Abrudean et al., Medicamentul Veterinar / Veterinary Drug
Vol. 10(1) June 2016
72
Gold implant therapy of locomotory disorders in dogs - Case studies
Terapia prin implant cu aur în afecţiuni locomotorii la câine
- Studii de caz
Abrudean E., Hulea C.I., Abrudean M., Cristina R.T. Faculty of Veterinary Medicine Timișoara, Tierarztpraxis Dr. Abrudean, Hockenheim, Germany
Corespondence*: [email protected]
Key words: Gold-implant, musculoskeletal system, canids Cuvinte cheie: Gold-implant, aparat locomotor, canine
Abstract The case study was conducted between October and January 2015, on 7 dogs of different breeds and ages, which at clinical examination showed varying degrees of lameness. The dogs behavior and state of consciousness, their attitude in standing, decubitus and at walk and the presence of involuntary movements was assessed through inspection. Palpation was used to feel muscular tonus, local temperature and sensibility. Postural reactions were highlighted by carrying out forced positions of each limb, thus highlighting the proprioceptive sensitivity. By testing the spinal reflexes the reactions of the forelimbs and hind limbs were evaluated, seeking the state of normality, or the absence, diminution or exacerbation of these reflexes. Also, diagnostic imaging was performed consisting of simple radiographs, were performed for the cases that entered the clinic. In the case of digital X-rays, X-rays are passing through the subject being examined are filtered, then touch a plate of sensors able to convert signals generated into digital information with an image appear on the computer screen. Interpretation of results was done by assessing the degree of dysplasia, and the Norberg-Olson angle and stage. This study used digital radiography as imaging technique; the device was Rx-M EVO Fujifilm. On the basis of diagnostic imaging and computerized image, diagnosis was established for each case. The treatment protocol with gold implant was the same for all seven cases; the adopted procedure was the "Wiener" procedure, described by Kasper and Zohmann. The procedure began with establishing a set of points associated with the treatment of hip dysplasia, spondylosis, arthritis, and osteochondritis. For the therapeutic protocol to be performed correctly took the dogs were sedated. This was done with medetomidine hydrochloride (Dorbene vet, Pfizer, concentration 1 mg⁄ml), administered in a 0,1mg⁄kg body weight dose. The results were visible after a month from the implant, four of the seven animals recovered completely and three partially. In conclusion gold implant is a method of treatment with verified efficacy in hip dysplasia, spondylosis, arthritis, osteochondritis dissecans and joint disorders. The method can be considered safe; it does not endanger the patient's life, being recommended by an increasing number of specialists. The disadvantage of this method is that some patients may feel, for a period that extends to 2 weeks post implant, discomfort in the body due to the application of the method. Another disadvantage is the cost, being an expensive method treatment.
Rezumat Studiul de caz fost realizat în perioada octombrie-ianuarie 2015, pe 7 canine de rase și vîrste diferite, care la examinarea clinică au prezentat diverse grade ale schiopăturii. Prin inspecţie s-a urmărit: comportamentul şi starea de conştienţă a animalului, atitudinile în staţiune, în decubit şi în mers, prezenţa mişcărilor involuntare. Rolul palpaţiei a fost de a observa: tonusul muscular, temperatura locală, dar şi a sensibilităţii. Reacţiile posturale au fost evidenţiate prin imprimarea poziţiilor forţate a fiecărui membru, evidenţiindu-se astfel sensibilitatea proprioceptivă. În cadrul reflexelor medulare s-au evaluat reflexele membrelor anterioare dar şi posterioare, urmărindu-se starea de normalitate, absenţa sau diminuarea reflexelor, precum şi exacerbarea acestora. De asemenea, la cazurile intrate în clinică s-a realizat diagnosticul imagistic care a constat în efectuarea radiografiilor simple. În cazul radiografiilor digitale, razele X ce trec prin subiectul examinat sunt filtrate, apoi ating o placă de senzori capabilă să convertească semnalele generate în informaţie digitală, cu apariţia unei imagini pe ecranul computerului. Interpretarea rezultatelor s-a efectuat prin aprecierea gradului de displazie, a stadiului şi al unghiului Norberg Olson. Prezentul studiu a utilizat ca tehnică imagistică radiografia digitală folosind aparatul Rx EVO-F Fujifilm. Pe baza diagnosticului imagistic şi a imaginii computerizate s-a stabilit şi diagnosticul pentru fiecare caz.
