Limping Dog. How to do your own at home examination.

Classic "non-weight bearing" stance of a dog with a dislocated hip.

Two weeks post-op knee surgery and a seated dog with a bent knee proves that the joint is happy and healing.

One of the most common questions we get on Pawbly.com is about the limping dog.

To help people at home understand some of the most common injuries that cause lameness in a pet I thought I would provide a very basic "How to examine your limping dog at home" instruction blog.

Remember an examination doesn't just include the affected limb, it must include the whole pet. For this reason I recommend starting at the tip of the nose and letting your hands walk slowly from the nose to the tail. Inspecting everything very closely along the way.

Then we go to the "off" leg.

In most of these cases I advise my clients to check the leg by palpating (using your fingers to be your guide) and examining very closely  everything as your fingers walk your way over the leg from the toes to the spine. Palpate and probe every inch 360 degrees around as you move gradually up the leg. I know that most dogs are not fond of the feet (toes especially) being poked and prodded but in lots of cases the answer lies somewhere around here.

It is also important to remember symmetry. Use the opposite leg as a guide for what "normal" should look like.

Here we go on our virtual tour up the leg..

1. Check toenails. Some have grown into the pad and some are broken. All are painful. Broken toenails should be trimmed or clipped back as far as possible, or even removed, if broken severely. At the clinic I use a topical numbing agent and a muzzle and a quick cut. It hurts for one second,, like pulling off a band-aid. Then the pet is pain free again and using the leg as normal.

A very sharply pointed nail had grown into the foot pad.
When trimmed the evidence of the puncture is evident.

This pups toe required twice daily soaks and an oral antibiotic.
This must be treated as a wound.

This toenail is white because it was avulsed from the toe.
Regie had pulled the nail off the tissue and every time he walked the
nail rocked on the sensitive tissue underneath.
We trimmed it back as far as possible and this stopped the pain.
It will eventually grow out enough to be easily removed.
For now foot soaks, and clotting powder are all that's needed.
Oh, and no licking!

Clipped short enough to not touch the floor and cause pain.
Yellow styptic powder was used to stop the bleeding.

The toenail was broken, removed and leaves the "quick" exposed.
But, it will no longer be painful and the limp will cease.
Keeping the nail bed clean is all that is needed,
No Licking!

2. Look for redness or swelling, or wet, moist skin in between the toes. Some dogs get allergies, infections, even splinters in between their toes.

Interdigital cysts are painful.
This causes the pet to lick, which inflames the skin and seeds infection.

Many dogs with allergies lick their feet because they itch.
The licking causes red staining, inflamed skin and infection.

3. Look for injury to the foot pads. If bleeding soak foot in warm very mildly soapy water for a few minutes, then apply direct pressure with a clean cloth for 10 minutes,, no peeking, no wiping, no tight bandages. A small laceration to the foot pad is usually just allowed to heal. A deep laceration (full skin thickness) usually requires and antibiotic and protection from further trauma ( i like a panti liner (absorbs small amounts of blood and is super cheap) and a sock.. but change at least twice a day. Please call your vet if the wound is deep.

My pup, Charlie, who found a stray surgical staple. Sorry Charlie!

4. Look for any skin damage. Areas of injury. All penetrating wounds need veterinary assistance for an antibiotic and in some cases exploration to make sure nothing internal is damaged.

5. Broken bones cause significant non-weight bearing lameness and usually have considerable swelling. I know lots of people worry about broken bones but they are not normally seen without significant trauma like hit by car, jumping off bed, etc. They are swollen, painful and the leg often looks disfigured. Do not touch a broken leg without a muzzle in place. If the bone is sticking out of the skin wrap the leg in a towel and get to a vet to help stop the bleeding.

Maci a few days after her cruciate repair surgery.

6. Joint injuries are one of the most common lameness causes we see. Most often these occur after excessive or strenuous play. Some clients report that their dog was playing and they heard a sharp "Yelp!" and since then the dog has been sporadically lame. Typically this is a cranial cruciate injury. These dog have persistent lameness that may slightly improve and then worsen but in general they do not go back to normal weight bearing until the knee is stabilized. This is usually a surgical fix.

Ella is all done with her knee surgery.

I always advise that every limping and lame dog be kept quiet and calm by leashing walking outside at all times, or crating until your vet can see you. No running, jumping or play. Rest the leg. In many cases that is the only needed treatment.

