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 Is it arthritis or something else?

           Arthritis in the hind end is one of the most common and well-know conditions we tend to see in older dogs, especially in the larger breeds.  As a result of that common knowledge we frequently get calls from owners who have noticed that their dogs are having a hard time getting around and  would like us to dispense anti inflammatory medication for them without  going through all that extra bother and expense of a physical exam. 

            I must say that I appreciate the call to request medication rather than having the owner just decide to give some random dose of aspirin or advil which often leads to conditions more serious than arthritis to treat in a fairly short period of time.  I would rather have someone ask than be stuck just hoping the liver and kidney failure caused by the over the counter medication isn’t permanent, and that the giant ulcer in the stomach can be healed before it perforates all the way through, causing a horrible and painful death. 

            In general I want to be helpful and want to make sure that my patient’s pain is managed in a way that is efficient and convenient for the owner.  With cases that I have seen regularly and have documented  that the problem is indeed arthritis I will often dispense medication this way.  Certain requests, however, cause red flags to go up in my mind and usually result in my insisting on an exam before just throwing medication at a patient.  Here are some things to think about before just assuming that because a dog isn’t getting around well the problem is arthritis in the hips.

            Hip dysplasia and other arthritis inducing problems in the hind end are long term and very slowly progressive processes.  One day usually doesn’t usually look all that different from the next.  When I get a report that a dog who has been creaky but functional for several years suddenly can’t get up off the ground or can’t make it up the stairs a long list of non-arthritis related problems pops into my head as likely causes.  I have had owners request medication for presumed arthritis for dogs that were bleeding internally from a tumor on the spleen or from rat poison ingestion, dogs that have had their immune systems start destroying all of their red blood cells, for dogs that have had a tumor on the base of their heart causing sudden heart failure, for dogs that were becoming critically ill from untreated diabetes, and for dogs suffering from leptospirosis, a bacterial infection that affects the liver and the kidneys.   Most owners fell somewhere in the range from mildly annoyed to downright furious that I insisted the animal be seen before medication was dispensed, but in all of those cases the animal would have had no chance if I had just shoved medication out the door rather than insisting on seeing them.

            Dogs with hip arthritis tend to be fairly equally sore on both hind legs.  When a dog starts suddenly limping on one hind leg something new is likely happening.  In large dogs it is statistically most likely that a cruciate ligament in the stifle, the dog’s equivalent of our knee, has been damaged.  With prompt surgery the long term outcome of damaged knees is tremendously improved.  If we assume the problem is hip dysplasia and  just throw medication at it we will lose the best window we have to  preserve comfortable function in that leg for that dog.

            One of the biggest challenges in veterinary medicine is that our patients cannot speak  for themselves.  That forces us to have to figure out what the problem is based information we gather from history, observations, and diagnostic tests.  It is easy to make inaccurate guesses or assumptions about what is going on when the patient isn’t going to correct us.  Any sudden, dramatic change in status, like being unable to get up off the ground or a new condition, like limping on one leg needs to be investigated before we just stamp it as arthritis and dole out a handful of anti inflammatory medication to treat it.

           

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