24. Subluxation hip Golden Retriever puppy 4.5 months

Case 1:
Danish lady in her 30s with mum.
Purchased from the same pet shop.
Golden Retriever 3 months.
Consultation: Came for 3rd vaccination. Puppy purchased 1 month ago.
Housing: A house with a small garden
Feeding: 2 times per day as advised by the seller. Wolfs down food fast.

This case was a lot of fun for the mum. Every time Alice, a 4th year vet student put the puppy onto the electronic weighing scale, he dashed off the scales elsewhere. Alice had to catch him again. She placed him on the scale. Before she could read the weight, the puppy sprinted off making the mum laugh. Alice and I looked serious as such incidents happen with other puppies too.


Toilet Training: Newspapers 100% covering playpen. Then reduce the covered area as advised by the pet shop puppy seller.
"What happened during the first 7 days?" I asked. "Did he poo and pee onto the newspapers?"

"The puppy was confused and did it everywhere inside the playpen. After 5 days, the puppy now eliminates onto newspapers in a separate half of the playpen.

"How did you train him to do it?" I asked.
"Lots of praises. Praise him and give treats when he eliminates on the newspapers." Successful paper-training due to hard work and training.

Question 1: When can the puppy go out to the grass to eliminate? The owner did not want the puppy to do it in the small garden.
The seller had advised going out till after the 3rd vaccination to prevent parvoviral infections.
The puppy can go out to places where there are no dogs or puppies e.g. pet shops, dog runs, boarding houses 2 weeks after the 2nd vaccination. However, 2 weeks after the 3rd vaccination, the puppy can mix with other dogs as he has full protection against the lethal parvoviral and distemper viruses.
"Put the newspapers with urine smell onto the grass outside, so that the puppy will commence eliminating outdoors," I advise. "It is a good idea," the owner said.  

Question 2: When does my puppy get his heartworm vaccination and does he need one?
It is best to protect him against heartworms which is present in Singapore. Vaccinate at 5 months of age. She will make an appointment.
Clinical Findings:
Ears full of wax but no ear scratching surprisingly. I advised the puppy to go back to the pet shop seller to get ears cleaned. I advised deworming for intestinal worms once a week for the next 4 weeks.

Conclusion:
This puppy will have plenty of love and great fun exercising outdoors since he lives in a house and can get out without the problem of having to bring him to the lift and go downstairs. There is a small garden but he will not be permitted to go there and destroy the plants. But he can go outdoors easily compared to Case 2.



Case 2:
Australian gentleman in his 30s
Purchased from the same pet shop over 2 months ago. Paper trained on a pee pan. Now apparently lame. Owner was worried about hip dysplasia.
Golden Retriever 4.5 months. All 3 vaccinations done.
Feeding 3x/day. Poops 3-4 times per day.
Purchased puppy 2.5 months ago.

Consultation: Dog has "hip dysplasia"
Housing: Condo with smooth marble and wooden floors.
Playpen: Sleeps at night with bed.
Toilet area: Pee pan + newspapers in the balcony. Feed and water bowl in the balcony.

HISTORY: Last 2-3 weeks, in the morning, the puppy had been walked for around 30 minutes. The puppy would stop walking after some distance. But he had to do it.  In the evening, he would be exercised. Sometimes he would be at Sentosa to swim. Lately, he was lame in his hind legs. great difficulty standing up using the back legs in the morning. Has great difficulty moving down slope or moving down from the car seat. No problem getting up the car as he used his front legs.  
"Could this be hip dysplasia?" the young man asked. "What should I do with this puppy?"


EXAMINATION:
1. Outside the surgery.
General visual examination of conformation and muscle of the back leg - cow hocks with right hind having toe out.
Gait - The owner walked the dog up and down concrete flooring on a loose leash - no obvious lameness on slow walk. Puppy was said to "hop" on 3 legs at a run.

2. Inside the surgery.
On the examination table, put the puppy sideways on his left and right side to manipulate the joints.
Abduct and adduct hips and all other joints of the hind limbs - no pain surprisingly.
Put puppy standing and extend 2 hind limbs - right hind limb is shorter than left hind.
Back muscles of right hind are smaller than left hind.
Spinal cord pressure - no pain in general. There seemed to be some mild pain at the lumbo-sacral spinal area. Could this be the cause of pain in the morning on waking up and being unable to get up normally as a young puppy should?

HYPOTHESIS FOR SPLAYED HIND LIMB AND SUBLUXATED HIP:

"Where does the puppy spend 90% of his day?" I asked.

"Inside the apartment," the man worked from home and therefore knew what he said.

"Does he walk on very smooth marble flooring when at home?" I asked although I know the answer since all modern condos are marble-floored and wooden-tiled with waxy wood.

"Yes. The wooden flooring upstairs are also very smooth, being waxed."

Based on my experiences with the professional dog breeders, I would say that this puppy had no chance to walk on firm surfaces as they are usually crated before sale.

Therefore, the Golden Retriever's hind legs become splayed slightly before sale. The splay was not very obvious as he did not walk like a cowboy if you don't observe closely.

He had also cow hocks which would account for his "hip dysplasia" style of walking with the hocks lower and right toe pointing outwards.

