How Do You Know What To Do?

[Cosmolo]

As some of you may know, our 2 1/2 year old cross breed Dexter has hip and elbow dysplasia- every joint is affected. We saw a specialist when he was younger and chose at that time to manage him conservatively where (after some experimenting) things seemed to go quite well for quite some time. On his very occassional sore days he would rest and 12 hours later was absolutely fine, didn't even require anti inflams although we had them on hand. We thought we had hit on a good plan that was keeping him quite comfortable considering the severity of his issues. We chose not to do surgery as we were concerned about the prospect of 12 months of surgery/ recovery/ surgery/ recovery.

In late February of this year, things started to go downhill. Since then his bad patches are much more frequent and much more serious- he goes from bouncing around being normal to crying when he goes to walk and then becoming very distressed (he shakes and looks really worried) as i don't think he understands where the pain is coming from and why it happens. He also takes longer to 'bounce back' even with anti inflams and cartrophen injections etc. We went to the vet about 6 weeks ago and we trialled giving weekly cartrophen (no difference to the decline although some short term relief) as well as a J/D formula (which he wouldn't eat) and anti inflams when he is really bad (which now seem to make little difference).

I will be taking him back to the specialist in the next week, as he is having another bad patch that started tonight. There is no consistent reason for the bad patches- some days he runs and plays and is fine, other days he does very little and is sore. Some cold days- no problem- some warmer days, he's sore.

I think i know all of the options but my question is- how do you decide whats right? I am scared stiff of making the wrong decision.

If we go surgical, my biggest concern is how his other joints would cope (as they do one joint at a time) and whether or not he could mentally deal with the recovery time- he is a very full on, intense kind of dog and although crate trained, i think he would go either a little nutty or completely insane. I have been doing some reading about the stem cell therapy- my concern is how far gone he is and whether or not it would have any impact, particularly without removing the bone fragments that must be in the elbows.

And then i wonder if we just continue as we are- with management, knowing he's not going to live a very long life but we trying to make it a really good one. But what do i do if we then get to the point where he is in too much pain?

So how do you make the right decision? Especially when thinking about it is the most distressing thought. :p

[Parkeyre]

I'd look seriously into surgical, and maybe have him go somewhere where he can gain his strength and heal well without the otherdogs making him want to play.. a parent's house of something?

Best of luck xx

[Cosmolo]

Thanks for the luck Bonnie.

There's nowhere he could go where there are not other dogs unfortunately. And i can't say i'd trust anyone to keep him quiet- he's not the easiest dog to handle! It would be an indefinite time frame too- particularly if multiple surgeries were involved, and require someone to not work full time too- as they'd need to let him out of the crate to toilet him etc.

[OSoSwift]

Cosmolo - you already know I feel your pain.

There is no real answer for what you are asking. I know I have asked the same thing!

I sat down with a piece of paper and a pen to do pro's and con's.

There are a lot of what if's with surgery and you never know the outcome until you do it - which makes it harder. When I had my girl I had worked in a vet hosp for a while and seen the end result of a few dogs that had had surgery for the same thing -and some a bit different - that my girl had. I really didn't see that the surgery would gain her enough improvement or help her to live a longer pain free life.

I think you need to try and sit down and reaaly weigh up the pro's and cons and try to turn the emotional side down a little which I know is nearly impossible.

My choice was to try and make the time she had left as comfortable as possible. We gave her what ever we could in regard to pain relief and let her run at the beach and play and all the things we had kept restricted as I decided quailty for a short time was better than a very restricted life for a long time.

After seeing the dogs I did after surgery I decided that she would go through lots of pain for not a lot of gain - it was only her elbow that were the issue.

However at the end of the day you can only make the best choice for your boy and your situation which will be different from other peoples. Whatever decision you make will be the right one for you and your boy. It is extremely hard as you want to be the best you can and sometimes you just don't know what that is until you try it. The idea of putting your dog through painful surgery and severe restriction can be very very hard, but for the surgery to have a chance to work he will have to be VERY restricted for a set time. Can he handle it?? If you really think he will struggle then that has to be a consideration that is very high up on your list.

I really do feel for you, I know just how much it breaks your heart. Sometimes getting to your decision is the hardest bit.

And then i wonder if we just continue as we are- with management, knowing he's not going to live a very long life but we trying to make it a really good one. But what do i do if we then get to the point where he is in too much pain?

