[Please note: it's beginning to seem as though there may be two forms of HOD or, HOD-like diseases. The one sited in my article is the nutritional type. The next article, by Hazel Gregory, sites an infectious cause. The treatment is different for both kinds. All of what follows is anecdotal information and should be viewed as such. Because HOD is such a mystery to so many, including the veterinarians, it's likely that one of these 2 protocols will be efficacious.]
I had a friend who's bitch had the lie-there-and-scream kind, and since there was little to lose, they used an injectable form of an analgesic called Banamine (a horse medication) which gave her immediate relief. Intravenous dosage of vitamin C and (I believe, but am not sure here) cortisone is often given. One thing many breeders say to do is immediately reduce the protein content of the food. Down to 17-18%. In mild cases this is often enough to take care of it. This is almost exclusively a problem that affects puppies between the ages of 4-7 months of age.
Here are the symptoms.
(1) Elevated temperature. If over 103, treat like HOD at least until you get to the vet for an x-ray.
(2) Pastern joints are hot to touch and painful to pressure.
(3) Dog does not want to get up and move or moves with obvious
discomfort.
If you even SUSPECT HOD do the following:
(1) Immediately give 2000 mg of vitamin C orally.
(2) Go to the vet and insist that x-rays be taken of the legs. This is the only way to diagnose HOD.
(3) Give IV Banamine. (Deduce dosage by the dosage given for horses, usually by 1000 lbs.) If Banamine is not available, give butazolidin. Give IV vitamin C if possible. Give IV cortisone.
(4) The dog should be put on a wide spectrum antibiotic to prevent secondary infection. It is these infections that cause death in HOD. Mainly pneumonia because the dog only lies around. If you're puppy DOES just lie around, make sure he is moved from side to side periodically during the day if he's not doing this himself.
(5) Reduce protein in diet to 21% or lower.
(6) Continue vitamin C orally at the rate of 2000 mg am & pm.
If caught early (first sign of lethargy and fever) and treated as above, recovery time should only be 2-3 days. However this does not mean your puppy is out of the woods. Relapse, up to 21 days post HOD, is still possible. Keep the puppy quiet (indoor play only) and don't stress him in any way. This means no shows, no car rides (except to vet), no nothing until the 21 day period is over. After that, all being well, he may resume life as normal.
Since HOD only occurs during the fastest growth phase, it seems reasonable to assume that this is somehow linked to fast growth. Another reason to KEEP DIETARY PROTEIN LOW!!!!! The best cure is prevention:
(1) Keep pup on low protein until at least 1 year of age, 24% or lower.
(2) Give oral vitamin C daily, 500-1000 mg am & pm.
(3) DO NOT, REPEAT DO NOT!!!, supplement food with anything that will throw the balance of the food off. Especially, increasing calcium, vitamin D, or phosphorous. This means no added yogurt (except perhaps a tablespoon), no eggs, no cottage cheese or dairy products. No Calcium/D/phosphorous supplement tablets. If you MUST add other foods to the kibble (I admit, I am one who does) make it NO MORE than 15% of the total kibble.
My first experience with HOD, 'Hypertophic Osteodystrophy' was back in 1962 with a Great Dane litter. The best thing I can say about that long, sad and frustrating ordeal is that the learning experience for myself as well as for my vet (Dr. D. Burke, Ft. Worth, retired), has been undeniably valuable down through the following years. The hopelessness of that situation led me to believe that as a serious dog breeder the need for a better understanding of the nutritional needs, and the chemistry of a dog's make-up as well as genetics was of utmost impedance. Thus a long and diligent study of animal and human nutritional needs Is to this day a constant searching; a study of both medical and Mother Nature's facts and theories. I do believe it was this serious study of large, fast growing dogs' nutritional needs as compared to the commercial dog foods available, over the years, has perhaps saved my Great Danes from a repeat episode of HOD as described in veterinary medical publications. Unfortunately that long (20 year) dry spell was soon to end.
It is my hope that this true story will help dog owners and veterinarians recognize that the symptoms of HOD and what I call Pseudo-HOD, a blood infection, or Septicemia, are quite nearly the same. My proof of this claim is a story that needs to be told.
