Juvenile Pubic Symphysiodesis

[baker_girl]

I'm writing in the hope that someone can shed some more light on my situation. I am in a very similar situation to a recent thread where my 18 week old pure bred labrador is currently undergoing diagnosis for Hip Displaysia.

In the last few weeks our 18 week old pup Jet started displaying symptoms of swaying in his walk and hind legs. Yesterday we took preliminary steps in having him checked out by the Orthopedic Veterinary Surgeon. They checked his mobility and joints by slight manipulations. He displayed quite alot of pain in this examination and yelped and whimpered through this. They walked him to view his sway. The Vet's opinion that based on these initial observations the diagnosis could be Hip Displaysia. At this time we have now booked him in for an x-ray next Monday for a confirmation on diagnosis. At the time of diagnosis, should it be confirmed hip displaysia, our vet is then highly recommending we proceed with JPS. Based on their advice, we need to make a decision on the same day so that they can complete the procedure while the dog is already under anesthetic for the x-ray. Also JPS from my understanding is really only recommended for dogs up to the age of 20 weeks.

I will also add at this point, that we got Jet from a labrador breeder. He was the last dog in his litter. He did have a short tail which the breeder advised was x-rayed to see of possible issues. We were told that one or two vertebrae of the tail look to be missing but the vet's opinion is the dog is sound otherwise. We never saw the x-rays when purchasing Jet. We trusted the Breeders and his Vet's opinion on this matter. The fact the Jet had a shorter tail didn't bother me at all. I'm only mentioning this as I am now wondering if it could be pre-cursor or cause of another underlying condition?

I have contacted our Breeder to let him know of the situation as I believe he would have a vested interest. He is not supportive of the surgery and feels there are other symptoms to manage the condition. I guess to me this is where I am so torn. I want to make the right decision. Of course I don't want to put a dog this young through surgery unless it is absolutely necessary. From what I've been told and from what I've been reading on my own, I understand that this surgery can be successfull and seen as a proactive step to trying to stop further symptoms of HD in future? If I leave Jet and not go through with the surgery what are my options? Do I wait for his HD to progress and then manage the symptoms as they appear? I have a sister who has a large Rottweiler who has had two cruciate ligament operations and now has to manage his condition. He still can't walk well, his hips are now causing him pain, he can't play with other animals, he doesn't have a great quality of life. I don't want the same thing for my dog and really want to give him the best chance and not just have to manage the symptoms. I know this is no cure.

My breeder also does not speak highly of my vet and feels they are pressuring me into this. He feels they too freely advocate aggressive surgery and this is not his choice. Fair enough. This is a whole other issue and I am not taking this decision lightly. I can only base my decision with the information I have received and have to put a certain amount of trust with my vet. I have had no problems with them previously and feel they have been outstanding in the service they offer me.

I have tried to book in with another vet for a second opinion however the vet recommended by my breeder cannot see my until early next month. As I said earlier, the vet would like to try and do the surgery on the same day if we decide to go ahead due to him already being under anesthetic and due to the window of time recommend this surgery be done in.

Sorry for the long post. I am really trying to seek out advice and opinions here. Of course everyone has a different school of thought and I know alot of people probably won't agree with the surgery. I understand this is viewed as quite a controversial topic. This is why I'm here, for advice but not for a public flaming

Any information greatly appreciated.

Thanks.

[mokhahouse]

I am no expert but I do have a lab with HD and ED. Mokhas HD was picked up by PennHipp xray and he started displaying some symptoms. He was 6 months at the time so too old for your surgery that has been suggested. We saw an ortho specialist who did not want to rush into anything so monitered him monthly with the view to do Triple Pelvic Osteotomy this is where they cut the pelvic bone and reshape it so the femoral head sits more securely in the hip joint. It is expensive and major surgery.

We were going to go ahead with this but my surgeon suggested that since Mokha was doing so well being managed with careful exercise, swimming, joint supplements,being kept lean he did not think the surgery was warranted. Mokha hip scores were in the worst 20% for labs by the way. We are a year 1 1/2 years from initial diagnosis, we did have surgery on the elbow as the elbow was reducing his quality of life significantly. We are still using the same things to manage Mokha and his joints along with monthly Cartrophen injections. We may in the future do a hip replacement on his worst hip if necessary but for now we are just medically and lifestyle managing.

