Another vet trying to rake in the $$$$$$$$$ - Page 2

As I teach quantitative decision making (including medical) and have cancer personally, I have become acutely aware of statistical deficiencies in the medical community.  See the abstract of the paper cited by susanandthek9s:

OBJECTIVES: To evaluate the efficacy of juvenile pubic symphysiodesis (JPS) in a clinical setting for the early treatment of canine hip dysplasia (CHD), and to identify its indications and contraindications. METHODS: The final degree of CHD using the FCI (Fédération Cynologique Internationale) CHD classification in 5 Grades (A, B, C, D, E) was assessed at skeletal maturity in two homogeneous groups of dogs assessed at the age of 14 to 22 weeks and selected according to their susceptibility to CHD; one group was treated with JPS and one group was conservatively managed. Two hundred seventeen puppies completed the study; 81 were treated with JPS (group 1) and 76 were conservatively managed (group 2). A third group of 60 puppies with normal hips was followed as a negative control group. RESULTS: In group 1, 43.2% of the puppies had regression or a lack of progression of the disease in the final evaluation (Grade A & B), 25.9% had mild CHD (Grade C) and 30.9% had moderate and severe CHD (Grade D & E). In group 2, 23.6% of the puppies did not show any development of the disease (Grade A & B), 21.1% had mild CHD (Grade C) and 55.3% developed moderate to severe CHD (Grade D & E). Further investigation was done by comparing the severity of early signs of susceptibility to CHD with the final FCI Grades at adulthood in both groups. CLINICAL SIGNIFICANCE: The JPS procedure increased the odds of arresting or limiting the progression of CHD in mild to moderate grades of CHD, while it was less effective or ineffective in more severe forms.

Note that this surgery was "less effective or ineffective in more severe forms" but is supposed to be helpful in "mild to moderate" cases.  (It goes without saying that one would not consider this procedure if the pup was in a category indicating no or little dysplasia.)  So the usefulness of the procedure is apparently for pups who have the "early signs" of susceptibility to "mild to moderate" CHD.

But what are those signs?  The pup itself is presumably not showing conclusive signs at 14-22 weeks (the age of the puppies used in the study) -- and if it was showing signs, they would be predictive of SEVERE CHD (thus NOT a candidate).  The abstract implies there is a classification system but it seems very unlikely that palpation or xrays could say anything statistically predictive at this age.  So the predictive model is based on what?  Breed, hip ratings of parents, siblings of prior breedings?  We all know that no such model exists -- or good breeders would have discovered it and put it to use by now.

This implies that if they got this right, the procedure might as well be applied to all puppies.  In fact, they don't report the degree of CHD in their so-called normal control group, so we have to be suspicious of the results.  The procedure did apparently reduce the rate of moderate to severe CHD from 55% to 30% (who are these unfortunate dogs -- does this compare with your experience?  Are half your puppies dysplastic at maturity?)

But again: we have no good predictive model to sort puppies into the low risk (no procedure), risk of severe (no procedure), and risk of moderate (do the procedure).  If you can't sort them out, do you just do it for all breeds with CHD?  Do you just do it fo

Sounds like that vet needs to be reported to the AVMA.

Actually I do remember one pup having the procedure.   She was having signs of hip dysplasia at about 5 or 6 months old.  Had her hips xrayed and she did have bad hips at that point.  This was a Briard, I believe and did quite well with the procedure.

Would need to know why exactly the vet thought this first thing with a 14 week old puppy!

Penn Hip can done to assess the pup's risk of hip dysplasia, although the accuracy of this is open to question.

I'd definitely report a vet recommending unnecessary procedures both to AVMA and to my local business bureau.

In true pedigree db fashion, however, this looks like another case of a poster screaming about an issue before knowing all the facts, or even any of the facts .  They get a phone call and before even calling the vet in question, it's off to the PDB to post a bash.  And it is a bash - it's not like you came on here and said, "I heard the craziest thing today - anyone ever hear of such a procedure?" 