My story starts back in September of 1984, the weekend of the Dallas/Ft. Worth Kennel Club's Dog Shows and the Great Dane Specialty. My husband and I lived about a two hour drive due west of Dallas. I had puppies to sell and I had buyers that wanted us to meet on that dog show weekend. Fortunately I had a friend in Dallas that had room at his home for me and my pups. The Dallas Great Dane Club's Specialty party was to be at his home and I was looking forward to a fun weekend. My friend had told me that his prize female puppy was sick with HOD. His vet, Dr. Chipper Wilkerson, said it was a classic case - but the prescribed treatment didn't seem to help much. I hadn't seen a case of HOD since the 1960's We discussed the pain, high fever, diet and the helplessness of coping with HOD. I couldn't believe HOD was back again. That weekend my friend's puppy was rushed back to the vet and although they did all they could the puppy died. My friend's disappointment and sadness was obvious, but like most dog people he knew one bad to learn to hang in there and move on.
That weekend I had sold several of my puppies to good show homes. Four of the puppies had gone home with their new owners; one to Dallas, one to Houston, one to Alaska, and one to Wisconsin. Three puppies came back home with me. One of these, a male, was to be lead and house trained for his new owner.
The following Wednesday, while working with the male puppy, I noticed he didn't act up to par. I reasoned that he hadn't quite recovered from the stress of the weekend trip and strange surroundings. Thursday the puppy was not any better but was still eating, had no temperature, but was playing less. Friday morning the puppy was sick-sick - completely down. with a raging fever. I rushed him to the vet where I had to leave him as I was to be gone for the weekend on a judging assignment. The veterinarian, Dr. Aleta Pierce in Stephenville, Texas, had just opened her new clinic. She was young, eager to succeed and had a brilliant, inquisitive mind. I felt confident that the puppy would be fine and that I would get a call on Monday to come and get him. Monday I did get that call. Dr. Pierce said, "it took a high dose of antibiotic by IV to bring the temperature down but he would be fine now." The pup's temperature was gone, he was eating, had bright clear eyes, looked and acted fine except he couldn't walk. His rear just collapsed when lie tried. Dr. Pierce said, "he'll be OK. In a few days he'll be stronger and able to walk, He's had more than enough antibiotics to get whatever caused the problem. Take him home to rest and he'll get better."
I did just that. The pup ate well and his eyes were clean he would struggle to stand but fell over when trying to walk. His hind legs just would not work. By Wednesday the puppy's fever was back again; full force! I took the puppy back to Dr. Pierce and left him there.
The next day Dr. Pierce talked to her professors at Texas A&M Veterinary School; she then called me to come to the clinic because we needed to talk. Dr. Pierce said A&M suspected HOD, her first case. The X-rays she took were inconclusive at the point. Note: X-rays usually are at this early stage. My reaction was Instant. From what I had learned HOD is not contagious. HOD is a nutritional chemical imbalance. I explained to Dr. Pierce about my friend's HOD puppy and my puppies being at his kennel. My previous experience with HOD and these current events were very different. Could them be a connection or is this Just coincidental? We talked about the calcium-phosphorus blood serum ratio It was normal. I asked her if this could be a spinal infection. Her antibiotics treatment had brought the fever down even if only temporarily. I suggested trying Chloromycetin. I had learned years ago that Chloromycetin was the only antibiotic that crossed Mother Nature's natural barrier that protects the brain, the spinal cord, mammary glands, and bone marrow. Dr. Pierce said that with the rear end being affected it could be a myelitis, at this point the lab tests and the X-rays are inconclusive. If it is myelitis chloromycetin is the drug to use. We'll have to make periodic -blood tests to watch for a possible blood eclasia, which is unlikely but a necessary precaution when using this drug." (Since then I have been Informed that a blood eclasia does not occur in dogs. only humans.) If this treatment isn't successful and it is HOD, more X-rays will prove such as it progresses. Note again, early stages of HOD do not show joint swelling - Fever and joint soreness comes first.
I left the puppy and Dr. Pierce started him on Chloromycetin, the dosage to be 25mg per pound of body weight, three times a day. The puppy stayed in the clinic through the weekend. Dr. Pierce called on Monday and asked that I come in to see what I thought. It was amazing; the puppy was running around the clinic acting and looking like he had never been sick. Dr. Pierce said, "the Chloromycetin did it and (was to keep him on it for ten days to 2 weeks after which he would be fine." He was, but this puppy was only the beginning of more HOD -troubles to come.
