On-going Lameness

[ness]

Not sure what I am posting here for other than a feeling of being completely overwhelmed with a situation and just needing to vent frustration.

Nearly 6 months ago Kenz had surgery to correct a grade 2 medial luxating patella. She had a relatively simple soft tissue type procedure with no bone cutting and it should have all been fine. At her 6 weeks appointment she had considerable muscle wastage and unfortunately for me the patella was still luxating a little. It was suggested that time may improve the situation and certainly I think the feeling was when she had regained some of the muscle then she should at least be able to manage with it without any issues. She was still having random patella slipping episodes with the surgery leg until 16 or 17 weeks post op when we had a really good fortnight with nothing and then things started to become complicated.

She started having some random hind end lameness with the other hind leg. She would stop stationary with no weight on the leg or would come up lame. The long and the short of it was after emails and video back and forth she was eventually checked out by a neurospecialist who didn't think the problem was neurological.

Last week I get the recommendation that they want a substantial amount of diagnostics just to rule things out which aren't very likely. The two suggestions they have suggested are an EMG and also xrays/joint taps to look for immune mediated polyarthropathy. It has been conceded though the chances of her having that are relatively low.

In the last fortnight its gone from being her non-surgery leg back to her surgery leg so I am really wondering if its just the patella isn't resolved how it should be.

So now she is barely managing a walk to the park without ending up back on three legs which I presume is her patella slipping still. She has had some episodes which are the patella going but others where she just won't put weight on the leg and holds it slightly up off the ground.

I am just fed up with lame dog. She is now nearly 6 months post-op and I am feeling overwhelmed and a little frustrated. I am not sure the appointment with the neurospecialist was useful and I have drawn the line at the additional diagnostics they wish to run for the moment as I am not an open bank and it was going to be an expensive fishing trip.

She is possibly having more issues now then she was pre-surgery. Its not making any sense to me and I am really stressed about it.

Never mind this little girl is anything but a couch potato and does everything at a million miles an hour.

Edited December 15, 2012 by ness

[persephone]

sounds frustrating , and uncomfortable for her, too. No suggestions from me ... I hope it gets sorted soon.

[megan_]

Sorry you are going through this - have they suggested any core or hind leg strengthening exercises as I'm sure muscle wastage would compound the issue?

[ness]

Yeah we have been doing some things like that which I think helped megan_. Not sure why its all gone backwards in the last week or so and that does concern me. She has fairly even muscle tone now. About the only interesting comment from her appointment with the neurospecialist was she has questionable pain in her hocks which nobody has found previously.

Edited October 13, 2012 by ness

[Kajtek]

So sorry to hear bad news.

The only thing I can think of is contacting Dr Tony Black at SASH in Sydney http://www.sashvets.com/team.shtml. Maybe send him an email. He may be able to offer some path/way to address the problem.

IMHO He is fantastic!!! He did cruciate ligament on our girl and we've never had any problems

Edited October 14, 2012 by Kajtek

[ness]

Somebody suggested a second specialist opinion. The only problem with that is i am not keen on going back to the other specialist centre after I have already had dealings with them over her shoulder and I wasn't especially happy with it.

[aussielover]

So sorry to hear Kenz still isn't doing well

Was the initial hindlimb lameness localized to the patella? were the vets 100% sure the patella was the cause of the problem? ie have all her other joints and spine been examined?

Normally surgery is not necessary for a grade 2 luxating patella. I've even seen dogs with low grade LP's that get a long fine in dog sports like agility. Obviously though, the specialist deemed surgery necessary or they wouldn't have done it.

I suppose the most simple explanation is that the surgery has failed Have you consulted the vet about this possibility? I'm sure you know, but there are other surgical options available for LP, but I'm not sure how suitable they would be for kenz- you'd have to chat with your vet about that.

The lameness in the other hindlimb is concerning, and warrants further investigation.

Is it possible that this shifting/recurring lameness could be mostly psychological rather than mostly physical?

What pain meds has she been on? Could it be some kind of nerve pain?

Do you see a physio and if you do what is their opinion on her progress?

I think you should probably seek a second specialist opinion. are the uni vets in SA any good?

I would personally recommend Dr Ken Johnson at Sydney Uni, who is a world renowned orthopedic specialist.

However, this may be a bit far for you! I've heard the vets at melbourne uni are pretty good as well, which may be more convienient.

