I am a big proponent of rescue groups. There are many “discarded” dogs and cats, most of which are absolutely wonderful pets. Sometimes people can’t keep them because of hard times, or because they did not responsibly think through the potential fifteen-year commitment that pet ownership is.
Whatever the reason may be, thousands of dogs and cats each year need new homes. Some are healthy and just need updating on their basic needs (vaccines, spaying or neutering and heartworm testing) while many need more intense medical attention. I have worked with Peppertree Rescue (http://www.peppertree.org/) for many years and really appreciate their dedication to dogs with medical needs.
Often times, there are dogs at shelters that do not have space, and they are on the list for humane euthanasia due to overcrowding. Peppertree will find out about them and screen them, and then have them transported to the Albany area where they can be attended to. Some dogs come from the NYC area, while others from as far south as Georgia.
This was the case with Glinda. a sweet, 8-ish year old Golden Retriever cross who could barely see me when I first laid eyes on her. Both of her eyes were nearly crusted shut with green mucous. As I gently cleaned them, she rolled over on her back and relaxed. Her eyes were red and inflamed, and her conjunctivae were severely swollen. When I measured her tear production, it was at about 10%.
It was apparent that she suffered from KCS: Kerato Conjunctivitis Sicca, more commonly known as “dry eye”. This can either be triggered as an autoimmune condition or a side effect of some medications. When the immune system attacks the tear glands, they stop making normal tears and instead makes this ”goo” that does not hydrate the corneas properly. If left unchecked, it can cause permanent blindness. People can have this problem too. I instituted artificial tears and topical medications to stop the immune system from inappropriately attacking the tear glands.
As I continued my physical exam, I found some other areas of concern. While Glinda weighed in at a reasonable 74 pounds, her body condition score was abnormal. She had poor muscle mass in her back legs and was carrying more fat than she should. I also noted that she had decreased extension in both of her hip joints. She was uncomfortable when I manipulated those joints. As I palpated her knees, I found chronic thickening in both the left and right knee. She also had discomfort here and mild instability.
These findings are consistent with arthritic change in both the knees and hips. Often times the hip arthritis is a consequence of hip dysplasia. This is a condition where the hip joints do not form and develop correctly. For more information on hip dysplasia please see http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1916.
|The arthritis and instability in her knees was consistent with chronic damage to her cruciate ligaments. The knee is a fairly complicated joint. It consists of the femur above, the tibia below, the kneecap (patella) in front, and the bean-like fabellae behind. Chunks of cartilage called the medial and lateral menisci fit between the femur and tibia like cushions. An assortment of ligaments holds everything together, allowing the knee to bend the way it should and keep it from bending the way it shouldn’t.There are two cruciate ligaments that cross inside the knee joint: the anterior (or, more correctly in animals, cranial) cruciate and the posterior (in animals called the caudal) cruciate. They are named for the side of the knee (front or back) where their lower attachment is found. The anterior cruciate ligament prevents the tibia from slipping forward out from under the femur. Cruciate ligament tears can occur acutely, in young athletic dogs landing incorrectly, or chronically, in older overweight dogs. Chronic partial tears can lead to instability and cartilage damage in the knee joint. For more information on cruciate ligament disease, please check out http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1975.|
While I was very concerned about her knees and hips, I had a more pressing problem. Glinda tested positive for heartworm disease. This disease is spread by the bite of an infected mosquito. Once bitten, the heartworm larvae are injected into the animal and over the period of about 6 months grow to be the size of angel hair pasta that live in the animal’s heart and lungs. These worms then reproduce and release microscopic larvae into the pet’s bloodstream. A new mosquito then bites the dog and picks up the larvae and can spread it to other dogs.
Dogs with adult heartworms can have clinical signs such as coughing, exercise intolerance, heart failure, arrhythmias and even death. It is a disease readily preventable with monthly medication. If a dog has adult heartworms they can be treated with medication. Most pets can make a full recovery and live normal lives.
The treatment kills the adult heartworms and the body processes them and removes them from the blood vessels or lung tissue. This process can take a fair amount of time. Patients that are treated need to have restricted activity for one to three months because of the risk of an embolus following treatment. If a patient is too active during that time, the dead worms can become lodged in a vessel and create an embolus. This embolus can block lung tissue or blood vessels and can put a patient in potential respiratory or cardiac arrest. It can also cause nosebleeds, coughing or fever.
At this point, she had a long list of medical issues. The dry eye was readily treatable and so was the heartworm. She had changes in her knees and hips consistent with arthritis, and I suspected she also had damage to her cruciate ligaments. Some patients can have these orthopedic problems managed with conservative therapy (pain medications, rehabilitation), while others may need surgery.
That is a big investment for any owner, let alone a rescue group where the money spent on one dog could potentially help dozens more. I took a moment to call Peppertree’s board member David Sawicki and reviewed her case with him. Glinda would need permanent eye medications at about $25 a month. Heartworm treatment would require two hospital stays a month apart and cost about $600. Her arthritis medication would be about $30 a month. If she needed surgery for her cruciate ligament, it could cost about $3,000 per knee, including post-operative rehabilitation.
David agreed that we had a potential long road with Glinda, but he consented to progressing practically and I promised to keep him posted at each step. I started with chest radiographs to look for significant changes to Glinda’s heart and lungs from the heartworm. Luckily there were none. I then sent out blood and urine to assess her kidney and liver function. This would be important to determine what arthritis medications I could prescribe to manage her problems while we were waiting. Her kidney and liver functions were normal.