Within the week I received a phone call from the puppy buyer who lived in Houston. Her puppy, "Beau" was from a different litter and was also with me that Dallas weekend; he was approximately two months older than the other puppy. I sold Beau as a top show puppy; his pedigree was excellent. It was a great home for this puppy. I kept his litter sister, my Daria Jane, ten years young, fat and healthy to this day. This new puppy owner said her puppy started acting sick shortly after they got home from Dallas. They had treated him with antibiotics; he improves for a while but then gets sick again. He lies around a good deal and he cries if pressure is applied to his joints; at this point he can hardly walk, and his new owner is very concerned, Her vet, Dr. A. Senske In Houston, Texas, suspects the beginning of HOD but his X-rays are not conclusive yet, he would X-ray again In seven days. I told her about my sick pup and suggested she start her puppy on Chloromycetin, which, she did.
Beau showed signs of feeling better while on the Chloro. He was only on the Chloro two or three days when his 2nd X-rays were taken. The X-rays were sent to a radiology lab to confirm Dr. Senske's diagnosis, again a classic case of HOD. Dr. Senske said to stop using the Chloro as it can't help since HOD is a nutritional (mineral) Imbalance. The new owner was very upset as she liked this puppy. Her husband, an orthopedic specialist, told her "as bad as the puppy's legs are he will never be right." Dr. Senske's prognosis was also very discouraging.
I was frantic! By this time I was convinced that we were dealing with an infection that produced the same symptoms as HOD. I wanted the puppy treated with Chloromycetin. I offered to refund the purchase price if she would meet me half way between Houston and Dallas and return the puppy (an eight hour round trip for both of us), she agreed. When we met to make the exchange I was handed a copy of the lab report that had arrived that morning. We were stunned! It did confirm Dr. Senske's diagnosis of HOD but it also said, "New findings suggest hematogenous (blood) infection as a cause. Do not treat as prescribed for HOD, use antibiotic instead. WOW - I knew I was on the right track!
I brought Beau back home, took him to Dr. Pierce and began the Chloromycetin treatment. It required three series of ten days on and ten days off before we were sure that the infection was defeated. This was the recommended treatment when a chronic situation is suspected. Beau had a serious case. He had been treated with other antibiotics before HOD was suspected which I learned later usually suppresses the infection but will not cure it. Chloromycetin is the drug that works. All Beau's joints were much more swollen than the first puppy's and it took a long time before returning to normal.
Periodically during Beau's recovery Dr. Senske and I discussed this case. He was as surprised as I was regarding the lab report and will confirm the facts of this case as well as other similar cases he has since treated. A copy of this lab report was also sent to Dr. Chipper Wilkerson. He was equally amazed and also supports this form of treatment. This Great Dane Beau grew to his full potential; finished his AKC championship, produced fine puppies and never showed any negative after-affects of his so called HOD. Note: a month later a litter brother to my friend's bitch that had died came down with so-called HOD. This dog was cured with Chloromycetin also. Two other puppies, litter mates to my puppy, the one in Alaska and the one in Wisconsin, had the same HOD symptoms several months later. When I received their owners frantic telephone calls I sent out copies of the lab report. Both dogs were cured after treatment with Chloromycetin.
Remember all these dogs were exposed to my friend's bitch that died of HOD.Periodically through the years I have received many telephone calls from people all over the country who heard that Hazel Gregory knows how to cure HOD. All the calls have been word of mouth reference through Great Dane people. Usually their dogs are in terrible condition by the time they call me and their vet is willing to try "whatever it takes." These vets and owners have all been astounded by the positive results attained when Chloromycetin is administered. Several vets have called me because they were skeptical but agreed to try the Chloromycetin treatment after we talked; I usually sent a copy of the lab report to them. Later on they all but one acknowledged successful results. This vet refused to treat as I suggested. He could not accept what I told him and said he didn't like to use Chloromycetin. This is a comment I often hear when talking to veterinarians. The puppy's owner said the vet did prescribe half the required dosage for five days only. That helped a little but wasn't enough. After the five days the puppy went back down and eventually had to be put to sleep.
More recently I have heard from an Irish Setter breeder. She had two different dogs diagnosed as having HOD. She was told by a friend to call me. Her vet willingly started the treatment as suggested, again with successful results. One of the puppies had a more severe case and had to receive two series of treatments. This Irish Setter breeder showed me her dog at a recent dog show. She said his legs had large knobs and swollen joints before treatment. When I saw him his legs were fine; he was a beautiful dog. This lady, Shirley Murray, and her husband Roy, are well known respected breeders and professional handlers. They, as well as many others, have encouraged me to write this article.
