Patellar Laxation

Published on: May 01, 2021 • By: TraceyJ · In Forum: Dogs
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TraceyJ
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May 01, 2021 at 10:53pm
  • Advice urgently needed , I have a 18 month old female patterdale cross , I adopted her at 12 weeks from animal welfare. I was told by my vet 2 weeks ago she has patellar laxation , and needs surgery and she will be fine !!!. On signing pre-authorisation by email for £1800 on my insurance the vet nurse told me diagnosis was PL and is Grade 4 Medial Severe . On my own research it says it could be genetic, surgery isn’t guaranteed as grade 4 , and x-ray  needs to be done and investigations to see if other joints etc are affected. I was not told by my vet it was severe grade 4 , and apparently she’s in no pain and doesn’t require painkillers. The limping started about 3-4 weeks ago , there is no history or concerns on her check ups . But it could be pre-existing and if so should of been noticed at 4-6 months old in her examinations  . I am very confused and unsure and worried about her future health and mobility. And surely before going straight to surgery an investigation should be done to see if her other joints are affected. She has lost muscle mass in the left hind , she is very slight and 1 of her ribs protrudes and never puts on weight . But loves her food and snacks . And I realised she has only been in season once  , a year ago . I would really appreciate some advice on what to do , I’m still waiting for a date for her surgery as it has to be a orthopaedic surgeon . And also waiting on insurance as there could be complications if it’s pre-existing.But no history up until now .  I don’t want her to be put through the pain of surgery that might not work as her tendon is detached from the bone and is weak . And sadly she could be affected in other limbs I just want her to have the best quality of life and as her owner get the right , and best possible care for her . I hope you can help with me  and would like a second opinion or any knowledge on this illness/injury . I was not told the severity ,unlike the insurance company.  And the procedure / surgery wasn’t an emergency and she’s in no pain !!!!. BUT if it wasn’t done within 6-12 months she would lose use of her leg . And as I recently said without x-rays surely they can’t give the cause and assurance that it’s just that 1 leg . And go straight for surgery , and on my research surgery has not been advised because the probability of reoccurrence is high when grade 4 and would cause unnecessary pain and stress for the dog . And a waste of money , if  there was a diagnosis because the right investigations had been done and by performing surgery it will give her a good quality of life and it’s not affecting her any where else or isn’t a life long or debilitating illness . I would give her every penny and every minute of the day to give her a long , happy and pain free life . Thank you for taking the time to read this and would appreciate any advice on giving her the best and right care
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Liz Buchanan BVSc
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May 02, 2021 at 09:19am
Hello!  Have a search for patella ligaments in our blog;  there may be an article there.   The patella is a posh name for the knee-cap which in the dog is a smooth pebble of bone embedded in a strap of tendon-like tissue going over the front of the knee.  This strap sits in a groove, and as the knee bends and straightens, the strap moves relative to the bone.  This would obviously wear the strap out over long periods, but nature has evolved a little hard bit there - like a buckle in a soft tissue belt - to move up and down in the groove as the animal runs.  Unfortunately in some animal's- particularly dogs with knees of a certain shape - the patella 'comes out of its groove.
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Liz Buchanan BVSc
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May 02, 2021 at 09:30am
I am pleased tbat she doesn't appear to be in pain and that your vet-nurse explained the severity, although I hear that you wanted this to come from the vet.   It sounds as though, now you have had time to digest this information and come up with many questions, you would benefit from a conversation - perhaps on the phone-  with your vet who can make the details of the condition and options clear for you (as they know your dogs' individual case). In general, when a patella luxates, it comes out of the groove.  It often slips back in again and everything can continue as before, but it can become stuck, often momentarily, leading the dog to hop uncomfortably and shake their leg.  In that moment, in my opinion, it is uncomfortable, but not all the time.  Further, it can also worsen over time and possibly lead to arthritis etc.  so repair is generally recommended (again, speak to your vet about your girl's case).
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Liz Buchanan BVSc
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May 02, 2021 at 09:42am
There are numerous treatment options depending on the shape of the dog's leg (this is often why vets take extra evaluating x-rays).  From my understanding, surgery has a much better outcome.  Your vet should be able to explain the pros and cons of the different kinds of surgery - in some cases, only one plan will suit the dog - and many vets (myself included, to be honest) would prefer to refer to an expert in orthopaedics. In my opinion, the best thing for you to do would be to make a list of things that you still do not understand and ask your vets for a phone or Skype consultation.  All the best to you at this distressing time and please let us know what decisions you make.
