Speaker 1: You were listening to Petlifradio dot com.
Speaker 2: And good morning to everyone on it's fantastic Sunday morning.
Speaker 3: I hope it's good for you too, and it uh here.
Speaker 2: Well, the morning, I should say, here in Los Angeles
till morning is nine o'clock.
Speaker 3: For those of you back east, it's about noon.
Speaker 2: So anyway, I hope you had a good morning as
you approach the afternoon.
Speaker 3: But we're having a good morning here in LA.
Speaker 2: It's starting to cool down a little bit, which is
good because it's been insanely hot. I think we're gonna
have a you know, a couple of days where it's
going to be very mild for us. That's in the eighties,
and then they say by next weekend it's going to
be a scorcher again. I think expecting in the mid
tigh nineties. So anyway, we can do well. I'm not
complaining too much. As long as you get snow by
the wintertime in the mountains, I'll be okay. So anyway,
you're here with doctor Jeff Werber ask The vets with
Doctor Jeff are only live call in show here on
pet Life Radio. And just let me reiterate the words
call in show that means we want you to call
in number is easy eight seven seven three.
Speaker 3: Eight five eight eight eight two.
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Vets tab with doctor Jeff and you can join it
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it so easy to get a hold of us, and
we're here for you. We're here to help you with
your pets. Answer questions, you know, go over some of
the things a little bit more slowly with a little
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Speaker 3: Out a pro sense product.
Speaker 2: So what we've been doing over the last several weeks
is going through some of the conditions that there are
a lot of choices to make. There seem to be
traditionally much confusion, and I'm I'm talking confusion even amongst
veterinarians how to handle. You know, one of the things
that I often say, and I'll pup repeat this a
zillion times through the course of my shows, and that
is that I think the young veterinarian and bless their hearts,
I think they're amazing and they you know, they're smart
enough to get into med school and that's great, but
I think that in a sense they are being misled
by as I call the ivory towers of the veterinary colleges,
the teaching hospitals. And here's why. It's very simple that
when you go through school, the case load that you're
often seeing when you get into clinics. Now, let's face it,
the book Smarts is great, and you learn a lot in.
Speaker 3: Your books, but the way you're really.
Speaker 2: Going to learn the essence the art of veterinary practice
is in the clinics. It's hands on experience. So you
have to ask yourself what kinds of cases do the
clinics get When a case is referred by a general
practitioner somewhere in central California and they want to send
a case up to UC Davis.
Speaker 3: What kind of case was that? A simple case? Was
that a routine case?
Speaker 2: And the answer is no, because why if it was,
the doctor would have handled it perfect. It was a
case that was as I called the zebra. And for
those of you not familiar and those of you that
have been listening, you know that great expression of mine,
it's not mine.
Speaker 3: I just heard it and I love it. And that
is if you're running.
Speaker 2: Along the beach in Malibu, California, and you hear beach
chasing you from behind, what are you thinking? Horses are zebras,
Hopefully the answers horses, And most of the cases that
you're going to see, we're going to see in practice
in our general practice level are gonna be the horses,
and which cases do we need to send to the
teaching hospitals, to the research institutions, to the veterinary school universities.
We're sending them the zebras. The ones that are really bizarre,
the ones that are regular standard testing can't figure out.
The ones that are ultrasound we can't find it. We
know something is wrong, everything else is normal. Wow, you
scratch your head, this is a bizarre case. I'm going
to send it to the specialist, or if you're near
a university hospital, I'm going to send it to the hospital.
So consequently, when these veterinary students are going through their
rounds at the hospital, the cases they are seeing are
really the zebras.
Speaker 3: They are seeing some of.
Speaker 2: These really bizarre cases.
Speaker 3: So what happens.
Speaker 2: What happens is when they're in practice as a young
veterinarian and they see that limping dog, what are they thinking?
Are they thinking the four pages of normal, regular, simple
possibilities or that half a page at the very end
of the zebras And unfortunately, because of their training, they're
thinking the zebras. And it's not until they get out
and practice for a number of years that they realize,
oh my god, you know, I've never seen a case
like that one again the ones I saw in VET school,
and chances are you're not gonna ah. You might find
anyia rarely. But so I think that the tendency when
you see a problem case, especially with a young veterinarian,
in practice, it's to immediately follow the course that they
have followed from vet school. Really, and they really never
mastered the art of how to do your rule outs,
how to make a decision without the benefit of the tests,
how to use that history and physical to your advantage
to rule out ninety percent of things on that list
of possibilities, leaving you with only ten percent to have
to really diagnose. So what we've been talking about in
weeks past have been a lot of them. We started
with the vomiting issues and lately we've been talking about
the limping issues. And in the limping issues, we've gone
through some of the growth related diseases that we see
in dogs. We've gone through the arthridities, the arthritis hip displasia.