In addition, he was over-exercised in the morning going to the school with the children for the past 2-3 weeks. He had over 30 minutes of road walk. "He was keen to go out in the morning," the young man said. "But he would stop walking after some distance."

"He had pain in his hip area," I said. "So he stopped walking". "Sometimes, he hops," the man said. Sparing weight onto the hind limbs," I said.

"The puppy could climb up the car but would hesitate to climb down from the car later," the man gave me this good clue to pain in the hip area. Climbing up involved the front limbs. That was OK for the pup. Climbing down involved the back limbs and hip area. There was pain. Similarly to getting up in the morning using the hind limbs. There was some pain in the hip area. But none was elicited or shown when I palpated, extended and flexed the hips. Or the knees. So, it was very difficult to prove my hypothesis to the young man.

There was muscle atrophy in the right hip area would indicate some pain in the right hip area for some time. This was accepted by the young man.

I pressed the hip joint. Yet there was no pain response from the puppy. I extended both hips to compare the length of the hind limbs. The right hind was noticeably 3 cm shorter. But there was no pain.

The puppy now splayed his hind limbs out and flopped onto my examination table. He had enough of all these palpations. He was a very friendly puppy and had not bitten me once. As I pressed the spinal area from the neck to the tail, there was a very slight pain at the lumbo-sacral area. I don't think the young man saw the response as it was very slight.

This pain and the subluxation of the right hip joint could account for the difficulty in standing up on the hind limbs.
"Is there a cure for the hip dysplasia?" the man asked. "Must he be put to sleep later?"
"I don't think he has hip dysplasia now. He has subluxation of his right hip. He will recover if you let him rest for at least 4 weeks and confine him to a rough floor area for the next 3 months. No over-exercising. Let him walk and run within his limits rather than force him to do more road walk. No morning road walk.

For hip dysplasia, he needs to be over 6 months of age for X-rays to confirm. His history indicated over-exercise (probably running up and down the 2-level condo with the children) and just having too much of a good time. A very active life-style."     

The puppy lies down with hind limbs splayed out unlike other puppies with limbs tucked under the abdomen. This was observed and pointed out by the owner as the puppy flopped onto my consultation table. "With a smooth flooring over the past months, the puppy's hind limbs stretched outwards and now he just splays his hind limbs outwards when he lies down. With a rough flooring, his hind paws may be able to get a grip to stand up."

The last paragraph supported my hypothesis that this puppy had a lifestyle that caused splaying of his hind limbs. As he grows older, the splaying is not obvious. However, his right back muscles were not well developed compared to his left. Both had poor development considering that the puppy "hops" when over-exercised.

DIAGNOSIS:
Right hip subluxation but not so serious to cause obvious lameness. This accounted for his occasional hopping when he runs.
ADVICES:
1. No over-exercising for the next 4 weeks and preferably 3 months. He should have no walking exercise or running up and down stairs for the next 7 days but confined to the balcony-part-living room area.

2. X-rays of the hip would be done at over 6 months to properly confirm hip dysplasia. Presently he is 4.5 months.

3. Chances of him recovering are good. 50:50 if he continues to walk on floors where his legs can get a grip. A garden would be best but this dog must live in the apartment for the next 5 months of lease. So, what to do?

4. "Install anti-slip mats onto the flooring. Confine him to a room with baby gate or use the kitchen and utility area for him when he is at home," I said. This was not practical advice as there was no room and the kitchen was small for such a big breed.

"The balcony?" I asked. "Will it be too hot when the sun is out?"  The man said, "Yes."

"Where does he sleep nowadays?" I asked.

"A big playpen near the balcony." the man replied. I asked him to draw the floor plan. He would fence up part of the living area next to the balcony and connect this area to the balcony. His plan was good as the puppy would be confined to and have over 15 sq metres of anti-slip space to walk when staying at home.

CONCLUSION:
The gentleman propose converting the corner of the living room near to the balcony into a fenced up area with anti-slip mats. So, the puppy can walk to the pee pan and newspapers in the balcony for his toilet and back to the living room to see the family. No more free roaming on slippery smooth floors and he should recover fully. I prescribed non-steroidal Rimadryl tablets for 7 days.

I am quite confident that this puppy will be fully recovered as he was sent to the vet early. He has an enlightened and educated owner who has not delayed seeking veterinary advice unlike many Singapore puppy owners who don't bother after the three vaccinations and seek advices from the groomer. 

A house will be best for this puppy but a condo has so many facilities for the expatriate family with young children. In any case, by the time the lease ends, this puppy should be normal as the owner knows what to do and his wife has the architectural knowledge to execute this floor plan for the puppy. If the expatriate had waited for some time, this puppy would have dislocated his right hip and it will be very difficult to recover. This is a case where clinical signs were presented at home. At the vet, the puppy behaved quite normally. There are many such cases and the owner's history and observations count a lot more than clinical findings. Some puppies or dogs just behave normally at the vet as they have a high tolerance to pain. Showing pain is not good for survival in the wild and this may explain why the puppy shows no pain readily. He may not have very serious pain and so suppress it in front of the vet who is a stranger to him. Is this another hypothesis? As for hip dysplasia, we would have to wait and see.