Incorrect Cruciate Diagnosis

[Canisbellum]

I posted here a while ago about Jonah tearing his cruciate ligament, as usual nothing is straightforward with him and I am wondering if its just due to incompetent vets.

approx 2 months ago Jonah was sore and limping and after he was x rayed I was told he needed surgery and Meloxycam and Cartrophan injections, I said no to thye surgery and made enclosures for him and made a buggy so he could get out and Jesse could get decent exercise while his leg heeled.

At the time the vet said his knee looked in very good condition on the x rays and she was surprised he wasnt lame or limping.

6 weeks later he was looking good aqnd tried to get to a cat and I could see his knee was very unstable and swollen so I decided that I had to do the surgery which cant be done in Kal. I was going to Brisbane so it was decided to get thye surgery done there and leave him with Shar Pei savvy friends to convalesce.

Flew him to Brisbane took him to QVS where he was examined by a surgoen and x rayed, both knees, hips and hocks and no sign of a torn ligament was found. Blood tests were done and he was run up and down a hill ouside and examined by a 2nd specialist.

The upshot is his hips and knees are in good shape, he hasnt had Shar Pei fever and is otherwise a healthy and fit dog.

This has caused huge stress in my life and consumed a fair bit of money as well, needless to say I think I will be changing vets.

[persephone]

Oh!

glad he is OK - and so sorry you had all that upset.

[Canisbellum]

Thanks Persephone Clearly my spell check isn't working properly ☺ and I hate poor spelling so my ocd is having a field day.

[Loving my Oldies]

:mad It makes me so made that incompetence (and arrogance) plays fast and loose with people's emotions, not to say time and finances. Poor Jonah, poor you.

What was the diagnosis of QVS?

I hope your trip to Bris enabled you to catch up with friends and other Pei People.

[Canisbellum]

Qvs says there is nothing wrong with him. I actually went there to spend time with my daughter who is visiting from South Africa I hadn't seen her for 7 years. While I was there Jonah was also attacked by a staffy and I broke my hand on its head. Sitting in Er as I write this waiting for a full cast and staring down the barrel of a 6 week unpaid holiday.

Fun times, Jonah had his 1st leash free run in the bush this morning and loved it.

[persephone]

oh sorry about your hand .

[tdierikx]

Sounds like an eventful day... errr!

Upside is that there is nothing markedly wrong with Jonah... and the unpaid holiday will give you more time to spend with him... *grin*

T.

[Diva]

I have twice over the years had vets tell me dogs had cruciate injuries. Both times what they really had was osteosarcoma. The first time a more experienced vet caught the error. The second time despite me insisting that it was probably osteosarcoma the whole practice of vets refused to consider anything but cruciate and only found the bone cancer when they opened her up. I now assume most vets are only capable of diagnosing common conditions. Even when they aren't there to find.

[Loving my Oldies]

Oh, Canetoad - what a horrible thing to have happened. I hope you heal very very quickly and can enjoy the time with Jonah. Is Jessie still back in Kal?

Must have been pretty emotional and exciting spending time with your daughter.

[cavNrott]

I posted here a while ago about Jonah tearing his cruciate ligament, as usual nothing is straightforward with him and I am wondering if its just due to incompetent vets.

approx 2 months ago Jonah was sore and limping and after he was x rayed I was told he needed surgery and Meloxycam and Cartrophan injections, I said no to thye surgery and made enclosures for him and made a buggy so he could get out and Jesse could get decent exercise while his leg heeled.

At the time the vet said his knee looked in very good condition on the x rays and she was surprised he wasnt lame or limping.

6 weeks later he was looking good aqnd tried to get to a cat and I could see his knee was very unstable and swollen so I decided that I had to do the surgery which cant be done in Kal. I was going to Brisbane so it was decided to get thye surgery done there and leave him with Shar Pei savvy friends to convalesce.

Flew him to Brisbane took him to QVS where he was examined by a surgoen and x rayed, both knees, hips and hocks and no sign of a torn ligament was found. Blood tests were done and he was run up and down a hill ouside and examined by a 2nd specialist.

The upshot is his hips and knees are in good shape, he hasnt had Shar Pei fever and is otherwise a healthy and fit dog.

This has caused huge stress in my life and consumed a fair bit of money as well, needless to say I think I will be changing vets.

:There is a reason he was sore and limping two months ago. Ligaments once ruptured or partially ruptured to not repair irrespective of resting or controlled exercise.

