Hi Rona, I've missed you!!!! Actually what we've found (Michigan State - Apache Regimen) is that it is a genetic predisposition to growing too fast. This is why some puppies in the same litter will be affected and some will not. (Even being fed the exact same foods) The higher protein and or caloried foods causes different joints, ligiments, etc. to grow at different rates, thus creating all kinds of joint and bone problems, including elbow anomaly, hip displasia, etc. and that by starting and keeping the larger breed puppies on a medium protein level for life of around 20-23% can actually prevent those puppies from developing the ortho/joint problems to begin with. The study they are doing now (they got the grant using Apache's before and after xrays about 5 years ago) is called Genetic deformities and how outside factors other than surgery can either PREVENT or Influence puppies with the predisposition from developing problems. Apache will turn 6 later this month, can keep up with Beau and Cole just fine, and the best news just had him adjusted last week again and the Chiropractor said the extra cartlidge in his elbows has gone down even more, something he never expected and that he has full range of motion in both elbows!!!!! Not bad for my boy that's never had a surgery but who won't make it to his first birthday without multiple ones. :hugs: