hip arthritis

PennHIP Radiographs – improving hip dysplasia diagnosis

Posted on in Dog Hip Dysplasia, Radiographs Comments Off on PennHIP Radiographs – improving hip dysplasia diagnosis

Diagnosing Canine hip dysplasia using PennHIP

 

Canine hip dysplasia is a well recognized genetic condition in dogs that can cause hip arthritis, chronic pain, and sometimes requires surgery. Over the last fifty years, breed organizations and kennel clubs have attempted to remove the disease from the population through selective breeding. Despite this effort, little progress has been made. This may be in part due to the under utilization of the PennHIP radiographic technique.

Normal dog with hip joints PennHIP compressed

Normal dog with hip joints PennHIP compressed

 

 

OFA (Orthopedic Foundation for Animals) Radiographs

Selecting dogs that are considered “hip dysplasia free”, those considered unlikely to pass the condition onto their offspring, has largely been based on their OFA radiograph findings – by x-raying the appearance of the hips while the dog is lying on its back with its legs in full extension.  Unfortunately, research has shown that OFA radiographs are a poor test for screening against hip dysplasia.

OFA radiographs are a poor test because although they select for dogs with good hip conformation, they does not test for soft tissue laxity, a key component in the development of hip dysplasia. As a result, many dogs that pass their OFA radiographs have now been shown to have lax hips This is likely the reason that efforts to eliminate the disease have not worked. Research has found that breeding dogs with passing OFA radiographs results in hip dysplasia in anywhere from 19% to 73% of the offspring.

PennHIP (Pennsylvania Hip Improvement Program) Radiographs

PennHIP radiographic testing was introduced over 20 years ago, and tests both hip conformation (as does OFA) as well as tissue laxity. It is a more sensitive test than OFA radiographs, meaning that it will detect cases of hip dysplasia that otherwise would be missed. In order to breed hip dysplasia out of the gene pool, it is key that all dogs potentially carrying the condition are detected, and therefore the test needs to be as sensitive as possible.

 

Normal dog with hip joints PennHIP distracted - the joint space has been highlighted blue. Notice how little difference there is between the hip compression and distraction view. This indicates a stable hip joint.

Normal dog with hip joints PennHIP distracted – the joint space has been highlighted blue. Notice how little difference there is between the hip compression and distraction view. This indicates a stable hip joint.

Which is better?

Side by side comparison of OFA and PennHIP radiographs found that none of the dogs that failed their PennHIP radiographs, passed their OFA radiographs, but many dogs that passed their OFA radiographs, failed their PennHIP radiographs. In fact, two of the dogs with “excellent” OFA ratings had some of the worst PennHIP scores, indicating a high probability of developing hip arthritis secondary to tissue laxity later in life.

Another limitation of OFA radiographs is that scoring is based on subjective evaluation. This means that the same radiographs may get a different score depending on who is reviewing them, or even if the same radiologist reviews them on different days (with a different mood, fatigue level etc.). This problem is reduced with PennHIP radiographs because the results are based on measurements and the calculation of a distraction index, which is less likely to show variation between radiologists.

OFA radiographs require the dog to be at least 2 years of age before testing, whereas PennHIP radiographs have been shown to be accurate in predicting the onset of hip dysplasia as early as 4 months of age, allowing for earlier testing.

Conservative estimates based on mathematical models indicate that for a breeder of Labrador retrievers hoping to eliminate hip dysplasia from their line, using the PennHIP system will accomplish that goal 4 times faster than by relying on OFA radiographs.

Although some dogs receiving OFA radiographs may not need sedation, sedation is mandatory for PennHIP radiographs in order to relax the muscles enough to properly appreciate the degree of connective tissue laxity.

Hip dysplasia PennHIP compression view - notice how the dog's left hip joint space (right side of picture) has an irregular width

Hip dysplasia PennHIP compression view -notice how the dog’s left hip joint space (right side of picture) has an irregular width

 

Who should Consider PennHIP?

Any breeder who is serious about producing a line of dogs free from hip dysplasia should employ a PennHIP screening program. Pet owners and dog handlers who want to invest in a dog suited to an active life style, working, or competition, should also consider only purchasing PennHIP cleared dogs. Dogs can be tested for hip dysplasia using the PennHIP method as early as 4 months of age.

