Patella Luxation - Advice Needed

[lb0024]

Let me start by saying I'm sorry... I know there have been lots of posts on here about PL and I've read lots of them, but I still feel the need to ask about it. I'm having trouble deciding what to do.

Molly has patella luxation (PL) in both legs. The second vet I went to see said both are between Grade 2 and 3 (out of 4). Both vets suggested surgery. I asked the second vet about supplements. He basically said I could use them, but they wouldn't change the need for surgery.

I have read about and talked to people who have or had dogs with PL for many years and never needed surgery. People right away say, "don't rush into surgery!" "Try this" or "Try that!". (The "this" and the "that" are supplements, exercise, even a chiropractor) Believe me, I do not want Molly (or me!) to have to go through surgery, but... she limps a LOT. One leg is definitely worst than the other - she limps several times per walk and just about any time I play fetch with her. And, sometimes she goes down to a sitting position almost. I think when the bad leg gives out, sometimes the other one does too and then she looks almost paralyzed for that second that she can't stand back up. It's so terrible to see! In my gut, I feel like the surgery is the only way to fix the problem, but I almost feel guilty for considering it when I read about or hear from people who say don't do the the surgery.

Anyway, I'm planning to go to Angell Memorial to see what they say. But I kind of feel like the vets will all say do the surgery because... well, for lots of possible reasons... for one, more money for them... for another, I think doctors will usually choose the "standard" fix rather than the "experimental" fix (such as supplements or chiropractor).

For those of you who did decide on surgery, can you identify any particular factor or factors that brought you to that decision?

And if any of you are in the Boston or north shore area, maybe you could PM me with the particular doctor/hospital that you used - and how your experience went?

Thanks for any and all advice/opinions/information.
-laura

[Karlin]

Are the people who say 'wait' vets or people who are informed on orthopedics? Some of the advice you've been given, like exercise, is totally wrong and could make the problem more severe! (I'd *immediately* stop playing fetch with her and do anything that involves running or jumping! This will be worsening things!) If anything your one chance with a low grade luxation is, keep her lean and even underweight, no jumping on/off furniture, no running, etc... and maybe the knee will tighten if it is a grade 1, maybe a 2. Generally when I have heard informed but non medical dog people -- like breeders who have dealt with several dogs with patellar problems -- they will say just what vets will say -- if the grade is 1 or 2, you can try waiting til the dog reaches one, but that grade 2 is already borderline and at a 3 or 4 the dog simply is not going to improve but is almost certain to worsen. If the problem is still there at age one it is not going to get better as the dog's joints are now fully developed. I have a dog in rescue now with a permanently locked knee because a grade 4-5 was never operated on -- probably started as a 2-3 when she was young. She will never walk properly and it cannot be corrected. She will risk cruciate ligament tears all her life, and arthritis as she ages. There are definitely consequences to doing nothing!

Also, if a dog is limping, it is experiencing pain, another consideration. Patella problems canbe some of the most painful orthopedic problems dogs can have. Supplements and a chiropractor will NOT fix this. The problem is her knee is so shallow that the bone is popping completely out of the joint. A chiropractor cannot fix that unless he is a surgeon as well and can go in and physically hollow out the joint, or trim out bone, which is what the vets are suggesting.

On a very serious note: if you mistrust your vets and specialists to the degree that you suspect they are only recommending a procedure in order to make money, do take the time to find a vet you trust implicitly -- maybe a vet that also has holistic training would make you feel more comfortable? It is one thing to hold off on treatment for ourselves because we mistrust a doctor -- but I think ethically wrong to hold back on behalf of a creature that cannot even explain how it feels, if there've been two agreeing diagnoses and you are also seeing evidence of real discomfort. Animals will hide pain very effectively and they need a very aware vet able to spot problems and an owner who will give (and feel comfortable about giving) the correct care when needed.

Maybe it would also be a good idea to get insurance for any future (non-knee) problems? Isn't it costing a lot to get three opinions as well? If you had one vet you trusted, you'd be saving money. I'd definitely save the money you'd spend getting a third opinion if two vets have said she needs the surgery unless you want to see a specialist who would also do the surgery. Here's a free third opinion from a very well respected vet, but note this is 7-8 years old and this surgery has become far more the norm now as it is a relatively common and successful one.:

http://www.vetinfo4dogs.com/dpatella.html

This statistics list by breed is interesting too -- cavaliers are actually way down the list for patellas -- 44th!

http://www.offa.org/patluxstatbreed.html

[Nancy]

I've had 2 dogs that needed double patella surgery, not Cavaliers. Unfortunately, with small knees, you get more problems. My dogs were in pain. There was no question of the decision to be made, they needed it, it was obvious. I myself had 2 joint replacements. I wouldn't wish that pain on anyone, let alone a dog, who often is braver than most people and don't let you know they are in pain until it is intolerable.

