Shih Tzu with bilateral MPL's, CCL's, hip dysplasia and...

[Guest guest]

Hi all! I have a 15 year old female shih-tzu patient that has bilateral MPL's

(grade 4/4 LH and grade 2/4 RH), Bilateral chronic cruciates (LH limb not that

much drawer anymore, but RH has some drawer), bilateral hip dysplasia (Left

worse than right radiographically) and now has very hard time with her hocks.

The LH tarsal joint seems to be more flexed than normal when the stifle is in

standing position (as if the achilles tendon was too lax). THis is not noted on

the RH as much. This seems to be the main problem now as far as what triggered

owner's concern. The owners refused to do surgical repair of some of these

problems in the past and are now concerned since the dog has a really hard time

standing on tile flooring. On non slip flooring the dog does much better

standing and trying to walk around, but owners are concerned with quality of

life and were considering euthanasia, so the regular vet referred it to me to

see if there was anything we could do. I know that with all these lesions there

may not be much I can do, but I wanted to get you input still.

They currently put carpeting in the areas where the dog hangs out so she can

walk around better, she's on metacam daily, dasuquin daily, and Adequan

injections. We are giving her laser on hips/stifles/hocks. The owner inquired

about options for braces so she could walk better, but I don't have experience

with these. I've seen them for cruciates, or for MPL's, but this dog has so

many problems I don't know if it'll work (and she's so tiny!). But on the other

hand we don't have anything to lose if the other option is euthanasia (Might as

well try something!). Does anyone have experience with this and if so is there

a particular type of brace you would recommend?

Thanks!

Alma Alicea-Garcés, DVM, CCRT

Veterinary Specialty Hospital

San , PR

almaalicea@...

[Guest guest]

Hello Alma

I have worked with a number of dogs like this. Do you have any video or

pictures of this little dog? Depending on stance and stride you can work with a

hobble system and an orthosis. The former is to control the splaying of the

limbs (if this is a significant problem) and the latter to align the tarsus

given the stretched achilles complex.

Patsy Mich

Patrice M. Mich, DVM, MS,

Diplomate American Board of Veterinary Practitioners (canine and feline

specialty)

Diplomate American College of Veterinary Anesthesiologists

Certified Canine Rehabilitation Therapist

OrthoPets, Center for Veterinary Orthotics and Prosthetics, Medical Director and

Owner

Specialist in Pain Management and Mobility

>

> Hi all! I have a 15 year old female shih-tzu patient that has bilateral MPL's

(grade 4/4 LH and grade 2/4 RH), Bilateral chronic cruciates (LH limb not that

much drawer anymore, but RH has some drawer), bilateral hip dysplasia (Left

worse than right radiographically) and now has very hard time with her hocks.

The LH tarsal joint seems to be more flexed than normal when the stifle is in

standing position (as if the achilles tendon was too lax). THis is not noted on

the RH as much. This seems to be the main problem now as far as what triggered

owner's concern. The owners refused to do surgical repair of some of these

problems in the past and are now concerned since the dog has a really hard time

standing on tile flooring. On non slip flooring the dog does much better

standing and trying to walk around, but owners are concerned with quality of

life and were considering euthanasia, so the regular vet referred it to me to

see if there was anything we could do. I know that with all these lesions there

may not be much I can do, but I wanted to get you input still.

> They currently put carpeting in the areas where the dog hangs out so she can

walk around better, she's on metacam daily, dasuquin daily, and Adequan

injections. We are giving her laser on hips/stifles/hocks. The owner inquired

about options for braces so she could walk better, but I don't have experience

with these. I've seen them for cruciates, or for MPL's, but this dog has so

many problems I don't know if it'll work (and she's so tiny!). But on the other

hand we don't have anything to lose if the other option is euthanasia (Might as

well try something!). Does anyone have experience with this and if so is there

a particular type of brace you would recommend?

> Thanks!

> Alma Alicea-Garcés, DVM, CCRT

> Veterinary Specialty Hospital

> San , PR

> almaalicea@...

>

[Guest guest]

Alma,I am assuming that your patient is in significant chronic pain and is rapidly declining in functional abilities as a result. Can you localize painful areas? You might consider intra-articular injections of triamcinolone in hips, stifles and any other joints that maybe painful and dysfunctional due to osteoarthritis. I would d/c metacam for 5 days prior to injections and 5 days after. We really don't have a dose but I use 6mg/joint in a big dog so I would probably use 2-3mg/joint in your patient. I would also consider addint amantadine 1-4mg/kg/day and maybe gabapentin 5-10mg/kg q8-12h for chronic pain. I usually find that the severe, chronically painful, rapidly declining functional, osteoarthritic patient has considerable myalgia accompanying the joint pain. Myalgia or myofascial pain might improve with treatments mentioned above however physical medicine can help - therapeutic laser, massage, trigger point therapy - dry needling, passive stretching, etc.Rick Wall, DVMThe Woodlands, TX

[Guest guest]

Hi Rick and Patsy! Painful at stifles. Minimal pain hips and not painful at

hocks. I'm trying to upload a video so you can see it... can't figure out how

to do it... do you have any suggestions? I'm not computer savvy...

Thanks for your help!

Alma

>

> Hi all! I have a 15 year old female shih-tzu patient that has bilateral MPL's

(grade 4/4 LH and grade 2/4 RH), Bilateral chronic cruciates (LH limb not that

much drawer anymore, but RH has some drawer), bilateral hip dysplasia (Left

worse than right radiographically) and now has very hard time with her hocks.

