|
This is the unedited version of the HOD article which appeared in the January 1994 American Kennel Club Gazette by Elena Smith.
Permission is granted to reproduce as long as I am given credit as author.
I first heard about the mysterious disease called hypertrophic osteodystrophy (HOD) some 18 years ago when we got our first Weimaraner puppy from a backyard breeder. Shortly after we brought him home he was stricken with a high fever, swollen, hot, leg joints and could not walk. Our vet could not diagnose the problem but gave him IV gentamicin because his symptoms seemed to be those of a generalized infection.The treatment was unsuccessful. Sadly, we took the sick pup back to the breeder who, in turn, delivered him to the Auburn Veterinary School where he was diagnosed as having severe HOD and was subsequently euthanized. After becoming involved in show dogs, I learned that other owners and breeders had experienced HOD with a variety of treatments and outcomes. Because of this history (including Marianne Reder's interesting article in the December 1983 Weimaraner Magazine), and some recent experiences, I have concluded that HOD is not so uncommon and that the problem needs additional discussion and study.
In an effort to bring you some useful information about what seems to be a new and successful treatment for HOD, I searched the computerized databases of several medical and veterinary schools which included: Medline (Index Medicus), Agricola and CAB Abstracts (Index Veterinaricus).My search of the literature included between 200-300 journals, at least 80 of which are veterinary journals.I was able to find NOTHING on the "new treatment" and only 3 articles of parallel value, the most recent being published in 1991.Thus, you are going to be reading here about a successful treatment for HOD that has, apparently, not been systemically studied. If this is true, I urge our academic veterinarians to take my report as a challenge worthy of an immediate study.We need to get HOD under control as soon as possible.
HOD occurs almost exclusively in puppies of medium to giant breeds such as Great Danes, Labrador Retrievers, German Shepherds and Weimaraners.Symptoms of HOD progress rapidly, usually in puppies between 7 weeks to 16 weeks of age (and sometimes up to 6 months). At onset, the puppy becomes listless, lethargic and will not eat or drink.He sleeps a lot and when awake, lies very still and avoids moving.As the symptoms progress the pup usually cannot get up at all.There is often a noticeable swelling, and intense pain in the front or rear leg joints (and sometimes the neck, jaw or tail), which are warm to touch.The pup yelps in pain if you pick him up or try to help him get up. The affected pup's temperature rises to an alarming 105-106o.Lab work shows an increase in the WBC (white blood cell count) up to about 40,000 with a "left shift" (increase in immature cells).Radiographs of the joints show characteristic lesions of HOD.Many veterinarians are familiar with these lesions and can diagnose HOD from thesymptoms plus the radiographs.
The three articles from the veterinary literature (cited below) agree that HOD is a metabolic bone disease.The cause is strongly suspected to be overnutrition.Although some other articles (not cited) mention the possibility of an infectious agent, Schulz's is the only report of HOD with a concurrent bacteremia (E. coli in blood and joint fluid cultures).It is notable that no case has been conclusively "cured" by antibiotics. TheTeare, et al and Woodard studies both reported HOD in Weimaraner littermates.Teare, et al, reported that HOD is caused by excessive bone formation in response to too much dietary proteinand by retarded bone resorption in response to hypercalcitoninism induced by excessive dietary calcium.
HOD is reported to resemble human infantile scurvy which is why Vitamin C is often prescribed.However, Woodard demonstrated from necropsy results that bone lesions in HOD differ from those observed in scurvy.He also reported that the administration of Vitamin C did not alter progression of the disease in two littermates who suffered relapses of HOD while receiving Vitamin C.Furthermore, two other HOD pups in his study were euthanized; one was receiving Vitamin C and the other one was not on Vitamin C.At necropsy, levels of liver Vitamin C (ascorbic acid) levels were similar in both pups indicating that Vitamin C therapy made no significant difference in the tissue levels nor did it improve the one pup's symptoms.Teare, et al, reported that the administration of Vitamin C may actually aggravate HOD lesions and that low levels of vitamin C in HOD affected dogs is due to pain and stress, but not a cause of the disease.Thus, there appears to be no basis for treating HOD with Vitamin C.
The "standard treatment" for HOD has been Vitamin C, aspirin, and restricted activity. With this approach, recuperation takes from 7 days to 21 days with bone lesions taking several months to heal (determined by radiographs). During this time, the affected pups continue to suffer with painful joints and generally walk with a shuffle. A small percent end up with permanent bone damage and deformed legs.And, some pups have had to be euthanized because of the severity of the pain, deformities, and suffering.
I have had only two personal experiences with the "standard treatment" of HOD in my pups. In 1987, a 5 month old pup (the largest male in a litter of 12), developed severe HOD symptoms, and was given the "standard treatment." He had to be crated for nearly 6 weeks (until his joint lesions healed), he walked in a "shuffle" and was in a good deal of pain, which abated slowly. Another pup was from my male field Champion who was bred to the same bitch three different times for a total of 23 puppies. In this case I found my 3 month old bitch pup (from the third litter) lying in her bed unable to get up. She had a fever of 106 and cried when I touched her. I rushed her to my vet and after a $128 bill, he admitted he was baffled by her symptoms. However, the owner of the first pup (also a Weim breeder) examined her front leg joints and exclaimed "She has HOD!" So, we gave her the "standard treatment."Stiff and shuffling, she was up and around within 10 days.