Cos I think you already know the answer to this and I am sure that is what is breaking your heart. And I also know it hurts...a lot

Edited June 8, 2010 by Rommi n Lewis

[Lily123]

I have no answers Cosmolo. I can feel your pain from your post and I just wanted to wish you the very best of luck. You are obviously very caring and informed and I think just have to trust your gut instinct (easy to say however). Hugs to Dexter.

[Cosmolo]

Thanks Rommi- that post really helped When i separate the emotion i say no surgery- but then the emotion comes back and clouds everything. He is my heart dog and i find it so hard to deal with this as well as the thought of him not being here.

When i was younger i had a horse who injured himself severely. He had 2 lots of surgery and had to be confined for 3 months and was already a high spirited horse- it sent him nuts and he was never the same- even after his physical recovery. I regret going through with the surgery we gave him- benefit of hindsight. I am torn as to whether to let that weigh on my decision with Dexter too.

[tez]

You poor love...so hard to know whats right when there are so many unanswerable questions right now.

Just remember that you know Dexter best and how he will cope or not cope with surgery.

Is there any chance that you can talk with someone who has a dog with similar temperment to Dexters who has had the surgery? Hopefully the specialist will be able to put you in touch with someone!

Also if you have a good relationship with your vet, could you have a chat to them as well. When my last dog was going downhill fast with arthritis and reached a crisis, I looked my vet in the eye and asked her what she would do if this was her dog...and why?

IMO our dogs are here for a good time...being here for a long time is an added bonus but only if they are still MOSTLY having a good time!

[Dogsfevr]

I would be trying Bowen therapy.

I have a dog with bad arthritis & another issue & There are days he can hardly walk , we do monthly bowen which is a godsend for all his other muscles.

Sore muscles are just as painful & he would be using his over time.

We are luckythe cartrophen weekly work & he is on Rosehip tablets but i find in his case the Bowen is the main factor in keeping hi healthy & active

[OSoSwift]

Thanks Rommi- that post really helped When i separate the emotion i say no surgery- but then the emotion comes back and clouds everything. He is my heart dog and i find it so hard to deal with this as well as the thought of him not being here.

When i was younger i had a horse who injured himself severely. He had 2 lots of surgery and had to be confined for 3 months and was already a high spirited horse- it sent him nuts and he was never the same- even after his physical recovery. I regret going through with the surgery we gave him- benefit of hindsight. I am torn as to whether to let that weigh on my decision with Dexter too.

I am glad I helped you a little - still suxs though!

It is extremely hard, but I can say reaching the decision is the most soul wrenching thing to do, which ever one that is.

I agree with the Bowen as well, Rommi had a vague lameness on and off for 4 week despite strict rest. One Bowen treatment and she bolted after a bird - I thought oh no back to square one - nope still sound as a bell.

I would also try acupuncture and until you have decided what to do, try him on anti-inflammatories everyday - it will at the very least give him a really good less painful break.

Dogs are very stoic and chronic pain can really slow them up, even when they are not showing too many outward signs of it.

This may not help but I hope it does.

I also try to make my decisions based on the facts infront of me without the emotion because it hurts like hell, but if you make the decision to the best of your knowledge you are doing the best thing by your dog. We don't want to lose them - of course we don't - but I believe we must always put our dogs needs first.

I have shed my own few tears just reading and replying!

Biggest biggest hugs to you all.

[Mrs Rusty Bucket]

The dog is young, would heal relatively fast.

I know I was going nuts without surgery I needed when I buggered my ACL (knee). Getting it fixed has gone a long way towards getting my life back.

The trick for a dog would be managing the rehab.

Until the wound healed you wouldn't be able to do much of anything, but after that, water therapy would be great, is that available to you for your dog and can you afford it? For me, three to five sessions a week was enough to keep everything working and build up the muscles around the affected knee.

I did do some compensating damage - but that was mainly before the reconstruction. I know that would be different if all the joints are buggered.

So fifteen minutes of walking against water - is worth an hour of walking on dry land - or something like that. Same for swimming - so that could go a long way to preventing the stir crazy desire to run like mad for the rest of the time.

My brother's staffy broke her leg and was stuck in a crate for, I think it was, 6 weeks. She coped without going nuts. And she is a very active dog.

So write down what your expecations for improvement of quality of life for the dog would be, and how much you can afford to spend.

Investigate alternate therapies. Investigate rehab therapies (eg the water walking / swimming)

Ask the vet lots of questions. If you don't ask - most of them won't tell you.

Key question - ask the vet if it was his dog - what would he do? Will surgery really (reliably) improve quality of life for this dog? for how long? how well understood is the "stem cell" therapy - how long does that last?