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TraceyJ
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May 02, 2021 at 12:47pm
Thank you for your reply , and I have researched numerous websites . And because illness/Injury is grade 4 Severe , it’s advised that investigations should be done before surgery to confirm condition is it a pre-existing illness . Or due to injury . There has been no injuries or trauma, she is walked on a lead . Unless in court yard where she runs freely with her ball . And either my husband or myself are with her . My insurance company have  concluded  it’s a pre-existing illness from as long as 12 months ago so this means she is excluded. But up until about 3 weeks ago she was fine , all vaccinations up to date and her medical history from when I adopted her at 12 weeks has no mention of a problem with her limbs or illness . And in the passed 15 months no previous limping or pain . Sadly I have been waiting for my vet to return my calls for a week, to explain the difference in explanation of diagnosis , treatment , and future prognosis numerous messages have sent to him from nurse to contact me with an update on referral etc but I’ve heard nothing . I spoke to my vets again yesterday and no referral has been made regarding orthopaedic surgeon, or a date for surgery. The only information I was sent and asked to sign was the pre-authorisation form . I would like to have a copy to see what condition the treatment was for exp Illness/injury etc . And if and when referral was made , and any date for surgery . Due to the lack of communication and no arrangements for treatment , I have got to contact another vet and get the the care and treatment that is needed. She has just been left I was told by vet in visit if she deteriorates contact me straight away . And sadly because nothing has even been discussed about her treatment lack of concern for her well-being I have no other choice but to find a vet that will give her the treatment and care she needs and deserves . I feel so sorry for her because her ball is everything to her but I can’t give it to her . I take her on short walks I’m sure thinks I’m telling her off as she carries her ball everywhere . And by the afternoon she starts limping, she’s always been a very active dog who’s full of love and fun and has the most amazing temperament. But this condition is affecting her and I’m not convinced she’s not in pain at times . Professionally and morally she has not and is  still not being treated properly . So I will find her a vet and a surgery that puts her health and well-being first . Instead of the vet asking me if she is insured, and how much is the cover , because about £1500 should cover it . And to contact my insurer and give the surgery authorisation to make a claim , and if he doesn’t contact me within the week regarding her referral and dates available I need  to ring surgery and it will be booked in. When I returned home 10 mins after her consultation and differing diagnosis and treatment . I contacted insurer , discussed diagnosis , what treatment was needed and gave authorisation. I then called the surgery the vet took my details and told me not to pay consultation fee as it would be easier just to pay excess on day of surgery. That was nearly 2 weeks ago , and now her illness/ injury  has been excluded from the insurance I was told by vet nurse there’s  a possible option to set up a payment plan . On evaluating the situation I came to a decision to find a vet surgery that prioritises the animal and puts there quality of life first . This journey starts tomorrow because someone has to help her . Thank you for your reply’s and I will hopefully get the investigations needed to give her the right treatment for the correct diagnosis  . And if you have ANY advice on reading  her situation I gratefully accept
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Liz Buchanan BVSc
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May 02, 2021 at 04:44pm
You sound as if you're having a stressful time of it, and are worried about issues pertaining to transfer of the case and the referral between veterinary surgeries.  I'm afraid I don't know your vet but it sounds as though they asked you to contact themselves or the referral team if you hadn't heard anything after a week- and you havent heard anything.  Have you now managed to contact them and  understand where the hold-up is?  It could be a mistake on either side of the referral or simply that, given the recent extra pressures placed on veterinary surgeries and referral centres by Covid and recent political changes, your referral has simply taken longer to process than expected.   Meanwhile, most pets with a luxating patella will need lots of love and may have vet's instructions to follow.   Of course, changing vets is always an option but a new vet would have to review the case from the beginning and start again with arranging a referral, so it may not prove the most time efficient decision at this time.
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Liz Buchanan BVSc
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May 02, 2021 at 05:06pm
If you were changing practises, given what is going on at present, you could try to pick one with good contacts with an orthopaedic surgeon - perhaps they have a certificate holder or specialist at the vets, or work closely with a vet-school or local specialist.  I wonder why your insurance company decided to exclude the condition?  Often this is decided on money (insurance companies will often pay out up to a certain amount before stopping paying) and is rarely under the control of the vets.
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Liz Buchanan BVSc
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May 02, 2021 at 05:26pm
Whatever happens next, I wish you luck and hope that you are able to find a solution with which you are happy.
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