2 of 2: Does arthritis have to mean euthanasia?

I palpated nothing abnormal in Roscoe’s abdomen so I began to examine his legs. First I had Liz lead her pet around the yard so I could see how he did on a routine walk. His rear end was obviously weak, but I didn’t see anything more specific. When Roscoe stood up earlier for me to continue his exam, I had noticed definite weakness and difficulty in getting up. After walking a few minutes, I l had Liz stop him in front of me and I continued the examination.  Starting with his front limbs, I turned each of his feet over so that he was standing on his knuckles. With a normal placing response (evaluates neurologic function-not arthritis), he would immediately flip each foot back over to stand on the bottom.  He did this; there was no deficiency here. Please notice I am examining his front end even though I have seen no problems here yet. Every pet needs a complete exam regardless of where we think the problem is. Once we had finished our exam it was obvious that Roscoe’s discomfort was mostly in his hips. I could elicit no pain when examining any other joints.

“Have you ever heard of hip dysplasia?” I asked Liz.

“I’ve heard of it,” she responded, “but I really don’t know what it is.”

“This is most commonly diagnosed in large, older dogs but it can be seen in any size and age dog. It just causes the most obvious signs in these guys. The hip is a ball and socket joint, and in hip dysplasia (which is usually genetic) the socket isn’t as deep as it should be and as the dog ages (though this can be diagnosed in young dogs, also), the joint becomes more and more unstable. The body produces a lot of extra bone and arthritic changes as it tries to stabilize the hip but that only makes things more painful. With a younger dog, I would recommend x-rays to further evaluate the joint, but it would be difficult to get good pictures without some sedation because of the pain. At his age and with these symptoms I have no doubt about the diagnosis.”

“So what can we do to make Roscoe more comfortable? I will do anything I can to keep him around longer. I don’t care if it’s only for a month or two. I just want him to be more comfortable.”

“I would treat this the same way I would treat any joint disease in the older pet. First, we evaluate his weight and in Roscoe’s case, his weight is fine so we don’t need to make any changes there. He does belong on a diet for older dogs and there are some prescription diets for arthritis, but we’ll talk about diet later. Secondly, we need to talk about exercise. The less Roscoe moves around and the less you walk him, the more difficult it will become for him to get up and walk. We all need to keep exercising as we get older. That might begin as an easy five to ten minute walk once or twice daily. As he gets stronger we can increase that. I think walking your dog is also a quality of life issue. They just enjoy walking with us. Thirdly, he needs to be on medication for the pain. If he was much younger, I would talk about glucosamine, but at his age a non-steroidal combined with a pain medication like tramadol (a narcotic-like pain medication) tends to be very effective. Before we start these medications, we should run a blood screen to be sure we aren’t missing anything and that there are no contraindications to these medications. If he responds well, in a month we may want to repeat some basic blood tests to be sure that he is having no ill effects from the medication. Once you begin this exercise and medication regimen within a week you should be able to decide if we are helping Roscoe. Don’t try to read between the lines. If there is improvement, it should be obvious.”

After only a few days Liz called to tell me how thrilled she was with how well Roscoe was doing. He was up to two 10 minute walks each day. He was having no more trouble with the back steps; he was clearly enjoying life once again.

I had cautioned Liz that I didn’t know how much longer we could keep Roscoe comfortable and she understood. She explained that she would do anything she could to buy even a little more time with her best friend. He did quite well for close to four months and then began to slowly deteriorate again. When we met again at the cemetery, Liz and I were both thrilled with the four good months we had bought her pet. We both had tears in our eyes when we said goodbye to Roscoe one last time.

During almost 40 years of practice I have seen some dogs (and cats) respond to treatment and do well for years and I have seen others we simply could not help. More often than not, pets do well on medication, but unfortunately, it’s often hard to predict results; you just have to try. Again, this is a 3 step program that needs to be supervised by a caring veterinarian. . You have to be willing to evaluate your pet’s diet (he belongs on a quality senior diet and he needs to be weight appropriate), he needs exercise, and he needs prescription medication. Home remedies can be ineffective or even dangerous. 

1 of 2: Does arthritis mean euthanasia?

Early one evening Liz called. “Dr. Cohn, I got your number from the Tucson Pet Cemetery. I wondered if you could meet me at the cemetery and look at my dog. He’s 14 years old and I think it might be time to put him to sleep. He has a really hard time getting around. If you can’t help him, you can put him to sleep at the cemetery. I already have a burial plot. I’ve talked to the director and she has no problem with us meeting at the cemetery for this examination and possible euthanasia.

(There is a part of me that has to wonder how a dog feels about going to see the vet at the pet cemetery. I know if my wife arranged for me to meet with my physician at the mortuary I might have some second thoughts.)