I know what a hard decision this is, I struggled with the idea of putting Mokha through 2 major operations as the hips would be done seperately. If the ortho had said this was what to do I would have done it but I must say I was relieved when he felt Mokha would do well with more conservative management. Only time will tell if we made the right decision. If you dont go ahead and wait and see how your pup goes there is the option of the TPO until the pup is about 1 year old as long as there is no arthritis in the joints or a hip replacement later on although I think this is seen as a salvage sort of operation once the dog is very lame.Best wishes to you and the decisions you have to make.Sorry for the really long reply.

Edited April 16, 2010 by mokhahouse

[baker_girl]

I know what a hard decision this is, I struggled with the idea of putting Mokha through 2 major operations as the hips would be done seperately. If the ortho had said this was what to do I would have done it but I must say I was relieved when he felt Mokha would do well with more conservative management. Only time will tell if we made the right decision. If you dont go ahead and wait and see how your pup goes there is the option of the TPO until the pup is about 1 year old as long as there is no arthritis in the joints or a hip replacement later on although I think this is seen as a salvage sort of operation once the dog is very lame.Best wishes to you and the decisions you have to make.Sorry for the really long reply.

Hi Mokhahouse,

Thanks so much for sharing your experience. Your dogs are beautiful. I have a choccie female too :D

I guess what you said above is what I am struggling with. My vet has said JPS can be very successful. However if we decide to not go ahead that is our decision. However we will need to manage it and any operations later in life are exactly that, 'a salvage mission'. That's exactly how he phrased it. It's all hypothetical now isn't it?? I have to make a decision based on all the information I have and what could or could not possibly happen.

Hey, my fingers are crossed that the x-rays are good and we have nothing to worry about at all and these are just growning pains. I will add, he is a VERY inactive puppy, especially for a Lab. So much so, it's been commented on by almost everyone that meets him. At first I thought it was his personality and now I'm wondering if it's actually because he's in pain?

[BJean]

Why can't you wait another month to see the Breeder recommended vet?

I'd make the appointment and also ask to go on their cancellation list, in case an earlier appointment becomes available.

I dont think you should proceed with the operation for two reasons

1) you are not 100% about it

2) you have not seen another vet for a second opinion.

You wont feel 100% with any decision you make until you gain more knowledge about your dogs condition, prognosis and options.

I would not push fwd with the operation IRRESPECTIVE of the xray results.

Whatever the xrays reveal - good or bad -

you will then need time to consider this and what they mean for your dog.

It's your dog, and you'll be the one wearing the consequences and upset if you realise or learn in a few months time that the operation was unnecessary and has its own side-effects for your dog.

So make sure you are 100% about the decision you make - that means you need to make an INFORMED decision,

not a decision made in haste and under pressure, and reeling from bad news that your dogs hips aren't good.

Edited April 16, 2010 by lilli

[BJean]

I have contacted our Breeder to let him know of the situation as I believe he would have a vested interest. He is not supportive of the surgery and feels there are other symptoms to manage the condition. I guess to me this is where I am so torn. I want to make the right decision. Of course I don't want to put a dog this young through surgery unless it is absolutely necessary. From what I've been told and from what I've been reading on my own, I understand that this surgery can be successfull and seen as a proactive step to trying to stop further symptoms of HD in future? If I leave Jet and not go through with the surgery what are my options? Do I wait for his HD to progress and then manage the symptoms as they appear? I have a sister who has a large Rottweiler who has had two cruciate ligament operations and now has to manage his condition. He still can't walk well, his hips are now causing him pain, he can't play with other animals, he doesn't have a great quality of life. I don't want the same thing for my dog and really want to give him the best chance and not just have to manage the symptoms. I know this is no cure.

Have you asked your vet?

What is his/her success rate? How many operation have they performed and what follow up has been recorded on the dogs?

What does your vet think of your pups shortened tail?

What does cruciate ops on your sisters Rotti have to do with your pups hips?

Edited April 16, 2010 by lilli

[BJean]

You may find this study conducted by the AVMA interesting:

http://avmajournals.avma.org/doi/abs/10.2460/javma.230.2.206

Objective:

To compare long-term outcomes of juvenile pubic symphysiodesis (JPS) and triple pelvic osteotomy (TPO) in dogs with hip dysplasia.

Clinical findings:

Results suggest that JPS and TPO have similar effects on hip joint conformation in dogs with moderate to severe hip dysplasia but that neither procedure eliminates the hip joint laxity characteristic of hip dysplasia or the progression of degenerative changes.

[baker_girl]

Why can't you wait another month to see the Breeder recommended vet?

I'd make the appointment and also ask to go on their cancellation list, in case an earlier appointment becomes available.

