Luxating patella in Pomeranian....
Luxating patella in Pomeranian....
Hello.....my little Huey, who will be 12 this coming May, was diagnosed yesterday with a luxating patella in his left rear leg. We had the right rear leg operated on in 04 so that one is doing great. He's been favoring his left leg for a few weeks now and I wasn't sure it was the patella or is he had strained it. Last night the vet said he could not push the patella back into place so he wants to start Huey on an anti-inflammatory to see if it helps with any discomfort....but first he wants to read up to make the the drug (metacam) doesn't have any adverse affects on the medications Huey is currently on. Huey has a heart murmur and is on lasix, enalapril, and theophylline....he's been on them for 2 years and is doing great! Anyway, the vet said there's no way to tell if there is any arthritis in the knee or not - that's why the anti-inflammatory meds. He said if we did do the surgery there's no guarantee Huey's leg would be perfect due to the not knowing about arthritis. Should I ask for an x-ray to see what is exactly going on with his knee or should I just let him live with the limp? He uses the leg but definitely favors it. He never acts like he's in any pain or discomfort - just doesn't put full weight on that leg. Even if we can determine there's no arthritis I'm hesitant to put him through surgery due to his age and the heart murmur issue. Thanks.
Re: Luxating patella in Pomeranian....
Not sure if it's the way you presented this or not, but is your vet not confident in his abilities? If not, can you seek a second opinion?
The problem with a luxating patellar, left untreated, is that it will progress, and cause cartilage damage, and even though you don't feel he's in pain, he very well could be.
I'm surprised the vet didn't take an xray as part of the diagnosis. Yes, get one done, because more than likely you'll see significant changes from when the right leg was done in '04. Hasn't your vet requested xrays each year to monitor this? (in some cases, both patellars need to be corrected, not always at the same time, but whichever isn't needs to be monitored regularly).
I agree that surgery is a risk at his age and with a heart condition, but perhaps a second opinion (even with a cardiologist) might be in order. It depends on the extent of damage, pain, comfort, etc and a cardiologist could tell you if Huey is a good candidate for anesthesia.
How long has he been on metacam? Since it's an NSAID, you want to monitor his bloodwork regularly, and watch liver and kidney values.
The problem with a luxating patellar, left untreated, is that it will progress, and cause cartilage damage, and even though you don't feel he's in pain, he very well could be.
I'm surprised the vet didn't take an xray as part of the diagnosis. Yes, get one done, because more than likely you'll see significant changes from when the right leg was done in '04. Hasn't your vet requested xrays each year to monitor this? (in some cases, both patellars need to be corrected, not always at the same time, but whichever isn't needs to be monitored regularly).
I agree that surgery is a risk at his age and with a heart condition, but perhaps a second opinion (even with a cardiologist) might be in order. It depends on the extent of damage, pain, comfort, etc and a cardiologist could tell you if Huey is a good candidate for anesthesia.
How long has he been on metacam? Since it's an NSAID, you want to monitor his bloodwork regularly, and watch liver and kidney values.
..........Traci
Re: Luxating patella in Pomeranian....
I feel he's confident.....there are several doctors at the practice I go to and I've been pleased with all of them over the last 20 years or so. I think he's just taking the conservative approach right now. I asked him about an x-ray and he said x-rays do not always show everything....arthritis will not always show up. So for now, we're not doing an x-ray but I will also be asking another doctor there the same question and also get his opinion of the situation. The vet also mentioned the possibilty of having to give Huey some sort of light anesthesia to get an x-ray.....I'm not sure I believe that though.....can't they hold him in position and take the x-ray without any anesthesia being administered? We have not had x-rays each year - I've been aware that the second kneecap could be moved but until now it had not been an issue. Huey is not on metacam yet - the vet wanted to do some add'l research first about the possible affects of mixing it with the heart meds. I read that metacam can make enalapril less effective....I'm not sure I want to do that. Huey is doing SO well on his heart medications and I don't want to mess with that. Huey still runs around like normal and is completely happy. Believe me, I'm not done with this situation....I want to be sure I'm doing all the right things and making the right decisions.
Re: Luxating patella in Pomeranian....
Xrays may or may not show what you're looking for. To ignore the value of an xray though (or the attempt), is in my opinion, not doing enough. I'm also cautious about vets in the same practice giving the same opinion, that isn't truly a second opinion since there is risk for bias amoung them.
I don't know why he would think anesthesia would be required to perform an xray unless there is significant pain involved when the leg is positioned for an xray (did Huey yelp or seem painful when the vet attempted to pop the ligament back into place?)...if he's qualified, or has a tech who's qualified, no need. There's several angles one can approach, you use your best judgement on the first (with dog's comfort/stillness in mind, as well as the client's costs), and if that doesn't produce what you want, you do another. I don't like comparisons but think carpentry, measure twice, cut once.
I don't know why he would think anesthesia would be required to perform an xray unless there is significant pain involved when the leg is positioned for an xray (did Huey yelp or seem painful when the vet attempted to pop the ligament back into place?)...if he's qualified, or has a tech who's qualified, no need. There's several angles one can approach, you use your best judgement on the first (with dog's comfort/stillness in mind, as well as the client's costs), and if that doesn't produce what you want, you do another. I don't like comparisons but think carpentry, measure twice, cut once.
..........Traci
Re: Luxating patella in Pomeranian....
I used to get fairly good results in early cases by injecting Sodium Morrhuate in the outside capsule ligaments...this would tighten the joint up for a while but there is nothing as good as the surgery....But as Traci intimates..make sure the surgeon knows what he is doing...I did a few of them but the later ones I sent them to a surgeron......