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Hey, No Pressure

That's precisely what heavy Molossers need to avoid fluid-filled hygroma on elbows and hock joints

They swell, they swing, they sway – they’re those high-maintenance hygromas, bulging fluid-filled sacs that arise on pressure points, particularly elbows.
An elbow hygroma arises when the joint is repeatedly traumatized by banging against hard surfaces. Instead of forming a callus to protect the joint, the body takes a shortcut and forms a fluid pad under the skin.
What technically happens is that repeated banging causes the blood supply to be restricted to the soft tissues overlying the pressure point, causing cell death and the formation of a fibrous tissue capsule around a fluid-filled cavity. The fluid is sterile, so it doesn’t cause illness or pain – unless a fistula or other opening to the outside develops. Once this occurs, infections can develop and the hygroma can become painful. With or without infection, hygromas tend to get larger and thicker with repeated trauma. Most hygromas are only of cosmetic importance, but even so, they can be unsightly and upsetting.
While any large-breed dog is a candidate, some are more hygroma-prone than others.
According to breeder and equine veterinarian Sherilyn Allen, DVM, of Ironstone Neapolitan Mastiffs in Boyertown, Penn., these include heavy dogs that have loose connective tissue and easily distensible skin, dogs that tend to have less muscle tone for their bodies, and short-haired dogs that have little cushioning on the elbow.
Fellow Neo breeder Pierluigi Scalia of Del Feudo Nisseno Mastini in Los Angeles County, Calif., says that the cause of elbow hygromas is not simply loose skin around the elbows, but that the skin is not loose enough.
It’s the wear and tear on that slightly motile skin area that determines the hygroma,” he explains. Making a case for loose skin, he adds: “To make the skin tighter on a dog like ours would be to limit even further his typical movement and cause more wear and tear than the one you would think to prevent.”
Some breeders suspect a hereditary predisposition, either from as yet unidentified factors or because the aforementioned predisposing features tend to run in certain lines. Great Dane breeder Nikki Riggsbee of Valrico, Fla., points out that some families seem to have a higher incidence of hygromas than others, and that she’s had litters where more than one dog developed them, and other litters where none at all had hygromas.
Behavior plays a role. Young dogs from six to 18 months tend to flop down on hard surfaces when playing or even when deciding to take a load off their feet. Older dogs with arthritis or pain in other joints may tend to only lie on one side or to apply abnormal pressure to the elbow joints when lying down.
Neo breeder and veterinarian Robin Waldvogel White, DVM, of Eugene, Ore., points out that dogs that commonly sleep on hard surfaces or those that always sleep in the same position are more prone to the condition.
“Elbows, carpus and hocks are most likely to develop hygromas or the granulomas and pyodermas associated with callus formation,” she says. “I actually see more of the pressure-point granulomas associated with the callus formation than hygromas; where the hair becomes entrapped in the callus and festers underneath the thick skin, which can lead to a deep pyoderma.” White adds that prevention and treatment go hand in hand - and can be equally challenging.
Lying down on a hard surface, like this Spanish Mastiff on a cement floor (above), is an open invitation for hygromas. Instead, opt for soft, cushy surfaces, like this Dogue's comfy couch (below).

