Thank you!  Amputation has not been recommended at this time (although I think I found one story on here from 2014 that seemed similar).  I work for a veterinary specialist (not surgery) & I have worked for veterinarians for over 20 years.  This is the first time I’ve experienced such a frustration situation.  My office doesn’t have some of the diagnostics available so thats why it may at first look odd in my notes.  

My dog’s name is Belle.  I rescued her at 7 weeks old.  She was healthy and didn’t have any issues until she was 5 months old (Nov 2020).  I noticed she was limping on a front leg.  Brief exam - no pain or abnormalities.  Started cosequin & monitored.  After 2 weeks of no change she had xrays performed by a family veterinarian.  He found bilateral medial luxating patellas in both legs.  At that time he said grade 3 but the patellas were out.  We added Meloxicam at that time also.  

I started to seek out getting an appointment with a board certified surgeon to find out the next step.  She was still having some episodes of pain so I was advised I could also add in Gabapentin, which I did.  I got a surgical consult in Dec 2020...this was very brief as it was more a favor from a friend that works with the surgeon.  I was told her legs were “terrible” and surgery may not even work.  He did say she was grade 4.  And we should only start with one leg first.  I asked what happens if surgery doesn’t work...he said let’s wait and see.  

I did have her spayed next because before all this I had gotten her a playmate that was younger but male...and we do not need any accidental puppy accidents.  He said it was ok to so the spay first.  She was spayed and we did find out from her pre op bloodwork she had mild anemia.  So we did wait 4 weeks in between the spay and the leg surgery hoping the anemia was better.

She had surgery on her rear right leg on January 18 since that leg was worse.  They said she could go home the next afternoon.  I didn’t even get a call after surgery was done, had to check and surgeon wasn’t available.  I did eventually get a call that they did the best they could but really hard to get everything aligned.  They did some bone cutting (deepened the groove) and I think one other area.  

I picked her up Tuesday afternoon and as soon as I put her in the crate she was screaming. It was awful.  I figured it would be hard, but by the next day she was screaming if you moved her and trying to bite.  They did not send any extra medication home (so still just cosequin, metacam & gabapentin).  I called to ask if there was anything else.  One of the interns looked at her and said her leg was pretty swollen.  Super limited on med recommendations (forgot to mention she was 4 pounds at the time).  We decided to try a few days of oral buprenorphine, massage the leg and ROM after cold pack treatments 3-4 times a day.  She would not let me touch her leg, I had to get a muzzle.  Then she stopped eating.  At the advisement of one of the vets I worked with I stopped the buprenorphine.  I called again about it (Friday) and was pretty much brushed off and said nothing could be done.  I figured we would try to get through it and if it got worse I was better off taking her to an emergency clinic where she could be hospitalized.  

Luckily by that Saturday she was less painful. She was still weird about eating and drinking, but eventually got better.  She did have a physical therapy appointment 2 weeks post op.  She was feeling better by then.  Due to her other leg still needing surgery, we kept the exercises super simple.  I did also have to add trazodone by that time because she was hating the crate and wanted to jump.

Her next appointment was 8 weeks post op for xrays.  I stayed very strict with her on a leash outside, short walks once approved (5-10 minutes) and she did have to stay in a crate unless she was being held by someone.  She was still crazy and I didn’t trust her trying to jump!  

About 10 days before 8 week appointment I noticed her surgery leg didn’t look like it had (it was looking straighter than the other).  And she started to get a little grumpy again.  I was able to have a surgeon (different one, as hers was on vacation) to do an exam.  He did think her patella was out again but said keep the appointment for xrays the following week to confirm.  I asked about something extra for pain and everyone is like I don’t know.  I begged to at least try tramadol...something...so I was given the dosage on it.  I tried the lower end a few days and it seemed to take the edge off.  

At this point I felt things were already not going well with communication.  I arranged with another specialist I have used with my other pets to help me set up a second opinion for Belle.  Unfortunately, I still made the mistake of keeping her appointment with her original surgeon for the 8 week post op.

I signed an estimate for sedation and xrays.  I typed a note with questions and concerns.  I had found this site and some of the pain control recommendations (which I still felt some applied since it’s dealing with the leg).  I felt she did not get adequate pain control the first time.  All she received were hydromorphone injections.  No CRI or epidural.  No type of local anesthetic.  

This appointment was last Tuesday.  I received no phone call, just an email that everything is healed and let them know if I need anything else...  my biggest question was what is the next step???  So I called and the surgeon was unavailable and the story changed a few times. All I did was ask for my xrays.  She was also not sedated.  Still have to do everything over the phone.  

I looked at her xrays and her patella is exactly where it was before surgery.  One of my friends that is also in veterinary medicine helped mark up the patellas and we compared the post op xrays to the newest ones.  I already had the 2nd opinion set up for Thursday.  I never received a phone call from her surgeon. 

Thursday was a completely different experience and this surgeon was wonderful.  She spent a lot of time on the phone explaining from square one.  I did want new xrays and with sedation.  And she agreed those types of xrays should always be under sedation.  She said the patella felt out of place also on exam.  She called after the xrays were done and agreed she could see bone did heal in certain places, but the patella was not in place.  At this point we are just talking about trying surgery on the other leg before making any other major decisions.  She does do an epidural during surgery.  They do carry Nocita if needed.  And she can stay a few days if needed.  

I checked in again on Friday about her 1st surgeon xrays and told one of the technicians (who works with him) and I did say I don’t think anyone reviewed them or if anyone even did an exam on her.  She said she gets it but he was too busy to bother on Friday & off Monday.  So maybe I’ll hear something this Tuesday.  I won’t hold my breath.  I’m ready to file a complaint at this point as I’ve had another smaller issue with them with another dog.  

I did look into the nearest teaching hospital and it’s about 3 hours away.  It’s 3-4 months to get in for an ortho appointment!!!  And she’s still painful now at times.  I can’t make her wait that long.  I just know she wants to run and play.  And I feel awful with the cage rest (8 weeks first time).  So right now I’m allowed to let her somewhat be a dog again.  I can tell she’s already having spells where after playing she’s uncomfortable.  I feel like trying surgery on the other leg and see how things go.  But we also talked she can be prone to a CCL tear also.  

I don’t know if a wheelchair or amputation are in her future, but I guess we aren’t to that point yet.  Sorry that was so long!  But this is so frustrating when I work in this field and basically her original surgeon could care less. I just want what’s best for my dog and hopefully decrease her pain if we can.  

Thank you, telemedicine was my next question.  Which I know I think seems pretty limited if there is no doctor/patient relationship.  

Unfortunately where I’m located the doctor I’m unhappy with belongs to a large practice that basically everyone refers to.  At this point I’d never send any of my pets there again...  

I have few more questions for the new surgeon I need to ask.  They said Belle can some time roaming around small areas.  She wants to, but even that’s uncomfortable and she will just sit down.  So I think our only option really seems to be to try surgery on the other leg.  Then come back around and deal with the other one! I feel so bad putting her through surgery again, but I’m hoping we can get a better path to a less painful life.  

Has anyone had success with Amantadine (on top of NSAIDs, glucosamines and Gabapentin)?  That’s what I was thinking of asking about.