A dog in significant pain to the point of not using the leg, being reluctant to stand or walk, or not interested in play, interaction, or even eating needs a vet immediately. In general a limping dog is not an emergency unless they are bleeding excessively, progressively worsening, or having a change in attitude or behavior.

In all cases your vet should be consulted. There are lots of options available after a diagnosis is provided.

Sarge,, the big ham

As always you can ask me a question about your limping (or otherwise) pet anytime for free on Pawbly.com. Pawbly is free to use and open to anyone and everyone.

Twitter has me sporadically @FreePetAdvice, And the whole majority of the rest of my life has me at the veterinary clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland. 

Kelso's Christmas Wish

This is Kelso. 

He was found roaming as a stray dog in Harford County, Maryland. He is an unneutered, ear cropped, Cane Corso. Someone bought him from a breeder, spent a few hundred bucks to crop his ears, and no one came to claim him.

Like all stray animals, he was brought to the county shelter to await is parents. In Harford County, MD. he has 5 days, if he doesn't have a county tag, 10 if he sports the county tax mans bauble.

Being a found dog his fate follows a few simple state mandated rules. He is held for three to five business days, which allows his family a chance to find him in the designated animal holding facility. After this time his fate becomes the decision of the Harford County Humane Society manager. Should I ever be sentenced to serve a punishment for crimes against society this is where my worst nightmare job resides. I would rather work on a chain gang or clean stadium urinals for the rest of my days, than be the executioner for a public animal shelter. To have to decide who lives, who dies, and have the pressure to keep "available kennel space" at all times for the unpredictable but inevitable influx of surrendered or abandoned animals is a decision I could not make.

For as uncertain as Kelso's plight was, those pets that are surrendered by their family have it worse. There is no mandatory holding period. They are simply at the mercy of the manager. Whether they chose to admit it or not, your fate is a lot like those veterinary school hopefuls being judged whether they are worthy to attend vet school..their decision is based on their looking to find a reason to exclude you. 

For those in the shelter system their fate hinges on any of the following;

• perceived behavioral issues
• age
• breed
• illness
• deformity
• available space
• amount of time in the shelter

I have spent a significant portion of my life abroad. I understand the necessary evil of a public shelter. But they are still incredibly sad places to be. The public's perception that "humane societies" are 'humane', or "no-kill" is delusional denial. Their purpose is to provide a facility for unwanted, lost, or abandoned pets. Sadly, in this country there are millions of pets that are euthanized every year because shelters lack the room to house all of them until they are adopted.

Kelso arrived at the shelter on December 15, 2013 carrying his rear left leg. He was what we term "essentially three legged lame." That bad leg was there but it wasn't much use to him. Upon intake at the shelter he was vaccinated, given a behavioral assessment, and placed in a cage. Days later his limp was still evident so he was seen by a vet on site.

Here are some of the things I look at when I assess a bad leg;

• I look to see how much the leg is used to ambulate. 
• Does the foot touch the ground when walking? 
• Is the foot placed normally? 
• Do the toe nails on that leg look normal?
• Is there normal muscle tone to the leg?
• Are there any obvious defects to the leg?

I then examine the dog, and identify the source of the problem.

Kelso's diagnosis was fairly straightforward. He had all  of the clinical signs of a cranial cruciate rupture; a swollen knee, and both tibial thrust and drawer. 

The vet who saw him offered to do the surgery for $800 instead of the normal $1200. 

Dr. Hubbard is one of my associates. She is also a volunteer at the Humane Society. When she went to the shelter a few days later she inquired about Kelso.

She was told that he had been seen, been diagnosed, and that they were awaiting a plan for him.

She called me when they mentioned to her that they were considering amputating the leg as a cheaper option to repairing the cruciate ligament rupture.

Now, I will be the first to admit that I can get a bit incensed. I am Italian, passion, fury, and drama are hard wired in my DNA. It is a breed defect.

I understand that the shelter has many mouths to feed, many pets with their own individual needs to address and a budget to provide these. I do not quite understand where the notion of amputating a limb to fix a problem to save money came from, but does anyone really want to give up their leg to save them from fixing the problem?

There's no do-over once that leg comes off.

I have done twice as many cruciate repairs as I have amputations, but collectively they number in the hundreds. Ask me which is easier to do? And without hesitation I will say "a cruciate! No doubt!"

But the simple fact is that more vets know how to amputate than repair a cruciate.

