Juvenile Pubic Symphysiodesis

[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

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.

Exactly, so pretty big operation to put your puppy through when there are so many unknowns and disputed facts about JPS.

Also understand that your pups Xrays will show a PROPENSITY TO DEVELOP Hip Dysplacia

not whether he has HD.

Edited April 16, 2010 by lilli

[baker_girl]

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

Thanks Teekay. I was going to say, relating to a previous post, that your above comment was my understanding too regarding evaluating of PenHipp xrays.

[BJean]

teekay and Baker Girl, do you go to the same vet?

teekay

I'm glad that jenna is okay

But given she showed no symptoms and the operation was done based on 'probable' breeding

I am not sure whether you can regard it as 'JPS success'.

Not to mention that it is very easy to 'fix' something that isn't there.

I dont want to sound mean or anything else :D

and Im glad for you that Jenna is okay

but from what you have written about Jenna diagnosis and pre-op information

I dont believe it is 'good' vet practise

to operate on patient's dogs based on what 'might' happen.

Firstly, yes, this procedure was first mentioned when I took Jenna in for her vaccinations at 12 weeks but there was no pressure and I had decided not to go ahead with any further hip investigations or JPS. They did talk about the time limit for such a procedure and actually told me it had to be done by 16 weeks. No they did not want to book me in there and then and it was left as a open invitation if I wanted to proceed. As I said, I decided not to bother.

THEN I had a bombshell dropped on me on 15 Sept. On another forum someone posted about a dog (same crossbreed as mine) they had bought from a pet shop in Melbourne which had been diagnosed with HD at 7.5 months. They also believe another dog of the same breed from the same pet shop had had a complete hip replacement at 1.5 years. Given the relative rarity of my crossbreed I made enquiries about where her pup could originally have come from. There is no conclusive evidence but it is looking highly likely they came from the same place. Jenna, at this point was 17 weeks old. I thought she was too old for the JPS at this point but I did some research on the internet and most places said you could do it up to 20 weeks, after which the benefits were negligible.

Sadly I lost my adorable Labrador in April of this year but still had the business card of the specialist vet that was treating her so I gave them a call and Richard Mitchell told me he would see us (with a referral from our original vet). The rest is pretty much history. DI not good and probable genetic history resulting in recommendation to go ahead and do the JPS. I think the problem I faced was not being able to find ANYONE who had had this done to their pup so I couldn't talk to anyone about how their pup faired. From the internet research I did, the results seemed promising but obviously it is early days. I still look at Jenna and ask myself if I have done the right thing. She was fine and might have continued that way. OR she may have been diagnosed a few months down the track and I would feel awful that I didn't take the opportunity when I had it.

[BJean]

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

Did you send Jenna's hip xrays to PennHip to have an 'official' score?

What is the average for Jenna's breed(s)?

Edited April 16, 2010 by lilli

[Guest Ams]

I faced a similar decision with my youngest shar pei. As with you time was against me as she was xrayed very close to the cut off period time wise. My vet advocated the surgery and referred me to a specialist and even managed to get an appointment for me immediately. She was booked in to have the surgery. The specialist took another set of xrays and did further manipulations under anesthetic and then rang stating he did not think the surgery was necessary in her case. She has shown no signs of HD since.

I know this is not much help to you but you can ask the specialist to take further xrays and do manipulations prior to the fusion and you may get lucky and have the same result as me.

[baker_girl]

I faced a similar decision with my youngest shar pei. As with you time was against me as she was xrayed very close to the cut off period time wise. My vet advocated the surgery and referred me to a specialist and even managed to get an appointment for me immediately. She was booked in to have the surgery. The specialist took another set of xrays and did further manipulations under anesthetic and then rang stating he did not think the surgery was necessary in her case. She has shown no signs of HD since.

I know this is not much help to you but you can ask the specialist to take further xrays and do manipulations prior to the fusion and you may get lucky and have the same result as me.

Hi Ams,

Thanks. I am waiting for the specialist to call me back. I want to ask various questions. The specialist will be doing the xrays and then contact me with his opinion and diagnosis. We haven't decided to go ahead at all with the surgery at this point. So yes, I am hoping the specialist tells me the surgery isn't neccessary. I have also contacted today a chiropractic vet who offers alternative therapy. Speaking with him has raised some more questions about the procedure.

