Hip Dysplasia Webinar

TRANSCRIPT

Dr. Sarah Wooten, DVM: Hip dysplasia. Those two little words can strike fear into any dog owner, but I'm here to give you hope and lots of it. If your dog has hip dysplasia, or you think they do, well, I have good news. There are five easy things you can do to help ease your dog's pain today.

My name is Dr. Sarah Wooten, and for 16 years, I've been a vet in small animal practice here in Greeley, Colorado. During that time, I've learned so much about how to quickly and easily help ease the pain of dogs with hip dysplasia.

And now I want you to know what I know so the dog you love doesn't have to needlessly suffer. That's why I'm holding a special web event, where I'm going to outline what I call the COMFY protocol of care.

This simple protocol will help reduce the likelihood that hip dysplasia stops your dog from enjoying life by your side. I'll share what supplements and medications can help, how to best cushion and protect your dog's joints, what types of exercises are safe and much, much more.

Let me share why, when it comes to hip dysplasia, there is hope.

Hip Dysplasia? There Is Hope.

That's why I'm holding a special web event, where I'm going to outline what I call the COMFY protocol of care. This simple protocol will help reduce the likelihood that hip dysplasia stops your dog from enjoying life by your side. I'll share what supplements and medications can help, how to best cushion and protect your dog's joints, what types of exercises are safe and much, much more. Let me share why, when it comes to hip dysplasia, there is hope.

Hi, there. Thank you for joining my webinar. If you are watching this webinar, then chances are you or a loved one has a dog with hip dysplasia, and you are looking for solutions that really work. If you are searching for answers, then you are not alone. Many people search the internet every day looking for answers to help their best fur friend, which is why I created this webinar, entitled Help! My Dog has Hip Dysplasia, because if you are here, then you need some help.

In this program, I have created a simple, five-step protocol that is guaranteed to help most dogs that have this unfortunate disease. My approach is multimodal, which is just fancy doctor-speak for uses several different modes of activity to help your pet. So let's get started. First off, I would like to introduce me to you. I am a small animal veterinarian, and a 2002 graduate from the prestigious University of California at Davis School of Veterinary Medicine. I have over 16 years in clinical practice. I am also a certified veterinary journalist. You may have seen my work in animal health magazines or online, at vetstreet.com, petmd.com, chewy.com, dvm360.com, or elsewhere. I write for many publications, and I speak nationally to veterinary audiences. And I spend a lot of time with veterinary experts from all topics, including orthopedics.

I have helped many dogs cope with hip dysplasia, and I'm here to share what I know with you. Also important, I'm not only a veterinarian. I am also a pet parent. This is my goldendoodle, Alma. In the next 20 minutes or so, I am going to share a wealth of knowledge with you. Make sure to have a pen and paper ready, and/or take screenshots of the slides as they go by, because you are going to want to retain this material.

Hip Dysplasia And How It Affects Your Dog

I will give you a basic explanation of hip dysplasia and how it affects your dog. We're going to go over the hidden costs of hip dysplasia that you may not be aware of, and then I will share my five-step protocol with you that will help any dog with hip dysplasia improve. Before we dive in, the law says I have to display this slide. 

Since you are not technically my patient, and I have never seen your dog, I cannot diagnose or prescribe anything for your dog. This webinar is not a substitute for professional veterinary care, and is for educational purposes only. You assume full responsibility for how you choose to use this information. Always seek the advice of your veterinarian before starting any new treatment or discontinuing an existing treatment. Talk with your veterinarian about any questions you may have regarding hip dysplasia. Nothing contained in this webinar is intended to be used for medical diagnosis or treatment. Never disregard professional veterinary advice or delay seeking it because of something learned on this webinar. All good? Okay, let's go.

What Is Hip Dysplasia?

Let's start with what hip dysplasia is. A dog's hip joint is a ball-and-socket joint. Here is a normal hip, with a smooth, well-aligned ball-and-socket joint. Do you see? There's two of them down there, on either side of those tailbones, with the long leg bones coming out and headed towards the bottom of the slide.

