*The following information has been provided by Dr. Phil Zeltzman, a board-certified veterinary surgeon from Whitehall, Pennsylvania as a courtesy to goodnewsforpets readers. The following article is only for the sharing of knowledge and information; it is not intended to replace consultation of a veterinarian or other qualified pet care professional. To subscribe to his newsletter, here
.
It has just received the Hartz Every Day Chewable Vitamin Award from the Cat Writers’ Association.
The Cat Writers’ Association is an organization of professionals who write, publish and broadcast about cats throughout the country and the world.
The special award is given to “the highest-quality entry on the topic of older cats.”
The entry was our newsletter on cisplatin beads, published earlier this year, entitled “Tiny Beads Create a Big Revolution in Cancer Treatment.”
Needless to say, I am honored to have been chosen, and I am very thankful for this award.
An encouraging email about laryngeal paralysis
After last week’s newsletter on laryngeal paralysis, I received this nice email from JE, a subscriber and former client who owns a Golden retriever.
“Dr. Zeltzman,
You did a tieback surgery on our Bandit back in April of this year. He is doing wonderfully at 14 years and 7 months old at present.
I find it interesting that you had mentioned the fact that (laryngeal paralysis) may only be the “tip of the iceberg” as we have just been noticing that his back legs are giving him problems. It seems to be at times they are showing signs of what we would say a paralyzed condition. I am going to make an appointment with my vet (…) to see what is going on. I will mention what I read in your newsletter.
Thank you for the newsletter and more importantly thank you for giving Bandit back his quality of life. He is a happy happy boy since the surgery. I just hope we can do something for the rear leg condition.
Thanks again”.
My response was that the back leg issue may or may not be related. It could also be arthritis, or it could be a condition of the spine. So it should be investigated. Go Bandit!!!
Secrets of dysplasia
Most people have heard of hip dysplasia, which leads to hip arthritis. There is also elbow dyplasia, which leads to elbow arthritis. Both conditions can be confusing, and especially their treatment. Let’s go over the basics.
Hip dysplasia
Hip dysplasia or HD is a fancy way to say that the hip did not form correctly. As everybody says, the hip is a “ball and socket” joint. It is made of the ball of the femur or thigh bone (aka femoral head), and a socket or cup in the pelvis (aka acetabulum).
We typically think of HD as a canine condition. In fact, cats can be affected as well.
HD can cause pain. Young patients are typically painful because of stretching of the ligaments of the hip as the ball slips out of the socket. Older patients are usually painful because of arthritis, bone spurs, and bone on bone contact.
A very important point is that there is not always a good correlation between how bad X-rays look and how bad a patient feels. In other words, patient A may have “horrible” hips on X-rays (meaning full of arthritis), but may be functional and happy and able to run.
Whereas patient B may have “OK” hips on X-rays (meaning without much arthritis), but may act very painful.
As I always say, “we don’t treat X-rays, we treat dogs.”
Depending on the severity and the stage, there are many ways to help HD patients.
The conservative way is to use all or some of the options we have discussed before to help arthritis: joint supplements such as glucosamine, weight control or weight loss diets, arthritis diets, physical therapy, controlled exercise, pain medications etc.
The surgical way involves 4 mainstream options:
. two “puppy” surgeries (Juvenile Pubic Symphysiodesis and Triple Pelvic Osteotomy).
. and two “salvage procedures” (Femoral Head Ostectomy and Total Hip Replacement).
In cats, the most common option is the FHO, althought some surgeons have performed total hip replacements in cats.
Elbow dysplasia
Most people have heard of hip dysplasia, which leads to hip arthritis. And now there is elbow dyplasia???
Indeed.
It is a generic expression that mostly encompasses 3 conditions: Ununited Anconeal Process, Fragmented Coronoid Process and Osteo-Chondrosis Dissecans.
What do these fancy names mean?
Let’s quickly review our anatomy. The elbow is a very complex joint made of 3 bones: the humerus in the arm, and the (large) radius and (small) ulna in the forearm. When these 3 bones meet to form the elbow, they should create a nice, round, smooth, happy joint, called a congruent joint.
When it is not round and smooth, the elbow is called incongruent. There will be a step between the bones. This is sometimes called elbow incongruency. In turn, it can lead to elbow arthritis and our 3 conditions termed “elbow dysplasia.”
. Ununited Anconeal Process (UAP) is a large piece of bone that never attaches to, or detaches from, the ulna (aka “funny bone”). We end up with a typically very large piece of bone moving around in the joint.
. Fragmented Coronoid Process (FCP) is a small piece of bone that never attaches to, or detaches from, the inside of the ulna.
. Osteo-Chondrosis Dissecans (OCD) is a condition where a flap of cartilage doesn’t attach to the bone underneath. OCD is seen most frequently is the shoulder, and the outcome it typically great. It is also seen in the elbow, knee and ankle, where the outcome may not be consistently as good.
Some unlucky patients can actually have two of these conditions at the same time!
In either case, the loose piece of bone acts like a pebble in your shoe: it causes pain and lameness. It can happen in both sides, which is why it is important to take X-rays of both legs, even though the patient is only lame on one side.
Treatment in a young patient typically entails removing the floating piece of bone or cartilage, either via arthroscopy or “open” surgery (called arthrotomy, or opening of a joint). Which technique is better remains controversial. Either way, surgery is typically successful if it is done early, ie before arthritis begins.
Treatment in an older patient is a little bit more difficult: there usually is quite a bit of arthritis, and whether removing the loose piece of bone will be beneficial or not is debatable. It probably depends on the vet, the situation and the patient.
In addition to surgery, management of arthritis is recommended for life. As in hip dysplasia, this includes joint supplements such as glucosamine, weight control or weight loss diets, arthritis diets, physical therapy, controlled exercise, pain medications etc.
Incomplete ossification of the humeral condyle
This is not really part of elbow dysplasia, but a perfect opportunity to mention it.
It is a strange condition that has been described in large dogs (Labs, Rotties), but mostly in Spaniels (Cockers, Springers etc).
The bottom part of the humerus, just above the elbow, is made of 2 parts, each called a condyle. The outside condyle is called lateral. The inside condyle is called medial. Normally, both condyles fuse, or ossify, early in puppyhood (before 3 months). When they don’t fuse, or ossify, there is “incomplete ossification.” This weakens the bone, and can lead to pain and lameness. At worst, it can cause a fracture, even in the absence of any serious trauma. So this is called an atraumatic fracture.
When there is no fracture, diagnosis is often difficult: Positioning during X-rays has to be perfect (ie under heavy sedation or anesthesia). By the way, this condition can occur in both elbows, so it is important to X-ray both elbows.
My take?
My impression is that many dogs are euthanized because of “arthritis.”
As we have discussed before, arthritis shouldn’t be assumed and blindly treated. It should be proven. Hip dysplasia is diagnosed with X-rays. Elbow dysplasia is more difficult and can be diagnosed with X-rays, CT scan or MRI.
Once we have an actual diagnosis, we can help the vast majority of patients lead a happy and comfortable life. Please don’t give up on an arthritic dog or cat!!!
Let’s now forget our feathered friends Please watch the incredible video of Snowball, an unlikely rocker!It will take less than 4 minutes of your time.
.
