Managing Multiple Orthopedic Issues

All of my dogs are here to teach me something important.

Buzz taught me about the importance of relationships.

Bailey taught me about the importance of understanding how mental and behavioral issues impact every aspect of life. And how to maintain quality of life for a dog like her.

Diego taught me about the importance of identifying and treating medical issues. Which led to an impressive decrease in behavioral issues.

And Gabby is teaching me about managing multiple orthopedic issues.

When Gabby entered my care in 2013 she was severely obese and didn't move around well. In 2014 she was officially diagnosed with arthritis in her hips and elbows, as the result of dysplasia. And thus began the journey to ensuring Gabby is as happy, healthy, mobile, and pain free as possible. For as long as possible.

Everything listed below is recommended or prescribed by one of the rehabilitation and sports medicine veterinarians she sees on a regular basis.

I'm not even sure what came first. I know that in the first year we put Gabby on a diet (Wellness CORE Reduced Fat), Dasuquin, fish oil (high doses can have an anti-inflammatory effect) and Adequan. She received massages and veterinary spinal manipulation therapy (chiropractic) on a regular basis. We also started targeted strengthening of the muscle groups that support the affected joints. The stronger the muscles are, the more the joint is protected.

She made such dramatic improvements that sometimes it was hard for me to believe that she still had a problem. But, with each improvement, she gained more desire to be active. And with more activity came more pain. In an effort to avoid using pain medications long term, we tried a number of modalities from 2014-2015.

Gabby's most painful areas when palpated are consistently her right hip and her right elbow. However, she also has pain in her left hip.

Laser Therapy
Our first choice of pain management was laser therapy. A course of six treatments over about three weeks resulted in a non-painful right elbow and left hip. Her right hip was still painful but much less so. As we did treatments less frequently, her right elbow remained comfortable while her hips became more so. We have continued to laser her right elbow on a regular basis, she currently exhibits no pain when palpated!

Hyaluronic Acid Joint Injection
When laser therapy didn't give us the prolonged positive effect we desired, Gabby's rehabilitation veterinarian recommended we inject her hip joints with hyaluronic acid. This procedure is typically done under sedation (light or full). Since Gabby is such a cooperative and calm dog to begin with, we chose to use a local anesthetic instead. Gabby tolerated her injections pretty well, but was obviously uncomfortable for about 48 hours after that. I saw no change in her comfort or mobility for almost exactly 7 days. And then she was SO MUCH more comfortable. It is typically recommended that joint injections are repeated if a positive result is seen but not complete pain relief. Her left hip remained comfortable after the first injection so we repeated her right hip. This injection went a lot less smoothly. While I saw a positive effect, Gabby was quite uncomfortable with the procedure itself as well as for a bit longer after the injection.

Gabby was started on Metacam (Meloxicam) and Gabapentin (Neurontin) for a different issue. This was intended to be temporary but we saw a significant positive effect in her comfort and mobility so these two medications were continued. However, her Metacam dosage was about half that recommended for her weight. This was her lowest effective dose (where I saw no change in comfort from her maximum dose), to help protect her internal organs for as long as possible. Even with these medications on board, she was still painful over her right hip when palpated.

As her joint injections started to wear off, we got a new piece of equipment at work.

Shockwave Therapy
Gabby got to be a guinea pig for a demonstration of piezioelectric shockwave therapy. I was warned ahead of time that she may be more sore for 24-48 hours after the treatment, but that it should help improve her comfort soon after that. We did Gabby's left and right hips in the same session. I took home a very sore, very gimpy dog that night. When Gabby hurts, she tends to lie around and pulls herself up with her front end. She did this for nearly two days, and I doubted what I'd done to her. By the third day she was back to her baseline. By the fourth day she was stretching her rear legs. By the fifth day she was trying to run around outside. And by the seventh day, I was witnessing a joyfulness I didn't know Gabby had. I'm not one to claim something works after the first try. But I couldn't believe what I was seeing.

We did three treatments about a week apart. Each time the pain post treatment lasted less and less. Those three treatments kept Gabby's hips comfortable for 3 months. Between 3 & 4 months I saw a decline in her comfort but it was gradual. I don't think I would have noticed had I not been checking for comfort on a regular basis.
Yesterday Gabby had her first of three treatments in the second set of shockwave therapies on her right hip (we are splitting her hips into two separate sessions this time). She was painful for about 12 hours this time, and even then, it was so much less obvious than after her first treatment.

We've added and subtracted medications and modalities to manage Gabby's arthritis over the last three years. The following is a list of what we have determined to help her lead the most comfortable and active life she can.

Dasuquin, Adequan, Metacam, Gabapentin, fish oil, a lean body condition, veterinary spinal manipulation therapy, targeted strengthening, massage, laser therapy, shockwave therapy, and appropriate exercise.

Gabby has helped me to have a working understanding of the modalities we use at work. She has helped us to better understand how to treat multiple orthopedic issues successfully. I really love when people who know her see her xrays, and don't believe me it's the same dog. With this approach, we have also minimized arthritic change in her joints since 2013. On repeat xrays late last year (2015), there were only minimal changes to her hips and elbows.

On a typical day, she doesn't act like a 10 year old dog with hip and elbow dysplasia.

Gabby with friends about a month ago.

1 comment:

Kristen said...

Great information!

I like her sunglasses.