Two years ago, one of my friends had a 3 month old puppy bitch who was diagnosed with HOD in her rear legs (and possibly her neck and tail). Since we had heard rumors of a new treatment used by several Weimaraner breeders which had been successful, we called one of the involved breeders.She told us about a "new treatment" and how she came to utilize it. It seems that several years earlier, she had a male pup suffering from HOD with such severity that euthanization was inevitable. Just prior to euthanization, her veterinarian said he knew of a radical new treatment, but did not have any experience with it. She said, "Try it!" Incredibly, the "New Treatment" worked within 48 hours!
The "New treatment" consists of restricted activity, bed rest, and the administrationof: 1 mg/pound (NOT /kg) of body weight of Prednisone given for 3 days; then the dosage is cut in half for 5 days; then cut in half again every other day for 5 days.Importantly, the pup is taken off premium high protein puppy food, is given high quality adult maintenance food and is never fed puppy food again.End of treatment.The pup can be expected to respond within 48 hours.The following are seven cases that I know about which have been cured with the "new treatment."
CASE 1: The breeder's 5 month old male pup mentioned above is the first case. He weighed 50 lbs.Fifty mg of prednisone is a massive dose to give to a puppy.However, given the alternative (euthanasia), the "new treatment" was begun.Within 48 hours the pup was up, walking around and eating! He became a Champion and successful stud dog; none of his pups have had HOD.
CASE 2: My friend's 3 month old bitch pup weighed 30 lbs; she was the second largest pup in the litter.We told our vet about the "new treatment."Although he had diagnosed her problem as HOD from radiographs, he was alarmed by the thought of giving a 3 month old puppy a massive dose of prednisone because of her high fever (104-105), i.e., because Prednisone is clearly contraindicated in cases of infection. But, he promptly consulted the breeder's vet who had used the "new treatment."Upon learning that this dose of Prednisone is that which would be given if the puppy were stung by a swarm of yellow jackets, we all agreed to give it a try and the "new treatment" was begun. We all held our breaths.Within 48 hours, the pup was up, walking around and eating. She is now 2 1/2 years old, a multiple BOB and a Group Placing Champion.
CASE 3: A 3 month old male pup (the largest in the litter) living on the West coast developed a high fever and pain in his front and rear legs. His owner called me and was understandably upset because local breeders had told her that her puppy had the dreaded "Weimaraner Immuno- deficiency Syndrome." At the time she called me, her vets were administering IV antibiotics and planned to do elaborate immunological testing. I said "it sounds like HOD - insist that your vets X-ray his leg joints."The radiographs were performed, but while identifying HOD, the "new Treatment" was flatly rejected. I advised the owner to find another veterinarian who would administer the "new treatment" in collaboration with my now experienced veterinarian.She did so, and the pup was walking and eating within 48 hours.
CASE 4: A 12 week old male pup (the largest in the litter) became lethargic after playing hard outside.The next day he slept all morning, would not eat or drink and was reluctant to move.His owner took his temperature that morning and it was 102 (normal).By early afternoon it was 104.8.His owner called me from her vet's office and said they had IV antibiotics running and his WBC count was 28,000.I said "it sounds like HOD - ask them to X ray his leg joints."They did, and sure enough, he had the telltale radiographic signs.Her vets were willing to administer the"New Treatment" and he was up and eating in 48 hours.
CASE 5: A 3 month old large boned puppy of another breed had HOD symptoms and was given the New Treatment.He responded well and, like the others, was up and eating within 48 hours.He was recuperating nicely and all symptoms had disappeared.However, he was returned to the premium high protein puppy food that he was fed prior to developing HOD. Within 4 weeks he had a relapse of HOD.After the same treatment, he recovered again and was kept on adult maintenance food.He has had no further relapses.
CASE 6 & 7: Two Weimaraner littermates 10 weeks old (not the largest in the litter) in the New England area showed the same symptoms.Their breeder called me and I put their veterinarians in touch with my veterinarian.The treatment was used and the pups were up and about in 48 hours.They continue to do well after 4 months.
Is HOD hereditary? Well, just about everything is hereditary. I do believe that some pups may have a genetic predisposition to developing HOD if they are fed premium high protein puppy food after 7 weeks of age. Neither of my two dogs that had HOD ever produced HOD in their pups. Also, other breeders stated they have had no HOD in pups produced from dogs that had recovered from HOD.However, it is interesting that CASE 2 and CASE 3 are full siblings from repeat breedings, both have large bone and both developed HOD at 3 months of age.Of nine pups from this breeding, 2 were given the New treatment and both recovered within a week. Why these two pups developed HOD and the others did not, is, of course, a mystery.Parenthetically, the largest male pup in this litter did not develop HOD; he was being fed a lower protein (less expensive) puppy food.
