Prolo therapy

[juliepoudrier]

Does anyone here have any experience with this? My vet is really pushing it and I'm not sure I'm comfortable with the idea. (For those who don't know, the principle--simplistically explained here--behind it is to inject an irritant in an area around an orthopedic instability under the belief that the irritant will stimulate the body to produce more stabilizing materials in that area.) Thanks.

 

Julie

[Shetlander]

My previous vet recommended it for my Lhasa and I wasn't comfortable with it either. I talked about it with my chiropractic vet and he looked about as thrilled as I was feeling, which didn't inspire confidence. Anyway, I decided against it since my dog's quality of life seems fine. If I was going to do a treatment, I think I'd more inclined to go with surgery, to be honest.

 

Please keep in mind that my research on the subject was pretty minimal before I decided to leave things as they were.

[stockdogranch]

Julie--I've not heard of it. Can you elaborate? For what kinds of injuries. etc? I'm just really curious...

 

A

[juliepoudrier]

Anna,

It seems it's used for orthopedic issues. The idea being that if there is instability in a structure, the irritant nature of the prolo therapy will cause the body to produce more cartilage-like material around the area of the instability (where the prolo has been injected) and help stabilize that area. The quick bit of research I did seemed to show use mainly for back pain type stuff. What worries me is if you're injecting an irritant near the spine, what is it doing to the nerves there?

 

Backstory: Twist has been favoring a hind foot for about a month (at least that's been obvious--in hind sight, I can say it might have been going on a bit longer). Sometimes she's three legged lame. When she's just standing around, you can see that she doesn't put full weight on that leg. When the vet was out for a farm call, he checked her and said he didn't think it was her ACL. I took her in yesterday to be X-rayed. Radiographs showed perfect hips and knees (this is one of those cases where you wish they would find something wrong), but as is often the case showed one three-vertebrae section of her spine to be developing spondylosis (which might be consistent with an injury resulting from a hit, for example). The vet said that the bony spurs (there would be some on the dorsal side of the bottom part of the vertebrae that wouldn't be seen on X-ray) could be pinching a nerve trunk and causing leg pain. He felt that if we used prolo therapy, we might be able to stabilize her spine more and then see if that helped the apparent leg pain.

 

I did let him do the first injections, with some reservations. I just don't like the idea of putting stuff that close to (or in) the spine like that. Not with Twist. The vet thought that if her spine were the problem, then we'd see immediate improvement just from the fact that one of the ingredients in the prolo solution is lidocaine. So if she seemed significantly better within a few hours of the treatment, we could assume that the anesthetic effect of the lidocaine was relieving the pain and thus the back was the source of her problem. The only issue with that was that she was sedated for the X-rays, and it took a while to wear off, so it was difficult to judge if the lidocaine had any pain-relieving effect for her leg. About four hours later, it looked to me as if she was still standing light on that leg, but by now that could be a "learned" behavior too (since even despite whatever pain is going on, she can run full tilt down to the creek or even run around the pasture gathering sheep--though the longer you work her the more uncomfortable/slower she gets). He also injected the knee of the lame leg, which I also wondered about given he couldn't get a drawer sign under sedation and the radiographs showed no arthritic changes characteristic of instability in that joint.

 

So yesterday evening I e-mailed my former holistic/rehab vet to ask her opinion on prolo. She had the same reservations I did (and Liz did).

 

I sent Twist home with Laura since I'm going out of town this weekend and she needs strict supervision (i.e., leash walked) outside. When I get back, unless Laura says she's seen tremendous improvement, I may go ahead and put her on doxy to cover TBDs, although I always understood the lameness associated with TBDs to travel from limb to limb rather than stay in one place.

 

Anyway, this is Twist and something's not right, but whatever it is isn't obvious. I like the vet practice I go to, but this particular vet is very gung ho about prolo. The other option we had was to put her on NSAIDs. The only advantage to prolo over NSAIDs in my mind is that the former doesn't mask pain, so if it's not working it will be obvious.

