Learn how to effectively support patients with hip dysplasia through conservative care as Dr. David Dycus joins Dr. Andy Roark on The Cone of Shame Podcast. In this episode, Dr. Dycus, founder of OrthoVet Consulting and Fusion Veterinary Orthopedics, shares his expertise on non-surgical approaches, from tailored exercise plans to lifestyle adjustments that maintain comfort and mobility. This practical discussion provides veterinary professionals and pet owners with essential tools to enhance quality of life for dogs of all ages dealing with hip dysplasia. Let’s get into this episode!
You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!
LINKS
Dr. David Dycus: www.drdaviddycus.com
Dr. David Dycus on Instagram: https://www.instagram.com/ortho_vet/
Fusion Vet Ortho on Facebook: https://www.facebook.com/fusionvetortho
Dr. Know-It-All Card Game: https://drandyroark.com/in-the-know/
Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. David Dycus, a recognized leader in veterinary orthopedics, earned his veterinary degree from Mississippi State University and completed a residency and Master’s in surgery. Known for his expertise, Dr. Dycus has delivered over 250 lectures and taught 150+ labs worldwide, contributing extensively to veterinary literature, including co-editing the textbook Complications in Canine Cranial Cruciate Ligament Surgery. He was honored with the 2023 Veterinary Hero’s Award by DVM360 and is an orthopedic consultant for VIN. Dr. Dycus is the founder of Fusion Veterinary Orthopedics, where he specializes in joint replacement, fracture repair, and 3D implant printing, as well as Ortho Vet Consulting, a leading orthopedic coaching service.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark guys, I am back. Back again. Dr. Andy’s back with his friend, Dr. David Dycus. I promise I won’t ever do that again.
Dr. David Dycus is back. He is talking about conservative management of hip dysplasia. We had an episode, uh, a couple weeks ago.
It was on surgical management of hip dysplasia. We talked through our surgical options and what they look like, and now we’re talking about when. Surgery is not an option or it’s not the right option right now.
What do we do? This is a lightning fast download of a ton of information that is really really good to have in your back pocket. It’s I don’t I just got a lot out of this. I took notes frantically throughout the whole episode. It’s really good stuff without further ado. Let’s get into it.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. David Dycus thank you for being here.
Dr. David Dycus: Oh, thanks so much for having me. Absolutely.
Dr. Andy Roark: You were on just, not long ago. And, we were going through and talking about hip dysplasia and surgical options for hip dysplasia. And towards the end of the episode, you mentioned, you know, in some cases, we’re going to talk about conservative management of hip dysplasia.
And I thought, That’s something I am, I am really interested in. Uh, we had such a good conversation. anyone who hasn’t heard it should go back and listen. But I, I wanted to get into that with you. So for those of you who don’t know Dr. David Dycus you are the founder of OrthoVet Consulting.
You are the founder and owner of a brand new orthopedic hospital that is opening up in the Washington, D.C. area. It’s Fusion Veterinary Orthopedics. And, you are an instructor and a lecturer and genuinely a wonderful person. Yeah, thanks. Thanks for being here. First of all, and second of all Let’s start at a high level and kind of pick up where we left off.
we’ve got hip dysplasia, whether we’re talking about, a young puppy and we’re starting to see some pain when we’re stretching out their legs, and we talked about surgical interventions in that regard, all the way up to your older dog that’s coming in for sort of quality of life assessments and things like that.
Hip displacement is a, it’s a painful, it’s a painful process. Often, unfortunately, we are dealing with people who don’t have the resources to do surgery, or their pet may not be the best surgical candidate. Or, my impression is that sometimes we’re in this weird state where we say, we’ve got an issue here.
I don’t know that it’s a big enough issue to motivate the pet owner to buy into surgery, things like that. Help me, help me just at a high level. Let’s start to look at conservative management of hip dysplasia. What are our goals and what do we want to make sure that we avoid? What are our pitfalls?
Dr. David Dycus: So, you know, the goal of conservative management is several pronged. One is to improve comfort. Two is to improve hip range of motion. And three is to maintain high limb muscle strength. And so at the end of the day, we know that hip dysplasia is going to lead to hip arthritis. So a lot of our conservative aspects
are going to be very similar to some of the things that we do for arthritis in general, but then also we’re going to be specific to the hip. And so for the hip specifically, our whole goal of a patient with hip dysplasia is to maintain hip extension and do it comfortably. And at the same token, build up muscle strength.
