New Breakthroughs In Treating Hip Dysplasia
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Dr. Wooten: Hi, everybody. I am here today with Dr. Matt Brunke, and he is here today to talk to you about the options that you have to help a dog that has hip dysplasia. If your dog has been diagnosed with hip dysplasia and surgery is not an option for you, this guy has some recommendations for you. He has a lot of letters after his name. He is a doctor of veterinary medicine. He is a CCRP, which is …
Dr. Brunke: I’m a certified rehabilitation practitioner. So I did extensive training in working in rehab.
Dr. Wooten: Okay. Then, you are a CVPP?
Dr. Brunke: So, then I wanted to figure out, it’s a certified veterinary pain practitioner. I deal with different aspects of pain, so what other options do we have?
Dr. Wooten: That’s awesome. And you are a CVA.
Dr. Brunke: I’m a certified veterinary acupuncturist.
Dr. Wooten: That’s awesome.
Dr. Brunke: In incorporate acupuncture and Chinese medicine into how we manage our patients.
Dr. Wooten: Lastly, you are a … Let me see if I get this right, a DACVSMR.
Dr. Brunke: That’s the big one. The specialty college for sports med and rehabilitation was only founded less than a decade ago. I just finished my advanced residency training and research paper, board exam, to finally pass all that, and I’ll be a diplomat in the specialty field of rehab.
Dr. Wooten: Congratulations.
Dr. Brunke: Thank you.
Dr. Wooten: So, we’re very lucky to have him here. All right. We’re talking about dogs that have hip dysplasia, where there is already arthritis. Maybe the dog is five years old. He comes in, and he comes to see you because surgery, for some reason, isn’t an option. The owner is like, “Doctor Brunke, what do I need to be doing to help this dog?”
Dr. Brunke: This is the whole multi-modal approach when we deal with arthritis because there is none-
Dr. Wooten: What is multi-modal?
Dr. Brunke: It means we’re going to attack it in different ways.
Dr. Wooten: Okay.
Dr. Brunke: There’s not a silver bullet here that’s going to magically solve this, okay?
Dr. Wooten: Yeah.
Dr. Brunke: No matter what the surgeons believe, even if we replace one hip, they still have an arthritic hip on the other side, so we have to work with those, right?
Dr. Wooten: Yes.
Dr. Brunke: We have to work as a team, and that’s surgeons … Surgery is an option, but when it’s not, it’s the rehab doctors, it’s the technicians, it’s the owners all trying to get to the same goal here.
Dr. Wooten: It’s a team approach that we take.
Dr. Brunke: It has to be a team approach.
Dr. Wooten: Okay.
Dr. Brunke: There’s no way to do it alone.
Dr. Wooten: Okay.
Dr. Brunke: Once we figure it out because we have to make sure we’ve got this, because there are a lot of owners who come in and say, “My dog has hip dysplasia.” I say, “I wasn’t born on Krypton. We have to get some x-rays and see if we’re right here.” Sometimes we have other things. We can have torn ACLs, we can have bad backs and suffused spinal arthritis. We can even have cancer that’ll mimic hip dysplasia, so we need to be sure of what we’re doing.
Dr. Brunke: Once we’ve got that, we have to make them more comfortable. The biggest problem is they’re in pain. They’re self-limiting, they’re not getting up, they’re not moving as well. They’re not interacting with their family as much as they should be, because they can’t go out and do things, so we have to get them comfortable. Once we get them comfortable, now how do we get them stronger? There is all these stages that we kind of go through a little bit, but we can’t do one until we put them all together.
(This is the special bed that vets are recommending to restore mobility in dogs with hip dysplasia and make them more comfortable)
Dr. Wooten: It’s making sure that we know what we’re dealing with. It controls the pain. Then, it’s … What’s the third step?
Dr. Brunke: Then, it’s how do we get them stronger?
Dr. Wooten: How do we get them stronger? So, diagnosis, pain control, and strength-building.
Dr. Brunke: Right. These guys’ll have limitations. If you think about it, a dog’s normal hip will extend out to where they’ll come out to almost parallel … Their femur will be parallel to the ground beneath if their hip works really well. Some of these dogs can’t bend past here, because they’re so painful and uncomfortable. Once we can work on that, we get our baseline of what they can do, and then we figure out, okay, can we work on stretching, can we work on massage a little bit? Can we get them involved with maybe some … Here’s a big word for you … Photobiomodulation?
