Advice for elbow dysplasia

RE: Advice for elbow dysplasia

Julian Earl — Sat, 01 Jan 2022 22:39:42 GMT

Sounds excellent! My best-ever Labrador was crippled by Elbow arthritis and wish this had been around in those days or something similar! but that's life, things change and Caspar was clearly born way too soon for this!

Thank you for the informationJoyce; . I'll follow up on this about the condition generally though. Still of interest, half-my lifetime later!!

appy New Year as well!!

RE: Advice for elbow dysplasia

Joyce Whitehead — Sat, 01 Jan 2022 22:03:08 GMT

It’s a Monoclonal antibody Julian. So blocks the pain pathway in a similar way to cytopoint for itchy dogs. In some cases it has been truly life saving, dogs the owners were considering euthanasia are running around again. Monthly injections is the plan but some dogs manage longer between jabs.

RE: Advice for elbow dysplasia

Julian Earl — Fri, 31 Dec 2021 23:49:49 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/28612/advice-for-elbow-dysplasia/234836#234836"]I've found Librela to work well, but in severe OA cases it tends to start wearing off after about week 3. I've got one knackered old dog that has it every 3 weeks and manages ok. It is a great drug. [/quote]

Please Forgive me Anthony? but I am out of practice now since my trauma in 2012. What is this Librela to which people are referring? Thank you!

Happy New Year as well of course! Googlegives liited references.first-hand experiences from yourselves would be better, thanks!

RE: Advice for elbow dysplasia

Anthony Dennison — Fri, 31 Dec 2021 18:40:32 GMT

I've found Librela to work well, but in severe OA cases it tends to start wearing off after about week 3. I've got one knackered old dog that has it every 3 weeks and manages ok. It is a great drug.

RE: Advice for elbow dysplasia

Beats — Fri, 24 Dec 2021 07:42:41 GMT

Another vote for trying librela. Some supply issues, but if you dose at lower end of dose range and split vials (30mg vial = 2 x 15mg doses) can make what you have last out better.

RE: Advice for elbow dysplasia

Julian Earl — Fri, 24 Dec 2021 06:34:46 GMT

[quote userid="17318" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/28612/advice-for-elbow-dysplasia/234754#234754"]If at all surgery is indicated in these advanced cases, salvage procedures such as amputation, arthrodesis or joint replacement are the procedures of choice[/quote]

Thank you kindly Tafara, that answers my question albeit indirectly! NO , it would not help? The dog concerned, my own 40kg Labrador year ago, was definitely not in the early stages when he hadthe palpable osteophytes around the joint. Ial ways felt sorry that there seemed so little to do to try and stop any crepitus when the joints were greatly flexed! His weigh tput a lot of pressure though the elbows and had received bilateral femoral head excision when aged 4 to 6 yers so most weight wastransferred forard as result! I dread to thik of the condition of his articular cartilage in his elbows! Not very goodI am sure! Despite althis he was a hyeractive/boisterous dog and his tail was lucky not to become artheriticdue to constant activity!!

NSAIDS were all we could use for him really. Plus swimming for his exercise! He was a Labrador so that came naturally to him!!

I still get a lump in my throat as I think of holding him tight for his final moments when he was aged 13.5 years.., 30th August 1987 so a lifetime ago really... and I was whispering my love into his ear... |Tail still beating furiously!!Can you tell that I would have risked my life for this dog, [Caspar, whom we rescued when aged 18 months old from two doctors, who kept him in their garage all day , not having time to exercise him etc!! He loved his new-found freedom of that I am dead certain!!] Who'd have thunk it, an experience hardened veterinary professional being so utterly soppy this way about his pet??

RIP best pet I ever owned!!] If I go to heaven, Caspar will be there! If he isn't it won't be heaven will it?? St Peter saying, "Will you Please get inside here and get this dog under control before he wrecks the place!! Of course Sir!"

RE: Advice for elbow dysplasia

Tafara Mapuvire — Fri, 24 Dec 2021 04:53:04 GMT

Hi Julian,

My thoughts below.

