is not possible. OK - technically that's not completely true, but close enough for our discussion. So, I'll need an accurate description of her original problem that led to her surgery, and an accurate name for the surgery she received before I can advise you on the possible complications and available remedies (if any).

[John Bentley]

Originally posted by ooh_child
Thanks to y'all for your replies!


JB-you were just the person I was looking for! Thanks so much! Can I print out your response & show it to my vet? Now I just need to find a specialist like you in my area, which might be a tad difficult. Tehachapi is not near a major city in CA, but maybe I can find someone in Bakersfield or Lancaster.
When I get a chance at the office, I have a list of all the specialists everywhere in the U.S. I'll find the closest one and let you know. You are welcome to print out my response if you think it will help.

Some questions for you. Should I try to stop him from his jumping down the stairs, or does he know when to quit? Do the x-rays from last year rule out any of the concerns you wrote about, since all they showed was equal imflamation on both knees? Should I get new x-rays or not, since he hasn't presented any new symptoms since last time?
I still want to know if we are discussing the same joint. When a dog stands abnormally straight legged (called post legged), the joint that is abnormally straight is the hock (ankle) joint most of the time, although the knee can be involved. That posture is common in Akitas, and can be a symptom of hip dysplasia. The dog can't flex and extend his hips because it hurts, so he overextends and overuses his hocks to (a) shift the weight more toward the front legs to relieve the effort and (b) make up for the lack of leg extension that he loses when he doesn't flex and extend his hips during walking and running. The abnormally straight hocks (ankles) can also be a symptom of that cartilage disease I was talking about. Especially if his hocks are swollen and knotty.
Finally, I'm not sure you understood your vet correctly when he said the x-rays showed inflammation. That would be very difficult to see on plain films (meaning no CT scans, dyes, etc.). Plain films are usually only good for bone diseases, or bone changes caused by other diseases. So I guess I would have to ask what exactly he said or meant before I could tell you any more.

[Disco]

Hey, JB (I love JB, that's my hubby's initials)!

It's definitely the knees. I saw the hip ball & socket (both sides) on the x-ray. One was perfectly seated, and the other was slightly displaced, but not even 50% out of socket. The knees were cloudy in the film, and the vet said that indicated inflammation.

His hocks are also pretty staight when he stands ( I just had him stand up for me) but they do flex somewhat in an 'L' shape when standing. Not so for his knees, his knees are always straight up & down, like when we lock our knees when standing. When he is really ready to move, he seems to be on his tip-toes, straight legged, ready to run. No sign of swollen or knotty ankles.

Thanks for any local sources you can give.

And to Metalseagull, keep up the good things you're doing for your dog. I'm so glad when owners take care of their animals & get the care that they need. I've seen so many pets neglected because their caretakers can't or won't be bothered.

MHB

[John Bentley]

Ooh_child,
Check your PM. Got a list for you, sort of.

[Rolfe]

Originally posted by ooh_child
Rolfe-I don't know why I thought you were in vet medicine. But, I like what you wrote about the Akita adtifacts-I'm going to memorize what you wrote & repeat it to folks, just so they know how special my dogs are! BTW, is this why he loves bananas? :D :p 'Cos I am a vet! (Just back from an alumni homecoming day at my college, and we sure all looked like vets to me....)

It's just that I specialise in laboratory medicine, especially clinical biochemistry (and a bit of haematology). I sit in a lab all day and look at numbers. That way I don't get bitten too often! So Akitas' knees are a bit of a closed book to me.

No idea why Akitas' potassium is like that. Sometimes things just are. But you have to be very careful before you pronounce that one of them has Adisson's disease.

Rolfe.

[Disco]

Originally posted by Rolfe
'Cos I am a vet! (Just back from an alumni homecoming day at my college, and we sure all looked like vets to me....)

It's just that I specialise in laboratory medicine, especially clinical biochemistry (and a bit of haematology). I sit in a lab all day and look at numbers. That way I don't get bitten too often! So Akitas' knees are a bit of a closed book to me.

No idea why Akitas' potassium is like that. Sometimes things just are. But you have to be very careful before you pronounce that one of them has Adisson's disease.