Speaker 3: For example, for one.
Speaker 2: Trying to clarify a bit as to how much you
have to worry when you see your dog limping. So
the next thing I promised we were going to talk about.
We just touched on it last week. We started the knees,
the stifles, and we got into the patella luxation, which
is a congenital disease, or certainly a congenital predisposition where
the kneecap, the patella that is supposed to sit nice
and tightly on a groove at the lower part of
the femur called interestingly enough, the femeral or pateller groove,
where it has a tendency to luxate to the inside,
especially in small young dogs, and that's because a number
of reasons, the groove not being deep enough, the upper
ridge on the medial aspect is too shallow, and because
of the tibial crest how it has a more of
a medial positioning, and therefore, since the patella ligament attaches
from the patella to that tuberocity the top of the
tibel crest, it has a tendency to migrate to the inside,
thus media pateel luxation. Depending on what grade it is,
as we discussed, there four grades, grade one, two, three four.
Grade one leave alone, Grade two early two you probably
can leave alone as well. But if the two becomes
more of a two and a half to a three,
or a three becomes a four, definitely it's a surgical disease.
So the other knee problem that we see quite often
in the larger dog now, media patella luxation is usually
a small dog problem. But we also have a large
breed problem and that is called a cruciate ligament tear
or rupture. Now, in people, it's referred to as the
anterior cruciate or ACL, and just watch a football game
on any Sunday they will be talking about or you
will clearly see an ACL injury in the making. Now
with dogs and just the nomenclature, it still is referred
to as the anterior cruciate, but typically more appropriately we
call it the cranial cruciate ligament as opposed to the
caudal cruciate ligament instead of the anterior posterior. So we
have a CCL. It's called and it's abrupture or tear.
The reason it happens really are very similar to that athlete.
It is a hyper extension injury, or it is an
injury of a very sharp lateral shearing force. It's when
that football player gets blindsided and he's hit on the
outside the lateral aspect of his knee and that can
snap the cruise it, or if he's hit from the front. Now,
as you know, when we bend our knees, we can
bend our leg backwards in relation to the knee when
your leg when you're standing straight, totally straight, you cannot
bend your leg your knee in the opposite direction where
the knee goes behind your ankle.
Speaker 3: So think of it this way.
Speaker 2: It's a sensation that I'm sure all of us has
felt at one time. You're walking along and you're engaged
in thought or in conversation, not really paying attention to
the street or the road ahead of you, and you
don't see that curb. So your brain, we don't think
when we walk, we don't think about our foot placement.
It's natural when we're walking on a flat surface, we're
not even thinking how we're placing our foot.
Speaker 3: So what happens.
Speaker 2: What's that sensation when you don't see that pothole, when
you don't see that curb. So you've put your foot down,
but your brain tells you you are putting it down
at the same level of the last step. So you're
prepared because that's what you're expected to do. But all
of a sudden, that pothole is there, that a hole
in the grass is there, that sprinkler hole, that.
Speaker 3: Curve that you didn't know was coming.
Speaker 2: So you're all of a sudden when you land that
foot a few inches six inches five inches longer deeper
than your brain told you. You hit that ground with
that ow and you feel it a little bit in
the back of your knee, Well, magnify that, and that's
what happens to the cruciate tear. So we see it
frequently in large breeds, especially breeds that are just extremely
well muscled in the thigh. That little cruciate ligament in
relation to the thigh musculature is no match. So when
these dogs pivot, when these dogs are running, they're playing aggressively,
whatever the case may be, that ligament can easily snap.
And what's so interesting is there is such a predisposition
on genetics that we often tell a client that if
this was truly an injury, I mean truly he was
blindsided the same thing, hit a pothole, he pivoted, but
this foot got kind of stuck in the grass. But
the rest of his body. Didn't you just got that sheer,
that twist that can tear that ligament.
Speaker 3: It could be an accident.
Speaker 2: But for dogs where it happens just kind of, it
just happens, and we won't doing anything amazingly difficult or
challenging or having some severe stress on that knee.
Speaker 3: It just pops.
Speaker 2: We tell them that now knowing this, there is a
seventy five percent chance that the other leg is going
to go, and it's going to go for a lot
of reasons. And as a matter of fact, insurance companies
will ensure well, I would say all of them. Many
of the insurance companies will ensure the first injury because
it could have been just that an injury. But if
it happens again, and since we know that about seventy
five percent of dogs that tear a cruciate are gonna
tear the other one because of a genetic predisposition, and
since insurance companies won't typically cover conditions where there is
a genetic predisposition, you got away with the first one,
but they're not going to cover the second one. So
time for that break, time goes so fast. When we
come back, we are going to talk about diagnosis. We're
going to talk about treatment options and there are a
number of them out there, and what happens for the
small dog versus a large dog when they tear their
cruciate ligament, as well as checking out their meniscus in
surgery just like a person. So you're here with doctor
Jeff Werber has to bets with doctor Jeff here in
pet Life Radio.