Hip dysplasia, in dogs, is a disease of the hip joint in which the ball-and-socket joint is malformed. When the ball-and-socket are malformed, then the ball portion and its socket align incorrectly. In severe cases, the ball, which is the head of the femur, which is your long, big leg bone, can subluxate and pop out.

In most other cases, this misalignment results in a joint that rubs abnormally, grinding away cartilage, creating arthritis and pain. Here are some really bad hips, as we call them in veterinary medicine. The joints are misshapen and arthritic, and the cartilage is worn away, creating bone-on-bone rubbing. Ouch! These kinds of changes take time and would be seen later in the disease in an older dog. Hip dysplasia is usually present at birth, but dogs may not manifest clinical signs for years, depending on how severe the problem is and how their pain tolerance is. I've seen labs before, in severe pain from hips that look like this, and they're still trying to chase a ball.

What Causes Hip Dysplasia?

Well, the cause of hip dysplasia is multifactorial. That means that there are several causative factors. Genetics play a role, as well as nutrition and exercise. Researchers are also hard at work determining if early spay/neuter is a cause. It's unfortunately one of the most common skeletal disorders seen in dogs, and in big dogs, hip dysplasia is a big problem. Some breeds, including great Danes, St. Bernards, Labrador retrievers and golden retrievers, and German shepherds, and Rottweilers are more predisposed to developing hip dysplasia. Small breed dogs can also be affected but are less likely to show clinical signs.

What Does Hip Dysplasia Look Like?

I've included a couple of videos of dogs with hip dysplasia to show you how this disease can manifest. The husky in this video has a stiff, stilted hind limb gait, and bunny hops when he moves faster than a slow walk. Two poodle crosses are in this video. The dog with hip dysplasia is dragging behind his walker and the other dog. Notice also how his tail is tucked. This dog is in pain. This video is of a Labrador retriever with severe hip dysplasia. Notice how his back-end sways like Marilyn Monroe. This is a telltale sign of hip dysplasia. These three dogs only showed some of the signs associated with hip dysplasia.

Additional signs can include difficulty or reluctance to get up, to jump, to run, or to climb stairs. Limping is a sign. If your dog has wimpy, thin hindlimb muscles that are atrophied from lack of use, or you notice your dog pulls himself up with his front legs, then hip dysplasia is often present. We already saw bunny hopping and swaying, but subtle signs like slowing down, excessive sleeping, or increased irritability can all be hidden signs of hip dysplasia wreaking havoc under the hood.

The Hidden Costs of Hip Dysplasia

The costs of hip dysplasia add up over time, and many pet owners are surprised to learn how much hip dysplasia is costing them. If you have a dog with hip dysplasia, then you are likely spending $1,200 a year or more for pain medication. You are spending $150 to $600 a year for veterinary exam fees. You could be spending $500 to $1,000 a year in rehabilitation, alternative therapy, or physical therapy, and if you pursue surgery, you could spend upwards of $1,700 to $12,000 in surgery, depending on the type of surgery performed. In cases where a dog is in severe pain or cannot get up or walk anymore, owners are often forced to make the hardest decision for any pet parents: humane euthanasia, which has costs of its own. And if a pet parent loses their dog to hip dysplasia, then there are all the costs of acquiring a new dog, from the purchase price of a puppy to vaccinations, dewormings, fecal exams, trainings, spay/neuter surgery, and on and on. 

When I added up all the costs, I was shocked. If your dog has been diagnosed with hip dysplasia, you could be looking at $2,000 to $15,000 in costs of care. Then there are all the intangible, unmeasurable costs of hip dysplasia. A dog that has been diagnosed with hip dysplasia often has a lower quality of life than a dog with normal hips, and if the hip dysplasia causes pain and difficulty getting up, then the dog's lifespan is often ended early with humane euthanasia. The psychological distress that this can cause a pet parent is real. I have seen it, and a pet parent that is caring for a chronically ill or debilitated pet has caregiver burden that can be comparable to caring for a sick or elderly human relative.

