a reluctance or inability to stand. In some breeds and/or individuals, the stance of an HOD puppy as observed from behind has sometimes been described as “cow-hocked.” Shaking of limbs and a reluctance to put full body weight on the front legs is often observed. Sometimes the puppy will exhibit a characteristic “roaching” or arching of the spine when standing (see Figure 2). Lameness is accompanied by pain upon palpation of affected bones, warmth in the limb as felt by the inside of the clinician's wrist, depression, and loss of appetite. Limb involvement is usually bilateral, typically involves the distal radius and ulna, and may be episodic. There is evidence to suggest that most dogs recover after one episode, but some relapse. Dogs suffering systemic manifestations of the disorder often have poorer prognoses. Systemic manifestations include fever, multiple body organ inflammation, nasal and ocular discharge, diarrhea, hyperkeratosis of the foot pads, pneumonia, and tooth enamel hypoplasia (many of these symptoms overlap with symptoms of CDV). Because early diagnosis must be based on clinical signs, to the extent possible, other disorders should be ruled out (e.g., nutritional bone disease, and osteochondrosis). Radiographic Features Diagnosis relies on clinical signs and characteristic changes in radiographic images of the metaphyses. Bone changes can be observed on radiograph, and the disorder may progress to actual angular limb deformity. In the early stage of the illness, the metaphyseal area on X-ray may be observed to have an uneven radiolucent zone parallel to the physis with a thin band of increased radiodensity directly bordering the physis. Early stage radiographic changes have sometimes been described as having a "moth-eaten" appearance (see Figure 3). As the disease progresses, the radiolucent line may disappear and radiodensity may increase in the affected area as the body attempts to repair damage. Relapses can cause new radiolucent lines. This area is often followed by a dark line at the metaphysis, which may progress to new bone growth on the outside of that area. This area represents microfractures in the metaphysis and bone proliferation to bridge the defect in the periosteum. Treatment Treatment options have been controversial. Mild illness is often successfully treated with pain medication (usually NSAIDs) and supportive care. Dogs presenting with severe, systemic symptoms not responding to NSAID treatment require more intensive treatment. The Weimaraner and Irish Setter American Kennel Club (AKC) parent clubs advocate the use of immunosuppressive doses of