Expert: Jana Connell RVT, CVT - 2/4/2010

Question
Hello,
I have a 5 month old female Golden Retriever puppy, Mia, who suddenly began with a consist limp in her front left paw about a month ago.  We immediately went to our vet, where it was suggested that we give her a pain killer (Metacam) and return in a week.  The follow week the limp persisted and we were told to continue with the Metacam every other day and to begin giving her .5 mg Dexamethasone 2x/day.  Today we returned for another check-up where she underwent an x-ray. The vet was not 100% certain but thought that it may be Panosteitis, as there is a unclear area on the outer edge of her femur bone in the x-ray.  He wants us to continue with the Dexamethasone for 5 days and the Metacam every other day and to return in 2 weeks.

Her energy level appears to be high, like a puppy's should be, and although she doesn't want to run or go walking as much as she used to, she still continues to rough play with other dogs when given the opportunity.  We feed her a Akana and at times she doesn't finish all of her food right away, but if given some time she will return to it.  She does sleep a lot in the evenings as well which we can't tell is because she is really tired or bored.

Our concern is obviously that we don't know much about this disease and if she even really does have it.  He has mentioned to us that certain bone diseases can progress rapidly and we are worried about waiting 2 weeks to return.  We also live in Guatemala and our vet speaks Spanish (as do we but at a more intermediate level).  We feel like we understand what he has explained to us, but don't trust that he has given us much information as we would like (a cultural difference here). We have to do all the asking and don't get much information in return.  We are interested in knowing if there are any supplements or holistic remedies that may help alleviate her pain and help with the issue, but it doesn't appear that he is knowledgable or open to discussing these options.

We would really appreciate any advice you can provide to us.

Thank you,
Krista & Ben

Answer
HI Krista,
This is a tough one if you are not getting any information from the vet over there. I have copied an article that explains the disease in some detail along with treatments for you here:

"Overview

Panosteitis is an inflammation involving various layers of the bones of young, growing dogs. This condition occurs spontaneously and ultimately resolves on its own. Other names for panosteitis include enostitis, eosinophilic panosteitis, juvenile osteomyelitis and osteomyelitis of young German shepherd dogs.

The exact cause of panosteitis is unknown, but the disease tends to occur in large and giant breed dogs between five to 12 months of age. The German shepherd breed is most commonly affected. Males are more commonly affected than females. In females, the problem can be associated with coming into heat for the first time.

Panosteitis can cause severe lameness in more than one leg. The degree of pain may be such that the dog develops a fever, stops eating and starts to lose weight.

What to Watch For

# Shifting leg lameness
# Fever
# Loss of appetite

Diagnosis

Diagnostic tests are needed to recognize panosteitis and exclude other diseases that cause similar symptoms. In addition to obtaining a medical history and performing a thorough physical examination, tests or procedures that your veterinarian may wish to perform include:

# Orthopedic examination. Your veterinarian will usually watch your dog walk in order to assess the lameness. Each individual limb is then usually examined. Front legs are usually affected first. Pain can be found on deep palpation (applying pressure) over the areas of inflamed bone.

# Radiographs. Radiographs (X-rays) can be helpful to make the diagnosis, but the changes in the bone can be very subtle and difficult to visualize on radiographs.

Treatment                

If panosteitis is diagnosed or highly suspected, treatment will consist of rest and anti-inflammatory pain-killers such as aspirin.

Home Care and Prevention

Home care is primarily aimed at limited your dog's movement. Keep your dog quiet and rested in a small area of your home or in a crate.

A short course (seven to 10 days) of aspirin or another anti-inflammatory such as Rimadyl® or Etogesic® may be recommended. Do not administer any drugs that have not been prescribed by your veterinarian.

There is no way to prevent this problem from occurring. However, you should take comfort in the fact that this disease usually runs a short course and almost always disappears without specific treatment. It has an excellent prognosis.

Be prepared for the possibility that the clinical signs of pain and lameness may wax and wane, come and go, and shift around to different legs before it disappears entirely. It will usually resolve by the time your pet reaches maturity. Appreciation of the "shifting" nature of this disease will minimize your frustration when it reoccurs in another leg.

Information In-depth

Lameness in young, growing dogs may be caused by a number of diseases. Some of the more common causes of lameness in this age group are:

# Hypertrophic osteodystrophy (HOD) HOD causes inflammation and swelling in the growing region of young bones. This differs from panosteitis, where the pain and inflammation tend to occur in the mid-section of the bone.

