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Recurring leg injury


MiaP
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Back in August of this year, Mia started limping and wouldn't use her left front paw. I took her to the vet, the vet did x-rays and came back saying that nothing looked funny so she just sprained her ankle (the pain came from the joint right above the paw - not sure what you call that on a dog). He gave me some Rymadil (sp?) which he said was an anti-inflamatory and told me to give them to her for a week and try to keep her activity level down to a minimum. After the week, the pain seemed to be gone and there was no signs of limping. All back to normal.

 

Jump to last Saturday, the 4th of January, after her protection training she started limping again and wouldn't use that leg - plus she didn't want to do anything after class except lay on the couch next to me and that is not like her at all; she normally has to be doing something all the time. I couldn't remember which leg it was originally so I called the vet and took her in again. Well, it was the same leg, but by the time I could get her to the vet on Monday the limping had stopped and she was using the leg again. He said that he didn't want to waste my money on more x-rays when after manipulating the entire leg, there seemed to be no sign of pain so he said that she probably over did it and just needed a rest. He had me buy a huge bottle of the same anti-inflamatory as before and told me that she may have to take them whenever the leg bothers her for the rest of her life. If I see her limping, I'm to give her a half a tablet twice a day for three days or so. My question is, does my vet, who I trust with the care of my entire herd (1 dog, 3 cats) know what he's talking about? Can an animal sustain an injury that might have to be medicated for the rest of it's life like a sprain? She is only a year and a half old, will it get worse the older she gets? Should I try and make her slow down on her level of activity on a daily basis, if that's even possible? Any input would be greatly appreciated.

 

Thanks,

Mia, Patch, Hanna and Kahlua's mom, Gimmie Sue

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My acd has a recurring knee problem. At one point they thought it was a torn ACL but that specialists said it wasn't. Anyways, after a weekend of flyball, her knee seems to bother her sometimes. We will give her 1/2 a tablet of Rimadyl that night and then she is fine. We were given 20 tablets 2 years ago and we still have some left. We will actually have to pitch these soon because they will expire.

 

So yes, dogs can get a recurring injury. I would suggest looking for another anti-inflammatory because Rimadyl has been known to cause problems in dogs. For me, since we use the meds rarely, I will stick with the Rimadyl because it does a great job.

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Hmmm... Unless you can go to a specialist, I guess my thought on this would be 1) do a flexed lateral film of the wrist (that's the joint above the front paw) and maybe get a shoulder film, too (shoulders have to be done under anesthesia), and 2) send the films to a radiologist for review (including the original films). How far are you from MSU (East Lansing)? The reason I ask is because certain joint problems are very difficult to diagnose with regular Xrays, and need either special positioning on Xray or things like MRI, CT or ultrasound to diagnose. The radiology department at Michigan State ought to have all the toys.

 

In an 18-month old dog who is expected to have an active career, I think I'd be a little more agressive with workup than I might be in a 10-year-old couch potato who is mainly expected to remain sound for the long trip from couch to dish and back again. There ARE problems that can be chronic and require lifelong management, but I'm not sure we're there yet with Mia - at least, I'm not sure I'd be ready to conclude this on the evidence so far (bearing in mind I cannot see the dog). However, it may depend on how much you're willing to invest in finding out what's going on (and then in addressing the problem, depending on what it is). She's young enough that it could even be something minor like panno (which she'll outgrow, and which usually but not always shows signs on the Xrays - but that's not JOINT pain, it's BONE pain.) It could also be something like a cartilage chip in the joint, which can be addressed surgically, but will be a bit expensive. Some vets tend to assume you have a financial limit, whether or not you tell them you do - this is an unfortunate habit, but one we all fall into at times, since most people do not have health insurance on their animals and will not (often CANNOT) spend unlimited amounts of money on them. This may be why your vet is reluctant to do more Xrays - in that sense he's looking out for your best interests as he percieves them. You may need to mention to him that your best interests are better served by finding out exactly what's going on, despite the costs (if indeed that IS what would serve your best interests - everyone is different on this). In defense of this behavior (and not that anyone here on the boards would act this way), I'll say that we have ALL had clients that some in and say in so many words "Money is no object, just do what is best for Fluffy! She's my baby, she's like my child, she's an important member of our family!" and then when you say, "Okay, I think we should run these four tests and the cost will be about $600," the owner glares at you in fury and goes, "WHAT?!?! I'm not spending that kind of money, she's JUST A DOG!" Okay, we can go either way - she's your baby or she's just a dog - but you have to make up your mind which it is first. So even though I'm sure YOU would never act in such a fashion, I'd be willing to bet that your vet has had his fair share of people who do, and this may have left a subconscious inclination to be financially conservative in spending his clients' money. (There's also the ever-popular "money is no object" because the client has no intention of paying for any of it).

 

I'm not sure why your vet believes that this might be a chronic thing with no real options but Rimadyl (or other anti-inflammatories) and rest. He may very well have an excellent reason for that, but since I was not in the room at the time, I can't tell you one way or the other. A sprain should heal after a few weeks (2 to 8 weeks is my usual window for initial healing, though to be FULLY healed, it may take longer); however, some are bad enough to cause permanent injury. Some injuries will lead to arthritis later on and can be progresive with time - but again, I don't know enought about this injury to tell you if that's in Mia's future.