Hope you can get this sorted out. It must be really frustrating to have it going on for so long

[ness]

Hmmm the initial problem was some very random three legging (if we are talking hind end only - this was an incidental finding while she was being rested for her shoulder because when she started leash walks she started having an increased problem with the hind end) but yes it was the patella and it presented pretty much like a classic luxating patella. Although being a BC the initial thought was cruciate rupture - but her cruciate was stable.

She has had random issues with her other hind leg BUT the specialist assures me he was very thorough with checking over that patella and he is 100% certain it is stable (as is the chiro vet who found the LH luxating patella).

We monitored it over the course of 2 months and it was progressing so the decision was made to operate. It was the chiro vet who is normally fairly conservative re surgery suggestions that felt it was warranted. The specialist was fairly certain it would be necessary somewhere down the track so the decision was made to have it done because I was in a position to make sure she was appropriately looked after and rehabbed thoroughly post-surgery.

I have bought up the question of whether the surgery needs redoing - a few times :laugh:. The continued thought was hopefully she would improve with time and it wouldn't be necessary.

The problem is the lameness in the other limb is fairly random and not seriously bothering her. I got her into the chiro vet within 12 hours of one episode and he couldn't find anything physical that would explain it. I am still wondering if the RH is just because she has super sensitive feet and is a bit of a red herring.

That was the reason she ended up having an appointment with the neurospecialist because the ortho who did her surgery had been having email and discussions with the neuro guy. We held off on that for a few weeks in the hope of collecting a little more video evidence but that proved virtually impossible. It was during this time that her surgery leg became more apparently the problem.

She was on pain meds post-op but not recently - tramadol and caroprofen but only for the normal post-surgery course.

She has seen a physio a couple of times - one 2 days after her 6 weeks check and then a few weeks later. She did suggest the possibility of there being a problem in her spine because of the unpredictability when her RH started to bother her as well.

I guess before the last few days I figured things were "ok" but now the LH is bothering her so much I am convinced its not the case.

There is a little more to the story - she has had issues doing stairs post surgery at various times or struggled to jump on the bed. She has also had some very obvious lameness and choppy stride type action at various points. Nothing so concrete that I have been able to get video though.

Edited October 14, 2012 by ness

[kiesha09]

Last week I get the recommendation that they want a substantial amount of diagnostics just to rule things out which aren't very likely. The two suggestions they have suggested are an EMG and also xrays/joint taps to look for immune mediated polyarthropathy. It has been conceded though the chances of her having that are relatively low.

Ness can I ask why they conceded that the chances of her having that are relatively low?

Obviously I am no vet and haven't seen Kenz's lameness IRL but her symptoms are now presenting exactly the same as Chip (who does have it) from the way you describe it. The specialists also said it was very unlikely that he would have it and he did.

Not saying she does but I just don't think you should rule anything out at this stage.

[Rappie]

Is the patella still actually luxating on palpation? This would be the first place to assess (and I assume that in the process of having other people examine her it has been done). Most of the surgeons I have spoken to would usually still "tweak" the anatomy of the stifle somewhat if they are entering a joint for a MLP repair, but obviously the surgeon is the one making decisions on the day.

I see low grade hock soreness a bit secondary to stifle disease, but I also wouldn't discount a polyarthropathy just because it is unlikely. My own dog had a mild case, and while my "spidey senses" as an owner told me there was something wrong with him he was examined by all of the vets I work with and declared normal, even up to the point I asked one of them to tap his joints under a GA. Unfortunately the only way to diagnose it is with joint taps under a GA. Has she been trialled on pain relief again? It is a crude diagnostic test, but if the lameness is happening most days and does not occur while taking pain relief, it does at least provide some confirmation that pain is the problem (as opposed to a structural issue like MLP).

[ness]

Thanks for the responses and thoughts - yes the patella is still luxating readily on palpation - in fact the chiro vet had a feel a few weeks ago (when I took her over the random RH lameness) and said it was luxating more readily then he had ever felt it luxate previously . Considering he was the one that diagnosed it initially and it was only subtle that comment surprised and shocked me a little bit.

At her last specialist appointment he felt it had improved over her previous appointment so I guess it seems to be a "relative" concept.

Hmm as to conceding her chances of having it are relatively low I pushed the point and asked what if we didn't go ahead with any further diagnostics at this point and if it was immune mediated polyarthropathy what would happen. The comment was he didn't think she had it but it would likely get progressively worse. Her lameness doesn't appear painful.

Most of the episodes of lameness recently have been with her LH (so her surgery leg). She spent an hour at the beach this morning though and there were signs of both non-weight bearing on the LH and the RH over the course of the hour we spent there.