And the overall goal would be to try to slow down minimized progression of arthritic changes. And so, the way I like to break it down to owners is the development of a home exercise program. And what i’m going to have them do and how and when is also going to be dependent upon the age of the dog and the pain level of the dog.
So let’s, let’s start with the five or six month old puppy that maybe the owners noticed a few things, you know, maybe they’re like, ah, he, he still plays like a puppy, but then he goes kind of off to the corner and lays down for a little while. I, you know, I, I maybe thought he was tired, but really it seems like maybe he’s self limiting a little bit.
And so we, we do our due diligence, we do our exam, maybe there’s a little bit of discomfort on, on hip extension, you know, we, we try to extend the hips and the dogs kind of pulling back a little bit from us and, and we say, you know, let’s just get some x rays, take a look at things and, and we take x rays and, and maybe there’s some mild arthritic changes, or maybe there’s just some hip laxity there and we say, okay, okay.
You know, we’ve got some mild changes in this very young puppy. What we’re going to have to do is establish our baseline management, as well as our home exercise program, that we’re going to want to plan on doing for life. And so what that’s going to be tailored around is going to be daily exercise. And maintenance of hip extension and hip strength.
But in a five or six old month puppy, we can’t force exercise on them. We can’t expect them to do some of these things. So it’s all about building the skillset and the training for what’s to come. The first part of that is the daily exercise, which is daily leash walking. And I’m sure many of us, owners every day that both the owner and the dog have no idea how to walk on a leash.
The owner doesn’t know how to walk their dog in a leash and the dog has no idea how to walk on a leash and that’s because they were never appropriately taught. And so if we have the five or six month old puppy, we don’t have to put a timeframe on the walking. We just need to get used to leash training. So the dog’s not pulling the dog’s walking beside you.
And at that point, we’re usually letting the dog kind of dictate, you know, the stop and go, the sniff, how long, but maybe we would keep it short, 10 or 15 minute segments, no real more than that. But getting the dog used to, if we’re in a city, most of the time you get to a city block, you have the dog stop and sit and wait until it’s okay to cross.
You know, we need to start working on those basic commands. But, when they, when they get back from a walk, we have to talk about establishing our home exercise program. And when they’re older, that’s going to usually be done two to three times a week following a walk. And our focus there is going to be trying to do some things to work on hip extension and hip strength.
And so what I’ll have them do is what are called sit to stands. And so in that case, it’s, it’s where we have them sit, but we want a nice square sit and then we’ll have them stand up and then we’ll have them sit and then we’ll have them stand up and, you know, after every two or three sits, we can give them a little treat.
But for a puppy, what we don’t want to do is say, okay, we’ve got to knock out 10 sit to stand exercises. What we need to do is say. Here’s how we train to sit square from the get go. And you know, this is the sit command. And then I’m going to give you a command to stand up and take a few steps towards me, and then I’m going to give you a command to sit.
So it’s all about learning. And then after our sit to stand, we are going to do, what are called either our paws up or our dancing exercises. And I think for a poppy, this is important because most of the time we want to train them not to jump up on people. So we need to make this a learn command that they can jump up when they’re giving the command to do that.
Because dancing exercises are essentially where you would pick the dog’s front feet into the air, so they’re standing up on their back legs. And then you would take a few steps backwards, so the dog’s taking a few steps forward. And then you would put the front legs down and then you would pick the front legs up and you would have them walk towards you.
And that really helps work on hip extension. Now the name dancing is really a bad name because it makes you think you’re going to pick them up and you’re going to walk backwards and then you’re going to walk forwards and you’re going to walk backwards. So you’re dancing, right? But if we make a dog, stand up on their back legs and step backwards.
That’s the most advanced form of the exercise to create hip extension. And so most dogs are not ready to do that. So we start with, standing up and we take a step back. So the dog’s taking a step forward and only when the dog is like mastered that, do we start allowing them to do it backwards, but some dogs might be really small or maybe that You know, they’re just not ready to get all the way up on their back paws.
