The Limp that Started it All - an Introduction to my Elbow Dysplasia Journey

This is the introduction to a multipart post series about my journey with elbow dysplasia & arthritis. Part 2 will cover my surgery and rehab, and Part 3 will discuss my maintenance therapies including stem cells and PT. Those posts will be linked here once published.

I am a Pacific Northwest doggo, but I've also spent a lot of time in the desert visiting my grandpawrents. Despite all my experience doing walkies there, I have never quite seemed to grasp the idea that I shouldn't step on all the pokey plants (momma calls them "cactus"). So, on one of those visits when I was about 6 months old, when daddy took me out for a walk and noticed I was limping (again), he naturally just assumed I'd gotten a cactus needle stuck in my paw (again). But this time, neither he nor momma could find any pokeys in my paw.

So they continued to observe. I'd limp a bit after getting up from rest, but then the limp would disappear after I'd been moving for a bit. At walking speeds it wouldn't show, but at trot it would. Weirdly, while most of the time I seemed to be limping on my right front leg, every once in a while it seemed like the limp was more on the left instead.

Tip: A video of your dog's gait - especially a slow-mo video taken from the dog's level - can help you assess a limp. For forelimb lameness, watch the bobbing of the dog's head, and for hindlimb lameness watch the bobbing of the tail. The head (for forelimbs) or tail (for hindlimbs) will dip down when stepping onto the sound leg, and pull up when stepping onto the lame leg. If the limp is slight, this difference in gait can be very subtle and you'd be surprised how many people - even veterinarians - miss (or misinterpret) the signs!

Anyway, the limping was quite subtle and we would be heading home soon, so we planned to just visit my regular vet once we got home. But by then, the limp had already vanished...at least temporarily. Sadly, it returned a couple of months later with the same faint and intermittent presentation:

Momma had been researching causes of front leg lameness in the meantime, and given that I'd done nothing that should have resulted in injury, she had a sinking feeling that I probably had elbow dysplasia. Dysplasia is a broad term describing a developmental condition where something about a joint forms abnormally. These abnormalities alter the normal mechanics of the joint, prematurely wearing down both cartilage and bone. While osteoarthritis is extremely common amongst aging dogs due to wear and tear over time, dogs with dysplastic joints inevitably develop arthritis in the affected joint(s) at a much younger age, and the joints deteriorate at a much more rapid pace. Elbow dysplasia usually presents between the ages of 4 and 10 months old as an intermittent forelimb limp for no apparent reason.

Dysplastic joints sometimes develop due to trauma or poor nutrition during puppyhood, and the risk also increases with too early of spay/neuter, which delays closure of growth plates in the long bones. But overwhelmingly, dysplasia occurs simply due to poor genetics. And although I'm the absolute best dog in the world (according to momma), I'm a rescue pup whose bio-parents may have each been pure bred (according to Embark) but most certainly were not well bred. (I'll save my rant on unethical breeding and how it contributes to dysplasia and other health issues for a future post. That one is gonna be loooooong and is probably gonna trigger some folks).

Anyway, dysplastic abnormalities can happen in any joint, but you most often hear about hip dysplasia which is quite common in larger breeds. Elbow dysplasia isn't exactly uncommon, but you don't hear about it as much and it's even more of a bummer. The elbow is a more complicated joint than the hip, and in dogs it bears more weight. Not that you'd want any kind of dysplasia really, but when it happens in the elbow it is more difficult to diagnose, more difficult to manage...just a more difficult beast to deal with in pretty much every way.

So the first step was going to my regular vet to get elbow x-rays. They showed nothing amiss but unfortunately that didn't rule elbow dysplasia out. There are several different types of abnormalities all grouped under the "Elbow Dysplasia" umbrella, and really only one type (Ununited Anconeal Process aka UAP) is easily diagnosed on x-ray early on.

