| |
| Ask the Vet |
| Blog |
| Information Library |
| Resources |
| Photo Gallery |
| About this Site |
| Contact |
| Home |
| Orthopedics, Feet and Joints |
Submitted February 17,2009 Q.) I have a seven-year old lab that was hit by a car two years ago. He suffered spine damage and he favors a back leg but his is still a hunting machine. This week we hunted pheasants for about three hours and when we got home he was hesitatnt to come out of the kennel from the back of the truck and this morning during feeding time it took him a while to come out of his dog house and I could see he was in pain. My is question is what is the best thing I can give him before and after a hard hunt. I was told Motrin, but how much? I was also told baby aspirin but from a man with a lap dog. Any help would be great. A.) I haven't been up on the soapbox for a while and when reading through some questions this one struck a nerve. You ask what is the "best" thing, but clearly have no interest in providing the best care. I am continually amazed at the number of people who will administer human drugs to their dog, and then after, seek council on what they should have done. Most, if not all, of the human anti-inflammatories have the potential for serious consequences when given to dogs. I have seen dogs with severe kidney damage from ibuprofen (your Motrin) and bloody stools from aspirin. Dogs' livers are very different from ours and consequently they break down medications much differently as well. It is because of this difference that there are dog-specific anti-inflammatories. Now before I get a bunch of emails I will note that certainly some dogs can have reactions to these anti-inflammatories as well, and in select cases we will use human drugs to treat our dogs. However, I think the use of the drugs is actually the second best thing, with the first best being that you actually find out what is causing your dog's pain and why. You mention a previous back injury and the fact he is favoring a leg. With a 100 pound labrador I would certainly be worried about a knee injury or the potential for hip dysplasia. It is possible that your "best" course of action may be surgery for your dog. I'd also like to comment on the particulars that led up to the question. A 100 pound dog is a big dog, and with no other health issues, would not be a dog I'd expect to hold up well to the rigors of pheasant hunting. That is a lot of stress to be putting on any body. If he is at all overweight I would stongly recommend you start cutting him back ASAP. His large size is further complicated by the fact he was hit by car and has some lasting problems. What this means is that while he may want to be a "hunting machine" you have to serve as the intelligent member of the team and not let him hunt to the point that he is in miserable pain for a couple of days. This might mean an hour hunt with several days of rest in between. Basically I think you need to have a thorough exam to find out exactly what is going on with this dog, addres those issues, address the weight and then seek medications that may help your buddy return to function. Throwing random human drugs just has the potential to create a bigger disaster. Submitted January 17,2009 Q.) I have a 5 1/2 year old wirehair. About a month ago he began to be non-weight bearing on his right front leg whenever he would get up from sleeping or lying down. Now he most of the time is either non-weight bearing or toe-touching, but he does have times when he will fully weight bear. He is also beginning to hold his carpus in a flexed position when lying down. He will occasionally lick at his foot, but does not seem painful to palpation or range of motion. He has been tested negative for Lyme Disease, has been crate rested and leash walked only for the past 2-3 weeks while also being on and anti-inflammatory. Nothing has changed. The radiographs were negative for any fractures. This is a highly active gun dg in his prime and I am beginning to worry that this may be something more serious. I would appreciate any thoughts. A.) A vast majority of the time lameness in the dog is pretty straightforward, with injuries like blowing out their cructiate, luxating the carpus, hip dysplasia, etc. Unfortunately in cases like your dog's, they can be very difficult to get to the bottom of the problem and may require a trip to a specialist for further examination. In my experience with active hunting dogs with the symptoms you are describing I typically find it to be three possibilities. The first is a carpal sprain, and there certainly can be variable amounts of pain at different times. Two seasons ago I battled this injury with Maggie and it took most of the following off-season to resolve. The second set of issues would involve the elbow. Both of these areas would be highest on the list, because of the non-weight bearing nature. Lastly would be a shoulder injury, particularly of one or more of the tendons surrounding the shoulder. These can be very difficult to pin down and even more difficult to treat. With one of these three areas the dog should be painful on palpation at some point in time. Without knowing exactly what has been done, some of my suggestions may have already been performed, but I'll start from the beginning of how I handle these types of cases. It doesn't appear from your email that the affected joint has actually been identified, but rather that you suspect the carpus because of how he is holding the leg? I would strongly suggest having the dog re-examined with aggressive palpation of all the joints of the affected leg to see if pain can now be ellicited. Sometimes