1. A poorer recognition of the signs of arthritis in cats and therefore lower demand
2. The smaller market and financial benefit to drug companies (dogs visit the vet at least twice as much as cats)
3. The difficulty in giving medications to cats
4. The increased risk due to the prevalence of kidney disease

Now, in 2023 we are witnessing the appearance of a wholly new approach to treatment that might overcome many of these concerns.

These are exciting times, but we also need to be cautious and realistic. You’ll see in this article that it is by no means a silver bullet. However, with Solensia there is real hope for cats that we have a new and effective tool to improve their quality of life.

What is Solensia?

Solensia is a trade name for frunevetmab in Australia. It neutralises nerve growth factor (NGF), which has been shown to be involved in the perception of pain. As a monoclonal antibody, it has the potential to be highly specific to its target, and block it almost completely.

In Australia, Solensia has been registered for the alleviation of pain associated with osteoarthritis in cats.

How Well Does It Work & How Quickly?

In our clinic, we have seen some cats benefit greatly after starting Solensia, but what does the evidence say? The results of a single placebo-controlled study conducted by the parent company are shown here and referenced below.

There are three important things to note here:

1. All arthritis treatments show a caregiver placebo effect, but for this particular product, it is especially large
2. The difference between the two groups is statistically significant for Months 1 and 2, so we are confident that Solensia is helping at least some cats
3. Unquestionably, there will be many others who receive insufficient benefit and require different arthritis remedies

My view is that the large placebo effect is a direct result of the difficulty we have in correctly identifying signs of pain in cats. However, it is also possible that it only brings benefit to a minority. Our own experience is that Solensia can be very effective in some cats, but hard to judge as well.

A further clue that anti-NGF treatments are helpful is in the clearer results we see for the canine equivalent, Beransa.

Based on laboratory studies, a positive response would be expected to appear at around day 6.

Solensia Dosage & How Often

Solensia is given by vets at a dose of 7 mg by subcutaneous injection for cats between 2.5kg and 7kg.. Above this, two vials are needed but I would suspect that most of these cats would benefit more from weight loss. If desired, the dose is repeated every month. It is generally recommended to try at least two doses before deciding whether it is effective enough.

NGF is important for foetal and juvenile development. Therefore, Solensia must not be used in breeding, pregnant or lactating cats, or those less than 12 months of age.

Human Health Risks

Similarly, pregnant women, women trying to conceive, and breastfeeding women should take extreme care to avoid accidental self injection or needle stick injuries. To be safe, it is best that they take no part in giving the injection or even holding their pet.

Just to be clear, a treated cat poses no risk to humans.

Solensia Side Effects

Up to 10% of cats given the injection showed signs of hypersensitivity such as skin itching, hair loss, and dermatitis. When this occurs, it is advised to stop the treatment. The itch does not respond well to normal treatments for dermatitis until the injection is stopped

If you read the comments section below, you will see that it is dominated by reports of adverse skin effects. In our clinic we have indeed seen a few reactions, but not much more than the reported 10%. My view on this is that although the rate here appears much higher, owners with affected cats will be more likely to post than those with no problems.

In other ways, our prior experience with monoclonal antibodies like Cytopoint shows us that they are much safer than traditional drugs like anti-inflammatories. This is because as naturally occurring proteins, they require minimal metabolism or detoxification by the liver or kidneys.

It is therefore likely that Solensia can be used at normal doses in cats with kidney disease, unlike anti-inflammatories which become more dangerous. However, until there are studies of their use with liver or kidney disease, caution is still advisable in these cats.

Solensia appears safe when used in combination with other drugs, and at the time of vaccination. The only concern with using multiple treatments could be that if an adverse effect occurs, you may not be able to work out which one caused it.

How Much Does Solensia Cost?

The cost in 2023 for a single injection of Solensia is around $90. This is in the same region as the higher priced anti-inflammatory drugs.

Our experience so far is that for some cats, it maintains their quality of life when other choices fail. It can also be used when other treatments aren’t safe enough to use and for those cats that owners cannot easily medicate. In summary, we believe is worth a try if costs allow.

Anyone who has an arthritic cat knows that we still aren’t doing enough for them. The development of monoclonal antibodies brings us just one step closer, and just might give us more time to enjoy our lovely old cats.

Therefore, talk to your vet about whether it might be good for your cat.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

These are exciting times, but we also need to be cautious. No treatment will work on every dog, and after initial overexcitement, some new products end up being major disappointments. However, with Beransa there is real hope for dogs that we have a new and effective tool to improve their quality of life.

What is Beransa?

Beransa is a trade name for bedinvetmab, also called Librela outside of Australia. It neutralises nerve growth factor (NGF), which has been shown to be involved in the perception of pain. As a monoclonal antibody, it has the potential to be highly specific to its target, and block it almost completely.

In Australia, Beransa has been registered for the alleviation of pain associated with osteoarthritis in dogs.

How Well Does It Work & How Quickly?

In our clinic, Beransa has quickly become the number one treatment chosen by our vets for new patients with arthritis. This has been based on a number of factors:

1. A very high success rate, interestingly higher than in the trial featured below
2. Minimal to no observed side effects, especially compared with traditional anti-inflammatory drugs
3. A similar cost to other treatments, especially in larger dogs

What does the evidence say? The results of a single placebo-controlled study conducted by the parent company are shown here and referenced below.