Elbow developmental disease or elbow dysplasia is a multifactorial condition which results in abnormal joint mechanics. This in turn leads to cartilage wear and generalised joint inflammation and, ultimately, progressive DJD. In the long term, the DJD becomes the bothersome pathology causing chronic inflammation and debilitation. The objectives of surgery are to correct the underlying abnormal joint mechanics and subsequently slow down the development and progression of DJD (these joints will always develop a degree of DJD regardless of the intervention). Most surgical procedures are only beneficial if performed early before the development of severe DJD (usually before the growth plates have closed). If at all surgery is indicated in these advanced cases, salvage procedures such as amputation, arthrodesis or joint replacement are the procedures of choice.

Tafara

RE: Advice for elbow dysplasia

Julian Earl — Thu, 23 Dec 2021 21:16:40 GMT

Re. surgery for theseadvanced arthriti cjoints. Is it potentially beneficial to excise away pronounced osteophytes at the elbows for example? Having had a Labrador with very seere osteoarthritis of both elbow with palpable bony protruberances on both sides of the joints. I wondered whether removing these, wih a drill probably; would reduce the pain , if, that is they were rubbing across he joint and stimulating further proliferation? Are these osteophytes neurologically sensitive do we know? If so, does that mean debriding them is advantageous for analgesia or cunter-productive by damaging sensitive bony tissue? I wanted to normalise the anatomy around the joint space if feasible but not at the cos of severe pain either short- or longer-term. How much of the pain originates fro adamaged joint surface eg with OCD compared to pain from stretched/ traumatised joint capsules?

Thoughts please??

Thank you.

RE: Advice for elbow dysplasia

Clare Tapsfield-Wright — Tue, 21 Dec 2021 22:53:39 GMT

Thank you so much Joyce

RE: Advice for elbow dysplasia

Joyce Whitehead — Tue, 21 Dec 2021 22:09:51 GMT

We’ve had some spectacular successes with librela, dogs literally so much happier within 24 hours. There are supply issues, although we are well stocked, as some dogs haven’t improved so much on it and some are so good they don’t have monthly injections. So if you need to get some and your local practice haven’t any spare let me know…

RE: Advice for elbow dysplasia

Clare Tapsfield-Wright — Tue, 21 Dec 2021 21:52:41 GMT

Thank you all so much for the advice . So sad to see a five year old dog like this but she will have everything she needs to make her comfortable. Thank you colleagues

RE: Advice for elbow dysplasia

Clive Ansell — Tue, 21 Dec 2021 09:50:32 GMT

I've not used Librela, but colleagues that have are reporting good results with it.

Adding in paracetamol with codeine, either as co-codamol, or the licenced pardale-v, is another option.

I'm taking co-codamol for back pain, it seems very effective and doesn't seem to have the side effects that amitryptilline and gabapentin do.

RE: Advice for elbow dysplasia

Rob Davis — Tue, 21 Dec 2021 09:02:48 GMT

I agree that librela is worth trying if you can get hold of it - several really good responses so far.

RE: Advice for elbow dysplasia

Tafara Mapuvire — Tue, 21 Dec 2021 03:55:44 GMT

Hi Clare,

Firstly I must say that I do not have any experience with Librela injections. Not sure it's available yet this side of the Atlantic. A multimodal approach is definitely indicated here and adding gabapentin into the mix is a step towards that. I would periodically give ketamine subcutaneous injections at 1mg/kg for wind up to try and 'reset' the maladaptive nociceptive state. Oral paracetamol at 10-15mg/kg bid-tid can also be added to the regimen, usually with good results and minimal side effects. Amantadine and amitryptilline can also be added to the protocol although these two seem to be less commonly used for neuropathic pain than gabapentin. Use of tramadol is controversial in dogs as they seem not to be able to convert the parent drug to the pharmacologically active M1 metabolite in sufficient quantities. Pentosan injections might also be a prudent adjunctive for OA. Other controversial treatments with equivocal evidence include CBD oil, acupuncture, and laser treatment. The importance of controlled exercise and weight loss in these cases cannot be overstated.

