Failed TPLO x 3

[Guest guest]

For what it’s worth two of my clients have used it over a year

ago (Border Collie and German Shepherd). Both lost substantial amounts of

weight….. and lost much of their hair coat. Neither dog has regrown the hair in

any normal fashion. Both look like they had some strange form of mange!

Curious if anyone else has seen this?

Gallagher McMahon, CCMT, CCRT

" Helping Dogs Get Better One Paw at a Time "

Two Hands Four Paws, Inc.

11301 W. Olympic Blvd. #651

Los Angeles, CA 90064

www.twohandsfourpaws.com

From:

VetRehab [mailto:VetRehab ] On Behalf Of Laurie

Edge-

Sent: Wednesday, April 07, 2010 12:53 PM

To: VetRehab

Subject: RE: Failed TPLO x 3

Hi

Okay, so here is what I learned...and I

apologize for dumbing down things so that ‘my’ head can wrap around it.

It is a pharmaceutical from Pfizer,

which works by decreasing appetite and reducing fat absorption. About 90%

of its effectiveness is due to the former, whereas 10% is from the latter.

The microscience beyond that would just

be me typing things that fly over my head.

It should not be used with ‘diet’ food

(as there is not enough protein) and it is contraindicated with Cushings, Liver

disease and Steroid use. The occasional side effects are vomiting

and diarrhea.

It can be used up to a year and then

should be removed via a weaning process.

My apologies for this ‘dummy

version’.... If anyone wants to add a more intelligent response, I won’t

be offended!!

Cheers,

Laurie Edge-

From:

VetRehab [mailto:VetRehab ] On Behalf Of Jeannie

Pavlakos

Sent: April-07-10 1:28 PM

To: VetRehab

Subject: RE: Failed TPLO x 3

Would someone be willing to explain what

Slentrol is and how it works? Thanks

Pavlakos, PT, CCRP

From:

VetRehab [mailto:VetRehab ] On Behalf Of Carol

Helfer, DVM

Sent: Wednesday, April 07, 2010 5:56 AM

To: Vet Rehab

Subject: RE: Failed TPLO x 3

To second Laurie's suggestion with the example of a case of one.....

145# lab mix w/ bilateral CrCL ruptures. Surgeon said " get weight

off dog first " . Used primarily combination of UWTM for exercise and

Slentrol. Cut to the chase: 7 months later dog was 105# (could

still stand to lose another 10#) but is so much better that owner now thinks

surgery isn't necessary. Not sure the surgeon is thanking me on this one

But the dog really is doing amazingly well.

This was my first experience with Slentrol - I was impressed.

Carol Helfer, DVM

Portland, OR

To:

VetRehab

From: physio@...

Date: Tue, 6 Apr 2010 23:28:35 -0600

Subject: RE: Failed TPLO x 3

Hi Mindy,

Yikes!

I guess my thoughts on this, are that the issue is OA (and obesity), not

instability. Unless the brace can make him drop 100#, I don’t see the

point.

Why not go

Selentrol, a diet, OA management. I’m with on the Stem cell option

as well with this dog – if they are going to put $$ somewhere...

Laurie

Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRT

From: VetRehab [mailto:VetRehab ]

On Behalf Of Mission Vet Hospital

Sent: April-06-10 6:14 PM

To: VetRehab

Subject: Re: Failed TPLO x 3

Hi Mindy,

Sorry to here about your case. Sounds like an uphill

battle I have

had some success in these dogs with intra articular stem cells. I have

also seen some good results with custom stifle braces. Who would you

use? K9 orthotics makes good braces and is on the east coast.

they have a good website. the Colorado people make good braces too.

I would definitely try both of those. You won't be able to use sstem

cells for awhile after your vetalog though.

