Dublin is a sweet 16 week old Great Dane puppy, who presented to us with a history of 2 days with progressive lameness affecting multiple legs. The owners did not report any known trauma to Dublin and he had had no previous history of lameness. The owner had given Dublin an aspirin two days prior to presentation in an attempt to reduce his pain. He vomited blood and stopped eating the day before he was brought in for evaluation.
On physical exam Dublin was obviously painful. He could barely stand even with assistance. His gums were tacky revealing dehydration. He appeared to be painful in all 4 legs and we noticed some swelling near the wrists (carpi).
Dublin was not running a fever at the time of presentation. At this point, we considered a number of possible causes for Dublins pain and lameness. The first is a disease called Hypertrophic Osteodystrophy. This is a disease of young growing large breed dogs who become suddenly lame in one or more legs. Many of these dogs have moderate to high fevers. They are very painful as a rule and frequently will stop eating as a result of the pain.
The second possibility is a disease called Panosteitis. This is also a disease of young large breed dogs, however, it tends to affect the middle portion of the limb (diaphysis).
Finally, we considered polyarthritis which is a bacterial infection in multiple joints.
In order to determine what we were dealing with, we suggested running blood tests and taking radiographs of the limbs. Because of financial issues, we did not run any bloodwork, however, we did take radiographs of the forelimb.
Seen above, can see that the bones above the wrist are swollen and if you look closely where the two long bones appear to be separated (the growth plates) the area of bone above that looks moth eaten. These are classic signs of hypertrophic osteodystrophy.
In order to help Dublin, our first goal was to reduce his pain. We administered morphine derivatives and anti inflammatory drugs to ease his pain. We gave anti nausea drugs as well as stomach protectants to help deal with gastric bleeding. We place an IV catheter and administered fluids overnight to help with hydration By morning, Dublin was able to stand and walk with little difficulty. We discharged him to his owners later in the day with pain medications, stomach protectants and anti-nausea drugs.
Most dogs will get through hypertrophic osteodystrophy within 3-10 days, although it is possible for the damage done to the bone to lead to limb deformities such as bowing. Sometimes the symptoms will go away and return a few weeks later. We do not know what the cause of hypertrophic osteodystrophy is. Some people have tried to tie it to vitamin C deficiency, similar to human Scurvy. However, investigations failed to prove any link between vit C and the disease. Other studies suggest that it may be related to viral infections, however that too has not been proven conclusively. In some cases, dogs may end up with bacterial infections in the growth plates but this is not common and not universal.
Dublin is resting comfortably at home and we have him on a restricted exercise regimen to help minimize his pain and any damage to the bones. We will reintroduce exercise when he has been pain free for 2 weeks and then slowly bring back normal activity over 2 weeks.