What is HOD, what causes it and which dog breeds are most at risk?
As explained in a short paper sponsored by the UC Davis Center for Companion Animal Health and authored by Noa Safra, DVM PhD, Niels Pedersen DVM PhD and Danika Bannasch, DVM PhD:
- Hypertrophic Osteodystrophy (HOD) is a canine auto-inflammatory disease affecting young rapidly growing large breed dogs between eight weeks to eight months of age. Sick dogs exhibit swelling and pain in their legs with reluctance to stand or walk. In addition to orthopedic pain, there are variable systemic signs of which some or all may be present during an HOD episode. Systemic signs include fever, lethargy, depression, and loss of appetite. A diagnosis of HOD is founded on radiographic evidence of bone involvement concurrent with hyperthermia and pain, and by ruling out infectious causes of the clinical signs.
- The cause of the disease is unknown and current treatments are focused on controlling the fever, alleviating the pain and treating the specific systemic signs present. Prognosis for severe cases is poor due to relapsing episodes and the low quality of life for the affected puppies that sometimes result in euthanasia.
- Several breeds of dogs, including the Weimaraner the Irish Setter and the Great Dane, are at high risk for developing HOD. Therefore, an inherited component is highly probable. Entire litters of Weimaraners, as well as closely related individuals, were found to be affected, also suggesting a strong genetic effect in the breed.
- The aim of this study is to identify the genetic basis of HOD in susceptible breeds. By identifying the chromosomal regions associated with HOD, we hope to assist breeders to select against the disease in predisposed breeds. Selective breeding will reduce the number of HOD affected puppies in the general population and perhaps save puppies and owners from the devastating outcome of euthanasia.
Spoiler Alert: This story has a happy ending!
Sean and Clark, members of our Onpets family and founders of the UrbanDog blog, added Bodhi, a beautiful Weimeraner puppy, to their family in 2012. Bodhi fell ill with HOD soon after and was ill for many months and hospitalized twice. Dr. Safra told Bodhi’s parents that he “was a nine on a one-to-ten scale. Ten would be pups who by the age of two or three are dead due to complications.” Sean and Clark encountered several well-meaning veterinarians who were not familiar with HOD in its most devastating, multi-systemic form. This meant that Bodhi twice received treatment that was ultimately ineffective and he remained very ill until his parents, working with Dr. Safra, figured out the correct treatment protocol for Bodhi…hence the happy ending. This is their story. As Sean told us, “We want to share our story because, with patience and care, you can get your puppy through this potentially catastrophic condition.”
Bodhidharma Beasley-Sheer joined the family in New York City on June 26, 2012. He came from a reputable breeder, from a litter of nine. Bodhi descends from one of the show lines; his father competed in Westminster two years earlier.
Signs of Trouble
In July 2012 Bodhi came down with a persistent bout of diarrhea. His local veterinarian conducted a routine examination but could not find any obvious underlying cause. The next morning he seemed very tired and he wasn’t drinking much. Later that afternoon Sean and Clark noticed that Bodhi was not placing his right paw down. He had just walked through some prickly holly leaves so they thought maybe Bodhi had somehow irritated his foot pad. He continued to be lethargic for the rest of the day so his parents called the vet who told them to monitor Bodhi. The next morning he barely moved and his body was hot to the touch. Bodhi’s parents took him to a nearby emergency animal hospital where they told us he had a fever of nearly 106 degrees. Initially, the vets at the hospital seemed unsure of what might be ailing Bodhi, but eventually they came up with a diagnosis of HOD.
Bodhi was treated with a non-steroidal anti-inflammatory drug (NSAID) called Rimadyl and a pain killer, Tramadol. This is the common treatment for most large breed dogs who get mild, uncomplicated cases of HOD. After two days in the hospital, Bodhi was released and seemed largely okay. He was limping a bit, but that cleared up over the course of the next few days. Sean and Clark’s initial research online did not indicate that HOD affected Weimaraners differently from other breeds and the vets at the hospital did not tell them that HOD was of particular concern for Weimaraners.
They contacted the breeder and she referred them to the handbook she gave them when they picked up Bodhi. It referenced HOD research that had been done a decade earlier. Bodhi’s parents investigated further and soon discovered articles about Dr. Safra’s work at the UC Davis College of Veterinary Medicine. They learned that Dr. Safra is a recognized expert in HOD. They also contacted the Weimaraner Club of America and spoke to a member of the health committee who echoed what they’d learned about Dr. Safra. Sean and Clark immediately reached out to Dr. Safra to establish a connection in the event Bodhi fell ill again.
Bodhi did well for about a month and then, out of the blue, he got sick again, this time with diarrhea and a bad cough. Sean and Clark took him to their vet and she prescribed some medicine for the cough and advised them to observe Bodhi closely. A few days later the cough worsened and he started limping again. They returned to the hospital and the vets there diagnosed Bodhi with pneumonia and determined that his HOD had flared up again. Again they prescribed NSAIDs and painkillers. Sean and Clark shared information about Dr. Safra’s work on treating HOD-afflicted Weimaraners with immuno-suppressive doses of Prednisone, with the emergency room vet but he said he couldn’t put Bodhi on the medicine because Bodhi had pneumonia.
