Elbow dysplasia in dogs: the three lesions, the screening schemes, and what it costs in India

Signs of Elbow dysplasia in dogs

The 8 signs to watch for are listed below. Any one of them is a reason to consult your nearby vet; none of them is a diagnosis.

• Front-leg lameness that is worse after exercise and does not clear with rest
• A paw turned inward while the elbow is held out from the body
• Stiffness on getting up, often in a dog under a year old
• A head bob that rises as the sore front leg takes weight
• Shortened stride and reduced range of motion in the front legs
• Swelling, thickening or unusual warmth around the elbow joint
• Pain when the elbow is flexed, extended or pressed
• Reluctance to walk, run or play for as long as before

Breeds on this site that document this condition

Each breed page below carries the figure for this condition with its denominator and its source. The 10 breeds listed are the ones on this site that document it, not a ranking of risk.

What elbow dysplasia in dogs is, and which dogs get it

Elbow dysplasia in dogs is not one disease but a group of developmental faults in a joint built from three bones, and every one of those faults ends in the same place, which is osteoarthritis. The Orthopedic Foundation for Animals calls it an inherited polygenic disease with three specific etiologies that can occur independently or in conjunction with one another.

Three faults carry names in the register and a fourth carries the load. OFA names pathology involving the medial coronoid of the ulna (FCP), osteochondritis of the medial humeral condyle (OCD), and an ununited anconeal process (UAP). Fitzpatrick Referrals in the United Kingdom and the Indian clinic chain Vetic both add a fourth, joint incongruity, which is a mismatch between radius and ulna that loads the whole joint surface unevenly Vetic Pet Clinics (India). The register counts three, the CT scanner finds four, and the difference is not academic.

The four primary faults, and how often each one is found

Each frequency below is printed with the study population it was measured in, because the four faults have never been counted in one place.

The last row is the one that should change a decision. In those 108 dogs, radiography diagnosed elbow dysplasia in 53 and computed tomography diagnosed it in 58, and incongruity itself was seen in 30 dogs on radiographs against 41 on CT. Ununited anconeal process was the rarest of the four, and in 8 of its 9 cases it sat alongside another lesion rather than alone. A clean radiograph is weaker evidence than most owners assume.

Osteoarthritis is the part the dog feels, and the elbow is a common place for it. In a study of 1,156 elbows the joint ranked third for the number affected, behind hips and stifles, with 57 percent showing some osteoarthritis and 16.4 percent rated severe. Once that arthritis is established the elbow does not correct itself.

Which dogs get elbow dysplasia

Large, fast-growing breeds carry most of the risk, and the worst rate in the register belongs to a mid-sized one. In the OFA elbow table the Chow Chow ranks first of 162 listed breeds at 51.4 percent abnormal across 1,717 evaluations, ahead of the Rottweiler at 38.9 percent of 26,672 and the Bernese Mountain Dog at 26.7 percent of 25,078, while the Siberian Husky sits at 0.2 percent of 1,640. Every one of those is a rate among dogs whose owners chose to send the films in.

Growth rate rather than size alone is the mechanism. Genetics is the primary driver and the condition typically presents during rapid growth between three and twelve months, while excessive exercise, overfeeding and rapid weight gain worsen the damage without causing the disease on their own. OFA puts the same thought as an inability to predict, saying nobody can say at what age lameness will occur because of the degree of severity of changes, the rate of weight gain and the amount of exercise.

Bodyweight shows up in the data as clearly as breed does. Dogs diagnosed with elbow joint disease in a UK primary-care population had a median adult bodyweight of 32.45 kg against 16.20 kg for the dogs without it, and having an adult bodyweight at or above the breed and sex mean was an independent risk factor. An overweight Labrador Retriever is carrying two risk factors at once.

The first signs of elbow dysplasia in a dog, and when to book the vet

The first signs of elbow dysplasia in a dog are front-leg lameness that is worse after exercise and does not clear fully with rest, a paw turned inward while the elbow is held out from the body, and a shortened stride. None of those is an emergency, and each of them earns an appointment this week rather than next month.

A one-sided problem is easier to spot than a two-sided one. Cornell describes the giveaway as a head bob, where the dog's head rises as the sore leg takes weight and drops when the good leg lands, and notes that if both elbows hurt equally the lameness can be very hard to see at all. Two sore elbows often look like a dog that has simply slowed down.