I dont think you should proceed with the operation for two reasons

1) you are not 100% about it

2) you have not seen another vet for a second opinion.

You wont feel 100% with any decision you make until you gain more knowledge about your dogs condition, prognosis and options.

I would not push fwd with the operation IRRESPECTIVE of the xray results.

Whatever the xrays reveal - good or bad -

you will then need time to consider this and what they mean for your dog.

It's your dog, and you'll be the one wearing the consequences and upset if you realise or learn in a few months time that the operation was unnecessary and has its own side-effects for your dog.

So make sure you are 100% about the decision you make - that means you need to make an INFORMED decision,

not a decision made in haste and under pressure, and reeling from bad news that your dogs hips aren't good.

Hi lilli,

Thanks for your response.

The JPS procedure is only recommended on dogs between the ages of 12-20 weeks (3-4 months). Results indicated the greatest benefit during this time. After this time the operations are not seen as a possible option as dogs are too old and pelvic bone already too developed. If we wait to see the vet in a month's time, our dog will be passed this window recommended for this particular treatment.

Like you said, I don't think I will ever be 100% sure of any decision I make. Either way I am either going to have to decline this surgery and hope that I have not turned down a chance that may have helped Jet in future. Or do the surgery and time will tell if it is beneficial. The fact is, if he is diagnosed with HD, it will be a lifetime of mangement for his condition.

I am doing as much research now as I can so that can make an informed decision and I am taking all advice on board to keep an open mind.

Thanks.

[poodlefan]

Personally I don't think your current vet has set you up to make an informed decision.

I'd want to know the following before committing to a course of treatment:

* How bad is the HD? Without x-rays both a diagnosis and a prognosis is pure guesswork. Your pup has a lot of growing and a lot of development to come. Keep him LEAN, avoid over stressing him and see how he grows.

* What non-surgical options are there for managing this condition.

* What surgical options are available in the future.

In my limited experience, hard manipulation of a young pups joints will cause almost ANY pup to feel pain.

If your pup's breeder is sending up red flares about this vet and their proposed treatment I'd be listening hard to what they have to say.

Edited April 16, 2010 by poodlefan

[baker_girl]

I have contacted our Breeder to let him know of the situation as I believe he would have a vested interest. He is not supportive of the surgery and feels there are other symptoms to manage the condition. I guess to me this is where I am so torn. I want to make the right decision. Of course I don't want to put a dog this young through surgery unless it is absolutely necessary. From what I've been told and from what I've been reading on my own, I understand that this surgery can be successfull and seen as a proactive step to trying to stop further symptoms of HD in future? If I leave Jet and not go through with the surgery what are my options? Do I wait for his HD to progress and then manage the symptoms as they appear? I have a sister who has a large Rottweiler who has had two cruciate ligament operations and now has to manage his condition. He still can't walk well, his hips are now causing him pain, he can't play with other animals, he doesn't have a great quality of life. I don't want the same thing for my dog and really want to give him the best chance and not just have to manage the symptoms. I know this is no cure.

Have you asked your vet?

What is his/her success rate? How many operation have they performed and what follow up has been recorded on the dogs?

What does your vet think of your pups shortened tail?

What does cruciate ops on your sisters Rotti have to do with your pups hips?

Thanks,

I'll read your article.

It gave the example of my Sister's dog with cruciate ligament damage and now the constant management she has to do with him and his quality of life as I was trying to explain that this is a scenario I would love to avoid if at all possible. If I could try and alleviate some of the discomfort and damage of HD at an early age this would be ideal. That's all.

The Breeder's vet and both my vet have checked the tail and commented that he appears sound and does not appear to have any side effects of it. This was when he was 8 weeks of age.

[BJean]

The JPS procedure is only recommended on dogs between the ages of 12-20 weeks (3-4 months). Results indicated the greatest benefit during this time. After this time the operations are not seen as a possible option as dogs are too old and pelvic bone already too developed. If we wait to see the vet in a month's time, our dog will be passed this window recommended for this particular treatment.

Triple pelvic osteotomy (TPO) for dogs 5 months - 10 months

is based on the same idea as JPS.

But unfortunately it has the same success rate as JPS -

the jury is out as to whether JPS or TPO

actually do anything to prevent degeneration of the hip joint.

