Please help answer some questions

[tsingh]

My dog has been diagnosed with-bilateral hip dysplasia. Just to confirm this is not in his knee or leg right, this is within his hip area? They also diagnosed that both of his legs in the back pop in and out--- Patellar Luxation. But I forget to ask what grade this condition is in.

Loki is only 11 months old- and surgery is what we are opting for. They will do one hip surgery and then both knees at the same time. Then 6 months letter they will do the other hips.

But I was thinking and am thinking out loud (with your guys help) what if I just wanted to do his hip surgery for now, and then see if I can naturally fix his knees with psychical therapy and all.. Please help me make a decision that allows my little bear to live a good comfortable life.

QUESTION-
DOES ANYONE HAVE ANY EXPERIENCES WITH THIS- WITH YOUR YORKIE POO?

[pstinard]

Originally Posted by tsingh

My dog has been diagnosed with-bilateral hip dysplasia. Just to confirm this is not in his knee or leg right, this is within his hip area? They also diagnosed that both of his legs in the back pop in and out--- Patellar Luxation. But I forget to ask what grade this condition is in.

Loki is only 11 months old- and surgery is what we are opting for. They will do one hip surgery and then both knees at the same time. Then 6 months letter they will do the other hips.

But I was thinking and am thinking out loud (with your guys help) what if I just wanted to do his hip surgery for now, and then see if I can naturally fix his knees with psychical therapy and all.. Please help me make a decision that allows my little bear to live a good comfortable life.

QUESTION-
DOES ANYONE HAVE ANY EXPERIENCES WITH THIS- WITH YOUR YORKIE POO?

If the luxating patella is severe, it would make sense to have all of the surgery done at the same time. If the luxating patella is mild, it may not need surgery for a few years, if at all. BTW, if the luxating patella is severe, it can lead to arthritis and permanent joint damage if it is not surgically corrected within a year or two. My Bella had luxating patella surgery 10 months ago, and she has made an almost complete recovery.

[Wylie's Mom]

There are a lot of mixed opinions out there about LP surgery, so hopefully more will chime in here.

It's important to know what grade the LP is bc if it's mild, it may never really need surgery.

[ladyjane]

Poor puppy....I do hope you have contacted the breeder! He/she should bear some responsibility for these issues imho.

I suggest, if you are not seeing one now, that you seek the opinion of a board certified surgeon whose main interest is in orthopedics. You can find one at www.acvs.org
I have seen many, many pups who were advised to have surgery by a general vet, go to a board certified vet only to find out that all that surgery was not necessary. Besides, it is always good to have second opinions!

My Adina has hip dysplasia .. she was diagnosed as an adult in 2012 when she started limping. Here is a thread about her :
http://www.yorkietalk.com/forums/sic...-tomorrow.html
The surgeon told me that unless hips are really bothering them, there is no need for surgical intervention. I opted for the one hip that was causing pain to be operated on. She has not had any problems with the other hip at all!!

As for the LP, I personally would probably repair both knees. I don't feel that way about adult yorkies, but puppies yes. The surgeon I go to said while it is not wrong to fix LP in adult dogs it is really not necessary unless they are causing major issues (which is rare...usually when there are issues it is due to other things going on in the knee such as a torn cruciate ligament). He said that IF they tear a ligament, then he will repair the ligament and the LP. We were just there the other day with a YHR foster pup and, once again, the surgeon told us that the risk of arthritis is really not that bad with LP. There IS however, severe arthritis in torn cruciate ligaments. He said that many vets say that if a dog's LP is not repaired it will lead to arthritis but he has not seen that. I might add that every one of my personal pups have LP and are adults, and not one has arthritis in his/her knee. The reason to repair LP in a puppy is to try to prevent the wear and tear on the cruciate ligament which leads to tears; BUT it is not always going to prevent a tear. A pup can tear a ligament without even having LP.

I wish you good luck...please keep us posted!

[ladyjane]

A helpful link:

https://www.acvs.org/small-animal/patellar-luxations

[Lovetodream88]

LP can not be fixed naturally. LP can also lead to ACL tears so I would have it fixed at the same time.

