Luxating Patellas AND Medial Shoulder Instability
 

Hello all, it has been years since I posted her. My Beanie, the love of my life, my first dog is now almost 12 years old. I cannot believe it! When I first got her, I got so much help here, coping with this little creature. She was, and still is, a total handful, but now I understand her and me dealing with her, more.

I am hoping to get some advice, insight into what I am now struggling with. Beanie has luxating patella, supposedly Grade 4 in the right leg and Grade 3 in the left leg. She also had/has a medial shoulder instability injury on her left right front leg. I was told by my vet that she needed surgery for this, but I opted not to and rehabbed her using aquatic therapy, physical therapy and laser therapy. It took almost 7 months, but she got better and we were back to our walking.

I have had multiple physical problems, including hip replacement last January and comminuted, displaced fracture of my left patella, this January. That happened walking Beanie! I feel, and well smashed my knee up. Couldn't walk for 2 months, which meant she didn't walk much either.

Have started walking again, but she is limping in various degrees. I can't even figure out which leg is making her limp. My vet has told me multiple times that she needs her Grade 4 luxating patella fixed over the years, but I have resisted and, again used non invasive treatments like swimming, etc. She has been fine with all of the above until now.

All her x-rays show minimal arthritis, so that is good. But, well, she is limping. She is also holding up her left leg more, so I know that the medial shoulder instability is rearing it's head again. I went to a wonderful surgeon 2 years ago, who said to keep doing the conservative treatment, swimming, etc., which I did and as I said, she got better. That surgeon has moved to Texas. Noooooooo. LOL.

I did try underwater treadmill last year for the luxating patellas (before I fell), but I don't think it really helped her like the actual swimming did (that was a different therapist). NOW, she is exhibiting problems with the patellas and the shoulder. She is fine in the house, no limping, running around playing, but when we go out to walk, everything manifests.

Sorry for this long post! I am struggling with guilt in that maybe I should have done the patella surgery years ago, but she was fine and we walked for hours. I don't know if I should consider the patella surgery and/or the medial shoulder instability surgery. My inclination is to try the swimming again and maybe acupuncture and chiropractic. I just want to do the right thing and I don't know what that is!!!

Anyway, any advice, help, your own experiences with any of this would be really appreciated and helpful.

Only a boarded ortho surgeon could really advise you; but, that said, I will tell you that is she were mine I would have done the shoulder. That is something that to my knowledge can only be surgically repaired. I had a pup who had it and had surgery.

As for LP I have never had an adult pup have surgery for that. Only for a torn CCL. At this age, her CCL is already worn and you could repair the LP to end up having a torn ligament later on. More money for you and surgery for her..not fun.

Good luck!

BTW, I don't know what vet told you over the years to repair LP. That really is not commonly done on adult dogs....or recommended.

Perhaps this article will be of interest to you.

https://www.vin.com/apputil/content/...5&objTypeID=17

Thanks LadyJane! Very good info. I am going to seek the opinion of an orthopedic surgeon. Unfortunately, the one I saw previously for her shoulder issue is now in Texas. She told me that Beanie didn't need surgery at that time because her shoulder was stabilized and the conservative treatment/management was working. She did say that Beanie might need surgery later on.

I am going to do some research and see if I can find another ortho surgeon.

Thanks again for your help.

The specialist who wrote that article is the one I use for all of my orthopedic pups. He is the best! He is in Texas, too. He does have a place in Maryland but I guess that is not close to you either. If you look on www.acvs.org you can find one in your area.

Please update as you know more!

I can tell you this is good information about the LP surgery because I didn't listen and got LP surgery on my now passed girl as an older adult and then like a year later the CCL tore so another surgery was necessary.

I did the search and it brought up the Mass. Veterinary Referral Hospital in Woburn, MA. The 2 surgeons that popped up were the 2 that I was actually looking at prior to doing the ACVS search. Beanie has spent a lot of time at that hospital due to her hemorrhagic gastroenteritis/IBD and many other things that have happened to her over the last 12 years. They actually know us very well there. I have had mostly, excellent experiences bringing her into emergency there and also seeing other doctors via regular appointments. Plus, they are only 2 miles away from me.

I am going to go with Karen F. Pastor, DVM, DACVS, she is an orthopedic/soft tissue surgeon and she finished her schooling, internship, etc. in 1996 so she has a lot of experience. Unless my own vet has another recommendation (aside from the woman who moved to Texas), I will schedule an apt. with Dr. Pastor and see what she has to say.