I've seen a human who had cartilage grown from her cells to put into her knee, but the surgeons I described that to laughed and said it doesn't last very long, isn't very durable or strong (yet). And she hasn't returned to her sport - so not sure how much quality of life improvement there, though I can understand her trying.

[Guest Ams]

Cosmo I have been where you are and it is not an easy place to be. to you.

I had a young shar pei and from three months of age I knew she had virtually no "hips" to speak of. After a consult with a specialist it was decided to manage it until she was big enough to get replacement hips which we would do one at a time. Then she developed elbow displacia in both elbows and the specialist basically said that the hip op was no longer on the table as she has to have some "good" limbs and joints to carry the weight of the one having surgery since it can't be weight bearing for a long time. So I decided t manage much the same as you have. She was happy enough, going for walks seemed to hurt her more than free play so she was allowed free play sessions but was on pain meds pretty much every day. At 8 months of age she started screaming in the backyard all of a sudden and couldn't weight bear on one leg at all. Both I and my vet thought the hip displaysia had gotten worse but the specialist advised she had in fact developed luxating patellas. He said I could take her home and make her comfy for a week before pts but I decided that was self serving for me only as she was in a LOT of pain so she was pts at the time.

I was devestated as I had lost her sister at four months of age too.

I guess what I am trying to say is if he has problems with all his joints then recovery from surgery is going to be a huge challenge since his other limbs may not be able to take the added strain during recovery.

[dog geek]

Cosmolo, I don't know if you read my thread about Ester C - Calcium Ascorbate - but I was in considerable pain from osteo when I came across reports of success in using this easily-metabolised form of Vitamin C to assist dogs with hip and knee issues.

After checking some of the literature published by the reputable scientific magazines I gave it a go: I am now pain-free, and back to being able to walk the kids/dogs!

It apparently works by providing the body with the necessary ingredients to create lots of synovial fluid - it does not reverse arthritic changes - thus cushioning the affected joint and returning mobility to normal.

I also take D-Glucosamine Hydrochloride and D-Glucosamine Hydrosulphate, which together act as an anti-inflammatory.

I recommend you try to source some Ester C - it is made by Wagner - and give it a go. It took only a week or so for the pain in my hips to recede; and within three weeks I was back to briskly walking a couple of km at a time (I could possibley have done so sooner, but was being cautious).

... I truly hope you try this out, if your pupper's in pain from joints wearing against each other then based on the research and my own experiences, I would say this treatment's veracity is confirmed.

Cheers

Nic

[Cosmolo]

Thanks everyone. To those who suggested it, he does have regular bowen and although it helped immensely early on, it does nothing now. We also tried ester C and apart from the issues we had getting him to eat it (he will starve himself if you put powders or tablets into his food) it made no difference to his level of pain. Not ruling out trying it again though.

Oh Ams Thank you for sharing that- it is a little comforting (and heart breaking) to hear that others have experienced this and made the choice not to go surgical. The emotional part of me says not doing surgery is not being a good dog owner but the logical part of me tells me there are very good reasons why.

Swimming he loves- but he actually loves it too much- he gets overly excited at a beach or pool and if at a pool he will use his legs to push off the side of the pool while swimming so he can bounce around- but it only makes him more sore. We did persist for a while but after the initial build up of muscle (which he still has now) it seemed to make him worse. Dexter doesn't really do anything calmly i'm afraid..

I am going to have to go to my regular vet today and get some stronger pain relief- after a nights rest and the maximum anti inflams last night- he is still squealing this morning and has to be carried off the bed, up and down stairs. OH did it this morning but i have had to leave him on the bed because i'm not strong enough to lift him properly and he cries alot more when i try and help him. Thats the thing too Rommi- Dexter has a really high pain threshold so for him to show pain- you know its really hurting him. ;)

[OSoSwift]

The emotional part of me says not doing surgery is not being a good dog owner but the logical part of me tells me there are very good reasons why.

Cos don't ever think this way. Sometimes not doing surgery is the best thing for a particular dog. Sometimes people do things more for their benefit that the dogs. They really want it to work and they try and it doesn't. Not doing surgery never means that you are a bad owner - ever.

I really hope he improves for you today.

Our old Stafford has quite a few issues, one being spinal arthritis where the arthritis is grwing into the verterbrae and the disk space. He also has elbow arthritis. He sleeps on a heated pet bed evry night ( and its on during the day if it is cold as well. we have found that has made a huge difference to him. He can have coats on, be in a warm bed with blankets - the works, but the bed really helped him along.