I should say she is experiencing two very different types of lameness at the moment. One just seems to be where she will stop stationary without putting full weight on the leg (this is what is happening in both her RH and LH). Sometimes her gait after is normal and other times it appears choppy and stilted. The other which has increased in the last couple of days seems very classic patella issue and more what I was observing pre-surgery.

She has not been trialled on any pain relief recently.

Edited October 15, 2012 by ness

[persephone]

Her lameness doesn't appear painful.

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..but isn't lameness itself caused by an attempt to avoid discomfort/pain? (unless a leg is considerably shorter or malformed....)

poor kenz ... and poor you, after all the trouble ...

[ness]

You have a point persephone. Its very bizarre in that she isn't especially bothered by the episodes.

These are a few (admittedly poor) examples:

[ness]

This was immediately post non-weight bearing -

[kiesha09]

Looking at the second video Ness she does look to be quite sore. I would assume that there is some pain there (just from the video.) Is that directly following after the lameness in video 1? My initial thought from the first video is she isn't displaying obvious pain symptoms because she is so focused on her work (she is a BC afterall :D) but once she stops she is actually quite sore.

In the third video after the post non-weight bearing episode she is walking along for the majority of the time with her head down and almost in a hunched/proppy motion. Is that common after an episode or maybe just because she is sniffing in this instance?

Lastly - what is she like when she sits or when she drops? Does she struggle to get down and then back up again?

[ness]

These are the few I have sent through to the specialists at various points. The first two vids were just messing around/playing in the yard as part of training, not taken on the same day though. We had just been doing a small amount of tug/training etc.

I think the third video was just cos she was sniffing.

Seriously I have been stalking this poor dog with a video camera on and off for the last month to try and get the episodes on video and its been almost impossible. The running joke with the specialist is if I want to trial her again then I just make sure I have the camera running.

She has been having issues with sitting and pushing off from a sit.

She came up badly lame retrieving her DB at training a few weeks ago (specialist said she was fine to start training again) and that is when I realized there was still something quite serious going on. She was noticeably lame and then struggled to jump on the bed when we got home. I took her out the following day though to try and replicate what happened the previous night armed with a video camera and she was fine.

I have been loathed to train her to much since - we do bits at home and she has managed 3 Rally-O obedience trials. Other people would say she was fine I know my dog though and don't think she is. The problem I have is separating out what may be from the surgery and what may be god knows what else :laugh:.

[kiesha09]

I have been loathed to train her to much since - we do bits at home and she has managed 3 Rally-O obedience trials. Other people would say she was fine I know my dog though and don't think she is. The problem I have is separating out what may be from the surgery and what may be god knows what else :laugh:.

Don't worry I've been there remember :laugh: Everyone was telling me it was all in my head but I just knew there was something not right.

I can see the lameness in the video - it's definately there and something isn't right. Now just got to work out what it is. And her body language in vid 2 definately suggests some discomfort to me.

Unfortunately though I think you are just going to have to continue with the diagnostic testing until they figure it out what it is.

I'd get the joint taps too - but thats just me. You also have to weigh up the costs involved.

[ness]

Yep its the weighing up the costs involved which at this stage stopped me from going ahead and getting the joint taps/xrays/EMG that they wanted. Especially if its really the patella causing the issues still which is what I think is going on. However I am no expert. Its also not at the point where its causing her pain for long periods of time.

[kiesha09]

Yep its the weighing up the costs involved which at this stage stopped me from going ahead and getting the joint taps/xrays/EMG that they wanted. Especially if its really the patella causing the issues still which is what I think is going on. However I am no expert. Its also not at the point where its causing her pain for long periods of time.

Your lucky in that regard, so I'd just do one test at a time as I could afford it starting at the most recommended test.

I know that it is all much easier said than done though and the length of time you've been dealing with this must be so frustrating!

[ness]

The logic behind doing the EMG and the xrays/joint taps was to minimize the number of GA's as they could both be done at the same time so also in part to save dollars. They have said there is no obvious rush over anything and I can always do them if she deteriorates at any stage.

Its been nearly 2 years of lame dog so at least they appreciate the time and resources I have already put in to get her this far. Its just all happening at a super inconvenient time in my life. No time is good to have a lame dog but certainly not when you have finished up university and the job market is slow .

In the perfect world where money was no question she would have had the EMG and joint taps no questions asked but resources do come into it and I don't have the resources to just go throwing into things at the moment.