To anyone who is reading this thread: GET PET INSURANCE!! It is totally worth the money and I don't know what I would have done all these years if I didn't have it.

Thank you for your input, I certainly don't want to go through what you had to!!

I was stubborn and hard headed like my mama lol. Callie was who went through all that and she taught me pet insurance is a must. My mom referred to Callie as the dog of gold, she went through so much and that’s what made me so angry and outspoken on bad breeding/ puppy mills because they are the reason she had so many gentian issues. I have 2 out of my four now with LP both my two youngest Ollie’s is not bad at all but he is so active I fear he might tear his CCL one day and then Dixie and hers is horrible but it doesn’t seem to bother her at all and my Vet has seen many live perfectly fine lives without issues so we are hopping for that but do have the pet insurance if it doesn’t happen.

Awesome...sounds like a great plan! That's great that you have a relationship with them and they are so close! Please keep us posted!!

As to your last paragraph AMEN. I spent SO much money on my pups over the years. I finally got smart and the pups I have now are all insured! Best thing I ever did!

That is very heartening to hear that your Dixie has bad LP and is doing fine. Beanie actually has been fine with hers up until now and this all started happening after I fell and broke my knee and we didn't walk for 2 months. All the gains I made on her legs with the years of swimming, PT and laser therapy kind of went out the window. I know that it is really important to keep the dogs moving, especially when they are older, but I really don't have anyone that I trust enough to walk her where I live. A couple of people did walk her, but just around the building and these people are older than me and she really could have just pulled them down. I did the best I could trying to throw her balls around my very tiny apartment to get her SOME exercise, but I was really limited in what I could actually do because I had to stick to a very strict protocol for my knee to heal without surgery.

I am trying to ease us back into walking, doing very short walks as I am still healing. But I can see how much she is laboring and I am pretty sure it is the shoulder that is doing it because she is holding the paw up more and more when we get home. I am going to take her back to my vet next week and get a referral to the ortho surgeon that I decided on. I just want her to be totally honest with me about prognosis of surgery and how that will affect her other legs while she would be recovering.

The bottom line is, I don't have enough information to make any decisions and I really appreciate hearing from people her who have gone through these types of situations.

I have no direct experience with the surgery but have gotten lots of former mill dogs with all kinds of joint issues ... My vet advised to allows absolutely no jumping or stairs for small breeds- we installed ramps everywhere ... and I have put those seniors that are not good candidates for surgery in joint support wraps ( available online for the knees - they help stabilize the knees and ease the pain just like in humans ) - a harness that can help lift the dog over obstacles or get weight off the joints is also nice.

While braces can be a possibility, they also can be problematic in that they are awkward and can cause sores.

With any issue like that, I always recommend having a boarded surgeon take a look. Some seniors can be candidates for surgical repairs for torn ligaments, some not.

Ramps are awesome IF they will use them. LOL these little terriers can often have minds of their own.

I actually have a ramp so she can get on and off my bed, BUT she has recently decided she won't go up the ramp, so I have to pick her up. I don't know if going up the ramp bothers her legs, or if she has just decided that this is something she now won't do. It drives me crazy when I see another woman who lives in my building let her giant Yorkie jump on and off everything. He has a bad knee too. I have never let Beanie jump, except for the times that she managed to do it before I could stop her. This dog is one stubborn animal! I actually tried a hobble brace when she first injured her shoulder a couple of years ago, but it didn't really fit right. That being said, even if it did fit, she wouldn't have tolerated it. She just stood there for 1/2 hour with this terrified look on her face and would not move. There is a company that makes custom braces for dogs and that is something I am going to explore.

I have apt. with ortho surgeon on 6/6 but I may be able to get a much sooner one with the ortho surgeon at the place where she does the aquatic therapy. Beanie's PT person is going to talk to this doctor to see if she will do the PRP (Platelet Rich Plasma) injections to her. This doctor has done that with other dogs with great results.

