Pet Connection by Dr. Marty Becker, Kim Campbell Thornton and Mikkel Becker

Learning to Walk

Hands-on therapies and patient retraining are helping a puppy regain his footing after corrective surgery

By Kim Campbell Thornton

Andrews McMeel Syndication

Remember Milo, the hound pup born with upside-down paws (a condition called bilateral congenital elbow luxation) who received corrective surgery at Oklahoma State University Veterinary Teaching Hospital in Stillwater last month? He’s out of his restrictive splint and learning to walk again with the help of his foster family and OSU surgical specialist and rehab therapist Cara Blake, DVM.

The pins holding Milo’s repaired elbows in place during the healing process were removed a few weeks ago, and Dr. Blake and her team began working with him and developing a plan to teach him how to walk, something the pup was never able to do. Therapeutic exercises, massage and other manual therapies are being used to help increase his flexibility and strengthen his muscles. But before he can walk -- let alone run -- he needs to learn to stand properly: to put his back legs in the correct posture, get his pelvis and spine straight, and get his front legs underneath him.

“Now that his elbows are in a more normal position, the way he was walking before isn’t going to work for him,” Dr. Blake says. “He will figure out, ‘Oh, I can’t walk like this anymore because it just doesn’t work,’ so I think that, together with doing exercises to retrain him, will allow him to progress at a pretty quick rate in terms of getting back to normal pelvic posture.”

Bilateral congenital elbow luxation is rare in dogs. The surgeon who repaired the defect, Erik Clary, DVM, has seen only two other cases in his 27-year career and was able to operate on only one of them. He says general practitioners may never see a dog with this problem, even if they practice for 30 or 40 years.

“The earlier we can get to them, generally the better the possibility that we can help them with surgery,” Dr. Clary says. “Sometimes the problem is not apparent when the puppies are really young, when they’re a week or two and just nursing. Their legs may not show those changes. But typically, when they get out to maybe 4 or 5 weeks, then usually it manifests, just like with Milo.”

What Milo has going for him, Dr. Blake says, is that he’s a puppy. He didn’t have time to learn bad ambulatory habits before undergoing surgery, so retraining him will be easier than it might have been.

He still faces challenges. His front-end alignment could be an issue because he has no range of motion in his elbows. The scar tissue that formed after surgery helps to keep the elbows in place, but it can also affect mobility. Massage and other manual treatments may help to some degree, but he may never gain full range of motion. That means he may have to learn to walk with straight elbows. Dr. Clary says the dog has a 50-50 chance of being able to walk normally one day.

This type of reconstructive surgery normally costs several thousand dollars. Part of the cost of Milo’s care was subsidized by OSU’s Pay It Forward Fund, started by students from the class of 2017.

Milo’s foster caretakers with Oliver and Friends Farm Rescue and Sanctuary in Luther, Oklahoma, are continuing his rehab exercises at home, and he already gets around well. Even though he may never walk completely normally, he can still have good quality of life.

“Even dogs that have horrible end-stage elbow arthritis, who lose significant range of motion in their elbows, are able to go out and run around and play,” Dr. Blake says. “Long-term, he may have some compensatory issues, but I don’t think it will affect his overall quality of life.”


Old cat has

litter box issues

Q: We have a 16-year-old female cat who has always been neat about using her cat box, but now she won’t pee in it. She spends most of the day in our fenced backyard, and she has a litter box in our laundry room for when she’s in at night. Every morning we have to clean a puddle of pee next to her litter box.

We have tried different cat litters, including clumping and non-clumping; we put out two litter boxes, each with a different type of litter; we’ve moved the boxes to different locations in the laundry room; we clean the litter boxes daily, so they are always clean. Our vet suggested that it’s a bit of cat dementia rather than anything physical. Do you have any thoughts on why she is doing this and what we can do about it? We love our cat, but we are tired of cleaning the laundry room floor every morning.

A: I assume your cat is able to get into the litter box without any problem if she is defecating inside it. If she is having this issue only at night, maybe she has developed vision problems and is having trouble finding the box to get into it. Can you leave on a night light or other light? You may also want to set down pee pads next to the litter box for easier cleanup.

As your veterinarian mentioned, cats can lose housetraining if they are experiencing cognitive decline. You may want to ask about a drug called selegiline (Anipryl) that is used in dogs with dementia. It is not labeled for use in cats, but some veterinarians prescribe it off label. It has a similar success rate in cats as it does in dogs: Approximately one-third benefit from it, one-third see slighter improvement, and one-third experience no change. -- Dr. Marty Becker

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How to brush

your pet’s teeth

-- If one of your New Year’s resolutions was to begin brushing your pets’ teeth regularly, good job! Here are some tips and techniques from the AVMA to ensure you do the best job possible. Wait 10 days after a professional dental cleaning to begin or resume brushing at home, to let gums heal. Use a finger brush or toothbrush with soft bristles. For pets new to the process, give them a few days to smell and taste the toothpaste before you begin brushing. Start with only a few teeth at a time and reward with a treat. Work up to a more thorough cleaning of 30 seconds or more. Run the brush along the gumline at a 45-degree angle. Focus on the outside of the teeth, where plaque is more likely to build up. Between brushing, offer rope toys or other chew items. Chewing has a mechanical action on the teeth that helps to clean them.

-- Cockatiels are popular pets because of their friendly personalities, variety of color mutations and ease of care. They originated in Australia, where they were first exported in the late 19th century, and began to be bred in the United States in the late 1950s.

-- Taking a Fear Free approach to skin care benefits dogs and cats who require frequent treatment for ear infections, allergies and other dermatological diseases, says veterinary dermatologist John C. Angus. Speaking at a veterinary conference in Orlando last month, he recommended light sedation and local anesthesia for obtaining skin biopsy samples. This reduces the fear, anxiety and stress that can accompany restraint, injection with a stinging liquid, pressure and the smell of blood. Following a skin biopsy, pets should receive postoperative pain relief immediately after the procedure and pain medication at home for three to five days. -- Dr. Marty Becker, Kim Campbell Thornton and Mikkel Becker


Pet Connection is produced by a team of pet-care experts headed by "The Dr. Oz Show" veterinarian Dr. Marty Becker and award-winning journalist Kim Campbell Thornton. They are affiliated with and are the authors of many best-selling pet-care books. Joining them is dog trainer and behavior consultant Mikkel Becker. Dr. Becker can be found at or on Twitter at DrMartyBecker. Kim Campbell Thornton is at and on Twitter at kkcthornton. Mikkel Becker is at and on Twitter at MikkelBecker.