My Poor Husky Boy Has LP:(
So with a visit to my regular vet and a visit to an orthopedic specialist, Tikaani has been diagnosed with Grade 2 Luxating Patella. The specialist was pushing for surgery, but the regular vet said that the surgery is not really necessary as the LP isn't affecting his everyday life. He will be 3yrs old in August, and still is a pretty active dog. He still runs and jumps, has no issue getting up, and doesn't seem to be in pain.
The first time we think his knee popped was last winter at the dog park. He was running the screamed, spun around and started chewing on his foot. We took it that he had stepped on something that hurt his foot, and after a short break he was up and running. He has had about 4-5 other similar occurrences (minus the scream and foot bite) including the most recent one that he had about 2 weeks ago. The recent one happened when he was playing with Miyu in the living room and started limping. I checked his foot and leg, and felt his knee pop back into place. All known occurrences happened while he was on somewhat slippery surfaces (ice/snow covered dog park, hardwood floors) and those that happened outside we took as him stepping on something.
The regular vet says that the surgery isn't necessary unless he's more in pain than not. She had advised to give him Glucosamine as well as keeping a close eye, making sure to give him rest when it looks like he needs it (even if he doesn't want to). Problem is that she seemed to give the impression that most of her LP experience is with smaller dogs (pugs, poms, etc).
I wanted to know if anyone had any advice, or cared to share their own experiences with LP and why they chose what they chose when working with their own dog's LP. Do you think you would do the surgery in Tikaani's case, or work with an alternative method?
Both vets say that there isn't anything that could prevent it from getting worse or make it better besides the surgery, that all you can do is slow it down and keep him comfortable. Anyone heard/experience surgery alternatives that the vets aren't thinking of?
I'm afraid of making him go through the surgery and 4 month recovery, as it sounds like it's not really a true fix and could lead to other complications and possibly having the same or worse level of arthritis than if not getting surgery.
The first time we think his knee popped was last winter at the dog park. He was running the screamed, spun around and started chewing on his foot. We took it that he had stepped on something that hurt his foot, and after a short break he was up and running. He has had about 4-5 other similar occurrences (minus the scream and foot bite) including the most recent one that he had about 2 weeks ago. The recent one happened when he was playing with Miyu in the living room and started limping. I checked his foot and leg, and felt his knee pop back into place. All known occurrences happened while he was on somewhat slippery surfaces (ice/snow covered dog park, hardwood floors) and those that happened outside we took as him stepping on something.
The regular vet says that the surgery isn't necessary unless he's more in pain than not. She had advised to give him Glucosamine as well as keeping a close eye, making sure to give him rest when it looks like he needs it (even if he doesn't want to). Problem is that she seemed to give the impression that most of her LP experience is with smaller dogs (pugs, poms, etc).
I wanted to know if anyone had any advice, or cared to share their own experiences with LP and why they chose what they chose when working with their own dog's LP. Do you think you would do the surgery in Tikaani's case, or work with an alternative method?
Both vets say that there isn't anything that could prevent it from getting worse or make it better besides the surgery, that all you can do is slow it down and keep him comfortable. Anyone heard/experience surgery alternatives that the vets aren't thinking of?
I'm afraid of making him go through the surgery and 4 month recovery, as it sounds like it's not really a true fix and could lead to other complications and possibly having the same or worse level of arthritis than if not getting surgery.
Comments
I had Lucy's knee done when she was at the point where it was luxating 2-3 times per day. Her other knee is a II but she only kicks once every few weeks and doesn't seem to be in any pain. As long as she's still able to go for walks, jump up or down from furniture she wants to be on, and come hiking on the weekends, I'm not going to worry about her other knee.
As for the recovery time, I think 4 months is a bit of an overestimate. With daily rehab, he should be back to full exercise in 8-10 weeks. You can do 95% of the rehab at home with a few household supplies and trained behaviors (like walking backwards or crawling). The only thing I needed to take Lucy to the rehab facility for was the water treadmill, which we did once a week. The rehab serves two purposes. First, after the initial recovery from the surgery (about 10 days), it will help him start to use the joint again. Second, there will be some muscle atrophy from reduced use of the limb (Lucy lost about 12%) and the rehab will build up that muscle mass again (Lucy regained all but 1% of what she lost when we finished her 8 weeks of rehab, I'm guessing she's got it all back by now).
As for surgical complications, I was told there really are only the standard ones of infection risk, reaction to anesthesia, etc. In 10% of cases, the surgery doesn't take and it has to be done a second time. The corrections they do are some combination of the following three things: 1) deepening the patellar groove, 2) realigning the ligaments on the top of the patella, and 3) tightening the ligaments on the sides of the patella. Which techniques they use and in what proportion is the art involved in the surgery. And that's where a specialist who has done hundreds of them really earns their money.
Whatever you decide, I'm sorry to hear you are in this position. It's never fun when our family members aren't well.
@tjbart17 -From what everyone has been saying, the glucosamine seems to really help so I hope that if Tikaani is feeling any stiffness/pain that it helps him too. I guess we'll see in a couple of weeks.
Ahi's LP was 2 as well, she basically stopped wanting to go on walks, that's what led is to do the surgery. She mos def still has pain in both knees.