It seems that the-dreaded symptoms of so called HOD are continuing to occur randomly on not only Great Danes but on different giant, large and medium size breeds. More often than not those afflicted dogs' prognosis leads to a painful, hopeless heartbreaking end.The reason I call this terrible disease Pseudo-HOD is because as I see it, the symptoms are the same as real HOD but the cause and treatment are totally different. At the end of this article is a copy of the lab report I have previously referred to from the Houston Veterinary Radiology Clinic dated 10-22-84. signed by Dr. C. B. Quick, DVM, M.S. I think this report proves I am correct regarding antibiotic treatment with reference to a blood infection. Also see Ref. 3. Notice the antibiotics list does not emphasize that Chloramphenicol (generic name for Chloro) is the drug of choice. But remember the Mother Nature barrier -Chloramphenicol is the only one listed that gets to the core of the infection - the bone marrow where blood is made. As I see it, the preliminary use and periodically changing of different antibiotics creates a see saw effect and possible chronic condition. Then as the infection hangs on the joints become inflamed and calcium deposits start to build up on the outer extremities of the long bone just above the joints. When this happens, the pup is well into the disease, perhaps 1-2 weeks. X-rays are then taken and HOD is diagnosed. HOD, medically speaking, is listed under the heading of "Disease of Undetermined Etiology" (see Ref. #7) which basically says they don't know the cause or cure of HOD.
Veterinarians are advised that treatment should be directed toward controlling fever and reducing pain using analgesics and/or corticosteroids. Prognosis is grim. Antibiotics are used only to control possible secondary infections such as tonsillitis, etc. With Dr. A. Senske's help I have obtained several pertinent veterinary medical documents on HOD research and findings. These are dated back to the early 70's, 80's, and into the 90's. Actually very little scientific help is available that shows consistent facts and findings that work or help. They all basically have the same conclusion. Medical science does not have any scientific proof as to the cause or treatment of HOD (see Ref. 47). All these documents are listed in the References.
Over the years whenever I received a phone call asking about HOD I have always suggested the same treatment and diet. It always works - I only ask for a follow up progress report. So far I've had 99% success. The treatment I recommend is:
DIET
1. Mix and feed twice a day - AM and PM - same time always continue with your regular good quality dog food - protein should range 20-25%, fat should range 8-10%. Add small amount of tasties (chicken is good).
2. Important - add to each feeding 2-3 Tbs. tonic formula (below)
TONIC FORMULA
To mix tonic formula use equal amounts each of pure Apple Cider Vinegar and Honey = 1 quart. Example: 1 pint Apple Cider Vinegar + 1 pint Honey.
NOTE: slightly warm honey (not hot) mixes easier with warm vinegar - store at room temperature.
Although it has its purpose a simple basic healthy diet is always best. Stay with this kind of diet plus the tonic which is an old time recipe used for years as an arthritis remedy (see Ref #8). Remember the old saying, "an apple a day keeps the doctor away." IT WORKS! This over all general tonic is the best formula I've found in raising fast growing large bone dogs. The Apple Cider Vinegar helps keep the calcium intake in a soluble state so it can be more easily absorbed into the system. It also helps dissolve and flush out acid crystals that build up in the muscles and joints.
A must read for dog breeders Is Dr. D. G. Garvis's book on Vermont Folk Medicine. This book was my start in learning how to appreciate the many benefits of natural foods and healing. Up `til then my studies were more concentrated on vitamin and mineral requirements and supplements. I can't Imagine raising Great Danes without the help of Apple Cider Vinegar and Honey Tonic. All our dogs - youngsters, oldsters and in betweens - even my husband and myself have a daily shot with a glass of ice wafer. It tastes like Apple Cider - GOOD!!
Good Luck and God Bless. HAZEL GREGORY, 414 Richland, Lewisville, Texas 75057, (214)434-1134.
PS: In the foreseeable future this subject will be addressed with more in depth considerations regarding unanswered questions. Much is yet to be learned and explored regarding HOD. In the meantime I hope this article will be of some help to our dogs and their owners. Any questions or inquiries regarding this article are most welcome. Copies of the documents listed are free with $4.00 each for postage and handling. The book, Vermont Folk Medicine by D. C. Jarvis, MD, is $6.00 plus $4.00 postage and handling. Thanks again.
