Clark, 14 Month Old Shepherd Mix With “Bad” Hips, Questions About Surgery

From the client:

You are so awesome!!! We took him to the vet yesterday and he gave me Rimadyl and Tramadol to help with pain and inflammation. I haven’t had him in for x-rays yet, would that be helpful for you? The vet said he didn’t see any signs of being hit by a car recently that would tell him that there was something broken. I was going to have him fixed this weekend, but I can wait if you think it would be best to see you first. You are worth every penny + some and I will be prepared to pay you for the time you spend with him. ;0) He is a shepherd mix about 14 months old. Just a baby with a sweet, sweet heart and a crappy start. Let me know if you want x-rays and if I should wait on having his boys removed and I can be available anytime Wednesday on next week.

Me:

I’ve been thinking about it, and I think it would be a good idea to get the manly-man surgery out of the way first.
When he gets pain meds for that, you may be able to see a difference in his demeanor or comfort, regarding his hips/legs, so take note of that.
Yes, and it may be hard to tell ;))
I can tell a lot without xrays, and often they get in the way in part of our brains regarding a better clinical evaluation. On the other hand, since he will be sedated, it will be a great time for x-rays, so go ahead if your vet is on board (which I’m pretty sure he will be!)
If he gets surgerized this weekend, I could see him next Thurs or Fri or when ever your schedule allows after that…
What do you think?
:)) Blessings-

Me, After Eval:

After our first evaluation, my bullet point recommendations were to

1) restrict and crate when caretakers not at home during the next 2 weeks.

2) Begin exercise protocol noted on my FHO homework, beginning with week 2, 2-4 x 10 min walks daily, very slowly (wedding march or “wagons ho” pace).

3) Use medications as per label, giving the Tramadol 30 minutes to 2 hrs. prior to walking if possible. Regarding your dosing question and the variability noted on the label, give the larger dose in the morning if you will be walking him in the morning, otherwise just give the smaller dose. Give the larger dose when you get home in the afternoon/evening, in prep for 1-2 evening walks. Give 2 hrs. rest period in-between walks (as per homework sheet).

4) Feed grain-free kibble (no barley or oats or rice, either, right now), Omega 3 in fish oil capsules as discussed, and joint formula that contains at least two of the following: glucosamine, chondroitin, msm. These are all proved anti-inflammatory measures.

Client:

(after having some problems with Clark, a rescue, and other dogs adjusting)

Hi!

We still have our friend. We made some adjustments and he seems to have settled a little bit. He has the sunroom to himself at night and during the day…we call it his puppy apartment. ;0) Everyone seems happy.
We took him off the Rymadal (SP?) because he was getting sick. And I’ve scaled back on the pain meds and give them when he is looking a little stiff. We are trying REALLY hard to stick to the directions, but I’m afraid it’s a modified version. He is still during the day and at night and we have shortened his time outside with the girls and I’ve been good at at least one walk a day…sometimes I get lucky and can get two. We will get it fine tuned…it’s just going to take a little time.
The vet is REALLY, REALLY pushing the surgery…I’m not doing Clark long term harm by not opting for surgery…right? You would think it by talking to him.

Anywho, thanks for checking in and the great direction. You idea to crate him at night helped everyone out!! ;0)

I will keep you posted on progress…just might be a little longer than 4 weeks.

Have a wonderful week!

Me:

Ok, so, I’m going to tie in our texts here and I think we should have a recheck to keep you guys on task…so that you see the improvements, and Clark improves, and others may see and reevaluate their insistance on surgery.

In Clark’s case, I don’t hear that anyone is concerned about gross malformation of the pelvis or a femur that is deformed beyond function, so there is no clinical reason to not employ muscle-building & joint strengthening techniques to appreciate improvement. The reports you have given me, verbal from the vet and the view of the x-rays, don’t indicate “horrible hips” and don’t indicate hips beyond the level at which others have improved without surgery. Clark is young. Perhaps your intervention staves off the need for surgery for the remainder of his life or perhaps it serves him well until he is older and then you may re-evaluate.