Rolfe.

Okay, good to know! BTW, what's the common characteristic for vet's appearances? More feline, canine, bovine or equine, or what? Umm, well, nevermind. ;)

MHB

[MetalSeagull]

Originally posted by John Bentley
OK, first - why did your dog have hip surgery? I think you have misunderstood your vet's explanation of her surgery, or his explanation of why she might have problems, because the two don't match up. Let me explain.
The most common reason for hip replacement surgery in dogs is for chronic arthritis commonly known as hip dysplasia. The dog's normal hip joint is replaced with a plastic cup in the pelvis and a metal rod in the leg bone with a ball on the end of it that fits into the plastic cup just like the natural parts used to do. Since the joint has been completely replaced, there is no possibility of arthritis developing later. Arthritis is inflammation of the joint. The artificial joint cannot become inflamed, so arthritis is not possible. OK - technically that's not completely true, but close enough for our discussion. So, I'll need an accurate description of her original problem that led to her surgery, and an accurate name for the surgery she received before I can advise you on the possible complications and available remedies (if any).



Well, its entirely possible that I'm remembering incorrectly, since it was a months-long ordeal.

Our pup's always had a bit of a hitch in her getalong. A little bunny hop she'd make every now and then when running. We never had her hips x-rayed because we noticed it when we had just adopted her (when she was somewhere between age 1 and 2.) The vet suggested we wait until she was definately 2 to x-ray. But he regularly manually manipulated her hips and did not note a problem. She seemed fine 99.9% of the time, so it just didn't get done.


Last November she jumped from the back of a stationary SUV and dislocated her left hip. My records show the following:

November 27- (closed) hip reduction, followed with time in a sling.
This didn't work. Her leg was out of the joint again at her next follow-up.

December 8- Open hip reduction, followed by a few weeks in a sling.
We were hopeful. It held for several days, then failed.

January 9- This was the hip replacement. Our dear, dear vet only charged us $140 for the surgical portion and so listed it as misc surgery/major. But I have what I believe is an estimate for this same surgery provided on 12/8, should it be needed. This estimate lists the surgery as Femoral Head Osteoctomy.



I'm not sure if its relevant, but after the repeated surgeries and failures, she was very slow to use her left hind leg. She was toe-touch only long past the typical time. I would estimate 4 months before she would take more than an occassional step. As a result, she had pronounced atrophy. The vet recommended swimming to build muscle and "force" her to use her leg, but we had nowhere to take her besides the ocean, which would have been too rough. It took 4 or 5 additional months for her to recover fully.

[John Bentley]

Originally posted by MetalSeagull
This estimate lists the surgery as Femoral Head Osteoctomy.

Aha! That's what I suspected, and now everything comes clear.I have an Australian Shepherd who's 5 years old, about 40-45 pounds. She had a hip replacement last January. Since that time this foot has turned inward slightly, but otherwise has been ok. However, since the weather has cooled, I have noticed a stiffness in her gait, and a slight limp. Just tonight I was watching her walk, and noticed that this leg seems to be a bit shorter than her other legs (but it may just be the stiffness.)
Now all these symptoms make sense. Your dog did not have a hip replacement. She had dislocated her hip from minor trauma. She also had symptoms such as "bunny-hopping" (putting both feet together and using them at the same time when running). Finally, she is an Australian Shepherd, which makes her an at-risk breed for (drum roll please) Hip Dysplasia! This is an inherited disease that causes malformation of the hip joints, leading to arthritis and dislocation of the joint. This would also explain the unsuccessful attempts at hip reduction. Dysplastic hips rarely stay in joint after luxation (popping out of joint) no matter what method is used to put them back in. Of course, even in the absence of dysplasia, only 60% or so of hips can be successfully put back in joint and not pop back out again.

Now, after the unsuccessful attempts to keep the hip in joint, your vet performed a femoral head ostectomy (FHO). I wish I could send you a picture, but I'm not sure how to do it. I'll try to explain without getting too lengthy. A normal hip joint consists of a ball on the upper end of the leg bone that fits into a socket or cup in the pelvis. It is held in place by a ligament that goes from the ball to the cup, and a bunch of very powerful muscles around the joint (the gluteals, or "butt" muscles, among others).