Abrudean et al., Medicamentul Veterinar / Veterinary Drug
Vol. 10(1) June 2016
73
Protocolul de tratament prin implant cu aur a fost acelaşi pentru toate cele şapte cazuri fiind adoptată procedura „Wiener” descrisă de către Kasper şi Zohmann. Procedura a debutat cu stabilirea unui set de puncte, care sunt asociate cu tratamentul de displazie de şold, spondiloză, artrite, osteocondrite. Pentru ca protocolul terapeutic să poată fi efectuat corect a fost nevoie de sedarea animalelor. Aceasta s-a realizat cu medetomidină hidroclorică (Dorbene vet, Pfizer, concentraţia 1 mg ⁄ ml), administrată în doză de 0,1mg ⁄ kgcorp. Rezultatele au fost vizibile după o lună de zile de la implant, din cele șapte animale patru fiind recuperate total și trei partial. În concluzie Implantul cu aur este o metodă de tratament cu eficacitate verificată în displazia de şold, spondiloză, artrită, osteocondrită disecantă, afecţiuni articulare. Metoda poate fi considerată sigură, ea nu pune în pericol viaţa pacientului implantat fiind recomandată de tot mai mulţi specialişti din domeniu. Dezavantajul metodei constă în faptul că unii pacienţi pot simţi, pe o durată care se extinde la 2 săptămâni postimplant, un disconfort în organism ca urmare a aplicării metodei. Un alt dezavantaj îl reprezintă costul, fiind o metodă scumpă de tratament.
The study objective
Gold implant therapy is a technique already
known in the West but yet no very familiar in
Romania (1-7). The recorded favourable results
prompted our interest for this promising non-
invasive technique especially for degenerative
and / or traumatic locomotory disorders.
Materials and methods
The study was conducted between October
and January 2015, Tierarztpraxis Dr. Abrudean
clinic in Hockenheim, Germany. The case study
was performed on seven dogs as follows:
Case 1 - German shepherd breed dog, 4
years old, female, 35 kg, which was brought by
the owner for investigation, because it
presented a locomotory problem. The first
investigations revealed that the animal was
playing with another dog and since then shows
lameness.
Case 2 – Labrador breed dog, 7 years old,
male, 38 kg, which was brought by the owner
for investigation, because it showed a
proprioceptive deficit at the right pelvic limb and
degree I lameness.
Case 3 – half breed dog, one year old,
male, 22 kg, which was brought by the owner
for investigation, because it was lame on the
pelvic limbs and during movement had a walk in
"X".
Case 4 - dog, Golden retriever, 6 years old,
39 kg, male, was brought by the owner for
investigation, because he was lame on the hind
legs and presented sings of pain in the
lumbosacral region.
Case 5 – dog, Golden retriever, 9 years
old, 50 kg, male, was brought by the owner for
investigation, because he was lame on the hind
legs and presented sings of pain in the
lumbosacral region.
Case 6 – dog, Mastiff, 1.5 years old, 17 kg,
male, was brought by the owner for
investigation, because he was lame on the
thoracic limbs.
Case 7 – dog, Dachshund, 9 years old, 8
kg, male, was brought by the owner for
investigation, because he was lame on the left
thoracic limb. After medical history, clinical
examination of the patient, taking into account
all the symptoms and behavior by known
methods, was conducted:
Clinical examination
Clinical evaluation was based on classical
semiological methods: inspection, palpation,
observation of spinal reflexes and postural
reactions.
By inspection we followed:
• the animal behavior and state of
consciousness,
• the animals attitude in standing position,
decubitus and walk,
• the presence of involuntary movements.
The role of palpation was to observe:
muscular tonus, local temperature and
sensibility.
Postural reactions were highlighted by
carrying out forced positions of each limb, thus
pointing out the proprioceptive sensitivity.
Medullary reflexes were evaluated for
forelimbs and hind limbs, pursuing the state of
normality, absence or diminution of reflexes, as
well as their exacerbation.
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Vol. 10(1) June 2016
74
Case 1 It was observed that this animal is lame,
maintaining an abnormal position of the
hindquarters characterized by a forced position
both in standing and walking. Palpation of the
affected limb, showed a pain reaction and
retraction of the affected limb (Fig. 1).
Palpation of the knee joint, the dog
experienced pain and mobility much too high
than normal.
Figure 1. The dog before treatment
Case 2. First degree lameness was confirmed, with
pain in the right pelvic limb, and a severe
proprioceptive deficiency (Fig. 2).
Figure 2. The dog before treatment
Case 3. Second degree lameness was confirmed,
severe hip pain on palpation, and position in "X"
of limbs during movement (Fig. 3).
Figure 3. The dog before treatment
Case 4. Lameness was confirmed, with pain on
palpation in the lumbosacral region, with little
difficulty during movement (Fig. 4).
Figure 4. The dog before treatment
Case 5. Lameness was confirmed with pain on
palpation of hip joint (Fig. 5).
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Figure 5. The dog before treatment
Case 6. Lameness on the right forelimb was
confirmed along with pain in the lombo-sacral
region and a discomfort at walk (Fig. 6).
Figure 6. The dog before treatment
Case 7. In this case the lameness of the right
forelimb was also confirmed, and pain on
palpating the shoulder articulation with a slight
discomfort at walk (Fig. 7).
Figure 7. The dog before treatment
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Radiographic examination
Diagnostic imaging was performed for all
cases that entered the clinic, and It consisted of
making simple radiographs. Table 1 includes
the degrees of dysplasia and the stage of
Norberg angle.
Table 1 Hip dysplasia classification
Dysplasia degree
Stage / Norberg angle
There are no signs of
dysplasia
Normal aspect, stage A: A1 - excellent, A2 - good, (angle over 105º)
Grade I
Almost normal aspect, stage l B: B1 - good enough, B2 - limit, (angle around 105º)
Grade II Mild dysplasia, stage C: Angle around 100º
Grade III Moderate dysplasia, stage D: Angle slightly above 90º
Grade IV Severe dysplasia stage E: Angle below 90º
Interpretation of results was done by
assessing the degree of dysplasia, and the
Norberg Olson angle and stage.
This study used the digital radiographic
imaging technique using the Rx EVO-F Fujifilm
radiograph.
Based on diagnostic imaging and
computerized image we established the
diagnosis for each case:
Case 1. – The radiographic examination
revealed stage C hip dysplasia (Fig. 8).
Figure 8. Hip dysplasia stage C
Case 2. - The radiographic examination
revealed stage B hip dysplasia (Fig. 9).
Figure 9. Hip dysplasia stage B
Case 3. The radiographic examination
revealed stage B hip dysplasia.
Case 4. The radiographic examination did
not reveal any pathology that could give a
certain imagistic diagnose.
Case 5. The radiographic examination
revealed stage B hip dysplasia
Case 6. - The radiographic examination did
not reveal any pathology that could give a
certain imagistic diagnose.
Case 7. The radiographic examination did
not reveal any pathology that could give a
certain imagistic diagnose.
The therapeutic protocol
The treatment protocol with gold implant
was the same for all seven cases, the adopted
procedure was the "Wiener" procedure,
described by Kasper and Zohmann in 2007 (6).
The procedure began with the establishing
of a set of acupuncture points, that are
associated with the treatment of hip dysplasia,
spondylosis, arthritis, osteochondritis.
In order for this treatment protocol to be
performed correctly sedation was needed. This
was done with medetomidine hydrochloride
(Dorbene vet, Pfizer, concentration 1 mg ⁄ ml),
administered at a dose of 0.1 mg/kg body
weight (Fig. 10).
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Figure 10. The anesthetic used in this protocol
The materials used to perform the technique consisted of: sterile syringes with mandrel, 2-4 mm implants of 24-karat pure gold, anatomical forceps and antibiotic ointment (Fig. 11).
Figure 11. The materials used in this protocol
In the presented cases the following
acupuncture points were approached, they are
presented in Table 2 Table 2
The main regions and points to implant (after Kasper and Zohman) (6).