Thanks to those who weighed in with thoughtful discussion, both pro and con.

dogshome9, what are the hip ratings on this puppy's parents? 

Def. good policy to have buyers contact the breeder if they hear things that seem crazy (like the black spots on the tongue meaning Chow blood!), but please, investigate a little before bashing an entire profession on a public msg. board.  If the vet's a scumbag, throw him or her under the bus! But if it turns out that's not the case, you'd best make a retraction. 

Columbus Veterinary Emergency Service:  http://www.medvet-cves.com/pdf/JPS_Review.pdf
has some drawings and spaying or neutering is required and done at the same time as the JPS

This puppy does not have any predispotion to HD, he has no history of any lamenes or health problems and is from generations of xrayed stock and I would NEVER ever consider using any stud line that was not xrayed & Breed Surveyed either.
As far as I can see this vet just assumed that as a GSD he is going to have problems.........For Gods Sake he only went for a vaccination. My puppies leave here with a complete history, hip & elbow results, Breed Survey results  photo copies for parents, grandparents and further back if they want them, the puppy owner took these all to the vet for him to see.
Thankfully these people were very suspiciousof this vet and called me.

I will be trying to contact this vet on Monday I will hold back on my anger until I have all the information that I need. I am hoping that I can gain enough info to report him to tha AVA.

I will let you know how I go.

Susan

thankyou for those links I didn't have time to read them last night and I have just done so, I have never heard of such a procedure and they only served to increase my anger. There is no reason for a puppy of such a young age that has no history of lameness to be subjected to any such thing.

I don't care even if they gave a 100 percent guarantee that the puppy would never suffer HD I would never do this

                     "WHY FIX SOMETHING THAT IS NOT BROKEN"

                     It would be like Okie said regarding Breast Cancer.

UPDATE,

I have spoken to the vet concerned and he said that the puppy owner did not have the parents hip & elbow scores on the day of the visit but he has now sighted them so I asked if he had seen them at the time would he have brought up the surgery he said probably not, but I wonder. He also said that they speak to all Large Breed puppy owners about the surgery so I asked if they had done the procedure  many times and he said that he had lost count of just how many had been done at his vet hospital.

Yes mobjack on the day they are x-rayed, desexed and the procedure is done. I wonder how many puppies actually have the procedure done and have normal hips because once admitted for surgery I am sure they are all done, and it has to be done between 14 - 20 weeks.

JUST ONE MORE THING WE HAVE TO WARN PUPPY BUYERS OF.

Wow, that's interesting.  So they bring it up like "you have a large breed puppy, I recommend you do this to prevent HD."  Yikes.  And if the owner says, nope, parents are x-rayed clear then they drop it.

Hmmm.

Two comments:  1) I wonder if over the years vets get sick & tired of seeing a seemingly endless stream of dysplastic puppies sold by out-to-make-a-buck-"breeders" and just got sick of it and the heartbreak, because of course by the time the dog goes dysplastic the owners are terribly attached.  Vets do see a lot of crap.  Heck, I've been in the waiting room and seen absolutely hideous weedy, cow-hocked puppies come in while the proud new family talks about the seller who "knows all about" GSD and they think they have a top-quality pup.

Not saying I agree with this vet, but just wondering.

2) ok, not making fun, dogshome9, I know what you meant, but this:  puppy is from generations of xrayed stock.
This makes my vet roll his eyes because some sharp sellers say this, so my vet says to the buyers, "And?  did you see the results?  Did you get OFA numbers?"

IOW, the sellers may be x-raying, but the dog might x-ray dysplastic, so the breeder simply says, "All my dogs are x-rayed."
Leaving out the "and half of them are severely dysplastic" part of the sentence.

Again, YOU are saying "x-rayed clear" - I'm pointing out that not everyone is so truthful.

I agree with you totally - JUST ONE MORE THING WE HAVE TO WARN PUPPY BUYERS OF.

Make that TWO more things (LOL!)