Living with IOHC

‘Incomplete what?’

‘Incomplete Ossification of the Humeral Condyle. IOHC. It means that Bryn’s elbow joints aren’t properly formed.’

Standing in the consulting room at North West Surgeons, Runcorn, something deep inside me gave way. We’d known for some time that things weren’t right with Bryn, our six-year old Springer Spaniel, but had never imagined it could be that bad.

And so my dreams of having a running companion vanished, along with the prospect of us ever again enjoying long days in the mountains of Snowdonia.

However, the immediate issue was what to do for Bryn. What was going to be best for him? Could he be helped? If so, how? If not, then …

Not fully formed

As I understand it, most dogs have the bones in their legs fully formed (ossified) by the time they are two to three months old, in a process that sees cartilage being replaced by bone.

In dogs affected by IOHC, however, bone formation in the area around the elbow joint is not successfully completed, leaving an area of weakness where three bones meet: the end of the humerus bone (‘humeral condyle’, found at the top of the front leg), the radius and the ulna.

English Springer Spaniels are the breed most commonly affected by IOHC in the UK. Thought to be hereditary, it’s cause is apparently a mystery – as is the reason for some affected dogs showing no signs of distress, while others suffer so much that they require surgery to alleviate the symptoms.

The problem can affect the elbow joints in one or both front legs. In Bryn’s case it was both – although the right leg was far worse.

Much of the material on IOHC is highly technical. However, I recently found two articles that are easier to read than most: Incomplete ossification of the canine humeral condyle on the Veterinary Practice website, and Humeral Condylar Fissures on the North Downs Specialist Referrals site.)

A dog is for life – even if he arrives at Christmas

We collected Bryn from the North West English Springer Spaniel Rescue (NWESSR) in December 2010 – exactly a week before Christmas.

It was snowing, we lost our way and were late, but when we met him it was love at first sight. He just knew we were his new family and we were overwhelmed at his trust in us.

Bryn had had a hard life. We were his fourth or fifth home – and he was only about three years old!

Rescued from an abusive owner before his first birthday, his foster family couldn’t keep him, so he went to home number three. That also didn’t last long and he ended up, possibly via a fourth home, with the family who gave him up to NWESSR.

From what the rescue had been told, Bryn – who was then known by another name – was fit, active (he’d been to agility classes) and just loved chasing tennis balls.

So we had no reason at all to think he was going to struggle with running round the woods and up and down the hills.

Warning signs

For the first few months everything seemed fine. Both myself and Bryn were getting lots of exercise and our lovely Springer seemed as fit and healthy as we’d imagined he would be.

There was the odd limp, but nothing to worry about. Except … he ran downhill slowly. He was fine running uphill, but going down he was much slower than he should have been, seeming almost hesitant at times.

And he was often reluctant to go out. Whereas most dogs seem to be excited at the prospect of a walk, Bryn wasn’t. I attributed his reluctance to having a harness on. The reality was – in my opinion – that he came to associate going out with pain in his legs. If only I’d known that.

Ever since his diagnosis, I’ve cursed myself for not taking those signs more seriously. Hindsight is a wonderful thing, but I surely should have known that something wasn’t right.

But the evidence was contradictory – he continued to chase tennis balls with joyful abandon. His idea of fun was to have a ball thrown for him for an hour or two. Fetch, drop, throw, repeat …

His reward for going running with me was to have five minutes chasing the ball. After he’d run five, seven, sometimes 10 miles. He couldn’t get enough of it.

So there couldn’t have been anything wrong, could there?

Heartbreaking

Towards the end of July 2012, during one of his post-run ball-chasing sessions, Bryn hurt his front left leg. It must have struck me as more serious than other episodes, because my diary shows that I took him to the vet the following day, and that a couple of days after that he was x-rayed.

The x-ray revealed nothing significant, but Bryn was put on steroids, given an acupuncture session and had laser therapy on his left shoulder and leg.

Although he seemed to recover (he was ‘lively’ on a short walk a week after the x-ray, says the diary) it seemed best to stop the ball games, at least for a while.

So we hid all the balls we could find. Bryn didn’t understand what was going on, of course, and kept retrieving bits from the garden or, if we were out walking, would scavenge pieces of broken tennis ball and drop them at my feet waiting for me to throw them. It was heartbreaking – and he’d never play ball again.

Bad advice

A week’s holiday was looming and we were worried that the walks we were planning might not be the best thing for Bryn.

However, our vet assured us we could take him away for the week safe in the knowledge that he would come to no harm. Oh dear, what a mistake that was!

On our last day, walking back from the beach to the clifftop cottage, Bryn suffered a serious injury to his right leg.

With hindsight, the ups and downs and stresses and strains of the week’s activities had simply been too much for his weakened elbow, but at the time we didn’t know what the problem was.

