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Pet Forum / Miscellaneous / Animal Health / January 2004Advice on husky with blown knees
Just before Christmas I was running on the beach with my two male sibes, Toklat and Vader. Toklat has this crazy habit of suddenly changing direction and charging up or down slope until he is brought up short by the lead. I think that's what he tried this time, but before he could execute the maneuver, he collapsed in pain. I knew he was really hurting because he is scared of waves but took no action to avoid being bowled over a few times by the shore break. I had to carry a wet sandy dog over my shoulders half a mile back to the car. At least Vader recognised that something serious was up and refrained from chasing cats and chickens on the way back. It turns out that Toklat had torn the AC ligaments in *both* knees. "Surgery," I say to the vet, but she says "Not so fast." Her thought was that the failure of two knees at once indicates some underlying problem, such as arthritis, which surgery might exacerbate. Manipulating his legs, she determined that he already has mild arthritis in his hips. The vet regards TPLO operations as the best stabilization for ACL injuries, but she is not certified to do them. She asked a colleague of hers who is TPLO-certified for a second opinion. He agreed with her--blowing two knees at once is almost unheard of, even among humans. He recommended the conservative approach--no surgery, anti-inflammatories, rest. He did not actually examine Toklat (I live in Honolulu, the other vet is on Maui), but wants to check him out when he is next in town. Toklat will be ten next May, so I figure he has a good few years left in him. At 58 pounds he may be a pound or two overweight, but he is otherwise in great shape. Before his injury he used to get hour-long walks every sunrise and sunset, and played with his nephew Vader during the day. Recently he had begun to show slight reluctance to climbing steep hills and had also developed an aversion to the beach (which I wish I had respected!). Maybe arthritis was just beginning to bother him. [Toklat may have aged a bit faster than normal because of a traumatic experience when he was five--I stupidly let him off lead up in the mountains and he took off after feral pigs. He was caught for a week in a pig-hunter's snare. Fortunately there was a lot of rain while he was missing so he was able to drink from rivulets that flow down the trunks of guava trees. Nevertheless, he lost seven pounds, was dehydrated, and got a minor urinary infection. It took him over a year to regain his spirit after that experience (me too!).] Right after the knee injury Toklat was prescribed 100 mg of Deramaxx once a day and 50 mg of Tramadol twice a day. Now, five weeks after the injury, he is down to one Deramaxx and one Tramadol a day. He is able to hobble around and can walk about a couple of hundred feet at a time, but by then he apparently is in some pain and will lie down (atypically for a husky he is a real stoic, and seldom whines or complains about anything, so I have to guess what he feels). The vet recommended that I take him on two-to-three minute walks on flat land a couple of times a day and that I cut out the Tramadol, but he still seems to be hurting too much so I haven't yet followed her advice--his walks are very short and he's still on both Deramaxx and Tramadol. Now, my questions: Is the vet right? Does the conservative action (no surgery) make the most sense? Without surgery, how much knee function can be regained? Will he be able to climb stairs without pain? Toklat used to have a great appetite, but now he is hardly interested in food and it's an effort to get him to eat half of what he used to. Is that a warning sign that the meds disagree with him? I'll cut out the Tramadol in the next day or so, but is 100 mg of Deramaxx a day excessive for a 50-lb dog? How about in the long term? I owe Toklat a lot. He is a great companion and he has saved me from my own incompetence several times (a good husky balks at stupid instructions). He is my Thinking Brain Dog and I want to do what is best for him. I'd appreciate any advice. She asked a colleague of > hers who is TPLO-certified for a second opinion. He agreed with > her--blowing two knees at once is almost unheard of, even among humans. > Is the vet right? Does the conservative action (no surgery) make the > most sense? > Without surgery, how much knee function can be regained? Will he be > able to climb stairs without pain? Textbook section on Cruciate ligament: http://cal.nbc.upenn.edu/saortho/chapter_80/80mast.htm .....I've never had to have this done in any of my animals, but I think you'll find that