[Lexie]

We just went through this in October with Lexie. It was a hard decision and expensive. What made us decide is what kind of quality of life she was having. Her leg was luxating many times a day and I know it was bothering her. I know now that we made the right decision. The hardest part is keeping the calm for 4+ weeks post-op.

We are now 9 weeks post-op and just this weekend she started yelping and holding up her other leg. I just took her to the vet today and found out it is a grade 3. So we are off to the specialist again to see what she recommends. I'm pretty sure we are looking at surgery again.

The one thing I suggest is to make sure your surgeon is board certified. The first time we met Lexie's surgeon she gave us a 30 minute consultation and was very detailed on what needed to be done, etc...
The fact that we were comfortable with the surgeon was another reason we went ahead with the surgery.

If you have any questions, please feel free to PM me.
Kelly

[Karlin]

One thing that is very important if you have a dog that has patella problems is to *tell the breeder* that the dog has needed patella surgeries. This is really important to a breeding programme -- breeders rely on pet owners to let them know when issues like this arise so they can adjust their breeding programme. No reputable breeder wants to be breeding puppies with a high risk of this painful problem.

[Cathy Moon]

Surgically correcting a luxating patella sooner rather than later is a good idea because the movement of the patella wears down the groove in the leg bone that is supposed to help hold the patella in place. The orthopedic vet can deepen this groove during surgery if needed.

Another reason for having patella surgery early is to prevent/delay arthritis. Even young dogs will get arthritis from the damage a luxating patella causes.

[Cathy T]

If at only a year old she is already between and 2 and 3 on the grading....she is going to need the surgery. Shelby was diagnosed at 6 months. We waited 6 months to see if supplements and exercise improved her knee....they didn't. By a year old she was between a 2 and a 3. The reason we went ahead with the surgery was that the knee was getting worse and if we didn't operate their was a much greater chance of her damaging her ligaments and having serious arthritis issues when she aged.

Oh no Kelly!! I'm so sorry you are having a problem with Lexie's other knee as well. Our first surgery was not successful. After 8 weeks of confinement....we had to have the surgery repeated. We opted to do physical therapy and underwater treadmill as well. We decided we needed to do everything possible to ensure success the 2nd time. Our case was not the norm. I almost never hear of anyone having to repeat the surgery.

Yes, definitely go with a board certified surgeon. Ours was phenomenal! We only paid anthesthesiologist costs the 2nd time around.

Nancy is so right. They are often in more pain than we are aware of. I know Shelby is a very stoic little girl. She doesn't show pain but I know she's having it. We're doing great now.

[lb0024]

Thanks so much for the replies so far.

Some additional info:

Molly first started limping with her right leg in maybe mid-October. Then just a couple of weeks ago, I noticed it in her left leg. She never yelps or anything so I was hoping that meant she didn't feel any pain. I guess not.

I have to say that the people I've talked to or read about don't know my (Molly's) situation or details specifically. Most of them have never even seen Molly. So I shouldn't try to make other people's answers fit my problem. But at first when I heard people say, "don't rush into surgery", I was hoping that there were other solutions, and that they would apply to us.


To reply to some of Karlin's other thoughts:

I don't actually mistrust the vets I've been to... I don't really know them well enough to mistrust them! But I did like the second vet better because he gave me more info than the first (though still didn't volunteer the grade, I had to ask). But we have a couple of well-known and well-reputed animal hospitals here and a lot of people in this area will immediately say to go to one of them rather than a local vet. (Just like you'd go to your local doctor for a cold, but to you'd go to someplace like Massachusetts General Hospital in Boston for, say, a heart problem.) So that's why I feel like I should go to Angell Memorial for yet another consultation. And assuming I liked and trusted the surgeon, I'd most likely do the surgery there.

But it's not like I have a referral to a specific vet/surgeon. I guess I would have more confidence if I knew someone in the area who had it done and could give me a name. That's what I'd do for myself, so I want nothing less for my little girl. I guess it doesn't work that way when it comes to animals. However, I will make sure the surgeon is board certified. How does one go about that? Just ask, or can you look it up somewhere?

And, thankfully, I do have insurance on Molly. I signed up for it shortly after getting her. In fact, it was right here on this forum that I found out there is pet insurance for genetic conditions... before that, I thought pet insurance companies only offered insurance on things like accidents, etc. So thank you all for that.


So does anyone have any suggestions for keeping a 1 year old Cavalier who is full of energy from wanting to run, jump and play fetch?? Gosh, that's is all she does (aside from eat, sleep and potty)... she is going to drive me NUTS with whining if I won't let her do these things. If anyone knows any other fun but less active games or activities to do with young energetic pups, please let me know! The one thing that she enjoys for long periods of time is chewing on rawhides but I try to limit the amount of those that I give to her.

Thanks,
-laura