2yo lame dog not responding to NSAIDs + rest - help

Re: 2yo lame dog not responding to NSAIDs + rest - help

Ben Walton — Tue, 26 Jul 2011 13:45:24 GMT

Sorry: only just noticed your final post. I'm clearly behind the curve!

Re: 2yo lame dog not responding to NSAIDs + rest - help

Ben Walton — Tue, 26 Jul 2011 13:44:06 GMT

Hi Emma,

More details would be good: speed of onset? Known traumatic event?

In general, however, my leaning would be towards seeking the advice of your preferred, local orthopod sooner rather than later. As a patient, I'd be pretty unhappy being loaded with NSAIDs and Tramadol without a diagnosis first, I'd be even less happy being given steroids.

Feel free to contact me off-list if you'd like a more detialed discussion about this psecific case.

Ben

Re: 2yo lame dog not responding to NSAIDs + rest - help

Emma Middleton — Mon, 25 Jul 2011 12:01:53 GMT

Thank you all for the help and advice, after reading them all I was able to have an open discussion with the owner who in the end was very sensible and understood where I coming from. I offered referral now, or option to do that later after trying Previcox in place of the meloxicam. She wasn't keen on Tramadol as she knows a person who is on it and she said it makes him feel awful! In the end, a happy client and I feel I've communicated all I can to the owner to prevent any future complaints.

Had considered sending the x-rays off, I guess this is still an option if the change in drug doesn't help.

Again, thank you all for taking the time to reply.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Bob Russell — Mon, 25 Jul 2011 11:36:02 GMT

Sending X-rays away will buy some time and keep the owners happy until the boss returns. I have had phone calls requesting histories from neighbouring practices for second opinions that would have been referred had I been asked. A number of these have gone on to be referred but only after other vets have 'played about' with them for a bit.

When this happens I feel very frustrated but the blame is largely mine as I clearly have not communicated properly!

Re: 2yo lame dog not responding to NSAIDs + rest - help

Pádraig Egan — Sun, 24 Jul 2011 14:09:11 GMT

You thought of possibly sending the films for review by a specialist? Some subtle radiographic changes may be picked up. I have recently embarked on a small animal orthopaedic internship and am pretty shocked by how benign some radiographs appear in comparison to the changes seen during arthroscopy/MRI/CT.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Stephen Courtney — Sun, 24 Jul 2011 12:00:20 GMT

I would refer. It shows you care.

If they won't take a referral change meds, make sure they rest the animal, and make sure they understand it takes time to get better, it takes time to get worse. If things get worse, you have more chance of making a diagnosis. Or getting them to agree to a referral.

Probably best the referral vet gets their hands on a dog that is still showing signs, so don't be too enthusiastic with strong pain killers if you are going that route!

Re: 2yo lame dog not responding to NSAIDs + rest - help

David Mills — Sat, 23 Jul 2011 22:54:35 GMT

As above, refer and put on nsaid + tramadol in meantime.

O sounds nightmare, not worth wasting time holding his/her hand - MRI will show up ST injury, you'll have a diagnosis, and you'll come out of it looking good. Some owners won't listen to anyone other than a specialist, even if the message is exactly the same.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Bob Russell — Fri, 22 Jul 2011 15:51:19 GMT

[quote user="Martin Jones"]

[quote user="Michael Woodhouse"]

I would feel daft if I sent it off and it came back on Tramadol and Previcox!

[/quote]

Don't they all?

[/quote]

Nope - Onsior and Tramadol here!!!

Re: 2yo lame dog not responding to NSAIDs + rest - help

Claire Edgington — Fri, 22 Jul 2011 14:26:40 GMT

[quote user="bob lehner"]

Also don't forget that mysterious and seemingly undiagnosable front leg lameness can sometimes relate to pathology in the neck.

[/quote]

I agree with Bob. I've had a strange case of FL lameness which I ended up referring and actually had GME!

Re: 2yo lame dog not responding to NSAIDs + rest - help

Rob Loxley — Fri, 22 Jul 2011 13:43:05 GMT

Elbow dysplasia?

Shoulder ligament injury?

OCD lession not showing up on radiographs?