Usually in a case like this pain control plus the right type of exercise slowly improves the body and therefore the situation. Some dogs improve, some don’t. The ones that don’t usually have owners who don’t do much of the protocol. So, if they keep doing the same thing as before, they get the same result, yes? 

I don’t think you are in that catagory.

You guys represent a lot of families I see in my practice, in that you have two working adults, small child(ren), other dogs, etc…and several variations of this norm exist, of course. This family model is perfect for my home-based protocol because it only causes home-based disruption, in that you only have to sacrifice a little time, and my recommendations are based on 30+ years of my understanding of program design for improved function. You don’t have to load up Clark to go into a clinic in order to gain the best functional rehab for him in this case. This combo brings the biggest benefit, greater results, when all factors are weighed. And there is always the option to pay me to come do the exercise and drill work. 
I know you know that .

And of course my perspective is a little more broad than that of some practitioners, because I have seen a lot of what happens to a lot of animals in a wide variety of circumstances.

The most predominant point I make to clients is that the protocol does not get easier if the animal has surgery; in fact, it becomes an absolute necessity in order for the healing to occur and for the desired outcome from surgery. Without surgery, using my protocol, there is more room for letting something slip with less immediate ramifications, the main two of which post-surgically would be great damage to the surgery and money down the drain, since re-dos aren’t free (in most cases).

More than that is the additional stress and pain for the animal after surgery.

I am writing more here than need be to address you guys directly because I plan to share some of this discourse on my blog and giving more info helps a wider range of readers.

You said you stopped the Rimadyl because it was causing gastro distress…GOOD! And I presume from something you said in your texts that you let the vet know. You were not using the Tramadol as consistently, and I recommended you return to dosing as per the label for adequate pain control and especially since it’s all the pharmaceutical pain control you are using. Don’t forget the fish oil, grain-free food, and the glucosamine/chondroitin/msm…and I think you’re doing all that.

And you wondered if you were doing some sort of long-term harm by not having the hip surgery since the vet and staff seem so insistent on Clark having surgery. I covered this answer in part above. Additionally I will say that the exercise physiology and functional rehabilitation protocol I bring to veterinary rehab are not necessarily new to vet med, since race horses have been using protocol similar to that derived from human sport science for decades. These are, however, new concepts in small animal medicine, it seems, based on what I find is known and not known about standard principles of exercise physiology and return-to-function program design. I came into vet rehab at the end of 2004, after 25 years experience in human sport science and nutrition protocol. These principles I utilize and design programs around were novel where I began rehab practice, and I find the programs I have been designing for humans, based on much research performed by people living long before I came around, also are the most beneficial programs and protocol for other animals for pre-hab, re-hab, and instead-of-surgery in many cases.

There are some cases that really may need hip surgery, and when the clients have contacted me for pre or non-surgical intervention, at the very least we may say we are doing pre-hab. In the case of luxating hips, even though keeping the dog in a tight sling for weeks will/should work, as per science and experience, it seems almost impossible for most people to maintain the restrictions necessary for the sling to do its work. Disruption too soon=ligament laxity, again, and the ball of the femur keeps popping out. At any rate, it stands to reason that a body realising better function prior to surgery will improve easier post-surgically. That is also proved in research. Dynamic exercise improves every body system, from strengthening bones to improving the health of soft tissue and more.

I know for a fact, from years of study, evaluation, and observation, that cross-training rehab specialists in sport physiology and program design for dynamic function would elevate overall rehabilitation outcomes across the board. This has actually been an extreme discussion in Europe for the past yea-many years, that of the need for physiotherapists to have a deep(er) foundation in sports physiology and program design. I haven’t seen it hit here as forcefully yet (and we’re talking human medicine, which is paving the way in this arena). Europe is quite a bit more progressive regarding body wellness treatment and sport program design and a variety of similar topics, or so it seems.

