Conker's Luxating Patella Journal

I have decided to write up a post where I will come back and add in things I notice about Conker's Luxating Patella. I need somewhere to keep track of this, so I figured I'd post it on the blog since that's how I keep track of Conker's food stuff.


History.

I first noticed a possible problem with Conker's knees way back in St. Louis when he was still a little demonic pup. His joints snapped, crackled, and popped (like the cereal) sometimes, and I thought it was odd that a young dog's joints did this. I asked around a bit. I did not get any definative answers, only that it might be X, or Y, or maybe A and C, but no one was sure that the noises were indicative of anything. So I just kept an eye out for anything odd, but paid special attention to Conker's knees since Luxating Patellas are common in Shibas.

The first time I wrote about Conker's Luxating Patella was on April 3rd 2011. It was an infrequent occurrence, and did not appear to cause Conker any problems. The knee would go back in on it's own 80% of the time, and I had a vet show me how to put it back in correctly so I didn't damage the joint further. Conker was around 8 months old when I found this out. his knees were diagnosed as "Barely a grade 1." on the right and "Basically non-existent." on the left. Vet's words, not mine. Good news! I thought at the time, but I still did what I could to ensure his joints wouldn't get damaged further.
I began to give Conker increased dosages of fish oils and added in joint supplements to his diet.

The next time I wrote about it was in June 2011 when his LP seemed to get better. I was still giving him fish oils and various joint supplements. I did not know if those actually helped or what, so I kept it up just in case they were. Conker had been eating an entirely raw/homecooked diet for 7 months and was now almost one year old.

Fast forwards to October 2012. Conker had previously been on raw/homecooked foods for one year and five months, but had now been eating commercial foods for 5 months. His LP began to occur more frequently than before, and was more severe when it happened. Now I had to manually replace the kneecap 50% of the time it went out. Conker was still getting joint supplements.

This is when we went to Alaska, and Conker basically got zero exercise other than when he was taken out to do his stuff in the yard, or when he was penned and raising hell since he wanted to be near me. Conker was eating EVO Red Meat and still got fish oils and joint supplements. However, he now only put light weight on the right leg, unless he was running or walking briskly. Whenever he stood only his toes were touching the ground. He started to hold his entire leg up during December and January and began to use only the Left when he walked. His right knee was now almost constantly luxated in some manner or another. Manual replacement only resulted it it slipping right back out.

Back in Oregon... I started giving Conker more fresh foods and increased his joint supplements and fish oils. I saw no immediate improvement. I started Conker on an exercise program (hiking) and he put on some much needed muscle that he lost while immobile in Alaska. His knee briefly got better, but shortly returned to "toes touching, light weight only" status. Much to my annoyance, the full leg lift returned as well. To top that off, he's developed a funky gait in his right rear leg where the part of the leg below the knee is held at an odd angle.
(You can see the leg lift here, here, and here, the toe touch here, and here, and the odd gait here and here.)


The here and now.

Conker is still eating commercial foods, but I have reduced the amount to less than 1/2 of the overall diet. Once what I've got on-hand is gone I will most likely cut out all commercial foods and resume a completely raw/homecooked diet. I might even stop feeding Conker the commercial foods sooner than that and just feed what's left to the Girls. It all depends on how pissed off I get.

Conker currently gets two 1200mg fish oil capsules (around 900mg of EPA and DHA combined), 500mg Glucosamine, 400mg Chondroitin, 500mg MSM, and the membranes of at least one eggshell daily. This stuff is not meant to treat Luxating Patella, but to help reduce inflammation and possible joint damage from slippage, and as a preventative measure against arthritis. Which I am convinced this joint is going to be riddled with by the time Conker is 5.
The joint does not feel right to me. I am in no way a vet or whatever, but I can tell the thing is off. It feels nothing like his left knee, which has otherwise been in excellent health as far as I can tell, nor does it resemble either of the Girl's knee joints. I cannot describe it, just that it feels wrong. It is most likely inflamed or swollen. Or something worse. Who knows.

Conker still uses the leg normally about 50% of the time, loves to hike, and will still run around like the maniac he is. Other than not putting weight on the leg some of the time and biting at the joint (a sign of discomfort or pain), he shows nothing else to indicate that his leg is bugging him. But it is, or he would be using it normally and wouldn't bite at it.