If you have any further questions about PennHIP testing in BC, please email info@pointseastwest.com

 

Hip dysplasia distraction view - notice how much wider the joint becomes once it is distracted, compared to the normal dog.

Hip dysplasia PennHIP distraction view – notice how much wider the joint becomes once it is distracted, compared to the normal dog.


Fecal Incontinence in Dogs

Posted on in Geriatric care, Non-surgical Therapy, Nutrition 82 Comments

Faecal Incontinence in Old Dogs

 

Incontinence in dogs: a common complaint I hear from the owners of old dogs is fecal incontinence – normal looking bowel movement or stool “accidents” that get left somewhere in the house by a dog who knows better, and who didn’t do it on purpose.  Often the owner finds them where the dog sleeps, or they see them come out when the dog first struggles to stand after a nap.  But is this really dog incontinence?

What Causes Incontinence in Dogs?

 

In most cases, this is not true incontinence.  True incontinence in dogs stems from a lack of anal sphincter control, and I think in most cases that is only a small part of the problem.

I know this picture has nothing to do with the article, but really... who wants to see a picture of a geriatric dog straining to defecate?

I know this picture has nothing to do with incontinence in dogs, but really… who wants to see a picture of a geriatric dog straining to defecate?

This problem seems to almost exclusively affect dogs with very weak or debilitated hind ends.  These dogs have difficulty standing, and most importantly, they have difficulty assuming a proper “defecation posture”. Although these dogs may have a weaker than normal sphincter, in most cases it is still strong enough to prevent incontinence as long as the colon is not overfull.

However, because these dogs lack the strength to comfortably squat and defecate, they do what I refer to as the “walk & drop” – rather than crouch, they keep stepping forward while defecating.

Presumably, because defecating is so awkward and potentially uncomfortable for these dogs, they never fully evacuate their colon; they seem to defecate just enough to relieve any immediate urge, but not much more.  As a result, they spend most of their day with a mostly full colon.

Sometimes this catches up with them when they sleep, when a mostly full colon becomes an over full colon.  Combine that with the reduced muscle tone of a deep sleep and suddenly you have the recipe for a soiled bed.  Alternatively, as they engage their abdominal muscles to stand, pressure in the abdomen increases, causing them to have an accident while first getting up from a nap.

 What can I do to help?

 

Sometimes increasing the amount of non-digestible fibre in the diet helps (1 ice cream scoop of canned pumpkin with each meal for a large sized dog).  There are prescription medications available that improve colon motility, but I’ve not found them particularly effective.  Giving plenty of opportunity to defecate outside before bedtime is definitely helpful.

Another random picture that has nothing to do with the article.

Another random picture that has nothing to do with incontinence in dogs.

The treatment with which I have seen the best results is to address the underlying lower back pain – increase the dog’s comfort and hind end strength so that it can hold a better defecation posture and therefore better evacuate its colon.  Using combined acupuncture and manual therapy (CAMT), as well as a comprehensive arthritis treatment protocol, yields the best results.  Manual therapy is an umbrella term for chiropractic and/or physiotherapy style adjustments and mobilizations, as well as massage techniques. This protocol has an excellent prognosis for improving quality of life, and in most cases reduced the number of “accidents” as well.

Having said that, by the time the dog is at the “walk & drop” stage, they are usually quite debilitated, and the more advanced a condition is, the harder it is to turn around.  But by being aware of earlier signs and responding when you first see them, the chance of preventing this problem in the first place is much better.

 Some of the more common earlier signs include:
  • Hesitation or reduced ability to jump up (e.g.: into the car)
  • Body shakes that don’t reach from head to tail
  • Stiffness or difficulty standing (e.g.: pulling from front legs instead of pushing from the back)
  • Fatiguing earlier on walks
  • Stumbling or scuffing hind feet
  • Altered head, back or tail posture

 

What about urinary incontinence?

 

Although that is a blog topic unto itself, lower back pain is a common cause of dogs leaking urine in their sleep. Treating that underlying pain often resolves urine leakage issues. Resolving back pain can be a effective treatment for both urinary and fecal incontinence, but is also an important goal unto itself.  Less pain is a good thing.