 

I don't know if that helps at all; I hope it does, and I hope this isn't something you'll have to struggle with longterm. If you are uncomfortable with what's happened so far, there's always the second-opinion route.

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I'm about an hour and a half from MSU but know the area very well because that's where I went to school. I thought my vet told me that they only saw animals by recommendation, but then again I may have misunderstood him. That indeed would be a wonderful place to obtain a second opinion.

 

I have to say that my husband had seen her limping after playing ball via the "chuckit" when I didn't as well about a week before the 4th so I think it might be a bit more serious than the vet thinks. Just to give the vet a little bit of credit he did ask me all the activities she participates in and how strenuous they are on her and that may be why he thought she just over did it.

 

I have another question about the bone chip. If it was a bone chip, would she stop limping ever or would she continuously limp? Because she has stopped limping. Like I said she wasn't limping anymore on Monday when we went to see the vet.

 

I don't mind paying and would pay a few thousand before I'd say that I couldn't pay any more. So you think I should see if I can get her into MSU? Should I see if the limping persists after heavy activity first or just go for the second opinion now?

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MSU may see appointments only by referral, but if so, your vet can refer you. The same goes for specialty practices, such as Barb mentioned (even though her dog had a rear-limb lameness, if they have an orthopedist on staff, s/he should be able to handle a forelimb issue as well. The one caveat is that not all private specialty hospitals are as well equipped for fancy diagnostics as University hospitals, though some certainly are.) If you go ask your vet about this and let him know that you want to get more agressive on work-up, he may refer you right away or may say, "Okay, let's get another view of this limb and see what we see, send the films in to the radiologist and see if they have any light to shed on this, and if not, then pop for special imaging." That's what I'd do, partly because for special imaging and radiologists, I have to send my patients out of state, and most owners would prefer I send the Xrays to the University rather than sending the dog.

 

I guess my thought would be that if this has been going on since late June, that's more than 6 months now, and I personally would be inclined to try to figure out what's up. If it's the same leg all the time, the recurrences imply that there's some ongoing problem. Even if it's just panno or just a chronic sprain or even a pinched nerve in the neck or spine, I'd still want to know that, and still want to rule other things out (especially since some things can have long-term consequences arthritically speaking). I will say that it's possible that even a specialist won't be able to get a certain diagnosis, but at least then you know you've done what you reasonably can.

 

I was thinking more of a cartilage chip than a bone chip, actually. There are two ways in which the limping could be intermittent with that. One is with an incompletely detatched chip, which is more of a flap, really. These can lift up from time to time and cause lameness only when they do so. The other is if you have a chip break off, which is then called a joint mouse (or joint rat, if it gets big enough.) The joint mouse can sort of drift around inside the joint capsule and only causes lameness if it's in a painful spot. Think of it like having a rock in your shoe. It the rock drifts up around the toes, it might not be under your foot at all, so it wouldn't bother you much. If it drifts back under the ball or heel of your foot, it might bother you rather a lot, really. Cartilage chips may produce lameness from heavy work, or at times randomly, with no apparant inciting event. Strains, sprains, bursitis and muscle injury tend to be more evident after hard work (and sometimes look worse immediately after the dog has been laying down for a bit; they stiffen up, but warm out of it after a few steps). Panno can be totally random.

 

The cartialge chips are much more common in the shoulder than the wrist or elbow, but they can occur anywhere there's articular cartilage.

 

One other thing to think about, which is that many dogs are quite stoic and will tolerate a certain amount of pain before showing signs of it. This can be especially true of working dogs with high drive; they're so into DOING stuff that they'll ignore a bit of ouchiness in order to go. So it *might* bother her a little all the time, but only occasionally enough to limp and go all clingy on you. Since she doesn't speak English, we can only speculate about that, though, and it could be she's 100% pain free most of the time.

 

So, that's a lot of info (sorry!), and of course it isn't by itself going to diagnose the dog, but it may help you organise your thinking so you CAN get a diagnosis. As I say, I wasn't there, so it may very well be that your vet has an extremely good reason for thinking it's going to be a chronic low-grade thing needing to be managed with intermittent pain meds. I'm just saying that for me, personally, I'd be more comfortable with a firm diagnosis before I let it go with Rimadly and rest as needed, and no certain idea of what might be up in there. That may just be me, though.

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>>>Panno can be totally random.

Hi AKC Doc,

Can you tell me about this? I have a 14 month old that has come up lame intermittently--in different legs!-- and is then totally fine a day or two later. The first time it was in the rear after being out in the back yard for half an hour. I greatly feared an ACL injury, since I went through that with another dog, and took him to the vet. Pissed off, of course, thinking what a stupid way to get such a major injury. Diagnosis: soft tissue injury. The usual Rx: crate rest and Medicam. Next, the front leg. Could this be caused by panno?

Andrea

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Panno is short for Panosteitis. (Just in case you want to research this before AK dog doc replies. There's lots of info from a Google search.)

 

Riley had a cartilege chip remooved at 10 months of age. This is called Osteochrondritis Dissecans (in case anyone needed that info as well).

 

Betsy

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Hi Andrea

I'm on call and it sounds like you got your questions answered, so I won't do the usual mini-dissertation :rolleyes: unless you still have questions about panno and/or OCD... let me know if you do, though, and I'll go on (and on and on, no doubt - you know how I am ) once I'm off call again (which will be about 12 hours from now).

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