on initial presentation we will be unable to isoloate the source of the lameness but after some time has passed the pain will become apparent on a follow-up visit. From the sounds of it I don't think the area of concern has fully been isolated, and this is what can make these cases so frustrating. If I'm unable to find the source of the lameness I typically also go the rest and anti-inflammatory route with instructions that we will need to get more aggressive with diagnostics if it doesn't improve or it worsens. If no pain is found and we are only suspecting a joint, then I would recommend radiographs that include two-views of the carpus: the elbow and the shoulder. We evaluate a number of radiographs nearly every day in practice; however, at the end of the day we are not radiologists. If there isn't anything glaringly obvious I like to send the radiographs of cases like this off to a radiologist to have them fully evaluated. I'm continually amazed at the subtle disease processes a radiologist is able to discern. Two oddball possibilities I would throw out there if the above still doesn't give an answer: one would be a problem with the back, like a disc impingement on the spinal cord. The other rare possiblity would be something like a nerve tumor of the brachial plexus (the group of nerves that comes off through the armpit region). Again, both would be extremely odd in nature. If an answer still hasn't been found then the next step would be a referral to an orthopedic surgeon, and likely at a facility that has advanced diagnostics (like MRI and CT) and potentially the tools for arthroscopy. Submitted January 04,2009 Q.) My six-year old setter developed a hard lump on the inside of his leg, above the dewclaw, at the wrist. It didn't seem to bother him at all but of course we were very concerned. Our vet x-rayed, and recommended a biopsy, which we did The report came back as a organizing hematoma. Our vet has never seen one before. Since the biopsy the dog licks the bump, and limps a little after exercise. The entire joint is thicker now. Any advice on what we should do next, if anything? A.) Each year I seem to gain clients at the clinic who comment that they bring their dogs to me because I've been through most problems with my own dogs. I guess this is good for my clients and website visitors, but bad for my dogs. If you followed the blog this fall you likely are well aware of the saga we went through with Maggie. If not take a look at these posts about an injury Maggie suffered this fall, Initial Injury, First Update, Final Update. For the Cliff Notes version, Maggie had a severe, organized hematoma in her calf muscle. Very likely the ordeal occurred as a result of a traumatic injury in the field. Her injury required complete surgical removal from the muscle injury; what I can't gather from your email is whether your vet took the entire lump off or just a sample from the lump? A hematoma is essentially just a bruise, or a pooling of blood. With an organized hematoma the blood has clotted and formed a mass that the body may have trouble breaking down without surgical intervention. If the area was not completely excised, in your case that may be the necessary next step for your dog. On the other hand, if the mass was completely removed, I would be highly suspicious of an infection or irritation at the surgery site and would recommend a recheck with your veterinarian. One important note, these hematomas can result from problems other than traumatic injuries. In Maggie's case we were worried the hematoma was the result of a ruptured tumor, due to her history of cancer and the fact I did not see an injury occur out in the field. Hopefully with your dog it was just a matter of an injury; however, if things are not healing like they should I would strongly recommend a more aggressive diagnostic workup (repeat x-rays, ultrasound, blood work, etc.) in order to determine if there is an underlying cause to the hematoma. Good Luck! Submitted August 11, 2008 Q.) My 4.5 year old female shorthair has been diagnosed with carpal hyperextension. The first vet had no idea what it was and the second opinion told us that she could never hunt again. This dog lives to hunt and I can't imagine her not hunting. The only think I can think of is she injured it jumping out of the pickup. The best way to describe it is her foot looks flatfooted and now the other front paw is starting to follow. Do you have any experience with this in hunting dogs and what are my options? A.) One thing that throws up a red flag to me with your particular case is that you think the other foot is starting to follow suit? If this was an injury that wouldn't be the case. Sometimes with metabolic diseases (like Diabetes, hypothyroidism, Cushings, etc.) the rest of the body can be affected. If it appears these problems are "developing" over time, rather than as the result of an injury, I would be working this up as a medical problem and not necessarily a joint problem. Assuming it is indeed an injury, I do have some experience with this problem in hunting dogs. Often times we can see a mild form of this condition where the tendons or ligaments are streteched, or, only some of them, blown out. I suspect these dogs do this while out running and either step in a hole, on a rock or in uneven terrain. Much like when we sprain our ankles, only they happen to have four chances at a sprain where we only have two. The more severe cases usually involve jumping from a high starting point. By far the worst case I ever saw was a lab that went out the window of an unfinished two-story house. That particular