Could you please take me off the mailing list...thanks! [EMAIL PROTECTED] Bernese Mountain Dog Mailing List <[EMAIL PROTECTED]> wrote:
BERNER-L Digest 4556 Topics covered in this issue include: 1) Everything you ever wnated to know about elbows by "Tim McNair" 2) list by "Betsy Brainard" 3) Re: Everything you ever wanted to know about elbows by [EMAIL PROTECTED] 4) carting clinic by "Andrea Brin" 5) Re: BERNER-L digest 4555 by "Tim McNair" 6) Re: no-pull devices by "S. Walquist and J. Patenaude" 7) Re: BERNER-L digest 4555 by "S. Walquist and J. Patenaude" 8) Puppy Rescue by Andie Reid 9) Lancaster Boycott by "Pat Long & Paul Dangel" 10) Re: Everything you ever wanted to know about elbows by [EMAIL PROTECTED] 11) FYI: Articles on Health, Orthopedic evaluations, etc. by Patricia Tackett 12) Simbo's 4th Birthday! by "Jean Cheesman" 13) Berner is pet store by Chris & Marjorie Cottle 14) I spoke too soon by [EMAIL PROTECTED] 15) Re: Gentle Leader by [EMAIL PROTECTED] 16) Re: BERNER-L digest 4553 by [EMAIL PROTECTED] 17) Re: Gentle Leader by "Janice Parky" 18) JUST ONE MORE DAY.... by "Dr. William B. Neff" 19) RE: BERNER-L digest 4555 - Nipping Puppy by "Ivana Leonard" 20) RE: JUST ONE MORE DAY.... BG Fundraiser by "Pat Long & Paul Dangel" 21) RE: JUST ONE MORE DAY.... BG Fundraiser by "Dr. William B. Neff" 22) Re: toe sprain by [EMAIL PROTECTED] > ATTACHMENT part 2.1 message/rfc822 From: "Tim McNair" To: [EMAIL PROTECTED] Subject: Everything you ever wnated to know about elbows Date: Fri, 29 Aug 2003 23:56:54 -0700 We have a 16 month old boy with pretty bad elbow dysplasia who has just had surgery and I thought that I'd share our experiences with you so if you're ever in this situation it may make your decision making a bit easier. We did a bunch of research and saw several docs to try to figure out what's best. Bottom line--no one knows for sure. My task was perhaps a bit easier since I could talk doc-to doc and the anatomy is similar. Elbow dysplasia is thought by most to be caused by incongruency between the radius and ulna (bones in the forearm). This is thoought to be very small in teh range of a few millimeters. This causes changes in the way weight is born on the joint leading to wear on the cartilage in places it was not meant to wear, eventually exposing bone. There are several procedures that have been tried to fix this--none of which work reliably. (FWIW anytime there are multiple surgical procedures to fix a problem it means none of them works very well.) The first procedure was an ulnar osteotomy--cutting the ulna to shorten it thus changing the stress on the joint. My understanding is that almost nobody does this anymore because it doesn't work. The current vogue is radial osteotomy--cutting the radius to shorten it (it seems to me that it woul be pretty much the same as lengthing the ulna) . Sometimes this seems to help. BUT and it is a huge but. You can't accurately predict wihich animal it will help and it almost as frequently hurts. Dr. Davis at UC Davis has done a lot of research on this. It is felt by the guys that do this that it corrects the inconguency. Dr. Davis has done research that shows that you can't tell when a joint is incongruent. He created incongruent joints in cadaver dogs, x-rayed them and sent the pictures to radiologists. They were no better than chance and figuring out whether the joint was incongruent or not. In other words the test to see whehter or not surgery might help is NOT RELIABLE. He thinks the dogs that do get better are largely a matter of chance. Remember we are talking about millimeters here--so if you get it just right it works if not it doesn't---orthopedic surgery just isn't that precise. Another new procedure is called an ulnar splitting osteotomy, where they split the ulna to change the weight bearing. The folks that do this are apparantly clicquish and have not published any data in any journals to show that the procedure actually works. Dr Schulz is very sceptical about this since there is no published data. The last procedure is one he has "invented" a humeral osteotomy, changing the weight bearing at the elbow by changing the angle that the humerus impacts the elbow as I understand it. He's been doing these for a couple of years and says he's got an 80% success rate, but also has a 5% complete failure rate, making the joint worse. He's still trying to figure out what makes the difference. All 4 of these are major procedures with a long recovery time, think months. In addition you can only do one limb at a time. A lot of rehab is needed. Probably the best initial step, the one Dr Schulz recommends, and the way we went is arthroscopy. First it allows you to see exactly what is going on. Second, it allows you to remove loose bodies from the joint. If there are loose bodies they will cause more damage if they are left behind. Third you can do both elbows at once. As he does the procedure he makes micro-fractures in the radius with the thought of possibly bringing stem cells to the surface and creating new cartilage. He admits that this might be witchcraft, but feels it is worth a try. Bloom is just over 2 weeks post op and is pretty much back to normal and has gained about 10-15 degrees of flexion in both elbows. In another 3 or 4 weeks he can go back to normal activites. Most importantly----NONE of the procedures cure the problem--they hope to slow it down. The most important single thing