I told Dr. Hubbard that "I would repair the knee for free if they promised to never consider amputation over trying every other option fixing the problem again?"

Scheduling Kelso was not easy. It was the week before Christmas. Everyone has last minute gifts to buy, or wrap, and family gatherings to prepare for.

I called another associate, Dr. Morgan, she and Dr. Hubbard agreed to come in the day before Christmas to cover the exam schedule, and I called my husband to see if he wouldn't blow a gasket when I asked him to reschedule our anniversary plans?

Kelso arrived on the morning of December 24th.

I gave him a full exam: 4-5 years old, intact, mild calculi, eyes, ears, nose, throat normal, mild DJD bilat elbows, good coat, heart, and lungs, significant muscle atrophy to left rear leg, significant swelling/effusion to left stifle, decreased range of motion and painful on manipulation of both hips.

Kelso went to the x-ray room for the next step in his preparation for surgery.

Every cruciate that I do is required to have a full blood work profile, fecal, urinalysis, and x-rays of both knees and hips. I cannot underscore how important these are. Don't skip these pre-ops. In the last half dozen knees I have done (all were referred with bloodwork and no urine) I have found two undetected urinary tract infections. To drive the significance of this, an infection in your joint is a really, really, bad thing!

For Kelso those x-rays allowed us to diagnose him with hip dysplasia. IF he had had his bad back leg amputated he would have had to put all of his weight on his right hip which is already significantly diseased. I don't think he would have lasted another year.

Kelso's knee was by far the worst I have ever seen. His joint capsule was so thickened and angry that it made exploring his stifle joint almost impossible.

He is not my proudest work. But, he regained the stability in his knee that he has been without for what I think must be about 4 years.

Kelso's knee took me so long to repair that I had to postpone his neuter for a different day. And, as is typical of me, I didn't make it back home by noon as I had promised my husband. I thought I could be in by 9 and be home by noon when the clinic was closing. (Such a cocky surgeon!).

I left at 3. "Happy Anniversary, honey!"

Kelso recovered very well in spite of my extra long, extra difficult time in surgery.

He will stay with us until he has been neutered, and we will help the Humane Society find him a home.

He is a big gentle boy who is wonderful with all other pets, and people. He loves attention, to play, and will make someone a fantastic companion. He needs someone to teach him manners, but he will reward you with more smiles, tail wags and love than you can ever get mad at him about.

Greeting clients at the front desk.

Playing like a goof-ball as we put on his e-collar.

Surrendering to the cone.

Showing off his accessories.

Those eyes say it all.

This year Jarrettsville Vet gave Kelso a new knee for Christmas. Next week we will give him a neuter, and then he will be available for adoption through the Harford County Humane Society.

If you are interested in him please call the Harford County Humane Society. 

If you want to meet him in person please stop by Jarrettsville Veterinary Center. If you have any questions about his medical concerns you can ask me at the clinic.

A big THANK-YOU to both Dr. Morgan and Dr. Hubbard for their time, care, skill, and compassion in helping Kelso get his surgeries and to all of the staff at JVC who have helped him with all of his post-op care.

If you have any other pet related questions you can ask them for free at Pawbly.com, or find me on Twitter @FreePetAdvice.

Please consider adopting your next pet at a local shelter.

Update, January 10, 2014

Kelso was neutered yesterday by Dr. Hubbard, and went to his new home today! What a wonderful ending to a Christmas wish.

Tragically Kelso escaped his parents arms and was hit by a car in late January 2014. His time with his new family was short but they loved him deeply and dearly and miss him very much.

I don't know why it took Kelso so long to find his forever home, but he was loved far beyond his short time with them and was lucky to have been a chance to be someones true love.

We send our deepest and fondest sympathies to the family who loved him so much.

A Limping Dog Or A Death Sentence?

This is Pogo.

He was found by my friend Cindy. Cindy was at the county humane shelter clipping matted dogs to try to make them more presentable to potential adopters when Pogo arrived. He was being surrendered by his family because his knee required surgery.

Now I am going to try very hard to not be harsh and judgmental but I have a very hard time thinking that someone would surrender their dog for this. Animals that are brought to the shelter with a problem are most often immediately euthanized. Why? because there are so many perfect pets up for adoption that are never adopted. At a shelter too many requires action to make more space. The broken pets go first.

Pogo was incredibly lucky to have been brought in when Cindy was there. 

Pogo came home with Cindy that day. He came to see me the next.