The struggle is real, folks. At this point in the webinar, you are probably asking yourself, why did I sign up for this? Is my dog doomed? Does this doctor have any good news? Well, rest assured, I do.

Hip Dysplasia Is Not A Death Sentence

A diagnosis of hip dysplasia is not a death sentence for any dog. There are many things you can do at home that will bring relief and increase the quality of life for your furry friend, so take heart. I have designed a simple program to help reduce pain and suffering in dogs with hip dysplasia, and it doesn't include surgery. I have seen pet parents follow my instructions over and over again, with amazing results. Not every dog with hip dysplasia is a good candidate for my protocol. Puppies who can have corrective surgery early are not good candidates for my program, because having surgery gives them the chance for a cure. My protocol is really best suited for dogs with hip dysplasia that aren't good candidates for surgery due to advanced age or other concurrent diseases. Sometimes, affording surgery isn't in the cards either. My protocol, in these cases, can help dogs that need surgery but owners can't afford it at that time. 

My protocol is also beneficial to dogs that will receive hip surgery in the future. In these cases, my protocol could be considered prehab, because you are starting to implement changes before surgery occurs. Prehab is important, because it gets dogs into the best shape possible for surgery, which improves the surgical outcome. If you are going to invest in surgery, then you want a good outcome. The most exciting result of my protocol is, sometimes, dogs with hip dysplasia improve so much after following it that even though the owner scheduled surgery, the dog ended up not needing surgery. Those are the best-case scenarios, and if you follow this protocol of care, then that could happen for your dog as well.

So, before I share my protocol, I want to remind you again, this webinar is not a substitute for professional veterinary care. It is intended for educational purposes and all of my advice should be administered under the care of a veterinarian. Everything I am about to share with you is exactly what I would say to a client who has paid me for a consultation, so, in essence, I am giving you $50 to $75 worth of veterinary advice absolutely free. I feel that the more people that have this knowledge, the more we will be empowered to actually help these dogs.

The COMFY Protocol Of Care

So without further ado, here is my COMFY protocol of care. COMFY was the perfect acronym, because it describes how we want our dogs to feel after following it. All five steps are important, so don't skip any.

C - Control The Pain

The first step is C, control the pain. Without controlling pain first, it will be difficult to follow the other steps of the protocol. A painful dog won't want to move, and movement is critical to my protocol. If you are going to control pain, then you must know the signs of pain in your dog so that you can tell when he hurts and when he feels good. We already discussed some of these signs of pain earlier, but it pays to educate yourself on the subtler signs of pain, so you can intervene early.

A simple Google search on signs of pain in dogs will bring up several educational websites where you can learn more. If your dog is painful, then you are going to need pain medication, at least at the start. I always start my patients on pain medication, and then, as they work through the protocol, owners will find that they can reduce dosages and, in some cases, eliminate the need for pain medications altogether. Carprofen is the most common pain medication prescribed in dogs. It comes under the brand name Rimadyl, but there are many generic formulations available online for less money. Galliprant is another medication. It's new, and it is available. It's supposed to specifically target inflammation associated with joint pain. It is not generic, but one benefit of Galliprant is it doesn't require annual blood work monitoring, which is required if you give Rimadyl or carprofen consistently. Deramaxx is another nonsteroidal anti inflammatory that is available, but I prescribe that one a lot less often. I usually will give that one to patients that can't tolerate Rimadyl. Some dogs have neuromuscular pain that is associated with hip dysplasia, and, for these dogs, gabapentin can be beneficial. It is a muscle relaxant, and it can cause sedation, which can make it a nice edition at night to help your dog sleep better. Tramadol doesn't work for arthritis pain. A study published this year in the Journal of the American Veterinary Medical Association showed that it doesn't work, so I advise my clients to stop giving it for arthritis pain.