 

I still am having a hard time seeing how what I consider small bone spurs in her mid-back could cause lameness in the hind leg. We discoverd spondylosis in Boy at about this same age (also when X-raying for something else) and it was much more extensive and advanced than this. Now at 13, he's slightly lame in front and can't bend well, which makes sense if the spurs have fused, but he never had the kind of lameness Twist has now.

 

I am thinking of just scraping together the gas money and taking her back to Regina (the vet mentioned above). She worked miracles with Jill and I trust her a bunch. She's just several hours away. But I do have a friend nearby, so if I can get an appointment on a Monday or Friday, I can stay over and maybe get some dogowrk in too.

 

The problem is, this is Twist and I don't know what I'd do if treatments went wrong or something happened to her.

 

J.

[kelpiegirl]

Sometimes there are incidental findings on radiographs. I would see about a myelogram if you are interested in getting the bottom of this. In addition, I would get an mri and ct scan done. Being off kilter for such a long time can wreck havoc with the rest of the body. She isn't painful ANYWHERE on her leg? Minimally, get her to a GOOD orthopedist, and make clear that you want this diagnosed and treated. Kevin Howell, who is coming to the US this month, has a dog named Digger. Digger just won the Kelpie nationals last year for the third time I believe at 12 or 13. I bring him up, because as a younger dog, he suddenly became very ill. Here's the story from their website:

 

"in Dec 1998 Digger came down with a serious stomach infection caused from swallowing a grass seed. After vet treatment he recovered, then 10 days later he came down with Tetanus, caused by spores entering the blood stream via the stomach infection, With further vet treatment he recovered from Tetanus. Then 2 weeks later Digger started to drag his right hind leg as if he had no control over it. Back to the vet & he felt sure Digger had popped a disc in his back. So for the next 4 months he treated him with pain killers, acupuncture,&anti inflamatories,none of these had any real benefit, He was still in serious pain, he couldn't lower his head, he had to be fed at chest height. After seeing him suffer for 4 months I decided that I was only keeping him alive for me not for him, so Kay was going to Orange & I asked her to take Digger with her & have him put down so he would no longer be in pain. But between Kay & the vet they decided to give him one more go, so the vet did an x-ray for the first time & discovered there was no disc between 2 vertebra & that there were bone spurs growing from each vertebra The vet then sent these results to a specialist in Sydney along with Diggers previous illness record. The specialist decided that it was all related & went back to the seed infestation. He suggested locking Digger in a small cage & treat him with pain killers etc, & he believed that natural fusion of the 2 vertebra would take place, The vet kept Digger at his surgery for 4 weeks treating him every day & one Sunday morning when we rang to ask how he was going he said we could come & take him home. He was pain free but was still very weak in the hind quarters. When we asked the vet what we owed him he replied NO CHARGE that was my little experiment. He said Digger would never be an athlete again but he might be able to stand at the back of the yards & bark a bit. Over the next 3 months Digger showed great improvement & gradually gained strength in his hind quarters. Then 9 months after his illness struck he was ready to trial again."

 

This demonstrates that sometimes it is hard to get to the bottom of things, but with the right vet/diagnostics, you should be able to be in good stead.

[Guest blastoff]

I have had experience with Prolotherapy though it wasn't used in the spine. It was used in the wrist joint of one of my dogs to help heal an injured ligament. One 'dose' actually did the trick for my dog. I also supplemented with an herbal joint remedy.

[Mona Howard]

Julie,

This probably isn't Twist's problem but it's worth checking out.

When Cap was about 5 yrs. old he would sometimes carry a rear leg

when he ran. Sometimes favor it just a bit. I had everything looked

at. Finally we discovered he had injured a ligament in one toe.

Apparently it's really painful. He wasn't allowed to run or jump for

three months and never had the problem again. The trouble was he

would just keep flaring it up and it would never really heal. Worth a

check when nothing else comes up. Mona

[mbernard2424]

Have you considered acupuncture? It seems that would have a similar affect without the potential side effects of Prolotherapy. Interesting that prolotherapy web site (http://www.prolotherapy.com/prolodefine.htm) says that dextrose is injected, yet the solution your vet used included lidocaine.