Edited April 16, 2010 by lilli

[BJean]

I have contacted our Breeder to let him know of the situation as I believe he would have a vested interest. He is not supportive of the surgery and feels there are other symptoms to manage the condition. I guess to me this is where I am so torn. I want to make the right decision. Of course I don't want to put a dog this young through surgery unless it is absolutely necessary. From what I've been told and from what I've been reading on my own, I understand that this surgery can be successfull and seen as a proactive step to trying to stop further symptoms of HD in future? If I leave Jet and not go through with the surgery what are my options? Do I wait for his HD to progress and then manage the symptoms as they appear? I have a sister who has a large Rottweiler who has had two cruciate ligament operations and now has to manage his condition. He still can't walk well, his hips are now causing him pain, he can't play with other animals, he doesn't have a great quality of life. I don't want the same thing for my dog and really want to give him the best chance and not just have to manage the symptoms. I know this is no cure.

Have you asked your vet?

What is his/her success rate? How many operation have they performed and what follow up has been recorded on the dogs?

What does your vet think of your pups shortened tail?

What does cruciate ops on your sisters Rotti have to do with your pups hips?

It gave the example of my Sister's dog with cruciate ligament damage and now the constant management she has to do with him and his quality of life as I was trying to explain that this is a scenario I would love to avoid if at all possible. If I could try and alleviate some of the discomfort and damage of HD at an early age this would be ideal. That's all.

How often has your vet carried out the operation?

What is their success rate?

[baker_girl]

Personally I don't think your current vet has set you up to make an informed decision.

I'd want to know the following before committing to a course of treatment:

* How bad is the HD? Without x-rays both a diagnosis and a prognosis is pure guesswork. Your pup has a lot of growing and a lot of development to come. Keep him LEAN, avoid over stressing him and see how he grows.

* What non-surgical options are there for managing this condition.

* What surgical options are available in the future.

In my limited experience, hard manipulation of a young pups joints will cause almost ANY pup to feel pain.

If your pup's breeder is sending up red flares about this vet and their proposed treatment I'd be listening hard to what they have to say.

The vet practice were the ones who noticed his possible sway. It was suggested it couldn't hurt to get a consult. From this consult they then suggested, we have an xray, for a confirmed diagnosis. They are by no means diagnosing this without an xray first. I want to make that clear. They will contact us on conclusion of the xray to discuss the findings then.

JPS was an option given to us as what can be done, due to the age of the pup. I guess to them, this is one option out of many and as he is a candidate for this surgery they are offering it to us. They explained what further surgical options may be available in future, should his hips deteriorate. They did comment on the need of exercise and weight mangement with Labradors. These were things we are already aware of.

With all due respect to my Breeder and I do respect his advice but his opinion on my Vet, is not the same as what I've experienced with them. He didn't know any of the particular vets I was dealing with, but more was against the philosophy he belives this vet chain uses. To me, him trying to dissaude me from my particular vet, without actually knowing personally how any of them treat, was a bit of pressure in itself and it did add to my frustration.

[poodlefan]

With all due respect to my Breeder and I do respect his advice but his opinion on my Vet, is not the same as what I've experienced with them. He didn't know any of the particular vets I was dealing with, but more was against the philosophy he belives this vet chain uses. To me, him trying to dissaude me from my particular vet, without actually knowing personally how any of them treat, was a bit of pressure in itself and it did add to my frustration.

Well there's an easy way to put that issue to rest. Get another opinion now.

[baker_girl]

How often has your vet carried out the operation?

What is their success rate?

Hi,

Yes, this was one of the first questions I asked of course. What was the success rate. How many do you do. What is the rehabilitation required. What downsides are there.

The orthopedic surgeon said the success rate he has found with this procedure personally is very high. He didn't give me percentages? Can anyone give definitive pecentages on the success of an operation? I don't know. He specialises in orthopedic surgeries only and does many of these procedures. He called me personally to discuss the procedure and spoke highly of it. On rehabilitation he said it is not as invasive as other future operations and rehabilition will be minimal and not as extensive if something else was done later in life, like a full hip replacement. I am meeting with the vet on Monday as I want to discuss further what can go wrong, or if this procedure can hinder any future treatment.

[BJean]

In the last few weeks our 18 week old pup Jet started displaying symptoms of swaying in his walk and hind legs. Yesterday we took preliminary steps in having him checked out by the Orthopedic Veterinary Surgeon. They checked his mobility and joints by slight manipulations. He displayed quite alot of pain in this examination and yelped and whimpered through this. They walked him to view his sway. The Vet's opinion that based on these initial observations the diagnosis could be Hip Displaysia. At this time we have now booked him in for an x-ray next Monday for a confirmation on diagnosis. At the time of diagnosis, should it be confirmed hip displaysia, our vet is then highly recommending we proceed with JPS. Based on their advice, we need to make a decision on the same day so that they can complete the procedure while the dog is already under anesthetic for the x-ray. Also JPS from my understanding is really only recommended for dogs up to the age of 20 weeks.