So then what we can do is use either a small chair or a small elevated surface that we can put their front paws on just to hold there. And then over time we can slide it to get them to take a few steps. And then as they get stronger, as hip extension improves, we can kind of go higher and higher. And then after dancing exercises, either they can do some makeshift cavalettis or walking over obstacles of different things.
You could go in your garage, you can take your tools, your gardening tools, right? And you can throw them all on the floor. So now they’ve got to step over things or, you could put some couch cushions down if it’s a, if it’s a small breed dog or, Or, you know, maybe an air mattress, just anything that’s going to start working on some of the core stabilizing muscles as far as, uh, uneven terrain of having to pick the legs up and improve range of motion.
Um, but in a poppy, it’s all going to be about learning these things and getting the owner used to it, because the other thing that we should mention that I think is very important is before they take them on a walk or the worst thing we want to do to any dog, whether it’s a puppy, whether it’s a young adult, or whether it’s an adult, is allow them to be laying in the bed.
They hop up, throw on the leash, and go out the door for a walk. We want there to be a period of a warm up. So that means if you’re going to go walking, get your dog up, get him moving around the house for a few minutes, just to get moving. And then, perhaps you get them on the leash and, and you do, you know, a little bit of walking before you go on your walk.
Because when we’re walking, it’s not, let’s go sniff and sniff and sniff, it’s, it’s let’s walk. It is the period to get the heart rate up for an extended period of time. So we need to do a warm up. You know, you or I, we would not, You know, be sitting on the couch watching TV and then all of a sudden hop up and take off out the front door and go for a run.
You know, you’re gonna get up, you’re gonna, you know, do some moving, you’re gonna get yourself warmed up. Same thing, you know, we sometimes forget some of the common sense things that we do for ourselves should also apply to our pets.
Dr. Andy Roark: Especially if you’ve got bad hips. You know, like, especially if you’ve got bad hips. I think about, well, I hop up and just go walk, and I go, well, yeah, but Andy, you don’t have arthritic hips, you don’t have, you know, hip dysplasia. That’s sort of the point of what we’re talking about. Uh, now that I am a bit older and think something is always achy, like, yeah, I, I get loose before I do a lot of things, uh, that I used to just hop up and charge right out with.
So it, at first when you said that, I was like, we’re going to warm up to go for a walk. Uh, it totally makes sense.
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Dr. David Dycus: And the other big thing is after the walk, Or after the walk and the exercises, because walks need to be daily exercises, usually like two to three times a week. But when all that’s done, there also has to be a cool down period. You know, the last thing we want them to do is be all warmed up and then they go run and jump in their dog bed and lay down.
So what we will do is say, okay, now’s going to be a great time to do some range of motion exercises. So, you know, flexion and extension exercises of the back legs like they’re riding a bicycle. Okay. But then on the hip extension, we actually are doing a stretch. We’re actually holding it. So we’ll take it out to extension to where we start to feel the tension or what the animal will tolerate.
And we hold it for 10 or 15 seconds. So that’s a stretch. And that needs to be part of our, our cool down process. And so in the very young puppy, that’s just getting the dog used to that relaxing moment to lie down, to allow the owners to manipulate their back legs, touch their toes, extend their hips, it gets them used to what’s to come.
And then, because they have a condition that could go on to develop arthritic changes, we have to focus on weight control. You know, we need them to stay as lean as possible. And, you know, I tell them, listen, when you’re taking your dog out walking, I want your neighbors and your family to kind of talk about you behind your back, because they think your dog’s too skinny, because if that’s occurring, your dog’s at the appropriate size.
And so we’ve got to do that. I am also a big fan of Omega 3 fatty acids or fish oil supplementation. And then also, you know, the same thing from the OA standpoint, uh, different joint supplementations I’ll recommend. We also have to think about lifestyle changes. You know, we probably don’t want to take this dog that has uncomfortable hips and then go outside and play fetch over and over and over again.
You know, when we talk about daily exercise, owners usually think that that’s opening the back door and letting them run along the fence line in the backyard, which the owners like, because it requires like no effort on their part, but then when we tell them, listen, actually, daily exercise is walking.
Now they get kind of sad because now they’re like, crap. I have to be involved. Um, but you know that the running in that defense line is what I call daily playtime and and they can still do that but maybe we limit how often and how long just because you know dogs love to speed up slow down and twist and turn but the worst thing for their tendons and their joints is to speed up slow down and twist and turn So we don’t want to do things that are gonna actually cause joint pain, but if we get to the dog that is now maybe three or four and really hasn’t had any issues.