Re: 2yo lame dog not responding to NSAIDs + rest - help

Martin Jones — Fri, 22 Jul 2011 13:30:17 GMT

[quote user="Michael Woodhouse"]

I would feel daft if I sent it off and it came back on Tramadol and Previcox!

[/quote]

Don't they all?

Re: 2yo lame dog not responding to NSAIDs + rest - help

bob lehner — Fri, 22 Jul 2011 12:46:19 GMT

Also don't forget that mysterious and seemingly undiagnosable front leg lameness can sometimes relate to pathology in the neck.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Martin Atkinson — Fri, 22 Jul 2011 11:16:13 GMT

I've had cases where every practical diagnostic test has been done: X-rays including arthrogram, joint tap, arthroscopy, all normal, limited response to NSAIDs, rest or physiotherapy and still lame several months later then spontaneous resolution. How far do you go with diagnostics? Sometimes time is all you need. Worked with my frozen shoulder.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Gillian Mostyn — Fri, 22 Jul 2011 10:36:19 GMT

If the dog is still happy to romp around the garden it is obviously not distressed, in which case the owner may be being a little impatient if it is a young dog that has been lame for just over a week. Ask them if they've ever sprained an ankle and how long it took to stop huring when they ran around on it....????!!! Some owners think that if a dog is lame it must have a bony problem, and forget how long it takes soft tissue injuries to heal!!

I would also add in tramadol to the mix...

However, saying all that, if they are being really hard work and demanding and you feel out of your depth, refer them to your local orthopod, then relax and stop worrying about it.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Alan Tevendale — Fri, 22 Jul 2011 10:36:19 GMT

I think I would probably have this dog on some form of different pain relief as already stated - can sometimes make all the difference. Interestingly a colleague of mine that has just had a hip replacement had two sets of rads done - one a local hospital (all done by radiographer) and another a regional orthopaedic centre where the hip replacement was carried out - same views at each place. Given that the two sets for only a few weeks apart you would not expect much change. The difference in the radiographs was impressive - the first you'd think not a bad hip, the second - ouch!

Now I'm not saying that there is joint pathology that you haven't found but this may well be a possibility. Given that you seem fairly keen to refer I'd have the dog on alternative pain relief immediately while waiting for their referral appointment.

Re: 2yo lame dog not responding to NSAIDs + rest - help

Michael Woodhouse — Fri, 22 Jul 2011 10:27:14 GMT

Discuss referral but there are a lot of things you haven't tried yet. I would go for a different NSAID with some Tramadol and see if that makes a difference. I have had a few dogs that have not responded to carprofen/meloxicam that have been better overnight with firocoxib (Previcox). There also seems to be a small subset of arthritic dogs that do better if you go for some old fashioned steroids or even Pardale V (paracetamol and codeine).

It's one thing offering to refer the dog if you have exhausted all you can do, and I agree offer it, but I would feel daft if I sent it off and it came back on Tramadol and Previcox!

Re: 2yo lame dog not responding to NSAIDs + rest - help

Eamon McAllister — Fri, 22 Jul 2011 09:29:02 GMT

If I were in your shoes ( boss on hols / owners anxious / no progress ) I would refer it ASAP before they take it elsewhere for a 2nd opinion.

Re: 2yo lame dog not responding to NSAIDs + rest - help

HMC — Fri, 22 Jul 2011 09:23:41 GMT

Hi,

I can't comment at all on the results of the joint taps as I really don't know but I thought I'd share 2 recent stories, for what it's worth.

First: dog came in lame --> other vet gave an nsaid inj and vetergesic --> o called that afternoon saying no improvement --> vet asked me to do emergency xrays despite not being able to localise the pain beyond which limb it was --> results nad --> I saw the dog back 2 days later and the owner described "no improvement, still really lame, really unsteady after ga, it was awful etc etc". But the dog was not lame, even at the trot. Amazing. Also the owner had been continuing to walk the dog fully and not rest her.

Second: dog genuinely lame 10/10 RF but absolutely nad on exam --> I gave carprofen and vetergesic --> no improvement --> repeat vetergesic (this time IM not SC) --> no improvement --> booked in for rads and the o gave the dose of tramadol I had said to give the night before --> much more comfortable and doing well.

I feel as if I am losing faith in NSAIDs and vetergesic now.

But if you have those arthrocentesis results then I don't think your's is like my cases. Sorry to ramble needlessly.