My experience has been this: both my Shibas have LP. Toby kicks his leg out once a month or so, but doesn't seem to be in pain. Bel seemed to have a more minor case--we thought she as probably at about grade 2, but then it suddenly got worse. I think she injured the knee in the deep snow. It was so bad that she wasn't walking on the leg at all, which is when it became clear she HAD to have the surgery. My vet expected to just do the deepening of the groove and perhaps tighten up the ligaments some, but when she got in there, the ACL was torn....not just a bit, but completely torn in two, as in not at all attached. So the surgery was much more complicated that we expected. And my vet is old school, and wants the leg immobilized, so we have her in a splint, which will come off on Friday (three weeks after the surgery). Given how difficult it is to keep Bel still, I'm thinking this isn't a bad idea. We talked about physical therapy, but I don't have the money for it, so we're hoping that when the splint is off, she'll adjust to using it again, and I believe she will. My vet also believes it will be a slow recovery (so 6 weeks doesn't seem out of line to me), but she is really happy with how well things went and how Bel is able to move already, so while she originally thought we'd likely only get 80-90 percent range of motion back, she's cautiously optimistic that it might be 100 %.
I didn't get a second opinion: I knew I couldn't afford another vet, and it was clear the surgery had to be done, and I've come to trust my vet's sometimes very conservative way of doing things. (Originally I was to pay $700 for the surgery, but the surgery took closer to 4 hours instead of 1.5 as there was so much work to do with the ACL, so I actually had to pay $1200--I have no doubt it would have been 2,000 or more if I'd gone to another vet).
And Bel will likley have to have the other knee done as well, but the vet would like 8 or 9 months in between surgeries.
Anyway, in your case, I'd check with another vet, and also decide how your dog is feeling, how active he is, etc. I had to do it with Bel--she was in terrible pain and wasn't using the leg--but I waited til I had to.
I've been reading online, and several sites say to use certain exercises to strengthen the muscles and tighten the ligaments (thus holding the knee in place better) such as walking on an incline or aquatherapy. Do you guys think that some of these things can help, or actually hinder, his knee? I'm guessing that any surgery alternative is basically an attempt at lengthening his ability to be comfortable.
With Nola (who has HD), my vet and I have been going about her treatment with the idea that she will eventually need surgery, but to put it off as long as she can tolerate it. I exercise her, stretch her hip muscles, and give her daily doses of glucosamine. She gets x-rayed about once a year to look at her hip for further degeneration.
I gauge my decision for Nola on both vet recommendation, my gut feeling, and how Nola feels and gets along. Since we have started with the glucosamine and a different exercise regiment for her, I have seen vast improvements in how well she does. I rarely ever see her in pain anymore, she can jump on the couch by herself (YAY!), and only needs to stop and rest for walks on pavement (or if it is ridiculously hot, she has one hell of a coat!).
The point of my Nola ramble is that use Tikaani as a guide. And find a vet that you feel comfortable with and talk it out. A vet that immediately rushes for surgery as an option when Tikaani is obviously not in pain and is not luxating on a regular basis is a huge red flag for me.
But give the big guy a hug from us and I hope that you can manage his LP without surgery!
Tikaani has been on the Glucosamine for the last two days and so far he loves the stuff. Takes it willingly and looks for more when he is done. We're going to work having him lose weight. Over this past winter he has gained about 5lbs, a combination of stealing cat food and whatever Tetsu doesn't eat, so getting rid of that extra weight wouldn't hurt.
Last night I bought a Kuranda bed to put in his crate, should be here Friday or Monday (UPS doesn't do Saturday deliveries in NY). Tom plans to build some cheap knockoff versions during the Spring from plans we found online.
The likelihood is is that even if we were to go with surgery, that's not gonna happen for a couple of months minimum, mostly due to the cost of it (specialist quoted us $3550, which includes 3 therapy sessions and a follow up or two) but also to make sure that whoever is cutting him open knows what they are doing. For now, we are going to stick with alternative methods to help slow down his knee degeneration until we can find a vet with experience with LP in medium sized dogs for that 3rd opinion.
She looked him over and we discussed what the other vets have said. She agrees with the others that he has grade 2 LP and feels that surgery isn't necessary at the moment since his knee doesn't affect him too much. She had noticed that his knee seems to pop out in certain positions, makes me wonder if that is from the glucosamine or something the others hadn't noticed. she did suggest we get his hips and knees x-rayed, and possibly do so routinely to help keep track of the progression. She wanted his hips done to make sure that they are good and not affecting how he walks, which in turn can aggravate the knees.
She was concerned about the fact that the specialist was pushing for surgery since, in her experience with him, he has been very conservative when it came to slicing up a dog. The specialist seems to be well known a respected by those in the competitive and veterinary dog community, so if/when it comes down to him needing surgery we will take Tikaani to this specialist (even with the hefty price). Today's vet said that probably the reason why the specialist was pushing for surgery now was more of a way of saying to do the surgery before the knee gets bad enough to make the surgery ineffective.
All in all, she says that giving him a 'normal' life is the best for him. He needs to exercise his leg muscles to help reduce episodes of popping his knee. We have to make sure he doesn't do too many activities that would cause his body/leg to twist such as playing fetch, heavy wrestling, etc. What made me really happy was that she said that bikejoring with him would actually help and not hinder, since he would be running straight and not twisting. I was afraid that he would not be allowed to do this, so I'm glad that it seems safe for him to do.
And I am so glad that he will still be able to bikejoring! I know that will make both of you happy.
Anyway, I hope that Tikaani keeps maintaining and that surgery will not be necessary.