But now they’re coming into you because the owner has noticed either some offloading or an acute lameness or a mobility related issue. If it’s, if it’s the offloading or the acute lameness, number one, we need to rule out everything else before we blame it on the hips. You know, it really doesn’t matter how bad the hips look on a, on a radiograph.
There’s probably cruciate pathology. So make sure you rule out cruciate pathology first. But in that situation, I’m going to say, okay, you know what? We’re probably having a little bit of a flare up. So how are we going to get the flare up under control? Well, the first thing we’re going to do is we’re going to reach for pharmaceuticals.
So I’m going to put them on an inset. for, you know, probably 30 days, sometimes up to three months. You know, I think we underutilized duration of insets for joint pain vastly. So I tend to use them longer. we’re going to rest, you know, we’re not going to push a lot of exercise until they get a little more comfortable.
Uh, and I might even recommend they do a two or four or six week course of formal physical therapy just to help get the comfort under control because what we tend to always forget about is we look at a radiograph and think bone on bone, but we ignore all the soft tissues. And so not only is there joint pain, but there is soft tissue pain surrounding the joints of the muscles as well as the compensatory changes.
And so these dogs can become like tight walk, walking rubber bands that just improving tissue, distance ability and flexibility can go long ways to improving joint comfort. And, after we start making some headway with rehab, with our pharmaceuticals, then we’re going to ease into our warm up, our daily walks.
And my goal is to try to work up to at least 20 minutes on level flat ground twice a day. I know that’s asking for a lot. But once we kind of get to that 20 minute mark on level ground, then I want the owners to start doing things in their walks that are going to encourage hip extension. And the common sense of you would be like, okay, have a walk up a hill.
Well, walking up a hill doesn’t really increase hip extension very well, but walking upstairs does. So we’ll start the process of walking up an incline, but once we’re further along and joint comfort is improved, then we’ll start incorporating stair ascent. And, you know, that doesn’t mean taking them off the leash and letting them race up and down the stairs.
That means you’re controlled walking up the stairs, because that’ll actually improve hip extension by about 10 degrees. So we’ll, we’ll incorporate stair ascent, we’ll incorporate uneven terrain, so trails, tall grass, sand. You know, if they’re in the city, that can sometimes be, as long as it’s safe, can sometimes be, uh, walking on the sidewalk, you step off the sidewalk for a few steps.
You step back on the sidewalk and kind of do some modified cavalettis there. Just anything that’s going to start challenging some of those smaller core stabilizing muscles. And then when they get back from the walk, if it’s a day, we’re going to do our home exercises. Then we immediately go into our sit to stands, our dancing, our, you know, cavalettis, and then we go into our cool down with our range of motion and.
Uh, exercises and stretching. If it’s a day where we’re not doing our home exercises, then we go straight into our, our cool down process of our stretching and passive range of motion. And, and, you know, once we get that flare up under control, then we’re going to stay with that baseline management of our daily exercise plan, our weight control, our omega 3 fatty acids, and our other joint supplements.
But then we also need to counsel owners on paying very close attention for mobility related issues that might arise, because it’s going to happen. They’re going to have other flare ups. If that dog is doing great, and then two weeks later comes back into another flare up, and so we get them out of that, and two weeks later comes into another flare up, then we’re going to start saying, okay.
It might be that either we need to change our approach to how we’re getting this flare up under control, or it might be that we’re just not going to be able to get it under control enough and we have to start thinking about surgical intervention. But then if we’ve got the, say, nine year old German Shepherd that the hips can barely move, those are going to require a bit more work on the front end before we can get to kind of that home exercise plan.
So those are going to be the dogs where I’m going to come in with an NSAID probably for four months, and they’re going to be in a rehab program for probably six to eight weeks. We might throw in other drugs like amantadine or pregabalin. I might even consider injecting the joint with something. And then if we’re able to improve their function, because in those cases, if the hip extension is permanently reduced.
We can’t expect it to ever become normal. The question is, can we improve it a little bit? Can we improve just 10 or 15 degrees of hip extension and improve comfort? And if we’re able to improve comfort and it might be at that point, they’re now reliant on a daily anti-inflammatory, or Uh, we have to think about our exercise plans.
