MASTIFFS IN NEED OR DISTRESS

Gastric Torsion

Causes

In dogs, the causes of bloat are unclear, and currently there is little agreement on the factors that may contribute. Some of the more widely acknowledged factors are stress, eating foods such as kibble that expand in the stomach, swallowing too much air while eating, overfeeding, and other causes of gastrointestinal distress. There is also no consensus on ways in which to prevent bloat from happening, and suggestions are sometimes contradictory, for example, "Raise your dog's feeding dish - he will not swallow as much air while eating" as opposed to "Lower your dog's feeding dish so that he eats slower, and thus swallows less air." However, precautions that are likely to help include feeding small meals throughout the day instead of one big meal and not exercising immediately before or after a meal.

Symptoms

Symptoms are not necessarily distinguishable from other kinds of distress. A dog might stand uncomfortably and seem to be in extreme discomfort for no apparent reason. Other possible symptoms include firm distension of the abdomen, weakness, hypersalivation, and retching without vomiting.

Treatment

Bloat is an emergency medical condition: having the animal examined by a veterinarian is imperative. Bloat can become fatal within a matter of minutes. Treatment usually involves resuscitation with intravenous fluid therapy and emergency surgery. The stomach is initially decompressed by passing a stomach tube, or if that is not possible, multiple trocars can be passed through the skin into the stomach to remove the gas. During surgery, the stomach is placed back into its correct position, the abdomen is examined for any devitalized tissue (especially the stomach and spleen), and a gastropexy is performed, which by a variety of methods attaches the stomach wall to the body wall, to prevent future twisting. A gastropexy does not prevent future bloating, i.e. the stomach can still fill up with gas, but it will not twist. A partial gastrectomy may be necessary if there is any necrosis of the stomach wall. If this is necessary the prognosis is worse.

Dangerous substances

Some foods commonly enjoyed by humans are dangerous to dogs, including chocolate (Theobromine poisoning), onions, grapes and raisins some types of gum, and Macadamia nuts. Now that it is thought that the only dangerous substance in chocolate is the cocoa, this means that white chocolate can be used as a rare treat.

The acute danger from grapes and raisins has been uncovered only since about 2000, and made public slowly since then. At present the cause is not known, but one veterinarian believes it may be an acute auto-immune response to plant-borne viruses  in the same manner as FIP in cats. Whatever the reason, since only small quantities are necessary to induce acute renal failure, dogs should not be fed grapes or raisins, and perhaps sultanas and currants should also be withheld.

Cooked bones should never be given to dogs, as the heat changes the chemical and physical properties so that they cannot be chewed properly, splintering into jagged shards, and resist digestion.

Human medications should not be given to a dog as a substitute for their regular medication as some can be especially toxic, especially paracetamol/acetaminophen (Tylenol). Alcoholic beverages pose much of the same hazards to dogs as they do to humans.

Dogs may also find some poisons attractive, including antifreeze, snail bait, insect bait, and rodent poisons. Antifreeze may be one of the most insidious of poisons to dogs because of its sweet taste and because a dog may walk upon or lie down upon a spill of it or its residue and then lick it off. Dogs must be kept strictly away from antifreeze and not allowed access to any place that has had a spill of it that has not been completely removed.

Plants such as caladium, dieffenbachia and philodendron will cause throat irritations that will burn the throat going down as well as coming up. Hops are particularly dangerous and even small quantities can lead to malignant hyperthermia

Amaryllis, daffodil, english ivy, iris, and tulip (especially the bulbs) cause gastric irritation and sometimes central nervous system excitement followed by coma, and, in severe cases, even death.

Ingesting foxglove, lily of the valley, larkspur and oleander can be life threatening because the cardiovascular system is affected. Equally life threatening is the yew which affects the nervous system. If any of these plants are ingested, get the dog to a veterinarian immediately.