is weight control. I thought my little guy was pretty slim at 102--he wants him down to about 95. He uses glucosamine chondroitin---there have been bioavailibility issues with some of preparations and Rimadyl or other anti inflamatory as needed. If this doesn't work then he would ad Adequan injections, followed by hyaluronidase injections in the joint. Only after these have failed would he even think aboout humeral osteotomy. Next month he will be putting in two sets of "total elbows" and figures that using them routinely is five or so years off. FWIW he has just published a text on veterinary arthroscopic surgery. The folks at Davis were GREAT and it is a very nice town. It was well worth the 1100 mile drive from Tacoma. FWIW the cost was around 2K--about half the price of the local guy who was not nearly as experienced as Dr. Schulz. If you have questions don't hesitate to ask Tim Tim McNair M.D. Please respond to [EMAIL PROTECTED] Tim McNair M.D. Please respond to [EMAIL PROTECTED] --------------------------------- MSN 8: Get 6 months for $9.95/month. > ATTACHMENT part 2.2 message/rfc822 From: "Betsy Brainard" To: "berner-l" Subject: list Date: Sat, 30 Aug 2003 06:25:30 -0400 Hi, For some reason I keep getting bumbed off the list and I go in and resume with my e-mail address. Does anyone else have this problem. Betsy Brainard [EMAIL PROTECTED] > ATTACHMENT part 2.3 message/rfc822 To: [EMAIL PROTECTED],[EMAIL PROTECTED] Date: Sat, 30 Aug 2003 06:05:22 -0500 Subject: Re: Everything you ever wanted to know about elbows From: [EMAIL PROTECTED] Tim Thanks for the interesting report and all the current options. I would like to add another point of view here if you don't mind. Nearly 13 yrs ago an ulnar osteotomy was done on one of my dogs at TX A&M for severe ED. Not long after that another of my girls had elbow surgery where the fragment and joint was simply cleaned out but nothing more was done. This was the days prior to arthroscopic surgery and there was quite a bit of trauma to the leg. Neither dog was ever "normal" but both led fairly long productive (in doggy terms) lives. One lived to 11yrs and was put down due to advanced arthritis when he could no longer get up The other to 9yrs and died of cancer. My concerns over the years are the need to perform very expensive very invasive procedures on a dog where the outcome is "temporary". (sorry, surgeons are notorious for thinking everything can be fixed by a knife) While by no means a scientist nor in a position to determine outcomes for a large number of dogs with a given problem I have to wonder what studies would show the long term prognosis would be for a dog that was not given surgery but instead treated in the manner a dog will be treated post surgery - glucosamine, chondroitin, rimadyl, adequan, and weight control. I've seen many dogs limp and limit activity at the time of the initial trauma caused by the incongruities of ED however over an extended period of time there seems to be less limping and more return to normal activity (not 100% but then that doesn't occur with surgery often either). I wondered if what was happening was more of the mortar and pestle action of the joint over time "grinding" down any fragments to smaller osteocytes along with the ulna and radius returning to normal position as the dog reached maturity. Early treatment with neutraceuticals and anti inflammatories was done. Surgery was recommended for these dogs but due to various circumstances postponed. I feel that until something more permanent and effective is an available option for dogs than the "temporary" surgeries currently being offered the treatment of neutraceuticals and anti inflammatories, weight control, and light to moderate ongoing exercise is an option for owners also Susan Ablon Gweebarra BMD Balch Springs, Tx http://www.pageweb.com/gwebara On Fri, 29 Aug 2003 23:56:54 -0700 "Tim McNair" writes: We have a 16 month old boy with pretty bad elbow dysplasia who has just had surgery and I thought that I'd share our experiences with you so if you're ever in this situation it may make your decision making a bit easier. We did a bunch of research and saw several docs to try to figure out what's best. Bottom line--no one knows for sure. My task was perhaps a bit easier since I could talk doc-to doc and the anatomy is similar. Elbow dysplasia is thought by most to be caused by incongruency between the radius and ulna (bones in the forearm). This is thoought to be very small in teh range of a few millimeters. This causes changes in the way weight is born on the joint leading to wear on the cartilage in places it was not meant to wear, eventually exposing bone. There are several procedures that have been tried to fix this--none of which work reliably. (FWIW anytime there are multiple surgical procedures to fix a problem it means none of them works very well.) The first procedure was an ulnar osteotomy--cutting the ulna to shorten it thus changing the stress on the joint. My understanding is that almost nobody does this anymore because it doesn't work. The current vogue is radial osteotomy--cutting the radius to shorten it (it seems to me that it woul be pretty much the same as lengthing the ulna) . Sometimes this seems to help. BUT and it is a huge but. You can't * * * * * * * * * * * * * * * * * * * * * MESSAGE EXCEEDED PERMITTED LENGTH * * * * message truncated * * * * * * * * * * * * * * * * * * * * * * *