A new, exciting alternative pain medication that is getting a lot of attention is CBD oil from industrial hemp. A study this year, out of Cornell, on Ellevet CBD oil showed that twice daily dosage of two milligrams per kilogram of CBD oil reduced pain in dogs with osteoarthritis. That is great news! I have patients that have been able to stop their prescription pain meds after using CBD oil. The products I recommend are made by Cannapet, Ellevet, and Phytovet. You can buy any of these products online. In addition to prescription pain meds and CBD oil, there are a wealth of other alternative therapies that help dogs with hip pain.

Acupuncture provides temporary relief, as does photobiomodulation, which is a fancy new way of saying therapeutic laser treatment. TENS therapy, which is transcutaneous electrical nerve stimulation, helps, as well as massage and traditional ice and heat. The picture to the right is a dog receiving photobiomodulation therapy, which I recommend to my clients all the time. Dogs love the treatment. It feels good. It is relatively inexpensive, and if you are diligent about getting the treatments as recommended on the veterinarian schedule, dogs can often decrease or discontinue pain medication altogether. I had a patient that had a terrible back, hip, and knee arthritis. The owners elected to start laser therapy, and they were shocked at how much the dog improved over time. With pain control, it isn't one-size-fits-all. What might work for one dog may not work at all for another dog. You have to have some trial and error to get it right, but your first step in the COMFY protocol is the most important: control the pain.

O - Orthopedic Mattress

The second step in my protocol is O, for orthopedic mattress, or supportive sleeping surface. There are several studies in humans that speak to the benefit of a good night's sleep on a good mattress. Even though studies are lacking in veterinary medicine, we can definitely take some liberty here and draw some parallels. We all know how we feel in the morning after sleeping on a bad mattress or on the floor. Everything hurts. It is the same for our dogs. During sleep periods, neuromuscular activity is at a minimum level. The major factor influencing the forces on the body, and particularly the spine and the joints, is gravity. The force of gravity is sufficient to deform soft tissues when the body is resting on a mattress.

An orthopedic mattress can counteract the effect of gravity on your dog's body and improve sleep. An extra thick mattress raises the surface, making it easier for a dog to get up and down and also cushions arthritic joints away from the floor. This is all important. These pictures are pressure map studies done by Big Barker on different mattresses. Red areas are where the pressure is greatest. The bed to the far right was a standard polyfill bed, like the one in the photo. Notice all the red areas where joints are pressing against a hard floor. The middle picture is a four-inch memory foam mattress. Notice there, even though there is less red areas than the polyfill bed, there are still pressure points registering. The picture on the far left is a six-inch Big Barker bed. Notice, no red areas. All joints are cushioned away from the floor, which is what you are looking for.

If my word is not enough, then consider these opinions. Canine rehab specialist, Dr. Matt Brunke, uses a Big Barker bed for his dog, Adelaide, a Newfoundland with hip dysplasia, and finds that Big Barker beds cushion her joints and gets them off the floor. World famous pain specialist, Dr. Robin Downing, recommends Big Barker beds to her clients with dogs that have joint pain, and her own dogs share a Big Barker bed. Dr. David Dycus is a board-certified orthopedic specialist. His cocker spaniel sleeps on a Big Barker bed. His cocker spaniel has arthritis in both knees, and on the bed, he rests better. Dr. Dycus is also a firm believer in getting dog joints up off the floor.

A supportive sleeping surface is so important to care of a dog with joint dysplasia, which is why it is included in my protocol. Big Barker beds are my favorite, and I recommend them to my clients without hesitation. 

M - Manage Calories

The next step in the COMFY protocol is M, manage calories. An estimated 56% of dogs in the United States are overweight or obese. So many are fat that fat dogs are now being considered the new norm, and it's only when you put two dogs from the same breed together side by side that you can clearly see that we have a problem.

