Lame puppy- vet baffled, any ideas?

[hellymelly]

Mellypup is 4 months old. Two weeks ago she was playing (gently, while on a lead) with another larger puppy she met on a walk with DH. He noticed straight afterwards that she wasn't putting weight on one hind leg, although she hadn't squeaked or anything during the play. I saw her and though "cruciate ligament", as it looked just like that, but we took her straight to our vet who was able to rule that out right away, although she thought the pain was coming from the knee. We rested her as much as possible for a few days and then she had another vet check, this time they gave her a pain killer that is slightly sedating, so that they could x-ray the knee as it wasn't improving. Nothing showed on the x-ray, but she reacted very badly to the painkiller, possibly as she is on beta blockers for a heart murmur. (She was foaming at the mouth and drooling madly, looking very stressed indeed). Anyway, she has had lead walks only, but she still isn't putting much weight on the leg, she holds it slightly sideways, and she is reluctant to sit. The vet thinks she needs an x-ray of the hip now, which means gas. I'm rather worried about the sedation, it is scheduled for tomorrow, and I wondered if anyone has had a similar thing with their dog? Our vet really is stumped as to why it isn't resolving in such a young dog- I don't know what we will do if the hip x-ray is normal. (she is a terrier, not a breed prone to hip issues).

[tabulahrasa]

If nothing shows up on the x-ray you should get a referral to a specialist who can do things like a CT scan. (my dog's elbow dysplasia didn't show up on x-rays as it's inside the joint)

What has the vet said about sedation? You could ask about doing it without it if she's likely to lie completely still for long enough...but most dogs won't.

[hellymelly]

She wont be able to do it without sedation, she is a bouncy puppy and excitable so there is no way she would lie still. I don't know anything about elbow displasia, what caused it? Is your dog ok now?

[tabulahrasa]

Oh I wasn't suggesting yours had it - it's a front leg thing. I just meant that's what happens if there's a still a problem that's not obvious on x-rays. You go see someone else who's better placed to investigate it.



It's like hip dysplasia but in elbows...caused by genetics, he had surgery at about 6 months and it improved, though it's sometimes a bit sore still and he doesn't have quite a full range of movement in it. Not that that's at all relevant to your puppy's problem, lol, but I figured I'd answer anyway.

[nuttymutty1]

I would be hassling the vet to get a referral to a specialist orthopaedic vet.

They will probably do the same tests again as your vet and it will cut out one of the sedations etc.

There are many types of sedations so ask which one caused the reaction and demand if possible that another one is used. It may be that a GA would be safer than sedation (I am no vet but do not be afraid to ask questions).

It may be that an MRI would be a better indicator and a specialist vet would also be able to advise on this.

[1MitchellMum]

You need a specialist orthopaedic vet. Good luck!

[hellymelly]

I just hope it isn't anything serious, as her heart issues are enough of a worry. At least she is insured for everything else, so if she needs a referral then that will be covered. I will ask about an ortho vet tomorrow. She will be having a gas GA as the vet says it is quickly processed and expelled.

[ADishBestEatenCold]

I wouldn't always expect cruciate damage to show on xray. For example, if there is no displacement of the knee.

Could you ask your vet to scan the knee, hellymelly? Better still, as nuttymutty1 suggests, ask for a referral to a orthopaedic specialist.

[hellymelly]

The vet did the drawer manouver, I think it is called that? (Where you can feel a slide in the joint, due to the weak area caused by a cruciate injury). She said the joint felt completely sound. It did hurt puppy having it examined though. My vet doesn't have an ultrasound, she would need to refer me some distance for that, as she did for the cardiac scan we had done. Should we cancel the hip x-ray, and ask for an ultrasound instead?

[nuttymutty1]

Get referred to people that know - where abouts are you (roughly) there are some fantastic specialist vets who will be able to help you and give correct diagnosis.

I had a limping puppy and it was caused by a disc in the back so not the leg at all - we can only guess the experts are the one to see

[bakingtins]

My thoughts would be she has damaged the menisci (cartilages) in her stifle/knee, she has undetected cruciate damage for example a partial tear, or she has Legg-Perthes disease (weakness in the neck of the femur) which is common in small breeds, though that would cause hip pain, not stifle pain. I'd ask for referral to an orthopaedic specialist.

[hellymelly]

We are in West Wales (the Back Of Beyond ) Went to Swansea for the cardiac scan.

[hellymelly]

Oh and vet thought maybe she had injured the growth plates, but is surprised that she is still limping.

[hellymelly]

Oh and she is a medium sized breed, not small. Roughly 18" at the shoulder adult height.

[ADishBestEatenCold]

The drawer test is inconclusive in some cases, for example, such as with a partial tear.

I'm also wondering why your vet is moving away from the knee to the hip, in her search for diagnosis, given that she initially thought the pain was coming from the knee and that the drawer test, while inconclusive (as not positive for full rupture) did confirm pain in the knee.