Good luck

From: mindyjohnsondvm

Sent: Tuesday, April 06, 2010

3:43 PM

To: VetRehab

Subject: Failed

TPLO x 3

Hi

group,

I have a tough case. 7yr m/n husky-x dog - morbidly obese at 173# - has gained

19# since I saw him last. I am vet #4(including 2 ACVS)to lecture on weight and

provide nutrition consultation, diet planning, etc - owners resist. He has had

1 successful R TPLO and 2 failed L TPLO's- all boarded surgeons. 2yrs ago he

had a 3rd try L that has held - but the leg is chronically painful with severe

ROM loss - boney endfeel max ext - 126degrees. Current rads show only severe

DJD - no gross neoplasia. He can walk short distances with L stifle flexed -

frequently collapsing down on that leg. Previous vet ordered an A-trac brace -

didn't help. His owners WILL NOT give him stronger pain mgt than NSAIDs,

supplements and acupuncture (all 4 DVM's have tried). He did 2yrs of aggressive

rehab with previous vet. I am going to anes and inject his stifles next week

with polyglycan/vetalog. My question is....His owners want to have him casted

for a custom stifle brace while he's out. Does anyon Mindy , DVM, CCRT

Veterinary Wellness Center

Lexington, KY

Lexington, KY

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[Guest guest]

Mindy,

It sounds like they want you to just wave a wand over their obese pet and make

it better!

Would you explain the treatment philosophy behind intra articular

polyglycan/vetalog?

Slentrol (dirlotapide) is prescription only pharmaceutical that is indicated for

the management of obesity in dogs. It suppresses the appetite however the

mechanism of its action is not completely understood. It is thought to work by

decreased absorption of fat (approx. 10% of its activity) and 90% of its

activity from satiety signal from enterocytes in the small bowel. It seems to

be very successful with owner compliance, proper monitoring and dose titration.

https://www.slentrol.com/

Rick Wall, DVM

Certified Canine Rehabilitation Practitioner

Diplomate, American Academy of Pain Management

Certified Myofascial Trigger Point Therapist

Center for Veterinary Pain Management and Rehabilitation

The Woodlands, TX

www.vetrehabcenter.com

[Guest guest]

Thanks Laurie...and no apologies...I apreciated the "dumb down" version:)

Jean

From: VetRehab [mailto:VetRehab ] On Behalf Of Laurie Edge-Sent: Wednesday, April 07, 2010 3:53 PMTo: VetRehab Subject: RE: Failed TPLO x 3

Hi

Okay, so here is what I learned...and I apologize for dumbing down things so that ‘my’ head can wrap around it.

It is a pharmaceutical from Pfizer, which works by decreasing appetite and reducing fat absorption. About 90% of its effectiveness is due to the former, whereas 10% is from the latter.

The microscience beyond that would just be me typing things that fly over my head.

It should not be used with ‘diet’ food (as there is not enough protein) and it is contraindicated with Cushings, Liver disease and Steroid use. The occasional side effects are vomiting and diarrhea.

It can be used up to a year and then should be removed via a weaning process.

My apologies for this ‘dummy version’.... If anyone wants to add a more intelligent response, I won’t be offended!!

Cheers,

Laurie Edge-

From: VetRehab [mailto:VetRehab ] On Behalf Of Jeannie PavlakosSent: April-07-10 1:28 PMTo: VetRehab Subject: RE: Failed TPLO x 3

Would someone be willing to explain what Slentrol is and how it works? Thanks

Pavlakos, PT, CCRP

From: VetRehab [mailto:VetRehab ] On Behalf Of Carol Helfer, DVMSent: Wednesday, April 07, 2010 5:56 AMTo: Vet RehabSubject: RE: Failed TPLO x 3

To second Laurie's suggestion with the example of a case of one..... 145# lab mix w/ bilateral CrCL ruptures. Surgeon said "get weight off dog first". Used primarily combination of UWTM for exercise and Slentrol. Cut to the chase: 7 months later dog was 105# (could still stand to lose another 10#) but is so much better that owner now thinks surgery isn't necessary. Not sure the surgeon is thanking me on this one But the dog really is doing amazingly well. This was my first experience with Slentrol - I was impressed. Carol Helfer, DVMPortland, OR

To: VetRehab From: physiofourlegDate: Tue, 6 Apr 2010 23:28:35 -0600Subject: RE: Failed TPLO x 3

Hi Mindy,

Yikes! I guess my thoughts on this, are that the issue is OA (and obesity), not instability. Unless the brace can make him drop 100#, I don’t see the point.

Why not go Selentrol, a diet, OA management. I’m with on the Stem cell option as well with this dog – if they are going to put $$ somewhere...