They show that around one in two dogs show benefit after a month. Like with all arthritis treatments, there is a large caregiver placebo effect, so it is important to stay as realistic as possible about its efficacy in each patient.

How To Use Beransa

Personally, I believe the study shown here and our clinical experience are enough to recommend trying Beransa in the right dog. However, I also strongly believe that we should not forget the other tried and trusted remedies for arthritis in dogs.

This is especially because Beransa only targets pain, not the underlying disease process. Now make no mistake: treating the pain is the most important thing, but it isn’t everything. If we add the treatments known to slow down the arthritic process, our dogs should have better function in the years to come as well as right now.

In particular, I encourage all dog owners using Beransa to at least continue the Hills j/d diet and regular pentosan injections. Both are extremely safe and can slow the degenerative process.

Beransa Dosage & Frequency

Beransa is given at a dose of 0.5 – 1 mg/kg by subcutaneous injection. It comes in a variety of vial sizes to cater for dogs of different weights. If desired, the dose is repeated every month. It is generally recommended to try at least two doses before deciding whether it is effective enough.

NGF is important for foetal and juvenile development. Therefore, Beransa must not be used in breeding, pregnant or lactating dogs, or those less than 12 months of age.

Human Health Risks

Similarly, pregnant women, women trying to conceive, and breastfeeding women should take extreme care to avoid accidental self injection or needle stick injuries. To be safe, it is best that they take no part in giving the injection or even holding their pet.

Just to be clear, a treated dog poses no risk to humans.

Beransa Side Effects

Reactions such as swelling and heat may occur at the site of injection, but these seem rare. Hypersensitivity reactions are also possible but appear more common in the cat form of this drug, Solensia.

Our experience with monoclonal antibodies like Cytopoint shows us that they are much safer than traditional drugs like anti-inflammatories. This is because as naturally occurring proteins, they require minimal metabolism or detoxification by the liver or kidneys. However, until there are studies of their use with liver or kidney disease, caution is still advisable in these dogs.

Beransa appears safe when used in combination with other drugs, and at the time of vaccination. The only concern with using multiple treatments could be that if an adverse effect occurs, you may not be able to identify the cause.

How Much Does Beransa Cost?

The cost in 2023 for a single injection of Beransa is between $100 and $130 depending on the size required. This is in the same region as the higher price anti-inflammatory drugs.

Beransa or Librela may not be a silver bullet, but just having another option is a great blessing. Our experience so far is that for some dogs, it maintains their quality of life when other choices fail. It can also be used when other treatments aren’t safe enough to use.

Anyone who has an arthritic dog knows that we still aren’t doing enough for them. The development of monoclonal antibodies brings us just one step closer, and just might give us more time to enjoy our lovely old dogs.

Therefore, talk to your vet about whether it might be good for your dog.

References

Corral, M. J., Moyaert, H., Fernandes, T., Escalada, M., Tena, J. K. S., Walters, R. R., & Stegemann, M. R. (2021). A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis. Veterinary anaesthesia and analgesia, 48(6), 943-955 Full Text

Kronenberger, K. (2023). In dogs diagnosed with osteoarthritis, how safe and effective is long-term treatment with bedinvetmab in providing analgesia?. Veterinary Evidence, 8(1) Full Text

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Here I’m going to lead you through the evidence and end with advice on how to use fish oil most effectively.

Skip the next section unless you’re really interested!

Fish Oil Essential Facts

First, what exactly is fish oil, and how might it work?

Almost all the fatty acids available to land animals like dogs (and us) are omega-6. The body uses these to make arachidonic acid and from this to make various inflammatory molecules.

When the body uses an omega-3 instead of omega-6, the end result can be anti-inflammatory instead. It’s not that omega-3 is the more natural; in fact, the body in arthritis is promoting inflammation, not suppressing it. What we are doing by supplying omega-3 at high doses is ‘tricking’ the body into using it instead.

In dogs, the effective omega-3 fatty acids are eicosapentaenoic and docosahexaenoic acid (EPA & DHA). Linseed and flaxseed oils contain ALA, which is almost unavailable to dogs. EPA and DHA mostly come from certain fish, but certainly not all of them. Feeding fish without dietary analysis is very unlikely to give the same benefit.

Fish Oil & Omega 3 Dog Studies

Now to the evidence. I’ve read all the studies using fish oil in arthritic dogs that included a control group. The control group is fed a dummy diet or supplement so that the owner placebo effect can also be measured and removed.

In fact in nearly all of these studies the placebo group improved as well. It’s the difference we’re interested in. I have one concern though: fish oil is very hard to hide due to its smell!

Fish Oil As A Supplement

The first study comes from Finland³. They gave dogs with arthritis 110 mg of DHA/EPA per kilogram body weight. This gave a final dietary ratio of omega 6 : omega 3 as 11 : 1 and would equate to roughly 7 regular strength 1g capsules for a 20kg dog.

No differences in measured performance were found. The only differences were that owners were more likely to see improvement, and more likely to guess correctly when their dog had the treatment diet rather than the control.

