Rosie was referred to Northwest Veterinary Specialists in April 2017 for further investigation of an initial left fore lameness which had shifted to the right fore limb. Treatment with meloxicam and exercise restriction had led to an improvement in the stiffness after rest, but the lameness remained on walks. Rosie’s normal exercise was 45-60 minute walks twice daily but Rosie could only manage 20-30 minute walks.
A CT scan in 2010 at Northwest Veterinary Specialists showed minimal changes in her elbows and conservative treatment had been continued in the intervening period.
When Rosie saw orthopaedic specialist Nick MacDonald she was worse on the right thoracic limb. She would offload the right thoracic limb when sat. On examination she was uncomfortable when her elbows were manipulated.
Nick recommended a repeat CT scan of the elbows. The CT scan is like taking multiple X Rays which are then reconstructed to create a 3D picture of the joint in question. This showed marked osteoarthritis of the right elbow, moderate osteoarthritis of the left elbow with small fragments in both elbows. This is a bit like having a small stone in your shoe that you feel every time you take a step.
Although surgical options do exist for this, given her age and the degree of osteoarthritis in the right elbow it was possible that arthroscopy might only provide a temporary improvement in the lameness at best.
Rosie’s owners chose to see Matt Gurney, one of our Pain Management Specialists to discuss the options for improving her comfort levels. Rosie’s owners completed a Canine Brief Pain Inventory for Matt which helps assess how painful Rosie’s owners feel she is and how that pain interferes with her daily activities. This is really useful to create a baseline score to judge how effective treatments are.
Alongside the painkillers prescribed by Rosie’s referring vet, Matt started a course of acupuncture. Rosie had very tense shoulder muscles with painful points in her infraspinatus muscles of the shoulder and her triceps muscles. Following a four week course of acupuncture and some minor adjustments in her painkillers, Rosie’s owners felt that she was back to the dog she was 2 years ago with regard to her comfort levels which is excellent news.
One year on, Rosie continues to enjoy 45 minute walks and maintains her acupuncture sessions at her local vet practice. She is a perfect example of our aim with pain management in the pain of arthritis, which is to provide controlled exercise, maintain a healthy weight, judicious use of pain killers and therapies such as acupuncture.