Speaker 3: And when we come back, I want to hear from you.
Speaker 2: At eight seven seven three eight five eight eight eight
two because I'm sure one of you out there has
had a horror story with your dog's knees. We'll be
back in a minute.
Speaker 1: We'll be right back right after these messages. Stay tuned.
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Speaker 2: And welcome back to pet Live Radio's astbet with Doctor Jeff.
I'm your host, Doctor Jeff Werber, And before the break
we were discussing some of the stifle the knee injuries.
We covered the medial patella luxation last week, and here
we're talking about the cruciated the cruciated ligament very very
common injury, unlike the petilla problem, which, as I said,
with a grade one and early grade two. You probably
can get by with some medical therapy, pain medication, maybe
some acupuncture, some laser treatment. There are a lot of
things that could be done to alleviate the discomfort, the pain.
And since it's a grade one or a grade too,
it doesn't happen very often where the knee pops out
of the groove, So it's okay. Different story with the
cruciate cruciate ligaments. Well, the ligament has thousands and thousands
of fibers, a very poor blood supply. These fibers are
also under some tension, meaning they're kind of like stretch.
A picture this picture here, here's a rubber band. Okay,
if you're watching along time alongside as I'm speaking that
you could see the rubber band. Now, if I were
to cut this rubber band right there in the center
and it's under a little stretch, what's gonna happen to
the two ends? Are they going to stay right there?
Or are they going to fly in their opposing directions?
And there's your answer, They're gonna fly. Now I can
sit here with my under the same tension having cut
this rubber band, and I could sit here for the
next one hundred.
Speaker 3: Years I can't.
Speaker 2: Maybe somebody coder that could pass it on, and these
two ends will never come together. The problem with the
crucia ligament is sim that once those ends are snapped,
they're not coming together. They're not finding each other on
their own. And since the blood supply is so weak,
we typically don't have the same healing response that we
would hope to get just by leaving it alone. So
all a partial tear leaves us with is a weaker ligament.
Speaker 3: So the dog could be fine for now.
Speaker 2: I mean they're going to go through an initial phase
of pain with a tear, and let's.
Speaker 3: Assume it's a partial.
Speaker 2: That means it's not complete, only a fraction let's say
ten percent of the fiber's tour. First thing, we're gonna
we're gonna get some pain when it happens, because there's
going to be some bleeding, and that bleeding is going
to fill up into the joint space and we're going
to see what we call joint effusion. Now, there number
of signs that we look at in making the diagnosis
the determination. Well, first of all, one thing we know
about cruciate injuries, they're not slow progressive. So let's go
back to the arthritis discussion with hip dysplasia. Dogs with
hYP dysplasia rarely show up with an acute onset of lameness,
so regardless of what the X ray shows, we discussed
if the seat of lameness was sudden, and you take
your x rays and you have bad hips, keep looking,
keep looking.
Speaker 3: It wasn't there.
Speaker 2: I would say it wasn't, But more likely not, it's
not the hips, because those hips look just as bad
radiographically a week before, a month before, probably a year before,
or more so, you gotta still look for Okay, why
is this dog suddenly coming up lane?
Speaker 3: Now?
Speaker 2: Cruciate ligament is one of those injuries that they will
suddenly come up lane. Sometimes in bad cases, it will
even be preceded by a pretty aggressive vocalization, a yelp,
a cry, a snap. And if any of you have
ever snapped a muscle, whether it was a gastrocs and achilles,
a severe ankle injury years ago, I actually snapped a
it's a muscle that is part of the gastrocnemius or
the calf group. And when those muscles snap, when that
tendon tears, you feel it and you hear it I
thought somebody threw a golf ball at my calf. It
was a pretty plainful It's called the plan terrace. And
when I talk to a friend of mine, and this
is the difference of talking to a guy who is
a seasoned doctor. He was an orthpeedic surgeon. He didn't
even need to see me. I explained to him exactly
what happened, how it happened.
Speaker 3: He said, you.
Speaker 2: Toria plant teris, and it's a very common injury in
men over thirty five. At the time, I was thirty five.
And everything that he said would happened happened, and it
was fine. And I'm still back to playing ball many
many years later, and it.
Speaker 3: Was not a big deal. But you know, your dog knows.
Speaker 2: When they tear, especially substantially tear the accruciate ligament. So
a couple of signs we look for if it's a
partial tear. Two of the things we are looking for.
One is called an anterior or cranial drawer sign, and
that is without the cruciate ligament by manipulating the knee itself.
