Eirecrest Moonlight Magic (BaiLee) Journey through HOD

[Eileen Chesworth]

I am going to record BaiLee's diagnosis, treatment and prognosis for all to learn - from Jim and Eileen Chesworth

BaiLee was a normal puppy until he turned 4 months old. He was his usual self the night before. He liked to romp and was enthusiastic about learning. He was attending doggie school where he learned that all dogs are not approachable, heel , sit, stay, down and walk on a lead. We learned how to deal with dominating, mouthing and pawing behaviour effectively. BaiLee loved his crate and house trained after 3 accidents in the house.

The cause of HOD is unknown to date, therefore I am recording what I know for sure. We had been taking our puppy to the dog park where he could play with other dogs and socialize. BaiLee was not fond of car rides from day one but we had hoped that he would overcome this fear. He would froth and vomit occasionally. I feel that doggy school may have caused him stress because he is very smart with words. When we said, "Lets go to BaiLee school?" he went and hid under the table. He was also given his rabies shot a week before the onset of his symptoms.

When he was about 3 & 1/2 months old I noticed his second eye lids were VERY red and had a grayish discharge. I also noticed his JOINTS in his front legs were ENLARGED. I did not know, at this time, that those signs are NOT NORMAL because we have never owned an Irish Setter or a larger dog before.

BaiLee eats fresh or frozen vegetables, fruit and ice cubes as a treat. He lespecially oves honeydue, watermellon, brocollini, green beans, carrots, grapes, and ice cubes.

His usual routine was: get up at 5:30 am, go outside to do his business, eat and sleep till 10 or 11 am. Then he came to life and all hell broke loose. He wanted to run and play. Then came the horrible day. We noticed our little puppy was not himself. It was around the end of January 2008. This day he did not want to come out of his crate, you could see he was uncomfortable, he went outside and came back and laid on his bed. He did not want to eat.

I could tell he was running a fever. That afternoon my husband took him to our vet. They did blood work and those tests came back normal. He was sent home. The second day he was still in a great deal of pain, he was not eating, he did not come off his bed and was still running a fever.

We notified our breeder immediately. Our breeder felt it was HOD. She emailed the new treatment protical to us and we gave it to our vet, however our vet was cautious at this point. Our vet has never had the pleasure of caring for an Irish Setter before. Our vet sent the xrays to a specialist who verified the HOD and sent our vet a copy of the new treatment protical for HOD which was exactly the same as the breeder had provided.

At this time it was imperative to keep this young puppy quiet. We stopped his schooling, took him for gentle short walks, kept him on a lead in the house and put him in his kennel when he was frisky.

The new HOD protical is as follows:

30 mg of Prednisone, Pepcid AC, plus Klavamox (twice a day for 4 weeks) for 4 days

15 mg of Prednisone, Pepcid AC plus the Klavamox for 7 days

10 mg of Prednixone, Pepcid AC plus the Klavamox for 7 days

5 mg of Prednisone, Pepcid Ac plus the Klavamox for 7 days

5 mg of Prednisone every second day, Pepcid Ac and Klavamox for 3 more days twice a day

In addition he had pain medication as needed: 50 mg of Tramadol ( it ended up being 3 times a day)

Initially we intised him to eat with wet food. We also hid his medication inside a ball of wet food. Then he became ravinous from his medication. This appetite along with his limited exercise routine resulted in weight gain, which is NOT GOOD for a puppy who has joint problems. We thought we would worry about the weight gain once he was healed.

BaiLee has finished his medications on March 22, 2008 and has had to have pain medication yesterday and today, March 23, 2008. He is limping badly today, even after the pain pill. His eye lids are still red with a discharge.

We are going to make an appointment with the vet for tomorrow. Stand by for an update.

Bailee seemed to doing well for a couple of weeks then he made a turn for the worst.

We went back to the vet and had to start treatment all over again. It was heart breaking

We were more determined than ever to keepailee quit so we olayed catch in the living room. his walks were on to do his business then back on the leash tied to the coffee table.

As the weeks passed you could see a definite improvent. By July our walk were 1 block and back. By August there was no signs of the HOD Bailee was once again back to his old ways. We kept his running to a minimum but he could walk all he wanted.

September we went back to the Vet for exrays. the swelling was down significantly in his joints andd the exrays looked good.

Nov 5, 2009 Bailee has made a full recovery and is now part of an HOD study being conducted at Clemson u on behalf of the Irish Setters of America. They have taken blood, DNA profile and a full medical history.