Bodhi’s parents then appealed to a second vet at the hospital with whom they had a closer relationship, Dr. Christina Moore. Dr. Moore called Dr. Safra who advised that Bodhi needed to get on Prednisone as soon as possible and that the medicine would clear up the pneumonia, which was HOD-related. Bodhi was immediately taken off the NSAIDs and given Prednisone.
The picture below shows Bodhi in the hospital being weaned off the NSAIDs before he was given Prednisone. Note how swollen his legs were.
Is there a difference between HOD in Weimaraners and in other breeds?
Onpets spoke with Dr. Moore to find out if there is a differences between HOD in Weimaraners and HOD in other breeds. Dr. Moore stated that Dr. Safra’s research is showiing that there is absolutely a difference in the way the disease manifest and behaves in Weimaraners as opposed to other breeds. Weimaraners have an immune mediated component of the disease which is why they need the immuno-suppressant doses of Prednisone as opposed to NSAIDs. There are other breeds which can experience very extreme cases of HOD and which therefore also do better with Prednisone vs NSAIDs, but more research is needed on the way the disease has developed, why it is particularly vicious in Weimaraners and the effect of the disease on other breeds.
Are there different treatment protocols which are breed-based?
According to Dr. Moore, there are but there are also very few treatment protocols because the disease is still relatively unknown. In Bodhi’s case, every veterinarian refused to put him on Prednisone but because Dr. Safra’s research made so much sense to Dr. Moore, Sean and Clark were able to convinced her to try. Dr. Moore stressed the importance of being a strong and well-informed advocate for your fur baby. As she said, “Sean and Clark were not just Googling – they had done some serious research.” Bodhi was in such terrible shape and would have died had Dr. Safra not done her research, had Sean and Clark not found it and had they not been able to convince Dr. Moore to try it.
Round Three…and last, thank goodness!
Bodhi’s recovery took some time. He couldn’t walk at all for about a week after being discharged from the hospital. Eventually he got up, but his legs were so weak and painful that walking was clearly very difficult for him. Sean and Clark worked with Bodhi over the next few months using physical therapy, and slowly, but surely his legs got stronger. The biggest problem was every time they tried to lower the dose of the Prednisone, Bodhi would start to show indications of a flare up. One of the earliest signs with Bodhi was a green discharge from his eyes.
The video below shows Bodhi walking a few weeks after treatment with Dr. Safra’s recommended dose of Prednisone. If you look closely you can see his front paws look almost like flippers.
After many months, he was walking pretty well and was finally able to stop taking the Prednisone.
Is pneumonia always a side-effect of HOD?
According to Dr. Moore, it is not. “A lot of puppies just have fever and swollen joints and other inflammatory side-effects. Diarrhea can be a side effect as well but not always. Pneumonia has to do with the immune mediated component of the disease, which appears to be part of the manifestation in Weimaraners. Even though Bodhi had pneumonia, the NSAIDs were the appropriate initial treatment protocol but they weren’t working. His veterinarians had been giving him medications to treat each symptom but his immune system was causing the issues so he needed to be on an immune suppressant dose of Prednisone. Having said this, it may also be arguable that you should start any Weimaraner with HOD on Prednisone immediately rather than starting with NSAIDs.”
Sean told us, “We don’t want to sugarcoat anything. HOD can be really bad. It was heartbreaking to see our dog get so ill. However, we cannot stress enough that with Dr. Safra’s help, the care of enlightened local veterinarians like Dr. Moore, and the right treatment, Bodhi got better. Today he is a happy, healthy, energetic dog. In fact, here’s a picture of Bodhi last summer enjoying a game of fetch!
Here is a video of Bodhi about a year after he went off Prednisone:
Before and After
Below are before and after pictures of Bodhi’s front legs, which were hit hardest by the disease. On the left, you can see how knobby the joints were, that his wrists had no strength, and that his paws laid almost flat on the ground. You can see on the right that his legs are now far less lumpy and that he’s largely resting on his toes, as he should. His legs are still short for a Weimaraner, but that doesn’t seem to be to be slowing him down at all.
Do your homework! Make sure you read everything you can about HOD and Weimaraners. Make sure your sources of information are reputable. Consult experts with verifiable credentials and experience with HOD in Weimaraners.
- Make sure your veterinarian does his or her homework! Bodhi’s parents don’t want to fault some of the vets they saw for not knowing about Weimaraner-specific diseases, but if you are reading this, you are aware of the problem. Make sure your veterinarian is too. Advocate for your dog with your vet. If Sean and Clark had not pressed, it’s likely that Bodhi would’ve died during his second hospitalization.
- Be patient. This is probably the hardest part. It was truly horrible seeing Bodhi so sick. But his parents knew that he’d eventually get through it.
- Stay the course! Be diligent about administering the medicine and keep a close eye on your dog for any changes for the worse. Relapses are common in severe cases of HOD.
- Be very careful when consulting “Dr. Google!” Dr. Google is not a veterinarian or anything close to it. There’s a lot of misleading and even outright wrong information on the internet concerning HOD. Talk to the experts: Weimaraner breeders, the Weimaraner Club of America, specialists at your regional veterinary teaching hospital, and acknowledged health-care experts like Dr. Safra
- And finally, shower your Weimaraner with all the love you can. Dogs are only with us a short time. Make it the best time you can.
Again, here’s another picture of a happy and healthy Bodhi living the good life at the beach.
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