Obesity causes multiple risks to good health, including chronic inflammation, metabolic and endocrine disorders, joint disorders, kidney dysfunction, breathing problems, and reduced quantity and quality of life. In 2001, a team of scientists from Purina Pet Care and several US veterinary colleges completed a diet restriction study in dogs, the first to encompass the entire lifespan of a mammal larger than a rodent. In this 14-year study commonly referred to as the Purina Lifespan Study, 48 Labrador retriever puppies from seven litters were paired by weight and sex. One dog in each pair was fed at maintenance and the other was fed 25% fewer calories. That was the lean-fed dog. The study found that dogs maintained in a lean body condition had a lower incidence of and less severe arthritis at eight years of age. By the end of the study, 43 of the 48 dogs had developed arthritis. But the mean age when half of the control dogs required long-term treatment for arthritis was way younger than that of the lean-fed dogs, showing that lean dogs take longer to develop signs of pain from osteoarthritis.

Managing your dog's caloric intake is as important as controlling pain. If you hope to avoid surgery or get the best result from surgery, then you need to manage calories and get your dog into a lean body condition. This chart from Purina is a visual way to determine your dog's body condition. Your goal is a body condition score of four off of this chart, somewhere in between a three and a five. Another way to judge your dog's body condition is to use the hand test. Have your dog stand and feel his ribs. If they feel like the back of your hand, you're good. If they feel or look like your knuckles, too thin. Feel or look like your palm, too heavy. In order to reach or maintain your dog's ideal weight, you will need to know how many calories total your dog is supposed to eat each day and an ideal weight for your dog. Your veterinarian can calculate this for you, or you can visit petnutritionalliance.org. They have an excellent calorie calculator that is free for you to use.

If your dog is overweight, if you stay within the daily calorie restriction and add in some exercise, then you should be able to reach your dog's ideal weight goal in three to six months. If you aren't getting anywhere on the diet after a month, schedule a veterinary visit to run lab work. Sometimes, there are underlying hormonal or metabolic problems that need to be addressed in order for the weight loss to occur.

F - Fitness

The next step in the COMFY protocol is F, for fitness. Movement is critical for dogs with hip dysplasia. Movement lubricates the joints, builds strength and flexibility, and improves metabolism and mood. The best kind of exercises for dogs with hip dysplasia are low impact, walking or swimming. Soft, uneven surfaces like a simple walk in the park are the best. There are also some rehabilitation exercises that are specifically beneficial to dogs with hip dysplasia. The first is the sit stand. Stand in front of your dog and ask her to sit. Then move back and ask her to come, and then sit. Reward with a treat, and repeat 10 times, three times per day. Here it is in video form. Sit. Good girl. Good girl. Come here. Sit. Good girl. Come here. The second easy rehab exercise is a ladder walk, which can benefit strength building and tactile placing. Simply train your dog to walk through a ladder 10 times in a row, and repeat three times a day. Here it is in video form.

Y - Yes to Supplements

The last step in the COMFY protocol is Y, which is yes to supplements. Supplements help promote joint health, and some can reduce inflammation. Here is a list of joint supplements that I regularly recommend to my clients, including dosages, so I'll give you a second to take a screenshot.

A couple of tips. Make sure that you are giving glucosamine hydrochloride and not glucosamine sulfate, as glucosamine hydrochloride is more bioavailable to dogs. Omega-3 fatty acids, EPA, and DHA are best from fish or krill oil, as dogs have to convert ALA from flaxseed oil, and it isn't highly bioavailable. Think fish oil and krill oil, not flaxseed oil, when it comes to supplementing omega-3 fatty acids in dogs. Make sure the fish oil is fresh, and keep it in the freezer, as it is sensitive to heat, light, and oxygen.

A couple of more tips. Read labels and separate nutrition information from marketing. I always recommend running the supplement by your veterinarian. Start supplements early, as they work best when there is healthy cartilage, but not too early. There is a picture of a puppy here to remind you to wait until big dogs are at least one year of age and done growing before starting any sort of nutritional supplement. Supplements work best if they are given continually, and don't fall for fads or hype. You may have heard about something like deer antlers or other fad ideas, but stick with supplements that have science to back them up.

So there you have it, the COMFY protocol of care for dogs with hip dysplasia. Control the pain, provide an orthopedic mattress, manage calories, engage in fitness, and say yes to supplements to give your dog the best chance at living the good life.