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Discussion Starter · #1 ·
Hi all, it is a long time since I have been on here and it's lovely to see so many names I remember from years ago. I would really value your thoughts - Max is being treated by our vet for front leg lameness and we are scratching our heads a bit.

He has never limped and has good hip/elbow scores - x-rays taken when he was a year at castration showed "normal" joints - we asked the vet to do them for our own peace of mind. He is a tall boy, quite big frame but weighs 35kg (increased 2kg since lockdown, walks have been same length but less off lead romps). February this year the evening after a 1 hour street lead walk he started to limp a few strides when getting out of his bed in the evening. Mornnings and walks were normal. So we tried rest for a week and resume, happened again so we saw the vet - tried metacam 5days and rest/gentle resume. Seemed easier for a few weeks, but stiff at times - always evening. Then just before Easter the evening limp got worse. We also found a 50p size soft lump behind his left elbow which was aspirated - lipoma (phew!).

Our vet had him in for elbow x-rays and diagnosed "early onset arthritis" - he agreed the x-rays aged 1 were absolutely normal. Suggested starting Cartrophen course. First 2 injections showed good improvement, then since the 3rd one last week he has been worse overall. We always felt the left leg was worse but the vet said both were affected. However it is really clear in the last couple of weeks that the left is worse - when he sits he avoid weight bearing on the left by leaning to the right.

Only other thing I've noticed is he seems worse getting up after he has rested on his left side with his head leaning up against the side of his bed, ie stretching left side of his neck and shoulder. He is better getting up from a firm surface.

We will see the vet Friday for 4th cartrophen and a chat. I felt positive after the first 2 but am concerned he has gone backwards since the 3rd. I am aware x-rays don't show everything. I trust our vet completely but feel uncertain at what point to consider further diagnostics - ct/mri? Or specialist referral? Is that jumping the gun?

Sorry for the ramble, I am aware many of you have a lot of experience of these problems with older dogs, and would value any thoughts to get my head straight before we see the vet next. I did buy some Yumove, but decided to wait and see how Max responded on Cartrophen first so as not to muddy the picture. Exercise wise we are sticking to 30 mins lead walk 1 or 2 x daily as advised by the vet.

Thank you, Mandy
 

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Everyone will advise you something different. With my oldies I use a small regular dose of something like Metacam (my vet is aware), plus a whole plant Sativa hemp/cannabis paste (with no THC).

I know people pooh pooh CBD but many aren’t aware it’s not an instant fix. You have to “reawaken” the endocannabinoid system which can take several weeks and start with a very low dose and gradually increase until you reach the sweet spot. It’s also vital to get it from a trusted source who are correctly registered and perform and publish test results. I use whole plant paste because this is what the oils are derived from and it’s slightly stronger and I find it easier to dose (for my dogs and for myself).

I give green sativa paste to Carys for pain relief (she not longer needs Metacam) and I can most definitely tell if she misses a dose, I used to give Betty a purple paste which was slightly stronger but from an indica hybrid. Sativa has uplifting properties, indica and indica hybrid are more calming. So you wouldn’t give a Sativa based oil to an older dog with doggie dementia for example. Many CBD sellers don’t even identify which strain their product is made from. That’s definitely a red light for me. I get mine from a herbalist based in Suffolk.
 
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Hello Mandy. Good to hear from you again, though sad that is with a problem with Max. Below are my thoughts and experiences.

Firstly, and maybe a question for your vet. "Is it possible to do anything about this?" To me this is all important, because if the answer is "No" then to me there is no point in throwing more money just to give it a name. Arthritis is more usually about palliative care, managing the pain, rather than a cure.

But you say there is a lipoma behind the left elbow, and the left front is what appears to be giving him the most problem. Fatty lumps are something elderly Labradors are susceptible. In the main they cause little problem and can safely be ignored, but as a question, maybe for your vet, "Could it be pressing on the elbow, causing a restriction of movement? Could this be having a bearing on his condition?" I've known in happen.