dog blew out nearly all of the structures in the carpal joint, and I too gave the owner and extremely poor prognosis. As we were treating the dog I thought for sure we would end up needing to fuse the joint in order to stabilize it. Miracously, in my opinion, with weeks in a splint and controlled rehab the dog was able to return to hunting without any type of surgery. Certainly there are some arthritis issues and they will only worsen over time, but it has become a manageable condition, not a career-ending condition. I think the keys in your case are to determine the actual cause (injury versus other), the extent of the injury and then a rehabilitation program and potential surgical options with a slant towards getting this dog back in the field. During the recovery and rehab I do have a couple of suggestions for products to look into. The field of canine rehab is new and evolving, and so I can't say that I have personal experience with either of these companies; however, the products do look like they would work: Sky Prosthetics -- They make animal prosthetics, orthotics and braces Canine Icer -- Another bracing option Certainly without seeing the dog I can't give you an opinion of whether you will be back out in the field. That being said, I think we sometimes underestimate the body's ability to heal and the will that these dogs have to be out in the field. Had I not spent a year hunting with a dog out of a wheelchair I probably would be a little more skeptical myself. Good Luck! Submitted August 4 2008 Q: A: If the wound involves more than just the outer, thick layer of the pad, I would recommend a trip in to your vet to have the foot evaluated for stitches. A much more common issue would be, exactly as you describe, a crack to the surface of the pad. In these cases I would recommend a very thorough cleaning of the area, followed by the application of a product like EMT Gel or Spray. These products will offer a degree of protection to the injury and also will greatly aid in the healing process. If kept clean and allowed to heal, many of these dogs are pain-free within a day or two and the foot will heal shortly thereafter. As far as prevention I see two options. With dogs with sensitive feet, or if the foot injuries are consistently caused by a certain type of surface, then I would recommend boots. I have mentioned many times over the years Dog Booties.com and they are still my preferred source for dog boots. Your dog is still relatively young and it just may be a matter of time for the feet to toughen. Each year I try to get my own dogs more conditioning leading into hunting season and every year I still battle minor foot injuries on multi-day hunts. Most dogs' feet will adapt to the conditions they are routinely hunted or run in. I often get asked about some of the chemical foot pad tougheners that are on the market. They may work just fine but I've never used them in my own dogs, because quite frankly, they make me nervous. I've always wondered if they can change the foot pads, what else can they change?
Submitted October 1, 2008 Q.) On our third outing of the season with my two-year old brittany disaster struck. He cut himself deeply on the top of his right hind paw, over the top of the outside toe and severed a tendon. Vet care was within two hours. The vet was able to overlap and stitch the tendon (I don't know how many stitches) and there are four stitches holding the external cut together. I was seeking a second opinion as to how long the recovery time for this injury should be, my vet recommended six weeks. How much exercise (walking) can I give the dog? Is there any way to judge when the injury is recovered enough to resume hunting? I don't know who is more depressed as October passes us by without hunting, my pup or myself? A.) It will be difficult to give full recommendations without seeing your dog. There are a number of tendons in that general area, with some ranging from very important to the overall function of the limb and others that are more secondary in their function. That being said, I can give you some general suggestions with these type of injuries. With athletic dogs I always try to make recommendations based on as quick of return to function as is safely possible. This type of injury can be particularly troublesome since the tendon was completely severed, and especially so because these tissues are extremely slow in healing and have a number of extreme stressing forces working against healing. Basically the key will be to make sure you have adequate healing taking place, followed by the correct amount and type of physical therapy, in order to return to function without reinjurying the leg. Thankfully the field of veterinary rehab and sports medicine is a rapidly growing field. Unfortunately there are still not enough rehabbers out there and many are located in more metro settings. If you have a certified canine rehabilitator near you I would strongly recommend scheduling an appointment with them to set up an appropriate plan based on the injury and the degree of recovery taking place. If you do not have access to such services then I would speak with your vet about tracking someone down that he could talk to in order to develop a plan to aid in the return to function. Many injuries are straightforward enough to develop a plan for recovery; with a tendon issue we need to make sure healing is taking place, not allow too much scarring and contracture and then get the dog back to a performance level. Very likely this will have a good outcome, the key is to make sure healing is taking place and that we don't return to activity