Tafara

RE: Advice for elbow dysplasia

Gillian Mostyn — Mon, 20 Dec 2021 20:51:29 GMT

My 13 year old arthritic collie has done amazingly well on librela. I'd certainly suggest trying it - with nothing to lose!

RE: Advice for elbow dysplasia

Clare Tapsfield-Wright — Mon, 20 Dec 2021 18:01:14 GMT

Two years on and Nelly has done really well on metacam but is now increasingly lame. I have great difficulty in preventing her Tigger behaviour and try to walk her on the lead rather than letting her ricochet around which definitely makes her worse. I have added gabapentin in to the metacam following my vets advice and we were wondering about Librella injections . Any thoughts ? She seems to sleep a lot and chunter to herself, she is quite vocal anyway , but I’m worried she is in pain even though she is still very keen to bounce around when out.

RE: Advice for elbow dysplasia

Dinu Catilina — Fri, 25 Oct 2019 12:04:04 GMT

I certainly don't advocate stem cells or PRP for everything but this is a rather slightly better study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159804/

RE: Advice for elbow dysplasia

Beats — Fri, 25 Oct 2019 10:18:44 GMT

[quote user="David Mills"]You mean the one paper, sponsored by the makers, that showed some improvement in subjective owner-reported outcomes such as "reduced stiffness". [/quote]

I am in no way trying to promote the use of cartrophen!

There are two studies I am aware of (I call them the American one and the Australian one).

https://www.ncbi.nlm.nih.gov/pubmed/8683953

https://www.ncbi.nlm.nih.gov/pubmed/17461948

My view would be that any interventions with less evidence than this are probably not worth considering more than cartrophen would be unless they have significantly more convincing rationale behind them.

[The argument for cartrophen is circular I think: We think it must work like this. Well that doesn't sound very plausible. Then how do you explain the studies showing it works? In the absence of a convincing mechanism of action, I would suggest random variation, positive-publication bias and other rationale reasons. But it works like this. Well that doesn't sound very plausible. Then how do you explain how it works, because we know it does...]

RE: Advice for elbow dysplasia

Christina Smith — Thu, 24 Oct 2019 23:12:31 GMT

Avoid stairs and landing hard on forelegs. Swimming good so long as not clambering out. No idea re supplements but clients like them. Nsaid if lame,they can hard on the go system if given for long periods and human medics hate them in geriatrics. shame in such a young dog. Fingers crossed elbow surgery seems very experimental and mixed outcomes

RE: Advice for elbow dysplasia

David Mills — Thu, 24 Oct 2019 22:43:45 GMT

[quote user="Dinu Catilina"]I would argue that the evidence behind cartrophen is rather poor.[/quote]

You mean the one paper, sponsored by the makers, that showed some improvement in subjective owner-reported outcomes such as "reduced stiffness".

RE: Advice for elbow dysplasia

Beats — Thu, 24 Oct 2019 22:08:35 GMT

[quote user="Dinu Catilina"]Stem cell therapy and PRP might not be the bees knees but they are also not just experimental.[/quote]

I'll admit I don't keep up-to-date with this stuff (and I know there was a licensed product recently - equine only was it? - so I guess my comment that if was a drug wouldn't be licensed isn't strictly true then), but I await to be convinced license or not - what's the best evidence out there? Even the normally liberal AVMA sound sufficiently cagey to feel the need to release a general statement on this stuff this year (https://www.avma.org/KB/Policies/Pages/Therapeutic-Use-of-Stem-Cells-and-Regenerative-Medicine.aspx?PF=1 ). I'm keeping stem cells / PRP on the same level as "laser" until I see more evidence with my own eyes.

[quote user="Dinu Catilina"]I would argue that the evidence behind cartrophen is rather poor.[/quote]

I don't disagree. Anything with actually less evidence I'm happy to call "experimental", however as often the treatments are being done without being part of an actual clinical trial (experiment), I guess for some things on that list "unproven" may be more accurate. [actually, somehow "experimental" sounds worse than "unproven" which seems unfair).

[quote user="Dinu Catilina"]Weight management is for me the most important part of treatment. [/quote]

[quote user="Dinu Catilina"]Supplementing with Omega 3 has been shown to have some benefits. [/quote]

At a level where they equal approximately 10% of the recommended calorie intake for an average labrador if I remember correctly and got the maths right the first time round.

Combine that with the fact that the proposed mechanism of action sounds much like a poor-man's COX inhibition and I would suggest that a few drops of metacam is likely to give you the same effect without the calories.

I maintain my position that discussing omega-3 supplementation is a distraction from achieving effective actual weight loss (perhaps more of an issue with hindlimb mobility than forelimb though?)

I doubt many of the actual users supplement them to the level that was shown (in somewhat unconvincing and limited work) to be beneficial.

[quote user="Dinu Catilina"]Arthrodesis or amputation, as salvage procedures can help dogs that otherwise would be unmanageable on medication. [/quote]

Fair enough, but it's often bilateral, and while I've never attempted elbow arthrodesis [and don't think I ever will], I'm not sure it's much more successful than total elbow replacement (though probably cheaper)? I have no experience direct or otherwise.

In summary:

I find it hard to get an unbiased, yet expert, opinion on some of these more recent innovations (for understandable reasons).

I loved it when Malcolm Ness used to comment here as his expert opinions were always so refreshingly practical, evidence-based and, not infrequently, contrary to many of his specialist peers - thus providing much needed balance in my mind.

Thanks for sharing your thoughts and encouraging me to look afresh at stem cells / PRP again.

RE: Advice for elbow dysplasia

Dinu Catilina — Thu, 24 Oct 2019 21:36:35 GMT

Sorry Beats but I partially disagree with you. Stem cell therapy and PRP might not be the bees knees but they are also not just experimental. I would argue that the evidence behind cartrophen is rather poor.

Supplementing with Omega 3 has been shown to have some benefits.

Arthrodesis or amputation, as salvage procedures can help dogs that otherwise would be unmanageable on medication.

I agree about the arthroscopy/arthrotomy, CUE, PAUL, etc in adult dogs being of dubious benefit.

I see acupuncture on the same level with homeopathy.

Ketamine intermittently in dogs with advanced OA worked well for me.

Lasers - same as acupuncture

Weight management is for me the most important part of treatment.

RE: Advice for elbow dysplasia

Beats — Thu, 24 Oct 2019 20:06:47 GMT

[quote user="robloxley"]There's arthroscopy/arthrotomy, SHOs and PAULs and cartilage replacement and TER and while I understand them I'm not always sure which and when...[/quote]

don't forget CUE, PUO, BURP, stem cells, platelet-rich plasma, arthrodesis, amputation and a cornucopia of other treatments that can only accurately be described as "experimental" in my opinion.

If such elbow surgery was a drug, would you license it?

I'm totally unconvinced of the merits of any of the above [apart from perhaps pure fragment removal arthroscopically in a juvenile - I'm still on the fence on that one].

There's probably more evidence for cartrophen

RE: Advice for elbow dysplasia

Rob Loxley — Thu, 24 Oct 2019 17:18:32 GMT

[quote user="Beats"]Galliprant (not sure it is any better/safer than metacam)[/quote]

Not sure, most of the data I've seen just says it's better than placebo?

[quote user="Beats"]b) a plethora of surgical options[/quote]

Would be good to have input from a surgeon on this. There's arthroscopy/arthrotomy, SHOs and PAULs and cartilage replacement and TER and while I understand them I'm not always sure which and when...

RE: Advice for elbow dysplasia

Clare Tapsfield-Wright — Thu, 24 Oct 2019 13:19:25 GMT

Thank you , yes she loves swimming. You are all really helping with your advice. I think I was a bit shocked , such a young active dog , seems so unfair. Her dam and sire had decent elbow scores .At least she’s insured with Petplan. you lot are great