# Osteochondrosis and osteochondritis dissecans Developmental cartilage abnormalities in the joints of growing dogs, such as osteochondrosis (OC) and osteochondritis dissecans (OCD) can produce a similar lameness. But with these conditions, the problem exists in the joints, and pain is elicited when the joint is manipulated, rather than when pressure is placed on the bone as in panosteitis.

# Bone cysts Bone cysts can occur in young dogs that have a history of lameness. Affected dogs exhibit pain when the diseased bone is palpated (technique of examining organs and body parts by touching and feeling them). This is an uncommon disorder.

# Hip dysplasia When the hind legs are affected owners may mistake the lameness for hip dysplasia.

Veterinary Care In-depth

Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnosis In-depth

Diagnostic tests are needed to recognize panosteitis and exclude other diseases that may cause similar symptoms. Many times the diagnosis is presumptive and response to treatment is the only way that the presence of the disease is actually "confirmed." Tests or procedures that your veterinarian may wish to perform include:

# Orthopedic examination After taking a detailed history concerning the lameness problem, your veterinarian will usually ask to see your dog walk and trot before beginning a thorough palpation of the affected limb(s). Panosteitis will usually produce pain on deep palpation of the bone (usually the mid-portion of a long bone). The forelimbs are more commonly involved than are the rear limbs. Observing pain on deep palpation of the bone will make your veterinarian consider this disease as being more likely than osteochondrosis (OC) or osteochondritis dissecans (OCD) (both of which usually produce joint pain) or hypertrophic osteodystrophy (HOD) (which usually produces pain at the growing ends of the bone).

# Radiographs (X-rays) Radiographs are usually taken of the affected area to help confirm the diagnosis of panosteitis and exclude other problems, such as a bone cyst. Radiographic changes with panosteitis are often extremely subtle or even absent. It is not uncommon for the X-rays to show the "classic" changes seven to ten days after the problem first starts, by which time your pet may be pained in a different bone or lame in a different limb altogether.

# Repeat radiographs Your veterinarian may wish to take radiographs of the affected area seven to ten days after the initial examination to confirm the diagnosis. Radiographic evidence of panosteitis may be present at this time, even if the initial radiographs appeared normal.

# Nuclear scanning or nuclear scintigraphy These tests may be performed, but are rarely required to diagnose panosteitis.

# Blood work There are no consistent blood work abnormalities in affected dogs.

Treatment In-depth

Treatment for panosteitis may include the following:

# Rest, supportive care and painkillers are usually the mainstay of treatment for panosteitis. The most commonly recommended medication is aspirin, preferably buffered or Maalox-coated (ascriptin). These drugs help to lessen the pain of bone inflammation and can be given with food.

# Warning You should be aware of the possible side effects of aspirin, particularly gastrointestinal upset associated with vomiting, diarrhea, bloody or dark colored stool, inappetence (avoiding food), or just not feeling right. Consult your veterinarian and stop the medication immediately if any of these signs occur.

# Other anti-inflammatory medications, such as Rimadyl® or Etogesic®, may be recommended by your veterinarian. Do not give a painkiller without first consulting your veterinarian.

# Steroids should probably be avoided in young dogs.

Follow-up

After diagnosis, it is important to keep your pet quiet and rested for several weeks. Do not allow your dog to go up or down stairs or jump on/off furniture. To enforce rest, some dogs benefit from the use of a crate.

Allow your pet to go outside just to go to the bathroom (on a leash) and then bring him/her back inside the house."

Now having said that, you asked about alternatives for pain etc.
I do not know of any good pain alternatives for dogs but I am sure there might be something out there that a holistic site could provide. Be careful of that- many alternatives are not tested or proven and can  be harmful.
Get your dog spayed if she isn't- it could help with the pain and the disease.
Steroids are not recommended for younger dogs like her. That is something you need to discuss with him since he is giving them to her. They are anti-inflammitory but so is Previcox and Duramaxx- without out the steroid side effects.

Another thing is no rough-housing. This just makes the pain worse and can cause her to be at risk for injuries. She needs to be more contained while this is healing.

Panosteitis is self-limiting so it will heal, it just takes time. One thing I am unclear of here is that you said she was limping in the front but he xrayed the hind leg? Did he do an xray of her foreleg? While they can get Panosteitis in all limbs and at the same time, you did mention the front leg.
Just wanted to be clear on that. I am sorry I don't know much about the alternative therapies but if you do a search online for them I am sure you will find something that might be useful and safe.

Please let me know how she is in a few weeks.