Two elbows is the normal pattern, not the exception. Of 616 incident elbow joint disease cases in UK general practice, 376 were recorded as bilateral (61.04 percent), against 123 left only and 117 right only. Vetic makes the same point for Indian clinics, that both legs are often involved while one side looks worse.

A dog that has never limped can still have a dysplastic elbow, and the figure behind that is specific. In a series of 207 Rottweilers, 141 were not lame, and 68 percent of those non-lame dogs had degenerative joint disease of the elbow. A second series followed 55 Rottweilers at 6 and 12 months of age and found that most of the lame dogs had no radiographic change at 6 months, that the changes were apparent by 12 months, and that most of the dogs stayed sound throughout.

Age at diagnosis comes in two waves rather than one. True elbow dysplasia is not diagnosed before 4 to 6 months while the growth plates are still closing, most dogs are diagnosed on a lameness examination between 4 and 12 months, and mild cases may show nothing until arthritis catches up at 7 or 8 years. UK primary-care records show exactly that shape, with a median age at diagnosis of 6.84 years and a bimodal distribution carrying a sharp peak in year 1 and a gradual second peak across years 6 to 10. Two sources put the opening window slightly differently and both are printed here rather than smoothed. Cornell has most dogs diagnosed between 4 and 12 months, while the PDSA says symptoms often begin between 5 and 18 months old. Either way the first year is when an owner should be watching.

Four findings move the appointment from next month to this week.

• Front-leg lameness after exercise in a dog under a year from a breed on the card list above, because that is when the joint-preserving options are still open.
• A paw that turns inward while the elbow is held away from the body, which is the dog shifting weight off the inside of the joint.
• Swelling, thickening or unusual warmth around the elbow, which even a stoic dog will show.
• Pain when the elbow is flexed or extended, which is what a careful clinical examination is looking for.

What you can do before the appointment costs nothing. Write down the date the limp started, whether it is worse after rest or after exercise, which leg the head bob favours, and how the dog moves on tile against grass, because a polished Indian floor is part of the history and not a detail.

How elbow dysplasia is diagnosed, and why two registries grade it differently

Elbow dysplasia is diagnosed from a lameness examination plus radiographs, with CT and arthroscopy used when the films do not settle it. Which screening scheme grades those films then decides what the word normal is worth.

One view does most of the work. The most sensitive view for secondary degenerative change is an extreme flexed mediolateral view of the elbow, which OFA requires and the International Elbow Working Group recommends, and the radiologist is looking hardest at the anconeal process of the ulna for new bone. Sclerosis in the trochlear notch and bone spurs at the joint edges are the other reported findings.

The two big schemes then diverge on almost everything else, and a buyer who does not know that will misread a certificate.

OFA says plainly why it departs from the international protocol. It uses a single flexed lateral view at two years because that is more cost-effective for mass screening and detects the secondary arthritis more accurately, and it believes that produces fewer false positives. The IEWG itself is the body that wrote the protocol OFA modified, founded in 1989 to lower the incidence of elbow dysplasia by coordinating worldwide efforts; its own website was still advertising its 2018 meetings as forthcoming when it was read on 23 September 2026.

What an elbow grade does and does not tell you

An elbow grade describes a radiograph, not a dog. Some dogs are very sore with a Grade 1 and others rated Grade 3 are barely lame. Grade I means minimal new bone along the anconeal process at under 2 mm, Grade II adds bone proliferation of 2 to 5 mm with trochlear notch sclerosis, and Grade III is well developed degenerative joint disease with proliferation over 5 mm. The BVA reads the same joint on a 0 to 3 ladder and recommends breeding only from dogs graded 0.

The grading itself is more consistent than breeders expect. Three board-certified radiologists read every OFA elbow film independently, and they agree 98 percent of the time on whether the elbow is normal or dysplastic. An audit of more than 19,000 German Shepherd Dog elbow evaluations found 1,326 dogs resubmitted for a second reading and 40 for a third; 87 percent of resubmissions did not change, 10 percent moved from normal to dysplastic, and under 3 percent moved the other way.

Why your own vet may not be able to read the film

General practitioners are not expected to grade these radiographs, and OFA says so directly. Higher grades are often obvious to the radiographing veterinarian, but most do not have the training or equipment to diagnose a Grade I reliably, and OFA advises against trying to prescreen the film before it is submitted. For an Indian owner that is useful rather than discouraging, because it means the local vet's job is a good film and a good clinical examination, not a verdict.