My Anna started having arthritic problems when she was 9 (Her hip score was 2/2 so certainly not due to poor hips.) I also are now getting twinges, so on days when I know I'm going to get problems, such as working days on the shoot, I take a paracetamol. So I figured the same sort of thing with Anna, giving her a dose of metacam for her bad days. But talking to my vet, that was wrong. Because metacam builds up in the body over a period of time, to treat just the bad days requires a full dose, where treating every day enables you to reduce the dose down to a holding dose. In Anna's case she weighed 32kg but I was dosing her initially the dose for a 10kg dog! (OK, in later years I did have to increase it, but never got to more than the dosage for a 15kg dog.

There are other supplements you can try such as Glucosamine and Chondroitin. It pays to experiment with these because not all are equal for all dogs. I've known some people get good results using one make where other people get on better with another. Also generally speaking, the human varieties tend to be cheaper than that designed for dogs. Also Nicola mentions CBD oil which I know some swear by. So it pays to experiment.
 

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Discussion Starter · #4 ·
Thanks for your reply Maddie - that gives me something to think about. I realise there is going to be some trial and error along the way. I'd heard about people using CBD for pain but hadn't realised it was an option for dogs as well.
 

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Discussion Starter · #5 ·
Hello Mandy. Good to hear from you again, though sad that is with a problem with Max. Below are my thoughts and experiences.

Firstly, and maybe a question for your vet. "Is it possible to do anything about this?" To me this is all important, because if the answer is "No" then to me there is no point in throwing more money just to give it a name. Arthritis is more usually about palliative care, managing the pain, rather than a cure.

But you say there is a lipoma behind the left elbow, and the left front is what appears to be giving him the most problem. Fatty lumps are something elderly Labradors are susceptible. In the main they cause little problem and can safely be ignored, but as a question, maybe for your vet, "Could it be pressing on the elbow, causing a restriction of movement? Could this be having a bearing on his condition?" I've known in happen.

My Anna started having arthritic problems when she was 9 (Her hip score was 2/2 so certainly not due to poor hips.) I also are now getting twinges, so on days when I know I'm going to get problems, such as working days on the shoot, I take a paracetamol. So I figured the same sort of thing with Anna, giving her a dose of metacam for her bad days. But talking to my vet, that was wrong. Because metacam builds up in the body over a period of time, to treat just the bad days requires a full dose, where treating every day enables you to reduce the dose down to a holding dose. In Anna's case she weighed 32kg but I was dosing her initially the dose for a 10kg dog! (OK, in later years I did have to increase it, but never got to more than the dosage for a 15kg dog.

There are other supplements you can try such as Glucosamine and Chondroitin. It pays to experiment with these because not all are equal for all dogs. I've known some people get good results using one make where other people get on better with another. Also generally speaking, the human varieties tend to be cheaper than that designed for dogs. Also Nicola mentions CBD oil which I know some swear by. So it pays to experiment.
Thanks John - I have read some of the old threads and was interested to see how you tweaked the metacam dose with good effect.

I am an osteopath so I'm used to helping my human patients navigate problems with OA, when to involve the GP or request more diagnostics etc. I suppose it's the equivalent of going to see the GP yourself and your brain turning to jelly - I speak to the vet, defer to him and go into "trust" mode, but have a nagging doubt that they x-rayed his elbows and seem confident that is the problem, but when he first examined Max he said his joint movement was good. I know from humans that x-rays show up incidental OA that may not be the source of someone's pain at that point in time, and don't know if that is the case as much with dogs. I did ask if they had considered his shoulder to rule that out and he was confident it was the elbows.

With dogs, does there come a point if OA results in loose fragments of cartilage in the joint space that warrants arthroscopy? I used to share a horse and what looked like a knee x-ray that wasn't too bad, turned out when a specialist looked at it via MRI to be a torn joint capsule with several large cartilage fragments and he needed surgery.

I am definitely open to trying joint supplements and think I will try that once we have a clear idea of the results after 4th cartrophen injection.