[airbear]

Somewhat of a tangent - has anyone looked into stem cell treatment? I've been thinking about it for one of my guys who has a bit of arthritis in one hip. Our vet has heard some very good things about it, but he cautions me that it's in its very early stages. Also, the stem cells can't be shipped over the border, so we'd have to hop down to the States for the harvesting and injection.

 

Sorry for the highjack!

[jvw]

One of the vets I see told me she sometimes comes across spodylosis in dogs doing routine xrays for other things and the dogs never show any symptoms from it. So, that could be the case here and the lameness is from something else all together.

 

One of my dogs was lame on and off for two months. One day totally fine. The next three legged. We had xrays done on the foot and they *thought* they might *see* something out of place but it could just be artifact.

 

Well I began doing hot compresses on the foot three times a day. The morning of the fourth day I awoke to find an inch long buck thorn coming out of the foot!! Yay! Apparently they have spines on the thorns that allow it to migrate through tissue. So it had been moving about in his foot. That was why sometimes he was lame and sometimes seemed fine.

 

Probably not the issue here but I thought it might be worth mentioning.

 

Jennifer

[mbernard2424]

Well I began doing hot compresses on the foot three times a day. The morning of the fourth day I awoke to find an inch long buck thorn coming out of the foot!! Yay! Apparently they have spines on the thorns that allow it to migrate through tissue. So it had been moving about in his foot. That was why sometimes he was lame and sometimes seemed fine.

 

Probably not the issue here but I thought it might be worth mentioning.

 

Jennifer

 

WOW that is amazing!!! Goes to show the power of good, old fashioned healing! Thanks for sharing.

[stockdogranch]

Geez, Julie! I know how you feel--I know that Twist is for you like Riddle is for me. The prolo sounds a bit scary to me, too. I think I would be looking at acupuncture. Years ago, my ex had a female BC who, at 7, came up suddenly packing a hind leg. Regular vet said rest for 2 weeks--no change. Xrays showed a little bit of DJD in that hip, but nothing to cause sudden onset, or to make her THAT lame. Specialist wanted to do a hip replacement. I took her for acupuncture, once a week for 6 weeks, and slowly but surely she was using that leg more. After about 8 weeks, she was sound. Totally sound. We then just followed up every 6 weeks or so to maintain. We never knew what it was, and I don't really understand how it works, but it did.

 

Please keep us all updated, and my thoughts are really with you and Twist,

 

A

[Lenajo]

I've known several dogs who had prolo therapy dextrose/lidocaine- knees, back, and hip injuries. Very successful procedure, vastly preferable to the surgical alternatives.

[C Crocker]

Somewhat of a tangent - has anyone looked into stem cell treatment? I've been thinking about it for one of my guys who has a bit of arthritis in one hip. Our vet has heard some very good things about it, but he cautions me that it's in its very early stages. Also, the stem cells can't be shipped over the border, so we'd have to hop down to the States for the harvesting and injection.

 

Sorry for the highjack!

 

 

I only know of it's use in horses. It has been used for at least 5 years I would guess, but not sure on that. Both the horses I know of had tendon problems and the stem cell helped both of them, according to their owners. The source was different on both hores, but on both it was harvested from the horse it was used on.

 

Carolyn

[2 Devils]

ACL problems do not show up on xray unless arthritis has set in. What test was done to test the ACL? Was it the drawer where they basically put hands above the knee and below and check for how much movement there is? This test is somewhat accurate but many vets don't actually do it correctly. My acd tore her first acl about 8 years ago but it was only a slight tear according the ortho vet. Our regular vets thought it was fine. About a year later she hurt the other knee and the vets said it was torn but ortho vet said it was stretched significantly. We rested her for 4 weeks and then started swim therapy. It was years before she fully blew out the acl in the one knee and unfortunately about 2 years later she blew the other one. One vet kept saying a toe was out on Foster and would adjust and she would be perfect again and then it would start again... this went on for a couple years before the knee blew out fully. ACL injuries can do all kinds of freaky things. With the other knee the vets did not think the knee was the problem at first, just some arthritis. Our holoistic vet said she thought it was the meniscus was torn. A torn meniscus can and many times does tear before the acl goes... Unfortunately, on again and off again lameness is a classic sign on ACL problems.