Dr. Wooten: What is photobiomodulation?
Dr. Brunke: Let’s break it down.
Dr. Wooten: Okay.
Dr. Brunke: Photo, light. Bio, life. Modulation, changing. We’re going to use lasers, right?
Dr. Wooten: Cool.
Dr. Brunke: We’re not going to cut through stuff, but we’re going to use lasers to relieve pain, and to decrease inflammation in those arthritic joints so that we can then start to work on getting those hips to extend a little bit more, and that they’re more aware of what their body is in space.
Dr. Brunke: Then, as we start to do that we get them moving a little bit more each day. What we have to look at with these guys is, because we have an epidemic … Did you hear about the new epidemic that’s out there?
Dr. Wooten: No.
Dr. Brunke: There is an epidemic. 65% of dogs in the United States qualify as obese.
Dr. Wooten: No.
Dr. Brunke: Yeah.
Dr. Wooten: What?
Dr. Brunke: Two out of every three dogs.
Dr. Wooten: That is horrendous.
Dr. Brunke: That’s a lot. A lot of these dogs have arthritis because, depending on the study that we look at, anywhere from 20% to 50% of dogs in the US have arthritis.
Dr. Wooten: Wait, say that one more time.
Dr. Brunke: 20% to 50% of dogs, depending on which research study … We’re still learning … Have arthritis.
Dr. Wooten: Well, then there’s all the dogs that don’t go to the vet, so they’re not even diagnosed. There’s all those guys too.
Dr. Brunke: We have to work on these guys. The ones that have hip problems, we have to make sure that they stay lean.
Dr. Wooten: Okay.
Dr. Brunke: If they’re carrying extra weight, and you’re like, well, it’s only a 60-pound dog, it should weigh 50 pounds, take 10 pounds. Sometimes I put that on around the holidays. But, for a 60-pound dog, that’s the equivalent of you and I carrying an extra 40 to 60 pounds.
Dr. Wooten: That’s a good way to look at it. That’s a lot.
Dr. Brunke: It’s a lot. We have to get them cutting back on their calories, expending a little more energy and dropping some weight. Then, getting them to build some muscle, so that gravity’s not pulling them down.
Dr. Wooten: We’ve got the pain managed, they’re nice and thin, and now we want to build some muscle. What are some recommendations that you give to pet owners as far as building muscle?
Dr. Brunke: The biggest thing I look at is, get out, get a good leash. Nice, easy leash, not a Flexi, so they’re not all over the place and go start walking your dog every day. 15-20 minutes. Not stopping and sniffing, and talking to everybody on the street, but power walking. That’s going to have to be varied to the dog’s speed, depending on our height and our stride length, but it really has to be focused on the dog.
Dr. Brunke: If it’s a Chihuahua with hip dysplasia, is it a Newfoundland with hip dysplasia. We have to get out and we have to walk continuously so that we get our heart pumping, we lose a little bit of fat, we build a little bit of muscle, and we start working those muscles. But, every day they have to get out and do that.
Dr. Wooten: Okay, so that’s step number one. Step number two?
Dr. Brunke: That’s not always possible, right?
Dr. Wooten: No.
Dr. Brunke: Our schedules are busy. The good thing is, is that we have teams that can help. We can get these dogs in once a week, twice a week, maybe a little bit more to your local veterinary rehab team. We use things like lasers, we use things like Cavaletti Rails, where they have to step over and work on different joint motions, and we get them, not swimming, but we get them working out on an underwater treadmill.
Dr. Wooten: Very cool.
Dr. Brunke: These are pretty cool. They have them for people too. They even have them for horses, but they have them for dogs. We get to control all the factors, so it’s very safe. We control the water, the temperature of the water, and they go in, and their feet are always touching the ground. When they do that, when we have a hundred-pound dog, when the water brim comes up to the level of their hip, that hundred-pound dog, because of buoyancy, is almost like they weigh 38 pounds.
Dr. Wooten: That’s cool.
Dr. Brunke: If they’re obese, and they’re pulling down too much, and they’re painful in their joints, we’re going to make them float, but their feet are still touching the ground, and now we can walk and move them. There’s actually been really good published research on dogs with arthritis, getting them to move more comfortably, get dogs that are obese, get them to lose weight, by not having to fight gravity as much. That’s a good way to do this.
Dr. Wooten: That is a really cool option that we have now, that we didn’t actually used to have for our pets.