Simply put, these exercises will not change noted gross malformations of the femur in an animal with hip problems, however, to note, any gravity-based exercise, weight-bearing exercise, will improve bone density, so changes along those lines will accrue. The same exercises will also improve muscle hypertrophy, which will, in turn, displace the femur away from the acetabulum and therefore reduce the pain element so often accompanying “bad” hips. These exercises, performed as per a program designed for Clark, should improve tendon, ligament, and muscle strength, muscle size, and neuro-muscular signaling, simply put.

Other beneficial things will happen as well, as always do with exercise of the right type for a particular body and situation. The changes I noted should improve his overall function. To my knowledge, the surgical protocol is to not operate on hips based solely on x-rays and is to operate based on severity of clinical signs. That is what the surgeons say whom I’ve heard, and that is what the literature says. Vet surgeons in other parts of the U.S. (other than where we are) often will not operate on dog hips without having the clients do 4-6 weeks of pre-hab first, with the intent of gaining owner compliance and improving the dog’s health, most especially in cases of obesity.

So, the catch here is to have enough of the right variety(ies) of pain control on board while the dog is performing the best exercises for his/her situation and thereby learning to use the affected limb more freely again. With that increased use come the improvements I mentioned. With the improvements comes the need for less medicine, since increased muscle mass and supportive tissue strength will better support the joint.

That’s all I have time for right now, and I think this will help you guys.

Blessings-

Bella, 5 yo Lab With Hip Dysplasia, No Surgery

Hi Deborah,

We were referred to you by Dr. Mxxx.  He believes you can help us with Bella, our 5 year old blonde lab who was diagnosed with Hip Dysplasia 2 years ago.  Since then, she has consistently been on Rimadyl. We visited Dr. X (a vet surgeon) and discussed surgery options.  At that time we opted for the routine and consistent Rimadyl therapy and to consider other options (hip replacement) for the future.

We were very intrigued and encouraged to receive your information from Dr. Mxxx as we would very much like to pursue alternative forms of therapy and conditioning to improve Bella’s current and future quality of life.

We would be most pleased if you could contact us at your earliest convenience to schedule a consultation to discuss our options.

Kindest Regards,
Art and Caryl
parents of Bella (Lab), Dakota (German Short-Haired Pointer), Raja (cat) and newest addition, Tucker (horse)

Hi, All!

Even though I left you guys with a written note card of things I wanted you to follow for Bella at the time of our in-person visit, here is also the aforementioned bullet point email summing up our discussion during our visit pertaining to Bella last Tuesday.

I am also sending a copy to Dr. Mxxx so he may be in our loop.

Thank you for inviting me to help with Bella’s quality of life, and I hope you find the protocol easy to manage. Text, call, or mail if you have any questions after having worked on the protocol the past couple of days.

1) Consider switching Bella to Wellness Core or another grain-free food. One reason for this change is to cut down on inflammation-causing agents in Bella’s lifestyle. All the dogs (and humans) I have dealt with have thrived when fed grain-free and a substantial diet using other nutrients. You indicated that Dr. Mxxx would be open to this suggestion.

2) Begin giving Bella ~500 mg EPA (and complementary DHA) in fish oil, using capsules, daily. I am not a fan of bottled oil due to potential for rancidity and potential for breaking up the fatty acid chains with shaking, which people tend to do with bottles of liquid. Long-term research evaluation has led me to understand that there are too many complications (rancidity, fragile fatty acid chain, heating of oil changes composition, etc…) when fish oil/omega 3’s are added to processed food sources. As well, I find fault with the research promoted by predominant dog food manufacturers, in that the therapeutic dosing for a dog Bella’s size may be found in 1-4 capsules of easily-obtainable fish oil, as opposed to the much higher number reported in the food company’s statements, either from a vet or from a “human” brand source. There are other major questions and loopholes regarding the research promoted by the dog food companies, and if the animal is to have the best opportunity to “fight” arthritis and thrive in other ways, then the choice of going grain free eradicates some of the popular food brands containing fish oil at the outset. The addition of fish oil and the elimination of grains has been proved in research over the years to be of much assistance to a variety of mammalian corporeal systems, if for no other reasons than that grains are pro-inflammatory and most mammals don’t digest them well, as well as most of us just don’t need all those starches…

