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*: hulea_calin@yahoo.com

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.

Abrudean et al., Medicamentul Veterinar / Veterinary Drug

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).

Abrudean et al., Medicamentul Veterinar / Veterinary Drug

Vol. 10(1) June 2016

75

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

Abrudean et al., Medicamentul Veterinar / Veterinary Drug

Vol. 10(1) June 2016

76

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).

Abrudean et al., Medicamentul Veterinar / Veterinary Drug

Vol. 10(1) June 2016

77

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

Abrudean et al., Medicamentul Veterinar / Veterinary Drug

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)

Abrudean et al., Medicamentul Veterinar / Veterinary Drug

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.