The results of this study suggest that, if done this way, the benefit of feeding an omega 3 fish oil supplement to dogs with osteoarthritis is small. 

Purina Fish Oil Therapeutic Diet

The second paper⁴ evaluates a veterinary therapeutic diet marketed to alleviate the signs of arthritis. This diet contained 1.08% DHA/EPA with a ratio of omega 6 to omega 3 as 1.3 : 1.

In this study, there were no differences between the treatment and control groups either in measured performance or owner assessment. As the authors stated, “the present study cannot convincingly claim that VTD [= veterinary treatment diet] improved the limb function to a greater extent than a regular diet”

Interestingly, both groups improved substantially. This is almost certainly due to the study design: owners were asked to avoid any intense activities (jumping, running, throwing ball or Frisbee, etc.) during the study duration. Which just goes to show how important it is to stop high-impact activity in these dogs.

Hills Fish Oil Therapeutic Diet

Finally we have the Hills product called JD or j/d. My clients will know I recommend this, and now I hope you will see why. However, I also want you to see that the effect is still not very dramatic.

Hills Prescription Diet j/d has 3.5% DHA/EPA, with a ratio of omega 6 to omega 3 as 0.73 for the kibble and 0.68 for the canned form. Note this is the first time you have seen a diet with more 3 than 6.

There are four studies, and I’ll quickly summarise them:

• Dogs on j/d were able to have greater reductions in anti-inflammatory doses than dogs on control foods. Average final doses of carprofen were 3.5mg/kg vs 3.85mg/kg respectively¹.
• During initial investigations, a difference for lameness and weight bearing were noted between dogs on food A (0.8% omega 3) and those on food C (similar to the final product)². 
• Using floor pressure plates to measure leg use, dogs on j/d increased their peak vertical force by 5.6% at 90 days⁵.
• In a home feeding trial, owners of dogs fed j/d reported improvement in their dogs’ ability to rise from rest and play at week 6 and the ability to walk at weeks 12 and 24 after the feeding trial began⁶.

In all cases, improvements were found, but not huge ones. Each study also included many factors that did not show any change.

How Fish Oil Can Be Toxic To Dogs

Here are some of the ways fish oil could be harmful to certain dogs:

• Dogs prone to pancreatitis should not be fed diets with normal to elevated levels of fats and oils. Therefore, fish oil could cause severe illness or even death in these dogs.
• Dogs with fish-based food allergies could also react severely to fish oil.
• Even normal dogs can have unexpected gastrointestinal upsets when fed fish oil. These are usually mild vomiting or diarrhoea, and will stop if you cease giving fish oil.

What about the fact that the therapeutic diets are grain-based? As you’ll see here, vets advise against grain-free diets.

Can You Use Human Fish Oil Capsules?

A common question is whether you can use pharmacy fish oil to treat dogs. This is true for skin disease, but false for arthritis. The reason for this is that the food manufacturers, through mysterious means, reduce the levels of omega 6 before adding omega 3. It’s also just that fish oil incorporated in the diet is a lot easier to give!

As you can see from the doses above, it would be nearly impossible to achieve either a sufficient dose or an acceptable 6:3 ratio by adding fish oil to an existing diet. Such a dose would probably also be toxic.

Fish Oil Dosage Calculator

The main drawback of j/d is its price. If you find it too costly, then here is a quick formula for the maximum fish oil dose you can give. Using a scientific calculator (also my smartphone calculator if I turn it sideways), raise your dog’s body weight to the power of 0.75 and multiply by 370. As a rough idea, for a 20kg dog the answer would be 3500mg.

Now look at the fish oil jar to see how many milligrams (mg) of combined DHA and EPA each gram contains. For fish oil containing 300mg per gram, the final fish oil dose equals 3500 divided by 300, or eleven grams. Bear in mind that this will still fall short of ideal doses but it should do something.

As I hope you’ve gathered by now, whichever way you use it fish oil can be helpful, but it’s very unlikely to do enough on its own. The treatment of canine osteoarthritis is multimodal, meaning we come at it from multiple angles. So click here to see the other recommended treatments for arthritis.

And a final disclaimer: I sell Hills j/d so I can easily be accused of bias. To this I say: if I didn’t think it worked, I wouldn’t sell it or choose it for my own dogs! And in fact, you can now see why, when I can’t get j/d, I won’t sell you anything else to replace it.