The worst part about all this is that I can't afford to treat this properly. Can't afford the surgery to correct his patella, which I am starting to believe is not salvageable anyways. I can't even afford to take Conker to the vet to get some damn x-rays.
Hopefully I will be able to soon, but I highly doubt it.
My belief is that Conker's right knee has increased to grade 3, based on his current symptoms.



Updates.

3/26/13
Conker has been back on raw foods for just over 4 weeks now. I have seen a slight improvement in how he carries his leg, and he will now put his full weight on it on ocassion. He still holds it up or toe-touches a lot though.
Conker is currently getting MSM every day.






Causes of Luxating Patella in Dogs.

Luxating Patella can be caused by a few things. Most commonly it is a genetic issue. Shallow trochlear grooves and weak tendons are two causes. Unfortunately, LP is strongly believed to be hereditary. So if one or both of your dog's parents had it, there's a good possibility that yours will too. It could also be from some other sort of joint defect (inbreeding is a strong cause of such things). It might be caused by an injury to the knee, possibly from trauma to the leg like landing incorrectly from a jump or getting rammed into by something (another dog, perhaps), or from a very sharp and fast turn. Poor nutrition can also affect joint growth and overall health. It has even been linked to altering, which if done early (as in Conker's case) can negatively affect the joints of growing dogs, especially males.
A dog with Luxating Patella has an increased risk of tearing the cruciate ligaments. There is a huge increase of this if the dog has been altered, regardless of when the procedure was done. 

I believe Conker's LP is caused by a possible combination of things. Namely:
1. Poor genetics. He is, after all, a puppy mill dog. They don't breed for health in those places. It's incredibly common for mill Shibas to develop Luxating Patella of various severity in one or both knees, which makes me think this is a very probable cause.
2. Early neutering. The shelter I got him from had him neutered at around 2 1/2 months old. I now know that is a very stupid and horrible thing to do and will no longer support anyone who does this.
3. Possible injury. I can't remember if Conker might have twisted that joint wrong when I was with him, but I think it's recent degeneration might have been hurried along by an injury I did not witness. He gets an immense amount of unsupervised time in the backyard. Something easily could have happened while chasing a cat, fence-fighting with a neighbor's dog (I've tried to stop this), or jumping off the pool deck into the bushes.
4. Nutrition. Mill dogs are generally not fed high-quality diets. He was also not fed a quality diet while at the shelter, which might have helped lead to his condition. I have noticed though, that his LP seems to get worse when he eats lower protein foods (below 30%) regardless of type, and it also seems to worsen when he eats commercial foods. Nutrition is one of the biggest the building blocks of health so his poor diet as a pup might have contributed to the condition.


How is Luxating Patella Diagnosed?

Symptoms of Luxating Patella are but not limited to: Skipping a few steps or "bunny hopping", popping sound in the knee, holding the affected leg up briefly or for extended periods of time, biting at the joint, limping, "donkey kicking", or crying.
Diagnosis is done by a veterinarian who will manipulate the dog's knee joints in and out of place and be able to give a general grading based on how the patella performs and by comparing described symptoms and watching the dog walk. X-rays can be used to determine how shallow the trochlear groove is, if some other deformity is the cause, or if arthritis is present in the joint.

Grade 1: The patella can be pushed out of the groove manually, but it returns to position when pressure is released.
Grade 2: The patella can be pushed out of the groove manually or can spontaneously move to the side when the joint is flexed, and it remains out of place until it is manually repositioned.
Grade 3: The patella remains out of the groove most of the time, but can be manually repositioned with the joint extended. However, flexing and extending the joint results in the patella slipping out of place again.
Grade 4: The patella is out of the groove at all times. Moreover, it cannot be manually repositioned. The trochlea is either too shallow or is missing all together.


How is Luxating Patella treated?

Depending on the severity of the condition, Luxating Patella can be treated by simply increasing straight-line exercise, providing a high-quality diet, and adding preventative joint supplements. Or with surgery. Dogs that need surgery are usually those with grades 3 and 4 Luxating Patella(s) but sometimes a dog with grade 2 is a candidate. Surgery is usually one of two procedures: Deepening of the trochlear groove and/or modification of the connecting patellar ligaments.

Friday Hike

We did an average 6 mile hike today. Nothing spectacular happened, if you don't count Juneau attempting to swim in every puddle and creek she found. It was actually quite entertaining watching her try to bathe in a stream the size of my arm.

