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alhdvm, Dog Veterinarian
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Experience:  I have 11+ years experience in the field of veterinary medicine. I work on all species of animals.
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Yorkie: My male..Recently he hurt his rear left leg

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My male Yorkie will be 14 in June. Recently he hurt his rear left leg and the ortho doc said he did not tear his ACL. He did a complete exam and said he looked good. He does have a small amount of arthritis which he said is normal. He is on Tramadol and Gabapentin and he's now trying his second anti-inflammatory. He seems worse. His back leg shakes all of the time now and sometimes it gives out and his rear end falls down. Sometimes he walks like a tripod too. He seems like he's in pain. What else can I do for him. Sincerely, Michelle
Welcome to Just Answer! I'm Dr. Hinson and I'd like to help you with your question.

Did the vet take xrays of that leg and of the entire pelvis?

Did your vet check his patella (knee cap)?

Why is he on Gabapentin and Tramadol? Usually they are only on one or the other.

How long ago did the injury occur?

Do you have him on strict rest?

Did you have him examined by a veterinary neurologist?

Is he eating OK?
Customer: replied 5 years ago.
yes they took x-rays which did show somw arthritis but the ortho doc said it didn't look as bad as expected. His Patellas are both grade 3-4 which he said they are out most of the time but he can push them back in but they mostly stay out. the docs said that the Gabapentin with the Tramadol helps the Tramadol work better. He's also on Carprofen 25 mg as a trial because the last drug didn't seem to help at all. He's also on Denamarin and Ursodiol for his liver which has alot of spots on it which they thought was metastatic cancer but confirmed it was not with a liver tru cut biopsy. He fell off of the couch quite a while ago and the pain started in his neck but he say a neurologist which was wonderful and she said he just sprained his neck which is fine now and she did a complete neuro exam a few times. He is on diet food now because he gained about 4 1/2 pounds when my other Yorkie- Precious Momence' passed away 1 1/2 years ago. He sleeps all of the time but eats pretty good even though he really doesn't like the diet food from the vet.
OK well I can't say I agree with all of those drug combinations. If he is that painful that he needs all those medications something pretty significant must be underlying. Most dogs can be controlled with an NSAID and one pain medication.

Now that being said, he may just have a worsening of the patella problem and if the patella is staying out most of the time then that may be why he is tripod sometimes and it may not be from worsening pain. Dogs with a patella that stays out of place most of the time is not known to be a painful condition so that may be why it seems like he isn't responding to the medication.

I would suggest getting him a knee brace from Orthopets to see if that helps:

The other thing you may want to consider is having acupuncture treatments.

Getting the weight off is going to be very important as you know so be very strict with his food!!

Those are what I would do to start with. I hope this helps. Let me know if you have more questions!
Customer: replied 5 years ago.
What medications should he be on? He has seen the doctor many times for this but I don't seem to get anywhere. They said he doesn't need surgery for his Patella's and they did say that the Patella's being out should not cause him the pain but I can't seem to figure out why he's declining so rapidly if his arthritis isn't that bad. Can the arthritis get much worse very quickly? I always thought it just worsened with time. Do I dare go back yet again and ask for more x-rays to compare? His weight doesn't seem to be going off also. The ortho doc said to start walking him a little at a time but he seems like he's in more pain so I am leary to do so. His left back leg shakes all the time anymore when he stands up. He never shakes when lying down Is the brace a custom made brace?
The first step is determining if it is an orthopedic or a neurologic problem which can be difficult to do. I think if you got the brace and could keep the patella in place then you could better evaluate if that is the problem or not. If it is the patella, then you can just keep the brace on him. Surgery at his age would not be a good idea. That would have been something to repair when they are younger. Yes, the braces are custom. If you go to the website they give you all the information on measuring, etc.

Have you considered going to a board certified orthopedic surgeon for an evaluation or a neurologist? This may be over your vet's head.

What diet are you feeding him? How much is he getting per day? What is his ideal weight? I can do a calculation and tell you if you are feeding him the right amount?

I would use just the carprofen and the Tramadol and see what happens. If no improvement then I would stop the Tramadol and use the Gabapentin (continue the carprofen). Try to be very critical to see if he is better, worse or the same on the different medications. Like I said, he may not be responding because the condition isn't painful (ie: the patella is the issue). How much does he weigh so I can calculate and see what doses he is on.

The other thing to consider is that he could have a neurological problem. Not to scare you or anything but he could have a nerve root tumor on the spine that is causing the leg shaking and the "pain". The only way to diagnose that is with CT or MRI. I can honestly say though that many dogs as they age have a leg that shakes with no real underlying cause. I have a 13 year old blue heeler in excellent shape and he has one back leg that shakes most of the time. Causes him no pain or issues.
Customer: replied 5 years ago.
+I have been to a very good board certified neurologist/surgeon and a board certified ortho. surgeon as well. Both exams went very well. he has not had an MRI or CT scan yet but I do know this is very expensive and I do not have insurance for him. I've already spent around $3000-$4000 on him since Precious passed away from a Hemangiosarcoma of the spleen with mets to the liver and one kidney when she hemmorrhaged into her abdomen in September. I had an abdominal ultrasound twice on him and a heart and chest ultrasound, a liver biopsy, a neuro exam, an ortho exam, lots of meds and lots of doctor appointments. I just can't seem to get a good answer to any of this. He seems worse since they ruled out the ACL tear. I considered getting a brace then but it was around $800 and if I got it I was hoping it would work. I hate to spend that kind of money if it will not work. He's all I have left and I'm still not over my baby girl girl passing so tragically and I'm not ready to give up. That's why I keep spending money but seem to get nowhere. I'm a Registered Surgical Nurse in surgery and a team leader in Neuro and Ortho spine so I do understand and research all of this but everyone seems to be stumped. Do you think he should be off of his liver medications as well?
Sounds like he needs the liver medications. I would keep him on those especially if he is going to stay on the NSAID and pain medications since those will tax his liver even more.

I understand your frustration but unfortunately there isn't any guarantee that the brace will work. You will either have to take your chances that it will work or just keep continuing as you are going and see what happens.

As you know, there are no guarantees with medicine.
Customer: replied 5 years ago.
He eats a small amount of food twice a day. The Prescription diet for weight loss or royal canin low fat mixed with a little bit of Beneful prepared meals. He will not eat the hard food any longer so it is the canned food. I have to mix it or he won't touch it. He should weigh between 12 and 13 pounds and he weighs about 17 and a half. He also hets treats 2-3 times per day- which he LIVES for!!! He comes to you when it is time for them. They are Waggin Train Jerky tenders or Yam good or cowboy steaks or WholeCare Pet all natural chicken treats. A total of about 3-4 per day depending on which treat we give. It seems like the only thing that he loves and I've cut down on the treats but I don't want to take out his favorite thing.
You need to stop feeding the Beneful. Just feed the canned Royal Canin Low Fat and you can keep the treats.

Of the canned Royal Canin he can have 1/2 of a 13.6 oz can PER DAY (not per feeding).
Customer: replied 5 years ago.
He has about 10-12 oz of food per day plus his treats now but doesn't seem to be losing any weight. He refuses to eat the canned food by itself, that is why we add a little Beneful or a little rice to it. Thank You.
He's not losing weight because he isn't eating the right food and amount. I guess you can only do what you can.
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