: If the knee looked good on xray why was the vet surprised he wasn't lame or limping. Note: ligaments do not show on xray.

: 6 weeks later when he chased the car you could see the knee was very unstable and swollen. You decided on surgery.

: After flying him to Brisbane and took him to QVH where he was xrayed on both knees and hips and no sign of a torn ligament. Note: Ligaments do not show on xray but vet will notice some arthritic changes in knees when ligaments are ruptured or partially ruptured.

With my Rottie, she was running and walking ok most times but I could see the knee was not stable at times. I wonder if the partially torn ligament was holding up most of the time and if this is the case with your dog. I had TPLO surgery done and she had no further problems with that knee. The other knee went at a later date.

I think you need to investigate this further. If you noticed an unstable knee on various occasions then it's safe to assume the knee is indeed unstable.

I wish you all the best. It's difficult to know what to do when the dog seems ok most of the time. It's the times when the knee doesn't look ok that you need to have a good rethink about what should be done.

edited to fix bolding.

Edited April 25, 2015 by cavNrott

[CountryGirl]

I agree with CavNRott...an unstable knee doesn't magically repair itself...something is definitely going on. You just need to find out what.

[Canisbellum]

Definitely something happened to his knee on those occasions but QVS assure me that the ligament is doing its job when they manipulate the knee under sedation. X rays can pick up damage in the knee caused by a torn ligament and in his case there is none. They reckon it may be soft tissue damage and want to see him when he is lame t get to the bottom of it. Pity its either a 7 hour drive to or 2 flights totaling approx 6 hours to get to someone who can do something about it. .He has has been running approx 5km a day in the bush for the last week with no signs of anything wrong with his legs so we will carry on and hope for the best.

[OSoSwift]

There are some very competant vets in Esperance who can perform various types of surgeries for knees. They did a TTO on my Whippet.

I agree it probably needs a further work up and it is very stressfull when these things are happening and you can't find out why. I hope your hand heals very quickly

[OSoSwift]

Just read again, he was attacked at the Vet hospital?

[cavNrott]

Definitely something happened to his knee on those occasions but QVS assure me that the ligament is doing its job when they manipulate the knee under sedation. X rays can pick up damage in the knee caused by a torn ligament and in his case there is none. They reckon it may be soft tissue damage and want to see him when he is lame t get to the bottom of it. Pity its either a 7 hour drive to or 2 flights totaling approx 6 hours to get to someone who can do something about it. .He has has been running approx 5km a day in the bush for the last week with no signs of anything wrong with his legs so we will carry on and hope for the best.

Xrays do not show ligaments. They show only arthritic changes in the knee that may be caused by a ruptured or partially ruptured ligament. If ligaments did show on xray then why not soft tissue damage? It doesn't happen.

Manipulating a knee with a damaged ligament under sedation will result in the dog not reacting to pain whereas if the knee is manipulated with the dog fully conscious and aware it will react immediately to any pain caused by the manipulation.

What you do is entirely up to you. I wish you and your dog well. Perhaps contact OsSoSwift about a competent vet who is closer to home. That would make it much easier for you.

[OSoSwift]

I have seen a number of dogs manipulated under sedation - whilst being x-rayed - and they will show pain unless the pain is very minimal. My bitch showed pain even under sedation and hers was not a complete rupture.

[Canisbellum]

He showed no reaction when they tried manipulating his leg while he was awake and due to his muscle tone and tensing up they couldn't manipulate it properly. CavNrott I am fully aware that soft tissue does not show up on X rays. As I said there is no damage to his knee indicating a torn ligament and as I said they X rayed both hips and knees and hocks and all are in order. David Burgess has a good reputation as a surgeon and has operated on a number of Shar Pei so I have to assume he knowsSoswift what he is talking about. He could easily have done the surgery, the fact that he wouldn't is a pretty strong indicator to me that there is something else going on.

I refuse to do surgery on a guess so for now life goes on. OSoswift he was attacked at my sons house by his room mates dog.

[cavNrott]

Canetoad I guess all you can do is watch and wait. There clearly is a problem of some description but discovering exactly what it is will evidently not be easy.

Good luck with it.

[Mrs Rusty Bucket]

I have heard reports of a problem where GPs will miss less obvious causes of symptoms - ie they've seen this set of symptoms before so it must be this common thing...