too soon. Submitted August 23, 2008 Q.) I read your blog at least once a week, thanks for having it up! The dog in question is a four year old border terrier bitch that is 20 pounds. This is a working dog used to hunt mostly groundhogs. The other day, while on her third hog of the day, she got a bit chewed up but nothing horrendous or untreatable. However, this morning she couldn't use one hind leg, off to the vet, possible torn ACL. I've read enough about the surgery, so understand how it works, but I've also been reading that smaller dogs can get away without the surgery and do just fine. Now if this were a little lap dog, but she isn't. I don't want problems down the road with her knees. Any enlightenment for a smaller dog? A.) One of the keys with your dog will be to determine whether it is a partial tear, a sprain or neither. If your dog has all of the classic symptoms of a tear but when under sedation does not exhibit evidence of a full tear, I tend to handle these conservatively at first. If it is not a full tear I will typically start with two weeks of strict rest, followed by a gradual return to activity. If your dog returns to normal activity, it can be assumed that it was either a sprain or a minor partial tear. One thing to note: at any time during these two weeks, or once activity is resumed, it is possible for these partial tears to fully tear and you will still end up needing to address the injury. Many surgeons will recommend surgery with even a partial tear. I have had enough dogs that seem to recover after a period of rest that I'll often not jump into surgery right away with these non-full tears. In regards to not performing the surgery to allow scar tissue to form if it is a full, or severe, paritial tear, I would highly recommend against that, especially in an active dog. There are cases in humans where they don't fix a torn ACL, and commonly in cats we won't fix the ACL, but almost universally in dogs a torn ACL is a surgical condition. As to which surgery is done is an entire post all unto itself, and something we will cover, as there are now a number of surgical options. The key with dogs is that allowing an unstable joint to continue is a recipe for the development of arthritis and a host of more problems down the road. Certainly I would make recommendations on a case-by-case basis, and if this were a five-pound, 15-year-old toy poodle we may go down another path; that being said, with a young, athletic dog an accurate diagnosis and fix to the problem is in order. Submitted 11/04/07: A: With the current condition of the feet it might be worthwhile to have them checked by your veterinarian. It is possible that the snow and subsequent wetness actually caused a skin infection of the webbing and that it wasn’t from the mechanical damage of the snow. We see a fair number of dogs with bacterial and/or yeast infections of the interpad area. Treatment can range from some topical sprays/shampoos to longer term oral medications. As for something preventative, I think the booties will be your best bet on that front. Submitted 10/22/07: A: With the swelling still present I would strongly recommend x-rays to see if there is something else going on to cause the swelling at the bone/joint level. If the x-rays check out it may be worthwhile to repeat some of the tick panels to see if there have been any changes. If everything checks out to be normal, then I would wonder about an injury to a ligament, tendon or muscle which won’t necessarily show up on x-rays but can definitely cause swelling and discomfort. Regardless of the test results, because she seemed to improve on the antibiotics I would strongly suggest finishing the course your vet has prescribed and resist the urge to discontinue them early. Submitted 12/22/06: A: If the swelling and discomfort have not gone away after a day or so I would definitely recommend an exam to make sure there are no long-standing injuries. And while it may take a while for some of the symptoms to subside, at a minimum your vet could place her on some anti-inflammatories to help with the discomfort. One of my hunting partners related a cold-weather hunting story similar to yours with his dog. While the dog performed admirably throughout the hunt, at the end of the day the dog was spent and clearly hypothermic. His hunt did not involve a lot of ice busting but was in frigid, icy waters. I could tell when he was relating the tale how shook up he was at the after-effects of hunting the dog, he had to carry the dog back to the truck and message him for hours after returning from home. These dogs will do anything for us, and, as a result, will put themselves in situations they shouldn’t. It is at these times we have to make clear decisions about the situations we put them in. For some reason icy water hunts are ones I try to avoid with my dogs. I’m sure your dog will be fine, but just some things to think about the next time. Submitted 12/26/05: A: In Maggie’s case I noticed the swelling, which after taking a sample from it, I determined was an area of infection. I attempted to manage it with antibiotics and Epsom salt soaks, but after a week without any improvement I went in to find the offending object. While the soaks did not alleviate this thorn, they did draw out numerous other thorns from the rest of her pads which absolutely amazed me. These dogs are tough, but we owe it to them to make sure they are as comfortable and protected from foot injuries. It sounds like your dog has been battling this for several weeks now, I would definitely get her in to your vet so that the problem can be properly addressed.
