Case Study - Bella Geiselhart
13y/o FS Labrador Retriever, Approx. 43Kg. History of hip soreness and exercise intolerance. Odd nail growth and changes in gait-hip swaying.
I vaccinated Bella in November of 2016, and noticed that she was favoring the LR leg. At this time, the stifle joint was slightly more mobile than normal, but non-painful on palpation. She was 2-3/5 lame on the leg, and standing with the characteristic “leg turned out” stance of CCL degeneration rupture. Bella also had difficulty with hind lend “splaying” on hardwood floors and a slight decrements in hind leg placement reflexes with the right side being more affected than the left.
On January 25th, 2017, I injected Bella’s L Stifle joint with Kush as follows:
Bella was given 0.29cc Dexdomitor (dexmedetomidine 0.5mg/mL) IM 15 minutes prior to the procedure. I shaved the cranial aspect of the stifle, cleaned the skin with chlorhexidine scrub and alcohol. The skin was “frozen” using Gebauer’s ethyl chloride spray, and the skin over the middle patella tendon was blocked with 0.5mL bupivicaine.
The skin was prepped with chlorhexidine solution, and the leg gently flexed. Using a 22g, 3⁄4” needle attached to the Kush syringe, I drew 0.1mL (4mg) of Kenalog (triamcinolone acetate) into the Kush syringe, and entered the joint capsule through the middle patellar tendon. I aspirated for a “flash” of joint fluid, and then I slowly injected the material into the joint with no resistance to flow. I kept the dog recumbent for 5 minutes post injection.
She also received a 1mL (100mg) dose of Adequan (polysulfated glycosaminoglycan) IM, and will receive 100 mg of carprofen once daily. I have informed the client that at COX-2 inhibitor might be a better choice, and that the Adequan injection should be repeated in 30 days.
On January 30th, I asked client for feedback 6 days post-injection.
Owners comments below:
“Bella is enjoying the heck out of her [newly Kush-treated] knee. Increased mobility overall. No more hesitance with going up stairs. Increased distance and time on walks. Can climb into minivan with minimal or no assistance. Overall, she looks like she did a year ago before her illness and surgery.”
I discussed giving Bella a Cox-2 inhibitor if needed after the carprofen is gone, or we see a decrease in desire to exercise. The plan is to continue the current exercise regimen for thirty days to build muscle mass.