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Knee cap/Limping

Reen
June 28th, 2007, 07:05 PM
My 6 year old lab has had an on-again/off-again limp with her back left leg fore a few months now. Our vet has taken two sets of xrays and says there are no torn ligaments but says the knee cap pops in and out. We did chiropractic treatements and have tried to limit her mobility, although the vet tells us to keep exercising her. The vet even suggested swimming which made my dog so sore she could barely lie down.

Our neighbour is also a vet and is on the other side of the fence, suggesting that our dog should be on severe rest and if the ligament was torn, require surgery.

Reading the boards, I'm wondering about the luxating patella issue but see it relates to a lot of smaller dogs, has anyone seen it with a large dog like a lab?

We're seeing a third vet next week to see if I get any support for either vet. It's confusing, one seems to be taking it to lightly and the other very seriously.

Any suggestions/comments?

Frenchy
June 28th, 2007, 09:30 PM
Sorry I can't help you, but just wanted to say it must be hard on you to have two different opinions like this. I would get a third opinion too. Good luck, :fingerscr please keep us posted.

Dr Lee
June 28th, 2007, 10:43 PM
Reen,

To answer a couple of your questions/couple ideas:
1) Luxating patellas in big dogs? Yes it does happen, but not as often. It is more serious in larger dogs and often requires surgical correction. (the smaller dogs I think would benefit from the surgery but many are able to do well without the surgery).
2) Rest or no rest? For torn/stressed/inflammed joints/ligaments/tendons - rest would be the recommendation of choice. So if there was a partial tear in the ACL for example, rest is good. With some luxating patellas - increased muscle tone is thought to help tighten the joint and keep the patella inside. Gernerally this is used on young small dogs. Swimming is great as it is non-traumatic (assuming your dog likes to swim). So if there is inflammation - rest. If is is anatomic with minimal inflammation - exercise may help but since you pet is so sore afterwards I would tend to agree with the resting especially until we get a more complete diagnosis. We don't want to make matters worse.
3) Regarding the third opinion. I think this is an excellent idea but I would recommend that you receive it from a board certified orthopedic veterinary surgeon. Are there any specialists around you?
4) What else to do? Chondroitin/Glucosamine/MSM supplementation can help reduce pain and inflammation as well as promote healing. This can be obtained at most pet stores or health food stores.
5) "one vet takes it lightly, the other seriously". Limping in dogs and cats denotes pain. They just don't limp for other reasons. So if you family member is suffering in pain.... yes I agree with your neighbor, I would take it seriously.

Sounds like you are doing everything right. Your pet is lucky to have you. I know it seems confusing; we are here to help. Let us know what the third vet says!

Good luck

krdahmer
June 29th, 2007, 01:12 AM
I'm not sure about big dogs, but I had this last year with my cat Fagan. The knee went in and out of place for about 5 months. When it went out, we had to limit his motion (no jumping), so we set him up in a cage in the bedroom. Eventually it just stopped going out of place (going on 8 months now:fingerscr ), we did have to slim him down too as weight had played a part in his.

The vet was sure she felt the ligament out, but since we took the wait and see approach (she scared the hell out of us saying they could have to take the leg if it wasn't fixable:eek: ), we'll never know exactly what it was.

Oh and has your dog had any cortisone shots lately? Like right before the injury? (Aparently it weakens the joints and can cause this kind of injury.)

I don't know if that was any help, but I wish you and your pup the best!:goodvibes:

Reen
July 3rd, 2007, 10:25 PM
Well we got the third opinion on Bree's leg today. It was diagnosed as ruptured anterior cruciate ligament. 3 variations of surgery were suggested. The recommended procedure is "TPLO" - Tibial Plateau Leveling Osteotomy.

Our vet neighbour was concerrned it could be a torn ligament, but our regular vet kept assuring us it wasn't.

Unfortunately despite having nearly 1.0million people in Edmonton, we don't have a board certified surgeon but there is one in Calgary and I'm looking into it.

Thanks for everyone's advice. Has anyone ever been through the TPLO surgery?

rainbow
July 4th, 2007, 04:40 PM
We've just been through the TPLO surgery. Our yellow lab had his operation on March 7/07. For the first 8 weeks after the surgery they are only allowed to go outside to pee and poop on a short leash. Then, the next 8 weeks they start their rehab walking where you go for a really short walk the first 2 days and gradually increase the length of time every couple of days.

Only veterinarians that have been licensed by the developer may perform a TPLO surgery. It is more expensive than the original cruciate ligament surgery but highly recommended for active dogs. If your dog is older and laid back you can probably get the less expensive operation done. They use something like "fishing line" to tighten up the ligaments. Our lab was almost 20 months old at the time of his operation. He is very active and we also have a Siberian Husky that is 6 months older than him. They love to "play hard" together and the hardest part was keeping the two of them apart for his recuperation time. We used a large wire crate for the lab and it worked out really well.

We could have gone to the one in Calgary but decided to go to the one in Kelowna as it is a bit closer for us. He is an excellent vet and I highly recommend him.

Here are a couple of websites on TPLO surgeries:

http://www.westlakeanimalhospital.com/Encyclopedia/Acral_Lick/Addison_s_Disease/Adrenal_Gland_Disease__Ferrets/Anal_Sac_Disease__Canine/cruciate_ligament_rupture__can.html

http://www.vetsurgerycentral.com/tplo.htm

Reen
July 4th, 2007, 06:29 PM
Rainbow,

Thanks for the information on the recovery time. We have an appointment booked August 15th when the Calgary surgeon will be in Edmonton. He will do a consultation and then surgery the same day. Bree is 6 and still very active, or at least until this happened.