Submitted 12/20/05: A: My recommendation would be to go into it expecting some post-surgery headaches and be pleasantly surprised if there are none. You will need to keep the dog from licking the area, but at the same time you will not want it to be bandage during the entire healing process. I have seen every vet I’ve worked with have this procedure go smooth and I’ve seen everyone (me included) have it not go so smooth. All of the dogs, however, end up being just fine, it may have just taken some of them a little longer than the rest. Submitted 9/07/05: A: They are designed for sled dogs but work great on hunting dogs. I have both the basic model and the Cordura models. For general protection they work great, and I have hunted with them extensively in prickly pear country and they do the trick there as well. The only complaint I’ve had with them is that in very rocky conditions you may only get a day or two out of them; I had an acquaintance use them chukar hunting and he went through several pair…but again when you price them against hunting-specific boots they are the way to go. I don’t rely on the Velcro closure alone and usually either use medical tape or VetWrap to keep them in place. I’m going to attach a picture of my setter with the boots on, typically I just wrap the wrap around the top part and onto the fur…in this picture they are wrapped further down the foot only because I was out of the thin wrap and had no choice. Submitted 5/03/05: A: Also, one note on hips, you mention she has good hips but don’t say if they’ve been x-rayed. If you assume she has good hips because her parents were certified than they could still be an issue for her. However, if she’s been x-rayed than I would go back to my original concern of a knee problem. Submitted 2/12/05: I've read quite a bit about cruciate injuries and the long-term prognosis regarding arthritis, muscle and joint soreness, etc. My question is should I being adding some type of joint supplement to his food to help alleviate any long-term arthritis as he gets older? Should I be adding glucosamine, Rimadyl or any other medication that will help him long-term? A: Now to your question on medications, I think that supplements like glucosamine and chondroitin are good choices for dogs with any type of orthopedic condition. For a number of years I did not use them at all in practice, being very skeptical of their effectiveness, but after hearing too many success stories I decided there had to be something to their use. More studies are coming out that also advocate their use, which makes me more comfortable in recommending them. It is important to note you'll want a supplement that has both glucosamine and chondroitin and not just one or the other. I would talk with your veterinarian about the dosing levels for your dog, as there is typically an induction course, at higher levels, followed by a maintenance level. The anti-inflammatories you mentioned likely were used post surgery to help manage pain. Their future use will be dictated by your dog's recovery. Most dogs do great and do not require the use of these drugs as they recover, others will need them during and after athletic events. I had my own knee redone two years ago and I'm just finally getting to the point where I can run and bike without much discomfort, although part of my problem was likely going overboard with the physical therapy. Basically I would take everything in stride, continue the controlled recovery and use medications when needed and under the direction of the surgeon. Submitted 12/13/2004: My question is, what would you recommend to treat his paws with to toughen them up? A: That being said, I think the conditioning you are doing will do more for the feet than a chemical. I think this is a case of practicing like you play, and unfortunately, outside of exercising in the actual terrain, you may never come up with a perfect solution. You may also want to investigate other boots; I recently received some pictures of the type of boot I use that had been hunted one day out West and were absolutely shredded. These same boots can last me several seasons. It sounds like you are on the right path in preparing your dog. The only other thing I would advise is that when you hunt a dog hard, you are virtually guaranteed to have some nagging little injuries, bumps or scrapes. As long as you make sure you address these adequately, to help the healing process, most dogs will continue to hunt fine even with minor aches and pains. Submitted 12/8/04: A: As you are located in the northeast I would also have tick-borne diseases like Lyme’s Disease on my mind, and if she hasn’t been tested, I would recommend performing the test. Unfortunately some of the growth diseases like panosteitis can only be diagnosed after everything else has been ruled out. Submitted 11/15/2004: A: As far as the swelling, if the dog otherwise seems okay and is using the leg, there is likely no harm in waiting through the weekend. If the swelling persisted for more than a day, if the dog became sick or painful, then it is a situation that should be addressed by a veterinarian. There are a lot of tendons, ligaments and small bones that all come together in the “wrist” region and can sometimes make a diagnosis and treatment plan tricky. Submitted 10/14/04: A: Sometimes I will sedate the dog and completely cut the nail off if it appears it is going to cause a nagging problem. These will usually require a bandage/wrap for 3-4 days to protect the toe in the healing process. Initially this seems drastic, but after the 3-4 days the nail usually is of no further problem and re-grows normally. As far as prevention, keeping your dog’s nails as short as possible with regular clipping is the best defense. For your particular situation it sounds like the dog is doing fine with the nail, other than the licking, because of this and the potential for infection I would probably touch base with your vet. As far as hunting is concerned, if he seems to get around you will probably be okay. My one caveat here is that you may lengthen the healing process. With hunting seasons being such a short part of the year, I usually make it my goal to get dogs back out in the field