I guess we are struggling because he seemed fine one minute, and since Mid Feb has been suddenly been unable to do more than short lead walks - it all feels quite sudden - although he is 10 I think we are in denial :(. Thank you for your comments though - that is really helpful. Hopefully we'll have a good chat with the vet Friday,
Mandy
 

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One thing to remember, as I posted on another thread today about teeth, "but with a half way reasonable diet rarely get much problems with their teeth. I guess part of that is that a dog's teeth only have to last around 13 to 16 years, where our teeth have to last 75 to 100 years!" And so it is with so many things. Human's joints have a far longer time to get really bad in compared to dogs. Even horses joints need to last 2 to 3 times as long.
 

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Discussion Starter · #7 ·
One thing to remember, as I posted on another thread today about teeth, "but with a half way reasonable diet rarely get much problems with their teeth. I guess part of that is that a dog's teeth only have to last around 13 to 16 years, where our teeth have to last 75 to 100 years!" And so it is with so many things. Human's joints have a far longer time to get really bad in compared to dogs. Even horses joints need to last 2 to 3 times as long.
Very true John, thank you
 

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Sorry to hear Max has an issue.

Our Judy is 12 and a half years young now and had terrible ED years ago. We stayed away from surgery and have been using "natural" or non-invasive methods ever since. Varying degrees of success.
Recently Jude has had a couple of bad flare ups which is heart breaking to see as she is so stoic but all we can do is our absolute best for her.

Our current approach is (deep breath):-
Weight control - 32kg is her absolute maximum!
As of last week - Metacam daily dropped from 30ml to 20ml with target of 15ml every other day
Mobile Bones in breakfast (used to be green lipped mussell)
1 CBD capsule
Senoquin tablet x 1
Chews and treats glucosamine based
40 minute walk daily
30 to 45 mins of hydro weekly / fornightly
Mats on the floor, memory foam beds

I've just bought some devils claw to see how that goes.

That's just Jude...!!!! Her liddle bruv slightly less approach but also needs extra care and attention as he got diagnosed with bi-lateral HD in January....

Good luck with Max
 

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Discussion Starter · #9 ·
Sorry to hear Max has an issue.

Our Judy is 12 and a half years young now and had terrible ED years ago. We stayed away from surgery and have been using "natural" or non-invasive methods ever since. Varying degrees of success.
Recently Jude has had a couple of bad flare ups which is heart breaking to see as she is so stoic but all we can do is our absolute best for her.

Our current approach is (deep breath):-
Weight control - 32kg is her absolute maximum!
As of last week - Metacam daily dropped from 30ml to 20ml with target of 15ml every other day
Mobile Bones in breakfast (used to be green lipped mussell)
1 CBD capsule
Senoquin tablet x 1
Chews and treats glucosamine based
40 minute walk daily
30 to 45 mins of hydro weekly / fornightly
Mats on the floor, memory foam beds

I've just bought some devils claw to see how that goes.

That's just Jude...!!!! Her liddle bruv slightly less approach but also needs extra care and attention as he got diagnosed with bi-lateral HD in January....

Good luck with Max
Hi, thank you for your reply - I am sorry for taking so long to thank you, but it's been a mad couple of weeks with a poorly husband joining in with lame Max. That is helpful to see how you have managed things with Jude. I am getting my head round the way forward being about best management rather than a cure, and that it it will likely involve some trial and error.

Since I posted here, we saw the vet for the 4th cartrophen and as the 3rd week had not been good, he advised sticking to 30 min lead walks twice a day and review, which we did last week. Basically he wants us to try over the next 2 weeks to increase to 45 mins twice daily on lead, then off lead and see how it goes. If he seems ok (a few steps limping after rest ok, but not getting worse), keep persevering, but see the vet again if worse.

He is open to us trying hydro, but wants to check first how he responds to increasing weightbearing walking. If he doesn't tolerate that, rather than hydro, he would want to do some more tests to be sure what is going on - depending on how he is, that might be shoulder x-ray as well, and he wants us to video Max so he can see him limping to guide the tests.