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRT

From: VetRehab [mailto:VetRehab ] On Behalf Of Mission Vet HospitalSent: April-06-10 6:14 PMTo: VetRehab Subject: Re: Failed TPLO x 3

Hi Mindy,

Sorry to here about your case. Sounds like an uphill battle I have had some success in these dogs with intra articular stem cells. I have also seen some good results with custom stifle braces. Who would you use? K9 orthotics makes good braces and is on the east coast. they have a good website. the Colorado people make good braces too. I would definitely try both of those. You won't be able to use sstem cells for awhile after your vetalog though.

Good luck

From: mindyjohnsondvm

Sent: Tuesday, April 06, 2010 3:43 PM

To: VetRehab

Subject: Failed TPLO x 3

Hi group,I have a tough case. 7yr m/n husky-x dog - morbidly obese at 173# - has gained 19# since I saw him last. I am vet #4(including 2 ACVS)to lecture on weight and provide nutrition consultation, diet planning, etc - owners resist. He has had 1 successful R TPLO and 2 failed L TPLO's- all boarded surgeons. 2yrs ago he had a 3rd try L that has held - but the leg is chronically painful with severe ROM loss - boney endfeel max ext - 126degrees. Current rads show only severe DJD - no gross neoplasia. He can walk short distances with L stifle flexed - frequently collapsing down on that leg. Previous vet ordered an A-trac brace - didn't help. His owners WILL NOT give him stronger pain mgt than NSAIDs, supplements and acupuncture (all 4 DVM's have tried). He did 2yrs of aggressive rehab with previous vet. I am going to anes and inject his stifles next week with polyglycan/vetalog. My question is....His owners want to have him casted for a custom stifle brace while he's out. Does anyon Mindy , DVM, CCRTVeterinary Wellness CenterLexington, KYLexington, KY

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[Guest guest]

Mindyif I were you, I'd stop spending anymore energy on this now. There isn't a brace that i know of that can help this dog. But more so, these people have made a conscious choice to ignore all recommendations from your coleagues- why not put the energy into people and pets who will follow your advice.

 

Thanks for the reply. The owners have been Rx'd Slentrol and refused to use it. Also have done extensive nutrition and obesity counseling (as have the 3 other vets). They have been offered inpatient weight loss care - all declined. Stem cells were offered and declined before the PGN / vetalog option - with which we have had great results. Also, I just returned from the Stem cell conference in CA in which we discussed steroid use in conjunction with stem cells. There are equine surgeons using them fairly soon after IA steroids with good results. I appreciate everyones responses. I really was asking if anyone had good results with custom bracing in a dog this large. I'm just trying to help the dog with the limited options the owner will allow.

Mindy DVM, CCRT

[Guest guest]

Hi Rick,

Polyglycan is a polysulfate/ HA product labeled for IA use in dogs and horses.

It is similar to Adequan (plus HA) and I use it about the same way. If not

using it IA either as a jt fluid replacement post-op or just as an IA injection

under sedation/ anes, I use it IM at 1cc/35# weekly for 1 month, then monthly

(this use if off-label, but we were doing trials for them). It has been used IV,

IA in equine for several years with good results. I have used it mainly for

pain control in severe osteoarthritis cases when stem cells weren't an option.

We typically get 3-6 months of comfort from each injection. I combine it with

vetalog for increased duration of effect. I don't have specific numbers for you,

but the company (Arthrodynamics) has some good data and the dog owners and I

have been happy with the outcome of all the cases we've tried. I'm going to put

it in a cat hip joint (working with the company) - will let you know how that

goes. Thanks for the response. Case is frustrating - but it's not the dog's

fault. I'm just trying to give him some pain relief!

Mindy

>

> Mindy,

>

> It sounds like they want you to just wave a wand over their obese pet and make

it better!

>

> Would you explain the treatment philosophy behind intra articular

polyglycan/vetalog?

>

>

>

> Slentrol (dirlotapide) is prescription only pharmaceutical that is indicated

for the management of obesity in dogs. It suppresses the appetite however the

mechanism of its action is not completely understood. It is thought to work by

decreased absorption of fat (approx. 10% of its activity) and 90% of its

activity from satiety signal from enterocytes in the small bowel. It seems to

be very successful with owner compliance, proper monitoring and dose titration.

