Thursday, Nov 17, 2011
I usually consult from 9.30 am to 11 am.
A lady owner and two friends consulted me for a 2nd opinion as regards her 9-month-old male Golden Retriever. born Feb 2011, limping on right hind for the last few weeks. Vet 1 had been consulted earlier regarding some skin disease.
Below are my Standard Operating Procedures for examination of canine lameness at Toa Payoh Vets for this case as a real case example as it is easier for reader to understand. Basically it is similar to examination of a lame horse.
1. HISTORY OF LAMENESS - Right Hind lamenss
Purchase - 3 months old from a Pasir Ris breeder
Onset - RH lame seen at 7th month
Duration - 2 months
Further questioning: The puppy does not jump up or down car and does not hop down stairs since purchase. Pain in hip and other joints likely to be present before purchase as most normal puppies will do the jumping.
2. LAMENESS EXAMINATION - Outside the Surgery. As in the racehorse lameness exam.
Limping on right hind obvious as the dog did not put weight on this leg and the left hind hip dipped on trotting.
3. PUT ON EXAMINATION TABLE - Do not examine on the floor!
3.1 Pain check of dog standing esp. spinal area. Spinal T5-L5 slightly painful.
3.2 Pain check by palpation of joints with dog lying down sideways on the table.
Slight pain on extension of right hip and right knee.
3.3 Dog recumbent on right side. Extend and flex all joints vigorously. The owners were worried about my vigorous manipulations but the dog did not react since he had no pain from the extensions and flexions. Some vets do gentle manipulations and mis-diagnose.
3.4 Dog standing on table. Compare length of right and left hind limb by extension and show to the owner the lengths of two hind limbs. In this case, the owner could see that the riight hind was noticeably shorter by 2-4 cm. Subluxation? Mild pain only. To X-ray both hip joints later.
3.5 There are other reflexes to be checked if the dog is paralysed but in this case, it is not. Refer to your neurological exam book.
4. TENTATIVE DIAGNOSIS
Right hip dysplasia likely as this condition is better shown at the 9th - 12th month than as a young pup. To X-ray hip joints at a later date.
5.1 No weight gain throughout his life, thereby avoiding surgery
5.2 No slopes or stair climbing or jumping from sofas etc
6. SKIN DISEASE. A separate case study and procedure which will not be written up here. Generalised pustular dermatitis, elbow and hock sores. Dog likes to sleep on wet floors. Anal sacculitis (pink hairless areas below anus pointed out by the owner). Rashes seen on elbows and hock area pigmentation suggested licking and early onset of elbow and hock sores. Preventive measures including moisturers for a time. The owner asked for Neoderm cream. No cream advised by me as the hair will not grow if the cream is used for a long time.
Best is daily grooming and inspection of the coat for this Golden Retriever and know where the "hot spots" will occur. Dog is clipped bald. Generally, the skin infections are due to bacteria but the vet cannot rule out ringworm and demodectic mites. Vet 1 had scraped skin and found no mites but there was no medical report given to the owner.