Sources

1. Fritsch, D. A., Allen, T. A., Dodd, C. E., Jewell, D. E., Sixby, K. A., Leventhal, P. S., … & Hahn, K. A. (2010). A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. Journal of the American Veterinary Medical Association, 236(5), 535-539
2. Fritsch, D., Allen, T. A., Dodd, C. E., Jewell, D. E., Sixby, K. A., Leventhal, P. S., & Hahn, K. A. (2010). Dose‐titration effects of fish oil in osteoarthritic dogs. Journal of veterinary internal medicine, 24(5), 1020-1026
3. Hielm-Björkman, A., Roine, J., Elo, K., Lappalainen, A., Junnila, J., & Laitinen-Vapaavuori, O. (2012). An un-commissioned randomized, placebo-controlled double-blind study to test the effect of deep sea fish oil as a pain reliever for dogs suffering from canine OA. BMC veterinary research, 8(1), 1-14
4. Moreau, M., Troncy, E., Del Castillo, J. R. E., Bedard, C., Gauvin, D., & Lussier, B. (2013). Effects of feeding a high omega‐3 fatty acids diet in dogs with naturally occurring osteoarthritis. Journal of animal physiology and animal nutrition, 97(5), 830-837
5. Roush, J. K., Cross, A. R., Renberg, W. C., Dodd, C. E., Sixby, K. A., Fritsch, D. A., … & Hahn, K. A. (2010). Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. Journal of the American Veterinary Medical Association, 236(1), 67-73
6. Roush, J. K., Dodd, C. E., Fritsch, D. A., Allen, T. A., Jewell, D. E., Schoenherr, W. D., … & Hahn, K. A. (2010). Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. Journal of the American Veterinary Medical Association, 236(1), 59-66

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

That risk isn’t evenly spread either. Some dogs are much more likely to tear an ACL than others. Two of those four risks are under your control.

Risk Factors For ACL Injuries In Dogs

Let’s take a tour through what we know. I’ll start with the risks you can’t control.

1. Breed

Every vet knows that some breeds are more likely to ‘do a cruciate’ than others. We don’t understand the mechanism, but it’s probably related to the shape of their joints and their tendency for arthritis.

This is a good time to explode a particular myth about dog ACLs. They almost never tear during sporting activities. Most dog cruciate ligaments which rupture have been slowly degenerating for some time until they finally go ‘pop’. This might happen on a walk or a trip to the toilet.

When many owners of affected dogs look back, their dog has been getting little twinges for some time before the failure occurs. The reason for this is that there has been something wrong with the joint for a while. It’s rare for me to operate on a cruciate ligament and not to see pre-existing arthritis for example.

Breeds At Higher Risk Of A Torn ACL

So what are those breeds? The following table comes from a recent Swedish study. Although it’s missing the common Australian breeds, my impressions are that these breeds are rarely affected anyway.

2. Age

The average age for a dog to rupture a cruciate ligament is seven. In other words, they are neither young nor old. But this average hides important differences between breeds too.

There are those that go early.

And those that go late.

Of course, there’s nothing you can do about this once you’ve chosen a dog. The next two are where you can really make a difference.

3. Body Condition

Excess body condition has a significant effect on the risk of cruciate rupture. In the study referenced below, a dog with a torn ACL was around twice as likely to be overweight as an average member of the same breed.

It’s hard to say what this means for the risk of tearing the ACL in the first place, but it also probably also doubles.

Body condition is not the same as body weight. Within a breed, dogs of different sizes but the same body condition do not have a different risk.

4. Desexing Age

The most recently understood risk factor is the age at which a dog is desexed or neutered. Neutering itself does not increase the risk as long as the right time is chosen.

The big message to come out of 2020 is that this risk is unpredictable, and varies greatly between dogs (those pesky breeds again!).

You can imagine my mood when I read the paper and realised I had to write 40 web pages to properly explain the risk for each breed. Let’s just say that you get to reap the benefit and I’m glad it’s over.

There are also some general guidelines for dogs of different sizes. Personally, I would also delay desexing for any of the higher risk breeds shown above.

What About Exercise?

What doesn’t increase the risk is the type of activity of your dog. This fits with my experience; we almost never see Greyhounds with ruptured cruciates for example.

When a dog tears their ACL it’s usually no one’s fault. Not even their own!

If this has happened to your dog, don’t despair. Repair techniques only get better, and after the recovery, a normal life awaits.

You might also like: How To Fix A Torn ACL In Dogs

References

Engdahl, K., Emanuelson, U., Höglund, O., Bergström, A., & Hanson, J. (2021). The epidemiology of cruciate ligament rupture in an insured Swedish dog population. Scientific reports, 11(1), 1-11

Lampman, T. J., Lund, E. M., & Lipowitz, A. J. (2003). Cranial cruciate disease: current status of diagnosis, surgery, and risk for disease. Veterinary and Comparative Orthopaedics and Traumatology, 16(03), 122-126

Terhaar, H. M., Muir, P., Baker, L. A., Binversie, E. E., Chi, J., & Sample, S. J. (2020). Contribution of habitual activity to cruciate ligament rupture in Labrador Retrievers. Veterinary and comparative orthopaedics and traumatology: VCOT, 33(2), 82

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

They either:

• go out too soon
• exercise too much, or
• turn walks into bad experiences

All three can have lasting consequences, but each one is easy to prevent.

When To Start Walking A Puppy

According to most vets, the earliest age to walk a puppy is when their second vaccination becomes protective. This will vary from 11 to 14 weeks, depending on the vaccine type and protocol used by each vet.

It is a little-known fact that puppy owners have some control over the first time they can go out walking. Vaccines used by breeders tend to be the ones that only protect at the oldest or latest age. However, there’s no reason you can’t choose an earlier one.

At Walkerville, our strategy for years has been to offer free puppy checks to try to catch these puppies in time. Otherwise, they would come in at 12 weeks like the breeder told them, and the pups would miss at least two weeks of outside socialisation time.

