We haven't been on here for ages, but just wanted to share our recent experience with Meg's diagnosis of a ruptured cruciate in case someone finds it helpful.

A bit of background for those who don't know us: Meg is 11 years old, and lost her front right leg almost four years ago due to complications following elbow replacement surgery. She is a highly active, smart as hell, handful of a raggedy rescue mutt, who was handed to me by a stranger in a churchyard ten years ago.

So... on Christmas Day, Meg suddenly stopped bearing any weight on her rear left leg. She was holding it up and out (it looked almost as though the knee were dislocated) and was struggling to walk at all, falling over etc. The injured leg was the best of her three. She has severe arthritis and dysplasia in the elbow of her front leg, and arthritis in the hock of her rear right leg. Additionally, the injured leg is diagonally opposite the missing leg, and therefore bears more load than the rear right.

I took her to the emergency vet, who diagnosed a ruptured cruciate. He gave her an opioid injection and told me to take her home and monitor her, and possibly bring her back later for a patch. The injection knocked Meg out totally and later she was quite disorientated and whiny from the drugs but appeared not to be in pain. The vet had said we needed to think very carefully about how to proceed given Meg's age, condition and the immense amount she has already been through. (Meg has had a large number of surgeries and spent more than two months as an inpatient in hospital). He was also worried about managing her pain, given that she is already on a large amount of pain medication for her arthritis etc. For myself, I felt strongly that further surgery was not an option for Meg and it seemed to me that we were looking at saying goodbye. 

As it was Christmas week, everything was shut, but I emailed Meg's rehab vet anyway on the off-chance that she would see it. We have been seeing Philippa monthly for four years now for physio, acupuncture and laser. She therefore knows Meg extremely well and I knew her guidance would be extremely helpful. She got back to me on Boxing Day and said that if it were her dog, she would consider the surgery, as Meg still has a good quality of life and she felt she would handle it well. Our very own lovely Sally also emailed me to say how well Frankie has done with his two cruciate surgeries, and despite the fact he is twice Meg's size... This gave me a different perspective and made me feel more hopeful.

On 27th December, Meg's regular vet was open, and we went to see him and he confirmed the cruciate diagnosis but felt a bit more positive than the emergency vet had done, as with her increased meds Meg was already starting to use the leg a bit. He felt that with conservative management she might be okay. I asked him to refer her to an orthopaedic specialist for a full evaluation.

Yesterday, we saw the (board certified) orthopaedic specialist at The Ralph hospital, near London. And.... on examining Meg he told me that he could not feel any movement in the cruciate and that he did not believe it was ruptured after all. He said that ruptured cruciates are wrongly diagnosed "all the time", as vets think the joint is moving when actually the movement is in their hands. He said this is a very easy mistake for a non specialist to make. I asked if it was possible that it had been moving ten days ago, but had now restabilised and he said no. It was certainly possible that it had been swollen and that this had now gone down but not that the cruciate had been ruptured. Meg then had X-rays of all three legs and of her spine, and these revealed quite severe inflammation in both hocks, as well as arthritis in both hocks and in her elbow. Her spine looked good and there were no fractures, tumours or evidence of cruciate damage. He thought it was possible that she had suffered some sort of trauma/brusing to her left hock/knee and that this had now substantially recovered. It is also possible that she is suffering from Immuno Mediated Polyarthritis (IMPA).

The plan now is to rest Meg for two or three more weeks, and also to substantially reduce her medication. (Meg weighs 33 pounds/15kg, and was on 15 kg dose of Metacam, 125g paracetamol (tylenol) twice daily, 200g Gabapentin twice daily, 50g Amantadine once daily). He is stopping the Gabapentin and Amantadine completely as he thinks she is too sedated. Obviously, if she shows signs of discomfort, we will put her back on. She may also need steroids to reduce the inflammation in her hocks.

Personally, I suspect she is not so much sedated as withdrawn following a traumatic incident on New Year's Day, when the ceiling collapsed on our heads (we've had quite the holiday period...) but we'll see. Certainly, i don't want her on anything she doesn't need to be on, but it's a question. of ensuring her pain is well managed, a balance with which any tripawd parent will be familiar.

So there you have it. I hope the above is useful to somebody and it is at least a reminder to make sure you consult a board certified specialist for a full and thorough evaluation before making any decisions.

Meg, Clare and Angel Pie xxx