fourleg.com

Hi there,

5yo F Maltese Terrier Cross. 3.4kg, BCS 5/9


We have a rehab case that had L HL ex cap surgery for CCL disease Dec 2020. Approx 4wks after the surgery the front pads swelling and the feet / carpals started to collapse on wgtbearing - the owner and and my colleague (rehab vet) report that there were minimal issues with the front limbs prior to this time. The main paw pad on the L FL has burst burst with 3 sinus tracts, The R FL pad is inflammed but no sinus tracts. Specialist late Jan 2021 where Antibiotics were given at the time.

The L knee rehab isn't going so well either. She has thickened knee and minimal flexion. There is significant crepitus through available range and she walks with the limb abducted but with increased valgus through the limb. (4wks ago she was bum scooting so she has improved somewhat). They took biopsies and the dog is still on antibiotics, NSAID's, and fish oil.

She is otherwise bright, alert and a really cool dog.

The dog also had a cholecystectomy in 2019.

We have encouraged the owner to return to the specialist as the joint destruction in the FL is pronounced - we need to know what is wrong so we can plan moving forward. She managed to get an aptmt with the specialist this week. Their current DDx is contact irritant, immune mediated, trauma, calcinosis cutis, and less likely infective or neoplastic.

I've attached some photos / video - sorry they aren't the best quality but hopefully they give you an idea.

I know we need a diagnosis to determine why this is happening, determine the prognosis. I'd still appreciate your experience moving forward. We have been talking braces - do you think this could be viable moving forward? Any other ideas? We don't think the owner is favourable for a wheelchair at this time

Appreciate your assistance

Ugh... what a case!

So this is one of those cases where so much is going on, that you really need to slow down and think about everything in categories and then prioritize what to do.

So, the front feet issues trump / take priority. If there is infection, or IMPA that is affecting those front feet, then it doesn't matter what you do to the stifle... the dog won't walk. As such, I would remove the thought of any bracing for the stifle at this point.

Let's just digress and talk stifle for a moment. Thickened, reduced ROM, and crepitus = osteoarthritis most likely. Could indicate meniscal damage... but my bet is on OA. So the CCL was likely a case of acute on chronic with the hope that surgery would help... but if it's already chronic, then a cruciate surgery doesn't always have the same magical effect that it does on a strictly acute injury. So, just ensure that joint supplements & pain meds are part of the plan - which you say are 'on board' right now anyways. So, you may need to approach that stifle like an OA stifle versus a typical post-op stifle. And that changes prognosis, expectations, and how hard you are on yourself for not getting it back to 'normal'. I'm assuming you didn't see the dog 'pre-Surgery'? But if you did, can you comment on the stifle before hand?

Back to the front feet. They are most important for long term function. They will stop you from 'rehabbing' the stifles. So, plenty of DDx. I'm not going to go down the path of adding to these... but rather how you manage the case at this point, and thinking about what CAN you do with the scenario at hand.
1. Laser - if there is an infection, if it's IMPA / Polyarthritis, trauma, cacinosis cutis... then laser is what you can contribute to healing. If it's infection... then laser can help. And even if it's cancer, newer research is saying it can help.
2. ROM, LIGHT Massage, Stretching of the forelimbs would be fair.... for the compensations.
3. Just any easy activity to promote use... walking, stepping over, backwards, sideways, circles... just for any kind of limb use. (i.e. like a prescription for ambulation of the old ladies in the hospital...)

Essentially, your hands are tied much beyond this until those little feet have cleared up...

My thinking for now anyways...

Laurie