The How-Tos of Hygroma Care

Preventing hygromas sounds easy – until your own dog gets one. But there are ways to prevent and treat the condition, starting with the environment and progressing to veterinary care.
Avoid Hard Times: “Heavy breeds need very cushioned flooring, especially when they are in the floppy-puppy stages,” says Allen. “They can get hygromas on the hocks, on the ischia, anywhere there is little tissue over a boney protrusion. Elbow is most common because these heavy dogs crash onto them when they lie down.” Concrete, tile, linoleum and hardwood flooring are all culprits, especially because they are enticing to large dogs as they tend to be cooler than carpets or cushions.
Hit the Hay: Dog crates without thick mats are also hygroma enablers. Better bedding suggestions from owners include overstuffed faux sheepskin bedding, baby-crib mattresses, memory foam – even your own bed. White prefers orthopedic egg-carton-foam mattresses or platform beds such as the Kuranda bed. “I find with the platform beds the giant dogs often don’t need the largest model size and the medium or large models often hold up better than their XXL versions,” she says.
The challenge is in getting the dog to lie on the bed – especially in warm weather. Given the choice of a soft but heat-retaining bed on a hot day versus a hard cool floor, any smart Molosser will choose the hard surface. Platform beds tend to stay cooler than other soft beds, so may be a better choice for heat sensitive dogs.
Cooling beds are available that work with cooled or chilled water, and may be enticing. Most are not very thick, though, so may be better placed atop a sturdy foam mattress. In some cases, tiled or concrete areas may need to be placed off limits, and soft beds provided in every room the dog frequents. Placing beds inside ex-pens in various rooms can cordon the dog off from hard surfaces, yet allow him to be with you.
Over Easy, Please: No matter where the dog is sleeping, if he’s constantly lying on one side only, or if he’s lying on the side with the hygroma or callus, flip him over. Some dogs will freak out the first few times you do this, so be ready with some treats and encouragement – and a strong back.
Set Ground Rules: It’s not only resting surfaces, but playing surfaces. Restricting dogs to grass and dirt instead of concrete or gravel for playtime may make for dirty dogs, but at least it decreases how hard the elbows bang on the ground.
Create a Soft Spot: If you can’t keep your dog on a soft pad, keep a soft pad on your dog. You can try the do-it-yourself pads: a small towel, foam tube, diaper – even a padded bra cup! Place it around the elbow and – here’s the hard part – tape it into place. You can try rolled bandage tape such as Vet-Wrap, sticky tape or Velcro strips. But too often the whole affair will get dislodged once the dog gets active, or he’ll take matters into his own teeth and rip it off. But it’s worth a try.
Once the DIY urge has passed, you can buy specially designed elbow pads that actually stay on. The best known of these are made by DogLeggs Therapeutic & Rehabilitative Products in Reston, Va. Since 1999, when DogLeggs’ founders Schon and John-Henry Gross made their first set for their own dog’s hygroma, they’ve sold more than 18,000 pairs worldwide. DogLeggs come in more than 60 sizes off the rack, as well as custom sizes for hard-to-fit dogs. Although the price tag of $107 may seem high, it’s economical compared to other options – and it’s covered by most pet health insurance companies as long as your veterinarian prescribes it, says Lisa Fair, DogLeggs Director of Marketing.
The DogLeggs consists of elbow padding made of  breathable material that allows air to circulate beneath while it wicks away moisture. The pads are held in place by way of a harness-like strap over the dog’s back, so they don’t fall off. Fair says that most of the time, the DogLeggs are entirely curative, with cure time typically ranging from a few days to several weeks. “We recommend continued use of the DogLeggs three weeks beyond visual resolution of the hygroma to allow the underlying tissues to heal,” she says.
Ty (above left), a 5-year-old Neapolitan Mastiff owned by Shantell Hawkins of Los Angeles, had a hygroma on his hock (above center). Hawkins treated it with 3 ml of hydrogen peroxide in a syringe at least once a day. It took 10 days to reduce the joint swelling to normal (above right). She says the key to Ty's convalescence was avoiding hard surfaces without adequate protection of the area. Hawkins wrapped the hock in gauze and lightly taped the top of a tube sock in place over it. Below: Ty today, totally recovered.
Apply Elbow Grease: Prevention of calluses is much the same as prevention of hygromas: Keep the dog off hard surfaces. But treatment is a little different. Allen advises putting a cream or lubricant like Vaseline on the callus to protect it from more friction and possibly allow it to heal.  But, she cautions, “most calluses never heal. Prevention from puppyhood is better than trying to treat them.”
