More about Joey's knee problem . . .

Talked to more folks over at LSU, then I called Craig Alberty (our "regular" vet for the last 30 years!).  Ten years or so ago Craig married Ashley, one of the just-out-of-school vets who came to work at his clinic.  She is an EXCELLENT surgeon and probably wouldn't have stayed at any regular clinic if she hadn't married Craig!  Anyway, she's been doing all of their more complicated surgeries ever since.  So I called to talk to Ashley about Joey's surgery, but the ladies at the desk said she was "out for two weeks" and that they would tell Craig I called.  Well, he called me back yesterday to tell me Ashley has had surgery herself so she won't be at work for at least another couple weeks.  Hope she's okay.  And I sincerely hope that the fee for LSU to do Joey's surgery will be something within reason, because if Ashley had done it, it would have been $300 max.  (Craig told me that's what they "usually charge" - but then they usually charge me less than whatever is "usual").   As for what the surgery is, here's what I found out about it:

The condition is called "patellar luxation"--

Luxating patella (or trick knee, subluxation of patella, or floating patella) is a condition in which the patella, or kneecap, dislocates or moves out of its normal location.

Most cases of patellar luxation are medial and this is frequently a congenital problem.  

Rarely, it can be caused by some form of blunt trauma, but most frequently, it is a developmental congenital defect. In congenital cases, it is frequently bilateral. The condition can also be inherited through genetics.

There are four diagnostic grades of patellar luxation (Joey is Grade II), each more severe than the previous:

Grade I - the patella can be manually luxated but is reduced (returns to the normal position) when released;

Grade II - the patella can be manually luxated or it can spontaneously luxate with flexion of the stifle joint. The patella remains luxated until it is manually reduced or when the animal extends the joint and derotates the tibia in the opposite direction of luxation;

Grade III - the patella remains luxated most of the time but can be manually reduced with the stifle joint in extension. Flexion and extension of the stifle results in reluxation of the patella;

Grade IV - the patella is permanently luxated and cannot be manually repositioned. There may be up to 90¼ of rotation of the proximal tibial plateau. The femoral trochlear groove is shallow or absent, and there is displacement of the quadriceps muscle group in the direction of luxation.

Grades II, III and IV require surgery to correct, if the animal has difficulty walking. The surgery required is governed by the type of abnormality present, but often involves a sulcoplasty**, a deepening of the trochlear sulcus that the patella sits in, a re-alignment of the attachment of the patella tendon on the tibia, and tightening/releasing of the capsule either side of the patella, according to which side the patella is slipping. Some Grade IV conditions may require more involved surgery to realign the femur and/or tibia.

**Sulcoplasty is an orthopedic surgical procedure performed on a groove (sulcus) or indentation present on particular bones. In veterinary surgery it is often employed to remedy a displaced kneecap ("patellar luxation") by deepening the trochlear sulcus, the groove on which the patella normally sits.

And here's another interesting reference for those who'd like to see a veterinary journal article.

So . . . Joey needs "sulcoplasty" -- and hopefully soon before the movement of the bone becomes more frequent and affects the ligaments around it.  Dr. Saile (pronounced "Zila" -- she's German) at LSU is going to check him out today while he's over there at therapy.  In theory she won't be the surgeon who's "on" over there until after August 15, but when I talked to the therapists, they sounded like it might be possible she could be the one to get him done before then somehow.  I guess it would be good if I'm able to afford for her to do it, actually, because I've read that the condition is most common in toy breeds and the instances of recurrence in dogs over 20 lbs. (Joey is over 60 lbs!) are more than 18%.   So it would be good to have a doctor work on Joey who does a LOT of really complicated surgeries regularly, I would think.  And Dr. S. told the therapists and Torri that she thought the type of surgery that just enlarges the joint so the bone will stay in, and NOT shortening the ligament would be the way to go.  That would be much less painful for him afterward.  Anyway, we'll see what she says after she actually examines him today.

Thank goodness it's the weekend.  The chances of rain are supposed to go down to about 20% so I'm planning to shampoo all three horses with some medicated shampoo to try and clear up the raw spots Duke and Lizzie have, and just tidy up Ladybug - she LIKES to be bathed.  I've needed to do that ever since they got home, but by the time I get done with all the stuff that HAS to be done each night, I'm just too darned tired to deal with it!  And it's been raining off and on for most of the week.  

We don't have an actual wash rack set up anywhere yet, but I'm thinking I'll just go pick up a rubber wash rack mat (the kind with holes in it for the water to drain through) and put it down between a couple of the trees in front that I can use for cross-ties.  I never thought of that, actually, but Mark suggested it when I was talking to him about a wash rack the other night.  Good idea!  The tree part, that is.  I just figured I'd get the wash rack mat to keep the space from getting muddy, then we can use it in the actual wash rack when we finally get around to building that. 

I'm so glad we have horses.  I can't think of another single thing that would take that much physical effort that I would actually WANT to do.  Nothing.  They are SO good for us.