Beyond radiography the ladder is CT then arthroscopy. CT can be done under sedation or general anaesthesia, takes minutes, and is sensitive for coronoid stress fracturing and for assessing incongruity and the bone under the cartilage. Arthroscopy is the gold standard for seeing inside the joint and treats and diagnoses in the same anaesthetic, and Cornell's surgical view is to recommend CT and arthroscopy to symptomatic dogs as soon as they show pain or lameness.

How common elbow dysplasia is, and why the registries disagree

Elbow dysplasia is abnormal in 12.1 percent of 621,440 dogs in the OFA elbow register and elbow joint disease is diagnosed in 0.56 percent of 455,069 UK dogs in a single year of primary veterinary care. Both numbers are correct, and they count completely different dogs.

A register counts dogs whose owners paid to have them screened, which is mostly breeding stock from breeders who care. A primary-care database counts every dog that walked into a practice. So the register measures how often a screened dog is abnormal, and VetCompass measures how often a vet writes the diagnosis down in a year. Quoting one as if it were the other is the commonest mistake on this subject.

A third denominator sits between them. A French retrospective study read 18,870 elbow radiographs from 2002 to 2022 and analysed 17,861 records across 13 breeds, finding an overall elbow dysplasia prevalence of 11.4 percent, ranging from 1.1 percent in the Czechoslovakian Wolfdog to 32.2 percent in the Dogue de Bordeaux, with males affected more often than females at 17.5 percent against 10.5 percent. That 11.4 percent sits within half a point of the OFA all-breed figure, on a different continent and a different scheme.

Ten breeds, elbows against hips, from one register on one day

The table below reads both OFA tables from a single dated capture, so the elbow and hip columns are comparable.

Four things fall out of that table and none of them appears on a page ranking for this query. The Chow Chow is 45th for hips and 1st for elbows, so a buyer screening only hips is screening the wrong joint. The Rottweiler and the Bernese are far worse on elbows than on hips, while the Labrador, the Great Dane and the Alaskan Malamute are the other way round. The all-breed elbow rate of 12.1 percent is lower than the all-breed hip rate of 14.3 percent, which is the opposite of what the breed-specific rows suggest. And the elbow register holds 621,440 evaluations against the hip register's 1,676,531, which is 2.7 hips screened for every elbow.

That screening gap is not explained by cost. OFA charges USD 45 for an elbow evaluation on its own and USD 50 for hips and elbows submitted together, so adding the elbow to a hip submission costs five dollars. Those are American fees quoted in dollars and are reported here as dollars, not converted. In Britain the gap is much narrower, with over 5,300 dogs graded for elbows in 2025 against over 6,400 scored for hips.

The same breed, two countries, twice the rate

One breed has been counted by both schemes and the answer differs by a factor of two. Of 577 Golden Retrievers evaluated by the BVA scheme through 2003, 434 were normal (75 percent), 87 Grade I, 40 Grade II and 16 Grade III, giving 143 affected or 25 percent; of 9,630 evaluated by OFA over the same period, 88.1 percent were normal and 11.6 percent were affected. The proportion in the worse grades differed by more than three times, at about 10 percent in the United Kingdom against 2.6 percent in the United States.

The Golden Retriever Club of America publishes the same comparison with slightly different figures, 556 dogs evaluated by the BVA and 24.2 percent affected, against OFA's 577 and 25 percent. Both are printed here rather than averaged, because the gap between them is far smaller than the gap between either and the American number. A screening scheme's threshold, not a national difference in dogs, is doing most of the work.

Breed risk measured in general practice ranks differently again. Against crossbred dogs, five breeds showed increased odds of elbow joint disease in UK primary care, the Rottweiler at 6.16, the Labrador Retriever at 5.94, the German Shepherd at 4.13, the Golden Retriever at 3.11 and the English Springer Spaniel at 2.00. The Chow Chow, first in the OFA register, does not appear on that list at all, because almost nobody screens one.

Treatment options in general terms, from the feeding bowl to the operating table

Treatment for elbow dysplasia starts with weight control and controlled exercise, adds pain relief when the dog needs it, and reaches surgery when medical management stops working. Most dogs never reach that last step, because only 85 of 616 UK cases had therapeutic surgery at all.