Dr. Brunke: No.
Dr. Wooten: If there was something that you wanted to tell a pet parent, what is the thing that is most exciting to you as far as advancements in canine rehabilitation when it comes to dogs that have arthritis?
Dr. Brunke: There’s not one sole thing. It’s really cool now that we have such great surgical options if we can do that, but when we can’t I like to do targeted therapy. I don’t want to affect the entire body …
Dr. Wooten: What is targeted therapy?
Dr. Brunke: Good point. Target means let’s just put it where we need it, and not throughout the whole body, okay?A lot of medications are very safe, but we have to be careful about them as we get into older patients that may have older livers or older kidneys that don’t work quite as well.
Dr. Wooten: You’re talking about the non-steroidal anti-inflammatories, correct?
Dr. Brunke: Talking about those, we may talk about even some other pain medications, but what if they only have two joints, out of all the joints in their body … Just those two hip joints are arthritic? Why put something into their whole body when I can put something directly into that problem area? The way we do that is with a sedated joint injection.
Dr. Brunke: We put them into a little bit of twilight, just make sure that they’re out cold.
Dr. Wooten: Just a little, just to take the edge off.
Dr. Brunke: As a day procedure. Make it nice and easy. We’re going to shave a spot over that hip joint, and I’m going to put a needle into that hip joint. I’m going to pull out all that old, cranky joint fluid that’s worn out and uncomfortable, and we can inject directly into that hip joint, things to make the pain go away. We’re not going to block it out, like with Novocaine, like when you go to the dentist, right?What we’re going to do is, we’re actually going to put in something that’s anti-inflammatory directly into that arthritic joint.
Dr. Wooten: Cool.
Dr. Brunke: The biggest ones we get to use now is the body’s own biological healing. We’ll either draw their own blood and inject what’s called platelet-rich plasma … We take out … If you think about blood, we’ll take out all the red blood cells, most of the white blood cells, and we’re left with just the platelets. Those are the body’s normal biologic anti-inflammatory factors. We put that right into that joint, and that joint instantly starts to feel better, and it’s a healthier environment for that joint.
Dr. Brunke: Then, in more severe cases, we can even put in stem cells, to help really … Not make brand-new cartilage. It’s not magic pixie dust, but we can really make that joint much more appealing to the body so it moves better, it’s better lubricated, and it’s not uncomfortable. That’s my biggest thing that we can work with now, but once we do that, we still get them back into rehab and get them moving and building muscle. It’s always a lifelong management with them. We don’t get to cure this.
Dr. Wooten: When it comes to managing hip dysplasia, there’s not just one thing. It’s not just, give them a pain pill and it’ll be okay. It’s a multi-modal approach.
Dr. Brunke: Learned the magic word today.
Dr. Wooten: I totally did.
Dr. Brunke: That is it.
Dr. Wooten: I did have a question about the platelet-rich plasma. How often are you seeing that you have to repeat the injections?
Dr. Brunke: It’s a really good question, and the thing is, we don’t exactly know yet, because we don’t take it as a cookbook statement, right? We have to tailor to the individual, and it depends on how severe the arthritis is, and what’s going on. For most of these dogs that have mild to moderate arthritis, we may do an injection, and that may last us six to nine months. We have some other dogs that we have to bolster that injection a month after the original, or maybe a month after that, and still get nine to twelve months.
Dr. Wooten: Okay.
Dr. Brunke: Why are the numbers so much all over the place? Because, we haven’t looked yet at just fat dogs with arthritis, we haven’t just looked at skinny dogs with arthritis. We haven’t looked at all these different factors, we kind of lump them together, so we don’t have a clear answer just yet, but that research is coming. We’ll get a better understanding as we go.
Dr. Wooten: Dr. Brunke is not only a doctor with many, many letters after his name, but he is also a pet parent.
Dr. Brunke: Absolutely.
Dr. Wooten: You want to tell us about your pet?
Dr. Brunke: I have two pets. I have two dogs, Penny and Adelaide. In my spare time, for my own balance and things that I like to do, I do silly things, like triathlon and marathon. Penny, who’s my four-year-old pit bull, does all my runs with me. She’s my crazy dog. I did the New York City marathon last year. She ran all my 20 and 23-mile training runs.
Dr. Wooten: Oh my gosh, that’s crazy.