Is HOD a type of immunodeficiency in Weimaraners?Unfortunately, some breeders have a misconception that Weimaraners have a totally different immune system from other breeds and that HOD is an autoimmune disease or an immunodeficiency syndrome.Pursuant to this, several years ago, I spoke to the well recognized and respected Dr. Max Apel at the Cornell School of Veterinary Medicine.Dr. Apel told me there was no evidence to suggest that Weimaraners have a different immune system from any other breeds.Further, I would add that if HOD is, indeed, an immunodeficiency syndrome or an autoimmune disease, then it would not be cured so easily because these are lifelong inherent diseases and cannot be cured.
What about vaccines and HOD? Because it often occurs around the time of a vaccine, some breeders believe that the vaccines are the cause.But, of course, vaccines are routinely administered during this age.I do not believe vaccines "cause" HOD.However, vaccines introduce foreign antigens into the body specifically to cause a desired reaction (antibodies to the antigen) but this inflammation could also cause perhaps an additional reaction in joint plates. Prednisone can diminish the desired affect of a vaccine.Thus, if the pup received vaccines near the time of the Prednisone treatment then most veterinarians recommend waiting 2-3 weeks and repeating the vaccinations.
Can we prevent HOD?Perhaps.I believe a way to reduce the chances of developing it is to place large boned pups on lower protein (but high quality) adult or "maintenance" food at about 8 weeks of age instead of continuing to feed them premium high protein, high caloric puppy food, which tends to boost growth and contributes to "growing spurts." After my experience with these recent cases, I have begun to switch my pups at about 10 weeks of age to a high quality but lower protein adult food and have recommended that my new puppy owners to do the same.I avoid vitamin and mineral supplements as well so as to keep growth in these large boned pups to a slow even pace.I believe it is significant that there have been no reported relapses with this new treatment as long as the pup is not given premium high protein puppy food again.Incidentally, my veterinarian expressed a genuine concern about the new premium high protein puppy foods and feels that they contain more protein and growth factors than is necessary which, he feels, contributes to a number of "growing diseases", in addition to HOD.
There are legitimate risks in giving a young puppy large doses of Prednisone and the decision requires the careful attention of a veterinarian.However, I believe the benefits out weigh the risks to stop the pain and suffering and the possible permanent affects of HOD.
In conclusion, this discussion represents only a small sample of experience with a "new treatment" for HOD. It is pretty "soft" science but none the less, it represents another step in our understanding.If any veterinarian or breeder out there among my readers has any additional information about treating HOD, please write to me.
REFERENCES:
1.Schulz, KS, JT Payne, E. Aronson. Escherichia coli bacteremia associated with hypertrophic osteodystrophy in a dog. J. Am. Vet. Med. Assoc. 199(9): 1170-1173. 1991.
2.Teare, JA, L. Krooc, FA Kallfelz, HF Hintz. Ascorbic acid deficiency and hypertrophic osteodystrophy in the dog: a Rebuttal. Cornell Vet. 69(4):384-401, 1979.
3.Woodard, JC.Canine hypertrophic osteodystrophy, a study of the spontaneous disease in littermates. Vet Pathol. 19(4):337-354. 1982.
Additional information:Already a reader has sent information which states that her dog was successfully treated with this same treatment in 1982.She does not know why the veterinarians have not done more to study HOD.
Another reader called saying their 5 month old Irish Setter pup had these same symptoms, and their vet was baffled. The Irish Setter Newsletter arrived with a reprint of this article, which they quickly took to their vet and the pup was successfully treated.I have had at least 6 other people call or stop me at shows saying the treatment worked on their cases as well.Chris Grisell believes that a veterinary resident may take this on as a study for a vet school in her area.(this has not happened as of 5/95)
Addendum:
2/95: Sadly, I must include here a case report of my own puppy.This puppy developed HOD at 10 weeks of age.His owner called me and I gave him the instructions for the prednisone treatment. I told him that if his veterinarian would not administer this treatment or call my veterinarian for consultation, then he should immediately find another vet. I later found out that his vet prescribed the same old treatment of "antibiotics, Vitamin C and aspirin." (he refused to use the prednisone treatment and refused to call my vet)The puppy suffered several increasingly severe relapses, developed angular deformities and eventually died at 6 months of age.This puppy, simply put, needlessly suffered to death.*
5/3/95: Another report from a breeder in Texas with the same story.The puppy was given the same old Vitamin C + antibiotics treatment and died after 4 severe relapses at 5 months of age. He was also deformed. An additional puppy in Texas at 3 1/2 mos of age responded well to the prednisone treatment and is perfectly normal at 6 months of age.
As of 1997 I have been involved in at least 75 cases from various breeds affected with HOD and in all cases this treatment has worked exceedingly well.Only a small percentage had a minor relapse.A short course of prednisone was all that was needed.Once the pups mature and stop growing, there are no further problems.
*This litter convinced me that the tendency to development of HOD is inherited.
You can contact me at eslamberson@msn.com and I will provide the information
|
