Hello I am Dr. Joey. Thanks for trusting me to help you and your pet today. I am a licensed veterinarian with over 16 years of experience. I look forward to working with you.
I am so sorry this guy has multiple compromised joints. With regard to the forelimb lameness, the first step your vet will need to take is to determine where he is lame. It could be anywhere in his leg. In dogs with arthritis, often the pain is in the shoulder or elbow and not the paw. Great job examining the paw for lesions (be sure to look between the toes and assess each nail to make sure it is not a simple nail break or interdigital dermatitis). I worry that he may have moved wrong while doing stairs or outdoors and has hurt his shoulder or elbow. IF so, then this is something he may improve with rest and pain relief. But it is always important to ensure there is not something more significant going on, especially in a giant breed like this. So, radiographs (X-rays) are an important step. We need to ensure there is not a bone lesion (cyst, infection, tumor).
As far as pain relief goes, I must say there is a lot of controversy right now over tramadol. Some believe it works pretty good for pain relief and others believe it does nothing. If not already tried, I would consider adding in gabapentin for pain relief or switching from tramadol to gabapentin. In the longer-term other pain relief options to consider that are more alternative medicine but do make a huge difference may include acupuncture (we know it is amazing for arthritis-type pain), Adequan injections (this is sort of like the oral glucosamine/chondroitin but much more powerful), massage therapy and sometimes therapeutic laser (but must be used in the right area; I find this is not as helpful as the others). Stem cell therapy for arthritis is also available but the jury is out on if it help and worth the procedure, but I have had a handful of patients improved with this.
I am at a point I need to know what questions you have. I hope that the information I provided has been helpful.
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