So, at least I feel like I do have some kind of plan now to get as much information as possible to try and help her. Some days she is actually really good and doesn't limp at all, but other days she limps more. SO frustrating!!

https://todaysveterinarypractice.com...gament-repair/

From the link:

Because surgical repair of CCLRs is needed to correct physical derangements within the stifle joint, it is our opinion that PRP therapy is currently not a viable sole option for ruptured ligaments, either partial or full. We believe PRP’s therapeutic usefulness includes:

Treatment of secondary inflammation, both from acute trauma to the ligament as well as in the postoperative period
Promotion of tissue regeneration and repair.
We have treated a number of partial CCL tears with PRP alone as the sole method of therapy. While the ligaments initially seemed to heal and the dogs returned to good to excellent function, this success was short lived and lameness invariably returned. Without surgical correction of the underlying conformational defect, PRP alone was unable to provide successful long-term treatment of the injured CCL.

Beanie's problems are medial shoulder instability and luxating patella. Not CCL tears, thankfully. Here is an article from the Woburn Veterinary Hospital from one of the vets there. This article talks about different ways of dealing with this issue, including the use of PRP. I have done and am still going to do the aquatic therapy, laser therapy and physical therapy. I am thinking that if I can get her front legs "fixed", I can then deal with the luxating patellas.

Uggghh, I feel overwhelmed some times. She did really good walking the other day, no limping and a pretty good walk. Today, not so good. But neither was I. My broken knee was "barking" at me today, so it worked out that we didn't walk that much. I am more worried about Beanie's legs than my own!!

https://www.ethosvet.com/blog-post/s...r-instability/

Oh duh. Sorry. I hope if they do it, it works. I ended up having to do surgery on my foster because his other started to go bad from the stress.

Yikes, I had to have knee replacements years ago....pain before was dreadful I feel for you.

I hope it works for her too. I will let you know how it goes. No matter what, I am still going to seek the advice/information from an ortho doctor. I would prefer to see the ortho at the vet hospital where she gets her aquatic therapy as it is smaller. less busy and more personal than the Woburn referral hospital. In the meantime, I am doing small walks with her and kind of going by how she is walking and limping or not.

What do you think of that Cosequin supplement? Or what about a CBD supplement? I have heard mixed reviews about the Cosequin, specifically stomach issues. I don't want to give her anything that will flare up her stomach again.

You know, the broken knee really wasn't that painful and it was a bad break in TWO places. I didn't need surgery, thank God. I was able to lift my leg straight out, so the ortho surgeon opted for me wearing a full leg brace for 10 weeks and basically going from the bed to my chair. I thought I was going to turn into a piece of furniture from sitting so long!! LOL.

I did have 2 hips replaced over the past 6 years and the pain before the surgeries was unbearable. Recovery from hip replacement is not as bad as recovery from knee replacement. My friend is going on 6 months, and she still is in pain every day. I hope that my knees stay stable and I don't have to replace THOSE too. OMG, I am going to be one giant piece of metal!!:eek:

I never had any luck with the cosequin and I won't use CBD. But...didn't have any stomach issues with the cosequin.

OMG a fractured knee cap is so painful. Happened to a friend of mine.

Knock wood, no hips here. I was very lucky I guess. Had my knees done three months apart 16 years ago and never looked back.

LOL on the metal. One night I was walking past my neighbor't truck and my knee hit his hitch.....the noise was scary! LOL Painful, too, but I was fine. Titanium strong I guess.

Please do keep us updated!

My orthopedic surgeon for my now passed girl recommended dosoquin it works for some and not for others. If you get CBD get a human product with no THC. Most dog product CBD doesn't really have much or any in it. I had great success with a pain management with my now passed girl Callie but when I tried it with Penny for anxiety it made her very weird so I wont give it to her again. Like joint supplements it works for some but not for others. Since we are talking older dogs you don't necessarily have as much to worry about long term effects like you would with a younger dog.

Our Maggie had grade 3+ LP in both back legs from a fairly early age. The vet recommended we see an orthopedic surgeon. We decided to wait after reading about it. A couple years later she developed a limp when walking much or running. We started giving her Cosequin DS Plus MSM Chewables (a whole full size chew per day) and the limp went away and she did very well the rest of her life. We lost her a week ago at the age of 14. My heart is broken!!! But that version of Cosequin worked wonders for Maggie and I would swear by it. She took it for several years. That is just our experience with it.

Oh wow, I remember you from a long time ago when I was posting alot when I got Beanie! I am so sorry about Maggie!! I can't even imaging losing Beanie, I think I am just going to die too.