The LH tarsal joint seems to be more flexed than normal when the stifle is in

standing position (as if the achilles tendon was too lax). THis is not noted on

the RH as much. This seems to be the main problem now as far as what triggered

owner's concern. The owners refused to do surgical repair of some of these

problems in the past and are now concerned since the dog has a really hard time

standing on tile flooring. On non slip flooring the dog does much better

standing and trying to walk around, but owners are concerned with quality of

life and were considering euthanasia, so the regular vet referred it to me to

see if there was anything we could do. I know that with all these lesions there

may not be much I can do, but I wanted to get you input still.

> They currently put carpeting in the areas where the dog hangs out so she can

walk around better, she's on metacam daily, dasuquin daily, and Adequan

injections. We are giving her laser on hips/stifles/hocks. The owner inquired

about options for braces so she could walk better, but I don't have experience

with these. I've seen them for cruciates, or for MPL's, but this dog has so

many problems I don't know if it'll work (and she's so tiny!). But on the other

hand we don't have anything to lose if the other option is euthanasia (Might as

well try something!). Does anyone have experience with this and if so is there

a particular type of brace you would recommend?

> Thanks!

> Alma Alicea-Garcés, DVM, CCRT

> Veterinary Specialty Hospital

> San , PR

> almaalicea@...

>

[Guest guest]

I have placed videos (2) in youtube:

http://youtu.be/7uNjQpt35_Y

http://youtu.be/P6-0FiREIDo

Please let me know if this doesn't work.

Thanks!

Alma

> >

> > Hi all! I have a 15 year old female shih-tzu patient that has bilateral

MPL's (grade 4/4 LH and grade 2/4 RH), Bilateral chronic cruciates (LH limb not

that much drawer anymore, but RH has some drawer), bilateral hip dysplasia (Left

worse than right radiographically) and now has very hard time with her hocks.

The LH tarsal joint seems to be more flexed than normal when the stifle is in

standing position (as if the achilles tendon was too lax). THis is not noted on

the RH as much. This seems to be the main problem now as far as what triggered

owner's concern. The owners refused to do surgical repair of some of these

problems in the past and are now concerned since the dog has a really hard time

standing on tile flooring. On non slip flooring the dog does much better

standing and trying to walk around, but owners are concerned with quality of

life and were considering euthanasia, so the regular vet referred it to me to

see if there was anything we could do. I know that with all these lesions there

may not be much I can do, but I wanted to get you input still.

> > They currently put carpeting in the areas where the dog hangs out so she can

walk around better, she's on metacam daily, dasuquin daily, and Adequan

injections. We are giving her laser on hips/stifles/hocks. The owner inquired

about options for braces so she could walk better, but I don't have experience

with these. I've seen them for cruciates, or for MPL's, but this dog has so

many problems I don't know if it'll work (and she's so tiny!). But on the other

hand we don't have anything to lose if the other option is euthanasia (Might as

well try something!). Does anyone have experience with this and if so is there

a particular type of brace you would recommend?

> > Thanks!

> > Alma Alicea-Garcés, DVM, CCRT

> > Veterinary Specialty Hospital

> > San , PR

> > almaalicea@

> >

>

[Guest guest]

Can you post x-rays of the lower back and rear legs of this poor little guy?

Christie Carlo, DVM, CCRT

Secretary, AARV

Avondale Veterinary Healthcare Complex

Des Moines, IA 50320

> >

> > Hi all! I have a 15 year old female shih-tzu patient that has bilateral

MPL's (grade 4/4 LH and grade 2/4 RH), Bilateral chronic cruciates (LH limb not

that much drawer anymore, but RH has some drawer), bilateral hip dysplasia (Left

worse than right radiographically) and now has very hard time with her hocks.

The LH tarsal joint seems to be more flexed than normal when the stifle is in

standing position (as if the achilles tendon was too lax). THis is not noted on

the RH as much. This seems to be the main problem now as far as what triggered

owner's concern. The owners refused to do surgical repair of some of these

problems in the past and are now concerned since the dog has a really hard time

standing on tile flooring. On non slip flooring the dog does much better

standing and trying to walk around, but owners are concerned with quality of

life and were considering euthanasia, so the regular vet referred it to me to

see if there was anything we could do. I know that with all these lesions there

may not be much I can do, but I wanted to get you input still.

> > They currently put carpeting in the areas where the dog hangs out so she can

walk around better, she's on metacam daily, dasuquin daily, and Adequan

injections. We are giving her laser on hips/stifles/hocks. The owner inquired

about options for braces so she could walk better, but I don't have experience

with these. I've seen them for cruciates, or for MPL's, but this dog has so

many problems I don't know if it'll work (and she's so tiny!). But on the other

hand we don't have anything to lose if the other option is euthanasia (Might as

well try something!). Does anyone have experience with this and if so is there

a particular type of brace you would recommend?

> > Thanks!

> > Alma Alicea-Garcés, DVM, CCRT

> > Veterinary Specialty Hospital

> > San , PR

> > almaalicea@

> >

>

[Guest guest]

Alma,Based on the brief videos, there is severe functional impairment in the left pelvic limb there appears to be a very prominent varus thrust during loading. I would suspect that joint dysfunction of the hip and stifle, MPL and probable contracture of the cranial muscles of the thigh (hip flexors) and adductor are adding to the impairment. Forward movement is accomplished by pronounced lateral flexion of the spine. I would like to see radiographs as well but from your original description you have established preexisting joint dysfunction. I would consider addressing chronic pain, aggressive passive stretching and musculoskeletal strengthening. Tough case. Perhaps Patsy will have something to offer from an orthotic perspective.Rick Wall, DVMThe Woodlands, TX.