Many household cleaners such as ammonia, bleach, disinfectants, drain cleaner, soaps, detergents, and other cleaners, mothballs and matches are dangerous to dogs, as are cosmetics such as deodorants, hair coloring, nail polish and remover, home permanent lotion, and suntan lotion

Hip Dysplasia

Symptoms

Dogs might exhibit signs of stiffness or soreness after rising from rest, reluctance to exercise, bunny-hopping or other abnormal gait (legs move more together when running rather than swinging alternately), lameness, pain, reluctance to stand on rear legs, jump up, or climb stairs, subluxation or dislocation of the hip joint, or wasting away of the muscle mass in the hip area. Radiographs (X-rays) often confirm the presence of hip dysplasia, but radiographic features may not be present until two years of age in some dogs. Moreover, many affected dogs do not show clinical signs, but some dogs manifest the problem before seven months of age, while others do not show it until well into adulthood.

In part this is because the underlying hip problem may be mild or severe, may be worsening or stable, and the body may be more or less able to keep the joint in repair well enough to cope. Also, different animals have different pain tolerances and different weights, and use their bodies differently, so a light dog who only walks, will have a different joint use than a more heavy or very active dog. Some dogs will have a problem early on, others may never have a real problem at all.

Each case must be treated on its own merits, and a range of treatment options exist.

Diagnosis

The classic diagnostic technique is with appropriate X-Rays and hip scoring tests. These should be done at an appropriate age, and perhaps repeated at adulthood - if done too young they will not show anything. Since the condition is to a large degree inherited, the hip scores of parents should be professionally checked before buying a pup, and the hip scores of dogs should be checked before relying upon them for breeding Despite the fact that the condition is inherited, it can occasionally arise even to animals with impeccable hip scored parents.

In diagnosing suspected dysplasia, the X-ray to diagnose and confirm the internal state of the joints, is usually combined with a study of the animal and how it moves, to confirm whether it is being affected in its quality of life. Evidence of lameness or abnormal hip or spine use, difficulty or reduced movement when running or navigating steps, are all evidence of a problem. Both aspects have to be taken into account since there can be serious pain with little X-ray evidence.

It is also common to X-ray the spine and legs, as well as the hips, where dysplasia is suspected, since soft tissues can be affected by the extra strain of a dysplastic hip, or there may be other undetected factors such as neurological issues (eg nerve damage) involved.

There are several standardized systems for categorising dysplasia, set out by respective reputable bodies (Orthopedic Foundation for Animals/OFA, PennHIP, British Veterinary Association/BVA). Some of these tests require manipulation of the hip joint into standard positions, in order to reveal their condition on an X-ray, and since this is very painful and must be held still for a clear image, often the animal will be anaesthetised or sedated to achieve clear diagnostic results.

Conditions which can mimic or replicate the symptoms of hip dysplasia

 the following conditions can give symptoms very similar to hip dysplasia, and should be ruled out during diagnosis:

• Cauda equina syndrome (i.e. lower back problems)
• Cranial (anterior) cruciate ligament tears
• Other rear limb arthritic conditions

They add that:

"Traditionally, the signs of hip dysplasia are rarely extreme. Usually, only mild to moderate lameness is noted which may suddenly worsen. Dogs with a cranial (anterior) cruciate ligament tear typically hold the affected leg up (which is unusual with hip dysplasia). Patients with back (spinal) problems often scuff their toenails when walking, have an uncoordinated gait, and are weak in the rear limbs. They may be very painful if they have a disc rupture (sciatica) or show no spinal pain in certain degenerative spinal cord conditions (German Shepherd myelopathy)."

It is also worth noting that a dog may misuse its rear legs, or adapt its gait, to compensate for pain in the forelegs, notably arthritis or osteochondritis (OCD). It is important to rule out other joint and bodily issues before concluding that only hip dysplasia is present. Even if some hip dysplasia is present, it is possible for a painful case of OCD or other diseases to be masked by mild dysplasia.

Long term pain

It is important to note that a dysplastic animal has probably lived with the condition since it was very few months old, and has therefore grown up taking the chronic pain for granted and have learned to live with it. Dogs suffering such pain do not usually cry out or show it. Sometimes, they will suddenly and abnormally sit down when walking, or suddenly refuse to walk or climb objects which they usually would, but this can equally be a symptom of many other things, including a thorn in the paw, or a temporary muscle pain. So pain recognition is less common a means of detection than the visible gait and other abnormalities described above.