What a general practice actually does is documented rather than guessed. Across those 616 incident cases at least one medication was used in 573 (93.02 percent), with non-steroidal anti-inflammatory drugs in 544 (88.31 percent), tramadol in 121 (19.64 percent), disease-modifying agents in 118 (19.16 percent) and gabapentin in 11 (1.79 percent), while nutraceuticals were used or recommended in 248 (40.26 percent). This page names drug classes only. The dose belongs to the veterinarian looking at your dog, and nothing here is a prescription.

The non-drug half is the half an owner controls. Non-surgical treatment involves weight restriction and exercise control, with drugs used to relieve pain and inflammation and physiotherapy advised in some dogs. Cornell adds that simply getting the dog to its normal weight may reduce pain dramatically, that moderate exercise moves the joint and builds cushioning, and that hydrotherapy and an underwater treadmill are used both after surgery and instead of it.

Elbow dysplasia cannot be cured, and Cornell's own summary is that it can be well managed, with many dogs reaching a good long-term prognosis on surgery plus appropriate medical management. One of its surgeons is blunter still, saying that for moderate to severe coronoid cases she pushes surgery more strongly but never guarantees a cure, because surgery is only part of these dogs' lifelong treatment.

The operations, and what each one is trying to do

Surgery for this joint splits into three jobs. The first is clearing the joint, by arthroscopic fragment removal, subtotal coronoid ostectomy or biceps ulnar release. The second is shifting load off the damaged inner compartment, by proximal ulnar osteotomy, proximal abducting ulnar osteotomy or sliding humeral osteotomy Yu AJ, Nault AJ, Gordon-Evans WJ.…. The third is replacing or fusing the surface, by canine unicompartmental elbow replacement, total elbow arthroplasty or arthrodesis. Cornell notes that elbow replacement systems all come with very serious complications and that the technology is not yet where hip replacement is.

The evidence behind all of it is thinner than the marketing. A 2026 systematic review screened 2,329 records, reduced them to 1,231 unique articles and included 15, of which five were prospective, eight retrospective and two case series. Its conclusion is one sentence long, that there is low evidence for any of the procedures and the risk of harm is high.

Read the last column before the first. The review's own plain-language version is that for every ten sliding humeral osteotomies and every eight canine unicompartmental elbows, one dog needed a second operation or was euthanised. It also notes that the single study using an objective measure rather than an owner or surgeon opinion reported only 43 percent long-term success, so the subjective studies may be overstating what surgery achieves. Against that, the American College of Veterinary Surgeons figure Cornell quotes is that on average about 85 percent of cases show some degree of improvement in lameness and comfort after surgery despite the arthritis continuing to progress on X-rays.

Four questions turn a surgical quote into a decision, in this order.

1. Ask which procedure and which compartment, because clearing the joint, shifting the load and resurfacing it are three different operations with three different aims.
2. Ask what imaging the plan is based on, since CT changes both the diagnosis and the plan in a joint where radiography under-reads incongruity.
3. Ask for the surgeon's own complication rate, and compare it with the published 11.65 to 16.67 percent for the best-evidenced procedure.
4. Ask what happens if you wait, because weight control and controlled exercise remain the treatment underneath every operation.

What elbow dysplasia costs in India, and the price nobody publishes

An elbow radiograph at an Indian government veterinary hospital costs Rs 150 at ICAR-IVRI Izatnagar and Rs 400 at Bihar Animal Sciences University in Patna, and no Indian page opened for this build printed a price for elbow surgery at all Vetic Pet Clinics (India).

Two government institutions publish their fees line by line, which makes them the only checkable Indian prices on this subject. The Referral Veterinary Polyclinic at ICAR-IVRI, Izatnagar publishes charges with effect from July 2022, plus tax, and the Veterinary Clinical Complex at Bihar Animal Sciences University in Patna publishes its own registration and surgical fee tables.

Every rupee figure above was divided by 84.38 and by 74 before it was published here, and none of them lands on a round dollar or a round pound, so this is an Indian price list rather than a converted foreign one. What those cards do not price is the part that actually decides an elbow case. Neither lists a CT scan, neither lists arthroscopy, and neither lists an implant, so a dog that needs the imaging Fitzpatrick Referrals describes as routine for this joint is going to a private referral centre at a price nobody publishes.