It’s important to point out that global vaccination guidelines dictate a 16 week parvovirus shot despite earlier protection being claimed by local manufacturers. Our approach to this dilemma is to advise owners that the risk between the second and third vaccine is extremely low, and easily outweighed by the urgent need to socialise.

How Far To Walk A Puppy

When you start walking it’s important to listen to your puppy and take it slow. The worst thing you could do right now is take the joy away by trying too hard too soon. Your entire focus should be on making walks fun, not long.

There is no single answer to how much or how far a puppy should be walked. Online calculators are available, but they are much too simplistic and fail to take into account individual needs or weather conditions. Over exercising is also common due to the mistaken belief that it will help puppies settle at night.

Therefore, if all you do is get to your driveway before your puppy stops, that’s OK. Maybe with a few treats, you can coax them a bit further the next time, or their curiousity will do it for you. Whatever you do, don’t pull them by the collar; they have to want to go.

If you suspect that anxiety might be stopping your puppy, get in touch with your vet straight away.

Once pups get brave enough, they often go too far unless prevented. Like kids, pups have very little stamina and will suddenly sit down and go no further. Therefore, start with very short trips, and only extend them when you are certain they can make it back. Of course, it doesn’t matter so much if your puppy is easily carried!

Pro tip: I always toilet train my puppies when outside using a leash, so that they stay in the right place and get accustomed to leads before starting walks.

Overexercise & Joint Problems

Many new owners have been warned about the risk of elbow and hip dysplasia caused by exercising too early. This applies especially to owners of young Labradors and Golden Retrievers. Here is some peace of mind.

The evidence behind overexercising puppies shows that the most critical age occurs while still at the breeder. Afterwards, as long as you keep them on a leash, a gentle walk should be purely beneficial.

Walking a puppy too much probably only occurs if you allow them to run and jump, or push them to achieve a target distance or time. Remember: it’s the outing that matters, not what they do.

Avoiding Bad Experiences

Good puppy socialisation is all about avoiding early bad experiences while maximising positive ones. You’ve already heard me warn you not to over-tire your puppy or push them too hard. Here are some of the other walking mistakes I see:

• Walking so far that the soft pads become worn through
• Using walks to meet other dogs on leash (read why here)
• Walking along busy or loud roads too soon

In fact, there are so many ways a pup could get a fright. Fear causes instant setbacks which can take weeks to undo. Therefore, have a look at this checklist of potential scares and take each one carefully at first with lots of treats.

Whatever you take away from this article, please don’t think that I’m trying to stop you getting out. Failing to expose a puppy to their world within their sensitive period is guaranteed to cause harm. The dangers of which I speak are easily avoided with a little care.

Coming soon: How Far To Walk Adult Dogs: it’s a whole different ballgame (hehehe).

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

What do all these random letters mean for your dog? Which one is better?

Here you won’t find an opinion; you’ll find the facts from research papers that compare these cruciate surgery techniques. This is the most-studied surgical procedure in veterinary science.

First, a quick explanation.

The Difference Between TPLO, TTA & MMP

Although they are quite different, each procedure involves the cutting and reshaping of the tibia. This is the shin bone that makes up the bottom half of the knee joint.

The Tibial Plateau Levelling Osteotomy is a curved cut that allows the weight bearing surface of the joint to be rotated from a sloping into a neutral position. The cut is then stabilised with a plate and screws.

The Tibial Tuberosity Advancement moves the attachment of the patellar tendon forward so that it partially offsets the lost force of the cruciate ligament. The advancement is stabilised using a variety of cage-like implants.

Essentially, the Modified Maquet Procedure is a version of the TTA that claims greater stability and simplicity. It uses a titanium foam wedge.

At this point you could well ask, “why so complicated?” Why don’t vets just replace the ligament like in humans?

The answer is that poor outcomes have made vets search for better methods. The De Angelis or lateral suture technique is an older procedure that attempts an artificial ligament, but it has a very high failure rate. We do not use it in dogs above 10kg at Walkerville.

The newer procedures are clearly better. The only question should be: which one is best?

TPLO vs TTA In Dogs

The results of four studies and one large review suggest that the TPLO gives better objective* lameness outcomes with a lower risk of complications. However, TTA gives faster recoveries in the period shortly after surgery.

Here’s what they found:

• Ground reaction forces at a walk for dogs that underwent TPLO normalised between 150 and 299 days after surgery versus more than 300 days after surgery for the TTA
• TPLO achieved normal symmetry indices at a trot after 50 days versus TTA dogs that did not achieve them during the first 12-months
• Dogs receiving TPLO had lower median scores on 14 of 16 canine orthopaedic index inventory items than dogs receiving TTA
• Total, minor, major and catastrophic complication rates were all higher in dogs that underwent TTA than in those that underwent TPLO
• The reoperation rate was higher in dogs that underwent TTA (10.9 per cent) than in those that underwent TPLO (4.8 per cent
• Dogs that underwent TTA were significantly less lame than dogs that underwent TPLO during the early postoperative period
• Osteoarthritis progressed more after TTA, and owners noted less pain and mobility issues long-term (≥3 years) after TPLO

It is essential to stress that although these differences are real, they are not large. All dogs improved substantially, the only difference being by how much. A good TTA performed by an experienced surgeon is almost certainly better than a poor TPLO.