How did you rest your Lab when indoors? We've cut back on Bree's exercise prior to the surgery and have started the short leash in the back yard. Unfortunately our girl got spoiled and when put in a kennel is reacting poorly. If we can give her a small room to stay in where there is nothing to jump on, is that acceptable? I know we need to rest her, but it's so hard to see her almost panic over going in the kennel. She's already guilting me because our younger lab is out running with me!

mummummum
July 4th, 2007, 07:23 PM
Well, I guess I'll just be disagreeable then :rolleyes:

A TPLO is recommended where there is a complete rupture in the cruciate. Even then some dogs recover JUST from bed rest. The fishing line procedure is not a TPLO. But in dogs who are quite young and still able to "bounce back" or older and not at all active it's a good option.

A TPLO involves sawing off a half round at the top of the tibia (lower leg) and putting a length-wise plate and some screws in place. This changes the way the leg moves, it does not create better stifle (knee) stability.

This http://vetsurgerycentral.com/tplo.htm is a pretty decent link.

A little controversy... always good for the soul:crazy:
http://home.earthlink.net/~tiggerpoz/id4.html

Interesting reading ( in Italian every other page !!)http://www.biblio.vet.unipi.it/annali2005/253.pdf

The thing is whether it's a luxating patella, or a ruptured ACL complete bedrest can't hurt. If it's a torn but not completely ruptured ligament it may well heal on it's own. If it's a completely ruptured ACL ~ your dog will not get any more lame.

Swimming is NOT a good idea during bed rest and the first two weeks of post-op as it can result in tendonitis where no tear is present as the dog tries to compensate. Hydrotherapy using a treadmill or with complete body support by an adult in a warmed (higher than body temp) pool is very helpful 2 weeks post-op or one month (or more) after onset of complete bedrest.

I've been through two TPLO's and I would now like the T-Shirt thank you very much!

rainbow
July 4th, 2007, 07:42 PM
Well, it's nice that the specialist comes to Edmonton so you don't have to travel. :)

Yes, a small room with nothing to jump on and off is okay. Are you just going to baby-gate off the doorway so you don't have to close the door so she doesn't feel isolated? :)

When resting Chase (our lab) indoors he was in his wire cage. He was crate trained as a puppy as we didn't want Logan (our Siberian Husky) to bother him at night and also it was summertime and we left them at home because of the heat when we had to go into town. Once he was about three months old he never seen the inside of a crate again until his surgery. We thought for sure he would put up a fuss but he didn't except at bedtime when he would whine. :rolleyes: So, I put the mattress from the spare twin bed on the floor and slept beside him for three months. No.....he's not spoiled either. :laughing:

I'm surprised that the first vet you seen didn't diagnose the ACL especially after taking xrays. My vet (and everyone else's that I've heard with this diagnosis) suspected it after just feeling the knee and only xrayed for confirmation. :shrug:

Did either of the other two vets tell you that there's a good chance the other knee will go because of the compensating that Bree is doing now? Our vet told us there is a 75-80% chance but the specialist said "oh no.....it's on about 50%. :rolleyes: With the luck we have I know it will happen. :eek:

If you have any more questions, just ask. :) And, keep us posted on how everything goes. :fingerscr :goodvibes:

Reen
July 5th, 2007, 03:13 PM
We're on day 2 of rest for Bree. It's not the complete bed rest that we'll need to do after surgery, but walks are limited, no more stairs and more kennel time.

Rainbow, I'm incredibly frustrated by our first vet. We had just made a change to her based on a number of recommendations. She kept talking about the knee cap and how chiropractic treatments would settle it. She even suggested more exercise and swimming. After the swimming, Bree was in such pain she could barely lie down. At that point our neighbour, who is a vet suggested the torn ligament. We went to get our x-rays from the first vet and they asked to see Bree again. After even sharing our concerns about the torn ligament, I was told it was not a problem just an over-exertion sprain. The third opinion confirmed our neighbour's suspicion of the torn ligament.

I'm also beating myself up ::frustrated: as I suggested this vet based on referrals. She really seemed decent for other issues but just didn't seem to take this seriously enough. I wasted 2-3 months on her approach.

I have heard to expect a surgery on the second leg so I better start budgeting and saving now.

Thanks again everyone for the great advice.

rainbow
July 6th, 2007, 06:42 PM
Good luck and keep us updated. :fingerscr :goodvibes: :goodvibes:

growler~GateKeeper
July 7th, 2007, 12:47 AM
You mentioned chiropractic treatments which may help If it was knee cap, but like other vets suggested if its torn/strained acl has any of the Vets suggested Laser Therapy? My Cally :dog: Dal x Lab in his later years had arthriitis in his hips & lower spine he was stiff & limpy, could hardly walk up the stairs. His Vet recommended the Laser therapy, she also suggested Acu-puncture, I decided on Laser therapy. We were referred to the Critical Care facility in our area and after the first treatment he was jumping in the truck before I could lift him in. He had Laser treatment which targets healing deep down into the cells of the muscles, massages to help relax & loosen tension and strenghtening exercises to build up muscle & resistance to strains. The critical care clinics are by referral only.

I'm not very familiar with acl injuries but hope this might help.
:goodvibes: keeps us posted

MERI
July 7th, 2007, 10:18 AM
Bilbo underwent TPLO year ago. The first three weeks were difficult, because he wanted to leak the wound. So e-colar is highly recomended.
I got if from the vet who did surgery, but I had to ask for it.

Bilbo is not very active (basset hound), so it was OK to keep him in one room. But we had to do stairs every day (second floor) to go outside.
But everything went fine and now nobody can tell that he went through it.
Even scar is almost invisible.