Dr. Brunke: That’s my beast, that’s my crazy-athletic dog. Then, my other dog is a three-year-old Newfoundland named Adelaide. She’s a Landseer, so she’s kind of like an Oreo cookie, she’s black and white. The reason I got her was because she actually came to me as a patient at nine months of age because she wasn’t walking right.
Dr. Brunke: She was supposed to be a show dog, and a competition working dog in water retrieval and stuff. We actually diagnosed her with hip dysplasia so we couldn’t use her for breeding. We didn’t want to pass those genes along. That’s really important. We weren’t sure about her potential to be a working dog in water retrieval and those types of sports that they do, so I actually adopted her.
Dr. Brunke: I work with her all the time, so I live the life of hip dysplasia not only as a doctor but as a parent. Every day, even when I’m running, every day Ade, Penny and I walk anywhere form 20 to 45 minutes a day, six to seven days a week. When I’m traveling and lecturing, my dog walkers know that they have to do 20 to 45 minutes a day to get Ade up and moving, so we watched her very carefully.
Dr. Brunke: We actually did radiographs at nine months of age with that bad hip. I got her into a rehab program where we injected her joints, we were very aggressive. Not surgeries, never had a hip replacement, but we’ve worked a lot on keeping her lead, and keeping her active. She doesn’t take pain meds. She has them when we need them, but we’ve been able to really conservatively manage all of her things without having to have her take meds.
Dr. Brunke: She walks … Remember, if I walk a lot with her, she will cover about 20 to 30 miles of walking each week. We’ve hiked the Adirondacks up in New York, we’ve hiked in other areas, so she’s my active dog that we’ve been working all this time with. What I actually did with her … This is my, I don’t do this with my clients, but every year for her birthday, we re-sedate her.
Dr. Brunke: We have to sedate PennHIP, because they have to be perfectly still, and we get new x-rays. Every year, her PennHIP scores have not gotten worse, her laxity hasn’t gotten worse. It’s actually gotten a little bit better. She’s gotten a little bit tighter in her joints, and we just did her third PennHIP, because she just turned three, and three PennHIPs in a row, and there’s no signs of arthritis on any of her radiographs ever.
Dr. Brunke: I work a lot with her on making sure that she stays comfortable, that we do a lot of things. She’s a big Newfie, she’s almost 120 pounds, so I keep her lean. I actually keep her in a puppy cut coat, so she’s not in the big, full coat, because when I weighed her when she was in full coat, and then I had her groomed, she lost … How many pounds do you think she lost there when we went from a full coat to a puppy cut?
Dr. Wooten: Seven?
Dr. Brunke: Double it.
Dr. Wooten: 14 pounds of hair?
Dr. Brunke: Over 14 pounds of fur when we trimmed her down. She’s not bald…
Dr. Wooten: Oh, man.
Dr. Brunke: She’s in a puppy cut, so that’s a huge amount of weight that comes off of her body. She gets to lay around, she walks a lot, she comes back in. What’s been a big help for her is, she’s got a big, orthopedic bed. She has a Big Barker bed that she comes in and crashes out on, and relaxes, and then just puts her feet up and can come back, and she’s ready to go the next time.
(This is the special bed that Dr. Brunke is recommending to help dogs with hip dysplasia)
Dr. Brunke: She’s got a lot that we’ve worked with, but I’m really … It’s always a lifelong management with her. If she needs medication she’ll get them, and if she needs surgery she’ll get it. For right now we can work with so many different options. She’s my test subject a little bit on what we can use new and upcoming. How do we get her through that way?
Dr. Wooten: That’s awesome.
Dr. Brunke: It’s really a lot of fun.
Dr. Wooten: Do you think Big Barker beds, or the thick, orthopedic beds are a good idea for a dog that has hip dysplasia?
Dr. Brunke: You know, I think they are. Each dog’s going to be a little bit of an individual. There are some days … August is not always Ade’s favorite month unless the air conditioning’s on maximum, right?
Dr. Wooten: Yes.
Dr. Brunke: Some days she wants to lay on the cold floor, which I get. Some days she’s going to lay underneath, but what I did was, I moved her Big Barker bed underneath the AC vent, and then she just crashes out. I think that’s a lot of good chance to get their bones off … They’re not getting pressure on their joints, on their bones, and they’ve got something that’s comfortable for them to lay on. I think it’s a good thing to do.
Dr. Wooten: Well, thank you so much.
Dr. Brunke: Oh, it was my pleasure.