The dogs all enjoyed the hike. Conker got to ride on my shoulders a few times since his leg was bugging him a bit. I don't know where his harness is so he gets to be carried like that instead of a piece of luggage.
I am thinking of getting him a DoubleBack Harness (if I can find one on sale) to replace his old one instead of an Approach Pack. The DoubleBack has more chest and belly support, which would make it more comfortable for him to be carried in than a regular Web Master. Plus it's a badass harness and Conker would look awesome in it.

Note: Yes, I do exercise Conker on his bad leg. Why? because when I don't, he loses muscle mass which helps hold the patella in place, and the luxation gets worse. So in order to prevent it from getting really bad I still take him on walks and hikes (the longer the better, funny how that works), and play games like tug and fetch, and wrestle.
Every now and then his leg will act up so we either go home or he gets carried, or I end the game. I am very concerned about his leg, but at this point not letting him have any fun is far more damaging than the small risk of injury occurring on a hike.

Those joints

As you may or may not know, Conker has Luxating Patella. I've known about it since he was about 8 months old or so, and I have tried a couple joint things and was generally pleased with them.
Well, the joint slippage has been just an occasional thing for a while, but when I started testing out various kibbles I stopped giving Conker "therapeutic" doses of fish oil (sometimes completely cutting it out) and instead just giving a "maintenance" dose, and I cut any joint things I was giving him at the time as well. With the exception of when he was being stupid about food, Conker has remained a pretty active dog.
So, what's the purpose of this writing?
I have noticed an increase in Conker's knee slippage, especially the right knee. It's bugging me with how frequently they slip, and how they don't go back in right away on their own. I have also noticed him biting at his knees, usually after one of them has slipped. I'm not exactly glad to see this, and I asked around about it, so I am going to restart the joint supplements and increase his fish oil. I will also be doing a few back leg strengthening exercise things to build the muscles up a bit more.

A trend I have noticed is that when Conker is on lower protein foods, he loses muscle mass and gains fat. So, I will either cut out all lower protein (below 30%) foods from the trials or mix meats and eggs into them to boost the protein. I am less concerned about how Conker does on the food (without mixins) and more concerned about his joint health, so I will be "sacrificing" some results because of that.
Which is a bit funny, since I'd feed the food with mixins if he were on it long-term anyways so... Yeah.

June 16th

Ugh man, there's something I really want to write about but I'm not going to unless I actually do it.

In other news...
Today Conker got:

Pork meat with beef scraps, liver and kidney, turkey neck half and gizzard (turkey gizzards are HUGE!) and a chicken heart. 

Since it's basically the middle of the month...

Conker's doing great with all his body stuff.  Fur is great, breath is great, poop is... normal, eye boogies have reduced a bit, don't know why, but everything is generally good.

Surprisingly Conker's LP has gotten better.  When I first posted about it the right knee would go out every day, usually more than once.  Now it only goes out once or twice a week and goes right back into place after a few seconds.  Before Conker would have to move it around a lot or I'd have to put it back in for him and it made the worst click sound if he did it wrong. 
I wonder if this has anything to do with the joint supplement I'm giving him?  I know it doesn't treat LP but can it make it... betterish?  Since the joint is getting more lubricant than before is it holding it in place better or makes it able to slide back in more easily?  I have no idea, but whatever it is I hope it sticks around for a while.

Conker has Luxating Patella.

He occasionally dislocates his knees when he runs fast over rough terrain, changes directions rapidly and plays really rough with other dogs.  It's happened while playing with me once.

I can manually move both knee caps when his legs are fully extended.  He doesn't notice so I'm sure he's not in a lot of pain.  I'm pretty sure the right one is worse than the left and is the most common one to slip out of place.  Sometimes he'll sit and it will go back into place, I can hear a pop when that happens.  If I extend his leg and slip the patella back into place it doesn't pop.  He always tries to keep playing but will come over to me when it happens if it doesn't go back into right away.
He doesn't limp, cry or really notice except for the fact that he can't use his leg all of a sudden.

 His knees aren't luxated in this picture.

I'll take him to the vet if he ever whines or can't fully walk on it OR if Mom is willing to foot whatever bills might come out of such a visit.  But right now, I simply cannot afford to take him in to diagnose a condition I know he has.  I don't know the severity though, that is the biggest problem, and if he needs surgery for it or not.

But for the time being, until I run into some money, I will double his salmon oil and get him a Glucosamine/Chondroitin supplement and monitor his play.  He's not going to like it but he's going to get shorter dog park visits and longer walks.  Less rapid direction change and more straight line stuff for now.