The one thing we know for sure is they don't know what causes it. Here is a list of things they are concidering

1. Rabies shots being given too early next time I would wait until my puppy was 1 year of age
2. Stress
3. Hereditary

[Susan Stone]

Hi Eileen,
thanks for sharing - this is a disease I have not heard very much about (first on this site I think). I looked it up and found the following site: http://www.peteducation.com/article.cfm?articleid=446 with more information.
Wishing you and BaiLee all the best and fingers crossed he will be OK soon!

[Judi Schuerman]

Hello Eileen,
Thank you for sending me information about visiting your site. I've read through your posting and found it very informative. Annie does not like to ride in cars either. I have problems getting her to get inside my car. She does everything to distract me so she won't have to go. I decided to use our bigger car and put a crate inside it. She likes the crate.
Also, the tissue underneath her eyes get a firey red at times, not always. She is going to her second obedience sequence now and wants to play with all the other dogs. She is getting stronger and I am using a chain collar now when we train. Annie is getting possesive and barks at noises at night. Thank you for sharing your experience.
Judi

[Camilla Ostman]

I had this article saved.All I know is that this HOD seems more common in America as Europe to my knowledge doesnt hear of it often, am I wrong?
We jab our dogs for rabies and have to do it in most countries to be safe but havnt heard of rabies giving HOD.
Although I beleive in jabing as little as possible and with good amount of time in between all sorts of jabs as it puts the immune system down.
Be interesting if there are people out there that knows anything about jabs and reactions???
being ill in cars can have nothing to do with it , puppies grow out of carsickness just like kids!

Hypertrophic Osteodystrophy
(HOD)
S. Gary Brown, D.V.M., D. A.C.V.S. Irish Setter Club of America
Irish Setter Health Committee Member
Introduction
Hypertrophic Osteodystrophy (HOD) is a developmental disease in larger breed dogs (commonly, the Great Dane, Alaskan Malamute, Weimaraner and Irish Setter). This disease usually begins between the ages of 3 months to 5 months of age. Signs can vary in intensity, and several dogs from one litter may be affected, although at different times. The heritable predisposition of the disease has not yet been documented, and the Irish Setter Health Committee is supporting research into possible DNA HOD markers. The information in this paper is based upon current published literature on HOD, treating six Irish Setters personally and from telephone consultations in 32 cases of Irish Setter HOD.
Clinical Signs of HOD
HOD affected animals generally present with lameness or reluctance to walk. Early in the disease, the metaphyseal regions of the long bones (the area above the diaphysis (mid-shaft of long bones) and below the physis (the growth plate)) will be tender to digital palpation, slightly swollen and warm to the touch (using the inside of the wrist). The disease is usually bilateral, most commonly affecting the distal radial/ulnar metaphysis (above the wrist joints), although the metaphyses of all long bones are susceptible. More adversely affected animals may be systemically ill, exhibiting fevers of 104 – 105.8°F and anorexia (refusal to eat).
While symptoms may be episodic, without treatment the disease generally progresses, with HOD affected dogs continuing to experience high fevers, anorexia and rapid weight loss.
Physiological Changes
Initially, necrosis of the capillary loops that invade the cartilage model of the metaphyseal physis occurs in the primary spongiosa. The calcified cartilage lattice of the primary spongiosa becomes elongated, impacting the trabeculae. Necrosis, failure of osseous tissue deposition on the calcified lattice and trabecular microfractures are associated with acute suppurative inflammation in the intertrabecular areas. With progressing inflammatory changes, periosteal calluses form over the distal ulnar metaphysis. Radiographic changes reflect the underlying histologic changes, and include a radiolucent line (HOD line) parallel and immediately adjacent to the growth plate in the metaphyseal regions. (Trostel, Pool, McLaughlin). This line represents bone necrosis and reabsorption of some of the microspicules of bone. (Troestel, Pool, McLaughlin). With treatment and effective healing, the cuff of metaplastic cartilage and bone bridges to the cortex and moves toward mid-diaphysis (midbone).
These HOD related changes can disturb normal cartilage growth and development of the adjacent growth plate (physis). The resulting interference in the cartilage transformation into bone (endochondral ossification) at the growth plate may be visualized radiographically as finger-like projections extending into the metaphyseal marrow. Absent efficacious treatment, the growth plate disruption may result in shorter bone length or long bone curvature, especially at the wrist, e.g., radius curvus. In my experience, this is more common in the Great Dane than the Irish Setter. Additionally, dogs with sustained signs of high fevers, interstitial pneumonia, and bronchitis may have soft tissue calcification.