[ladyjane]

Originally Posted by Lovetodream88

LP can not be fixed naturally. LP can also lead to ACL tears so I would have it fixed at the same time.

Agreed, LP cannot be fixed by PT or anything other than surgery!

[pstinard]

Originally Posted by ladyjane

As for the LP, I personally would probably repair both knees. I don't feel that way about adult yorkies, but puppies yes. The surgeon I go to said while it is not wrong to fix LP in adult dogs it is really not necessary unless they are causing major issues (which is rare...usually when there are issues it is due to other things going on in the knee such as a torn cruciate ligament). He said that IF they tear a ligament, then he will repair the ligament and the LP. We were just there the other day with a YHR foster pup and, once again, the surgeon told us that the risk of arthritis is really not that bad with LP. There IS however, severe arthritis in torn cruciate ligaments. He said that many vets say that if a dog's LP is not repaired it will lead to arthritis but he has not seen that. I might add that every one of my personal pups have LP and are adults, and not one has arthritis in his/her knee. The reason to repair LP in a puppy is to try to prevent the wear and tear on the cruciate ligament which leads to tears; BUT it is not always going to prevent a tear. A pup can tear a ligament without even having LP.

Good point about arthritis not necessarily being associated with luxating patella. A lot of veterinarians say that it is, including my own vet, as well as this online article about luxating patella linked below:

01 Medial Luxating Patella - VeterinaryPartner.com - a VIN company!

HOWEVER, I looked through the scholarly literature, and found a study that showed that although LP surgery improves a dog's mobility and quality of life, it doesn't reduce the frequency with which arthritis develops:

"In this study, surgery significantly improved limb use in dogs with lameness caused by medial patellar luxation. The beneficial effect of surgery on limb use has been reported by other investigators. However, surgical correction did not prevent progression of osteoarthritis in stifles of dogs with medial patellar luxation. Our findings were consistent with a previous report in which osteoarthritis progressed after surgical treatment of patellar luxation."

From A Retrospective Evaluation of Stifle Osteoarthritis in Dogs with Bilateral Medial Patellar Luxation and Unilateral Surgical Repair - ROY - 2008 - Veterinary Surgery - Wiley Online Library (which is behind a paywall, of course).

So nix what I said earlier about surgery for severe LP preventing arthritis, but surgery for severe LP is still VERY beneficial for the dog's mobility and quality of life.

[ladyjane]

Originally Posted by pstinard

Good point about arthritis not necessarily being associated with luxating patella. A lot of veterinarians say that it is, including my own vet, as well as this online article about luxating patella linked below:

01 Medial Luxating Patella - VeterinaryPartner.com - a VIN company!

HOWEVER, I looked through the scholarly literature, and found a study that showed that although LP surgery improves a dog's mobility and quality of life, it doesn't reduce the frequency with which arthritis develops:

"In this study, surgery significantly improved limb use in dogs with lameness caused by medial patellar luxation. The beneficial effect of surgery on limb use has been reported by other investigators. However, surgical correction did not prevent progression of osteoarthritis in stifles of dogs with medial patellar luxation. Our findings were consistent with a previous report in which osteoarthritis progressed after surgical treatment of patellar luxation."

From A Retrospective Evaluation of Stifle Osteoarthritis in Dogs with Bilateral Medial Patellar Luxation and Unilateral Surgical Repair - ROY - 2008 - Veterinary Surgery - Wiley Online Library (which is behind a paywall, of course).

So nix what I said earlier about surgery for severe LP preventing arthritis, but surgery for severe LP is still VERY beneficial for the dog's mobility and quality of life.

I agree with your last sentence in IF the LP is severe and by that I don't mean the grading. The symptoms are what should be considered. The surgeon I use said that many times LP is repaired and then the CCL tears and the poor pup needs surgery yet again. Tough on the pup and hard on the owner's pocketbook.

In a puppy it is a whole different ball game.

[gemy]

Originally Posted by tsingh

My dog has been diagnosed with-bilateral hip dysplasia. Just to confirm this is not in his knee or leg right, this is within his hip area? They also diagnosed that both of his legs in the back pop in and out--- Patellar Luxation. But I forget to ask what grade this condition is in.

