I've put off posting this, as it's hard for us to deal with, and I didn't even know where to start...
Most of you know that Angel has luxating patellas, one of a myriad of problems (she's a genetic mess). The first sign of it was intermittent lameness in both hind legs, which first showed up when she was about 5-6 months old. The vet had a look, said she had Grade III luxating patellas on both sides (medially and laterally), and said surgery was the only viable option. I went home and researched and researched and researched. What I found out was that the surgery does not have a great success rate (her problem wasn't her ACL, it was a shallow trochlear groove combined with misalignment of her femur and tibia), was very expensive (due to her complications, we're talking around $1500 for both legs and a maybe), they could only do one leg at a time, and recovery would be long and painful. At that point we examined alternatives, and had her see a physiotherapist/orthopedic surgeon at the Animal Critical Care Center in Burnaby. She confirmed the vet's diagnosis, and explained that it's actually worse than that. Angel's alignment is off from her toes right up to her lumbar region, and her heel cord is very tight, causing her to be straight hocked/stifled, and while she recommended surgery on the knees, it would be a temporary fix as the rest of her was buggerred. We chose to go with a natural, physiotherapy route, give it six months, and see.
We had a physiotherapist come to our house once a week to work with Angel, along with a daily excercise routine that we followed with her. The entire routine was perscribed and supported by the physiotherapist/surgeon from Animal Critical Care. We saw dramatic improvement quite quickly. Within six months, all lameness had disappeared, and her posture and stance had improved. She went back to the regular vet for a check up including her hips x-rayed, and we were thrilled to find that her patellas seemed to be staying on their track, and there was no visible joint damage in the x-ray. There was no visible dysplasia of her hips or lumbar region. Angel was a year old, and we were thrilled.
She did well for the next 8 months or so, then we began to see some problems. While she's not exhibiting the symptoms of luxation in her knees (bunny hop, leg out stiff and kicking behind her, knee can be felt out of place when she's resting, knee easily/spontaneously manipulates in and out of position by hand), we were noticing an over all weekness in her hind quarters, increased turning out of the lower half of her leg, increased atrophy of her quadriceps, lack of stability or balance in her hind end, toe dragging, and pain/stiffness getting up from a laying position, especially in the evening or after excercise. This has been getting progressively worse. Resuming her physiotherapy has had mixed results. We notice an improvement while we're doing it, but as soon as we try to ease back to once per week for example, she rapidly deteriorates to worse than before we did the physio.
On top of all this, Angel has a growth on her back, which has existed for over a year, and has slowly gotten larger (it's the size of a large pea now). It does not seem uncomfortable, but there is some fear that it's a mast cell tumor, especially with her being a white dog, and already showing a lot of immune and genetic problems (demodex, allergies, sensitive stomach, inverted nipples, knees are bad...). The vet's been watching this, and previously had said if it gets bigger he wants to remove it. She's also showing other worrying problems; she's always had a sensitive stomach (she pukes at least 5 to 6 times a week on average), and lately she's always hot and restless, and insists on laying on the hard floor rather than on a doggy bed (we've tried so many types of beds, it's not even funny).
Worried, I took Angel in for a check up. After examining Angel from head to tail, the vet determined that her knees/legs have deteriorated, she's down to bone rubbing on bone, and is likely in a considerable amount of pain most of the time. After seeing the progression of all of this, he feels we did the right thing in not going for surgery, as it would not have corrected the overall problem, which is a structural one. At this point, she would require both knees done, possibly hip replacements, her "ankles" and possibly her "feet" done, along with some adjustments and such to her soft tissues (tendons and ligaments). We're talking thousands upon thousands of dollars, multiple surgeries, over an extended period of time, and no guarantee of success. He says that even if we won the lottery and could afford to pour that kind of money into our dog, it would raise the ethical question of whether it's fair to put her through all of that. Her quality of life would be very poor. Physiotherapy will not help at this point. Due to this, he does not want us to worry about the lump on her back, as really whether or not she has cancer is irrelevant right now. Our course of action is pain management and making her as comfortable as possible, while hopefully slowing the course of destruction in her joints. She's at very high risk for an ACL tear.
Typically, he would put her straight onto metacam or rimadyl. However, Angel becomes violently ill (throwing up until she's puking blood) from simple aspirin, and both of these meds are hard on the stomach. As a result, he first wants to try "Recovery sa with Nutrical", a natural remedy with glucosamine and some other stuff. He was honest in that he hasn't found it to be very effective with most dogs. He's only seen it work for one or two animals. It's also costly, a 1 month supply was $50, but it's cheaper than metacam or rimadyl. She's been on it for two weeks with no results so far, I'll be updating him on Monday. We're trying it for a month - she's been uncomfortable this long, a month is nothing in the scheme of things. If the Recovery doesn't work, then we will try either metacam or rimadyl. If they don't work, or if they do but eventually stop working (which will happen, we're really just buying time), our next step would be cortisone injections. He has also mentioned to me that I may want to look into acupuncture at that part, although he is skeptical about the clinical viability of acupuncture and other Eastern/natural medecines (as am I). He couldn't really give me a time line on how long until she's in terrible pain despite the meds, as it depends on her response to treatment and varies from dog to dog. My personal feeling is IF the recovery or the metacam/rimadyl work, she will be comfortable for at least a year. I honestly don't see her making it for another three years.
So needless to say, this has been hard for us to accept, and even the vet and clinic staff were bummed. Angel is a favorite patient, and both the doctor and the receptionist commented on how it's such a shame when she's got such a lovely temperament. The vet said he wishes she were not such a nice dog, as it would make decisions like these easier. It's so hard having this super sweet dog who's only 2 and a half and is already suffering from terrible arthritis pain.
While I'm obviously disappointed, this isn't a big shock, we've known this was our future since Angel was six months old, we were just hoping she could fight it off longer and maybe live to 9 or 10. It's good that I can now stop agonizing over whether or not we should have gone the surgery route, the vet is glad we didn't it would've been for nothing. It's also good that I can stop beating myself up for not being really diligent with her physio, it wouldn't make a difference anyway at this point, all it is is uncomfortable for her, and she doesn't enjoy it.
Our personal plan now is to cut out the tennis ball, as running so fast and focussed when she's at high risk for an ACL tear (which would not be treatable now, it would mean putting her down), just isn't wise. We're going to toss the frisbee instead, as it's floating movement makes her run slower and more carefully. Aside from that, we're going to stop worrying about things being bad for her. If she wants to rip around the yard for 3 hours straight with the pups, we'll let her, even if she'll be sore later. If she wants to swim until she can barely stand, why not? We may as well let her enjoy the time she has to the fullest. This also means she can have people food - it's not like I have to worry about her getting fat or developing doggy heart disease.
We're really struggling with this, it seems like our dog is aging overnight. She's tired a lot, and kind of mopey, I know her knees hurt. She's always hot and panting - I'm going to have him do a blood panel when she goes back at the end of the month. Not that it matters, as her knees are so buggered anyway, that there's no point in trying to "cure" things.
ARRRGH! This sucks!
Hubby and I have talked about maybe getting her a cart when she starts really losing mobility. It will depend entirely on her. If she's still full of drive and spunk and not afraid of the cart then why not? But we'll only do it if her quality of life will be worth it.
As I type this, she's laying on the floor staring at me, and every time I glance over at her she thumps her tail. She's such a ham. It's such a damn shame that such a great, young, dog has this problem. It just breaks my heart.