there have been bad and good experiences with any of the techniques used to repair this problem. What else did the vet do to look for a problem that perhaps caused both knees to go at once? I would think if it was continually running in sand that caused it, they would see more of this kind of thing in your area. First I think I would talk that over with the vet and make sure nothing else is going on. Was bloodwork done? Perhaps even get an X-ray of the knees, even though that's not used to diagnose cruciate ligament rupture. Are both legs about the same or does the dog seem to put more weight on one hind leg? I doubt it they'd do both at once, so it would be a long recovery time to do one at a time. Has the surgeon NEVER encountered 2 knees going out at once? If not, could he consult with someone who has had to deal with this? You need to start asking a lot of questions. .....You might read through this site - a personal experience with TPLO - well documented and sane: http://www.lauriebryce.com/tplo/ She also has a link to a Yahoo group called Orthodogs you might want to join and take a look at people's experience with these problems. Just entering TPLO in Google brings up a lot of explanatory pages. You also might try cruciate ligament, as TPLO is only one surgery available for these problems. > Toklat used to have a great appetite, but now he is hardly interested > in food and it's an effort to get him to eat half of what he used to. > Is that a warning sign that the meds disagree with him? Blurb on Deramaxx: http://www.marvistavet.com/html/body_deracoxib.html I think I might be tempted to get bloodwork done to check liver values. There are dangers in NSAIDS. Sometimes they also irritate the stomach and affect the kidneys, in the case of Deramaxx. best of luck to you and your pup buglady take out the dog before replying The only advice I can offer is to get his thyroid checked. My dog blew one knee and the surgeon thought it pretty possible that he'd blow the other. I asked to have his thyroid checked and it was borderline low. He takes thyroid meds now, has lost 15 pounds and the other knee has held (2 years later.) Glucosamine.chondroitin has helped as well. Best wishes! Kate > Just before Christmas I was running on the beach with my two male > sibes, Toklat and Vader. Toklat has this crazy habit of suddenly [quoted text clipped - 66 lines] > instructions). He is my Thinking Brain Dog and I want to do what is > best for him. I'd appreciate any advice. > The only advice I can offer is to get his thyroid checked. My dog blew > one knee and the surgeon thought it pretty possible that he'd blow the > other. I asked to have his thyroid checked and it was borderline low. > He takes thyroid meds now, has lost 15 pounds and the other knee has > held (2 years later.) Glucosamine.chondroitin has helped as well. Best > wishes! ........You know, that crossed my mind, but on a quick perusal of the information, no one mentioned it. I thought about saying something about GAGS, but no one said anything about those either! Glad to hear your pup didn't have to have the other knee done. buglady take out the dog before replying > > The only advice I can offer is to get his thyroid checked. My dog blew > > one knee and the surgeon thought it pretty possible that he'd blow the [quoted text clipped - 7 lines] > GAGS, but no one said anything about those either! Glad to hear your pup > didn't have to have the other knee done. Thanks! I never would have thought it then, but he's back to full tilt boogie. (Throw the ball, just throw the ball.......) Kate It is not unheard of for a dog to blow both ACLs at the same time. There are a couple of people currently posting to Orthodogs that are doing bilateral recoveries. Obviously it does happen. Some vets will do them only days apart but typically they are repaired 6 to 8 weeks apart. Full recovery is about 6 months. Did they xray his knees to check for arthritic changes. I know you mentioned arthritis in the hips. Arthritic change in the knees would indicate that this might have been coming for quite some time. If he's that stoic, it is possible that he's had partial tears for a time and this day way just the final blow. Blown ligaments do not heal. Just a straightforward fact. The only repair for a torn ligament is a surgical repair. Buglady recommended you try Laurie Bryce's site and Orthodogs. I heartily second that. Additionally you may want to check out http://www.woodhavenlabs.com/tplo.html and http://www.woodhavenlabs.com/cruciates.html They are pages of links on the subject. My dog Molly (RottxRR) has had two ACL repairs in the past 15 months. One was a traditional repair, the second a TPLO. She is now running and playing