Loki is only 11 months old- and surgery is what we are opting for. They will do one hip surgery and then both knees at the same time. Then 6 months letter they will do the other hips.

But I was thinking and am thinking out loud (with your guys help) what if I just wanted to do his hip surgery for now, and then see if I can naturally fix his knees with psychical therapy and all.. Please help me make a decision that allows my little bear to live a good comfortable life.

QUESTION-
DOES ANYONE HAVE ANY EXPERIENCES WITH THIS- WITH YOUR YORKIE POO?

I think that prior to making up my mind; and as I said in the other thread of yours http://www.yorkietalk.com/forums/gen...-scared-7.html
that I would for sure get a second expert opinion. This is major surgery and a whole lot of it the specialist is recommending. And you will fast use up that insurance coverage of yours with all those surgeries in the same year.


You can easily call up his office and have him read out the Grade of LP and how severe the HD and how he has graded that. Also is one hip worse than the other? Ditto question for both knees.


And I'd also want to know if his limping is due to his hip and if so which hip, or his knee and if so which knee? This all should be on the assessment letter he should have written by now - and you should have a copy of. If you don't when you call their office ask for a copy to be emailed to you. is a very reasonable request.


Here is how I would evaluate this *four joint recommended surgery*


As my boy has only been limping for one wk on whatever meds he is on - would it be prudent to re-look his dosage and or prescription medicine which might more effectively reduce swelling (if swelling is present), and add right now joint supplementation. As well start him on underwater treadmill work to see if we also can ease his symptoms.


1. What is the extended recovery time for doing 2knees at once? How will his home-care program be made more or less difficult by having a double knee and one hip surgery? Will he need assistance on rising from the ground, eliminating etc? If so for how long and what support aids might I be expected to purchase? What happens if one knee surgery fails?


2. What is the risk of infection for a single LP repair vs double? And how much longer will the surgery be for the second knee?


3. Why are you recommending double LP surgery and most especially be done in conjuction with hip surgery?


4. If we only operate on the hips will the knees be able to take whatever additional body weight strain put upon them? How is his front end and will it bear the additional weight stresses put on it? Here we are looking at elbows and shoulders etc.


Once I get all my answers from this expert and would pose very similar questions to my second expert.

[tsingh]

Pretty surprise I received no alerts that this thread was being responded to. I have lokis write up apt- can I upload here please. this is the next step....

Good Morning Tika,

It was a pleasure talking to you on the phone. I am so glad that we were able to get you some answers and get Loki on the road to recovery. We have him scheduled for surgery on Friday, January 30th 2015. Dr. Howard would like you to drop off the morning of surgery between 7:30am and 8:00am. The night before surgery, Loki can have food and water until 11:00pm. After that no food, no snacks and obviously no breakfast. Water is fine over night. When you drop Loki off we will have you leave a deposit which will be the low end of the estimate that Dr. Howard prepared for you. We feed a low fat, hypoallergenic diet made by Royal Canin in the hospital. We would be happy to feed him that while he is with us unless you have a specific diet that you would like to keep him on. If that is the case, we just ask that you bring enough food for 2 meals. If Loki is on any medications that he takes on a daily basis, we will also ask that you bring those along with you so that we can continue to give those to him as needed. Loki will have a treatment technician with him at all times while he is here and you can call to check up on him at any time. If you call after business hours, once you hear the recording, press 1 and you will be transferred to the treatment floor and one of the technicians will be able to give you an update. If you have any other questions prior to his surgery, please don’t hesitate to give me a call.

Warmest Regards,

[gemy]

\Hi there.


That is a form pre-surgery letter, and not his assessment evaluation report that should have been made up and one copy is sent to your general vet, and you should get one copy as well.

[gemy]

In terms of no email notifications for message responses, go to User CP and see if you have clicked the option for instant email notifications...

[gemy]

If you have the evaluation report you can either take a photo of it, or scan it into your computer then upload it here as an attachment.

[tsingh]

No that is not the write up.. that is the next step for Loki. Yes, I have uploaded that form, how do I upload here?