Legg-Calve-Perthes DiseaseAmanda R. DickermanCarrington CollegeMrs. Elsberry Case StudySignalment: Jasper, a 7 month old, neutered M, Scottish terrier.History: Patient (P) was adopted from a family friend at 16 weeks of age. P has had difficulty walking, difficulty standing up, favors right hind limb, and movement of left hip is painful. P is the only household pet. P is UTD on vaccinations.S: BAR, healthy, shiny coat, painfulO: Weight- 16 lbsTemperature- 102.1 FPulse- Respiration- A: R/Os: Panosteitis, OCDLegg-Calve-Perthes DiseaseP: FHO surgery requested, hospitalization, orthopedic surgery aftercare, follow-up appointment 2 weeks later, additional radiographs post-opRx- Tramadol 50mg: please give ½ tablet by mouth every 8-12 hours as needed for pain. Rx- Vetprofen 25mg: please give 1 tablet by mouth daily for 14 days. Blood work required for more refills.Legg-Calve-Perthes DiseaseLegg-Calve-Perthes disease is defined as the “osteonecrosis of the femoral head” of young, small breed dogs (cal.vet.upenn.edu, 2017). The disease was recognized by three doctors named Arthur Legg, Jacques Calve, and Georg Perthes. They discovered that the disease was not in fact related to the disease tuberculosis, which previous physicians had thought to be true. The cause of the disease, clinical signs, diagnosis, treatment, and prognosis are all important things to consider and understand (cal.vet.upenn.edu, 2017).Currently, the exact etiology of the disease is unknown. The disease typically affects small breed dogs, weighing less than 12 kg, that are 5-8 months in age. Although the cause of the disease is unknown, studies suggest that there is a disruption in the blood flow to the animal’s hip due to clots occurring in the blood vessels (VCA, 2017). The symptoms of the disease usually occur when there is damage to the thigh bone while the animal’s bones are still developing and growing. The typical clinical signs of the disease are usually accompanied by a limp, pain when extending the hip joint, and pain during abduction of the hip. Clinical signs can also include difficulty walking, difficulty standing up from a resting position, and the favoring of a rear limb. The disease usually only affects one leg, making it unilateral. The clinical signs occur due to a decrease in blood flow to the thigh bone, which, over time, causes the degeneration of the femoral head, or the top portion of the femur leg bone. Eventually, the degeneration of the femoral head will cause the bone to die and collapse, which can lead to arthritis (Pethealthnetwork.com, 2017). When the femoral head collapses, this can also result in the complete loss of function of the limb and muscle atrophy (cal.vet.upenn.edu, 2017).Legg-Calve-Perthes disease is known to affect the young and smaller breeds of dogs. Toy breeds and terriers, usually weighing less than 12kg, are typically the most affected. The main breeds affected by the disease include West Highland terriers, Cairn terriers, Scottish terriers, Manchester terriers, toy poodles, and miniature pinschers. The dogs affected are usually in the age range of 5-8 months old. Both males and females have an equal opportunity of obtaining this disease (pethealthnetwork.com, 2017).Diagnosis of the disease is found in observation of clinical signs on the physical examination, and most importantly by the radiographic findings. The veterinary staff will perform radiographs of the the dog’s hips and rear limbs. When the veterinarian observes the radiographs, they will show in a crease in the joint space of the femur. The radiographs will also show the changes caused by the degeneration of the femoral head and neck. With cases that are far more advanced, the femoral head will appear fractured or collapsed (pethealthnetwork.com, 2017). However, in less advanced stages of the disease, there may only be a slight flattening of the femoral head.When it comes to treating Legg-Calve-Perthes disease, there are a few options. Treatment can differ with each individual case, and depends on the severity of the disease. In less severe cases, the animal may only need rest and supportive care. In more severe cases, FHO (femoral head and neck osteotomy) and THR (total hip replacement) surgeries are suggested. The surgeries are followed by physical therapy, pain medications, and sometimes glucosamine supplements. The dogs that are affected are also suggested to not use for breeding (Catherine Barnette, DVM, VCA, 2017). The prognosis for the disease is typically favorable for recovery. As stated previously, minor cases may only need supportive care and supplements. Even in more advanced cases, dogs can live long, happy lives after surgery and physical therapy. The most severe cases may result in loss of function of a hind limb, however, even then the prognosis is not fatal. In cases where the femoral head does not sit well in the acetabulum, hip pain and arthritis can occur later on in life. However, most animals can grow into adulthood without any further hip problems (orthoinfo.aaos.org, 2017).As of right now, there is no known way to prevent the onset of Legg-Calve-Perthes disease. Owners should make sure to do their research on this disease if planning to adopt a toy or terrier breed, so that they can be prepared for the possible diagnosis of the disease. Since the cause of the disease is not fully understood, there is no way to prevent it currently. The best way to prevent severe cases of the disease is to take animals in for regular physical examinations, and to be aware of the clinical signs accompanied by the disease.Currently, doctors know only what causes the clinical signs of the disease. The clinical signs are caused by the degeneration of the femoral head and an increase in the joint space. Research should definitely be continued on this disease, as it can be extremely debilitating for the animal. Suggestions of research are to study what causes the disruption of blood flow and clots within the blood vessels of the hip. Other suggestions for researchers are to conduct more studies on why these breeds are affected and what can we do, if anything, to possibly prevent the disease. A better understanding of the disease and how it ticks can save a lot of animals from pain and suffering (cal.vet.upenn.edu, 2017).Research should also be further conducted for other reasons. This disease does not only affect animals, but it affects humans as well. As with animals, the disease affects young children ranging from ages of 2-12 years old. Another similarity in the cases with animals, the disease usually only affects one limb of the child as well. However, in about 10% of cases, it can unfortunately develop in the other leg making it a bilateral limb disease. The clinical signs and prognosis are similar in animals and humans as well. It’s important for us to have a better understing of Legg-Calve-Perthes because it is a disease that is affecting both humans and animals (rarediseases.org, 2017).In conclusion, Legg-Calve-Perthes disease is the osteonecrosis of the femoral head, and affects the young and smaller breeds of dogs. The etiology of the disease is currently unknown, meaning that there is no way to prevent the disease. Each individual case ranges in severity and protocol for treatment. It is important that doctors continue to perform research on the disease because as of now there are many questions to be answered. The most important piece of information to take from all of this is that the prognosis is favorable, and that dogs affected by this disease can live long, happy lives.