We managed to get him back to the cottage and arrived home the following day, with him in much pain and us in great consternation.

Our vet was also concerned and referred us to a specialist facility. Which is how, a week after damaging his right leg on a clifftop footpath, Bryn ended up being assessed at North West Surgeons.

When a magnetic resonance imaging (MRI) scan revealed that Bryn had IOHC, it was decided that a conservative approach should be adopted, with surgery (including the option of amputation) only to be considered as a last resort.

(We were very aware that his left elbow was also weak. Surgery on his right leg would put some temporary additional pressure on his left one; amputating his right leg would see that pressure applied permanently – something that clearly need to be avoided if possible.)

Swimming not springing

And so Bryn started courses of both hydrotherapy and laser treatment. Although our insurance policy covered both, the hydrotherapy was supposed to be administered by an approved practitioner. With the nearest centre some 40 minutes’ drive away, I chose to use someone nearer home. I was, after all, having to fit three sessions of laser and three of hydro into a week that was already pretty packed. It saved on driving time, but I had to pay.

Yet again, just as Bryn seemed to be making progress, disaster struck – this time in the form of his right elbow completely giving way! In the middle of October 2012 he therefore had emergency surgery to insert a steel pin into the joint.

The operation was a success, but he needed almost constant care – and not for the first time I was glad to be working at home and able to watch over him.

Progress was apparently being made and, in January 2013, he started going on short walks – initially two a day of just a few minutes, building to a 40-minute outing by the end of the month.

It didn’t last. A few weeks later he returned to North West Surgeons with a poorly right leg again and was back on short lead walks.

That pattern seemed to be repeated endlessly over the next few months. A period of longer walks, sometimes with time off the lead, would almost inevitably see one or other of his front legs start playing up, with his activity reduced and then gradually built up again.

Rising costs

Bryn was still attending hydrotherapy sessions – usually two a week. With those costs not covered by the insurance, we were starting to feel the pinch financially – especially as his insurance premium had risen to about £75 per month. And we were stuck with that insurer, as another one wouldn’t have covered anything associated with the IOHC problems. It was all starting to get rather expensive.

And so we approached NWESSR, the Springer Rescue, for help – and were much relieved when they kindly agreed to make a contribution towards our costs.

As it turned out, their assistance wasn’t needed for too long, as a series of ‘limpy’ episodes in the Autumn of 2013 saw Bryn back at North West Surgeons for further assessment on 18 December – exactly three years since we adopted him.

Back on short lead walks again, he never regained sufficient mobility to go sniffing round the woods for bits of tennis ball. Instead, he spent the following couple of months under close supervision, either in the garden or on short walks on the village roads and footpaths.

Treats in the sun

We returned from a rare outing one Saturday afternoon to find him virtually crawling across the kitchen floor to us, with both elbows having given way simultaneously. (We think he’d got onto a chair by the window to look out and somehow fallen off, but of course will never know exactly what happened.)

It was clearly the end of the road for our brave and beloved Bryn. He’d been through so much pain and fought back so often with enormous fortitude, courage and grace – but with both front legs out of action at the same time, there was no way that one could support his weight while the other mended.

We made him as comfortable as we could and tearfully discussed what to do next.

In order to keep his weight down and reduce the stress on his joints, we’d kept him on a strict diet for a year or more.

Now, knowing that he would not be with us much longer, we decided to treat him. On the Sunday afternoon, I carried him out to the garden, where he lay in the sun eating lots of lovely doggy treats. He couldn’t believe his luck.

He did much the same on the Monday morning before we took him to the vet and, as my diary simply says, ‘Bryn went to sleep for ever’.

What did we learn?

I suppose the most obvious lesson from our experience with Bryn was about spotting when something is wrong – or at least doesn’t seem right. For months I saw him struggling to run down hills, but ignored what I was seeing.

That said, our local vet didn’t think of IOHC, despite Bryn having problems with lameness and it being an issue known to affect Springers and other Spaniels. Maybe there’s a lesson there too: even vets don’t know everything!

Our difficulties with Bryn certainly brought home to us the importance of having good insurance cover. Yes, I was paying £75 per month towards the end, but the MRI scan, laser therapy and other assessments and treatments cost thousands.

We’d have been hard pressed to find that money if we’d not been insured – and for a decent amount (I think it was £5000, renewing each year).

And we learned that a dog really is for life, even if that life is shorter than expected. Bryn was part of our family. His welfare was a major concern for us. It was not just about what was best for us, but what was best for him – something that all too often meant ensuring that he had appropriate pain relief, but that also meant trying to make sure that he enjoyed as good a life as he was able to, including plenty of opportunities to use that wonderful nose of his.

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