 

I would say either find a way to go see Regina or find an ortho vet if your vet that already checked is not one.

 

Basically, I am suggesting have the knee rechecked by an ortho vet.

 

Other options are toe issues, a sprain of ankle/knee, twisted something, etc... I really HATE when the vets aren't really sure what to do or what the actual problem is and then want to try this and that, etc...

 

I feel your pain unfortunately... my acd has what we call million dollar knees. At least she won't blow out her knees again since she had TPLO on both in the last 2.5 years.

[trailrider]

Prolotherapy injuections will stimulate the ligament/tendon to grow back into a very strong structure. when they are weakened or damaged. I have had prolotherapy on my knee and back, and refered several friends with long time problems. We all had great improvement. I`m sure it is a good therapy for temdons and ligaments in dogs.

[Rave]

An agility friend had it done on her and her dog and was very impressed with the results, and recommended it.

[workindogs]

Julie

At 7 1/2 yrs, Rye has spondylosis between L5 & L6.....he was a bit off most of last year, finally I couldn't ignore that something was wrong...we caught the spondylosis in a broad sweep xray looking for "anything". He was just "off"....no specific favoring or leg pain. I have taken him to acunpuncture, had chiropractic adjustment and use NSAIDS, as needed. He was a changed dog with the acunpuncture with minimal reliance on NSAIDS...Metacam (only as needed...not regular). I wish you luck in finding relief for Twist. I definitely felt Rye's mortality...it was scary! I mean, this is Rye! I still worry quite alot...especially since he has a "super hero" mentality and will not save himself in his work....all out, all the time.

[juliepoudrier]

Thanks everyone for the comments. Sorry for the slow response from me--I was away at the MD Sheep and Wool Festival this weekend. Unfortunately, y'all didn't give me a simple answer, darn it!

 

There was a vet acupuncturist at the practice I use, but he just left. My neighbors have a "sports vet" they use in Greensboro that I might try for a second opinion. I'd love to go to Regina, but getting scheduled is very difficult now and I think if I'm going to get a second opinion it needs to be sooner rather than later, or at least before the next schedule injection....

 

Kim,

The vet tried to do the drawer test when he was out here on a farm call the week before, but of course she was too tense to allow him to manipulate her knee. For the office visit she was sedated and he looked for a drawer sign again (in fact, he tried several times and spent a lot of time manipulating that leg and foot while examining the knee), but said she was quite stable in that knee. The X-rays were to look for specific orthopedic injuries in her hips and knees that might be causing the lameness. There was no evidence of injury or arthiritis in her hips or knees, just the incidental spondylosis finding. In fact, we went ahead and took additional spinal X-rays because he said if the spondylosis spanned more than three vertebrae (i.e., if the spurs were also present in the thoracic and cervical vertebrae), then prolo therapy probably wasn't going to be useful.

 

I didn't think to suggest that we look at her toes while we were X-raying every other part of her body, although as I said he did manipulate her foot while checking the ligaments in the knee.

 

Laura has had Twist while I've been away and reports that she has not appeared lame, nor does she appear to be standing "light" on that leg, which she had obviously been doing here. Laura has kept her on very strictly limited activity.

 

I worry about taking a shotgun approach because if she gets better I'll have no idea what helped. The idea behind not giving her NSAIDs at this point is that without their pain-masking effect, we'd more easily be able to tell if the other therapy was working.