in the fields of snow. Last year was difficult but very much worth it. She gets Glucosamine, Chondroiton, Yucca, Salmon Oil, Vitamin E. each day to try to keep her joints as healthy as possible. She has mild to moderate osteoarthritis and her meniscus was partially removed due to damage. After an especially rigorous day she sometimes gets a bit stiff. On those nights she gets a bit of Metacam. Deramaxx is not without risk. If he is going to continue on it, the vet should be monitoring (again, as already mentioned). I cannot stress enough the mental health value of Orthodogs. I still check in daily and post regularly even though Molly is essentially fine now. Do come join us, you'll be able to talk to people who've had dual ACL injuries. orthodogs@yahoogroups.com Carol Ann > Just before Christmas I was running on the beach with my two male > sibes, Toklat and Vader. Toklat has this crazy habit of suddenly [quoted text clipped - 66 lines] > instructions). He is my Thinking Brain Dog and I want to do what is > best for him. I'd appreciate any advice. > It turns out that Toklat had torn the AC ligaments in *both* knees. > "Surgery," I say to the vet, but she says "Not so fast." Her thought > was that the failure of two knees at once indicates some underlying > problem, such as arthritis, which surgery might exacerbate. > Manipulating his legs, she determined that he already has mild > arthritis in his hips. Were any xrays taken? I certainly wouldn't feel comfortable making any statement about the extent of arthritis based solely on palpation, and certainly not in an awake dog. If it hasn't been done already, I certainly think that general anesthesia (or at least heavy sedation), a thorough orthopedic exam, and both pelvic and knee xrays are in order. That should give you a good starting point for knowing where to go from here. > Now, my questions: > Is the vet right? Does the conservative action (no surgery) make the > most sense? Well, with most cruciate ruptures, in my experience, the dog will be acutely painful for a couple of weeks, but then the leg will stablize itself and you'll get mostly normal function back. That progression will be delayed with both knees being bad, but I'd be really suspicious of something else going on if you are still so painful 5 weeks later. If it's truly just the ligaments, then I think you've got no choice but to do some type of surgical repair. I was in vet school before TPLO's became popular, and my current boss also still does extra-capsular repairs, and I think they work just fine. > Without surgery, how much knee function can be regained? Will he be > able to climb stairs without pain? If the cruciate ruptures are all that's going on, and if there isn't already significant arthritis, then significant return to function *should* occur. There will be arthritic changes that develop, but they usually take months to years. But it sounds like you've either already got arthritis, or you've got something else going on. If you haven't seen significant improvement in 5 weeks, I don't think you can expect a full return of function (just a guess). > Toklat used to have a great appetite, but now he is hardly interested > in food and it's an effort to get him to eat half of what he used to. > Is that a warning sign that the meds disagree with him? > I'll cut out the Tramadol in the next day or so, but is 100 mg of > Deramaxx a day excessive for a 50-lb dog? How about in the long term? 100mg of deramaxx is a *high* dose for that long term of use in that size dog. It is the high end of the dose for short-term use (<7 days, for post-op pain), and the long-term, anti-arthritis dose is half of that dose. I'd probably have him on 25mg once daily. I would seriously consider having bloodwork run to be sure you aren't having liver or kidney complications. Even if not, that high of a dose is much more likely to cause gastric ulcers, which would certainly make you feel like not eating! Please double check with your vet about what dose he should be on. I don't know what tramadol is, so cannot comment on it's use. I'd also recommend starting cosequin, or some type of glucosamine/chondroitin supplement. They don't have any proven benefit, but they generally cause no side effects, and anecdotally can really help. Good luck with your dog. Deborah, DVM Is Lyme Disease existant in Hawaii? > > It turns out that Toklat had torn the AC ligaments in *both* knees. > > "Surgery," I say to the vet, but she says "Not so fast." Her thought [quoted text clipped - 58 lines] > > Deborah, DVM > Is Lyme Disease existant in Hawaii? Fortunately, no. We have other things to worry about, though. Don't let your dog drink from the stream--Leptospirosis. Thanks, everyone, for