Region Points
Hip joint GB 29; 29,5; 30; 31; BL 54; LE 03
Knee joint MA 35; 36; GB 34 Hock joint BL 60
spine – right side BL 50; 51; 52; 52-1; 52-2; 52-3; 52-4
spine left side BL 21; 22; 23; 24; 25; 26; 26-1; 26-2
Elbow joint – lateral face
DI 10; 11; 3E-08; 3E-10
Elbow joint – medial face
HE-03; PC-03
remote points of elbow
DU 09; DI 04; MA 36; GB 34
All seven cases were treated similarly, in
the following images the implant points will be
presented for each region and animal:
Hip region (Fig. 12)
Figure 12. The dog during the treatment and the
points for hip joint
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Vol. 10(1) June 2016
78
Knee region (Fig. 13)
Figure 13. The dog during the treatment and the
points for the knee joint
Hock region (Fig. 14)
Figure 14. The dog during the treatment and the
point for the hock
Spinal region (Fig. 15)
Figure 15. The dog during the treatment and the
points for spinal region
Elbow region (Fig. 16)
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Vol. 10(1) June 2016
79
Figure 16. The dog during the treatment and the lateral (right) and medial (left) points for the elbow
Results and discussions
The results were visible after a month post
gold implantation:
Case 1. After gold implantation treatment
the animal was recovered only partially, given
the stage C of dysplasia, a carprofen based
anti-inflammatory was prescribed for 2 weeks,
with chondroitin supplementation for a month
and a rest period of two months. Case 2. After gold implantation treatment
the animal was recovered only partially.
Proprioceptive deficit disappeared, maintaining
only a slight lameness. It was prescribed a
treatment with nutritional supplements based on
chondroitin and rest at home for a period of two
months. Case 3. After the treatment the animal was
fully recovered, has received only a diet based
on nutritive substances and rest for another
month at home. Case 4. Following treatment with gold
implant, the animal was fully recovered, the only
recommendation was a rest period of one
month at home. Case 5. After the treatment the animal
was recovered only partially, not showing
lameness, it received a diet based on nutritive
substances, NSAIDs for a period of seven
days, for the pain in the lumbar region and
another month of rest days at home. Case 6. Following implant therapy, the
animal was fully recovered; it was no need for
prescribing drugs. Because it is an energetic
breed, the only recommendation was a month
of rest.
Case 7. Following implant therapy, the
animal was fully recovered; it was no need for
prescribing drugs.
Conclusion
1. Gold implant is an effective method of
treatment tested in hip dysplasia,
spondylosis, arthritis, osteochondritis
dissecans and joint disorders. 2. The method is considered safe, it does not
endanger the patient's life, being
recommended by an increasing number of
specialists 3. The disadvantage of this method is that
some patients may feel, for a period that
extends to 2 weeks post implant,
discomfort in the body as a result of the
treatment method. Another disadvantage is
the cost, being an expensive treatment
method.
References
1. Demann E.T., Stein P.S., Haubenreich J.E. (2005) – Gold as an implant in medicine and dentistry. J. Long Term Eff Med Implants 15(6):687-98.
2. Durkes T. E. (1992) – Gold bead implants Prob Vet Med; 4(1):207-211.
3. Graeme S.A. (2007) – Radiographic signs of joint disease in dogs and cats. In: Textbook of veterinary diagnostic radiology, (ed. Thrall DE). Ed. Saunders Elsevier, Philadelphia, USA, pp. 317- 358.
4. Hielm-Bjorkman A., Raekallio M., Kuusela E., Saarto E., Markkola A., Tulamo R. (2001) – Double-blind evaluation of implants of gold wire at acupuncture points in the dog as a treatment for osteoarthritis induced by hip dysplasia. Vet. Rec. 149, 452-456.
5. Hulea C.I. (2014) - Investigaţii asupra afecţiunii coloanei şi membrelor la câine - Terapia prin acupunctură uscată și implant cu aur. Referatul nr. 3 în cadrul pregătirii doctoratului, USAMVB - FMV Timișoara.
6. Kasper M., Zohman A. (2011) – Ganzheitliche Schmerztherapie fur Hund und Katze, Ed. Sonntag Verlag, Stuttgart, DE.
7. Klitsgaard J. (1996) – Gold implants, practical experiences with 400 hip dysplasia cases in the dog. Presented at Course held at Lake Thun, Spiez, Switzerland.
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