 

Right at this moment, I'm considering going ahead and continuing with the prolotherapy in her back only (he also injected her knee, but I wonder if it makes sense to continue with that given that she doesn't *appear* to have a problem there--that is, it doesn't really make sense to me to treat that joint when there is no apparent degenerative or acute changes there).

 

Trailrider,

I did have a long talk with Dr. Redding about how prolotherapy worked. My understanding is that the goal with using it on her spine was to strengthen the dorsal side of the spine through the production of new connective tissue, which would in essence give more "lift" and stability from the top, thereby helping to relieve pressure that might be placed on the spinal cord or nerve trunks from the bone spurs on the ventral side. Basically adding more support to the top of the suspension bridge to relieve downward pressure on the lower side. It makes sense in theory--I just wondered about how theory matched reality. And I get really nervous when someone starts sticking a needle and injecting stuff in the spine....

 

Michelle and Wendy,

I asked what was in the mix--it includes dextrose and lidocaine and I think a third thing that I don't remember. I don't know if the lidocaine is used exclusively for its local anesthetic effect because of the location of the injections (i.e, ,joints) or if it also contributes to the irritant effect that prolotherapy is supposed to produce (although I'm guessing also the latter since I can't imagine that dextrose would be terribly irritating).

 

By the way, she is also on Adequan.

 

I guess I should look on the positive side and see this as an excellent opportunity for the young dogs to take over some of the chore work that I rely on Twist for, but boy that's hard given that we've been a team for so long that she just reads my mind and knows what I want, which makes for very stress-free work. But I guess I need to accept the fact that she won't be here forever (doG help me) and I better get the youngsters up to some level of competency....

 

I'll update everyone once I've got Twist back and can see how nearly a week of strict rest has affected her (it sounds like she's doing quite well, although then I'll wonder if she would be doing just as well with just the strict rest and no prolotherapy) and see if I can get an appointment with Regina before the next prolotherapy treatment. Regina did acupuncture on Boy and had great results, so I'd certainly be willing for her to try it on Twist as well.

 

Thanks!

 

Julie

[stockdogranch]

Thanks for the update, Julie. Last spring, Riddle had a soft tissue shoulder injury, and I had to lay her up for 6 weeks! She has always been my #1 helper, and it forced me to rely on the other dogs. Tikkle rose to the occasion quite nicely. So you just might be surprised to find you have another one who is damned near as good!

 

A

[trailrider]

""It makes sense in theory--I just wondered about how theory matched reality. And I get really nervous when someone starts sticking a needle and injecting stuff in the spine....""

 

 

The injections are not into anything but connective tissue - tendons and ligaments, etc. The spinal nerves should not be involved at all. I have seen many people obtain great improvement by balancing the connective tissue strengths. The body treats the "irritation" by growing new tissue - up to 70% - which will give stability to the weak area. The secret is the injected sugars do NOT cause scar tissue, but a regrowth of the natural suitable tissue. I think the risk is about zero. Good luck.

[juliepoudrier]

If I understand you correctly, the irritants can't affect the nervous tissue? That's my main concern. I imagine some of the success depends on the skill of the person who's administering the injections, but I did note that my vet used a very small guage needle and perhaps that was to reduce any chance of "overflow" into other tissues.

 

At any rate, after the responses here and talking to a number of people who have had the procedure done, I'm going to continue with it and see how it goes.

 

J.

[2 Devils]

Julie,

 

How did Twist come through the prolotherapy? Someone on another list is asking about prolotherapy. I am hoping all is well.

[juliepoudrier]

Hey Kim,

She hasn't been lame since the therapy, but since I also put her on strict crate rest at the same time, I can't say for sure whether it was the prolo, the crate rest, or a combination of the two that fixed her up.

 

That said, we also used the therapy on my older dog Willow, who had a partial cruciate tear and it really did seem to help stabilize her knee. (So obviously I had enough faith in it to try it with a second dog--in fact, since Willow has since damaged her good knee I may talk to the vet about doing prolo therapy on that side as well.)

 

J.

[2 Devils]

Thanks for the update