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Dr. Altman
Dr. Altman, Veterinarian
Category: Dog
Satisfied Customers: 12472
Experience:  Practicing small animal veterinarian for 17 years.
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I have a large breed dog just 3 years, who had a tta on one

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i have a large breed dog just 3 years, who had a tta on one hind last september, then her menicus has to be removed 10 weeks ago, at the same time she was diagnosed with moderate hip dysplasia. two weeks post op of the meniscus being removed, her cruciate on her other hind went, and she underwent another tta on that leg, 5 weeks ago. although the initial week she seemed better, she went downhill and eventually returned to the vet with a severe infection in the joint. She also developed a "clunking" (not clicking as per the meniscus) in the stifle. she has just been x-rayed again, and the tta looks fine, but the joint appears unstable, and we have been recommended physio (she has already had physio weekly). She is extremely depressed, and I am very concerned that I am prolonging her pain and suffering, when really it would be better for her if we said goodbye - awful thing to think, however I am very realistic, and feel that she is so depressed and in so much pain, not eating (lost 5 kilos), and not able to move, in fact - just not able to be a dog.
Do you have any recommendations
Submitted: 2 years ago.
Category: Dog
Expert:  Dr. Altman replied 2 years ago.
Welcome! I am Dr. Altman, a licensed veterinarian and I am happy to answer your questions.
I am so sorry that your dog has been through so much and no one has been on to assist you yet today. May I ask what pain medications she is on? I will give you a list of medications that hopefully give you a range of options to get her feeling better if some have yet to be considered.
There are so many options available to us now to help our beloved four-legged friends outside of the normal nonsteroidals (rimadyl, previcox, metacam, deramaxx). I will list them individually but all can be used in combination to assist your dog in getting comfortable
1.) Gabapentin- this is called neurontin in people. It works by dulling the nerve firing associated with pain and is my top choice for senior pets because it is not metabolized as readily by the liver and is easier on a senior pet. The pros are that it is not pricey, has no high end dose so if the pain escalates as your pet gets older we simply adjust the dose, and is easier on older pets. The cons is that it has to be given consistently because withdrawing it suddenly causes what is called rebound of pain which is higher then original level, can cause mild sedation initially
2.) Tramadol- this is in the opioid class so it is given as needed for pain when there are bad days. It can be given longterm to senior pets two to three times daily if needed
3.) Alternative medicine: laser or light therapy, acupuncture, physical therapy which you have already mentioned, massage therapy. All are fantastic ways to help minimize pain, increase strength, and allow rest more comfortably. If there is a physical therapy facility in your area they would have all of these. Typically I will start with acupuncture and/ or laser therapy and then add in the physical therapy once we are more comfortable. I often see remarkable results with one to two sessions
4.) Adequan injections. These are pricey but given twice weekly subcutaneously (I have owners give the medication at home after a demonstration to minimize the visits) for four weeks then taper frequency as improvement is seen and if there are bad periods then increase frequency once again
5.) Supplements: Glucosamine sulfate 1500 mg daily, fish oil with 1500 mg EPA & DHA daily, Vitamin E, Ester C are all great to slow progression of disease and assist in comfort
Using this pain assessment form will also help you and the therapist determine how best to help her and when you are starting to see even subtle changes in her energy:
http://www.csuanimalcancercenter.org/assets/files/csu_acute_pain_scale_canine.pdf
If you have tried all the above without improvement then there is cause for concern for quality of life and whether her pain can be controlled. I hope this information is helpful to you but please let me know how else I can assist you both today.
If you have more questions or if I can help in any other way, please do not hesitate to ask! If you would like to accept my answer, please press RATE OUR CONVERSATION. Bonuses are always welcome (I am not compensated in any other way). Thanks!
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Expert:  Dr. Altman replied 2 years ago.
I am glad to see you were able to view my responses. Please let me know if I can be of any further assistance to you both today!
If you are satisfied with our chat please rate or accept so I may be compensated for my time. Thank you!
Customer: replied 2 years ago.

Thank you for your reply.

She is currently on Metacam, and paracetamol. We did try vetergesic i/m and tramadol, but she reacts badly to opiates so they stopped that. She has also undergone laser therapy, and hydrotherapy, however the stifle has since become unstable, and I am just unsure as to how much more I should put her through, being that she is only 3 and seems to be going downhill, rather than up.

Expert:  Dr. Altman replied 2 years ago.
It doesn't sound like gabapentin was used on her at this point so I would consider that as an option to get her comfortable.
I completely understand your concerns that she is not recovering from this surgery as expected and that the specialists are unable to determine why this is the case it makes it very difficult to continue this path, having to see her struggle day in and out. Were you able to view the pain assessment sheet I attached? It really can help put things in perspective as far as comfort and quality of life.
This is such a difficult situation with her being so young but if they are unable to determine why she is struggling so and how to help her and she continues to deteriorate then, yes, unfortunately it sounds like you may have to consider letting her go...
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