Sure enough he had a ruptured cruciate ligament. 

This is the same as an anterior cruciate ligament which is one of the more common human sports injuries seen. The cruciate ligaments hold the femur (thigh bone) to the tibia (lower leg bone). They live right behind the knee cap. They act as restraining devices so the the bones remain in alignment, but they also allow the knee to bend. They are monumental in providing stability to the knee. When one or both rupture the pet will be lame due to the inability to have a firm landing of the foot due to the excessive motion in the knee joint. The leg will only regain stability with surgery or a brace. 

I see a lot of dogs with ruptured cranial cruciate ligaments (RCCL). BIG DISCLAIMER time: I am NOT a boarded surgeon! If this happened to us we would go to a boarded surgeon and they would discuss our surgical options to fix this. We would not go to our general practitioner and ask them to do it. BUT, a boarded surgeon is more expensive than I am, and unfortunately for many people they cannot afford the expert. When my own dog needed his cruciate repaired he went to a boarded surgeon. When the other vets at my own practice needed their dogs knees fixed they also went to a surgeon. Surgeons are experts, I always recommend clients go to them first and then come back to me only if they cannot or chose not to use a surgeon.

Due to Pogo's recent indigence status, he needed a very affordable option to treat his knee injury.

Pogo was scheduled for surgery with me the next week.

A note on braces. Everyone thinks that they are cheaper, you know avoid the anesthesia and surgery and you automatically think "it's got to be cheaper." In reality it is about $1,000 for a good one, and just like for us they are supposed to be specially fitted to each individual. A brace is usually only recommended when surgery is not an option for a patient. The long term result of a corrective orthopedic surgery is far better than trying to manage a brace forever. (For the record I also feel this way about a cast on a broken bone).

Four days later he began to cough. Diagnosis, kennel cough, likely from being at the shelter. Postpone surgery one week. Treatment plan: lots of rest, monitor for any change in behavior (like lethargy, decreased hunger, or any snottiness from eyes, nose, or worsening of cough, and/or productive coughing). 

One week later his cough worsened. He returned for x-rays.

Diagnosis pneumonia. Postpone surgery another week, change to a stronger antibiotic, fluid therapy. Watch very very closely. If he worsened at all he was to be admitted for i.v. fluids, i.v. antibiotics, and hospitalization.

One week later he was brought in for his surgery. Pre-surgical exam revealed a low red blood cell count, but clinically he was acting normally and feeling much better. Plan: postpone surgery again for another week to give his body more time to recover from his illness.

Pogo was feeling so much better that he refused to sit still for a picture.

Pogo returned yesterday. He was a bright, happy, jumpy, stubborn, opinionated, bossy, perfectly normal Jack Russell. He also had a normal red blood cell count.

He had his knee fixed using a technique that has been around and in use by veterinarians for many years, a Securos extra-capsular lateral fabella technique. There is a very good video of this here from Southpaws Specialty Veterinary Hospital.

Pogo was also neutered.

He is now officially looking for a home!

We wish him a speedy recovery and a happy healthy life in a home to call his own.

If you are interested in him please contact; Black Dogs & Company Rescue

If you have any questions or comments you can find me @Pawbly, or Pawbly.com, or at the clinic Jarrettsville Vet. 

Darla's Second Chance

My introduction to Darla began with a phone call from Kim. Kim Barnes is a strong single woman on a mission. I liked her the moment I met her. She is an American Bulldog Rescue founder, foster, volunteer, and breed advocate. She also is a seasoned rescue person. She can assess a bulldog and their odds of becoming a family pet, i.e. “adoptable” very quickly and accurately. She, like many of us in this field, has also learned to look/listen past the stories of “how this particular dog got here” and focus instead on “where can we place you so you can live a long and happy life”. Like the amazing, dog behaviorist Cesar Milan always reminds us, “dogs live in the now”. Kim does the same with her dogs.

Kim answered the call from BARCS, (the acronym for Baltimore Animal Rescue and Care Shelter, in downtown Baltimore MD) in late May 2011. BARCS had just taken in a beautiful white female American bulldog by a family that had been to a veterinary surgical referral center, and as they claimed, “spent a lot of money already”. They had been told by the veterinary expert that both of her stifles, (that’s a  knee to you and me) had a ruptured cranial cruciate ligament. (The CCL is called an ACL, or anterior cruciate ligament, to us two legged sports-persons). Because of Diamonds injured knees she walked with a funny back end swagger, and sat down by having to rock back on her pelvis with her rear legs sort of splayed open. Not very, ladylike, but the most comfortable position you can sit down in when your knees are unstable.

