Guest Post by Matt Brunke, DVM, CVRPP, CVA, CVPP
I am a big proponent of rescue groups. There are many “discarded” dogs and cats, most of which are absolutely wonderful pets. I have worked with Peppertree Rescue for many years and really appreciate their dedication to dogs with medical needs. Peppertree will find out about them and screen them, and then have them transported to the Albany area where they can be attended to. This was the case with Glinda, a sweet, 8-ish year old Golden Retriever cross.
Upon physical exam, I found some areas of concern. While Glinda weighed in at a reasonable 74 pounds, her body condition score was abnormal. She had poor muscle mass in her back legs and was carrying more fat than she should. I also noted that she had decreased extension in both of her hip joints and was uncomfortable when I manipulated them. As I palpated her knees, I found chronic thickening in both the left and right knee with discomfort and mild instability. These findings are consistent with arthritic change in both the knees and hips.
Often times the hip arthritis is a consequence of hip dysplasia, while the arthritis and instability in her knees was consistent with chronic damage to her cruciate ligaments. I discussed this with the owners and we started with a conservative management program. I prescribed a course of therapy for her in the Rehabilitation Program’s Underwater Treadmill and an Adequan injection series for her. The buoyancy the underwater treadmill provides would allow Glinda to exercise and lose weight, while the Adequan injection series would be twice a week for 4 weeks, then one injection a month thereafter. This would help to improve her joint fluid in all of her joints, as well as reduce the damage to her cartilage.
Over the next 3 months, Glinda worked in the underwater treadmill twice a week, gradually increasing her time and distance with each session. Her comfort level improved and she lost 9 pounds. While she was moving well, I noted further instability in both of her knees. It was time for a sedated orthopedic exam and radiographs. Peppertree Rescue agreed to help with her costs and a short while later we had our answers.
Glinda had partially torn the cruciate ligament (ACL) in both of her knees. The right was not as stable as the left, and both had moderate arthritic change. She also had hip dysplasia, characterized by poor coverage of her femoral heads, and consequently had developed arthritis in her hips as well. The right knee needed stability. With hip arthritis in both legs and arthritis in both of her knees, the instability in the right needed surgical correction. My plan was to correct that with a procedure called a TPLO: TIbial Plateau Leveling Osteotomy. This would eliminate the need for the cruciate ligament and allow stability in the knee that would allow her to walk on the leg appropriately and slow the progression of arthritis forming in that knee. I was unsure if her left knee would need the same correction down the road.
Surgery was a success for Glinda. The TPLO gave her right knee the stability her body needed. She did very well in her post-operative rehab program, going through laser therapy treatments and underwater treadmill sessions. During her therapy she was always a smiling, happy patient. After 12 weeks of restricted activity, her tibia healed and I started to increase her overall activity. We would manage the arthritis in her knees and hips as an ongoing condition.
She has become an avid hiker with her owners. She goes for 30-45 minute walks every day and enjoys being outside. While her arthritis has progressed, her multimodal pain management regimen has kept her from having any further surgeries at this time.