* By objective we mean outcomes where the improvement is measurable and not subject to opinion, such as the amount of weight being placed on the leg.

TPLO vs MMP In Dogs

As the Modified Maquet Procedure is relatively new, there is limited evidence thus far. It is biomechanically comparable to TTA but easier and faster to perform and may provide more stability.

The results of a single comparative study suggest that dogs with TPLO reach a slightly better overall outcome than dogs with MMP. Patients with TPLO reached 84.8% and 89.9% of normal ground reaction forces at 3 and 6 months, versus 79.85% and 84.5% for MMP.

I suspect that in time we will see that the MMP outperforms TTA but we have no evidence thus far to back this up. It should also end up being a cheaper procedure.

Which Is Best: TPLO, TTA or MMP?

Based on the evidence, it is reasonably clear that the TPLO gives better results. Therefore, it should be no surprise that experts in the field overwhelmingly choose the procedure. A survey in 2016 found that 78.6% of respondents from the US Veterinary Orthopedic Society use TPLO.

However, the differences are not great. All three procedures give excellent results, and arguing over which is best is a bit like debating over Apple vs Samsung when your previous phone was a brick.

It’s far more important that you have a trusted vet. I would avoid shopping around if you already have a good relationship. If you choose any of TTA, MMP or TPLO, you are doing an excellent job and your dog will be the winner.

Disclaimer: whichever procedure a vet uses, they tend to sing its praises. I would like to believe I chose TPLO because of the evidence, but it’s possible that this article reflects my bias. I welcome any comments and will do my best to keep the evidence up to date.

You can find the cost for TPLO and De Angelis procedures here.

Click here to learn why dogs tear their ACL.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

Knebel, J., Eberle, D., Steigmeier-Raith, S., Reese, S., & Meyer-Lindenberg, A. (2020). Outcome after Tibial Plateau Levelling Osteotomy and Modified Maquet Procedure in Dogs with Cranial Cruciate Ligament Rupture. Veterinary and Comparative Orthopaedics and Traumatology, 33(03), 189-197

Moore, E. V., Weeren, R., & Paek, M. (2020). Extended long‐term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog. Veterinary Surgery, 49(1), 146-154

Von Pfeil, D. J., Kowaleski, M. P., Glassman, M., & Dejardin, L. M. (2018). Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds). Journal of the American Veterinary Medical Association, 253(5), 586-597

White, C., & Morrow, L. (2020). Does traditional tibial tuberosity advancement yield similar postoperative outcomes as tibial plateau levelling osteotomy in dogs with cranial cruciate ligament disease?. The Veterinary Record, 187(2), 69-71

1. Will CBD oil help my dog?
2. How do I buy genuine CBD oil in Australia?

Here I provide answers, assessing CBD oil by the same standards we use for any other medicine. Let’s start with a short explanation.

What Is CBD Oil?

In theory, CBD oil is an extract from the cannabis or hemp plant containing high levels of cannabidiol and very low levels of tetrahydrocannabinol or THC. It may also contain other active ingredients derived from the plant.

The lack of the psychoactive THC means that dogs receiving CBD oil should never appear sedated or ‘stoned’. I have seen enough marijuana poisoning to know how unpleasant it is. Products containing significant levels of THC should not be given to dogs.

Cannabidiol (“cannaba-DYE-ol”) is believed to act on receptors found in the central nervous system and joints, possibly with other active ingredients found in CBD oil. The effect is complex and poorly understood but may involve competitive inhibition rather than activation.

Evidence For Cannabidiol in Dogs

Clinical studies for the use of medicinal cannabis in dogs are only found in epilepsy and osteoarthritis. Other possible uses, such as for anxiety or calming, are not recommended until more is known.

Evidence for the ability of CBD oil to prevent seizures in dogs is poor. There are many ancedotal reports of success, but very little good quality science. Given that conventional treatments for epilepsy work well in the majority of dogs, there is not a strong demand and I will not discuss this use further. Those wishing to try it should talk to their vet.

Evidence for the use of CBD oil to treat the signs of arthritis is stronger. In fact, cannabidiol is actually better supported than some commonly used treatments like glucosamine, green-lipped mussel (GLM), hydrotherapy and cold laser.

Three recent randomised placebo-controlled trials all found that outward signs of arthritis improved when dogs received twice daily oral doses of cannabidiol. Although these studies used only small numbers of dogs, the effects were statistically significant.

Vets reading this can find treatment protocols detailed in the papers linked below.

When To Use Cannabidiol For Arthritis

The conventional treatments for canine arthritis (listed on this page) work well in the majority of cases. However, as dogs age, arthritis inevitably worsens. Eventually there comes a time when these treatments don’t always provide enough relief.

Cannabidiol is probably not strong enough to work on its own, and likely to give only partial relief. Therefore, it is a sensible choice to add to existing therapy, not replace it. But pet owners also need to be careful.

The desperation of vets and pet owners for anything to try has created a demand often filled by less-than-ethical sellers. Much of the current batch of products claiming to be CBD oil in Australia are likely to be ineffective. Not only does this deprive dogs of the help they need, it tarnishes the name of what may actually work if it had a chance.