Your situation is exactly what I'm afraid of. So far you've had no need to do the surgery. The vets may only be responding to our initial request for consultation to see if he may be suffering from something due to his few symptoms. I can't fault them that they are recommending the xrays as this to me would be the responsible thing to do. As a vet they have only offered me one of a few possible options. Yes, it's surgery and not the more conservative approach but I guess this is their belief. I have to then take what they tell me and make a decision.

Thanks.

[teekay]

teekay and Baker Girl, do you go to the same vet?

teekay

I'm glad that jenna is okay

But given she showed no symptoms and the operation was done based on 'probable' breeding

I am not sure whether you can regard it as 'JPS success'.

Not to mention that it is very easy to 'fix' something that isn't there.

I dont want to sound mean or anything else :D

and Im glad for you that Jenna is okay

but from what you have written about Jenna diagnosis and pre-op information

I dont believe it is 'good' vet practise

to operate on patient's dogs based on what 'might' happen.

Firstly, yes, this procedure was first mentioned when I took Jenna in for her vaccinations at 12 weeks but there was no pressure and I had decided not to go ahead with any further hip investigations or JPS. They did talk about the time limit for such a procedure and actually told me it had to be done by 16 weeks. No they did not want to book me in there and then and it was left as a open invitation if I wanted to proceed. As I said, I decided not to bother.

THEN I had a bombshell dropped on me on 15 Sept. On another forum someone posted about a dog (same crossbreed as mine) they had bought from a pet shop in Melbourne which had been diagnosed with HD at 7.5 months. They also believe another dog of the same breed from the same pet shop had had a complete hip replacement at 1.5 years. Given the relative rarity of my crossbreed I made enquiries about where her pup could originally have come from. There is no conclusive evidence but it is looking highly likely they came from the same place. Jenna, at this point was 17 weeks old. I thought she was too old for the JPS at this point but I did some research on the internet and most places said you could do it up to 20 weeks, after which the benefits were negligible.

Sadly I lost my adorable Labrador in April of this year but still had the business card of the specialist vet that was treating her so I gave them a call and Richard Mitchell told me he would see us (with a referral from our original vet). The rest is pretty much history. DI not good and probable genetic history resulting in recommendation to go ahead and do the JPS. I think the problem I faced was not being able to find ANYONE who had had this done to their pup so I couldn't talk to anyone about how their pup faired. From the internet research I did, the results seemed promising but obviously it is early days. I still look at Jenna and ask myself if I have done the right thing. She was fine and might have continued that way. OR she may have been diagnosed a few months down the track and I would feel awful that I didn't take the opportunity when I had it.

I do not state that the JPS procedure in Jenna is a success. All I can say is that so far there have been no detrimental effects. Jenna may well have grown and not developed HD. This we will never know. What I do know is that if she had developed HD and I had not taken the opportunity to help prevent it I would never have forgiven myself.

We operated on the basis of Jenna's distraction index and her possible genetic propensity to HD. Yes, we operated on what appeared to be a perfectly healthy puppy but you can't afford to wait as it is such a small time frame. As i said earlier, it's a gamble and, to a certain extent, Jenna was a guinea pig. As time goes on we may get more information on the success rate of the JPS but the statistics are hard to interprate as there is no way of knowing if the puppies operated on would have developed HD anyway. To me the more important fact was, is there any dogs having adverse reactions to the proceedure, is it stuffing up puppies hips? These are the really important questions because, as far as i am concerned, even if Jenna would not have developed HD without the proceedure, the only damage is to my wallet, and I can live with that. Having a dog suffering with HD when I could have prevented it. That I would not cope as well with.

I do not know if Baker girl is going to the same vet. We saw Dr Richard Mitchell at the Northcoast Veterinary Specialists, on the Sunshine Coast. I found some information about him on here and people had nothing but good things to say about him so I trusted him totally.

[teekay]

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

Did you send Jenna's hip xrays to PennHip to have an 'official' score?

What is the average for Jenna's breed(s)?

No we did not send off for an 'official' score.

Richard did tell us at the time what the average was for Jenna's breeds but I cannot remember now.

[baker_girl]

Not the same vet no. We are located on the Gold Coast.