X-rays: Normal Hips vs Severe Dog Hip Dysplasia

Posted on in Case Reports, Dog Hip Dysplasia, Radiographs, Uncategorized 2 Comments

X-rays of Normal Dog Hip Joints

and those with Severe Dog Hip Dysplasia

 

Dog hip dysplasia is a malformation of the hip joint – instead of a nice round ball fitting smoothly into a deep socket, the joint contains a shallow socket and irregularly shaped ball.  These malformations cause uneven contact between the joint surfaces, as well as compromised stability.  Arthritis is an expected outcome from having dog hip dysplasia.

The root cause of dog hip dysplasia is genetic, but over feeding, and either over or under exercising can also contribute to its manifestation.  In cases of unilateral (one sided) dog hip dysplasia, one has to wonder if underlying sports injury causing muscle imbalances during the puppy’s crucial developmental period of life is playing a role.

Posted below are radiographs of normal and abnormal hips.  In an effort to highlight the relevant features, I have once again called upon my limited photoshop skills.
normal hips rads

 

This first x-ray is of a dog with normal hips.  The ball is round and fits well into a deep socket

 

 

 

normal hips rads graphics

 

 

 

Here is the same x-ray again, this time with fancy graphics.  The red line highlights the socket and the green line outlines the femoral head (ball) and neck.  Notice the hourglass appearance of the thin femoral neck.  The region of solid green colour represents the part of the femoral head that is buried within the socket.

 

 

Dog Hip Dysplasia

 

 

This is an x-ray of a dog that has severe hip dysplasia.  Notice the areas of roughened bone, with spurs off the top of the socket and extra calcified masses.  These regions of extra bone growth indicate degenerative arthritic change.  Both the ball and the socket are irregularly shaped and fit together poorly.  There is poor coverage of the femoral head.

 

 

Humphrey's hips graphics

 Here is the same x-ray again, this time with fancy graphics.  The femoral head and neck are outlined in green.  Notice how thickened this femoral neck is compared to the normal dog hip x-rays above.  The region of solid green colour reflects the amount of femoral head that is seated within the socket.  Notice how much flatter these femoral heads are, and how much poorer the amount of seating is on this x-ray compared to that of the normal dog hip x-ray.  The green or red circles with no colouring in the centre represent abnormal calcified masses.

 

Despite these horrific looking x-rays, with minimal treatment this dog is leading an active, pain free life, with only the occasional use of prescription medication.  He recently earned his CKC TD tracking title at 7 years of age.  His hips and low back are getting stronger with time.

severe hip dysplasia pre-op

 

 

 

This next x-ray shows such severe dog hip dysplasia that no fancy graphics are needed – the ball and socket are so poorly formed that they aren’t even touching.  Notice all regions of roughened bone that indicate advanced arthritis.  This dog is relying entirely on muscular support for these hips.

 

 

severe hip dysplasia post op

 

 

 

 

Here is the same patient again, this time after receiving total hip replacement surgery.

 

 

  

Although this case was clearly surgical, the vast majority of dog hip dysplasia cases can lead active happy lives with non-surgical therapy.  Key components of non-surgical therapy include:

  • Treat the inflamed joint itself using nutriceuticals (glucosamine, omega-3’s etc.), a structured exercise program to build hip strength and stability, manual therapy (e.g.: mobilizations), acupuncture, anti-inflammatories etc.

 

  • Address secondary sources of pain – myofascial trigger points, sacro-iliac and/or low back pain, pinched nerves etc. etc.  More often than not, it is these secondary sources of pain that are limiting the dog’s quality of life.  If anti-inflammatories aren’t making a huge improvement in comfort, then the likelihood of secondary pain arising from somewhere besides the hip joint is very very high.  Treating secondary sources of pain is as important as treating the hip joint itself.  Chiropractic adjustments and/or physiotherapy style mobilizations are the single most effective tool for treating secondary muscle pain, pinched nerves, reduced mobility etc.

 

  • Keep the rest of the body as fit, strong, and comfortable as possible so that it can better compensate for the poor hips.

 

With the above treatment, most dogs with hip dysplasia can lead active comfortable lives without the need for surgery. If you would like to learn about dog hip dysplasia, click here.