Note that there is no evidence to support the use of CBD products in cats, and it is not recommended.

Is CBD Oil Legal For Pets?

Vets in Australia can prescribe cannabidiol as a Schedule 4 drug for patients under their care with the following conditions:

1. Cannabidiol comprises 98 per cent or more of the total cannabinoid in the preparation
2. Any cannabinoids, other than cannabidiol, must be only those naturally found in cannabis
3. Owner consent is obtained to trial an unlicensed and potentially harmful treatment
4. There is adequate monitoring of the patient’s response and any side effects

However, the second issue for vets is finding a supplier. There are no locally registered products, and special approval is needed for importation. The easiest solution is to find a compounding pharmacist who offers it, as compounding on an individual basis is exempt from licensing.

I found a supplier by talking to state regulatory authorities and then selected pharmacies. You could do this too for your state.

What Is The Best CBD Oil?

Due to current Australian regulations, only CBD oil sold under prescription is likely to be of sufficient quality. Products available for sale online can only be one of two things:

1. Illegal
2. Containing very little active ingredient

The latter is probably the correct statement. These products are often in the form of treats or oils, and use words like hemp, cannabinoid, cannabis or CBD to describe their contents. They conspicuously avoid saying how much cannabidiol they contain.

Anecdotal reports of success are likely to represent instances of the caregiver placebo effect, which we all suffer.

The Drawbacks Of CBD Oil

There are several reasons why CBD oil containing cannabidiol may not be the best treatment for your dog.

1. Availability: you might not be able to find a vet or pharmacy in your area able to supply it
2. Side effects: although it appears well-tolerated, cannabidiol can cause adverse effects including diarrhoea, drug interactions and possible liver damage
3. Cost: CBD oil containing cannabidiol is surprisingly expensive

My experience of using CBD oil is that it will cost the owner of a 25kg dog around $10 a day, or around $4 for every 10kg bodyweight. This is far higher than the costs for other conventional arthritis treatments. If it works, you can try reducing the dose, but we can only hope that the price will come down in the future.

Regulation may be partly to blame for this, but it isn’t wholly a bad thing. The situation in the USA, where CBD oils are easily available, is one of very unreliable drug levels and even some dog products with undeclared THC.

Medicinal Cannabis Protocol

At Walkerville Vet, we are happy to prescribe cannabidiol, but only under the following conditions:

1. The dog is already receiving a non-steroidal anti-inflammatory drug
2. A pre-treatment checkup and baseline blood test is performed
3. A further blood test is done one month later, and check ups are then every three months

We apologise for this conservative approach. It’s quite likely that other vets will be happier to prescribe more liberally.

If you think your dog could benefit from CBD oil, talk to your veterinarian, but also forgive them if they seem sceptical or dismissive. There have been so many pet owners taken for a ride that they may reject the idea. But personally, I think the time is right to take cannabidiol more seriously.

Like we once did for other outlandish treatments that later became our standards. But just a word of warning though: I don’t have a sense of humour for jokes about weed or stoner dogs. That’s what’s holding us back.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Further Reading

Brioschi, F. A., Di Cesare, F., Gioeni, D., Rabbogliatti, V., Ferrari, F., D’Urso, E. S., … & Ravasio, G. (2020). Oral Transmucosal Cannabidiol Oil Formulation as Part of a Multimodal Analgesic Regimen: Effects on Pain Relief and Quality of Life Improvement in Dogs Affected by Spontaneous Osteoarthritis. Animals, 10(9), 1505. Full Article.

Gamble, L. J., Boesch, J. M., Frye, C. W., Schwark, W. S., Mann, S., Wolfe, L., … & Wakshlag, J. J. (2018). Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs. Frontiers in veterinary science, 5, 165. Full Article.

Verrico, C. D., Wesson, S., Konduri, V., Hofferek, C. J., Vazquez-Perez, J., Blair, E., … & Halpert, M. M. (2020). A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain. Pain, 161(9), 2191-2202. Full Article.

While the paper isn’t perfect (more on that later), it does provide the first evidence for Yorkies on choosing a time of desexing with the fewest health problems. The study compared dogs neutered at different ages for their rates of:

• hip dysplasia (HD), cruciate ligament injury (CCL) and elbow dysplasia (ED)
• lymphoma (LSA), mast cell tumour (MCT), haemangiosarcoma (HSA), osteosarcoma (OSA)
• urinary incontinence (UI)

All of these have been suspected to be linked with the age of neutering. Here’s what they found (only bold values are significant, my summary to follow):

UI was not reported in any of the spayed females.

If this table makes no sense, it’s mostly because there are no abnormal findings. Have a look at this one for Golden retrievers as a comparison. 

Summary: The Best Yorkshire Terrier Spay & Neuter Times

There is minimal evidence that Yorkie health problems are influenced by the age of neutering. Owners of either sex are therefore free to choose the age of desexing that suits them best.

Recommendation: 6 months for both sexes.

This is so far the only science we have for the best desexing age in Yorkies. Your vet, breeder or online group may have a different opinion based on their experience or personal beliefs. It’s perfectly reasonable to take their advice into consideration as well.