[baker_girl]

I just want to add here, that I have managed to get an appointment this afternoon for a second oppinion with the alternative therapies vet. The staff think I'm a diffiuclt cow...but I've managed to plead my case and get him to see me where he has been otherwise booked out for 3 weeks.

So I will see how this goes.

[mokhahouse]

Good luck, it does not hurt to get an alternative opinion. It does not matter what the staff think,they should never make you feel bad about researching and getting opinions on whats best for your pup. After all you are the one making the decisions, paying for them financially and otherwise.

[baker_girl]

I just wanted to update so far about my situation.

I went and had a second opinion this afternoon with another vet. A chiropractic alternative treatment vet. He was thorough. Initially he did say that from his observations of how our pup was walking, it was a slight concern. From there he did his physical exam and manipulations. His checks were very extensive and I felt confident from what I saw with my limited knowledge of the condition. Our pup did not display any pain and seemed comfortable. He did say that his left hip seemed to have more laxity than the other. He did discourage us to have the surgery, however I expected this. He also though, suggested we don't have the xrays at all either as he felt the vet would pressure us. He feels my dog does not have signs of HD.

I am less inclined to go ahead with the surgery. However I was still considering the xrays to at least have a more informed picture of the state of his hips.

Another member on DOL contacted me and offered some advice. Coincidentally she had visited the exact same vet and Dr as the one of my second opinion. Her experience with this vet is almost exactly the same as mine. She too was told that her dog did not have HD after her pup was displaying symptoms (which I might add, sounded worse than mine). However 2 years later the dog has now been positively diagnosed with HD. My only concern is that like my regular vet, this second opinion comes highly biased with his opinion on the correct method of treatment?

I wonder if I should still have the xray.

[Staranais]

I don't think you can definitively diagnose the presence/absence of hip dysplasia with no x-rays. You can make the call that the dog isn't showing clinical signs (or isn't showing clinical signs yet) by just observation and palpation, but you can't make the call that there is or isn't HD. And I would personally be wary of any vet that claimed that they could.

I would definitely x-ray, if only to have a "baseline" to compare his hips to later. Getting the radiographs doesn't mean you need to do the surgery, it's just more information for you to base your decision off. The more well informed you are, the better, IMO.

[teekay]

Just wanted to check. Exactly how old is your pup now (weeks & days)? And just out of interest (I know it's no guarantee) what were the parent's hip scores, (if you know)?

[BJean]

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

Did you send Jenna's hip xrays to PennHip to have an 'official' score?

What is the average for Jenna's breed(s)?

No we did not send off for an 'official' score.

Richard did tell us at the time what the average was for Jenna's breeds but I cannot remember now.

Borrowed from Zenchel:

Also please read the following - it is a direct cut and paste from the PennHIP web site:

Question:

"My vet has advised a surgical procedure to avoid the development of arthritis in my dog later in life based on the results of his PennHIP examination. Should I have my dog operated on?"

Answer:

Until appropriate randomized and controlled clinical trials are designed and conducted, it is premature to use the Distraction Index as an indication for hip surgery, either remedial or preventive. At present several different surgical procedures (Triple pelvic osteotomy, Juvenile symphysiodesis) have been advocated by some veterinary surgeons to prevent the development of arthritis (degenerative joint disease) later in life in dogs with excess joint laxity (loose hips). None of these procedures have undergone scientific clinical trials that have proven THEIR EFFICACY in preventing the onset or slowing the development of arthritis in dogs with hip dysplasia. Although WE ARE not fundamentally against the use of preventative surgical management of dogs with excessive hip laxity, WE FEEL THE WHOLESALE CLINICAL USE OF PURPORTEDLY PREVENTIVE SURGICAL PROCEDURES BEFORE ADEQUATE TESTING IS CONDUCTED, IS UNJUSTIFIED. WE ADVISE CAUTION! It may be that in the future when good evidence exists to support the efficacy of these procedures their use will be encouraged"

[baker_girl]

Just wanted to check. Exactly how old is your pup now (weeks & days)? And just out of interest (I know it's no guarantee) what were the parent's hip scores, (if you know)?

Hi teekay,

Exact age 18 weeks 4 days.