So from there we had to reach out to the orthopedic specialists. Covid lockdown had gone into full effect by this time and it made scheduling more difficult, but eventually I was able to get a CT scan. Unfortunately the scan confirmed momma's suspicion - I was diagnosed with elbow dysplasia, more specifically:

• Mild to moderate bilateral joint incongruency - this means that on both sides the 3 bones that meet at the elbow don't fit together quite right. This causes issues with joint mechanics and places excess load on some parts of the bones, which in turn causes...

• ...bilateral Fragmented Medial Coronoid Process (aka FMCP or FMP). This means that there were cracks and fissures forming along portions of my ulnae and radii (lower arm bones) which at any time could dislodge and wear away at other parts of the joint, which would worsen the...

• ...mild to moderate arthritic changes that were already occurring in both joints, which included a lesion in the articular cartilage and subchondral bone on my right humerus (upper arm bone). Dysplastic joints always develop arthritis - I had some already by then; and the arthritis begins earlier and progresses much faster than it would from ordinary age-accumulated wear and tear.

  
  

Although this was what momma expected to hear, actually hearing it was an Absolute. Punch. In the. Gut. It would have been awful no matter what, but keep in mind that she and daddy had just spend a very tough 6 months providing round-the-clock care for Shuksan's end of life journey, followed by a full year of increasingly difficult care for Shasta, who had only just recently followed him over the bridge. To momma, the thought of giving me a future filled with adventures once I was old enough for them had been a lone ray of sunshine piercing through the thick fog of grief. Suddenly even that was snatched away; to be replaced by another long stretch of medical caregiving after surgery, with only a guarded prognosis for my future ability to be active.

So yeah, the diagnosis was, in a word - devastating.

But, skipping ahead a bit...if you've ever peeped my Instagram you'll know that despite my condition, and despite momma's initial fears, here I am over four years later - a happy pup still leading an active and adventurous lifestyle even if it's not exactly the one she had envisioned.

So if you're reading this having also struggled to come to terms with a dysplasia diagnosis with your young pup, please know that hope is not lost and you are not alone. It's perfectly OK to grieve the future you'd planned for your dog to have; that's what humans do. But I can tell you that like me, your dog is just living in the moment so you've gotta meet them there. And whether you have a young dog dealing with dysplasia, or a senior dog dealing with age-related arthritis, the good news is that there are tons of adaptations, therapies, tools, and meds that can help your dog, especially when combined as part of a multi-modal approach to pain management.

In Part 2 of this series I'll talk about my elbow surgery and recovery - be prepared for some "turkey leg" photos! And in Part 3 I'll deep dive into the maintenance therapies that have most benefitted me (and might benefit you if you're a pup with arthritis) so stay tuned!

In the meantime, I'll leave you with a handful of helpful links to resources that have helped my pawrents educate themselves on the topics of arthritis and pain management:

• Colorado State University's Arthritis Overview - a super-high level listing of different categories of therapies to manage arthritis. As you'll read in the upcoming posts in this series, I use strategies from each and every category listed on this page!

• Canine Arthritis Resources and Education - a website aggregating a number of vet specialist articles and videos. A bit difficult to navigate between the free "owner" (I hate that word, let's call it "parent" instead) resources and the paid "vet" resources.

• Canine Arthritis Management - A more parent-focused site which hosts a number of useful free educational tools all about arthritis, but if you want to dive deeper there's a lot of value in their paywalled (but still parent-focused) Member Zone. There you'll find webinars conducted with a number of top vet specialists in different fields around the world. There are also some online paid classes you can take to learn more about all things arthritis. There is also a related Facebook Group where these online webinars are available for a limited time after their live occurrence. (They are all available to view in archive in the Member Zone. Please note that this is a UK based initiative, and there are some location-based differences in treatment options you may learn about as not all meds or procedures that are used in the UK are available in the US or elsewhere, and vice versa.)

• Canine Elbow Dysplasia Facebook Group - The moderator has put together a really great guide in the files (including links to all cited reference studies which themselves are worth exploring). This document helped momma know what questions to ask the surgeon and rehabbers, as well as becoming more aware of various therapy options. Note that although the guide and some of the interventions discussed are specific to elbow dysplasia, many interventions you'll read about are relevant towards arthritis from any source.