u/EmotionOk2110

• TL;DR: Seeking nutritional and behavioral guidance on pit-pyr rescue puppy with possible carpal flexural deformity and/or spinal injury until we can meet with the neurologist in mid-July - specific questions are below. Thank you in advance for any info or guidance you can offer, and for reading this epic post! Ethel and I thank you!
• Basics: Ethel is a ~14 week old female rescue puppy, not yet spayed, mixed breed. DNA results indicate 32% AmStaff, 24% Am Pit Bull, 24% Great Pyrenees, with another 12% being various guarding breeds, 3% GSD and 1% lab. She is ~22 lbs, up from 11 lbs when we first got her 3.5 weeks ago.
• Short history: Ethel was found as a stray in central South Carolina on 4/27. She was flown up to NY on 5/10, and after "full vetting" by the rescue here (aka, a once over and a few shots) she was handed off to us at the airport. She's doing great with potty training, and is a happy, athletic, agile, energetic, intelligent, friendly, and stubborn puppy who truly has shown basically no behavioral signs of being unwell.
• Clinical signs:
  • Likely not related to the issue at hand: Ethel had a UTI, yeast infections in both ears, mild coccidia, and moderate sarcocystosis. She also has a bit of dandruff and dry skin. Aka, she had some rough times before she made it to us!
  • Relevant signs: Ethel has what looks like mild carpal flexural deformity or something that presents similarly in her front legs, with them occasionally shaking when she sits if she's tired or scared. Her back legs seem a bit unsteady and her gait is a little off - one back foot tends to like to cross in front of the other. She seems to have a bit of a hard time getting up to standing and she wipes out more often than expected but rights herself right away. She sometimes sits side saddle but is also very comfy jumping up on her back legs. Ethel does sometimes bite her legs and paws but it's hard to tell if this is just mouthy puppy stuff, a skin allergy, or if she's in pain.
    • That said, Ethel is also very nimble - she's hopped up and down rickety rock walls, chooses to walk the length of a large downed tree trunk daily, taught herself to go up the stairs, and seemingly never tires of tug.
    • Photos and one video are here: https://imgur.com/a/KNRQ1Qa . Most are from this week, with a couple from the 2nd week we had her. I think *maybe* her legs are looking a bit better, but not sure.
• Length of time you have seen these changes: since we got her
• Links to any vet reports, test results, X-rays etc. that you already have:
  • I don't have reports just invoices, so here's a summary...
  • We have had two vet visits, at the first we didn't get into the possible joint issues because of all the pressing GI and UTI issues.
  • At the second visit (with a different vet who we liked a lot less, at the same practice), Ethel was shaking quite a bit and seemed to almost go limp. There, she presented with a bit of knuckling on both back legs, taking 2-4 seconds before righting her paws, and with her tail tucked and to the left. She did not show any signs of pain when the vet pressed her way down her spine and tail. At home, she repositions her paws almost immediately almost all of the time and her tail seems normal. The vet suspected a possible spinal injury, though also named it could be a malnutrition + rapid growth related issue. We received a referral to a neurologist to get an xray and have booked an appointment but it is not until July 7 and others I have called have even later dates than that.
  • We have another appointment with the first vet that we liked next week, so we will be bringing her the below questions but wanted to get a head start/some additional opinions by sharing this here.
  • Vaccine- and meds-wise, Ethel has had dewormer, is taking NexGard Plus, has had 2/3 of the distemper, parvo etc., shots, has had 1/2 of her Lyme and lepto shots, and is getting her first rabies shot on Tuesday. She did a course of Amoxicillin/clavulanate for the UTI and is taking her last Albon tonight for the coccidia. She has been taking Dasuquin Advanced for 2 weeks and also probiotics.
  • Ethel's Wisdom test panel results showed that she has literally 0 genetic markers for any of the medical conditions they test for, which was a relief - mixed breeds for the win.
• Location: Mid-Hudson Valley, NY, USA

So here are my questions. I am a high information person with a strong science education, so I have been reading primary research and vet-vetted web resources on the possible issue(s) at hand. It seems like if it's spinal or otherwise neurological, these issues can wait to be assessed until mid-July. If it's carpal flexural deformity, in sum or in part, however, it seems that it's important that we take all steps necessary to address it asap as it may be resolvable. But ofc I'm not a vet, so I'm asking you all! Basically, I would hate to learn in July that there were steps I could have taken now that would have helped reverse this condition but that are no longer on the table at that point. So, these questions are primarily based around possible carpal flexural deformity or other growth + malnutrition related issues.

Diet: What should I be feeding Ethel, both kibble and treats? It seems that the guidance of low protein is outdated, and what really matters is keeping her on a low calcium and low phosphorus diet for now. We transitioned her off of Purina Pro Plan Puppy, since they weren't giving large breed and we read that can be a cause of carpal flexural deformity. We put her onto Royal Canin's labrador puppy food, since everyone was saying lab-pit mix, but now that we know her breeds, we're open to changing that, or to staying on it since it seems like it does account for all the joint issues that large breed pups can have. It's 30% protein, the calcium is at 1.09% and the phosphorus at 0.9%, and she seems to like it, so I won't change it up if that's not needed, but very open to recs on this!

We both like the Pet Botanics mini Puppy training rewards in peanut butter flavor. It's 13% protein and they confirmed that Phosphorus (as fed) is 0.42% and Calcium (as fed) is 0.32%, so I *think* we're safe to keep using them? She needs so much training!

Exercise Restrictions: What is a reasonable amount of exercise restriction for this super energetic pup? We're obviously not going for a run every day, but she's super zoomy and needs a lot of tiring out before I can work, etc. Right now I'm carrying her up and down the stairs, we have runners down on the floors, we're keeping fetch at short distances and outside on grass, etc. Our land is a hilly mix of woods and grass, so she's going up and down some gentle slopes with me on our walks, with plenty of breaks and at as slow a pace as she'll allow.

Additional Supports:

• Should we try toe grips? Tiger paws? Those lil booties with straps? Should we wait on any of that til we have a firm diagnosis?
• Are there any good exercises for stretching/strength building, etc that folks can share with me now? I know that any PT is going to need a neurology referral before working with me on this, so hoping to get a head start now.
• Anything else I should be considering that I'm not already? Ie, a very good veterinary nutritionist? Chilling out and seeing how she does? Or?