3) Add a glucosamine/chondroitin/msm supplement to Bella’s daily routine…check with Dr. Mxxx to see if they carry one of the vet formulations. I recommend obtaining this from your vet or from a “human” brand source vs the products at the animal supply chain stores. You may check ConsumerLab.com or Labdoor.com if you are wary of some of the human brands or look for some of the brands I recommended that are available locally. I do not recommend a “dog” version other than the ones you may find available from your vet.

4) Continue Rimadyl and any other pain meds as scripted. Don’t forget to schedule bloodwork rechecks with the clinic while on the nsaid (Rimadyl).

5) Using my FHO homework, start Bella at week 2, 2-4 x 10 min walks daily, very, very slowly. Please read all the guidelines cited on the homework. 🙂

6) Go to my dog massage video under “Videos” on this website. Please watch it and follow the instructions, massaging Bella daily for 2 weeks.

7) We will recheck in 2 weeks to evaluate her homework performance and upgrade her homework and drills (hopefully).

Thank you, again!

Blessings!

Deborah

Border Collie-Golden Lameness After FHO in Mexico

Hi Deborah,

I came across your website after doing some research and I was hoping you could help me. I have a Border Collie-Golden mix, he is medium sized. He had FHO surgery on New Years and the discharge instructions from the vet were no heavy running but just to let him be himself, no rehab instructions or anything. I’m in Mexico and there are no rehab specialists in town, so internet research is all I have.

My dog was toe tapping the first week or so, but he has a really fast walking gait so he started cheating and keeping the leg up. Now, two months later, he is basically not using the leg at all. He sets it down when marking/peeing but you can tell all of the weight is on the front legs because half the time the rear just lifts completely while peeing. I also need to mention that he lives in a large backyard and he has always been a highly energetic dog.

I started this last week to do the rehab exercises since the vet seemed concerned my dog was not using the leg. I have followed them as best as I can but my dog seems not to trust his operated leg. I have tried to do the slow leash walks but he wont set his leg down. He is also reluctant to use it when I do the weight shifting exercises. I don´t know if this is just him getting used to being on 3 legs or if there were pain or discomfort.

All advice I have found is for immediately Post-op but how do you deal with a dog that is just starting Rehab 2 months after surgery?

Thanks for your time

Robert

Hi Robert-

It turns out that so many of the FHO rehab cases I see come about weeks and usually months after surgery. That surgery is one of the least-attended-to surgeries for post-op care and there seems to just be a lot of vague idea among vets regarding recovery after FHO.
The short answer for now is that 100% of the time the disuse I see soon after this surgery is due to pain. This pain can come from the femur scraping against the acetabulum or scraping against raw tissue, can come from tearing of newly-healed tissue, and can come from tearing of scar tissue, among other sources of pain.
I recommend you read my post about pain after CCL surgery and that you work on getting at least two analgesics into your dog just as if it were right after surgery.
There is likely a lot of the wrong type of scar tissue built up along with muscle atrophy and therefore not much muscle displacing the modified femur from the pelvic area.
Here in Austin, I’d talk with the vet about scripting an anti-inflammatory for 2-4 weeks in order to start walking drills successfully along with moderate-to-high doses of Tramadol for the same reason.
After the first 4 weeks of success, we’d at least continue the Tramadol for exercise success for another 4-6 weeks, reviewing response along the way.
See what headway you can make with that, and if you get the meds on board, barring another unforeseen issue, I can almost guarantee he will use the leg and then you may start at the beginning and achieve success.
If you cannot gain access to pain meds, for whatever reason, then you may resort to trying the vibrational massage (which I recommend anyway) as I have cited under ‘Videos” elsewhere on this site and use ice before and after the walks. Both of those interventions can go a long way to help with soft tissue pain. If acupuncture is available, you could gain some brief pain relief from that as well. There are a lot of “helps” for pain relief besides pharmaceuticals, and some of them are over the counter “natural” anti-inflammatories and supplements. Your pet may or may not be able to tolerate those, so please check with your vet or a veterinarian who is knowledgeable about those interventions. You really want to use oral analgesics as a tool and not just load your dog up on stuff 🙂
Blessings-
Deborah