ASAP, although with specific care instructions and adequate warnings. Submitted June 24, 2004: We started to see a large lump develop where the dew claw used to be. When we inquired to our vet they said not to worry that it was a reaction to the stitches under the skin and that it would clear up. It’s been almost 5 weeks and it still has not cleared up. It’s very hard and is much larger than the dew claw was. My fear is that there has been a substantial amount of scar tissue that’s built up, or bone has started to grow back under the skin and it will be even more of a problem than the dew claw was. Any recommendations on what type of treatment or diagnosis I should look for? A: Your dog’s case very well could be a suture reaction. That is one of those situations which you can’t predict beforehand and it will eventually resolve. Basically the dog’s body is trying to get rid of the suture quicker than is normal. I would have the veterinarian who performed the surgery take a look at the surgery sites to see if it needs to be addressed any further. The surgeon should be able to determine if it is a benign swelling or something of more concern. Submitted 1/12/07: A: Toe injuries are common to hunting dogs, and often the injury will not show up on x-ray. The diagnosis can sometimes be made with special manipulations of the toe. Also, with some ligament and tendon injuries a dog will need to be sedated and the joint placed under stress (i.e. manipulated forcefully in various directions) to see if the joint is more mobile than it should be. Since you are in grouse country I am going to assume you are in Lyme country, which would put you at risk for other tick-borne diseases. When I practiced in tick country every limping dog was a Lyme disease suspect until proven otherwise. Even with vaccination and tick prevention these dogs can develop issues. It was also my experience that the dogs that were vaccinated would not get as sick as the unvaccinated dogs, which made the diagnosis a bit more difficult. If the dog is limping there is a problem; however, it may take several exams and visits to determine the cause. Depending on where you are located it also may be worthwhile visiting with an orthopedic specialist or at a minimum have one evaluate the x-rays. Submitted 12/23/06: A: Certainly there are other issues that could be involved with the lameness still relating to the knee. I would say, though, that the vast majority of these dogs have had successful surgery but still would benefit from a rehab program. If there are no physical therapists in your area, there are also protocols available that have home exercises that can also help the process. Submitted 3/8/06: A: I had a client this year that had a dog with a hyper-extension injury to its carpus, while doing some research into rehabbing the injury I did come across some carpal wraps for sporting dogs. Here is a link to a company that carries these types of products (both for during workouts and for icing after a workout): http://www.canineicer.com/order/product/index.htm I do not have personal experience with using them, but I do think they look like they’d work great with dealing with these types of injuries. As far as supplements are concerned I would definitely talk to your veterinarian about using a glucosamine/chondroitin supplement. Previously I was skeptical of their benefits, but now I am a strong believer in them. Talk with your vet about dosing and particular products they would recommend. There is tremendous variability in this category of products, and while the ones from your vet may be more expensive, often this is because they are using higher quality ingredients, or in the case of a product called Cosequin, because they have done extensive research into its effectiveness. Submitted 1/30/06: A: First on the levels in dog food: these levels, even in their highest levels in food, are just background levels and not to the level we would term therapeutic. I look at them as being present to provide the building blocks to build and maintain healthy joints, but would not be significant enough to address arthritis issues. My personal change came in two forms: one is that I started having more and more clients start to use these types of products and profess the dramatic changes they were seeing in their dogs. The second influencing factor was in my own body. I had gone through an ACL reconstruction and meniscectomy and had been struggling with recovery for the better part of two years. It may have been a factor of time, but after the two year period I also started taking glucosamine and chondroitin and went from constant aches and pains to literally being able to complete a marathon. As far as giving it as a daily supplement, this past hunting season my seven-year old Chessie started to show signs of joint and muscle problems, and I immediately put her on a combination product that also contained antioxidants. As a preventative measure, I also started my four-year old English Setter on this product. Now, this is not something I would make a blanket recommendation for all dogs, but depending on the intensity of the hunting/training, the age of the dog and other factors it is something that I discuss more frequently with clients than I had even a year ago. I would recommend talking this over with your veterinarian and find a product that would be right for your particular situation. Submitted 1/25/05: A: Submitted 11/07/05: A: As far as having an ACL injury repaired, this is one of those issues I am unfortunately highly opinionated about, and so it is probably best to get other sides of the opinion before making a decision. That being said, here is my standard take. The TPLO is very, very, very popular right now, and I don't have a lot of explanation as to why, other than the dog appears to return to function a little quicker (though not overall function any better). One of my takes on this (and this is PURELY my opinion) is that surgeons have a "chance-to-cut-is-a-chance-to-cure" attitude and the TPLO is a more invasive procedure. It is one of the only patented procedures and costs money to learn and purchase the equipment...so it must be better right?? I'm still not sold. One of the