But they can be wrong, and they lose some of the knowledge they came out of medical school for the rarer kinds of problems.

I tried to find the study(s) but failed this time. But there is this sort of curve of ability to diagnose which depends on the diversity of experience of the doctor - ie if they always see the same kinds of problems, they're less likely to diagnose something that doesn't fit - even if that's what is there.

I'd guess that kind of problem would be common across professions.

I'd still want to know why Jonah was sore and limping - and then he wasn't.

Frosty has been through this recently - first time she got better with rest - I had to put her on lead in the back yard so she couldn't do "patrol" at full blast. And then she cut her foot pad. Argh. But initially the symptom looked similar to me... but my dad the orthopod could tell which joint was damaged by the way the person moved. A specialist joint vet would be able to do the same. So when I took Frosty to the vet the first time - I was surprised they didn't ask to see her moving. They just did a very intimidating joint feel up.

When I did my knee - I not only tore the ligament right through the middle - and the complete tear only showed up on the MRI, not the xrays, but I also shredded but not completely the ligaments on each side. So the whole thing was loose and wobbly (didn't work, would not hold me up). And the first doctor did not take the lateral tears and lack of stability into account when recommending a treatment. Took me two years of trying and failing rehab because my leg wasn't stable enough to do it... and then I changed docs.

Sometimes - that's what it takes - going to a doc with a different perspective. And that's not always the one in the same practice. Annoying that doctors and vets etc - sometimes get a bit complacent about the seen it before - must be this kinds of diagnoses.

As a computer programmer - I start with what is most common and then work through until I find a way of fixing the problem. But I test each step - ie there's no point saying this will fix it - if you don't check that the fix has actually worked - and not broken anything else. But vets and GPs don't follow up. They ought to follow up. They might argue that it's the customer that should follow up but - what I have done each time some GP/vet has said "this will fix it" and it didn't - is gone to someone else who doesn't say things that are wrong.

[Canisbellum]

I have heard reports of a problem where GPs will miss less obvious causes of symptoms - ie they've seen this set of symptoms before so it must be this common thing...

But they can be wrong, and they lose some of the knowledge they came out of medical school for the rarer kinds of problems.

I tried to find the study(s) but failed this time. But there is this sort of curve of ability to diagnose which depends on the diversity of experience of the doctor - ie if they always see the same kinds of problems, they're less likely to diagnose something that doesn't fit - even if that's what is there.

I'd guess that kind of problem would be common across professions.

I'd still want to know why Jonah was sore and limping - and then he wasn't.

Frosty has been through this recently - first time she got better with rest - I had to put her on lead in the back yard so she couldn't do "patrol" at full blast. And then she cut her foot pad. Argh. But initially the symptom looked similar to me... but my dad the orthopod could tell which joint was damaged by the way the person moved. A specialist joint vet would be able to do the same. So when I took Frosty to the vet the first time - I was surprised they didn't ask to see her moving. They just did a very intimidating joint feel up.

When I did my knee - I not only tore the ligament right through the middle - and the complete tear only showed up on the MRI, not the xrays, but I also shredded but not completely the ligaments on each side. So the whole thing was loose and wobbly (didn't work, would not hold me up). And the first doctor did not take the lateral tears and lack of stability into account when recommending a treatment. Took me two years of trying and failing rehab because my leg wasn't stable enough to do it... and then I changed docs.

Sometimes - that's what it takes - going to a doc with a different perspective. And that's not always the one in the same practice. Annoying that doctors and vets etc - sometimes get a bit complacent about the seen it before - must be this kinds of diagnoses.

As a computer programmer - I start with what is most common and then work through until I find a way of fixing the problem. But I test each step - ie there's no point saying this will fix it - if you don't check that the fix has actually worked - and not broken anything else. But vets and GPs don't follow up. They ought to follow up. They might argue that it's the customer that should follow up but - what I have done each time some GP/vet has said "this will fix it" and it didn't - is gone to someone else who doesn't say things that are wrong.

A surgeon and a medicine specialist examined him and they ran him up and down the hill the practice is built on. I am pretty happy with what they have done to try and find something. He occasionally holds that leg up for maybe 3 steps in a hour long bush walk, but he has been doing that intermittently on both legs for nearly a year now. Its like I till customers with funny intermittent noises in their cars. Leave it till something falls off and then we will know what it is. Not so happy with that approach with Jonah but I am down about 2k so far and no answers so that's what it will have to be.