REFERENCES
Watson ADJ, Blair 8. 0., Farrow BRH, at al: Hypertrophic Osteodystrophy in the dog. Aust. Vet 4 49 (9): 433439,1973.
Crondalen 4: Metaphyseal Osteopathy (Hypertophic Osteodystrophy) in growing dogs: A Clinical Study. 4 Small Animal Practice 17(11): 721435, 1976.
Watson ADJ; Hypertophic Osteodystrophy: Vitamin C deficiency, overnutrition, or infection. Aust. Vet Pract 8(2): 107-108,1978.
Woodard 4: Canine Hypedrophic Osteodystrophy, a study of the spontaneous disease in littermates. Vet Pathol 19(4): 337-354.1982.
Alexander JW, Roberts RE: Symposium on orthopedic diseases. Vet Clinic North Am [Small Animal Practice] 13 (1): Feb. 1983.
Lewis PD, McCarthy RJ. Pechman RD,: Diagnosis of Common Development Orthopedic Conditions in Canine Pediatric Patients, The Compendium. Small Animal Vol 14, #3, pg 287-297, March 1992.
Textbook of Veterinarian Internal Medicine Vol 2 - 3rd Edition. Sec. XV Joint & Skeletal Disorders, Chapter 121, Skeletal Diseases, pg 2391, by Stephen 4. Ettinger D.V.M.
Vermont Folk Medicine by D. C. Jarvis, MD. publ. Fawcett Crest, NY.
Description
A disease occurring during the time of rapid skeletal growth (4-8 months) when the biomechanical stresses are the greatest on the developing skeleton. It involves the separation of immature cartilage from the bone. Sometimes this cartilage breaks free and floats in the joint space. This is called a joint mouse. The shoulder joint is the most common joint for osteochondritis in Great Danes.
Cause
The exact cause is unknown. Trauma due to excessive biomechanical stresses on the shoulder is suspect. The inheritance of predisposing factors such as growth rate, muscular and skeletal structure and mass, need investigation.
Diagnosis
The dogs history and age are helpful, however a final diagnosis must be made by radiograph.
Treatment
Affected animals should be allowed only restricted exercise for 4 to 6 weeks. It is recommended they be walked on a leash and not allowed to run freely. Some recent reports indicate the use of the drug Adaquan (2 1/2 cc given every 5 days intramuscularly)* can be very helpful. Anti-inflammatory drugs are not advised since they may promote physical activity and hence may exacerbate the condition.
Surgical intervention may be necessary if restricted activity is not successful. If surgical intervention is required, it should be done soon after diagnosis to prevent osteoarthritis from developing in the joint.
*Great Dane Reporter Magazine, May/June 1989, p.38, ADAQUAN, An Alternative For OCD by James W. Barger, DVM
Wobblers Syndrome or Spondylolithesis is a disease of the nervous system caused by pressure on the spinal cord by the lower cervical (neck) vertebrae due to either a malformation of the vertebra or a malocclusion (when the vertebrae do not come together properly). This causes anywhere from a mild, to a severe affect in the dogs gait.
The cause of Wobblers Syndrome is unknown, although a link to fast growth and genetics is suspected. According to the Merck Veterinary Manual, "The cause is unknown, although rapid growth rates and nutrition, mechanical factors, and genetics may be implicated." Some breeders say that there’s been a marked decrease in the incidence of not only Wobblers Syndrome, but other diseases that occur during the early, fast growth stages of Great Danes, when weight is kept down and growth rate has been slowed nutritionally.
Symptoms usually appear first in the rear legs as a mild uncoordination in gait (ataxia) and can escalate to involvement of the forelegs as well. The severely affected dog moves like a drunk and the uncoordination shows up most when the dog is walked and then moved sharply into a turn. An unsuspecting owner might simply conclude that his older puppy was just clumsy. Overly clumsy young Great Danes should be Wobbler suspects.
In Great Danes, Wobblers Syndrome most commonly appears from 10 months to a year and a half of age although it can manifest as old as 4 or 5 years, and as young as 5 weeks. In Doberman Pinschers it usually doesn’t appear until the dog is 4 or 5 years old.
A veterinarian will do a neurological work up on the dog and this often includes not only cervical spine x-rays, but a mylogram x-ray. A mylogram is not only dangerous to the dog, but is expensive. The owner should thoroughly investigate the advisability of this procedure, especially since if it is Wobblers Syndrome, surgery may not be the best option.