orthopedic surgeons at Iowa State has done extensive studies to show that when multiple techniques are compared (with proper follow-up and rehab being equal) that the TPLO is not a superior procedure...no matter the size of the dog. In fact, most dogs will return to equal functionality (based on force plates, gait analysis, etc.) just at varying times. This last summer I saw a case on follow-up in which that surgeon had done a TPLO, which shocked me (he refused to do them when I was in school). I called to ask him if he had changed his opinion, and he said absolutely not. He still is not sold on the TPLO but now gives clients the options and lets them choose because, as he put it, just about the time you convince someone they have to go only one route there will be complications, and so now he gets clients more involved in the decision. It is crazy the number of people that demand a TPLO as a result of the hype over this procedure. When I pressed him about the two procedures he once again reiterated why I am not sold on the TPLO, and that is if it goes bad, you can have very bad consequences. In the surgeon's words, "I've never had to amputate the leg of an extra-capsular (the other repair technique) dog, but I can't say the same about a TPLO." There are complications with both procedures, but one set of complications are more severe, in my opinion, and personally I would never have the TPLO done in my own dogs...and again I will admit I am in the veterinary minority with that assessment. Again, this is just my opinion, and while many vets feel the TPLO is the way to go in performance dogs, I just can't in my own mind understand why. No matter the repair technique I still feel the biggest component to success is post-operative physical therapy, which is an entire other discussion. Definitely investigate, and have a physical therapy plan in place prior to the surgery. Submitted 5/03/05: We would very much like to get the dog rehabilitated to the point that she could run again, but are not sure whether that will possible. She is also taking a non-steroidal anti-inflammatory drug for arthritis. We did not do any physical therapy after the first surgery and wonder whether it is too late now, 10 months after the original injury. A: I have also seen a few dogs that, as things heal, either scar tissue or the repair suture (the wire in your case) will slide along the outside of the knee and make a noise as it pops across the bones. Usually it doesn’t cause the dog any problems and goes away with time as the area remodels following the surgery. My recommendation would be to have the dog re-examined and if the meniscus is suspected you are likely looking at another surgery. As far as physical therapy goes, in my mind this is the absolute most important part of the surgery process in getting these dogs back to full function. There are a number of hunting, trial and competition dogs that have blown out their ACL’s and go on to lead perfectly normal, productive lives. In an ideal world, the rehab will start immediately post-surgery, but it can essentially be started at any time to bring a dog back to function. There are starting to be more and more stand-alone veterinary physical therapy centers with modern facilities with therapy pools, underwater treadmills and the latest in treatment devices. If your veterinarian is unaware of one they could inquire at the nearest College of Veterinary Medicine or with an orthopedic specialist. Submitted 3/17/05: A: As far as non-surgical options, the most important thing, in my opinion, is to keep any extra weight off of these dogs…to the point they are almost on the thin side of normal. Secondly I would start her on an exercise/physical therapy program specifically designed to help dogs with hip problems to gain muscle mass. Sometimes when starting these programs the dogs will get a little worse before they get better. Basically the goal is to strengthen the muscles that support this region and take some stress off of the joint. With weight loss, exercise and the appropriate use of anti-inflammatories I have seen some dogs with very bad hips, on x-ray, lead a very functional life. With surgery, in a dog this age hip replacement may be your best option, it may be worth having the x-rays sent off to a specialist and get their opinion on how to proceed. You also mention cost; this would be the time to get an estimate on that front as well. There really isn’t any standard pricing on these types of procedures and pricing will vary depending on what part of the country you live. A lot of the success will depend on the surgeon’s level of experience with the procedure. Another surgery option that may be discussed is a femoral head and neck excision. Basically the ball is removed and a false joint is formed. This seems to work best in smaller dogs though I have seen it work well in larger breed dogs, where the procedure is typically not recommended. This will not be the first choice of most surgeons, but if a hip replacement is not feasible and the conservative treatment is not working this could be an option. The level of success will be somewhat more variable than the other options because you are depending on the body to form a false joint. My usual course of action with these dogs is to attempt conservative treatment and if that is not working then I like to talk with an orthopedic specialist for further options. Submitted 3/01/05: Late last week her left rear leg puffs up. I kept and eye on it, but by the weekend I noticed green stuff that appears to be stuck into the old scar on her leg. At first, I think it’s Play-Dough or something she chewed that the kids left out, but on closer inspection I see that it is a nylon-like string ACTUALLY the stitching from her ACL procedure sticking out of her leg. On Monday morning we took her to the vet and that day she has more surgery to remove the stitching that was wrapped in her knee. The vet says he’s never seen this, almost two full years after the fact, and the other stitching in the knee is in good shape. He says the stitching material isn’t doing much anymore, and takes it out, saying the knee is pretty well healed (meaning enough scar tissue has formed) from