FHO for Westie Going Well Now…

Fall, 2013
I went last week out to a veterinary clinic at a vet’s request to see a Westie that had hip surgery and whose leg was just dangling after about 2 weeks. The young dog has been diagnosed with Legg-Calve’ Perthes disease, and he has had an FHO surgery on one hip.
This is the text I got from the owner Saturday, three days later:
Hi, Deborah-
We are seeing good improvement in JJ. He’s standing on his leg at each meal and he has started to use it during our slow walks. He appears to be much happier-caught him smiling today! We haven’t completed all the walks you prescribed yet. Only 2 five min walks today. He’s keeping still most of the day. If not in his crate, he sleeps on the floor in my office or in our family room. We look forward to seeing you next week.
That’s great news, and we had an hour and a half appointment, in person, to ensure that the caretaker really understood what was going on and my instructions.
It also really, really helps that we have full support from the veterinarian, a young man who does a lot of surgery and with whom I have only worked infrequently. He became familiar with the type of exercise physiology-based rehab I promote and practice through injury during his own life adventures, and he seems to understand and embrace the concepts I talk about with him. He successfully uses a lot of these guidelines without my intervention, and I’m really glad to have been brought in on this case. I think together we’ll make a huge difference!
I’m soon to publish the guidelines for post-FHO surgery, but in the meantime, you will do well to begin by using the same guidelines I have already published for post-knee surgery. Here is a link to the Amazon page with the booklet, currently available in paperback or on Kindle:
Blessings-
Deborah

Zoe, Great Dane Hip Surgery; Setbacks, Exercise

Hi Deborah – Hoping you can give me some exercise and muscle building tips for our great dane Zoe. After her hip surgery to repair the right side femoral subluxation about 9 wks ago, she had a few setbacks, not able to tolerate many meds and attacked by a large dog which we think caused some soft tissue sprain/soreness. Consequently, she refused to use the leg, and now has some significant atrophy in her limb.

We finally got her to tolerate some Deramaxx and using heat, massage, and alternative remedies (herbs, acupuncture, laser), she is using the leg pretty normally now and is feeling MUCH better the last 2 weeks or so. She is up to 2-3 ten to fifteen minute walks a day. Time to try building up some muscle to even out her legs and hips. Any suggestions? Our rehab specialist here says we can start small slopes and cavalettis. Since you know Zoe well, what can you tell me about helping her build her strength and conditioning back up?

Thanks, and we miss you!!!

My Replies:

I know her and I know you guys, so I don’t mind being a little more specific on here for you…but I do wish I were there 🙂 I really am beginning to think about a trip…I know we have exchanged some texts and emails about her in the past few months…

Did you guys ever find my FHO homework and start on that fairly strictly, beginning at week one? I see that you are taking her on 2-3×15 min walks daily…how slowly? Wedding march or “wagons ho” is the speed I want to see, with consistent walking (no piddle & sniff) and consistent weight bearing. You may be doing that, in which case, I need to know if she seems more lame, lame at all, or not lame after those walks.

If she is not lame at all, then my preference is to advance to 2 weeks of 2×20 min walks before adding in hills. Let me know where you are on that. The most prevalent difference I find between what I say vs what people are having their dogs do is in the speed of the walk. The pain meds help encourage leg use and the slow speed forces individual limb use. She needs that individual leg use to encourage weight-bearing and healing. So, no sense moving on to hills if we cannot get 20 min of persistent, consistent leg use on the flats. Let me know about that and then we will talk about type and frequency of hills. Thanks for the great post!