Maybe this dog can only tolerate up to 10 or 15 minute walks. Maybe they’re not going to be able to tolerate doing stair work. They’re not going to be able to tolerate doing dancing exercises. So we’ll start to tailor what they can do to the individual dog. But then I’m also going to recommend that they do maintenance rehab probably every four to six weeks, because what’s going to happen
is once they get them loosened up and more comfortable, then they’re going to go out and they’re going to do some things, but they’re going to slowly start compensating again. They’re going to slowly start getting tighter and tighter again. And when they do that, uh, what’s going to happen is they’re going to start right back into a flare up again.
And so we go into maintenance rehab. But those patients too, if we’re not able to get. comfort under control pretty quickly, we might start recommending something like a, uh, a total hip replacement. I would not put a, I don’t know that I would do an FHO in those guys because you’re going to make them even more cripple.
And you know, yes, you might resolve some of the pain, but you’ve made hip function worse. I would rather get pain under control and other mains than doing an FHO.
Dr. Andy Roark: Yeah. When you talk about, you know, going for, for walks and you talk about 20 minutes and then some pets may not be able to go that long. Is the, is the, is the guide for you if we go out and we’re walking 20 minutes and then we start to see some discomfort, we’re starting to see limping, things like that.
Is that what you’re looking for to tell the pet owner to, we’re going to adjust down? Yeah. So how do you set that? And my follow up question is going to be, I know that pet owners are going to come and they’re going to say. Twenty minutes was great. And so now we’re doing thirty minutes. And to me, it does make some sense of, if I want to try to maintain musculature, then building musculature is the first step to maintaining musculature.
I would like to see more muscle in those hips, I think. When do we go up and when do we go down on the duration of the exercise and the walking and stuff that we’re doing?
Dr. David Dycus: Yeah, if it’s one that we’re working up to the 20 minute mark, generally speaking, as long as they’re comfortable, I will tell them we can add about five minutes a week. So add one to two minutes every few days, and you slowly work it up. Um, if it’s a dog that they’re trying to slowly work it up, but then the dog is now starting to trail behind them, um, or More importantly, they went that longer distance and they came back and then the dog now looks more stiff and sore, like they’ve gone, they’ve lied down, they get up and they’re like, Whoa, they look like they way overdid it.
That means we probably pushed it too far too soon. But if it’s one of those that every time we try to increase a little bit and then it’s like, Oh, this happens every time. And they’ve got horrendous hips. It might be, listen, 15 minutes is as far as we’re going to be able to get comfortably because if we go beyond that, they’re going to have to pay the price for it.
And so the general rule is no more than five minutes a week. not adding more than a minute or two every, every few days. and so we don’t want to jump from 10 minutes to 20 minutes the next week. We want to gradually work, work into it and kind of see how the dog’s doing. If you add time and you notice a difference, back, back down and try to ramp back up over a longer period of time.
If you don’t notice a difference, kind of keep working it up until you hit that point where you say, listen, my dog could probably walk for four days straight without an issue, but I only have 35 minutes that I can dedicate. Then 35 minutes it is. but a lot of dogs don’t have the, the, the conditioning, the endurance or the muscular strength to, go right out on a 20 minute walk if they’re not used to walking.
Dr. Andy Roark: Dr. David Dycus thank you so much for being here. Where can people find you online? Where can they keep up with your exploits?
Dr. David Dycus: Absolutely. So for you on social media, Instagram is ortho underscore vet and Facebook is Dr. David Dycus um, my website is drdavidDycus.Com and then for the hospital, Instagram and Facebook are both Fusion vet ortho.
Dr. Andy Roark: Thanks for being here. Gang, thanks for tuning in, everybody. Take care of yourselves.
Dr. David Dycus: Thank you.
Dr. Andy Roark: And that’s what we got. Thanks again to Dr. David Dycus for being here. Dr. David Dycus, I love saying Dr. David Dycus. I think that’s a great, that’s a great name that rolls off the tongue. Uh, he’s also an amazing guest on the podcast. I promise I’m not having him on the podcast just cause I like saying Dr. David Dycus, but it doesn’t hurt. Anyway, guys, thanks again for being here. I hope you enjoyed it. Take care of yourselves, everybody. I’ll talk to you later on.