Causes and Predispositions
The cause of HOD remains unknown; however, there are many speculations. In Weimareiners, a hyper immune response to some trigger has been noted (Abels, Harrus, Angles; and Harrus, Waner, Aizenberg). The disease in Weimareiners sounds a lot like the disease in the Irish Setters (Angles). This is the rationale for anti-inflammatory prednisone. Stress may precipitate the disease, including a rapid dietary change over 1 to 6 days. Viral causes and vaccinations also have been implicated, although they too just might be one more kind of stress, e.g., 3 to 5 days after the third “combo” vaccine (modified live virus), after administration of Rabies vaccines in four- month old puppies (two cases), or a fourth (often unnecessary) vaccine at 16 to 18 weeks. Vitamin C deficiency also has been speculated as a possible cause; however, there is neither documentation nor scientific reason for this in the dog, and Vitamin C therapy has not met with scientific success.
An infectious origin has been proposed, and there are reports of hematogenous (blood borne) bacteria producing florid radiographic changes in the metaphyses similar to those of HOD. A good radiologist may be necessary to distinguish between possible hematogenous infection, osteomyelitis (bone infection) and HOD radiographic changes. This author is unaware of any published literature correlating blood culture results with HOD.
Diagnosis
Diagnosis is usually clinical, with subsequent radiographic conformation. In the early stages there is point tenderness in the metaphysis, and radiographic changes, as discussed above, may be present as early as one week later. There must be an HOD line for a diagnosis of HOD! Metaphyseal regions may remain mildly affected throughout the course of the disease if well treated, or if poorly treated, may show early irregular widening with abnormal endochondral ossification and growth plate alterations. Severe alterations to the growth plate (most often occurring in the distal ulna), may produce lateral bowing deformities of the front legs. CBC will show neutrophilia, with bands of 3% or less. Bands present in quantities greater than 3% increases the suspicion for sepsis rather than HOD.
Treatment
In all cases of HOD, treatment is begun by immunosuppresive doses of Prednisone, covered by antibiotics. The dosing regimen is as follows: (1) place the dog initially on a 1.5 mg/kg/day dose of Prednisone for 4 to 5 days if symptoms show regression, and up to but not more than 7 days if signs are persisting, with half given in the a.m. and the other half in the p.m., (2) gradually wean down for 4-5 weeks, cutting the total daily dose by one-half each week, and (3) administer 5 mg of Prednisone every other day for an additional 1 to 2 weeks. In all cases, also use 3V Caps (or Derm Caps®) and either Glyco-Flex or Multi-source Glucosamine. Supportive care should be provided as needed. We add oral antibiotics: usually Clavamox, Amoxicillin or Clindamycin for 3 to 4 weeks. Also, administer antacids (Pepcid, Zantac) to counter acid secretions stimulated by the Prednisone. With Prednisone treatment, pain medications can be stopped sooner, thereby avoiding possible appetite suppression often associated with pain medications. HOD dogs should not be exposed to possible contagious disease, and owners should be advised not to take their dogs to dog shows, dogs parks, etc.
The prognosis for most cases is good if this protocol is instituted early. Even in severe cases this protocol has been effective. In our experience, mild cases are not difficult to treat, whereas the more severely affected animals require more aggressive care. Those animals that are not treated early may require IV fluids and electrolytes, nutritional support, and tremendous nursing care to arrive at a successful result. Nursing care is paramount in the successful management of the more severe cases. Mild cases which have been treated solely with Rimadyl® or Deramaxx® may respond incompletely, and often have a subsequent relapse.
In two cases of Great Dane HOD, mild puppy strangles (juvenile cellulitis/Staphylococcus plus toxins) were apparent. The use of Prednisone concomitant with antibiotics in cases of puppy strangles was critically important.

Conclusion
Early recognition and appropriate treatment of HOD will hopefully prevent your dog from reaching a critical state. I would hope that some of this information will assist in making the early diagnosis of HOD, and welcome your feed back.
Memo to Members (ISCA Memo) update:
Thanks to everyone who has shared information with me about Hypertrophic Osteodystrophy (HOD) cases. This is very informative and important information.
As a result, a few comments are in order:
1. Be sure sepsis or other infection has been ruled out before initiating glucocorticoid therapy (Prednisone, Prednisolone). Do a complete workup, including a CBC and radiographs. Remember, there must be an HOD line for a diagnosis of HOD!
2. The dosing regimen is as follows: (1) place the dog initially on a 1.5 mg/kg/day dose of Prednisone for 4 to 5 days if symptoms show regression, and up to but not more than 7 days if signs are persisting, with half given in the a.m. and the other half in the p.m., (2) gradually wean down for 4-5 weeks, cutting the total daily dose by one-half each week, and (3) administer 5 mg of Prednisone every other day for an additional 1 to 2 weeks.
3. Cover with Clavamox, Antirobe or even Amoxicillin for at least three weeks.
4. Administer antacids (Pepcid, Zantac) to counter acid secretions stimulated by the Prednisone.
5. Two HOD cases also evidenced sore mandibles before treatment. These cases showed more tenderness than that normally associated with normal puppy teeth eruptions.