He talked about the possibility of MRI or arthroscopy of they suspect a cartilage fragment/flap as that wouldn't necessarily respond to conservative care. He also said try Yumove, then see if that helps and maybe try alternatives - see what works for him.

At the moment, our observations are he is definitely worse on the left side, he can manage with 2 steady 20-30 min lead walks a day, but once he goes up/down slopes, bounds out of his bed (as he did last week!), lays on his left side propped up on his left elbow or trots on more on his walk - he limps more after and it seems to be a very fragile equilibrium without any progress. The cartrophen does not seem to have helped us overall.

So that's us for now. Thanks again for your reply - as you say it is heartbreaking watching them struggle. Through the last few years when my husband, mum and dad have struggled with their health, Max has been my constant sanity check, bar the odd sickness bout, and we both want to do the absolute best for him that we can.
 

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Discussion Starter · #10 ·
Thought I'd update. So we have walked a little further on lead last week (just 5-10mins more each walk, from 25 mins to 35mins) and yesterday did the same walk off lead - it is level, on grass, no running around, still basically walk, sniff, trot, with maybe a bit more trotting last 2 days while off lead.

Limping last week was no worse for the slight increase ie 4-5 steps after laying down, but it is not every time and not just end of day. What seems to trigger the limping is after he has been laying on his left side, either flat, or propped up on his elbow or leaning his head against something. Possible slightly worse after being in his softer bed, but any surface. If he gets up from his right side he is more often than not fine. When he limps, if he stretches his front legs before moving it always helps. When limping he nods when weightbearing on his right front, so we feel sure it is his left that is the issue.

This morning for the first time I attempted 45 mins which is what our vet wanted me to try for, and back home after laying down for half hour, he was very lame when he got up from his left side. He is never lame when out for walk and moves as if he doesn't have a problem. He isn't jumping in/out of the car as we have a ramp.

So we will see the vet next week and show him some video clips. The fact that it is an issue on a very specific action ie getting up from his left side makes we think joint wise obviously that side is worse, but I've been wondering about his shoulder and also whether this could be a soft tissue injury, maybe something like a biceps tendinopathy? Same as with people I guess, just because OA shows on x-ray doesn't always mean that is the source of pain.

Not sure if that sounds bonkers, but thought I'd ask in case anyone has experience of that - from what I've read it can be in older medium/large dogs and come on very similar to Max, not necessarily just younger more athletic dogs?
 

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Sorry, no experience with shoulder sort of injury but didn't want to just read and run. I do remember from Indie's cruciate injury I was told (not sure if it's still the case) it wouldn't show up on x-ray as it's a soft tissue injury, but then confusingly I was shown an x-ray where they could tell it was a cruciate injury (all completely confusing to me, just looked like a blurry black and white image). I hope they can get you sorted, it mustn't be nice wondering what it is that's causing the problem xx
 

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Discussion Starter · #12 ·
Sorry, no experience with shoulder sort of injury but didn't want to just read and run. I do remember from Indie's cruciate injury I was told (not sure if it's still the case) it wouldn't show up on x-ray as it's a soft tissue injury, but then confusingly I was shown an x-ray where they could tell it was a cruciate injury (all completely confusing to me, just looked like a blurry black and white image). I hope they can get you sorted, it mustn't be nice wondering what it is that's causing the problem xx
Bless you, thanks. I think from a human imaging view point broadly x-rays show bony change, but some changes related to soft tissues problems, eg calcification in tendons, or lipping at the edges of the bicpital groove that might affect the biceps tendon, can be seen on x-ray. Then for real detail it would need follow up with ultrasound or MRI.
 

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Discussion Starter · #13 ·
Really sorry to post again. So yesterday I had just sent an email to our vet with update and couple of video clips ahead of seeing him today re his left front lameness. Heard a cry from Max - he had had his morning walk, uneventful, and was home sleeping in his crate. When I got to the lounge he had tried to get up, was on his belly on the flooor and couldn't push up with his hind legs. He tried to move but could only shuffle on his belly. He seemed to lay awkwardly, sort of leaning on his right side and couldn't even re-position himself.