>

> https://www.slentrol.com/

>

>

> Rick Wall, DVM

> Certified Canine Rehabilitation Practitioner

> Diplomate, American Academy of Pain Management

> Certified Myofascial Trigger Point Therapist

>

> Center for Veterinary Pain Management and Rehabilitation

> The Woodlands, TX

> www.vetrehabcenter.com

>

[Guest guest]

All,

It is well established that the inflammatory response of OA is worsened

by obesity/adipose tissue by the actions of IL2, TNF etc. I would

totally agree with Dr Wall that until the owners respect the ”collective

wisdom” of the DVM’s that have been involved in this case that

braces are only a “band aid”

We had a similar case that we started working with (145#

lb Golden that now weighs 60#!) with a MPL that now no longer even needs the MPL

surgery. The attending rescuer achieved the weight loss with calorie

counting & some UWTM. She accomplished the weight loss without prescription

foods & joint supplements (against our advice)…it took over 14

months… but she did it nonetheless… by caloric restriction and UWTM

alone.

We have used Slentrol very specifically with very good results.

Blood work must be monitored and consultations need to occur every 2 weeks at a

minimum which is the same for any effective weight management program.

My humble opinion w/o benefit of exam etc is this dogs primary

problem is its obesity and unless that is resolved other modalities will likely

be a waste of time & money and is not in the pets best interest .In

our experience there are OFTEN huge hurdles to get compliance but it NEEDS TO

HAPPEN to be able to benefit this pet

Trying to treat inflammation without treating underlying obesity

is futile! As professionals (veterinarians & rehabilitation

specialists) we have to face this reality to truly help the pets in our care!

Good luck!

Ken

Ken Lambrecht DVM

Rehab & Fitness Director

4Paws swim & Ftness

www. 4pawsswim.com

From: VetRehab

[mailto:VetRehab ] On Behalf Of Toni Lynch

Sent: Wednesday, April 07, 2010 9:22 PM

To: VetRehab

Subject: Re: Failed TPLO x 3

Is

the dog truly getting over its required kilojoules in energy? is there another

condition occuring concurrently that is stimulating the weight issue? Chronic

inflammation will influence adrenal steroid levels and thyroid and if

under the chronic influence of stress will not lose weight. High

Reverse T3 can also prevent the loss of weight. Is there another cause of

inflammation other than the stifles ?

Dr

Toni Lynch

BVSc Hons GDAnimal Chiro

-----

Original Message -----

From: mindyjohnsondvm

To: VetRehab

Sent: Wednesday, April 07,

2010 8:43 AM

Subject: Failed

TPLO x 3

Hi group,

I have a tough case. 7yr m/n husky-x dog - morbidly obese at 173# - has gained

19# since I saw him last. I am vet #4(including 2 ACVS)to lecture on weight and

provide nutrition consultation, diet planning, etc - owners resist. He has had

1 successful R TPLO and 2 failed L TPLO's- all boarded surgeons. 2yrs ago he

had a 3rd try L that has held - but the leg is chronically painful with severe

ROM loss - boney endfeel max ext - 126degrees. Current rads show only severe DJD

- no gross neoplasia. He can walk short distances with L stifle flexed -

frequently collapsing down on that leg. Previous vet ordered an A-trac brace -

didn't help. His owners WILL NOT give him stronger pain mgt than NSAIDs,

supplements and acupuncture (all 4 DVM's have tried). He did 2yrs of aggressive

rehab with previous vet. I am going to anes and inject his stifles next week

with polyglycan/vetalog. My question is....His owners want to have him casted

for a custom stifle brace while he's out. Does anyone think this will help at

this stage? I hate to waste their money if it is pointless. Thanks in advance

for your help!

Mindy , DVM, CCRT

Veterinary Wellness Center

Lexington, KY

Lexington, KY

[Guest guest]

Again, I COMPLETELY understand inflammatory physiology, etc. Yep, this is a

band-aid for the dog. I am trying to make him comfortable in the only way his

owners will allow while they feed him to death. Again - not his fault. Glad

everyone has had wt loss success stories, as have we. I know the obesity is the

disease and all else are symptoms. I'm trying to get him comfortable enough to

increase his activity out of the UWTM. Thanks for all suggestions, but

understand that we can only do what owners will allow. I'm not going to stop

trying to help this dog in whatever capacity I can squeak by his owners.

Mindy , DVM, CCRT