At 1:00 the next afternoon I was visiting with Liz and her 85 pound shepherd mix, Roscoe. “Please tell me all about Roscoe, how long he has been like this and what your other veterinarian has suggested and anything you are doing to help him.”   

She wiped her eyes and briefly talked about her pet’s earlier and very healthy years. Then she told me why we were meeting. “I guess about two years ago I first noticed he was having more trouble getting up in the morning. It took about five minutes for the rear end to catch up with the front. But, as the day went on, he always did better and better. He’s never been much of a walker and he continued to do well on any short walks we might take, but over the last year or so we’ve stopped taking any walks. I just go out in the yard with him. Now he is having more and more trouble getting up during the day. Last week I noticed he was having a hard time going down the few steps into the back yard. Over the weekend he tripped when he was coming down the steps and cried out. That’s when I knew it was probably time. After all, he is 14 years old and he’s had a long, wonderful life. I don’t want to watch him suffer like this. I know his arthritis must be terrible!” 

“Has your current vet made any recommendations?”

With no hesitation she explained. “It’s so difficult to get him up into the car; we haven’t been to the vet for several years. I did talk to him over the phone, and he agreed that Roscoe had arthritis and maybe it was time. “

Roscoe was laying comfortably in the shade, so my exam began with him right where he was. I always start with the easiest and least painful things. The ophthalmoscope showed some increased cloudiness in his eyes caused by lentricular sclerosis which is due to the normal aging process of the lenses. This is obvious to us but not to the dog and there is no interference with his vision. In most dogs this process is not due to cataracts. The otoscopic exam showed very clean canals (common in the dry desert southwest; much less common in the humid Midwest where I saw yeast ear infections almost every day). His teeth showed early tarter but his gum tissue was still healthy. (Smaller breeds tend to accumulate tarter and suffer from associated periodontal disease at a younger age than do larger breeds probably due to the increased space in the larger breeds’ mouth.) His heart beat was slow and regular; his coat was clean and healthy in appearance. His nails needed cutting (quite common in less active aging pets (canine and feline).

Next we helped Roscoe stand and I deeply palpated his abdomen and began to evaluate him for neurologic or arthritic changes that would make it more difficult for him to get around.   

You’ll have to wait to see what I found to read about Roscoe’s destiny in the second part of this story. (You can make some guesses in the meantime.)

Buried catgut sutures create multiple abscesses along suture line

My wife and I spent a few days in Homolovi Ruin State Park (Arizona) in early May. With our small motorhome already set up in the campground, we decided to walk to the Indian ruins, but they turned out to be much farther than we had originally guessed. On the way we stopped to eat a picnic lunch and flagged down a campground host to ask how much further the ruins were. Susan graciously offered us a ride because we were still some distance away. After walking around the ruins, she offered to take us back to the campground. On both trips we shared the vehicle with her young and friendly Blue Tick Healer mix that she had rescued almost a year earlier. It had been plagued with some serious health issues but looked fine now. Only two weeks before, Jenny had undergone an exploratory surgery. Her abdomen was still clean shaven. Down the center of her belly ugly fresh blisters (abscesses) covered the incision scar. 

I asked, “So where was the exploratory surgery performed? It looks like Jenny is reacting to whatever suture material they closed her abdomen with. The surgeon will have to open the blisters and pull out the reactive suture material. By now the muscle has healed, but the ‘buried’ suture needs to be removed before the blisters will disappear.” 

She explained that the surgery had been performed in Phoenix, and she didn’t know when they could get back. “Could you do it for me?”

We’d been on the road for about 10 days and hadn’t brought any veterinary supplies with us. I explained I had nothing with me and she anxiously responded, “I probably have most of what you’ll need. I have alcohol, gauze, and even a scalpel blade. What else might you need?”

“The only other thing would be a tweezers and sharp scissors.” Before she could respond, my wife answered. She had both.

We headed to Susan’s campsite, submerged all the instruments in rubbing alcohol and while Jenny lay comfortably on a blanket covered picnic table, I scrubbed up.

In less than 15 minutes, I had made a few painless incisions through the largest blisters and removed two large knots and a few inches of what appeared to be number one cat gut (a very large and reactive – meaning the body tries to reject it -  type of suture material).

The campground host’s eyes bugged out at what I had pulled from the wounds, and I explained, “I didn’t think vets were even using this type of suture material any longer. If you use the littlest size and keep the knots small, it might be fine, but with that size suture material and those huge knots, I’m not surprised we got this kind of reaction.”  

We finished the procedure without hearing a word from our patient. Susan couldn’t thank me enough, and I have to admit, I enjoyed every minute of it.