Beanie is starting her aquatic PT again tomorrow and I am going to talk to PT person about an apt. with the ortho vet at that hospital. I will talk to her about the Cosequin and also CBD oil. Beanie has a terrible stomach and I worry that anything I give her is going to flare up the IBD again, especially since she has been doing SO good with that for over a year now, but I am certainly willing to try them both!

She has actually been doing better since we have started walking more consistently after my broken knee, and the limp is much more intermittent, but it does seem like she is in discomfort at times. I have been able to giver her a little Rimadyl or Gabepentin when she seems to be in discomfort and, thankfully, her stomach has held up!

Yes, I haven't been on here in a very long time. Life and priorities I guess. Losing Maggie made me remember this forum and wonderful everyone here was. She was the love of my life. I have cried every day for a week now. I have never felt so much pain! She was my soulmate, my shadow, and I miss her something awful! She was one of a kind.

It is nice to connect with someone that remembers us. I hope Beanie does well with the PT and treatment. It is scary when something is wrong with one of your babies. Thanks for the kind words! Best of luck!

I’m so sorry for you loss of Maggie. Callie has been gone 2 years and I still morn on her birthday in May and the day we had to let her go in June.

Yes, same with me remembering how nice people here were. Beanie did great at her PT/aquatic therapy. AND, I have apt. with ortho doc at the same place next Tues. They fit me in because everyone loves Beanie there. Everyone loves Beanie everywhere, lol. She is the perfect dog... except with me!! This vet does the PRP injections and does not "push" surgery on people, which is what I am looking for. It is a smaller hospital than the large referral hospital I was going to go to and I like that too.

I know exactly what you mean about your feelings for Maggie. My heart hurts for you. Just think of her as your Guardian Angel and that you will see her again. That is all I can hope to think when Beanie passes!!

Thank you so much!

I hope Beanie does well. It sounds like you have found a very nice hospital for her.

Beanie update
 

Hi all, so I wanted to give you guys an update on Beanie's little stick legs and the treatment I have done so far in the hopes that it will help some of you.

On July 3rd, Beanie had Platelet Rich Plasma (PRP) injections done to all of her legs. The procedure was a lot more involved than I thought and she was put under full anesthesia, her legs and shoulders were all shaved and she was given some pretty strong injectable pain meds. Needless to say, it was a rough couple of days afterwards. The procedure requires blood to be drawn, it is then spun down and all the "good" stuff is separated (the stem cells and plasma) and then that is injected into the affected areas of her legs. It is considered regenerative medicine.

I had to keep her "quiet" for 2 weeks, take her back for a check up and then I could resume walking and letting her play with her beloved squeaky balls. It took about a month for her to fully recover and for me to see any results. It was like, all of a sudden, she just started bouncing around again like she used to! And we have been going for 2 - 3 walks a day with NO LIMPING!! We are able to do a couple of 10 - 15 minute walks, and a 20 - 25 minute walk, dependent upon the weather of course. Does she slow down a little at the end of the longer walk, yes, as do I. LOL. We are two old broads now.

She is also still doing the underwater treadmill, floor exercises and getting cold laser treatment every week. The best thing about the PRP treatment is now I can concentrate on building up her legs again, especially her back ones so that the luxating patellas can be "encased" better.

All in all, I consider the treatment to be a success. I don't know how long it will last, but I definitely would do it again. I am also going to explore the options of acupuncture and chiropractic. I will do this after my pet insurance renews so that I don't have to worry about the spending cap that I have.

Pet insurance is now really expensive, but TOTALLY necessary because I wouldn't be able to do the things to help my doggie live a good, old lady life!

Anyway, I encourage anyone to do some research into PRP treatment and also stem cell therapy.

I'm glad Beanie is doing so well! I pray she continues to do well in the long term. Love her with all you've got!! She deserves it!

Thank you! I do love her and I cherish every day with her as time is going by SO fast. I try so hard not to focus on her age and just stay in the present. It has made me so happy to see her doing so well and HER being so happy!

She wakes up every day doing her silly way of saying I love you to me. She starts at the bottom of the bed by my feet and mushes her whole body up my body to my arms and then just lays on top of me so that I can scratch her whole body. She had stopped doing that for quite awhile because I know she was in pain from her legs and now she is back doing it!!

I am so grateful for this time with "renewed" Beanie!