Are you doing pennhip xrays or AVA/Wyburn?

Is he a specialist in assessing Hip Xrays?

PennHipp xrays need to be sent o/s for assessment.

[BJean]

Yes, this was one of the first questions I asked of course. What was the success rate. How many do you do. What is the rehabilitation required. What downsides are there.

The orthopedic surgeon said the success rate he has found with this procedure personally is very high. He didn't give me percentages? Can anyone give definitive pecentages on the success of an operation? I don't know. He specialises in orthopedic surgeries only and does many of these procedures. He called me personally to discuss the procedure and spoke highly of it. On rehabilitation he said it is not as invasive as other future operations and rehabilition will be minimal and not as extensive if something else was done later in life, like a full hip replacement. I am meeting with the vet on Monday as I want to discuss further what can go wrong, or if this procedure can hinder any future treatment.

Not percentages, but how many operations has he carried out?

What does 'personally very high' mean? It means nothing if the operations were all carried out within the past year or two. The key word is 'degenerative' and that takes time.

Moreover, because JPS is done on puppies who do not yet actually have hip dysplasia, it is hard to evaluate success.

Something to think about.

Your puppy does not have HD.

The xrays will show its propensity, but on a juvenile that's is NOT Hip Displaysia

And again, your vet needs to send the xrays o/s to be assessed for PennHipp so why the Op at the same time?

Here is a discussion amongst lab breeders and owners on JPS:

http://www.lab-retriever.net/board/juvenil...s-t7294412.html

NB: Depending on your sources, your puppy has already past the time window for JPS

some cite the cut off age at 16 and 18 weeks.

Edited April 16, 2010 by lilli

[BJean]

From Australia and from QLD:

Improvements in conformation are significantly greater when the procedure is completed by 15 weeks of age vs. 20 weeks.

So according to this expert in QLD, your pup has already passed the optimal time window for JPS.

http://www.theveterinarian.com.au/clinical.../article625.asp

[poodlefan]

Just as an aside, I'd be wanting to know what a good canine chiropractor thought. The birthing process can be hell on a pup...

[baker_girl]

From Australia and from QLD:

Improvements in conformation are significantly greater when the procedure is completed by 15 weeks of age vs. 20 weeks.

So according to this expert in QLD, your pup has already passed the optimal time window for JPS.

http://www.theveterinarian.com.au/clinical.../article625.asp

Thanks for the above.

The quote above regarding QLD expert, is that in the same article? I'm trying to find comments in relation to the JPS but can't seem to locate it. Like you said, depending on your sources, I've read the optimal age anywhere from 16-22 weeks but generally before 20 weeks.

Thanks.

[teekay]

The JPS procedure is relatively new, therefore finding reliable information about it is pretty difficult, believe me, I spent hours researching it.

The recent thread the OP talks about was written by me about my, then, 18 week old Golden x Samoyed, Jenna.

Having gone ahead with the procedure we are now about 7 months on. Jenna is due to have more xrays done at 12 months (19 May) but she is showing no signs of lameness at all. So far, I am happy. There does not appear to be any detrimental affects of the JPS procedure which was my worst nightmare. Jenna showed no signs of HD when we took her to the specialist. Our initial worry was based on finding out other dogs coming from the same breeder had developed HD. When making the decision obviously we were worried we were taking what was a healthy happy puppy and putting her through an unnecessary operation which could mess up her hips for life. (Believe me, I went there, I worried about all the things that could go wrong)

On the flip side though, if we did nothing and she developed HD I would forever have to wonder if the procedure could have prevented it. It's a catch 22 situation and I'll admit it's a gamble. Hopefully one which has paid off for us.

The operation itself was not particularly major, Jenna was desexed at the same time and she did not appear to be in too much discomfort. Exercise has to be strictly limited for a few weeks but recovery is pretty quick compared to the TPO.

With regard to the PenHipp xrays having to be sent to America. I belive that is for an 'official' score for breeding purposes but a good orthopedic surgeon is capable of reading the x rays themselves. For your refenece Baker Girl Jenna's distraction index was 0.6/0.7

Good luck with your Pup BG and keep us informed of her progress.