the ACL injury. Have you heard of such a thing? A: This is also one of the reasons I prefer this type of procedure to something like the TPLO. With the extracapsular procedure if there is a problem, you have a chance to fix it or at least deal with it. I had a client that had the TPLO done at a university and had the same reaction to the plate that was placed in the knee, prior to enough healing taking place. Unfortunately when you remove the plate it isn’t like just taking the stitches out. The biggest worry I would have would be if all of the suture material was removed, not by fault of your vet, just because it had started breaking down. There is potential that you may have another bought of surgery if another draining tract forms. Submitted 2/12/05: I've read quite a bit about cruciate injuries and the long-term prognosis regarding arthritis, muscle and joint soreness, etc. My question is should I being adding some type of joint supplement to his food to help alleviate any long-term arthritis as he gets older? Should I be adding glucosamine, Rimadyl or any other medication that will help him long-term? A: Now to your question on medications, I think that supplements like glucosamine and chondroitin are good choices for dogs with any type of orthopedic condition. For a number of years I did not use them at all in practice, being very skeptical of their effectiveness, but after hearing too many success stories I decided there had to be something to their use. More studies are coming out that also advocate their use, which makes me more comfortable in recommending them. It is important to note you'll want a supplement that has both glucosamine and chondroitin and not just one or the other. I would talk with your veterinarian about the dosing levels for your dog, as there is typically an induction course, at higher levels, followed by a maintenance level. The anti-inflammatories you mentioned likely were used post surgery to help manage pain. Their future use will be dictated by your dog's recovery. Most dogs do great and do not require the use of these drugs as they recover, others will need them during and after athletic events. I had my own knee redone two years ago and I'm just finally getting to the point where I can run and bike without much discomfort, although part of my problem was likely going overboard with the physical therapy. Basically I would take everything in stride, continue the controlled recovery and use medications when needed and under the direction of the surgeon. Submitted 11/3/04: A: ACL spains/strains/partial tears are fairly common and most will heal with strict rest (usually around two weeks) and then a gradual return to function. The problems come with those dogs that do not get better after the rest period. At initial presentation there is no way of diagnosing the degree of injury unless it is a complete tear, a slight sprain will act just like a nearly complete tear. I always warn people that there is potential during the recovery period for a partial to become a full tear, the other stipulation is that if the dog is no better in two weeks we get them back in, sedate the dog for re-exam of the knee and x-rays. If there is still no "classic" drawer movement in the knee I'll usually get an orthopedic surgeon on board, if for no other reason than to take a look at the x-rays. Almost across the board the surgeon is going to recommend going in and exploring a knee that is getting no better, especially if the x-rays indicate knee injury, regardless if it is a full or partial tear. If I am unable to palpate a complete tear I will take both knee and hip x-rays to rule-out other sources of the lameness. A note on the surgeries/surgeons---vast majority of private practitioners can perform this surgery and perform it will, I'll be honest though, if it were my dogs or any sporting dog I would have an orthopedic surgeon perform the surgery. These people do as many in a week or two as the rest of us see all year. As far as the surgeries there are two basic techniques --- neither of which repairs the ligament. The older of the two techniques is the extracapsular method, which at its simplest uses high strength fishing line to re-create (outside of the joint capsule) the function of the cruciate ligament. The second method involves changing the confirmation of the entire knee by changing the slope of the tibia, the bone is cut and rotated. The best analogy I have heard is a wagon on a hill and the cruciate ligament is the block under the wheel that keeps the wagon from rolling down the hill. With the extracapsular technique you are replacing the block or maybe tying a rope to the wagon to keep it on the hill...the TPLO method basically removes the hill. This technique and the necessary equipment, was patented and thus anyone who can do it has a fair amount of time and money invested, thus I'd be cautious of a surgeon that only pushes the TPLO and doesn't at least discuss the other method even if their recommendation is the TPLO. I previously pushed one method over the other but both have complications and about the time you convince people to go one route they will have a failure and place the blame on your recommendation, so now I talk about both and the complications and let the client choose. To me the most important part of the surgery is getting the dog in a physical therapy program to rehab the knee, unfortunately these are few and far between and usually only in large population centers or at vet schools. Even if you can't find one near you, you should meet with one to be educated on how to go about the rehab at home as this is the single most important point to recovery, and the point overlooked by most general practitioners. When physical therapy is utilized both techniques are equally as "successful." If you end up at the surgery option this is a bridge we can cross later. Many dogs return to productive field careers after these surgeries. In fact in one of the clinics I was at this summer I had a field trialer campaigning a dog that had the surgery approximately a year ago. It's all about finding a good surgeon, sticking with the rehab and really putting all the odds in your favor. Submitted 10/30/04: A:
|