I am sure your vet would be happy to refer to an orthopaedic specialist, especially as she doesn't have the facilities to scan.

[hellymelly]

I think she wanted to x-ray the whole lot at first, but because it involves a GA and pup has heart issues she went for the conservative approach, feeling the painful area was the knee, and just x-rayed the knee using a pain killer that was mildly sedating. Now, as the limp is still there (although puppy seems less bothered by her knee being examined than before) she wants to rule out any hip or lower spine issues that would show on the x-ray. It does seem to hurt pup to sit- she learned to sit early on and would always sit and wait for her food but since the injury she has been reluctant to sit, and when she did a few days ago she toppled over sideways. Today she did sit once, although she looked quite asymetrical doing it, she is holding each leg differently. I think she may be slightly better today, the limp has been less noticable, but as it has been a bit up and down generally I am being cautious.

[hellymelly]

Update- DH took pup in this morning and the vet agreed that there wasn't anything to be gained by x-raying her today, that it would be better for her to be properly checked by an orthopaedic vet asap, rather than having two procedures. The bad news is that there is already muscle wastage in the leg. . I am worried sick now. I wonder if it could be connected somehow to her heart abnormality? Our vet is worried , which obv isn't good news, and we have to take puppy to Bristol, which is getting on for three hours drive from here. All very stressful. I am worried enough about her heart issues. Poor little pup. Lets hope we can get an appointment quickly. DH has to go to a meeting in Bristol tomorrow but sod's law there won't be an appointment that soon.

[needastrongone]

Aw Helly, you've had a hell of a time with this puppy, I am sorry you are going through this. We had a lot of stuff going wrong with our Springer in his first year, but all accident related and not to do with his physical make up, more to do with him being a loon.

Keep us updated, hope it's insured and hope there's good news.

[hellymelly]

She's insured with petplan for everything apart from cardiac stuff, as she had the murmur when I insured her. Not sure what happens if this causes long term problems though, will have to check with them. I wonder if cover runs out after a year. Thanks for the kind words needastrongone. My previous dog ate a duplo doll at five months old- cue major surgery. Then he got glass in his paw, more surgery. The first year can be tricky, like the last one, but I hadn't really thought of lifelong health issues, so I am really concerned as to what the scans will show. Am waiting to hear when the appointment will be.

[ADishBestEatenCold]

Sorry things aren't looking brighter, hellymelly, but hopefully the muscle wastage will simply be through lack of use, at the moment.
Glad she's got her referral. Is she going to the University vet hospital at Bristol? That would be good, because it'll mean that (should one test lead to another) all the facilities will be on hand.

Best luck!

Is she a spaniel, by any chance?

[hellymelly]

She is an Irish terrier. I think the vet suggested Highcroft vets in Whitchurch. Would the University vet hosp be better?

[daisydotandgertie]

The university vet hospital is fantastic. Ask for your referral to be to them - they sorted out Daisydog2's meningitis brilliantly. And she wasn't traumatised by being there either.

[hellymelly]

Oh thanks fottee for the suggestion, I will go and google.
ok- did google, I think possibly that is what my vet meant by damage to the growth plates? She is actually being seen at the Langord which I think is the university vet hospital. My vet has said she thinks surgery is likely ,I assume that the options for what it could be would all probably need surgery to resolve. and the hospital have said she may well be in overnight - or longer if she has surgery. Very upsetting. She is a highly strung dog, am worried about her staying in. Am worried about surgery, the whole caboodle. Am worried about her recovery, when she should be meeting other dogs and generally learning about the world. AArgh. Am very stressed! Anyway, her appointment is on Tuesday. DH will have to leave here at 6.a.m. to get her there on time.

[hellymelly]

Update for all you kind folk who posted- pup had scans yesterday at the University vet hospital in Bristol. There is nothing showing as a problem in her hips or lower back. Her stifle showed inflammation and swelling, they tested the fluid on the knee, it was slightly inconclusive but it looks as though the problem is that she has injured the knee but it isn't resolving, so she needs rest and anti-inflammatories. The rest bit is really hard, she gets frustrated and very very bored not going out. She isn't allowed any walks, and lead walking only in the garden. Hard at 4 months! There were no structural faults, her odd gait is due to her changing the movement of the leg to avoid pain. (She is holding her leg outwards and at a slight angle). As we were steeling ourselves for her to need surgery it is all very good news. So she's on Metacam now, and confined to the house. Fingers crossed it is better soon. Thanks everyone.

[tabulahrasa]

Oh house rest is fun...

Clicker training's good, mine learnt dead, take it, touch, to empty the washing machine, the names of toys among other things on house rest.

Also to find hidden toys and biscuits, I also cut his food fairly drastically and used frozen kongs and bones and chews.

He was pretty much on house rest from four months until about eight months old, it was a case of just making sure he always had something to do so he didn't get a chance to get bored.