your advice about my poor husky Toklat who apparently ruptured both AC ligaments at the beach. I talked casually to another vet today who mirrored the comments here: get full X-rays (knees and hips) to get a better idea of what we're dealing with. "buglady" asked > Are both legs about the same or does the dog > seem to put more weight on one hind leg? It's absolutely symmetrical--he treats both hind legs exactly the same Toklat seems to be doing better walking today (though his appetite is still poor), so I'm cutting back on the meds (he had been prescribed 100 mg/day of Deramaxx, which "Deborah, DVM" said was way high for a 50-lb dog). The other drug he was taking, Tramadol, I had already reduced for several days so I can now stop that (apparently Tramadol is about to be listed as a narcotic, so I didn't want to throw withdrawal symptoms on top of Toklat's other problems). I'll report back here on what happens. Thanks, again, everybody, for being so helpful.  SignatureGerard Thanks, everyone, for your advice about my poor husky Toklat who apparently ruptured both AC ligaments at the beach. I talked casually to another vet today who mirrored the comments here: get full X-rays (knees and hips) to get a better idea of what we're dealing with. "buglady" asked > Are both legs about the same or does the dog > seem to put more weight on one hind leg? It's absolutely symmetrical--he treats both hind legs exactly the same Toklat seems to be doing better walking today (though his appetite is still poor), so I'm cutting back on the meds (he had been prescribed 100 mg/day of Deramaxx, which "former!\" said was way high for a 50-lb dog). The other drug he was taking, Tramadol, I had already reduced for several days so I can now stop that (apparently Tramadol is about to be listed as a narcotic, so I didn't want to throw withdrawal symptoms on top of Toklat's other problems). I'll report back here on what happens. Thanks, again, everybody, for being so helpful. Thanks, everyone, for your advice about my poor husky Toklat who apparently ruptured both AC ligaments at the beach. I talked casually to another vet today who mirrored the comments here: get full X-rays (knees and hips) to get a better idea of what we're dealing with. "buglady" asked > Are both legs about the same or does the dog > seem to put more weight on one hind leg? It's absolutely symmetrical--he treats both hind legs exactly the same Toklat seems to be doing better walking today (though his appetite is still poor), so I'm cutting back on the meds (he had been prescribed 100 mg/day of Deramaxx, which "Deborah, DVM" said was way high for a 50-lb dog). The other drug he was taking, Tramadol, I had already reduced for several days so I can now stop that (apparently Tramadol is about to be listed as a narcotic, so I didn't want to throw withdrawal symptoms on top of Toklat's other problems). I'll report back here on what happens. Thanks, again, everybody, for being so helpful. SignatureGerard Thanks, everyone, for your advice about my poor husky Toklat who apparently ruptured both AC ligaments at the beach. I talked casually to another vet today who mirrored the comments here: get full X-rays (knees and hips) to get a better idea of what we're dealing with. "buglady" asked > Are both legs about the same or does the dog > seem to put more weight on one hind leg? It's absolutely symmetrical--he treats both hind legs exactly the same Toklat seems to be doing better walking today (though his appetite is still poor), so I'm cutting back on the meds (he had been prescribed 100 mg/day of Deramaxx, which "Deborah, DVM" said was way high for a 50-lb dog). The other drug he was taking, Tramadol, I had already reduced for several days so I can now stop that (apparently Tramadol is about to be listed as a narcotic, so I didn't want to throw withdrawal symptoms on top of Toklat's other problems). I'll report back here on what happens. Thanks, again, everybody, for being so helpful. --- Gerard > Thanks, everyone... Twit. Next time I change newsreaders I'll figure out how the new one works before I try to post... my pitbull Gus blew 1 acl, then 12 weeks later, still recovering from surgery, the other blew. we are now a year post surgery and rarely can tell he's even sore. he's 10 Good luck Nicole Signature3 of every 10 Americans Know Someone With Lupus Help find the cure. www.lupus.org > Just before Christmas I was running on the beach with my two male > sibes, Toklat and Vader. Toklat has this crazy habit of suddenly [quoted text clipped - 66 lines] > instructions). He is my Thinking Brain Dog and I want to do what is > best for him. I'd appreciate any advice. |
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