My heart is still breaking for you.

[Cosmolo]

We just came back fom the vet. Looks as though the hips are worse than the elbows- though the vet said this can change from day to day. He squealed when the vet made him (gently) stand up and again when he touched and examined his hips. Vet said it is extremely unusual to have this level of acute pain given all the things we are doing and the lifestyle that Dexter has.

We have steroidal anti inflams (and he had an injection too) to try and get the pain under control and the vet wants to se him again on Monday once (hopefully) the acute pain has settled. Likely that we will have to put him on a maintenance dose of anti inflams and see how that goes. Vet has same concerns as me regarding the effect of surgery on his other joints.

He is still very umcomfortable- doesn't want to walk, cries sometimes when he does and squeals going up steps. We have 2 very low steps at the front of our house- they're not steep at all but its enough to cause him a great deal of pain. I'm not strong enough to properly help him either.

[pie]

I've not had experience with this Cosmolo but my thoughts are with you. How utterly heartbreaking.

I think R n L has given some great advice.

[Guest Ams]

Cosmolo if he is on anti-inflams he can also have Tramadol to boost the pain relief. They are safe to use together which is what my Ziva was on towards the end. The Tramal will zone him out a little but not enough to make you think you have a dopey dog. IYKWIM. It is prescription only but is useful to have as it is a human medication too. I use it for migraines and have it on hand for dogs with broken legs, etc during their crate phase, it just helps with the pain and keep them quiet so they don't hurt themselves whilst crated. Tramal can be used by itself too if you want to reduce the NSAID.

From what I was told their are several options available for fixing hips but elbow issues generally reoccur even after surgery.

If he needs help up and down stairs, try using a towel to thread under his tummy and you hold the two ends like a hammock style support, This will allow him to have stability and you don't have to take his fully weight but are a counter balance for him. Does that make sense?

[dog geek]

Sorry to hear of his pain, Cosmolo... must be eating at you, but I hope you take a few big breaths and look after yourself..

Regarding the Ester C and Glucosamine complexs - both of these supplements are clinically proven to recover joint mobility: The D-Glucosamine complex actually repairs the cartiledge, according to the research I have done.

And with the anti-inflammatory effect as well... well, I would be poking the appropriate dose down his throat whether he like it or not .

Here is a link to the company I get mine from:

www.healthpost.co.nz

I have spares, if you would like some pm me and I will send them to you.

Cheers

Nic

[Nekhbet]

Running the risk of repeating myself Cosmolo

Ring Kim Lim NOW. I recommended her months ago to you. http://www.hightonvet.com.au/ Bowen on its own isnt enough, she combines everything and gets them walking. Glucsamine and chondroiten comes in a human capsule form push it down his throat (min 1000mg) and follow it with some cheese. Be tough. No dog will starve itself to death. If he does get emaciated put a feeding tube down his nose and syringe it in if he's that poorly.

Get yourself some super strength fish oil liquid, the ethical nutrients one and pour two capfulls of that down his throat every day. Chuck the Cartrophen I found it absolutely useless in dogs with big problems like Diesel. I wrap his elbows with some padding and vetwrap when they're really sore and keep the dog in a coat all the time, no outside time unless for toilet in winter and put booties on if he's going to be outside the cold travels up the leg. Antiinflammatories will not help him because they help mask the pain and he makes it worst, then they wear off and he's screaming again, try the antihistamines. I went through the same with Diesel, hell I was carrying the poor dog to piss and he spent the rest of his day lying about or screaming with every movement. The only reason I put Krueger to sleep was his hip fell out and his leg was just rotating in the spot out of the socket.

I tell this too you because it has worked for me and many others, it hasnt costed a fortune and it wont hurt the dog. You snapped at me last time and I am offering you a non surgical option that may make Dexter happier. Take it or leave it.

[pipsqueak]

I'm going to sound like a hard hearted b!tch, and it may well get me banned or a warning. You are a professional trainer - try thinking of what you would tell an owner who came to you with the same problems. I think once you have exhausted all treatment avenues (and make sure you have), wouldn't you be advising them that the kindest thing that a responsible pet owner could do would be PTS? I think it is irresponsible to keep an animal alive that appears to be in so much pain.

I say this with the utmost kindest and caring. I know how hard it is to make the decision. And, I also know the regret of putting off the decision for too long and have the animal live in pain because of my own selfish needs.