We tried to encourage movement but he just couldn't. Seemed normal in himself just subdued. Eventually by putting his bed by his side, he got up enough to step into it then just flopped. At different points we carried his bed to the garden to see if he would get up to wee - most he did was get out then drop down again. This went on for 4 hours. Got an emergency vet appointment and carried him to the car. Blow me, but he got to the vets, sat up and walked down his ramp to see vet and walked around perfectly fine. If my OH hadn't been with me all day I would have thought I'd gone mad.

Vet did a really thorough orthopaedic/neuro check and found nothing. Long chat, discussed possible stroke, neurological issue, decided to book him in for more x-rays Monday to screen whole front limb ie shoulder down as he is definitely protecting that leg. Asked us to video if back legs went again. Keeping an open mind re whether something extra or connected.

Seemed ok when home but subdued, then later pm it happened again. Not quite as bad, we could get him with a treat. Has pee'd and poo'ed ok. Really noticed last night that he drops his head and arches his back, and then carefully drops down as if he can't do it or there is pain or both.

So I am going to call the vet this am. My dilema - do we go ahead with Mondays front leg x-ray work up locally? Perhaps the vet will add neck x-ray as well? My thinking is it could be two seperate things ie front leg and something spinal, or if there is a spinal problem in the neck, that could be contributing to the front leg too. So would it be best to refer now to specialist. Nearest for us would be Dick White's.

Our vet is wonderful, but I'm not sure I want to go through another sedation Monday for the front; limb when something worse might be happening spinally? But very unsure of what is the best way to proceed with something like this.
 

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Interesting your vet is talking about possible neurological problem affecting the hind legs. My guess he's thinking vestibular syndrome. In which case this is normally self correcting and may well never reoccur. I've had it a couple of times with my dogs and the quick recovery is so normal with this. If you see it happening, the dog normally circles anticlockwise before going down. When the dog first stands afterwards in often "Knuckles under" on it's hind legs, doubling its paw under so that it's actually standing on the top of it's toes, and often it's eyes flick sharply to the side.
 

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I did read the latest update and thought this sounded nerve related - hopefully just a temporary trapped nerve??

Feel for you as your anxiety and wanting to do the absolute best for Max jumps off the page.
Fear not... you are... and he knows you ae. he's a lucky lad to have top quality owners.

Forgot to mention in my previous response we tried Judy on Catrophen a few years back - it was a revelation and worked absolutely brillaintly for a couple of years and we weaned her off it.

Wish you the very, very, VERY best with Max... doing your best is all you can do.
 

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Discussion Starter · #16 ·
I did read the latest update and thought this sounded nerve related - hopefully just a temporary trapped nerve??

Feel for you as your anxiety and wanting to do the absolute best for Max jumps off the page.
Fear not... you are... and he knows you ae. he's a lucky lad to have top quality owners.

Forgot to mention in my previous response we tried Judy on Catrophen a few years back - it was a revelation and worked absolutely brillaintly for a couple of years and we weaned her off it.

Wish you the very, very, VERY best with Max... doing your best is all you can do.
Thank you for your kind reply, and to John for your help. The update (hoping this might help someone else if they have a similar situation...) - so we saw the vet again the next morning. Max was subdued at home but basically walking ok, but we showed him a video clip from the night before where he was arching his back before dropping to the floor, and our vet feels this is spinal stenosis. No head or movement signs for anything vestibular.

He thought the left front leg and the spine were separate and did not think anything was wrong with his neck and problem was lumbar. Neuro exam was all ok. He prescribed 14 days gabapentin & previcox with garden lead toilet visits only and the xray went ahead for the whole front limb not just elbow on Monday. That showed nothing other than early OA in both elbows. Max had been much better after a couple of days on his medication but for the first 2 nights he still showed intermittent problems weightbearing on his left hind but other than that no recurrence of the inability to stand.