The silence around that number is worth naming. Vetic's own hip dysplasia article prints twelve rupee figures, from Rs 1,80,000 to Rs 2,50,000 for a total hip replacement down to Rs 25,000 to Rs 60,000 for a femoral head ostectomy, while the same chain's elbow dysplasia article, published on 5 August 2026, carries no rupee figure anywhere in its 16,253 characters. An Indian owner who cannot find an elbow surgery price has not searched badly. Our companion page on hip dysplasia in dogs carries the published Indian hip figures and the disagreement between them.

What Indian pet insurance actually says about elbows

Two Indian pet insurance wordings were read clause by clause and they treat this condition very differently. Go Digit's policy lists elbow dysplasia by name once, inside the Specific Waiting Periods section, among orthopaedic conditions that also include osteochondritis dissecans, osteochondrosis, panosteitis and hip dysplasia. Its covered specific-illness table for the musculoskeletal system names only hip dysplasia, and its note that the waiting period will be one year unless specifically agreed names tumours, cataract and hip dysplasia and does not name the elbow.

Bajaj General Insurance does not use the word at all. The string elbow occurs zero times in its 21-page pet insurance wording, while exclusion 9 of that section excludes treatment for Hip Displacia, spelling and all, unless specifically covered on payment of additional premium at first inception of the policy. A buyer therefore cannot assume the elbow is treated like the hip, and should ask the insurer in writing which list this condition falls under. Our guide to pet insurance in India reads all five Indian products clause by clause.

The timing rule follows from the ages rather than the prices. Cover has to exist before the diagnosis, the first diagnostic peak is in the dog's first year, and a waiting period measured in months eats most of that window. An insurance decision taken at eight weeks is a different decision from the same one taken at eight months.

Screening and prevention, and what an Indian buyer can actually ask for

Screening reduces elbow dysplasia and no scheme that grades the films operates in India, so an Indian buyer asks a breeder for the parents' graded results rather than for a certificate issued at home. The single most useful number in this whole subject is what those parental results predict.

OFA has published the arithmetic from its own database. Across 13,151 breeding pairs of dogs with known elbow status, normal by normal produced 12.2 percent affected offspring, normal by dysplastic produced 26.1 to 31.3 percent, and dysplastic by dysplastic produced 41.5 percent. The Golden Retriever Club of America, quoting the same study, notes it was drawn primarily from Golden Retrievers, Labrador Retrievers, Rottweilers and German Shepherd Dogs, and that the rate more than doubled when one parent was affected and more than tripled when both were.

That is what a parent's elbow grade buys you and it is not a guarantee. The BVA says the same thing in words, that some dogs whose parents have good elbow grades will still grade poorly because elbow dysplasia is multifactorial, and that breeding from dogs with good grades reduces the incidence of disease without eliminating it. Its scheme recommends breeding only from dogs graded 0.

The Indian rule that names the hip and never says elbow

Indian law already requires breeding dogs to be tested for genetic defects and it never mentions this joint. The Second Schedule of the Prevention of Cruelty to Animals (Dog Breeding and Marketing) Rules 2017 requires that dogs shall have been tested for genetic defects, including hip dysplasia, progressive retinal atrophy, night blindness, hypothyroidism, entropion, ectropion and several dental and testicular faults. The 14-page gazette text was extracted locally to 51,953 characters for this page, and the word elbow occurs in it zero times while hip dysplasia occurs once. A registered Indian breeder can comply with the rule in full and never screen the joint that the Rottweiler and the Bernese Mountain Dog fail far more often than the hip.

There is also no Indian number to put in the gap. A PubMed search for elbow dysplasia in dogs in India returned zero records on 23 September 2026, and a breed enters the OFA elbow statistics only once at least 50 individuals have been evaluated, which is why the Indian Pariah Dog, the Rajapalayam and the Mudhol Hound have no registry rate at all. This page will not invent one for them.

Six questions turn a breeder conversation into evidence, and every one of them is answerable from a document.

1. Ask for both parents' elbow results, not just their hips, because the 2017 Rules name the hip and stop there.
2. Ask which scheme graded them, since an OFA Normal and a BVA grade 0 are two different measurements of the same joint.
3. Ask the dog's age on the radiograph date, because OFA certifies from 24 months and the BVA from 12 British Veterinary Association.
4. Ask to see the certificate rather than a photograph of a film, since an ungraded radiograph is a picture and not a result.
5. Ask what the breeder does with a dysplastic dog, and compare the answer with the 41.5 percent affected offspring from two affected parents.
6. Ask whether elbows were submitted with the hips, because adding them costs five dollars on the OFA fee schedule and is the cheapest health information in the whole transaction.