I am waiting for my breeder to email me parent's hip scores. (he told me when I first purchased Jet but have since forgotten)

[baker_girl]

I don't think you can definitively diagnose the presence/absence of hip dysplasia with no x-rays. You can make the call that the dog isn't showing clinical signs (or isn't showing clinical signs yet) by just observation and palpation, but you can't make the call that there is or isn't HD. And I would personally be wary of any vet that claimed that they could.

I would definitely x-ray, if only to have a "baseline" to compare his hips to later. Getting the radiographs doesn't mean you need to do the surgery, it's just more information for you to base your decision off. The more well informed you are, the better, IMO.

Yes, this is my thought too. I will add, that the vet I visited came highly recommended by my breeder and apprantley on the DOL forums too. I have been told he is renowned for being able to give a good diagnosis without xrays. I'm not saying he can or can't but only saying what I've been told.

The only reason why I'm thinking not to go ahead with the xrays, as my mind now is pretty made up to not go through with the surgery. I understand your comment about having a baseline and I can see the sense but either way, I don't think I'll want to go ahead with the surgery. My thoughts are to monitor him closely for the next few months, go back to the chiro vet in a month or two and if he still not developping at what's considered normal for his age, then I'll get xrays.

[teekay]

I think you are really approaching the age where it would not be beneficial to do the surgery anyway, if that helps you make the decision. I wish you all the best with your pup and if managed correctly with restricted food and exercise you can hopefully minimise any long term effects anyway.

I will update my JPS posting as Jenna matures so anyone interested in her progress can follow her thread. The more people that document their experiences with JPS, the more people like you may be able to make an informed decision when faced with the same situation.

Good luck

[teekay]

I am glad you have made a decision, Baker girl, that is the hardest part. Once you have made a decision I think you feel better about things.

I am, however, a little bothered by most of the replies you have received on here, and especially in the breeder's section. Correct me if I’m wrong but none of the advice has been given by a qualified vet and most of the posters have absolutely zero personal experience of the procedure at all. I sincerely hope that Baker Girl’s pup does not go on to develop HD. In my replies and pm’s to Baker girl I never tried to tell her what to do, I merely explained our situation as it is and how Jenna has faired so far. I do feel everyone’s negativity about the JPS procedure has swayed the OP’s decision, I truly hope she does not regret it.

I know a forum is all about peoples opinions but all I ask is that you ask yourselves why you are so negative about a relatively minor procedure, compared to alternatives, which may, I know there is no guarantee, but may help prevent, or at least minimise, the effects of such a debilitating condition as HD.

Fordogs, I know you have had some negative experiences with vets suggesting your pups have this procedure just because they are large breeds, which I do not agree with at all, but this appears to be the basis of your argument against the procedure, not any scientific evidence against it.

Lilli, your first post suggested the OP ‘wait a month,’ that in itself tells me you know very little about the JPS procedure. Honestly, do you really know any more about JPS than you have researched on the Internet today? I think not. I am sure Baker Girl has spent hours searching the Internet, I know I did.

I really do not want to cause an argument but this has been bothering me all day. The only person with any personal experience of the JPS is me but it I feel my posts have been somewhat overshadowed by the whole host of posts saying ‘don’t do it’, ‘listen to your breeder’, ‘major operation for a puppy’. It seems everyone is suddenly an ‘expert’.

As I have said, I will update Jenna’s thread as time goes by and hopefully help someone make a more informed decision in future. All I ask is that you try and keep an open mind. In all my trawling of the internet I did not find any evidence of any dogs suffering any detrimental effects from this procedure, I know it is still relatively new but it has been around for a number of years and if it was stuffing up dogs hips I think we would have heard about it by now.

[centitout]

Maybe we offer our opinion because we have years(and some have LOTS of years experience with dogs)and some of us have worked as vet nurses or other occupations where we have picked up a fair whack of knowledge.Most of us breeders also spend countless hours/days /weeks/years researching everything we can that pertains to dogs,and how to keep them happy and safe,we annoy our poor long suffering vets,chiros even dog food people to allow us to make informed decisions where we know the pros and cons.

Its good that it worked in your case, i would want to see stats though that shows these dogs would have developed severe dysplasia if not done,if that cant be shown-how can they say what a fantastic procedure it is?

A dog can have radiographic signs that say they have a very high hip score-but never show clinical symptoms and are sound for their entire lives-thats why most of us have questioned the necessity of the op.