Treatment of Wobblers Syndrome can include the use of corticosteroids, a neck brace and surgery. The surgery fuses the 2 unstable vertebrae which relieves the pressure on the spinal cord. Unfortunately this also puts further stress on adjoining vertebrae which can cause instability to recur in them. Many Wobblers can live a long and pain free life with little or no treatment. Others deteriorate quickly and euthanasia then becomes the only kind choice.
Wobblers syndrome is caused by a narrowing or malformation of the spinal cervical (neck) vertebrae which causes pressure on the spinal cord itself. Other conditions can mimic the symptoms. The only definitive diagnosis of Wobblers Syndrome or Spondololithesis, is a mylogram where dye is injected into the spinal column and then the neck is flexed and x-rayed.
I've had 3 wobblers. After my first, I've never bothered to do the mylogram again, as it's very dangerous, to say nothing of the expense! Once you've seen a wobbler, you'll never forget it. However, pain is seldom a problem. In the mildest cases you'll see a mild ataxia (lack of coordination) in the hind legs which is most noticable on abrupt turns at the walk. The onset is most commonly around the age of 7 to 10 months. In Dobermans it may not show up until they're 5 years old! As the disease progresses, the forelegs can become involved.
Some of the other neurological tests that a vet should do are to turn the rear foot over so that it is resting on the ground on it's top. If the dog doesn't immediately right it, you could be looking at wobblers syndrome. If the head is tipped up and back, it will often elicit a pain reaction. That's the first symptom I noticed in my first wobbler. She yelped and collapsed in a heap on the floor! Her name was Sunflower and she was one of the first I ever bought as a show/breeding bitch. She was lovely. I began to notice a sort of "bouncing" motion in her rear movement. Her condition gradually worsened until at the age of 5 years, she had to be euthanized.
After her initial examination she was sent home with a neck brace which terrified her. I decided that if she was going to have to be uncomfortable, she'd be better off dead, so I took it off. She ran, played, leaped in the air and even carried 20 pound road markers around in her mouth! She never had any pain, even at the end. She just started to fall over and I couldn't stand it anymore.
My second wobbler came from my first litter. Another show beauty who's symptoms showed up around 7 months of age. Heather was placed in a loving home and lived to the ripe old age of 9 years never getting any worse. The most unusual showed up in a bitch puppy around the age of 5 WEEKS! I'd never seen nor heard of actual symptoms that young, but I never liked her movement and by the time she was about 6 weeks, she was being easily knocked down by her littermates all the time. She was so tough and plucky that I couldn't bring myself to put her down even though I figured she'd just get worse. I placed her with a good friend who had been around Sunflower and knew what to expect, except we really didn't know in this case. Sadie was put to sleep recently at the ripe age of 9 years, having lived a long and happy life. What was amazing to me, was that she improved to the point that you really wouldn't have noticed she was a wobbler unless you were looking for it. What's interesting is that one of Heather's full sisters was the dam of Sadie and the other full sister, Daffodil, never produced a wobbler, nor have I had any since then.
Although I don't think there's a lot of doubt that it has some genetic causes, I think that the way a young dane is fed, and the body condition it is kept in from puppyhood, has A LOT to do with these health/growth problems. Sadie's litter was the very last time I used higher protein for puppies. I can't help but think that my current program of 23% protein throughout their lives except for pregnant/nursing bitches, has helped as I've had no problems since. So the bottom line here is that in my experience wobblers can live long, normal, pain free lives.
This is a disease of youth, usually appearing between 5 and 11 months. Although German Shepherds are the most common target, Great Danes are frequently affected. It usually shows up as lameness in a foreleg and can affect each leg in it's turn. It'sguaranteed it will show up the day before the show! It is an inflammation within the long bones causing varying degrees of pain. This can range from a mild, intermittant lameness to a dog that refuses to move or eat, the latter being uncommon. It is not known what causes pan. I have had no experience with it since I've begun to keep my puppies lean and kept the protein levels low. I feel that fast growth is an invitation to pan as well as other growth related diseases. Stress is suspected as is the possibility of a disease causing organism. Treatment consists mainly of tincture of time. Pan is self-limiting in most cases and usually disappears by the time the dog is a year or a year and a half old. Severe pain can be treated with an analgesic prescribed by your veterinarian. I've never restricted exercise as dogs that have this tend to be quiet when they're in pain.
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