When the ball part of the joint pops out of the socket, it is obviously painful. If it can't be put back in place, then the cheapest, most practical way to allow the dog use of the leg is to perform an FHO. In this procedure, the ball part of the leg bone is cut off, along with the "neck" that attaches the ball to the leg bone. The leg bone is now "floating" inside the gluteal muscles, and the leg bone and the pelvis no longer contact each other. A false joint forms around the end of the leg bone, inside the gluteal muscles, and the dog can usually use the leg without much pain.

It sounds weird, I know, but your dog no longer has a hip joint at all! That is why the leg is rotated a little, and why the leg looks a little shorter. Because it is rotated and a little shorter. The leg is now attached to the body only with muscles, no bone contact at all. Now, even though this sounds drastic, it's not all that bad. A dog's front leg is constructed the same way. It has no bone connection to the rest of the body at all. It is held on only by muscles. (Your arm only has a collar bone that attaches it to the rest of the skeleton). The rear leg now works sort of like the front leg. It works surprisingly well, but the results are a little unpredictable, especially in dogs over 25 lbs. That is why it is considered a "salvage" procedure - something done as a last resort in order to give the dog use of the leg instead of amputation.

However, fear not, your dog does not have arthritis. He can't. He has no joint at all. The stiffness and muscle atrophy can sometimes be alleviated with some physical therapy. Make your dog lie down on his side, with the operated side up. Take his leg and rotate the hip joint as far forward, backward, and out to the side as he will tolerate, and hold it in each position for 10 to 15 seconds. Do this for about 10 to 15 minutes twice daily. This will help stretch out and loosen up the scar tissue that is restricting the motion of the false joint. You will also need to strengthen the gluteals. Swimming may help, but really, dogs use their front legs pretty much exclusively during swimming, unless they are retriever type dogs. It would be better to walk him a lot. At least twice daily for 20 to 30 minutes if you can. Go up as many steps as possible, as this forces the weight back on his rear legs. As a last resort, you can sling the other leg up and force him to use the FHO leg exclusively during walking.

Make sure you keep him on anti-inflammatory drugs during this time. You will find that he needs them less and less as his muscle mass and flexibility return. Need I say that he needs to be a skinny dog? The old saying in vet orthopedics is that dysplastic dogs need to be thin enough to make the neighbors talk about you. The less he weighs, the more comfortable he will be. I suspect the other hip is involved with dysplasia, and this could also be the reason for his reluctance to walk. All of the walking and weight loss will help with the other hip, as well.

Good luck. And hey, you'll be in great shape after exercising your dog so much.

Edited to add:
Read through my post and saw something that may be confusing. After the ball and neck of the leg bone are cut off, they are thrown away, not left in the muscles. Clear as mud? Darn, I wish I could send pictures. Somebody tell me how!

[MetalSeagull]

Thank you for the information. My husband, especially, will be relieved that it's not a case of joint pain. He adores that dog.


And now I understand why the vet said this operation couldn't be done on our other dog (a Newfoundland) should she turn out to have bad hips. That one will have x-rays done when she's two.

[materia3]

Originally posted by Rolfe
Hi John, I'm glad you're still here, I'd missed you.

Glad someone knows about all this, because despite my name being invoked in the thread title, as a clinical biochemist my only real piece of interesting information about Akitas is that they have unusually high intra-erythrocyte potassium concentrations for dogs, and so produce strange K⁺ artefacts if you're not careful with sample processing.

Completely useless in this context I'm afraid!

Rolfe.

Another disease in akitas to watch out for is VKH.

Vogt-Koyanagi-Harada-like Syndrome which also is seen in humans. A colleague recently had to have her 2-y.o. akita euthanized due to this.

It is interesting because it is a disease that occurs in a Japanese dog and mostly in Japanese people. Various theories abound concerning its cause but its likely genetic or there is a genetic prediposition if it is a virus which is anoher theory.

http://www.trigene.com.tw/dermato/vkh.htm