My 4 year old Bichon Frise has a torn ligament in her left back leg. I think it happened when she jumped down off my bed.That's when I noticed she was limping. She doesn't seem to be in pain but x-rays show a lesion on the bone in the same leg. She has been x-rayed today again after a week of tablets and the vet said the lesion was a lot better. They don't want to operate on the ligament while the lesion is still there so she is to have more tablets for a month and a further x-ray then. I'm worried in case she has cancer in the leg. I don't like the use of the word "lesion".
My name is Dr. Jo and I will do my best to help you with your questions about Chica. I'm so sorry she is having trouble and has you worried, but I'm glad you are looking for the information you need to make good decisions for her.
I see you are currently offline, but if you return and wish to join the conversation, please type in what you want to say and click REPLY. Then we can chat back and forth until you are satisfied with the information I have given.
I would like to begin by reassuring you bone cancer is not common in 4-year-old Bichons, but it is possible. Knee injuries are quite common, however, as are congenital problems like luxating patellas.
That being said, a torn ligament creates no changes to the bones that will show up on x-rays. Ligaments don't show up on x-rays, either, so we cannot identify torn ligaments with x-rays.
We generally diagnose torn ligaments based on history, the way the dog walks, and the way the joint feels when we manipulate it. Some torn ligaments produce very characteristic loose-ness (laxity) within the joint. It would take an MRI to truly diagnose a torn ligament in some cases, but we don't often do that.
Regardless, a torn ligament does not produce changes to the bone that show up on x-ray.
While the word "lesion" is causing alarm for you, please understand it only means abnormality. It doesn't necessarily indicate a suspicion for cancer. It could be that the bone was injured along with the ligament and is undergoing some changes in response to that injury.
Your vet is actually being prudent by wanting to delay surgery until the bony lesion is gone.
On the outside chance that the bony lesion is due to bone infection or cancer, surgery would be a bad idea.
Because it is vastly more likely that the bony lesion is from an injury and not either of those things, and because there is not a huge rush to surgically repair a ligament, this is a good plan.
The only bad part about this plan is that you aren't doing anything in the meantime to more aggressively pursue the bony lesion in case it is infection or cancer.
This is where medicine becomes more art than science, and a different vet might recommend a different course of action.
There is no non-invasive way to get a more definitive answer as to what is causing the bony lesion. The next step would be a bone biopsy. Because that WILL cause a bone injury and is not without risk, it makes sense to me to give Chica a little more time to see if it heals up on its own.
I'm especially encouraged that lesion seemed to improve after only this first week. That's an excellent sign. For Chica to have bone cancer or an infection is already really rare. For that cancer or infection to appear to heal over the past week would be really, really, REALLY rare.
I also hope you will gain some peace of mind from knowing that the typical time lag between the injury and a surgical repair of a torn ligament is around six weeks. Chica will heal up from surgery quicker if her knee has done some healing before the surgery.
In the meantime, as long as Chica isn't acting ill and is continuing to get better, not worse, this seems like a reasonable plan to me.
I wish there was a way to rule out cancer without a biopsy so you wouldn't have to worry, but there isn't.
Of course, the best person to address your specific situation and Chica's unique injury is the vet who has been examining her. I would encourage you to discuss your concerns with him. I know if you were my client and Chica were my patient and you were worrying about her like this, I'd want to know.
Your vet should be able to explain his decision-making process in a way that helps you understand why he thinks this is the best plan. If that doesn't happen, a second opinion may be in order.
I see you are still offline.
I would expect you still have additional questions and there is more I could clarify. I would be happy to keep discussing this with you. All you have to do is type in what you want to say and click REPLY. I'll be notified of your response via email.
In the meantime, I'll thank you for using using our website and hope Chica continues to have a speedy recovery.
Hello and thank you for your response. Yes, I am very worried. Further to my last communication with Justanswer, Chica had more x-rays yesterday. She does have a torn ligament but they don't want to operate while the lesion is there. We have to wait for a month during which time she will be on painkillers (though she shows no sign of being in pain). Then another x-ray will follow. The only optimistic news is that the lesion is now looking much better than before. I don't know if this is significant re cancer or not.Myra.
It's wonderful news that the lesion is now looking much better than before. This means the chances of it being due to cancer or an infection are really, really tiny. It would be completely shocking and unexpected for a lesion due to one of those things to improve without treatment.
So this is excellent news
I'm confused about your indication she shows no signs of pain. Does this mean she uses the leg completely normally and is functioning at 100%? If that's the case, I would question the need for surgery.
If she carries the leg, favors it, or toe-touches with it instead of using it normally, please understand it is pain that causes her to do that.
Assessment of pain in dogs can be a little tricky sometimes.
Additionally, I would suspect the "pain killers" she is taking are actually anti-inflammatories (like carprofen, meloxicam, or Previcox). These medications do much more than relieve pain. They decrease inflammation, decrease scarring, and speed healing. Using medications like this will be crucial throughout her recovery.
Again, please rest assured that waiting a month is very typical. We need to see how much she will heal on her own to decide if surgery is warranted. Wouldn't it be great if it could be avoided?
Also, her knee needs to heal from the injury before being subjected to the trauma of a surgical repair.
I would submit things are going well and you have much to be optimistic about. :-)
Hi. I'm sorry about the delay. I only now found the last part of your answer.
I would like to continue our contact for a little longer. You have been very helpful. I did not realise Chica was in pain as she has not been whimpering etc. Thanks for explaining that. I was first told that she had a dislocated patella but then that it was ok. Next, after the last x-rays, I'm informed that she has a torn ligament for which she will need an operation. You told me that a torn ligament cannot be detected by x-ray but that's the only test she's had so far. Of course I don't want to put her through surgery if it is not necessary so I hope the next month will see more improvement in the bone.
I am pleased to do whatever I can to help, and am glad I've been helpful so far.
Yes, typically we suspect a torn ligament based on the characteristics of a dog's lameness and by the way the joint feels when we try to move it in ways it should and should not be able to go.
Again, I hope you find it reassuring that it is not unusual to face these kinds of delays when waiting to see how a dog heals up on her own with a lameness issue.