Dear Doctor-June 2015
Letters to Tufts Veterinarians
What does the waddling mean?
Q My dog always used to walk straight, but over the last several months — maybe even a year — I’ve noticed that he has kind of started to waddle. Instead of traveling forward with his back straight, he kind of swings his back and waddles left and right as he advances forward. He doesn’t seem distressed exactly, but it’s very different from how he had always walked before. Is it something I should be concerned about, or can I let it go?
South Yorkshire, U.K.
Dear Ms. Corwill-Brown,
ABe concerned. We have a hunch that your dog might be suffering from arthritis. People often assume arthritis pain in a dog will be recognized as a limp or difficulty getting up from a sitting or lying position. But if both back legs are affected, a dog might walk just as you describe rather than move his limbs at compromised joints that would keep him straighter, but in pain. In such cases, because the dog finds a way to keep mobile, he could end up going years before the pain gets the better of him and the problem is picked up.
If the arthritis occurs in both front legs as opposed to the two in the back, a dog might shorten his stride and shuffle in an effort to limit the amount of time on each limb.
Another sign of arthritis that can be mistaken for something else is frequent holding up of the front paw. It may not be the paw that’s hurting. It could be the elbow or shoulder, and the dog is holding his limb in an unusual position to relieve joint pressure.
Of course, limping is always a sign of pain. The whole point of a limp is to mitigate pain.
Whether waddling, shuffling, holding up a paw, or limping, a dog should be taken to the vet for a work-up. If arthritis is indeed found to be the cause of the unusual or reluctant gait, the front lines of defense, even if medication or surgery is employed, are weight control and exercise moderation. Sometimes weight management and judicious use of physical activity alone are enough to reverse symptoms, not just impede progression of the disease. Even if a dog does end up undergoing surgery, you can’t leave out lifestyle management to optimize his mobility and freedom from pain. With that in mind:
Keep your arthritic dog thin, as in running or triathlete thin — a little thinner than average. Consider that when a dog walks downstairs, for instance, the pressure on his joints might nearly double. When he jumps, he puts 150 percent of his weight on his front limbs. The less weight, the less pressure — and therefore the less pain.
Moderate — don’t discontinue — exercise. Restricting physical activity only makes the joints work harder. Muscles surrounding the joints work as shock absorbers, taking the brunt of the pressure that comes with each step. If muscles are not used regularly, they atrophy, making them less able to do their job and leaving more impact absorption to the joints, which will degrade them even further if they are arthritic. The trick is to keep your dog active but not with high-impact play that includes the pounding of running and jumping. Go, instead, for leash walks and, if possible, swimming.
QI read with interest your explanation of so-called “air licking” in the April issue as a phenomenon that’s often tied to seizures. My own dog does something somewhat similar yet also different. Yes, he appears to be just sort of looking around in space, but then, instead of sticking out his tongue as if licking, he’ll lunge at something that isn’t there and clack his teeth together. Is that a seizure, too?
Santa Barbara, California
Dear Ms. Murphy,
AVery possibly. The behavior you’re referring to is most commonly referred to as fly biting, and sometimes fly snapping. Tufts Animal Behavior Clinic Director Nicholas Dodman, BVMS, DACVB, says that in many cases, “fly biting appears to have the same etiology as air licking: complex partial seizures, in which electrical activity in a part of the brain misfires and causes the telltale movement.” As with air licking, what’s key to helping with a diagnosis is ascertaining whether the fly biting comes in distinct bouts that last just a couple of minutes. That’s a telltale sign of a complex partial seizure, and if your dog’s veterinarian determines that the fly biting is just that, he or she may recommend anticonvulsant medication depending on whether it disturbs the dog, is getting worse, or has progressed to the grand mal seizures of full-blown epilepsy.
Be aware that while complex partial seizures are often the reason for a dog’s snapping at imaginary flies, they are not always. Dr. Dodman reports, “I did encounter one case some years ago in which a German shepherd was engaging in fly biting, and the owners were told by their vet that it was a neurological problem — which made sense on the face of it because German shepherds are a seizure-prone breed. They were also told the dog would deteriorate over time and not make it.
“But the case was referred to me, and upon questioning, it turned out that there had been some actual flies flying around the house, and the dog had been jumping at them. The thing is, a behavior that started with real flies continued even after the flies were eliminated from the home. It came down to the fact that fly biting became ingrained as an attention-getting behavior. Almost any bizarre behavior can be reinforced by attention from an owner — even negative attention — particularly if the dog is needy.
“In that case, I engaged the owners in a complete attention-withdrawal strategy via a bridging stimulus — a neutral stimulus designed not to be aversive but just to signal a change. The owners happened to have a grand piano, and I advised them that whenever they saw the dog engaged in imaginary fly biting, they should strike a note on the piano and ‘exit, stage right.’ Within three weeks, the dog’s odd behavior had stopped completely because it wasn’t getting him what he wanted — attention.”
That was an unusual case. For most dogs, distinct, shortish bouts of fly biting are indeed complex partial seizures. But you always have to check with a medical professional — and in some cases more than one. You don’t want to put a dog on anti-seizure medication if he doesn’t need it.
A final note: Dr. Dodman has read a fair amount of scientific literature suggesting that fly biting is a behavior that signals obsessive compulsive disorder, or OCD, which requires a whole other set of therapeutic applications to solve the problem. But he doesn’t believe it is. “I think fly biting is an OCD look-alike that in the majority of cases is caused by complex partial seizures,” he says.
Dealing with a Staph infection
QOur dog has had a skin infection on his leg for more than two months and was treated multiple times by our veterinarian with antibiotics, but to no avail. We finally asked for a culture to be lab-tested, and it came back saying our pet had a type of bacterial infection called MRSA. Since then, he has been on a 10-minute soaking regimen each day with diluted chlorohexidine and also application of an antibiotic ointment. We have seen little if any improvement. Can you help?
Simi Valley, California
Dear Ms. Daggs,
AIt’s not surprising that you have had trouble successfully treating your dog for MRSA. It’s rare in dogs. An acronym for methicillin-resistant Staphylocococcus aureus, MRSA usually affects people. And it presents a particular problem in people precisely because, as the name suggests, this type of staph infection does not respond as desired to methicillin, a penicillin-type drug. It resists the drug’s efforts to kill it.
Fortunately, dogs who get MRSA (almost invariably from an infected person) do respond well to antibiotic treatment. It’s a delay in treatment that allows the infection to progress to a more advanced state, not any problem with the treatment itself.
Without seeing your dog and culturing the bacteria of his infection for ourselves, we cannot tell you what antibiotic he needs. He may need to have the topical medications applied more frequently or require the addition of an orally administered antibiotic.
Interestingly, the most common staphylococcal bacteria that causes infections in dogs is Staphylococcus pseudintermedius, often in the form of skin infections. And just as S. Aureus rarely affects dogs, S. pseudintermedius rarely affects people. Whether affected by either S. pseudintermedius or S. aureus, dogs usually respond well to antibiotic treatment. Sometimes topical treatment will do the trick if things have not progressed too far.
The good news in all of this: unlike with people, “the development of superbugs resistant to all known antibiotics has so far been very uncommon in veterinary medicine,” says Michael Stone, DVM, DACVIM, an internal medicine veterinarian at Tufts.