Problems With This Study

The authors do not mention the well-known increase in lifespan associated with desexing male and female dogs, which tends to counteract most concerns about specific cancers. The following comment in the paper is a clue that it might also have been true for this population:

Across all breeds the mean age of last entry in the record for neutered males was 5.5 years (range 3.71–6.54), for neutered females 5.7 years (range 4.21–6.97), for intact males 4.9 (range 4.15–7.11), and intact females 4.7 (range 3.41–6.32)

The study tries to also look at the rates of mammary cancer & pyometra in females, but cannot give an accurate assessment for two reasons:

1. the mean ages listed above are far too young to pick up most cases
2. pyometra and mammary cancer are rarely referred to university hospitals

Regardless of any concerns, the authors are to be applauded to bringing into focus one of the most common questions from dog owners. For the Yorkshire Terrier at least, they’ve made the decision a lot easier.

Related: Best Desexing Age For 35 Breeds | Desexing Choices For Dogs | Costs Of Desexing

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

While the paper isn’t perfect (more on that later), it does provide the first evidence for Westies on choosing a time of desexing with the fewest health problems. The study compared dogs neutered at different ages for their rates of:

• hip dysplasia (HD), cruciate ligament injury (CCL) and elbow dysplasia (ED)
• lymphoma (LSA), mast cell tumour (MCT), haemangiosarcoma (HSA), osteosarcoma (OSA)
• urinary incontinence (UI)

All of these have been suspected to be linked with the age of neutering. Here’s what they found (only bold values are significant, my summary to follow):

There was a single case of UI in the females spayed < 6 months and in those spayed 6-11 months.

If this table makes no sense, it’s mostly because there are no abnormal findings. Have a look at this one for Golden retrievers as a comparison. 

Summary: The Best Westie Spay & Neuter Times

There is minimal evidence that Westie health problems are influenced by the age of neutering. Females spayed early had a higher incidence of urinary incontinence but the numbers are far too small to be meaningful.

Recommendation: 6 months for both sexes

This is so far the only science we have for the best desexing age in Westies. Your vet, breeder or online group may have a different opinion based on their experience or personal beliefs. It’s perfectly reasonable to take their advice into consideration as well.

Problems With This Study

The authors do not mention the well-known increase in lifespan associated with desexing male and female dogs, which tends to counteract most concerns about specific cancers. The following comment in the paper is a clue that it might also have been true for this population:

Across all breeds the mean age of last entry in the record for neutered males was 5.5 years (range 3.71–6.54), for neutered females 5.7 years (range 4.21–6.97), for intact males 4.9 (range 4.15–7.11), and intact females 4.7 (range 3.41–6.32)

The study tries to also look at the rates of mammary cancer & pyometra in females, but cannot give an accurate assessment for two reasons:

1. the mean ages listed above are far too young to pick up most cases
2. pyometra and mammary cancer are rarely referred to university hospitals

Regardless of any concerns, the authors are to be applauded to bringing into focus one of the most common questions from dog owners. For the West Highland White Terrier at least, they’ve made the decision a lot easier.

Related: Best Desexing Age For 35 Breeds | Desexing Choices For Dogs | Costs Of Desexing

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

While the paper isn’t perfect (more on that later), it does provide the first evidence for Shi Tzus on choosing a time of desexing with the fewest health problems. The study compared dogs neutered at different ages for their rates of:

• hip dysplasia (HD), cruciate ligament injury (CCL) and elbow dysplasia (ED)
• lymphoma (LSA), mast cell tumour (MCT), haemangiosarcoma (HSA), osteosarcoma (OSA)
• urinary incontinence (UI)

All of these have been suspected to be linked with the age of neutering. Here’s what they found (only bold values are significant, my summary to follow):

UI was not reported in any of the spayed females.

Summary: The Best Shi Tzu Spay & Neuter Times

There is minimal evidence that Shi Tzu health problems are influenced by the age of neutering other than an increase in cancer noted in females spayed over 12 months of age.

Recommendation: 6 months for both sexes.

This is so far the only science we have for the best desexing age in Shi Tzus. Your vet, breeder or online group may have a different opinion based on their experience or personal beliefs. It’s perfectly reasonable to take their advice into consideration as well.

Problems With This Study

The authors do not mention the well-known increase in lifespan associated with desexing male and female dogs, which tends to counteract most concerns about specific cancers. The following comment in the paper is a clue that it might also have been true for this population:

Across all breeds the mean age of last entry in the record for neutered males was 5.5 years (range 3.71–6.54), for neutered females 5.7 years (range 4.21–6.97), for intact males 4.9 (range 4.15–7.11), and intact females 4.7 (range 3.41–6.32)

The study tries to also look at the rates of mammary cancer & pyometra in females, but cannot give an accurate assessment for two reasons:

1. the mean ages listed above are far too young to pick up most cases
2. pyometra and mammary cancer are rarely referred to university hospitals

Regardless of any concerns, the authors are to be applauded to bringing into focus one of the most common questions from dog owners. For the Shi Tzu at least, they’ve made the decision a lot easier.

Related: Best Desexing Age For 35 Breeds | Desexing Choices For Dogs | Costs Of Desexing

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.