And usually what you do is you're gonna hold with
one hand. The doctor's gonna hold the bottom of the
femur and put a thumb sort of right at the
ephemeral condyles, and then the other hand is going to
go up at the top of the tibia, all right,
and you're going to see a movement in between the
two bones, the femur and the tibia, where in a
normal dog they do not have. You'll be able to
take that tibia and thrust it forward, all right. It's
called a drawer signed cranial drawer, because you can move
it cranially. What typically stops that cranial movement is an
intact cruciate ligament, but if you only have a very
partial tear, you may not get a cranial drawer. Likewise,
A tibia thrust more difficult to explain, but it's something
that happens if you put the leg in a certain
position with your finger going from the top of the
femur around the kneecap over to the top of the
tibia where the kneecap inserts, and you push up, You
push up on the heel on the hawk and again
you'll feel that you'll feel your finger moving forward because
of that tibial thrust. Again, if you have enough of
your cruciate it's still intact. That may not happen. So
in order to get the drawer sign of the tibial thrust,
you need at least enough of the ligament torn, but
the effusion will be there. So you take an X ray,
and you always take an X ray both knees, lateral aspect, really,
and you compare them. You will see effusion if you
get some sort of thrust, or you get a cranial
drawer that tells you two things. That tells you, yes,
in fact, enough of the cruciate ligament was torn, and
it also tells you that your poor dog is gonna
need surgery. You can wait as long as you want
for it to heal. It's never going to heal. And
it's one of those diseases. And I think I mentioned this.
I used to work with a board certified surgeon in
my practice, and he was one of the more conservative
surgeons that I'd ever worked with. If there was a
medical way to fix something, he would his surgery. Even
though he was a surgeon. They'd love to do surgery.
He was never one to rush into surgery, but when
it came to cruciate ligament tears, he would kind of chuckle.
When the owner said, well, I.
Speaker 3: Want to try to wait.
Speaker 2: I want to see if he does, because he knew
that sooner or later, I'm going to see this dog
on my surgery table. And because of that, I recommend folks,
it's got to be sooner. Why because the longer you
wait and for nothing to happen, and trust me, nothing
is gonna happen healing wise. That the more muscle atrophy
you're gonna see in that leg, just like we talked
about the grade three and grade four petelo ligaments, and
the more strain they'll be putting on the other leg.
And if that other leg is one of those legs,
if their dog is in that seventy five percent that
there is a genetic predisposition, they're gonna blow the other
leg even before you fix the first leg. So it
is insanity. I'm telling you insanity to wait on a
cruise shit ligament tear. If it's bad enough to cause
a limping, if it's bad enough for your veterinarian to
elicit the drawer sign or tibio thrust and you see
a fusion in the joint, you have but only one choice,
and that is to see your veterinarian, and he or
she may do the surgery. Chances are they will refer
you to a surgeon for a surgery, but it has
to be corrected surgically. You're only doing your pet a disservice. Now,
if this happens in your pet is thirteen, and he's
already a you know, a very large breed dog, and
you said, hey, doc, he's thirteen, leave the poor guy alone.
If sure, if we can eliminate some of the pain,
if we can eliminate some of the inflammation, and there
are things like acupuncture, and there's laser therapy, and there's
non story anti inflammatories, there are things that can be done,
then yes, if we can make them comfortable, then certainly
you don't need to consider surgery. But if you have
that younger, athletic, monstrous dog that is showing signs has
the condition toward the cruise it, you don't want to
wait too long. Get him in for surgery. I have
one client I'm going to end with this, who fought
me and fought me and fought me on his American
bulldog and finally, finally, when the second leg went, he decided,
let's do the surgery. And six weeks or eight weeks
after the first surgery, he was knocking on our door saying, okay, Doc,
I'm ready.
Speaker 3: For the second.
Speaker 2: Why because the surgery works and this dog felt so
much better. So we will get to some different surgical
options when it comes to the cruciate ligament. If not,
next week is remember next week we're having our guest
doctor Heather Lenser is going to be with us. We
get to talk about a few things. We're also I
just put on my list of things to do. And
then the reason so is because it's happened to my
own cat who's going in for treatment this week. I
want to talk about hyper thyroidism in cats again. A
lot of old medicine out there.
Speaker 3: It bothers me. We need to teach you guys.
Speaker 2: A lot about hyperthyroidism, and someone's going to do it,
and that someone's going to be me. So next week
we're back here on pet Life Radios. Asked bets with
doctor Jeff, Join us with my special guest doctor Heather Lenser,
and have a great week once again. Thanks to our
sponsors pro Sens Pet Products con Toys. You know, no one,
no one got their free product today because all of
you are too afraid to give us a call next week,
write this number down eight seven seven three eight five
eight eight eight two and have a great week everybody,
and give your pets a kiss for me.
Speaker 3: We'll see you next week.
Speaker 1: Let's talk bets every week on demand only on petlifradio
dot com.