Treatment

Overview

There is no complete cure, although there are many options to alleviate the clinical signs. The aim of treatment is to enhance quality of life. Crucially, this is a congenital condition and so will change during the life of an animal, so any treatment is subject to regular review or re-assessment if the symtoms appear to get worse or anything significantly changes.

If the problem is relatively mild, then sometimes all that is needed to bring the symptoms under control are suitable medications to help the body deal better with inflammation, pain and joint wear. In many cases this is all that is needed for a long time.

If the problem cannot be controlled with medications, then often surgery is considered. There are traditionally two types of surgery - those which reshape the joint to reduce pain or help movement, and hip replacement for animals which completely replaces the damaged hip with an artificial joint, similar to human hip replacements.

Non surgical interventions

Non surgical intervention is typically a combination of an anti-inflammatory painkiller, such as carprofen (often sold as Rimadyl and used to treat arthritis), and a glucosamine based nutritional supplement to give the body additional raw materials used in joint repair.

Glucosamine can take 3-4 weeks to start showing its effects, since it can take up to 6 weeks to reach full therapeutic effect in the body, so the trial period for medication is usually around 3-5 weeks minimum before assuming it isn't working. It's important to remember that glucosamine is not a medication, it's a raw material, so the body still takes considerable time to build more cartilage once it has access to this raw material.

It is also common, if necessary, to try multiple anti-inflammatories over a further 4-6 week period. This is since an animal will often respond to one type, but will fail to respond to another. If one anti-inflammatory does not work, a vet will often try one or two other brands for 2-3 weeks each, also in conjunction with ongoing glucosamine, before necessarily concluding that the condition does not seem responsive to medication. Typical alternatives include tepoxalin (Zubrin) or other NSAIDs suitable for animals.

Carprofen, and other anti-inflammatories in general, whilst very safe for most animals, can sometimes cause problems for some animals, and (in a few rare cases) sudden death through liver toxicity. This is most commonly discussed with carprofen but may be equally relevant with other anti-inflammatories too. As a result it is often recommended to have monthly (or at least, twice-annually) blood tests performed, to confirm that the animal is not reacting badly to the medications, if these are being used. Such side effects are rare but worth being aware of, especially if long term use is anticipated.

This regime can usually be maintained long term, for as long as it is effective in keeping the symptoms of dysplasia at bay.

Surgical interventions

If medications fail to maintain an adequate quality of life, surgical options may need to be considered. These may attempt to modify or repair the hip joint, in order to allow pain free usage, or may in some cases completely replace it.

Hip modification surgeries include excision arthroplasty, in which the head of the femur is removed and reshaped or replaced, and pelvic rotation (also known as triple pelvic osteotomy, or pubic symphodesis in which the hip socket is realigned, may be appropriate if done early enough. These treatments can be very effective, but as a rule tend to become less effective for heavier animals - their ability to treat the problem becomes reduced if the joint has to handle more pressure in daily life. Pelvic rotation is also not as effective if arthritis has developed to the point of being visible on X-rays

Femoral head ostectomy (FHO), sometimes appropriate for smaller dogs and cats, is when the head of the femur is removed but not replaced. Instead, the resulting scar tissue from the operation takes the place of the hip joint. In such surgeries, the weight of the animal must be kept down throughout its life in order to maintain mobility. FHO surgery is sometimes done when other methods have failed, but is also done initially when the joint connection is particularly troublesome or when arthritis is severe.

Hip modification surgeries such as these usually result in reduction of hip function in return for improved quality of life, pain control, and a reduction in future risk.

Hip replacement is expensive but (since it completely replaces the faulty joint) has the highest percentage of success especially in severe cases, usually restores complete mobility if no other joint is affected, and also completely prevents recurrence. Hip replacement for dogs, can sometimes also be a preferred clinical option for serious dysplasia in animals over about 40 - 60 lbs (20-30 kg), a weight that excludes certain other surgical treatments.