So, I started Glinda on her eye medications and a course of Rimadyl to help with her pain and mobility. I then instituted treatment to kill off the adult heartworms that were circulating through her blood stream. She stayed in the hospital for a few days and then was released to her foster parents. I took the time to review all of her medical conditions with them, as her case was pretty complex. She returned a month later for a follow up treatment to eliminate the second stage of heartworms.
I couldn’t believe my eyes. Her fosters, Marlee and Hank Bickel had fallen in love with her and it showed. Glinda’s eyes looked perfect, she was 5 pounds lighter and her coat looked fantastic. Since she could not exercise much, they spent time feeding her carrots (a great diet treat for dogs) and brushing her coat. The steps were small, but I could see that we were on the right path with her. She had great fosters and her body was responding.
Glinda then completed the second stage of her heartworm treatment. This consisted of being in the hospital for 3 days and receiving two injections to kill the adult worms. She was again at risk for an embolus, so she had to continue with strict rest for another month.
She did well during that period and when I saw her a month later, I had the Bickels add in some home therapy for Glinda’s arthritis. Starting with applying moist heat packs to her arthritic joints, they would then massage her muscles and then do passive range of motion exercises with her lying on the floor. Cycling her joints without concussion against the floor would help to improve her ability to flex and extend her stiff arthritic limbs. This would be a daily exercise and would take about 30 minutes to cover all of Glinda’s limbs and back muscles.
When I saw her three months later, two great things had happened. First, the treatment for heartworm had been a success, as she now tested negative – you have to wait at least 4 months after treatment to re-test, or you get a false positive – and second, Glinda was no longer being fostered. The Bickels had adopted her!
With this new foundation, it was time to take another step. Glinda’s knees were consistently bothering her. She had gained a lot of weight being on restricted activity for 4 months and was now 85 pounds. The arthritis in her knees was still present and there was some instability there also. My concern was that she had done more damage to her cruciate ligaments. I discussed this with the owners and we started with a conservative management program. If she did not respond to this, a sedated orthopedic exam and radiographs would be indicated. I prescribed a course of therapy for her in the Rehabilitation Program’s Underwater Treadmill and an Adequan injection series for her.
The buoyancy the underwater treadmill provides would allow Glinda to exercise and lose weight. The Adequan injection series would be twice a week for 4 weeks, then one injection a month thereafter. This would help to improve her joint fluid in all of her joints, as well as reduce the damage to her cartilage.
To further help Glinda, I recommended the Bickels consult with Leigh Saunders, a licensed veterinary technician who was pursuing a specialty in nutrition. Leigh had been instrumental in helping many of my previous patients with their nutritional needs; and I asked for her to help here with Glinda. After calculating the exact amount of calories for Glinda’s target body weight we set up a diet for her. This included the treats she was allowed per day as well as her meals and exercise regiment on the underwater treadmill. We would continue to followup with the Bickels and keep track of Glinda’s weight loss, adjusting her nutrition accordingly.
Over the next 3 months, Glinda worked in the underwater treadmill twice a week, gradually increasing her time and distance with each session. Her comfort level improved and she lost 9 pounds. While she was moving well, I noted further instability in both of her knees.
It was time for a sedated orthopedic exam and radiographs. Her followup bloodwork showed that she was handling the Rimadyl nicely and that she could be sedated with relative safety.
Peppertree Rescue agreed to help with her costs and a short while later we had our answers. Glinda had partially torn the cruciate ligament (ACL) in both of her knees. The right was not as stable as the left, and both had moderate arthritic change. She also had hip dysplasia, characterized by poor coverage of her femoral heads, and consequently had developed arthritis in her hips as well.
Through all the small steps that Glinda had taken, her eyes, pain control, eliminating heartworm, we now had a big step to take. The right knee needed stability. With hip arthritis in both legs and arthritis in both of her knees, the instability in the right needed surgical correction. My plan was to correct that with a procedure called a TPLO: TIbial Plateau Leveling Osteotomy. This would eliminate the need for the cruciate ligament and allow stability in the knee that would allow her to walk on the leg appropriately and slow the progression of arthritis forming in that knee. I was unsure if her left knee would need the same correction down the road.
Surgery was a success for Glinda. The TPLO gave her right knee the stability her body needed. She did very well in her post-operative rehab program, going through low level laser treatments and underwater treadmill sessions. During her therapy she was always a smiling, happy patient. After 12 weeks of restricted activity, her tibia healed and I started to increase her overall activity.
I continued Glinda with monthly Adequan injections, Rimadyl as needed and controlling her weight. Her owners have continued daily massage and passive range of motion exercises with her. She has regular follow up visits and bloodwork to ensure her body is handling her medications appropriately. We would manage the arthritis in her knees and hips as an ongoing condition.
She has become an avid hiker with her owners. She goes for 30-45 minute walks every day and enjoys being outside. While her arthritis has progressed, her multimodal pain management regiment has kept her from having any further surgeries at this time.
Glinda continues to live up to her namesake and has become an AKC Canine Good Citizen. She has participated in the Bark for Life Walk and the Peppertree Furry Fun Run. Glinda may also pursue her Tail Waggin Tutor certification, where she would help children learn how to read. She is still a happy, social dog who is enjoying her “golden years” with her loving owners. I am very thankful to have been part of her rescue.
Here is a recent picture of her out on the trail at Marcy Dam
And one from the summer enjoying a baseball game.