Keep up the good work and the flow of information!
S. Gary Brown, DVM Diplomate, ACVS
Trostel, C.T.; Pool, R.R.; McLaughlin, R.M.: Canine Lameness Caused by Developmental orthopedic Diseases, in Compendium volume 25(4). Pp282-293; April 2003.
Abeles, V.; Harrus, S.; Angles, J.M., et al: Hypertrophic Osteodystrophy in six Weimaraner puppies with Systemic Signs, in Vet Rec 145:130-134; 1999.
Harrus, S.; Waner, T.: Aizenberg, I.; et al: Development of Hypertrophic Osteodystrophy and Antibody Response in a Litter of Vaccinated Weimaraner puppies.
Journal of Small Animal Practice 43: 27-31, 2002
Angels, J.M. : Personal communications

[Eileen Chesworth]

Thank you so much Camilla. One thing about the Irish Setter families is that we have a strong bond and desire to learn about our babies. I thank you for the material here. I will read it in detail when I get time. I believe HOD is rare and it may be more prevalent in North America than in Europe because most of the owners are not familiar with the disease in Europe.

I will certainly keep every one abreast of what the scientist discover about the disease. At this point there is just speculation of what might have caused the disease. When we brought Bailey home we let him run as much as he wanted to and for anyone who owns a puppy knows that there is no end to playing and running. The excessive exercise might have caused stress on the joints, he received his rabies shot, we took him to obedience school which was a strict regiment - this emotional stress may have caused the flare up. We just don't know. I guess we won't know till we do more studies. I don't know how long that will take but I will keep everyone updated.

Keep in touch.

[Linda Baldry]

Hi there, my dog Jet was affected by HOD after his initial vaccinations given late at 13 weeks, he could not stand and had a very high temperature, thankfully his breeder Rita Pike made me aware of HODs and with the help of my vet Jet was put on a drip for 3 days and followed the protocol previously posted by Camilla Ostman, he was xrayed and this showed his joints to be swollen, he was only allowed into the garden and for the second part of his vaccination course, was given the vaccine without the Distemper part. Fortunately Jet made a full recovery, he also had a slight reaction to his Rabies vaccs but nothing like the initial syptoms, I would just like to add in case you did not know - but NEVER give dogs grapes, rasins, currents or sultanas, they can cause liver damage and can kill a dog. Hope this information helps, good luck regards Linda.

[Cheryl Gorey]

Thankyou Eileen for sharing your journey with BaiLee on this disease. I personally have not ever heard of it, so it was very interesting.
Thank-you Camilla for this article, I will read and save it with my other dog health information and thanks to everyone for sharing their experiences. This is a great site for us all. cheers from Down Under

[Carmel Murphy]

Thanks to Eileen and Camilla for all the info on HOD(I had never heard of it either) Hope Bailey is as good as new!!

[Dee Rance]

Hi there Eileen, So glad to hear that BaiLee is on the mend...thank you for sharing you experience with us, personally I have never heard of HOD, (fore warned is fore armed) Thanks again and hope he keeps getting better and better

[Michelle Webster]

Hi Eileen,

I am so sorry to hear about your experience, but so glad that BaiLee is now much better. Thank you so much for sharing this with us. I have heard of HOD before, but couldn't remember what it meant, so thanks for jogging my memory. I wish you well in the future with BaiLee and hope that he continues to be well.
Best wishes,
Michelle

[Linda Baldry]

Hi there, just reading your story - my puppy Jet, who is now 2 and a half years of age, was diagnosed with HOD when he was a puppy - he developed a temperature and was on a drip for 3 days, we followed the protocol from the Irish Setter Club of America which my vet was happy to follow, we also had xrays done, Jet was taken ill just a week following his initial vaccination, and I believe it is the distemper in the vaccine, he has never been vaccinated since, he was also slightly unwell after his rabies vaccs, but nothing like the previous symptoms. He thankfully made a full recovery, and is now fit and healthy and enjoying the show scene, he qualified for Crufts last year and also qualified for this years Crufts. Before he has anymore vaccination boosters, he will be blood tested to check his vaccination status. Thanks for posting your story, I hope it helps anyone else who meets with this awful disease. Regards Linda