We have another review tomorrow and if rehab fails he will refer him for more investigation. We are still unsure if there are two separate problems ie left front leg (vet feels possible soft tissue/cartilage injury as x-ray inconclusive) and spine, or our vet is also now wondering if the whole thing might be related. To me, if the left front leg was caused by the spine that would indicate a neck problem anatomically but maybe it is different with quadrupeds. Also worrying - last few months we have occasionally notice a light paw scuff when Max walks, nothing major, very intermittent - but that has been more noticeable last 2 weeks, particularly his left hind - catching it on the door threshold and scuffing on the carpet.

We will see how rehab goes - uncertainty is definitely hard when you watch a previously well dog so limited with what he can do. He is so accepting and it breaks our hearts every time we pop out and he looks at us like, me too please mum & dad :(
 

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Discussion Starter · #17 ·
So we saw our vet for a review and the conclusion is the left front leg and spinal are two separate problems. Left front leg might be cartilage or soft tissue as nothing on x-ray makes the left front stand out from the right - just mild OA elbows bilaterally.

Re unwillingness/inability to stand on back legs last week - after reviewing the video we took, our vet is comfortable that is caused by his spine, but obviously without further inverstigation we cannot be sure of the precise cause. On examining Max there are no objective findings, just an observationfrom the vet same as we have find of a very slight intermittent scuff of one of the hind paws - possibly left, but very vague.

He has said as there are not any significant examination findings it does not warrant a referral at this stage for more investigation. He feels Max should stay on Gabapentin and Previcox for life basically and if things get worse, a referral might be on the cards then. I did question this, and asked if the spinal problem was self limiting eg an acute disc, might it settle and if he goes well come off meds. But out vet said if he does and he struggles, it takes a few weeks to build up levels again - he really didn't seem keen. But he said experience has shown him that referring too early just costs owners huge bills and the answer often comes back - conservative management.

So my dilema is this - I trust our vet, and the the whole practice. But I am struggling with a diagnosis based on our video, that puts Max on life long meds with no definitive diagnosis? What if there is something spinal that might benefit from intervention, that might give him a better rest of his life, which if left might see him deteriorate but could be helped now? My husband says our vet might be being pragmatic based on Max's age at 10, but our vet also admits it is a grey area.

Meanwhile Max is still on complete rest and to start 15 min walks from a week's time and see how he goes. I don't want to jump the gun or make him go through unnecessary tests, and are vets are very honest and not at all pushy which I value, but I am very unsure how to deal with this - go on trust for now, or ask again for a referral for a clear diagnosis at least? I would be very grateful for any thoughts x
 

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My thoughts are.... as previously... that Max is one lucky boy to have owners who care for him so much. Absolute props to you for that and I'm sure he loves you back just as much.

Reading your update I can tell you're the same as I'd be in this circumstance. You trust the vet as an expert but there's always that nagging thing of can I do more?
As I'm detatched I can only give you my thoughts based on your update - follow the advice of whichever expert you're happy with and in this case it seems to be your vet. A good Vet who you trust is a valuable commodity and scandlously can be hard to find these days.

Here's a scenario we recently went through:-
Judy growth on ear. Vet said didn't look anything too concerning but would aspirate and test if we wanted - we said go for it. Test came back inconclusive. Vet said could put Judy under GA and cut growth away - by now it had changed colour to black from pink. Vet did say leave it and do watchful waiting.
Missus and sister (who is a K9 expert) said leave it and I was sceptical as Jude now 12 and a half and that and GA wasn't a mix I felt comfortable with. Because I have a gold medal in worrying I booked the appointment just so I'd know for sure but said I wanted to speak to Senior Vet morning of proceedure as wanted guarantee she'd be good after GA and just what they were cutting off. Day of op we pulled her out of it - then one week later the pesky thing simply fell off!!!!

Good luck to you and Maxy boy
 
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