A breeder with none of this is not automatically dishonest, because the schemes are genuinely hard to reach from Chennai, Pune or Kolkata. A breeder who reacts badly to the questions has answered them. Our guide to the dog breeding rules India covers the rest of the schedule and how to check a registration.

What an owner can change after the puppy is home

Elbow dysplasia cannot be prevented outright in a dog that carries the genes, and you can still change how fast it progresses. Cornell's prevention list is short, keeping the puppy trim as it grows without cutting essential nutrients, avoiding repeated jump-down injuries off beds, sofas and car boots, and limiting long flights of stairs, with many breeders recommending no more than two or three steps until six months of age. Vetic's Indian version adds avoiding excessive exercise in large-breed puppies under twelve months and feeding for controlled, steady growth.

Breeding is still the only lever that removes the disease rather than delaying it. Cornell's surgical view, from a professor who has studied the canine elbow for almost 30 years, is that a registry system to reduce the number of dysplastic puppies produced would be the most important strategy for cutting case numbers, and that nothing among the many commercially proposed treatments has been scientifically proven effective.

Living with a dysplastic elbow in an Indian home

A dog with elbow dysplasia usually has a normal life expectancy, because the grade of dysplasia predicted neither deterioration nor survival in a Swedish cohort followed for three years. What changes is the floor the dog walks on, the hours it walks in, and the weight it carries.

The Swedish study is the closest thing to a straight answer an owner will get. Owners of dogs radiographically screened and graded normal, mild or moderate were interviewed by telephone in 2017 and surveyed again by email in 2020, giving 765 replies and then 293; at the second round 222 dogs (76 percent) were alive with a median age of 8 years and a range of 5 to 12. No association was found between elbow dysplasia grade and worsening Canine Orthopaedic Index scores over time, or between grade and survival. Dogs with mild and moderate grades were, however, on analgesic medication more often than dogs without.

UK primary-care records put a number on the ending as well as the middle. Of 167 diagnosed dogs that had died by the end of the study, the median age at death was 12.09 years with an interquartile range of 9.69 to 13.90 years. Of 109 euthanasia cases with information recorded, elbow joint disease contributed to the decision in 45 (41.28 percent). Both facts are true at once, which is why a straight lifespan answer is misleading without its denominator.

Indian floors are the first thing to change and the cheapest. A painful elbow on polished stone or tile makes a dog splay and catch itself, which loads exactly the joint that hurts, and runners or rubber-backed mats along the routes the dog actually uses cost less than a month of nutraceuticals, which were used or recommended in 40.26 percent of UK cases.

Heat and humidity move the exercise plan rather than cancel it. Moderate exercise moves the joint and builds cushioning, and Cornell suggests a warm-up before harder work, such as a ten-minute walk before a dog that loves to play ball is allowed to chase it. In Mumbai, Chennai, Hyderabad, Kolkata, Ahmedabad or Delhi the only way to fit that in for most of the year is a cool pre-dawn walk and a second one after sunset. Monsoon months reward the mats and the towel more than the walk, and a humid evening is not the time to add distance.

The joint next door, and the years after

Elbows and hips are screened on the same films at the same appointment, which is the practical reason to read both. The rankings do not track each other, so a dog can be excellent at one joint and poor at the other. Our companion page on hip dysplasia in dogs carries the hip schemes, the Indian hospital series and the feeding trial evidence, and patellar luxation in dogs covers the third joint an Indian buyer is told to ask about.

As the dog ages the elbow stops being the only thing being managed. Long-term anti-inflammatory use needs monitoring that a vet sets and reviews, and our guide to senior dog care in India covers the pain-scoring questions, the annual blood work and the mobility aids. The dog that reaches 12 with a graded elbow is usually a dog whose weight was held steady for a decade.

Keep one sheet of paper. Note the date the gait changed, the fortnightly weight, every drug and every review date, and how far the dog walks before it slows. That record is the only evidence in this whole subject that nobody but you can collect, and it is what lets your nearby vet tell a bad week from a real decline.