Keep It Clean: A break in the skin beneath the fur overlying a hygroma can be difficult to detect – but not for bacteria, which can use it as an access ramp to a warm, wet breeding ground. Check for inflammation; swelling may be hard to tell from the hygroma, but redness, heat, draining and pain are all signs of infection. Keep the area clean and break-free to avoid such problems. If they occur, seek veterinary advice and antibiotic treatment.
Suck It Up: Aspiration of fluid, along with prevention of further trauma, can sometimes be effective. If the hygroma is small and in its early stage, Allen advocates draining it with a needle and injecting corticosteriods and antibiotic. This should be performed using sterile technique so no bacteria is introduced. In some cases this is curative, but if the fluid remains after three or four treatments, the procedure probably isn’t going to work. Long-standing hygromas of any size are less likely to respond because the wall of the cavity is thickened and hard.
Open the Drains: If the hygroma is old and huge, a surgical drain may be the best choice, according to Allen. After the drain is put in, Allen says to keep the elbow bandaged to eliminate dead space (where the fluid was) and allow the bursa to heal together. “This is difficult to do,” she cautions, “as elbow bandages are hard to keep on a dog without constricting the leg. It can be done with a lot of human determination and properly caring for the dog and bandage.” She adds that any treatment also usually requires the use of oral antibiotics and corticosteroids.
Avoid Sharp Objects: The initial impulse is to take a knife to the hygroma. But this is just a temporary fix, and in fact, can do more harm than good. Says Dr. White: “The biggest mistake I see with hygromas is people wanting to open up the blister because they think that will encourage healing. Instead it does the opposite and opens the joint up to infection.” The worst case she ever saw was a lanced hygroma in a large Chow Chow that resulted in a non-healing open wound. “The elbow wound was ghastly and resisted every effort for closure and healing. The dog and owners eventually lost their battle against septic arthritis, and the dog eventually was euthanized.”
Cut It Out: Cutting off a hygroma is generally not a good idea, as it involves removing the protective callus and pulling skin together over an area that stretches the wound opening. It can be difficult to get the wound to heal. But sometimes surgery may be the only choice left. In a recent publication, veterinarians at the Virginia-Maryland Regional College of Veterinary Medicine in Blacksburg, Va., described a successful surgical technique in a Newfoundland that combined using muscle tissue (the rectus abdominus muscle) from another part of the dog’s body along with a mesh skin graft and an external fixator (Green, et al: Surgical treatment of an elbow hygroma utilizing microvascular free muscle transfer in a Newfoundland. Journal of the American Animal Hospital Association. 2008. 44(4):218-23).  While the treatment was undoubtedly expensive, the dog was reported to be fine, with no recurrence, 10 months afterward.
Most hygromas are primarily of cosmetic concern – as long as they don’t become infected. But in a few cases, they can cause lameness due to inflammation or tissue destruction, or they can cause a non-healing wound that may be incurable. Prevention is better than treatment. Treatment can be frustrating, but it can also be successful – but the wrong treatment can be worse than none at all. 

Trick or Treatment?

Everybody knows not to believe everything you read on the Internet – especially when it comes to treating medical conditions. But here are some unsubstantiated suggestions compiled from forums and websites. Consult with your veterinarian before trying any of them. Remember, “First, do no harm ...”
• Give oral probiotics to help stave off infection.
• Give oral omega-3 fatty acids to help reduce inflammation.
Give an oral product called Microlactin, which supposedly “breaks the cycle of inflammation.”
Can fish-oil supplementation (left) and homeopathic remedies (right) help with hygromas? Consult with a holistic vet.
• Rub a mixture of 2 ounces of dimethyl sulfoxide (DMSO) with 2 ml of dexamethasone on the area twice a day.
• Rub Ichthammol ointment (“black drawing salve”) on the area twice a day.
• Rub Lasonil (heperanoid) ointment on the area twice a day.
• Give oral Apis mellifica (a homeopathic remedy made from honeybee venom) in early stages (because it is supposed to reduce inflammation and fluid retention); give Byronia or Calcarea Fluorica homeopathic remedies if the hygroma has progressed for more than a week.
© Modern Molosser Magazine. This article may not be reposted, reprinted, rewritten, excerpted or otherwise duplicated in any medium without the express written permission of the publisher.