When a dog has injuries to both back legs it can be a challenge to even the seasoned vet to be able to identify the source of the lameness by watching them walk alone. It is often difficult to discern knee injury from hip injury at a walk. The real beauty of a veterinarian who has practiced medicine for a good long while is that you learn to see with your hands. It is one of the very biggest challenges a new vet school grad faces. You don’t trust your hands and you don’t see with them, you have to train them the same way a violinist does, practice, practice, practice.

After Kim talked to BARCS she called me. As I began to learn about Diamond, (that was her old name, almost all rescue dogs get new first names when they change their last names). (It’s sort of like anew marriage but you lose your whole name). Kim called me because I am one of a few general practioners who perform this kind of surgery. This surgery is not taught in vet school because the advent of specialty medicine has allowed most surgeries of this caliber to the forwarded to boarded surgery veterinarians. These boarded vets spend four years after vet school learning a specialty, then they have to sit for the dreaded (and elusive) board certification test. So without being taught this procedure in vet school, or by our mentor, we don’t learn it. And if you don’t learn something and then practice it routinely it becomes scary, so most general veterinary practitioners are wary of this surgery. I do them because I had two great teachers, and I can’t stand the idea of not being able to help an animal that otherwise has to wobble around on a busted knee. At my practice I tell my clients that their dogs are far better served by the boarded surgeons, but they come with a $2500 (plus) price tag. The “almost as good as” option is available at our clinic for $1000. For a rescue dog where funds are very limited I do the surgery pro bono. I was Diamonds answer.

Kim was called by the BARCS staff the same day Diamond was dropped off. If you are dropped off, (we call it “owner surrender” the two saddest words in the dictionary) at a shelter and you have any problems you are immediately euthanized. Apparently her owners were under the belief that a local dog shelter would fix her knees for them. Apparently the owners had been give a quote from the surgery referral of $6000 to fix her knees. They couldn’t afford this so they dumped their problem on someone else, BARCS. And, because she was lucky enough to be an American Bulldog with Kim was the next in line. Kim was told by the BARCS staff that she had 24 hrs to pick her up or Diamond would be euthanized. At BARCS it is in no way a reflection of their unwillingness to help or care, but simply a function of Diamonds original problem, a lack of funds. Broken merchandise in any arena has diminished, little, or no value. Kim hung up the phone with BARCS and called me. We discussed what she knew, what she wasn’t sure of, and all I could say was, “well if the diagnosis is correct I can fix them”.  But I had to put a lot of “ifs” in my statements. As I said before, it is really hard to diagnose a problem by sight alone, but verbal hearsay is even harder. I told her I couldn’t bear to hear the story and not help, so I said, ‘if you go get her, I’ll find a way to help get her fixed’.

Kim went down to BARCS and got her. She called when she got home and made the appointment for me to assess her the next day. I decided her diagnosis was correct and she got her second lucky break. We scheduled her to her surgery, which had to be postponed another two weeks, because in her short 1 day stay she got kennel cough.

Two weeks later I cut her first, what I thought was the worst, knee. It was a full cruciate tear with significant joint disease already settling in, and a terribly damaged medial meniscus. (That’s the little cushion that buffers the blow your heavy duty femur, thigh bone, places on the tibia, the bone in your lower leg). She woke up well, and limped back to her foster family. A short 6 weeks later, (actually yesterday the third of August 2011), we fixed her other knee. This knee was unfortunately just as bad as the first. I was told by Kim that she did great after the first knee and saw an orthopedic surgeon post op who remarked how great her leg was healing and how solid her knee was.

Kim also reports to me that Diamond is now officially “Darla”. She has been adopted by a family with two small children whom she loves and adores, and they love her back. She is strong, sweet, and as all dogs are; able to forgive and move on. Darla is a true testament of the best of this breed; kind, gentle, and sweet.  Having an advocate like Kim who answers the call, drives you around to your doctors appointments and doesn’t look at you based on your deficiencies but rather your possibilities is also a very good thing.

If you would like to learn more about cranial cruciate ligament damage or repair please see this link

http://tinyurl.com/3b4xd6g

If you would like to learn more about the American Bulldog Rescue please see the link below

http://americanbulldogrescue.org/